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9 Lessons Learned About Gamification

As I was writing the post about gamification in healthcare, it got me thinking about what I’ve learned about gaming especially in today’s device centric world.  [As a side note, I certainly wouldn’t take advice on gaming strategy from someone who doesn’t play games.]

Whenever I go on vacation, I always pick a new game to download to my iPad and iPhone to play with.  My devices have things like:

  • Nuts
  • Tiny Wings
  • Temple Run
  • Doodle Jump
  • Jetpack
  • Tiny Tower
  • WipeOut
  • Subway Surfer
  • Sunday Lawn
  • Torpedo Run
  • Battle Nations
  • Clash of Clans
  • Candy Crush
  • Angry Birds

As I think about the games, they fall into several buckets:

  • Quick Hits – I play them a few times then delete them.
  • Interesting – I play them on and off when bored usually with a one week spike at the beginning.
  • Long-Term – I play them multiple times a week (or day) for months.

But, in the end, most games fail to keep you engaged long-term.  But, based on what gets the best engagement, here’s what I’ve learned:

  1. Games need to be relatively simple to understand and play.  There can’t be much to learn or read about them.
  2. Games have to constantly be upgrading and evolving – new levels, new upgrades, new things to earn, new challenges.
  3. Games should be able to be played online and offline.
  4. Games should offer you rewards to keep you coming back every day.
  5. Games need to be social so you can compare yourself to others, compete with people, and collaborate.
  6. Games can’t be too easy or they are boring.
  7. Games can’t be too hard or they are frustrating.
  8. Games that have you build things get you to come back and check status, but the build time can’t be too long (e.g., 6 days to wait for something to be ready).
  9. Good games will create a user community for sharing ideas and discussing success with challenges.

A Few Corporate Wellness Tips

While Al Lewis has become the industry antagonist (in a good way), he makes a lot of great points that anyone working in the industry should understand and consider.

If you haven’t read some of Al’s articles, let me point you to a few:

His writing reminds me of some of the things my former boss pointed out several years ago about the disease management industry.

In one of his posts, he makes several points that I wanted to discuss here:

  1. You should use a source like the US Preventative Services Task Force (USPSTF) as the evidence-based reference for appropriate screenings – frequency, age, gender.  Of course, I agree with this.  We need some common source that we all can use that’s based on best practices and evidence.
  2. He argues that you should stop weighing people.  I’d argue that knowing your numbers is important.  As a country and a world, we’re seeing massive growth rates in obesity which is linked to numerous diseases.  We need people to be more conscious of this risk factor especially in our sedentary work environments – see sitting disease infographic.
  3. His third point is about targeting and nudging the right population versus over-sampling everyone.  I couldn’t agree more.  This should be what the Big Data push in healthcare gets us.  How to build predictive algorithms to identify people with multiple risk factors.  How to identify people with gaps-in-care.  How to figure out what someone needs to take an action.  I always say there are 3 factors to consider:
    • Is there value in the intervention?
    • What channel / method is going to get the consumer’s attention?
    • What information is going to get the consumer to take an action?

To follow-up on my points above, here’s some information on obesity and it’s link to other diseases.

The CDC says that obesity is linked to:

  • Coronary heart disease, stroke, and high blood pressure.
  • Type 2 diabetes.
  • Cancers, such as endometrial, breast, and colon cancer.
  • High total cholesterol or high levels of triglycerides.
  • Liver and gallbladder disease.
  • Sleep apnea and respiratory problems.
  • Degeneration of cartilage and underlying bone within a joint (osteoarthritis).
  • Reproductive health complications such as infertility.
  • Mental health conditions.

And, for a fun video by Mayo Clinic on Knowing Your Numbers watch this:

17 Healthcare Blogs You Should Read

This is just a list of my favorites.  Feel free to add your own recommendations.  I broke them into 3 categories.

(BTW – I’m sure I missed a few of you so I’m sorry.)

1. Key Foundational Blogs To Follow

2. One’s I Read Frequently

3. Good Blogs That I Use For Certain Topics

I’ll also give a shout out to a new blog that has started that I have high hopes for based on their initial content –

Limiting Factor For Behavior Change is We Don’t Believe We Will Change

One of the biggest challenges in healthcare is getting people to change behavior or as Express Scripts would frame it – activating intent.  Since approximately 75% of healthcare costs are due to preventable conditions, it’s important that we can help people see the future value of change.  People often discount that future value of change based on the amount of effort required to get there.  They see the short-term pain not the long-term gain.

A new study puts an interesting perspective on this.  It shows that people can generally see the amount of change they’ve made in the past decade, but they fail to realize that change will continue for the next decade.  They appear to see themselves as stable at the current moment without significant change in the future.  I believe this is really important as we think about Motivational Interviewing techniques and communications for engaging consumers.

So, as you think about behavior change in healthcare for things like diabetes, you will likely continue to see more and more emphasis on behavior change and research in this area (see example from RWJF last year or Cigna whitepaper).

To learn more about this topic of behavior economics, you might look a few places:

And, here’s a good list of books to start with.

New Year Blog Survey

Happy New Year!

For those of you that are regular readers, I’d love to get your thoughts on the following:

  1. Do you like me including infographics in the blog?
  2. Do you like the mix of content from mHealth to PBM to population health management?
  3. Do you like the mix of short posts sharing articles and other information or would you prefer less posts that were more detailed analysis of a subject?
  4. What would generate more discussion / comments on the blog?

Thanks for your time.  You can comment here, e-mail me at gvanantwerp at mac dot com, or respond anonymously to the survey embedded here.

The Express Scripts 2011 Drug Trend Report – Full of Infographics

Those of you that have been readers for a few years know that I love to read and summarize these reports. They provide a huge set of aggregated data and summarized information that is useful in creating business cases and identifying trends.

This year is no different although the graphics within the Express Scripts Drug Trend Report continue to get better … ala infographics (as they even posted one recently on their blog).

So, what caught my eye this year…

  • There was one ex-Medco person who signed off on the intro letter…and interestingly (compared to other DTRs), no George Paz signature.
  • They have a big picture of their Research & New Solutions Lab upfront (see below). It reminds me of the NOCs (Network Operations Centers) that I had at my past 3 employers. [Maybe one day before I move out of St. Louis they’ll take me on a tour.]

  • I was definitely interested to hear what they would say about Walgreens. They tackled it early on in the document.

Our 2011 retail-network negotiations marked another milestone in our heritage of independence from pharmacies and alignment with our plan sponsors. One retail pharmacy chain, Walgreens, was unwilling to offer rates and terms consistent with those of the market, and instead opted to leave our pharmacy network at the beginning of 2012. Although we remain open to Walgreens being part of our pharmacy network in the future, the positive reaction we received from plan sponsors and members during the process of transitioning patients to other pharmacies confirmed what our prior analyses had shown: the vast majority of the U.S. has an oversupply of pharmacies, suggesting that networks can be tightened significantly while maintaining sufficient patient access.

  • 17.6% of the total Rx spend was for specialty
  • 47% of specialty medications are processed under the medical benefit
    • 78% for oncology
  • They talk a little about evaluating genetic tests and when to recommend a test. It’s definitely an evolving space, and it will be interesting to see the Medco influence here in terms of what they recommend.
  • They talk about $408B in waste from adherence, generics and mail order. All consumer behaviors. (see last year’s report focused on waste)
  • They show the breakdown of waste by state where the South is the biggest problem. It looks a lot like the Diabetes Belt although it also includes the SouthWest.

  • Not surprisingly, diabetes, cholesterol, and hypertension represent 3 big opportunities.



  • FINALLY…For years, I’ve been comparing two older studies to make the point that people think their adherent when there’s no way that perceived adherence can match reality. The most exciting thing to me was that they actually looked at perceived and actual adherence on the same patients.

For example, patients in the least-adherent group in the survey of Express Scripts members had an average actual MPR of 24.3%. The average perceived MPR reported by patients in this group, however, was 90.6%. We therefore found a staggering 66% gap between perceived MPR and actual MPR.

  • They talk about how this data is being used to predict non-adherence with some crazy high reliability. (Meaning only that it sounds too good to be true.) Regardless, they’re right in using data to identify behavior gaps (current and future) and developing personalized interventions to address barriers.

  • The overall drug trend was 2.7%
    • 17.1% specialty trend
    • 0.1% traditional drug trend
  • Here’s the breakout by class of specialty spend

  • Actual member out-of-pocket and percentage of cost actually went down $0.14.  Surprised?

  • Perhaps most interesting (and new) is a huge section on Medicare and Medicaid trends. Obviously this shows their focus here in an area that CVS Caremark has also been focusing on.

I’d also point you to Adam Fein’s breakdown of this report (in a more timely manner).

Get Blog Posts By Email

I was talking to several people yesterday that read the log regularly. Thank you all for that.

One thing they didn’t realize is that you can have the posts emailed to you regularly. To sign up just go to and enter your email in the area on the right hand side of the website.

Bad Pitch

I was just reading an email pitch that I received from a healthcare social networking vendor talking about their system for engaging patients and physicians.

Maybe, it’s just me but that seems to imply some understanding of how to engage people and use social media. First, they didn’t use my name in the email. It just said “Hi ,”. Then, at no point in the pitch did they say anything about why they reached out to me. And finally, they then asked me to tweet specific pre-formatted tweets that they had created. If I wanted that, I would follow them and do a RT.

And to top it off, they don’t offer a way to follow-up to learn more. It was just shameless self-promotion. #Fail

Uping The RxAnte: An Adherence Predictive Model

Those of you that have heard me speak know that I look at this topic of predicting adherence both from an area of fascination along with the eye of a skeptic.  While I love the concept of predicting someone’s adherence and therefore determining how to best support them from an intervention approach, I also believe that the general predictors are pretty straightforward:

  1. Number of medications
  2. Plan design (i.e., cost)
  3. Gender
  4. Health literacy and engagement (see PAM score research)

And, this is a hot topic (see post on FICO adherence score).  You can see my prior posts on some different studies, on the Merck Estimator, and some notes from the NEHI event on this topic.  It generated a good dialogue on Kevin MD’s blog when I talked about paying MD for adherence.

I had a chance to talk with Josh Benner the CEO of RxAnte the other day.  It sounds very interesting, and they have an impressive team assembled.  In general, they’re focused on:

  • Predictive modeling
  • Decision rules
  • Monitoring and managing claims to track adherence
  • Evaluating effectiveness of interventions
  • And creating a learning system

There are definitely some correlations to the work we do at Silverlink Communications around adherence.  We’re helping clients determine a communication strategy that might include call center agents, direct mail, automated calls, e-mail, SMS, mobile, or web solutions.  We’re looking at segmentation and prioritization.  We’re looking at past behavior and messaging.  The goal is how to best spend resources to drive health outcomes from primary adherence to sustaining adherence.  This is a challenge, and we all need to build upon the work that each other is doing to improve in this area.  We have a huge problem globally with adherence.

Wellpoint Quote On Drug Copay Cards

This topic seems to be heating back up based on several posts on Adam Fein’s blog (Lipitor, adherence) and an article in Drug Benefit News where this quote appeared along with an AIS blog post questioning the PBM’s dislike of copay cards (from the same article that Adam mentioned).

“Copay offset programs [offered by brand-name drugmakers to compete with generics] mitigate the effectiveness of our tiered benefit design programs and [are] going against what we’re trying to accomplish for our members’ health and for employers.”

— Peter Clagett, vice president of pharmaceutical strategies and PBM oversight for WellPoint, Inc.


2011 Blog Overview and Press Hits Update!

2011 was a great year for the blog with over 120,000 visits and 365 new posts (conveniently averaging 1 per day).  You can see the top posts here.  The blog led to several new opportunities at Silverlink, and it generated numerous press opportunities. 

The blog now has over 400 people who get an e-mail every time a new post is published.  The content is then syndicated to the 930 people who follow me on Twitter and to my 1252 contacts in LinkedIn.  I’m happy with this for something I do in my spare time.

In August, I shared my press hits YTD which numbered 25 times.  Since then, I’ve had 27 more which are listed below:

  1. Dec 26th issue of Health Plan Week about Express Scripts and Walgreens
  2. Jan 1st issue of Managed Healthcare Executive on limited networks
  3. Dec 2nd issue of Drug Benefit News on Lipitor
  4. Dec 2nd issue of Drug Benefit News on Prime Therapeutics Retail MTM solution
  5. Dec 2nd issue of Drug Benefit News on PBM Deal Making
  6. November Frost & Sullivan newsletter on consumer engagement
  7. PBMI Report
  8. Nov 11th issue of Drug Benefit News on Pfizer’s Lipitor strategy
  9. Nov 11th issue of Drug Benefit News on the PBMI Report
  10. Oct 28th issue of Drug Benefit News on OptumRx
  11. Oct 28th issue of Drug Benefit News on CVS Caremark case study
  12. AIS webinar on copay cards / coupons
  13. AIS webinar on PBM outsourcing
  14. Oct 7th issue of Drug Benefit News on Outcomes-Based Contracting
  15. PCMA Smart Brief on Oct 5th regarding PBM disclosure of profits
  16. Sept 23rd issue of Drug Benefit News on Mobile Apps
  17. Sept 23rd issue of Drug Benefit News on Anthem study
  18. Drug Channels mention of my post on the Prime Therapeutics Trend Report
  19. PCMA Smart Brief on Aug 11th re: NY bill
  20. Sept 9th issue of Drug Benefit News on the Prime Therapeutics Trend Report
  21. Sept 9th issue of Drug Benefit News on the proposed Express Scripts acquisition of Medco
  22. Sept 9th issue of Drug Benefit News on Generics
  23. Aug 22nd issue of Health Plan Week on Generics
  24. Aug 24th Reuters article on the proposed Express Scripts acquisition of Medco
  25. Aug 19th mention in Health Reform Watch
  26. Aug 19th issue of Drug Benefit News on Part D
  27. Presentation with Aetna at the Care Continuum Alliance on engaging the hard to engage

Tagxedo Word Cloud For Blog

I love the way Tagxedo takes your blog, tweets, or something else and turns it into word art.  Here’s one from my blog.

I also created them for a few of my favorite blogs…

Drug Channels


WSJ Health Blog

NY Bill Continues To Stir The Pot – NCPA, FTC

The bill to restrict mail order utilization for pharmacy is not the first attempt, and it won’t be the last attempt by the independents to try to even the playing field with the PBMs through legislation (see comments about KS bill).  If limiting networks (retail, specialty, mail) can lower prices and save consumers and payers money, why shouldn’t they exist?  The payers should have this option in their toolkit.

Here’s the actual text from the bill:


Let me make a few comments:

  1. Does this mean that Express Scripts has to let it’s members go to Caremark mail order if they meet their rates?
  2. What does “comparable” mean?  Why isn’t it the same?  Do the independents really want to go to mail order rates?
  3. No more copay differentials?  If this works, pharma should lobby for no more formularies.  (That might not be relevant today, but in the biologics or biosimilars world, they could say we’ll meet the price but you can’t have any copay differentials or utilization management restrictions…AND get it legislated!)

You can see some similar comments on this from Ed Silverman at Pharmalot and Adam Fein at Drug Channels.

As Adam points out, this may even be a leading indicator on how the FTC views the acquisition of Medco by Express Scripts (although the $MHS stock doesn’t reflect that right now).  Here’s what the FTC said in their letter:

FTC staff appreciate that A-5502-B seeks to enhance consumers’ ability to fill their prescriptions at the pharmacies of their choice. We are concerned, however, that the Bill impedes a fundamental prerequisite to consumer choice: healthy competition between retail and mail order pharmacies, which constrains costs and maximizes access to prescription drugs. We are concerned that, in the end, higher costs will lead to higher prices and fewer choices for New York health care consumers. For some consumers, increased costs may mean higher out-of-pocket prices for prescription drugs. For other consumers, it may mean that prescription drug benefits are curtailed or eliminated. Scaled-back drug benefits are likely to create pressing financial concerns for many consumers, and may even lead to additional health problems. As an article in ealth Affairs noted, “when costs are high, people who cannot afford something find substitutes or do without. The higher the cost of health insurance, the more people are uninsured. The higher the cost of pharmaceuticals, the more people skip doses or do not fill their prescriptions.”

As I mentioned in a Pharmacy Times article that I just wrote for their online version, this is a unique time for the independents to try to figure out what to do about consolidation in the industry.  If it’s not Express and Medco, it will be others.  This will look like the wholesaler market sooner rather than later.  It’s time to figure out how to make lemonade here and differentiate their pitch and value. 

In the end, I think you do yourself a long-term disservice to not allow for pricing differentiation within the network based on copays.  I would want to position myself as a higher service pharmacy with greater satisfaction, better medication possession ratio, better outcomes, and therefore become a preferred pharmacy within a limited retail network. 

15 Things You Should Know About Prescription Non-Adherence

One question I frequently get is “what should I know about adherence”. This is then followed by “so what should I do about it”.

Here’s my starter list of what you need to understand about medication adherence.

  1. It’s a $290B problem.
  2. Patients fall off therapy quickly.
  3. There are a lot of reasons for non-adherence…it’s not just about reducing out of pocket spend. AND, to make it more complex, there are variations by gender, culture, medication, condition, trust, copay levels, etc.
  4. There are lots of predictors of non-adherence (old study, Express Scripts, Merck tool), but generally the best predictor is past behavior.
  5. Interventions can improve adherence (CVS Caremark study, Express Scripts study, Silverlink data). BUT, physicians generally don’t see non-adherence as an issue they can address. (see also White Coat adherence)
  6. Patients don’t think they’re non-adherent (see “Rx Adherence Hits The Ignorance Wall” by Forrester that says only 8% of people think they are regularly non-adherent).
  7. Adherence reduces total healthcare costs (CVS Caremark study, Sokol study).
  8. Communications matter (misperceptions, physician-patient gap, health literacy, what physicians tell patients).
  9. There are lots of cool technologies that will work for different people (talking bottles, monitoring devices, iPhone reminders, websites, pill boxes). BUT, improved labeling and bottle design may not be the answer (analysis of Target improvements).
  10. Starting on generics (or lower cost drugs) improves the probability of adherence.
  11. Pharmacist involvement is key and impactful (CVS Caremark study, Ashville).
  12. 90-day prescriptions lead to better medication possession ratio (Walgreens study, CVS Caremark study, Kaiser study, Express Scripts study).
  13. Complexity of therapy (e.g., number of prescriptions) increases the likelihood for non-adherence.
  14. Electronic prescribing gives us new visibility into primary adherence and should also create opportunities to improve this issue.
  15. It’s an area where everyone wins and there’s lots of research…but there’s no silver bullet.

QR Codes – The Ultimate Opt-In Tool

You probably are starting to see them more (those 2D barcode boxes).  They’re called QR codes.  Here’s a few articles about them:

I find this a fascinating area.  Imagine a few examples here:

  1. You want to get a member to opt-in to a program (e.g., auto-refill).  You can put a QR code on their invoice.
  2. You want to offer an educational video about a condition.  You can put a QR code on the Rx label.
  3. You want to get consumers to opt-in to a SMS program.  You can put a QR code on a mailing.
  4. You want to offer a physician access to the clinical studies about a drug.  You can fax them some information with QR codes on it. 
  5. You want a patient to learn more about a condition.  You could put up DTC materials in the provider’s office with QR codes. 

I think you get the point.  I expect this will grow rapidly especially as the smart phone market grows and more and more people have cameras in their phones (devices). 

One of the biggest uses right now in pharmacy is from Walgreens where they allow you to order a refill by scanning the QR code on their bottles using their mobile app.

Data: Should You Be Paranoid?

I think we all know or are quickly realizing that everything we do leaves a trail of breadcrumbs.  That trail is a series of data points which now can be aggregated to create a record of you.  What you do?  What you buy?  What ads you respond to?  Who your friends are?  The list goes on. 

The question of course is whether you should be paranoid and worried about it. This video below shows you the extreme scenario of how data could be abused.

In a more balanced view, Time Magazine had an article call Your Data, Yourself which just appeared on March 21, 2011.

Oddly, the more I learned about data mining, the less concerned I was. (Joel Stein, author of article)

The article talks about a variety of companies that collect and sell data:

  • Google Ad Preferences
  • Yahoo!
  • Alliance Data
  • EXelate
  • BlueKai
  • RapLeaf
  • Intellidyn

The author makes a key point…a lot of the things we get for free are free because people collect and sell our data.  Otherwise, these “free” business models wouldn’t exist.  Would you pay for all the content and other things you get today or do you just want to understand what happens to your data?

On the other hand, the author shows you how data put together adhoc can paint erroneous pictures of you.  Should you care?  Do you want to fix this?  Can you control it?

This is all important since there is some do-not-track legislation being discussed.  (See Joe Manna’s post on this for some additional perspective)  Several people bring up the good question…

While we say that we don’t like to know that our data is being used to target ads at us, do we really want to have to sort through all the irrelevant advertisements?

Of course, we all become a lot more sensitive around healthcare data.  But, somehow, I doubt many of us think about what happens when we use our work PC to research a condition (see article on 10 ways to monitor your employees).

The article also suggests some sites for protecting yourself:

Don’t expect this one to go away.  With issues like the data breach at Epsilon, people are concerned.  Additionally, as data gets co-mingled and your credit score is used to determine health programs (for example), there may be limits about what and how information is used.

Can We Use Technology To Address Gaps In Resources – YES!

Dr. Joseph Kvedar writes a great piece about the psychology of persuasion and the possibility of using technology to engage consumers and drive behavior change.  This is an important topic as we look at addressing healthcare as a country.  Since behavior and consumer choice drive a significant portion of our healthcare costs, we have to think more about how to engage patients – what is the right message?  what is the right channel?  what is the right time to deliver the message?

We can deploy technology in smarter to ways to engage consumers in new ways that leverage our limited resources in better ways – i.e., get good and scalable outcomes without increasing costs.  That is what we do everyday at Silverlink Communications with our clients whether it’s around HEDIS, adherence, condition management, or many other programs. Recently, there was an article in Time Magazine that talked about some work we did with a Medicare population for Aetna.

I also think you can look at the research Stanford has published on the topic over the past decade.  You can also look at some of the data from the CVS Caremark Pharmacy Advisor program. While it certainly showed the value of having pharmacists involved, it also showed some positive results from automation.

The reality is that combining automation and live resources can be very powerful. Technology can screen and triage people to connect the at risk population with critical resources. This can allow resources to support as many as 4x as many consumers.

The Cost Of Chronic Pain

The March 7th edition of Time Magazine has a whole section on chronic pain including a fascinating timeline of how pain has been managed over the years.  It’s just in recent history that pain has moved from being a side effect to being a condition to be management.

An article by Dr. Oz provides some statistics on pain:

  • The annual price tag of chronic pain is $50B.
  • Lower-back pain is one of the most common complaints affecting 70-85% of adults at some point.
  • 7M people are either partially or severely disabled because of their back pain.
  • Lower-back pain accounts for 93M lost workdays every year and consumes over $5B in costs.
  • 40M Americans suffer from arthritis pain.
  • 45M Americans suffer from chronic headaches.
  • People with chronic pain are twice as likely to suffer from depression and anxiety.

One of his key suggestions – if you’ve worked with your physician for six months and its not resolved – go see a specialist.

He also points you to the American Chronic Pain Association for communication tools in helping you verbalize your pain.

In his article and in the other articles, it talks about stretching as a way to alleviate pain.  Obviously, there are medications that can help with pain relief although some of them can be abused and addictive.  And, both Dr. Oz and the other articles mention acupuncture as a potential solution.

You can also go to the American Chronic Pain Association to learn more.

From a management space, one of the areas where chronic pain is a big area of focus is in Worker’s Compensation.  For more about this space, you can follow Joe Paduda’s blog.  You can also follow some of the Worker’s Compensation PBMs such as:

(Community) Pharmacy 101

The NCPA blog talks about educating Congress about their value.  They also share their slide deck

I’m not sure I see how this is community pharmacy specific, but I agree that this is a good educational deck of what pharmacists do (retail, mail, specialty). 

  1. It’s more than counting pills.
  2. Immunizations.
  3. Address adherence.
  4. Educate patients and serve to support patient centered care and address MD shortage.
  5. Medication management

I was surprised at the low numbers of non-Rx discussions they have per day and the low number of physician discussions.  It would be good to benchmark those based on average store volume.

Grand Rounds (volume 7: number 17): Engagement Is Multi-Faceted

The concept of “engagement” in healthcare is a difficult one. Traditionally, we’ve had a build it and they will come approach that didn’t encourage preventative care. It also didn’t openly acknowledge the challenges that consumers have in dealing with medication adherence and even understanding the system or their physician’s instructions.

In this week’s edition of Grand Rounds, I looked at submissions and recent posts from several angles on this issue.

One of the most engaging was from the healthAGEnda blog where Amy tells her personal story about being diagnosed with Stage IV inflammatory breast cancer and trying to work though the system. Her focus on patient-centered care and support for the Campaign for Better Care make you want to jump out of your seat and shake the physician she talks about.

“It doesn’t matter if care is cutting-edge and technologically advanced; if it doesn’t take the patient’s goals into account, it may not be worth doing.”

Another submission from the ACP Hospitalist blog tells a great story about how to use the “explanatory model” to engage the patient when it’s not apparent what the problem is. I think this focus on understanding that physician’s don’t always have the answer is an important one, and one that Joe Paduda talks about when he addresses guidelines as both an art and science. Dr. Pullen also talks about this from a different perspective by describing some examples of “Wicked Bad” medicine on his blog.

One of the common focus areas today from patient engagement is around adherence. Ryan from the ACP Internist blog talks about the recent CVS Caremark study which looks at how total healthcare costs are lowered with adherence. He goes on to point out the fact that understanding the reasons for non-adherence is important so that you can – simplify, explain, and involve.

Interestingly, my old boss from Express Scripts recently started her own blog and also talked about this same study but from a different perspective.

And, Dan Ariely briefly touched on this topic also when he shared a letter he got from a reader on getting their child to take their medications.

While I think a lot of us believe HIT might save the day, the Freakonomics blog mentions a few points about HIT to consider. And, Amy Tenderich (of DiabetesMine) who I think of as a great e-patient gives a more practical example when she talks about what diabetics need to do to stay prepared in the winter. (What’s the basic “survival kit” and where can you go to get one.) I think this has a lot of general applicability to how we plan our days and weeks and try to stay healthy. One physician I know who travels a lot always talks about the need to be prepared with healthy food on the road and at the airports.

On the flipside, we hear a lot about genomics and social networking as ways to engage the consumer and to understand their personal health decisions. To that affect, I liked Elizabeth Landau’s post on how your friend’s genes might affect you.

Of course, there are lots of other considerations. Louise from the Colorado Health Insurance Insider talks about the fact that we are so focused on health insurance reform rather than health care reform. She goes on to point out the lack of connectivity between the consumer and the true cost.

And, Henry from the InsureBlog points out a change in the NHS to look more like the US system and cut out one of the steps for cancer patients. Will it help?

But, at the end of the day, I think we have to address the systemic barriers while simultaneously figuring out how to better engage consumers. Julie Rosen at the Schwartz Center for Compassionate Healthcare talks about Patient and Family Advisor Councils. This was a new concept to me, but it makes a lot of sense that engaging the family in the patient’s care will lead to better outcomes and a better experience. I also heard from Will Meek from the Vancouver Counselor blog who talks about how dreams can be used as part of therapy, and Dr. Johnson who presents a story of woe about her challenges as a physician.

And, since many of us “experience” healthcare thru pharmacy and pharmacy thru DTC, I thought I would also include John Mack’s Pharmacy Marketing Highlights from 2010.

Next week’s Grand Rounds will be hosted by 33 charts.

Benefits Package Blog Carnival


The new blog carnival (3rd edition) is up this morning with one of my submissions and lots of other great posts.  I would encourage you to visit or participate if you’re a blogger.  Thanks.

Humana and Concentra

I’d forgotten about this deal until someone sent me a note about 2010 earnings for Humana and the fact that this was Humana’s 11th acquisition over the past 5 years.  (Can you name them all?)

Given the push for ACOs and PCMHs and clinics, I think the acquisition of Concentra which owns 300 clinics and almost 250 on-site facilities is an interesting one.  It will give Humana another tactic for managing care and creating stickiness with employers.  I also think that clinics have a lot of opportunity to coordinate with pharmacy and improve adherence, therapeutic conversion, and use of mail order.  (See some of Joe Paduda’s comments here.)

With the Concentra staff, I’d be interested in seeing a deal with American Well or another company where they could be leveraged further in a virtual consultation setting with the option of driving them to a physical facility for follow-up. 

The other potential here is to leverage the clinics to improve HEDIS scores and STAR ratings

I think there is more to come here and with similar deals.

CVS and Universal American – 2 Additional Facts

Well, two things I didn’t know yesterday came out as everyone returned from vacation and started analyzing the acquisition.

  1. Adam Fein pointed out the close relationship that NCPA has with UA’s PDP plan and the fact that that is different from their prior relationships with CVS Caremark.  Will that change anything?
  2. Carl Mercurio points out that this now makes CVS Caremark the second largest PDP plan after United.

Press Hits in 2010 (and before)

2010 was a good year.  21 press hits.  (Thanks to a great press team at Silverlink that supports my ideas.)

This built on some success with the press in 2008 (2) and 2009 (15).

Just out of interest, I went to pull some older press hits from pre-Silverlink:

AND, I finally found a link to my first healthcare publication in the International Journal of Radiation Oncology Biology Physics on using activity based costing to compare different treatment options.

Express Scripts To Grow The “Select” Programs

It looks like the concept of “Select” Home Delivery which has been one of the products to come out of the Consumerology approach at Express Scripts is about to get some cousins such as Select Step Therapy, Select Networks, and Select Specialty.  Obviously, the concept of Active Choice has legs.  (I understand the networks and specialty, but I’m not sure what the step therapy product will look like.)

(Here’s a good article from the Brookings Institute on choice architecture for healthcare enrollment.)

The concept of choice has to do with the decision framework with which options are presented.  Making it active choice typically refers to the requirement of the consumer having to make a decision.  They can’t do nothing.  This doesn’t mean that the company can’t select a default recommendation, but it can’t implement that option without the consumer verifying it.  (See the book Nudge for more details on this concept.)

The example that is often used for choice architecture is enrollment into 401K plans.

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