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2013 PBMI Presentation On Pharmacy Need To Shift To Value Focus

Today, I’m giving my presentation at the PBMI conference in Las Vegas.  This year, I choose to focus on the idea of shifting from fee-for-service to value-based contracting.  People talk about this relative to ACOs (Accountable Care Organizations) and PCMHs (Patient Centered Medical Homes) from a provider perspective.  There have been several groups such as the Center For Health Value Innovation and others thinking about this for year, but in general, this is mostly a concept.  That being said, I think it’s time for the industry to grab the bull by the horns and force change.

If the PBM industry doesn’t disintermediate itself (to be extreme) then someone will come in and do it for them but per an older post, this ability to adapt is key for the industry.  While the industry may feel “too big to fail”, I’m not sure I agree.  If you listened the to the Walgreens / Boots investor call last week or saw some of things that captive PBMs and other data companies are trying to do, there are lots of bites at the apple.  That being said, I’m not selling my PBM stocks yet.

So, today I’m giving the attached presentation to facilitate this discussion.  I’ve also pre-scheduled some of my tweets to highlight key points (see summary below).

 

Planned PBMI Tweets

59% Of MDs Want To Know About Employer Care Mgmt Efforts

I just came across this survey data from January of 2010 where the Midwest Business Group on Health (MBGH) did a survey of physicians. I found it really interesting. Let me pull out a few points with some comments…

  • 72% of physicians agree that employers should have a role in improving and maintaining the health of their employees with chronic disease. [Since they ultimately are the one paying the bill, this seems like a reasonable expectation in today’s world.]
  • 59% believe that they should be informed about employer efforts to help their patients manage chronic conditions. [This is increasingly becoming important as we move from a Fee-For-Service (FFS) world to a value-based or outcomes-based healthcare environment.]
  • 46% agree that employers should have a role in helping employees adhere to their medication and treatment regimes. [Since MDs generally don’t view this as their task, if it’s not someone acting on behalf of the employer, I wonder who they think should be doing this.]
  • 32% agree that employers should play no role in the health of patients. [With healthcare impacting productivity and global competitiveness, I think this is an unreasonable expectation.]
  • 61% want the employer to provide physicians with information on what is available to patients so they can counsel them on the value of participation. [How would they want this information and what would they do with it?]
  • 49% would like to receive workplace clinical screening results to reduce redundancies in testing. [Do the other 51% want duplicative testing?]
  • 48% want to receive actionable reports (e.g., screening results, health coaching reports) to support them in treating patients. [I would hope so. If the employer (or really their proxy) is managing the patient in a chronic program, why wouldn’t the physician want this data?]
The study went on to say that physician’s want employers to provide support around weight loss, smoking cessation, flu shots, and other broad programs. They also want the employer to focus on lifestyle change and health improvement not the chronic disease itself. This makes sense, but in general employees are more focused on trusted information coming from their physician not their employer so there’s a clear gap here. (See graph from Aon Hewitt’s 2011 Health Care Survey, New Paths. New Approaches.)

Less Than 1/3rd Of Health Insurers Very Confident In Their Big Data Value To Consumers

With all the discussions these days on Big Data and how to use information to create insights and wisdom, I was really shocked when I looked back at this PWC survey from 2011.  In it, less than 1/3rd of health insurers were very confident in their use of informatics to add value around case management, disease management, wellness, and consumer health tools.  WHAT???

This seems crazy to me.  In this interconnected world where everyone is talking about connected devices, mHealth, and ENGAGEMENT, health insurers are in the optimal position to leverage their data to provide insights, to provide transparency, to create algorithms, to be preventative in their actions, etc.  Maybe their technology platforms are too old?  Maybe they’re too silo’d?  I’m not sure.  But, I find this an interesting arbitrage opportunity.

With a system that integrates data from claims, labs, patient reported sources, HRAs, and biometrics, you can add value by creating a personalized patient experience that adapts with their needs.

Clinical Informations for Care Mgmt

Why We Need Whole Patient Adherence Programs

While prescription adherence continues to be a $290B+ problem, we still address the problem in a drug by drug approach due to silos within our healthcare value chain.

For example:

  • Generic drugs (about 80% of the prescriptions filled) are the lowest cost and most profitable drugs (to the suppliers).  For these medications, you’ll usually have several programs:
    • Refill reminder calls, text messages, letters
      • From the PBM
      • From the retail pharmacy
      • From the mail pharmacy
  • Auto-refill programs
  • Brand drugs are usually higher cost and profitable (to the manufacturers).  For these, you have pharma funded programs such as:
    • Messaging attached to your bill at the pharmacy
    • Letters sent to your house by the pharmacy
    • Specialty drugs which are the highest cost and typically profitable (across the supply chain).  For these, companies often take a higher touch approach:
      • Pharmacy techs calling you
      • Nurses calling you

Additionally, there is additional effort made to keep you adherent if:

  • You’re a Medicare Advantage member in one of the categories where adherence is measured for the STAR metrics program
  • You’re have a condition where adherence is a key metric for HEDIS or some other quality program

For those of us that have studied adherence, you know that this is a multi-factorial issue meaning that there are numerous things that impact your adherence.  Some people will respond to nudging.  Some people need to better understand their disease.  Some people need co-pay relief or patient assistance programs.  Some people need a different medication.

But, the two things we don’t need are:

  • Being treated like a disease not a patient
  • Getting 4, 5, 10 different communications from different parties on different schedules

So, what’s the answer.  There isn’t a silver bullet (which is what we’d all like).  I believe the best alternative is to drive adherence through the disease management and case management companies.  These nurses are treating the patient.  They are discussing their multiple co-morbidities with them.  They are talking about and understanding their barriers.  They should be able to help “prescribe” information and tools to help them with their adherence.

Of course, the issue here is engagement.  If we’re only getting 10% of the patients with chronic illnesses to participate in our programs (which is about the national average – I believe), what about the other 90%.  This is where a care coordination program that incorporated the provider and the pharmacy into a technology solution which pushed gaps-in-care and messaging through the EMR and pharmacy system to drive coordinated solutions is the answer.

I don’t know when this will happen, but I don’t believe we’re going to put a dent in adherence until we think differently about this problem.

PHM Is The New Black Post At CCA Blog With Diabetes Examples

This is a partial copy (teaser) of a guest blog I did on the Care Continuum Alliance blog earlier this week.

**********************

With all the talk about Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), the adoption curve for the Care Continuum Alliance (CCA) model for Population Health Management (PHM) should move beyond the innovators in 2013 and begin to “Cross the Chasm.” I believe there are several preconditions that would set the stage for this to occur, for instance:

  1. Technology advances leading to the “Big Data” focus;
  2. The changing paradigm from fee-for-service to outcomes-based care;
  3. The realization of the role of the consumer led by the e-Patient movement, the idea of the Quantified Self, and the focus of large healthcare enterprises on being consumer centric; and
  4. The budget crisis that is driving employers and other payers to embrace PHM, wellness, and other initiatives that impact cost and productivity.

Of course, most companies are still in the infancy of designing systems to address this coordinated care model, which does not view the patient as a claim, but longitudinally aggregates demographical, psychosocial and claims data.  Additionally, training staff using Motivational Interviewing and integrating external staff into the virtual care team in partnership with the provider will continue to evolve as do our care delivery models.

To read more especially the diabetes examples that I shared, please click over to their blog.  Thanks.

 

Physician Information From The Patient’s Care Manager

Long gone are the days where a small practice can afford to have an onsite case manager.  Aggressive cost cutting, defensive medicine, and other pressures continue to pull at the budget for running a practice for most physicians.

At the same time, the value of a nurse or pharmacist to work with the patient to coordinate care, provide medication reconciliation, and answer clinical questions has been demonstrated in numerous settings.

Of course, most patients with chronic illnesses like diabetes or asthma or even cancer often have a disease manager or case manager provided to them by their employer through a population health management company or their health insurer.  So, if this work is being done, what should be done to coordinate this care with their PCP or their specialist?

I’ve never seen it done when which prompts several questions:

  1. What information a physician would want to receive?
  2. In what format?
  3. And, with what frequency?

Here are some of my ideas:

  1. A copy of the care plan that’s been created for the patient based on evidence-based guidelines.
  2. A list of any gaps-in-care that have been identified and discussed with the patient.
  3. Any assessment that has been made of the patient’s risk level along with information about how that assessment was made – i.e., claims based modeling versus nurse based assessment.
  4. Information about the patient’s Rx adherence and/or barriers to adherence.

But, what about things like:

  1. Benefit information.  Does the physician want to better understand any network limitations, Centers of Excellence, or other clinical pathways to be followed?
  2. mHealth.  Does the physician want to understand any apps that the patient is using and how that data is being incorporated into the care plan?

The more challenging question is how to deliver this information in a valuable format.

  1. Direct mail seems slow and difficult to manage.
  2. Faxing seems quick but an outdated modality.
  3. Secure e-mail could work, but I don’t think most physicians want to have multiple secure e-mail accounts to coordinate.
  4. A physician portal could be efficient, but probably only if there’s a concentration of patients at that office that use the same care management company.
  5. Integration into the EMR is probably ideal, but this is a challenge with all the different vendors out there.

The other question is frequency.  Should this data be provided after every interaction?  Should it be batched and provided weekly or monthly?

And, in the case of print materials, should the data be sent per patient or aggregated per physician?  It would seem overwhelming to get one letter with data on 20 patients, but on the other hand, having 20 letters would allow the information to be more easily filed per patient.

This type of coordination is critical as we move from a fee-for-service to an outcomes-based environment where care coordination is more important than ever.

Guest Post: Is It Too Late To Avoid The Flu?

By Paula Spencer Scott, Caring.com Senior Editor

The 2012-13 flu season is shaping up to be one of the worst in years. If you or your loved ones haven’t succumbed yet, these steps can help you stay healthy. And if someone does get sick, many of the same steps can prevent a wider spread of infection.

Get a flu shot. No, it’s not too late. This year’s shot only offers 62 percent effectiveness, according to Thomas Frieden, director of the Centers for Disease Control and Prevention. But it’s still considered the number-one prevention tool.

Give the flu shot time to kick in. It can take one to two weeks for a flu shot to offer protection (see: How Long Does It Take for a Flu Shot to Offer Protection? for more information on flu shot protection). So don’t expect instant immunity.

Keep vulnerable loved ones away from crowds. Given how widespread the flu already is, we’re all courting trouble by hanging out in crowded public places like shopping malls. But those who should especially keep away include the very young, the frail old, and those with health conditions that weaken the immune system or who are using treatments that can affect the immune system, such as.

Keep suspicious visitors away from vulnerable loved ones. If you live with someone with a chronic illness or who is a frail older adult, be a good gatekeeper. If a guest has a cough, a runny nose, or is complaining about being under the weather, don’t endure a visit. Invite him or her back at a better (healthier) time.

Stay home if you’re feeling under the weather. Best to avoid crowds, including the workplace, when your immune system is low. And in case your symptoms mean you’re coming down with something, you can avoid infecting others.

Wash hands often. Pretend you’re obsessive-compulsive and do it all day long. Be sure to wash hands (with soap and water or hand sanitizer) after touching doorknobs.

Become a clean freak. Stock up on cleaning supplies. You may use them more if you have them handy right in each bathroom and the kitchen. Wipe down surfaces often. Bring portable wipes to work so you can keep your keyboard and any shared spaces cleaner, too.

Try a face mask. It’s not clear they’re super-effective, but in a situation where some people are sick, they can provide an added barrier between a frail older adult and the flu.

Stay well hydrated. Keeping nasal passages moist helps them resist germs. Drinking lots of water and using nasal saline sprays helps — especially when flying, as aircraft cabin air is dry.

Get at-risk groups to the doctor at the earliest symptoms. Very young children and the very old should get swift treatment, says the CDC. Medicines such as Tamiflu work best within the first 48 hours.

About the Author

Paula Spencer Scott is senior editor at Caring.com, the leading online destination for caregivers seeking information and support as they care for aging parents, spouses, and other loved ones. Paula is a 2011 MetLife Foundation Journalists in Aging fellow and writes extensively about health and caregiving. You may also want to see Paula’s article 7 Ways to Have Fun While Fighting Cold and Flu.

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 – http://hoopayzblog.com/.

Guest Post: How Nursing Can Help Reduce Healthcare Costs

Yes, the election has come and gone. No doubt we’re still suffering from the latent effects of election-fatigue, buzzwords still echoing in our heads like bad nightmares; stimulus packages, fiscal cliffs, economic malaise, and the ever-popular budget cuts. But the super-sensitive topic at the crux of our current political polarization is undoubtedly, one of healthcare. It’s hard not to get caught up in all the political hoopla in regards to current policies versus proposed plans and how we seem unable to find that magic bullet to rescue us from this healthcare maelstrom instead of dooming us further into the partisan abyss.

It has been estimated that between 2012-2022, Medicare spending will skyrocket through the current $550 billion to the astronomical tune of $1.064 trillion (that’s trillion with a ‘T’). Medicaid will likely double from $253 billion to $592 billion. Additional costs created by expenditures and subsidies for mandatory healthcare will rise from $25 billion to $181 billion. Where will all this money come from?

To counter rising healthcare costs, the burden will be shouldered by all Americans. But don’t start crying that the sky is falling just yet; there is a remedy that would not only benefit our healthcare needs and reduce costs, but also maintain that all-important mark of quality. How? Let’s take a look at how nursing can be the ultimate solution to remedy our economic woes as well help improve our overall good health.

  • Nurse Practitioner: One of the fastest rising fields of healthcare, Nurse Practitioners (NPs) can receive their training and certification four-five times quicker than a physician. The costs of educating an NP is far less than the cost of putting a medical student through medical school and with quicker training that means seeing more patients earlier and subsequently shorter waiting lines and getting in and out of the doctor’s office and on your way to better health in a much more efficient manner. Nearly 96% of all Nurse Practitioners can write prescriptions and according to healthcare studies, patients ranked them as high as they would their primary doctor.
  • Traveling Nurses: If you can earn your nursing degree, than a host of numerous healthcare opportunities will arise for you. Among them are temporary jobs with flexible schedules, some such assignments include nursing jobs all over our country as well as overseas. Here in the states such a program is called, “Nurse-Family Partnership”. This provides a visiting nurse to make house calls for lower income families that might not have the opportunity otherwise to have high quality healthcare provided for them.
  • Silver Boom: In the next twenty years, the elderly population will not only increase due to aging baby boomers but because of better diagnoses and preventative care, we are ALL living longer and more productive lives. According to the Center for Healthcare Workforce Studies*, by the year 2050 the number of older adults will increase from 12.5% to 20% of the United States population (this is among the population of those 65 years and older).

At the end of the day, healthcare will continue to grow as our population follows along this similar trend. Having nurses filling in those costly gaps will pay off down the road with better care, quicker appointment availability and lower overall costs. And in a climate of ever-changing political landscapes, to have one sector not only reducing costs but composed of those continually seeking higher quality standards would be hard to argue against.

*”The Impact of the Aging Population in the Healthcare Workforce in the United States Summary of Key Findings” – Center for Healthcare Workforce Studies, School of Public Healthy, University at Albany.

Kathryn Norcutt has been an active member of the health care community for over 20 years. During her time as a nurse, she has helped people from all walks of life and ages. Now, Kathryn leads a much less hectic life and devotes most of her free time to writing for RNnetwork, a site specializing in travel nursing jobs.

Guest Post: I’m Ready To Lose Weight!

Guest Blogger Lynn Gieger is a contributor to Everyday Health and its calorie counter and fitness tools.
The signs were all there, but until the doctor commented, “You’re overweight and your weight is negatively impacting your health,” it was no longer easy or healthy to ignore the too-tight belt, too-small jeans, and the steering wheel poking into the stomach.

Now what are you going to do about it?

Ignore the hype of the hundreds of weight loss programs that promise effortless weight loss. If it was that easy, you wouldn’t be in this shape right now, would you?

To truly take charge of your weight and health, start by giving yourself some time to think about why weight loss is important to you. What will be different in your life when you lose weight? Look at the health implications: decreased cholesterol, lower blood pressure, reduced risk of type 2 diabetes, less pressure on your knees and hips. Also think about personal reasons why weight loss is important to you: do you want to get on the floor and play with your grandchildren, go hiking with your kids, dancing with your spouse, or just look smashing? List all of the reasons how losing weight will improve your life to increase your motivation to make changes.

The National Weight Control Registry, established in 1994, tracks over 10,000 people who lost an average of 66 pounds and kept it off for 5.5 years. The NWCR research identifies 3 key steps to lose weight and keep it off:

1. Keep a journal detailing what, when and how much you eat. 78% of the NWCR participants report eating breakfast every day, and the majority decreased both calorie and fat intake to lose unwanted pounds. Use your journal to identify specific places to make changes, such as using lower fat salad dressing, choosing water instead of a high-calorie sweetened beverage, and swapping fruit for chips at snack time. Need help figuring out where to make changes? Find a weight management specialist with the knowledge and skills to streamline your food choices and encourage you to make lasting changes in your eating habits.

2. Keep track of daily exercise. 90% of NWCR participants exercise for an average of one hour each day. Create a habit of daily exercise to burn calories and improve your fitness – plus give you something else to do besides eat. Find a certified fitness expert to get you started or ask at your local gym.

3. Decrease the number of hours of non-work screen time (TV, video games, movies, computer). NWCR recommends less than 10 hours of screen time per week. If Sunday at your house means 6 hours of TV football, change your weekly screen-time habits and guess what – you just found time for exercise!

If you’re stuck and can’t figure out how to get started losing weight, work with a certified wellness coach to help you set realistic goals and hold you accountable.

Avoid a weight loss/gain rollercoaster by clearly identifying why weight loss is important to you and focus on the long-term. It doesn’t matter if it takes you 6 months or 6 years to reach your weight goal: the key is changing your habits so you stay at a healthy weight.

And the next time you see the doctor, think of this comment, “Wow, you’re looking great!”

FitBit Review Summary – Device, Apps, And Suggestions

In the spirit of the Quantified Self movement and in order to better understand how mHealth tools like FitBit can drive behavior change, I’ve been using a FitBit One for about 6 weeks now. I’ve posted some notes along the way, but I thought I’d do a wrap up post here. Here’s the old posts.

Those were focused mostly on the device itself. Now I’ve had some time to play with the mobile app. Let me provide some comments there.  And, with the data showing a jump in buyers this year, I expect this will be a hot topic at the Consumer Electronics Show this week.

  • The user interface is simple to use. (see a few screenshots below)

  • I feel like it works in terms of helping me learn about my food habits. (Which I guess shouldn’t be surprising since research shows that having a food diary works and another recent study showed that a tool worked better than a paper diary.) For example, I learned several things:
    1. I drink way too little water.
    2. I eat almost 65% of my calories by the end of lunch.
    3. Some foods that I thought were okay have too many calories.
  • In general, the tracking for my steps makes me motivated to try to walk further on days that I’m not doing good.
  • The ease of use and simple device has helped me change behavior.  For example, when I went to go to dinner tonight, I quickly looked up my total calories and saw that I had 600 calories left.  Here’s what I ate for dinner.  (It works!)

Meal

But, on the flipside, I think there are some simple improvement options:

  1. I eat a fairly similar breakfast everyday which is either cereal with 2% milk and orange juice or chocolate milk (if after a workout). [In case you don’t know, chocolate milk is great for your recovery.] Rather than have to enter each item, FitBit could analyze your behavior and recommend a “breakfast bundle”. (and yes, I know I could create it myself)
  2. Some days, I don’t enter everything I eat. When I get my end of week report, it shows me all the calories burned versus the calories taken in. That shows a huge deficit which isn’t true. I think they should do two things:
    1. Add some type of daily validation when you fall below some typical caloric intake. (Did you enter all your food yesterday, it seemed low?)
    2. Then create some average daily intake to allow you to have a semi-relevant weekly summary.
  3. The same can be true for days that you forget to carry your device or even allowing for notes on days (i.e., was sick in bed). This would provide a more accurate long-term record for analysis.
  4. The food search engine seems to offer some improvement opportunities. For example, one day I ate a Dunkin Donuts donut, but it had most types but not the one I ate. I don’t understand that since there’s only about 15 donuts. But, perhaps it’s a search engine or Natural Language Processing (NLP) issue. (I guess it could be user error, but in this case, I don’t think so.)
  5. Finally, as I think about mHealth in general, I think it would be really important to see how these devices and this data is integrated with a care management system.  I should be able to “opt-in” my case manager to get these reports and/or the data.

The other opportunity that I think exists is better promotion of some things you don’t learn without searching the FitBit site:

  • They’re connected with lots of other apps.  Which ones should I use?  Can’t it see which other ones I have on my phone and point this out?  How would they help me?
  • There’s a premium version with interesting analysis.  Why don’t they push these to me?

I also think that they would want an upsell path as they rollout new things like the new Flex wristband revealed at CES.

And, with the discussions around whether physicians will “prescribe” apps, it’s going to be important for them to be part of these discussions although this survey from Philips showed that patients continue to increasingly rely on these apps and Dr. Google.

Philips_Health_Infographic_12%2012_F3

Finally, before I close, all of this makes me think about an interesting dialogue recently on Twitter about Quantified Self.

Court Decision Allows Pharma Reps To Discuss Off-Label Uses Of Prescriptions

I must admit that I’ve heard very little about this decision from the Federal Appeals Court for the Second Circuit of Manhattan that decided that discussing off-label uses for prescription drugs was an issue of free speech. This could change the way pharmaceutical manufacturers interact with physicians. It could change the job of the pharmaceutical rep. It could change how clinical trials are done. It could change how prescriptions are used. It could also lead to a whole new set of prior authorizations by companies that actually have to actively manage off-label usage as it becomes widespread.

On the other hand, I wonder if this door hadn’t already been opened. Have you looked at some of the peer-to-peer (P2P) healthcare websites out there or the disease based communities (e.g., PatientLikeMe or CureTogether)? Patients are already talking about what medications they are using to treat their diseases and their symptoms. Don’t you think those are leading to requests to the provider and discussions with them about off-label utilization?

And, I’m sure that Dr. Google has helped many patients identify other uses of medications. This process (to the best of my knowledge) is completely un-managed. It’s a popular enough topic that Consumer Reports talked about it earlier this year and even put together the following table on drugs commonly used off-label.

Specific drug, type of drug Examples of off-label use**
Aripiprazole (Abilify), antipsychotic Dementia, Alzheimer’s disease
Tiagabine (Gabitril), antiseizure Depression
Gabapentin (Neurontin), antiseizure Nerve pain caused by diabetes, migraines, hot flashes
Topiramate (Topamax), antiseizure, in combination with phenteramine for weight loss Bipolar disorder, depression, nerve pain, alcohol dependence, eating disorders
Risperidone (Risperdal), antipsychotic Alzheimer’s disease, dementia, eating disorders, post-traumatic stress disorder
Trazodone (Desyrel), antidepressant Insomnia, anxiety, bipolar disorder
Propranolol (Inderal), high blood pressure, heart disease Stage fright
Sildenafil (Viagra), erectile dysfunction To enhance sexual performance in people not diagnosed with erectile dysfunction, to improve sexual function in women taking certain antidepressants
Quetiapine (Seroquel), antipsychotic Dementia, Alzheimer’s disease, obsessive-compulsive disorder, anxiety, post-traumatic stress disorder
SSRI antidepressants such as paroxetine (Paxil) and sertraline (Zoloft) Premature ejaculation, hot flashes, tinnitus (ringing in the ears)
Prazosin (Minipress), high blood pressure Post-traumatic stress disorder
Amitriptyline (Elavil), antidepressant Fibromyalgia, migraines, eating disorders, pain after shingles infection
Bevacizumab (Avastin), certain types of cancer Wet age-related macular degeneration (eye disease)
Statins such as atorvastatin (Lipitor), simvastatin (Zocor), high cholesterol in adults, children with an inherited cholesterol condition Rheumatoid arthritis, to lower cholesterol in children who lack the inherited condition
Clonidine (Catapres), high blood pressure Smoking cessation, hot flashes, attention deficit/hyperactivity disorder (ADHD), Tourette’s syndrome, restless legs syndrome

* Not meant to be a comprehensive list. Many of the drugs listed here are also available as generics.

** Does not imply that use is clinically appropriate or inappropriate, or beneficial or not.

***To find out if a drug’s off-label use is supported by evidence, click on the medication name.

 

I would imagine that pharma is going to tip-toe through this open door not simply crash through it. They’re generally risk adverse so their discussions of off-label utilization will be fact-based (to limit exposure) even if (as we all know) statistics can lie. I would suspect (as I’ve seen on other blogs) that this will ultimately go to the Supreme Court before anyone really takes advantage of it.

I guess I’d also point to the issue that physicians have responsibility here. They prescribe off-label today. Here’s what the FDA says about this:

Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgement. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product’s use and effects. Use of a marketed product in this manner when the intent is the “practice of medicine” does not require the submission of an Investigational New Drug Application (IND), Investigational Device Exemption (IDE) or review by an Institutional Review Board (IRB). However, the institution at which the product will be used may, under its own authority, require IRB review or other institutional oversight.

One way to begin to manage this would be to require the use of diagnosis codes (Dx) on all prescriptions. This would at least great a way of tracking how the medications are being used and allow for better technology oversight across the provider, payer, pharmacy, and PBM.

In the interim, Consumer Reports suggest consumers do the following:

  • When your doctor prescribes a drug, ask if it’s an approved use. If he or she doesn’t know, ask your pharmacist.
  • Check for yourself. Go to DailyMed (dailymed.nlm.nih.gov/) and search for the drug. Then click on the tab for “Indications & Usage” to see if your condition is listed.
  • If it’s an off-label use, ask your doctor if it’s supported by well-designed trials showing significant improvement for people with your condition.
  • Ask your doctor why he or she thinks the drug will work better than approved drugs for your illness.
  • Find out if your health insurer covers payment for the off-label use. Some may require evidence of effectiveness or failure with conventional treatments, especially if the drug is expensive.

Diabetes Discussion – Clinical vs Technical vs Plain Language

One of the big issues in healthcare communications which is a rate limiting factor on health engagement is the language we use with patients. Here’s my attempt to talk about diabetes using different frameworks to drive home why this is important.

A clinical discussion:

You have diabetes mellitus. Because of that, you’re at increased risk for multiple co-morbidities including atheroscelerosis, hypertension, periodontal disease, retinopathy, neuropathy, and renal disease. Diabetes is considered a progressive disease. As our first line, I’m going to start you on monotherapy. Based on comparative effectiveness, this has the best clinical end points and lowest DUR issues. You will also need to maintain glycemic control and modify your physical activity level and caloric intake to minimize the long-term probability of getting ESRD and to lower your risk of myocardial infarction.

A mHealth discussion:

Based on our predictive algorithm and quantified self-tracking, I’m 90% confident that you have diabetes. To manage your diabetes, there are numerous widgets for assessing your risk along with online tools leveraging embodied conversational agents to support your efforts to self-monitor your condition. There are also apps which you can download which use gamification and location based services to address your intrinsic motivation to change. These tools will leverage the Trans Theoretical Model to understand your readiness for change and tailor messaging to you. Additionally, there are clinical staff available to help address your symptoms post-encounter.

A plain language discussion:

As you know, diet and exercise are important to maintain a healthy lifestyle. The test I had you take confirms that you have diabetes. Diabetes is a manageable disease, but it can lead to other health problems including gum disease, high blood pressure, and problems with your heart. We are going to start you on a prescription called metformin which will help to manage your diabetes, but you will still need to make some lifestyle changes. There are lots of technology tools on the Internet and your smart phone that can help you. I’d be happy to show you a few. They will help you track your calories, your exercise, and provide you with reminders about taking your medication. They can also help you learn about diabetes and answer some of your questions.

(And the above is at 7.8 grade level which is still too high for Medicaid and many programs.)

Here’s a summary from the CDC on Health Literacy…

What is Health Literacy?

The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. This definition is almost identical to Healthy People. The only difference is the addition of “communicate” to the legislative definition.

Why Does Health Literacy Matter?

Every day, people confront situations that involve life-changing decisions about their health. These decisions are made in places such as grocery and drug stores, workplaces, playgrounds, doctors’ offices, clinics and hospitals, and around the kitchen table. Obtaining, communicating, processing, and understanding health information and services are essential steps in making appropriate health decisions; however, research indicates that today’s health information is presented in ways that are not usable by most adults. “Limited health literacy” occurs when people can’t find and use the health information and services they need.

  • Nearly 9 out of 10 adults have difficulty using the everyday health information that is routinely available in our healthcare facilities, retail outlets, media and communities.1
  • Without clear information and an understanding of the information’s importance, people are more likely to skip necessary medical tests, end up in the emergency room more often, and have a harder time managing chronic diseases like diabetes or high blood pressure.2

What Needs to Be Done to Improve Health Literacy?

We can do much better in designing and presenting health information and services that people can use effectively. We can build our own health literacy skills and help others—community members, health professionals, and anyone else who communicates about health—build their skills too. Every organization involved in health information and services needs its own health literacy plan to improve its organizational practices. The resources on this site will help you learn about health literacy issues, develop skills, create an action plan, and apply what you learn to create health information and services that truly make a positive difference in people’s lives.

References

1 Kutner, M., Greenberg, E., Jin , Y., & Paulsen, C. ( 2006 ). The health literacy of America’s adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics.

2 Rudd, R . E., Anderson, J . E., Oppenheimer, S., & Nath , C. (2007). Health literacy: An update of public health and medical literature. In J. P. Comi ngs, B. Garner, & C. Smith. (E ds.), Review of adult learning and literacy (vol . 7) (pp 175–204). Mahwa h, NJ: Lawrence Erlbaum Associates.

Diabetes Innovation – mHealth; Quantified Self; Business Model

I’m not a diabetic, but I’ve been researching the topic to understand the space and what innovation is occurring around diabetes. This is a space where there are lots of applications, tools, devices, communities, and research. The ADA estimates the total US cost at $218B with very high prevalence. If you expand that on a global scale, the costs and impact is staggering.

  • Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes.
  • Diagnosed: 18.8 million people
  • Undiagnosed: 7.0 million people
  • Prediabetes: 79 million people*
  • New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.

So, what’s being done about it? And, what opportunities exist? I think you’ve certainly seen a lot of innovation events being sponsored by pharma and others.

You’ve seen a shift from drug to engagement for a few years as evidenced in this old post about Roche – http://www.diabetesmine.com/2009/10/a-visit-to-the-roche-new-concept-incubator.html

You’ve seen a proliferation of diabetes apps. (A prime opportunity for Happtique.)

From my traditional PBM/Pharmacy focus, you’ve seen several efforts there:

Obviously, Medco (pre-Express Scripts acquisition) thought enough of this space to buy Liberty Medical.

I pulled some screen shots and examples into a deck that I posted on SlideShare. I’d welcome people’s thoughts on what’s missing or what are the key pain points from a diabetes perspective (e.g., not integrated devices).

While I was doing my research, I found a few interesting things worth sharing.

Several interesting studies:

Some good slide decks:

Additionally a few videos:

I also posted some diabetes infographics on my blog – https://georgevanantwerp.com/2012/12/13/more-diabetes-infographics/

And, while I started to pull together a list of diabetes twitter accounts below, you can follow @AskManny’s list with 360 people already tagged in it. https://twitter.com/askmanny/diabetes

My starting twitter List:

Diabetes Infographic

Our marketing team at inVentiv Medical Management created this infographic that I thought I would share.

Diabetes infographic inVentiv

Using Gilligan To Drive Colonoscopies

While I do applaud the creative concept here, I wasn’t overly impressed with the creative itself.  At the end of the day, the question for me is results.  Did it pay for itself?  Did it get more people to get colonoscopies (in the target audience) than otherwise would have?  I’m unsure of that.

Here’s what I did find in a HealthLeaders article…At the end of the day, I’d want to compare that to a program we did at my last company for UHG in this area.

The campaign also netted 44 colonoscopy appointments. Of those 44 appointments, 13 were current Good Samaritan patients and 31 were new to the hospital. Forty-three of the 44 scheduled an appointment through the call center and one booked online. Of those who called, 27 cited the radio spot as how they found out about the service. More than half of the patients were in the target group of 50–59 year olds, with 24 female and 20 male.

10 Healthcare Trends To Monitor in 2013

I came across the chart below and thought I would post it with my perspective on trends for next year.

  1. “Accountable Care” in the form of CMS ACOs or Patient Centered Medical Homes will continue to expand.  I predict some companies will begin to provide the infrastructure such that providers don’t have to come up with the $2-4M in capital needed.
  2. Integrated “Big Data” looking at pharmacy, medical, lab, AND patient reported data AND physician EMR data will be the rage to mine and use in predictive models. 
  3. Consumer engagement around health will continue to be a huge focus.
  4. Obesity will continue to be an issue that people struggle with and employers begin to focus more actively on managing.
  5. mHealth in the form of mobile apps, connected devices, telemedicine, and remote monitoring will begin to move from the innovators to be a more standard component of the solutions with ROIs being more standard.
  6. The core components of health reform will remain (regardless of who wins) and the shift of people from underinsured and uninsured into the insured pool will finally be the tipping point for provider access and push growth in the clinics and telemedicine (video and phone) world. 
  7. Transparency will become something that consultants begin to mandate and try to get into contracts around pricing, claims auditing, and other services across the entire healthcare spectrum.
  8. Hospitals will continue to buy physicians and look at how they can play a more dominant regional role especially outside of the urban areas. 
  9. Consolidation will continue across all areas – providers, payers, pharmacy, pharma, technology.
  10. Investment in healthcare will continue to outpace other industries. 

Infographic: Your Health In One Drop From WellnessRx

I saw a mention of WellnessRx from Health 2.0 and went to look at them.  I found this infographic which I think is interesting and reinforcing of the value of biometrics in population health management.

Will You Be Charged More For Not Participating In Wellness Programs?

Thus, the major factors that insurance companies traditionally use to charge higher premiums – such as health status, the use of health services, and gender – will no longer be allowed under the ACA. However, the ACA does permit employment-based health plans to charge employees up to 30 percent more on their premiums (and potentially up to 50 percent more) if they fail to participate in a wellness program or meet specified health goals.  [From Kaiser document]

Traditionally, health plans and employers have rewarded consumers for taking some basic action (e.g., $100 for completing an HRA)…although some companies prefer penalties versus incentives.

At that same time, there is some evolution happening here with companies moving from simply paying for an action to requiring participation in a program (e.g., disease management).  The next step that a few companies are engaging in is actually incenting or penalizing consumers based on health outcomes.  This will certainly open some doors for legal challenges where people will argue that they are genetically pre-disposed to some factor that limits their ability to lose weight or lower their cholesterol or some other measure of health.

But, in one of the first legal challenges in FL, the court recently upheld the idea of rewarding (or penalizing) consumers based on taking a specific action (like completing a biometric screening).  With that, I expect companies will be more empowered to take advantage of the fact that under health reform they can charge consumers up to 30% more for their healthcare for either not participating or not achieving a specific health outcome.

With an average monthly premium of $468 per month of single person coverage and consumers paying an average of 21% of their healthcare costs (or $97 per month), this means that a consumer could pay an additional $29 per month (or $349 per year).  [If I interpret all of this correctly…if it’s 30% of the total health premium (not just the consumer’s share), then this jumps up dramatically.]

Not surprisingly, employees aren’t real excited about this.  In a survey by the National Business Group on Health, 62% oppose charging employees more for health coverage if they do not participate in wellness programs.  And, 68% oppose requiring employees to participate in a wellness program in order to qualify for health insurance.

And, according to the survey, the most effective cost control tactic was believed to be Consumer Driven Health Plans by 43% and wellness programs by 19% while 60% of employers plan to increase the premium paid by employees (i.e., cost shifting).

But, if companies throw out a life preserver (i.e., wellness program) to a drowing individual (i.e., unhealthy individual), why isn’t it a reasonable expectation that the individual has to grab it (i.e., participate in the program)?

Absenteeism And Presenteeism Costs > Medical Costs

I always hear people talk about ROI around population health programs.  The problem is that most people struggle to estimate the absenteeism and presenteeism costs associated with poor health.  Various studies continue to reinforce that these costs actually exceed the medical and pharmacy cost savings.

The Transtheoretical Model And Setting Goals

There’s a good article in Time (9/17/12) called “Goal Power” by Dr. Oz.  I found it interesting on a few fronts.

“Getting people to make meaningful changes in their lives is much more complicated than explaining to them what to eat for dinner, how often to exercise and which kinds of tests they should get from their doctors.  The psychology of health is every bit as complex as the biology, and to create seismic shifts in behavior, we have to probe the subconscious.”

1. The topic of goals and objectives and their importance relative to healthcare behavior change is a repeating theme.

  • A month ago, I was at a presentation by Dr. Victor Strecher who founded HealthMedia.  He was talking about the importance of getting people to articulate their goals or objectives for changing.  (E.g., I want to become healthy to see my daughter get married.)
  • I had a pharmacy client who was looking into this as part of an adherence program a few years ago.

2. The topic of behavior change and behavioral economics has been a very popular theme with Nudge and many other publications and programs over the past few years.

3. Obesity, which is part of the focus of his article, is widely becoming recognized as the greatest public healthcare challenge of the 21st century.  And, it is a very complex issue tied to sleep, stress, social network, and many other factors.

4. He introduces the transtheoretical model (also known as the Prochastka model or the Stages of Change), which is widely known in the academic and health areas, into the public domain which surprised me.

(Here’s the abstract from what one widely quoted paper on this.)

The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to data have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stage-matched programs is the similarity between participants reactively recruited who reached us for help and those proactively recruited who we reached out to help. If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.

5. He references two of the big studies that looked at social pressure an its influence on health.  Something that peer-to-peer healthcare and social network tools can create for us by developing support communities and “buddies” to support our change.

  • 2012 study in the journal Obesity about weight loss.
  • 2008 study in the NEJM about smoking

6. He references Dr. Nicholas Chrisakis who co-authored the book Connected which is being manifest in the company called Activate Networks.

Overall, for those of us that work in the healthcare field, these are all critical topics that we constantly talk about.  It’s nice to see it brought to the “popular press”.

Highlights From The Prime Therapeutics Drug Trend Report

It’s been a busy year, and I’m getting a late start on reviewing the drug trend reports as I’ve done in the past. I’ll try to get to the CVS Caremark and Express Scripts reports next week.

As I mentioned last year, the Prime Therapeutics Drug Trend Report takes a more aggressive stand and how they compare to the competition. I’ll give a lot of that credit to Eric Elliot’s presence there as the CEO.

“Smart car buyers know that the actual cost of a car does not always align with the price on the window; the same is true for pharmacy benefits. Yet plan sponsors continually focus on “sticker price” measures such as brand-name discounts or manufacturer rebates — metrics that can be manipulated to make a deal look more attractive.”

The one thing which is noticeably different this year is that the document has more of a care management sound to some of the programs they talk about with an emphasis on total healthcare cost savings. Again, I attribute that to both being owned by the Blues and having several people in the management team that came from payers. Buried towards the back, they call themselves “total health focused” versus their competitors.

As always, here’s a few things that caught my attention:

  • A $4.73:$1 ROI for using the local pharmacist to address gaps-in-care.
  • 1.3% trend increase.
  • 74.7% generic fill rate.
  • 20.1% specialty trend increase.
  • 15.4% of client’s pharmacy spend is for specialty drugs which cost on average $2,654.
  • 0.4% of Rx claims processed are for specialty drugs.
  • Their Rxs PMPY have gone up to 12.4 which I think is closer to industry.
    • This is an interesting one. I pointed out a few years ago that they were below average which I wasn’t sure if this was due to plan design, member mix, or client mix.
    • They seem to be going up even though some industry data suggests a downturn in Rxs filled which again is something I can’t explain.
    • It could simply be more people >50 years old are staying in the insured mix…and they use more drugs.
  • Their average net costs per Rx were:
    • $165.33 brand
    • $17.95 generic
    • $57.53 combined
  • They breakdown specialty spend by category and also show how it’s growing and is projected to grow as a percentage of total drug spend.
  • Of course, another big piece of the specialty picture is how the spend breaks out between medical and pharmacy benefits. This is why blending data to understand the complete picture is important.
  • I thought the list of specialty drug management tools was a good starting point although I expected to see more here about how to integrate with the payers especially around categories like oncology and what BCBS of Florida is doing around an oncology ACO solution.

 

Some ACO Facts From Modern Healthcare and CMS

In a Modern Healthcare article about ACOs, there was the following graphic which is a quick snapshot.  The key here is that companies are rapidly moving forward with ACOs (commercial and Medicare).  The initial data is positive, and it seems like everyone is jumping on board.

Interview With Michael Graves On Healthcare Design

When I was in architecture school, Michael Graves was one of those architects that we studied.  Everyone wanted to be like him designing cool building like this one below.  Since then, he’s gone on to be even more famous both from an architecture perspective and a design perspective (even having his own Target line).

But, since he was left paralyzed from the chest down in 2003, he’s had an incredible focus on redesigning healthcare from the perspective of the patient.  [I would put him in a similar e-patient category as e-Patient Dave, but while Dave is focused on technology and data, Michael is focused on furniture and spatial experience.)

I was thrilled to get the chance to talk with him yesterday to see how this effort was taking off, and on a personal note, to see if this idea of architecture influencing outcomes would be generally accepted.  My general takeaway after talking with him was that he’s getting a very positive response as he talks to people about it, but you’re not seeing a sea-change in terms of clients focusing on this or his fellow architects embracing this.  But, as someone in healthcare, this isn’t surprising.  We know it takes physicians 17 years to adopt new standards…why should it take the administrators of those physicians any less.

At the same time, there is a huge focus on the patient experience and on outcomes these days.  Both of those can be improved through a focus on the physical experience.  I asked him whether he was seeing interest from both inpatient and outpatient facilities.  He indicated that the dialogue is all happening around hospitals which isn’t surprising given their investments in new facilities and the industry shift around ACOs and PCMHs.  But, any of us that have sat in a physician’s office looking at posters from the drug companies, outdated magazines, or just an overly sterile room, know that these things don’t relax you or make you comfortable.

Michael tells a story that I’d seen in other articles about how he first came to understand all the problems with the physical space in the hospital.  He wanted to shave one day and realized that he couldn’t see himself in the mirror and he couldn’t reach the water to turn it on.  It was all designed by someone that hadn’t put themselves in the patient’s shoes (or wheelchair) to understand their perspective on the space.

Since “evidence-based medicine” is all the buzz in the healthcare area, I asked him about the term “evidence-based design” which is used in several articles and on his website.  As he pointed out, it’s basically about just using common sense, but I do think there’s more there (to eventually sell this).  To me, this implies a level of rigor linking more practical furniture and spatial redesign to clinical outcomes and patient satisfaction.  These are the things that are going to motivate the CFO to open the purse strings to make a change.  Unfortunately in our healthcare system, there aren’t a lot of changes made just because the patient wants them or they make sense.  Otherwise, we’d have a healthcare system not a sick care system.

The final topic we discussed was moving beyond furniture to look at art and color and other things that could effect the patient’s experience.  He told me that he’s also a painter (which I didn’t know) and mentioned that one of his clients had bought some of his art and furniture for their facility.  He also reinforced a study that I’d seen before about not using abstract art but focusing more on natural scenes within the patient setting (also mentioned below).

Here’s a few articles from other interviews and a link to the work he’s doing with Stryker on medical equipment / furniture.  You can also see a press release on his upcoming presentation at the end of this post.

And, while Michael is focused on the furniture and spatial experience, there are others focused on the art, colors, and other aspects of the hospital experience.  I found this text from The Atlantic from a few years back that even talks about some of the studies that have been done.  [Maybe case managers should be asking for specific rooms in facilities!]

Such “evidence-based design,” which draws its principles from controlled studies, is the great hope of professionals who want to upgrade the look and feel of medical centers. Much of this research follows a seminal 1984 Science article by Roger S. Ulrich, now at the Center for Health Systems and Design at Texas A&M. He looked at patients recovering from gallbladder surgery in a hospital that had some rooms overlooking a grove of trees and identical rooms facing a brick wall. The patients were matched to control for characteristics, such as age or obesity, that might influence their recovery. The results were striking. Patients with a view of the trees had shorter hospital stays (7.96 days versus 8.70 days) and required significantly less high-powered, expensive pain medication.

Along similar lines, a 2005 study compared patients recovering from elective spinal surgery whose rooms were on the sunny side of a ward with those on the dimmer side. Those in the sunnier rooms rated their stress and pain lower and took 22 percent less pain medication each hour, incurring only 80 percent of the pain-medication costs of the patients in gloomier rooms. Other studies, with subjects ranging from the severely burned to cancer patients to those receiving painful bronchoscopies, have found that looking at nature images significantly reduces anxiety and increases pain tolerance. Not all distractions are good, however. Ulrich and others have found that inescapable TV broadcasts and “chaotic abstract art” can increase patients’ stress.

Press release about his upcoming presentation:

World-Renown Architect Becomes Healthcare Advocate After Rare Illness Leaves Him Paralyzed

Michael Graves to speak at medical conference about his passion for healthcare design


Michael Graves, the award-winning architect and product designer famous for his collection of home products sold at Target, will address the country’s top healthcare professionals during a special reception at the 2012 Health Forum and the American Hospital Association Leadership Summit next month.  He will give a personal account about how paralysis fueled his desire to improve healthcare design.

Graves, who was recently named the 2012 recipient of the Richard H. Driehaus Prize and applies his design philosophy to designing better hospitals and home care environments, will be the featured speaker immediately following the welcome reception of the 2012 AHA Summit, at the San Francisco Marriott Marquis, at 7 p.m., Thursday, July 19.

In his lecture, “People First: Redesigning the Hospital Room,” Graves will discuss his own experience with a sinus infection that left him paralyzed from the chest down and how undergoing hospitalization and rehabilitation in inadequately designed hospital rooms has inspired his healthcare designs.

Graves talk will focus on design solutions for Stryker Medical, including a collection of hospital patient room furniture that addresses common hospital problems such as infection control, patient falls and clinician back.

“We are thrilled to have such a highly-acclaimed and gifted architect speaking before the healthcare community about ways of improving the hospital setting,” said Harold Michels, senior vice president of the Copper Development Association (CDA), the organization hosting the dinner event with Graves.  “This is a can’t-miss event that will certainly have hospital CEO’s and healthcare advocates talking about way after it’s over.”

Graves has said that spending months in hospitals during his recovery in 2003 opened his eyes to poorly designed patient rooms, and made him realize the patient experience could be improved by design.  He immediately began to sketch ideas for improving hospital buildings, room and furniture.

The event is being presented by CDA’s Antimicrobial Copper team, which is working to advance the message that copper surfaces intrinsically kill disease-causing bacteria.  On display will be a variety of antimicrobial copper products, which can play a pivotal role in healthcare facilities by killing bacteria that cause hospital-acquired infections and by reducing costs.

Laboratory testing has demonstrated that antimicrobial copper surfaces kill more than 99.9% of the following HAI causing bacteria within 2 hours of exposure:  MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7.

Graves is internationally recognized as a healthcare design advocate, and in 2010, the Center for Health Design named Michael Graves one of the Top 25 Most Influential People in Healthcare Design.  Graves regularly gives lectures to major healthcare advocacy groups, including AARP, the Healthcare Design Conference, Medicine X and TED MED.

About Michael Graves & Associates

Michael Graves & Associates has been in the forefront of architecture and design since AIA Gold Medalist Michael Graves founded his practice in 1964. Today, the practice comprises two firms run by eight principals. Michael Graves & Associates (MGA) provides planning, architecture and interior design services, and Michael Graves Design Group (MGDG) specializes in product design, graphics and branding. MGA has designed many master plans and the architecture and interiors of over 350 buildings worldwide, including hotels and resorts, restaurants, retail stores, civic and cultural projects, office buildings, healthcare, residences and a wide variety of academic facilities. MGDG has designed and brought to market over 2,000 products for clients such as JC Penney, Target, Alessi, Stryker and Disney. Graves and the firms have received over 200 awards for design excellence. With a unique, highly integrated multidisciplinary practice, the Michael Graves Companies offer strategic advantages to clients worldwide. For more information, visit www.michaelgraves.com.

About the Copper Development Association

The Copper Development Association Inc. is the market development, engineering and information services arm of the copper industry, chartered to enhance and expand markets for copper and its alloys in North America. Learn more on ourblog. Follow us on Twitter.

Pediatric Cancer Article in EBN

“In the 1950s and 1960s, 4% of children survived with that diagnosis [leukemia].  In 2010, 80% to 85% of children in all risk categories survived and are cured.”  Dr. Beverly Bell, Medical Director of the oncology program at inVentiv Medical Management

This is a quote from the June 1, 2012 article titled Trial and Error in Employee Benefit News.  It’s an important fact as we watch cancer go from a terminal diagnosis and medical event to a chronic disease.  Working with the survivors is something that Dr. Bell and I have discussed several times.

Here are some other facts from the article:

  • 1/3 of childhood cancers are leukemias.
  • 10,400 kids under 15 in the US were diagnosed with leukemia in 2007.
  • About 1,545 of them will die fro the disease.
  • Approximately 75-80% of pediatric cancer patients are put on a clinical trial.

The article goes on to talk about several things to consider:

  • Plan language modifications.
  • Access to pediatric oncology nurses.
  • Access to a oncology network of centers of excellence.
  • General support for the entire family perhaps through an EAP program.
  • Hospice care.
  • Medical travel / tourism.

Creating a holistic strategy to address oncology is a big effort and one that is critical to helping these patients.

Get Ready For The Gamification Of Healthcare

Whenever I bring up “gamification“, most people say “what?”.  But, gamification is gaining some steam based on a recent article from AIS that talked about United, Humana, Aetna, and Kaiser all looking at the topic.  (see Perficient white paper)

The idea is to improve patient engagement and outcomes by using games and the idea of competing, earning rewards, and solving challenges to improve health.  I think this is especially relevant with all the chronic diseases and obesity challenges in kids, but there are gamers of all ages.  Certainly, Wii and other technologies that respond to movement and integrate into social media help enable this.

Keas is certainly one company whose name I’ve heard a few times in this space for healthcare.  But, I think lots of people are talking about this and trying to figure it out.  A simple Google search pulls up lots of discussion on the topic.

With the upcoming Facebook IPO and their success working with Zynga on gaming, it makes me wonder if they’ll make any movement in this space.  They’ve generally stayed out of the healthcare space other than exercise and diet, but with their recent effort around organ donation, one could speculate about what they could do with all the money they’re raising.

Gabe Zichermann, the author of Game-Based Marketing, speaks of balancing the fun and frivolity of gamification with the task of making life easier for cancer patients. He says, “I don’t presume to think that we can make having cancer into a purely fun experience. But, we have data to show that when we give cancer patients gamified experiences to help them manage their drug prescriptions and manage chemotherapy, they improve their emotional state and also their adherence to their protocol.”

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