Archive | Consumerism RSS feed for this section

Fortune Article Questions Generic Equivalency Of Drugs

A new Fortune article “Are Generics Really the Same as Branded Drugs?” (1/14/13) sets a dangerous tone for something that has become a standard across the pharmaceutical industry.  This is either:

(a) giving consumer credibility to a long-standing rumor with a case study or

(b) a dangerous perspective which will only further activate the conspiracy theory consumers and clinicians.

Let’s start with a few basics from the Generic Pharmaceutical Association:

  • There are over 4B prescriptions filled in the US per year.
  • Of those, over 80% are generic medications.
  • Generic medications saved over $190B last year.

For facts on generics, I would point you to the FDA website.  I posted some of their slides years ago on SlideShare which I put below along with their latest infographic.

The article in Fortune focuses on a case regarding an anti-depressant called Wellbutrin and its generic counterpart.  The article goes on to point out that the active ingredients in the generic (compared to the brand) can vary from 80% to 125%.  (I think a good more detailed explanation of this is available here).

But, the author goes on to point out the risks associated with the fillers (or inactive ingredients) and talks about the issue of NTI (Narrow Therapeutic Index) drugs that no one substitutes for anyways.

One big thing that I was always taught was to understand that the difference in active ingredients between brands and generics was similar to the differences in different lots of the same brand drug.  And, given the fact that traditionally, 50% of generic drugs were made by the brand manufacturers, it would seem difficult to believe that they were simply throwing caution to the wind by producing substandard product.

I would hope that Express Scripts, CVS Caremark, Walgreens, PCMA, and many other groups will come out strongly to address this article. This is the type of article that could be a significant setback to the generic industry which has proven itself under lots of scrutiny over the years to save money and have very few negative impacts with the FDA’s scrutiny.


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.


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.

46% Of Physicians Say Transparency Will Increase Costs

trans·par·en·cy [trans-pair-uh n-see]

noun, plural trans·par·en·cies.

1. Also, trans·par·ence. the quality or state of being transparent.

2. something transparent, especially a picture, design, or the like on glass or some translucent substance, made visible by light shining through from behind.

3. Photography .

a. the proportion of the light that is passed through the emulsion on an area of a photographic image.

b. a photographic print on a clear base for viewing by transmitted light.

This is the definition of a term that gets thrown around in healthcare all the time.  I’ve talked about transparency several times this year, and I expect a lot from companies like Change Healthcare in 2013. 

That being said, I found an article in HealthLeaders in November 2012 very interesting.  It referenced a study showing the answer to this question – “how will greater transparency on healthcare costs affect your organization’s cost of care”?  I just assumed the answer would be that it would decrease costs.  The data didn’t support that.

While 56% of health plans thought that transparency would decrease costs…

  • Only 28% of hospitals thought it would decrease costs
  • Only 26% of health systems thought it would decrease costs
  • Only 14% of physicians thought it would decrease costs

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 –

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 –

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.

My starting twitter List:

My Fitbit One Has Arrived – Challengers?

I’m a big believer in the idea of connected devices – Quantified Self movement.  While I’d love to track my data via manual input, that comes and goes.  So, over the summer, I began thinking about a device to use.  There are lots of them out there, but I’lll admit that it was hard to determine which one would be best (see one review):

For me, I decided there were several criteria:

  1. Able to track multiple activities – walking, running, biking, and steps.  (in terms of calories and raw numbers)
  2. Easy mobile and web interfaces with wireless integration.  (Mac and PC)
  3. APIs for connecting into other applications.
  4. Battery life.

I didn’t spend much time looking at the communities associated with each and how they work to motivate you to exercise.  I do think that’s important.

I also like the Striiv game idea where you earn points based on your activities (badges) to unlock more things in a virtual world.  For gamers and others, this plays into the “gamification” trends.


Did I pick right?  We’ll know soon, and I’ll give you an update.  But, I certainly welcome challengers.  (If you want me to try your device and compare it, let me know.)

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)?

Guest Post: Treat Your Health Like Your Finances

I am a big believer that we need to change our approach to how individuals manage their health. After a dinner with a financial planner friend of mine, it got me thinking what if we helped individuals plan for a long healthy life the same way we help them plan their careers or their finances. We have whole industries dedicated to helping people make smarter investment decisions for their retirement and job choices for their careers, but when it comes to our health we are rarely proactive.

According to Morgan Stanley, 90% of Americans think financial planning is important. Why? Three of the top reasons people undertake financial planning include:

  • Making sure your money will last during retirement or rolling over a retirement plan
  • Being prepared for a financial crisis such as a serious illness
  • Caring for aging parents or a disabled child

The common thread through all of these reasons is personal health. Whether concerned directly about illness, both our own and that of our loved ones, or about our ability to enjoy our retirement to its fullest, personal health is a key component of a well-planned retirement.

The reality is life expectancy has increased dramatically. We may live 30 years in retirement. I would argue the quality of that retirement is even more dependent upon our health than our finances. Yet no one hires a “personal health coach” or creates a “personal health plan.”

It is about time we stop neglecting our future health. You can take control of your future health by developing a personal health plan. These simple steps can help you get started:

Step 1: Conduct a Personal Health Audit. Before you can build a plan you need to understand your base-line. You can’t map directions to your destination until you know where you are. When you meet with a financial planner the first thing they want to know is how much money you have saved for retirement. Your personal health plan is the same way. Do you suffer from any chronic illness? What is your height & weight? How much exercise to you get? What are your eating habits? Do you have any family history of disease? What type of pain do you suffer from? How is your mental health your relationship with your spouse and children? Capture everything and identify areas that need attention or improvement.

Step 2: Define Success. What does a healthy future look like? The second question a financial planner will ask you is how much monthly income will you need in retirement to live the lifestyle you want? The same is true for health. When do you plan on retiring? What hobbies do you have that you would like to pursue? Do you plan on having grandchildren? How will bad or good health impact all of these plans? Does your family history require you to focus on preventing cancer or heart disease or Alzheimer’s? The ability to visualize your health in the future both good health and your health if you let yourself go is a strong motivator for change. A point of note: Thinking about health 30 or 40 years into the future can be very abstract; I suggest breaking down your definition of success into annual targets is more manageable and motivating.

Step 3: Know your Personal Health Indicators of PHIs. By this point in the process you should have a sense of what measurements are most critical to your health. Develop a method for capturing your PHIs on a regularly basis. For some like weight you might update your PHI daily, weekly or monthly. For others like a PSA level for men at risk for prostate cancer, you might update it annually. I detail some of the more common PHIs here:

Step 4: Engage your Health Partners. Now that you have completed your audit, defined success and developed your most important PHIs it’s time for you to engage all of the people in your life who help you manage your health. This will include your family, your physician or other healthcare professionals; maybe you have a nutritionist, acupuncturist or other complimentary practitioner that you frequent. Inform them of your personal health plan and get their feedback and buy in. The more people who are on your side the greater the likelihood of success and the more people that know your health, the greater the likelihood you will have a plan that fits you and your goals.

Step 5: Build and implement your Plan. Building the right plan takes an understanding of what you learned in steps 1-4. By way of example, if you have a family history of colon cancer, you need to understand what behaviors help reduce your chances of getting this cancer, what preventative screening you should be getting and when you should be getting them. All of our plans should include a path to maintaining an ideal Body Mass Index that includes some form of daily exercise and nutrition plan, but we are all unique and will have plans specific to our health situations and desired goals. I do think it’s important to understand that no one is perfect 100% of the time, if you deviate from your plan for a day, week or even month, you are only one day from starting again.

Step 6: Review & Measure your progress. You can’t manage what you can’t measure. At some pre-planned interval you should step back and take stock of your progress. Use your annual physical or dental cleaning as a reminder to sit down and review your health plan. Personally I like to review different elements weekly or monthly, but find what works for you and stick with it. Like the stock market, it won’t be a straight line, but as long as the trend continues up over time you will be alright.

No one is responsible for your health but you. We all need to take a proactive approach to our health. Developing a personal health plan is a great way to insure you live a long, healthy and happy life.

About the Author

Bill Paquin is the Chief Executive Officer at Vertical Health, a publisher focused on improving patient care associated with back pain and endocrine disorders such as diabetes. He is a husband, father and writer who is passionate about and supports the creative destruction of our current healthcare system.

Shifting Spend In Pharmaceutical Spending

Pharmaceutical manufacturers are dealing with massive shifts in their industry – less blockbuster drugs, more generics, emergence of different global markets, a greater payor emphasis on outcomes and adherence, less interaction with sales reps, more use of biologics, and the emerging biosimilar opportunity.

All of that is causing a massive shift in where they invest.  In some cases, you’re seeing manufacturers invest in devices (e.g., Sanofi diabetes device) or into education and content at a disease (not drug) level or even in mHealth (e.g., Boehringer and Healthrageous). 

With that in mind, I found this Booz & Company survey interesting in highlighting how their shift in spending is changing.

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).

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

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.

Healthcare Transparency, Out-Of-Network Claims, and Technology Solutions

Another big focus area these days is around the creation of transparency solutions to enable consumers to make better cost decisions about their healthcare.  While several companies have sprung up to work directly with consumers, the large payers have begun to rollout their own solutions.   And, as you can see from the Towers Watson and National Business Group on Health 2012 Survey, this issue of transparency was the 3rd biggest focus area for 2013. 

If you havent’ heard much about the topic, here’s several articles about the challenge of price discrepancies and surprise bills to consumers:

Here’s what UHG and Aetna are doing:

A few of the companies to look at are:

Companies like GoodRx are creating solutions in this area. 

You also might enjoy this infographic from Change Healthcare.


If you don’t believe this is a big issue in terms of price differentials, take a look at this data from the Healthcare Blue Book.  This shows a huge swing in prices which depending on your plan design can directly impact your out-of-pocket spend. 

Test or treatment Low Fair High
Brain MRI $ 504 $ 560 $ 2,520
Chest X-ray 40 44 255
Colonoscopy 800 1,110 3,160
Complete blood count 15 23 105
Hip replacement 19,500 21,148 43,875
Hysterectomy 8,000 8,546 16,480
Knee replacement 17,800 19,791 42,750
Knee arthroscopy 3,000 3,675 7,350
Laminectomy (spine surgery) 8,150 11,744 25,760
Laparoscopic gallbladder removal 5,000 6,459 12,480
Tubal ligation 2,865 3,183 5,729
Transurethral prostate removal 4,000 4,409 8,875
Ultrasound, fetal 120 169 480
Vasectomy 700 1,003 2,100

NY Law On Soda Is Simply A Nudge To Be Healthy

I know we can all complain about the government telling us what to do, but at the end of the day, they’re not saying we can’t drink soda.  As far as I know, you can still have unlimited refills in NY.  They are simply reframing one aspect of drinking soda to try to nudge us into being healthier.  Ultimately, this should be a good thing for us for several reasons.

  1. We eat or drink whatever is put in front of us.  Just look at this research.
  2. Soda and other sugary drinks are generally not good for us.  Just look at the infographic below.
  3. We have an obesity problem in this country (in case you didn’t know it).
  4. Obesity drives diabetes, kidney problems, hypertension, and many other problems that are driving up our healthcare costs and turning us into the first generation to potentially live shorter lives than our parents.
  5. Nudging people into behavior change works.

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.”

Changing Marketing Paradigms

Traditionally, consumer marketing has focused on the “young invincibles” as they are sometimes referred to in healthcare. Those are the 18-34 year olds that traditionally were the DINKs (dual income no kids) and younger population with more disposable income or focused on acquiring goods (as they bought homes and started careers).

Well, I think this quote by Sunil Gupta summarizes the issue:

If [young adults] have no money in their pockets, there is nothing to sell them.

With 46% of those age 18-24 unemployed and 20% of those 25-34 living at home, this group’s financial dynamics are very different. The focus on both those with money and those driving the healthcare costs have shifted to Baby Boomers. (Facts from Time article on page 16 in the 4/9/12 edition.)

At the same time, I read an article about marketing to women which continue to make majority of healthcare decisions both for themselves and their families. (and caregivers (often women) are less likely to be adherent to their own medications.)  Here were the recommended approaches:

  • Offer highly personalized formats
  • Provide complete anonymity
  • Eliminate the middle man
  • Understand self-perceptions
  • Consider the unique point of sale

And, some of these changes are driven by the economy. For example, according to NCH Marketing and Parks Associates, 81% of people are using coupons regularly and they redeemed them for 3.5B in 2011. (Of course, the jury is still out on the Groupon model…)

AHRQ Questions are the Answer campaign

I often talk about the issue of communications in healthcare. That could be patient to patient, healthplan to patient, pharmacist to patient, or physician to patient (or many more).

Understanding health literacy and personal motivation are critical as are so many other factors. With that in mind, I was glad to see this new campaign from AHRQ.

(Here’s the text they sent me about it.)

“When patients become more actively involved in their own health, there’s a much stronger likelihood their health outcomes will be better.

That’s why “Questions are the Answer,” a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), encourages patients to have more effective two-way communication with their doctors and other clinicians.

“Questions are the Answer” features a website — — where you will find these free educational tools to use with your patients:

· A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.
· A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit.
· Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

Clinicians can request a free supply of these materials by calling AHRQ at 1-800-358-9295 or sending an email to”

All of this is good information, BUT:

  • Do physicians have time for this and are they prepared for these dialogues in plain language and with handouts and URLs they recommend?
  • Are patient’s prepared to slow their physicians down and make sure they explain everything?
  • Will this get measured at some point as a qualitative metric and correlated to outcomes?
  • Infographic: Making Patient Experience A Priority

    Here’s another good infographic with some information about readmissions at the top.

    Rock Health Report on Digital Health

    I saw this out on Slideshare, and I thought I would share it here.

    Why People Under 35 Are Stressed

    This is a great list from what Beth Braverman calls “The Beaten Generation” looking at what’s happened since 2005:

    • Their home equity has dropped 51%
    • Their net worth is down 55%.
    • Their student debt is up 19%.
    • Unemployment for college grads is up 64%.
    • Their income is down 4.5%
    • 31% more are living with their parents.
    • The birth rate is down 7.1%.
    • 22% less think they’ll be able to retire by age 65.

    And, we wonder why they’re pessimistic…

    The New Post-Recession Consumer

    I’m always fascinated by segmentation, and I think understanding how market events like the Great Recession have changed the fundamentals of the game is important. In November 2011, Money Magazine shared some data from a survey they did. Here are some of the results.

    • 53% of Americans aren’t sure their kids will better off then they are.
    • 67% are worked their quality of life will suffer in retirement.
    • 80% say they’re eating at home more.
    • 75% say time with family is more important than ever.

    “Big periods of economic upheaval can define a generation. Not so much because of the depth of this recession, but because of its prolonged nature, it will have lasting impact.” Paul Flatters, Managing Director of Trajectory Partnership. (How The Economy Changed You by Dan Kadlec)

    • 85% spend more time looking for deals before they buy. (hence the couponing craze)
    • 57% are building an emergency fund.
    • 51% are pessimistic about the US economy in the next 12 months.
    • 61% are pessimistic about government officials spurring growth.

    I don’t know about you, but I see a ton of nuggets in here about positioning generic drugs, preventative health, adherence, mail order, and many other cost savings actions in healthcare.

    “Twight” (Twitter Fight) Between $ESRX and $WAG

    This is either a massive validation of the perceived value of Twitter or a crazy distraction, but either way, it’s interesting to those of us who study the industry and/or study marketing and communications. 

    As part of the ongoing dispute between Walgreens and Express Scripts, Twitter has become one of the latest tools.  (see June post and September post)  In an effort to sway public opinion and thereby pressure Express Scripts and its clients, Walgreens turned to bloggers and Twitter to push their messaging…but these were in some case paid comments which was surprising.  They already have strong messaging in their IChooseWalgreens website and whitepapers on the Value of Walgreens.  I also thought they were demonstrating some success in converting people to their discount program which was part of their overall growth strategy shared at their shareholders meeting

    After Walgreens (with almost 84,000 followers) created a promoted hashtag of #ILoveWalgreens, Express Scripts (with 1,645 followers) countered back with several Tweets about the dispute (see below).  I guess the question is whether with millions affected and decisions made by the businesses and not consumers…does this forum matter?  But, journalists and analysts follow them so it’s important to keep the messaging up.  (Other articles on this are here, here, and here.)

    Conveniently, I found this infographic on how Twitter is changing healthcare.  At the same time, this is an interesting fight because it’s a blend of B2C and B2B crossing paths.  More to come since I’m sure this fight is long from over.

    Using the Local Pharmacist to Moderate the P2P Discussion

    P2P or Peer-to-Peer healthcare is a common discussion topic these days. Patients want to go online and learn from others with their condition on sites like or The government has been one of the early adopters.

    “The social media sites we have created show that the government can interact in a meaningful way with the public. We don’t just push information out; we strive to make the content relevant so people can act on it, share it with family or friends and ultimately change their behavior.” Amy Burnett, CDC (Tapping Into The Power By Getting Personal, Robin Robinson, PharmaVOICE, May 2011)

    The question is how can traditional companies – pharmaceutical manufacturers, disease management companies, providers, managed care companies, pharmacies, and PBMs – interact in these discussions. On the one hand, they have a broad depth of experience and data to share. On the other hand, they can’t just jump in and drive their agenda. They have to add value to the conversation, demonstrate that they care, and add value.

    Much like the idea that you can purchase things online and return them to the physical store, I think these virtual discussions need to eventually be tied to a physical experience for many patients. One group that I think could play significantly in this is local pharmacists. Imagine that a chain or an association created a social media team. That team could monitor and interact with patients especially in key conditions such as some of the specialty drug areas. As relevant, this could be linked back to a local store where a pharmacist could spend time consulting with the patient. I think this would be a great way to drive the retail specialty business and increase consumer brand awareness.

    “The potential use of social media as a bellwether for identifying trends, informational gaps, support tools, even improved communications between providers, allied health professionals, and others could pave the way for a more collaborative approach to population mapping and patient care.” Michael Parks, Vox Media (Social Media: Paving The Way, Robin Robinson, PharmaVOICE, May 2011)

    The CDC has even created a toolkit for people to use.

    Medicare Patients Save $1.5B on Rxs!!

    Now, here’s a great story.  This may be one of the best government success that I’ve heard about in what I think of as a collaboration of the government with multiple businesses.  (Although I think this is a lot more of what HHS is doing these days under Todd Park’s guidance.)

    According to USA Today this morning, more than 2.65M Medicare recipients have saved an average of $569 per person this year based on addressing the donut hole with a 50% discount on the brand drugs filled during this time.  And, the average premium for 2012 is actually LOWER than the premium in 2011 (by $0.76 per month). 

    The other part of the article is about the potential value of preventative care and leveraging this as part of the Medicare benefit.  The key here is engagement of the participants to help them understand and take action on their healthcare.  The power of the consumer in driving healthcare costs and outcomes is significant which is a topic that I know was discussed by several people today at the mHealth event in DC.

    What’s A PAM Score?

    PAMTM is the Patient Activation Measure which was developed by Dr. Hibbard, Dr. Bill Mahoney, and colleagues. It helps you gauge how much people feel in charge of their healthcare. To find out more, you can go to InsigniaHealth’s website.

    Given the focus on health engagement across the industry these days, I think this is an important tool to consider. It’s been used broadly and has been validated in a lot of published studies. The questions lead people to be assigned to one of four different activation levels.

    You can collect and use the PAM score for segmentation, developing customized messaging, measuring program success, and/or identifying at risk populations.

    A few other interesting points from one of their FAQ documents were:

    • Patients who are more activated are more likely to adopt positive behaviors regardless of plan design.
    • People with higher activation levels are more likely to choose consumer directed plans.
    • People with low activation often feel overwhelmed with the task of taking care of themselves.
    • You increase the level of success in by breaking down change into smaller steps where the consumer has a greater likelihood of success.

    Reprint: Getting Aligned For Consumer Engagement

    (This just appeared in the publication by Frost  & Sullivan and McKesson called “Mastering the Art and Science of Patient Adherence“.  It was written by me so I’m sharing it here also for those of you that don’t get that publication.)

    According to the 15th Annual NBGH/Towers Watson Health Survey, employees’ poor health habits are the number one issue for maintaining affordable benefits. Since studies have shown that 50-to-70 percent of healthcare costs are attributed to consumer choices and adherence is one of those issues, the topic of how to engage consumers isn’t going away.

    The challenge is getting the healthcare industry to use analytics and technology tools when engaging the consumer in a way that works for each individual and builds on their proven success in other industries. Healthcare has an enormous amount of consumer data ranging from demographics to claims and behavior data. Consequently, there is great opportunity to use this data to engage consumers in their health to improve clinical outcomes. While on the one hand, it’s like motivating consumers to buy a good, the reality is that healthcare is both personal and local which complicates the standard segmentation models.

    This is a dynamic time where people are experimenting with different strategies for engagement. For instance, in medication adherence, people are trying everything from teaming those who have chronic conditions with community pharmacists to make sure they are taking their medications correctly to technology that monitors when the pill actually enters your body. But, there are still fundamental gaps in the process which can be addressed using interactive technology to complement the pharmacist interventions.

    Consumer engagement in healthcare is increasingly moving to new channels with 59 percent of adults in the U.S. looking for health information online and 9 percent using mobile health applications according to Pew Research Center. Additionally, there is more and more participation in social media or peer-to-peer healthcare applications. Modes like SMS, which companies are starting to leverage in programs like Text4Baby or the diabetes reminder program recently launched by Aetna, are gaining popularity. Companies like Walgreens have also begun exploring the use of SMS and Quick Response (QR) codes for medication refills.

    At the end of the day, consumers want preference-based marketing where they can elect how to best engage them, but that doesn’t mean that’s the most likely channel to get them to take action.They want you to learn from their past responses to improve your future outreach, but they are also skeptic about how their data is used. You have to put yourself in their shoes to create the optimal consumer experience. You have to deliver the right message to the right consumer at the right time using the right sequence and combination of channels.This is not easy.

    So, if you’re going to optimize your resources and build the best consumer experience, you need an approach which is dynamic and personalizes each experience. For example, we found that creating the right sequence and timing around direct mail and automated calls improved results by as much as 100 percent in a pharmacy program. Or, in another case, at Silverlink Communications, we found that using a male voice in an automated call to Latinos got an 89 percent better engagement rate around colonoscopies. We also know that using a peer pressure message does not work in motivating seniors to take action in both a retail-to-mail program and a cancer screening program, but does work for those younger than 55-years-old?

    You have to make simple messaging relevant to them—why should I get a vaccination, why is medication adherence important, how can you address my barriers? Only an ongoing test and learn approach to consumer insights will suffice, and those that figure this out will become critical in the ongoing fight for mindshare and trust. But, this isn’t a stand-alone opportunity. We have to partner with providers to improve engagement, adherence, and ultimately outcomes in different forms. We have to offer them a platform for engagement that is built upon consumer insights and provides a unique consumer experience to them based on their disease, their demographic attributes, and their plan design. All of these factor into their behavior and are important in “nudging” them towards healthcare engagement and ultimately, better health.

    “Code Lavender” – Focusing On The Patient Experience

    If you don’t know it yet, the consumer “experience” is rapidly becoming the hot topic. I’ve talked about it a lot beginning with companies like Cigna that have hired and staffed a consumer experience team and Chief Experience Officer. But, as the WSJ pointed out earlier this week in their article “A Financial Incentive For A Better Bedside Manner“, this is getting quantified in the provider world. One might argue that experience has always mattered more in the provider world since it’s easier to switch hospitals or physicians than insurance companies, but that is likely to continue to change as the individual insurance world and Medicare continue to create competition for the individual.

    For payers, you can already see this individual market playing out with the growth of retail stores which is where the experience begins. In other cases, the PBMs and payers have to rely on many cases on their call centers as the front-end of the consumer experience. Additionally, with pharmacy being the most used benefit, this is another critical area. And, we know that pharmacy satisfaction is highly correlated with overall payer satisfaction.

    But, let me pull a few things that caught my attention in the WSJ article:

    • CMS will begin withholding 1% of their payments and tying payment to quality standards for medical care AND patient satisfaction surveys known as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Services). This will go up to 2% in 2017.
    • The survey is a 27-question survey sent to a random sample of discharged patients (about 25% of the 36M patients admitted in 2010 with a pretty low response rate of 7%). It asks about cleanliness, quiet, communications, and an overall satisfaction based on something similar to the Net Promoter Score (i.e., would you recommend the hospital to friends and family).
    • 67% of patients give their hospitals the top two ratings on a scale of 1-10 (which I actually think is pretty good).
    • Only 60% say that doctors and nurses always communicated well about medications (which was higher than I expected).

    Cleveland Clinic Chief Executive Delos “Toby” Cosgrove, a heart surgeon by training, says he had an epiphany several years ago at a Harvard Business School seminar, where a young woman raised her hand and told him that despite the clinic’s stellar medical reputation, her grandfather had chosen to go elsewhere for surgery because “we heard you don’t have empathy.”

    • The Cleveland Clinic calls their program HEART—for hear the concern, empathize, apologize, respond and thank. They also use the term “Code Lavender” for patients or family members who need immediate comfort.

    I look forward to watching how this transforms over time. I know I’ve seen this play out in the dentist’s offices for my kids. The waiting rooms have video games and other things to keep them and their siblings busy, but I do agree with the article that this may unfairly bias the wealthier hospitals.

    Sustained Patient Engagement Around Hypertension: Silverlink and Aetna

    At Silverlink, we had a great opportunity to work with one of our clients and publicize it. This morning, Aetna released a joint press release with us about our hypertension program.

    As companies continue to look at new ways to use technology to engage patients around chronic diseases, solutions like this offer companies a unique way to blend multiple channels into an overall consumer experience that improves engagement and outcomes.

    From the press release:

    The program also achieved high levels of engagement, with nearly 60 percent of participants continuing to actively monitor their blood pressure by using a free blood pressure monitor and submitting readings on a monthly basis. The frequency of participants’ cholesterol (low-density lipoprotein (LDL) cholesterol) screening also improved 5 percent.

    “By helping our Medicare members manage their high blood pressure, we are hoping to help prevent heart disease, strokes and even deaths,” says Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Our nurse case managers work closely with our members and do a tremendous job providing them with the information, tools and support they need to help them control and improve various chronic conditions, including hypertension. The results of our program with Silverlink demonstrate that an automated program can further support and engage members in managing their own health conditions.”

    Retail Pharmacy Mobile Applications

    I’ve talked before about some of the mobile PBM efforts, but what about the retail pharmacies. You should expect that the chains will have different mobile strategies than the grocery stores or the big box retailers. And, it will be interesting to see how the independents might collaborate on a shared platform.

    Here’s a few things already out there:
    Walmart new shopping application and Walmart’s page on mobile
    CVS retail application
    Walgreens has a mobile pharmacy app
    Target also has a mobile pharmacy application

    So what should or could pharmacies offer consumers in terms of mobile applications:
    – A refill application is a minimum
    – Education or drug information is another basic
    – There are certainly some geographic options such as a store locator or clinic locator
    – There are options for location based check-in using Foursquare
    – Scheduling MTM consultations or vaccinations are a reasonable option
    – What about promoting saving thru 90-day retail or generics?
    – As retail pharmacies are in the specialty business, there could be opportunities to promote this channel and offer support.
    – Telemonitoring is another option (e.g., FaceTime)
    – Use of QR code is another part as is augmenting the shopping experience with augmented reality
    – Of course, couponing will be part of the solution, but what I’d like is someone who would download my shopping receipts (from multiple companies) and provide me with relevant savings.
    – Should it include Rx coupons? Unlike the PBMs, retailers want traffic and if coupons increase adherence then why not.
    – There are other options like photos and integration with social networks and tools.

    I think one of the key “killer apps” is secure rules based messaging. Imagine using data to identify when you need a vaccination or identifying a potential drug-food issue or having age based triggers. These could be sent directly to the consumer in a secure environment. Of course, we’re only at about 10% adoption and the key question is whether these are the key consumer that everyone wants to attract. Are they the high utilizers? Do they buy other goods?

    More to come here. This is a rapidly evolving space.

    CMS Quote On Customer Experience

    I really liked this AIS Quote of the Day and thought I would share it.  It makes the point that we should strive to create a world-class experience not simply be good for our market niche.

    “Our goal [with exchanges] is not to say, ‘It’s better than it was before.’ Our goal is not to say, ‘It’s pretty good for government work.’ Our goal is not to say, ‘It’s pretty good for Medicaid.’ We set a goal for ourselves that we really wanted a 21st Century customer experience…an experience that people feel good about.”— Penny Thompson, deputy director for the CMS Center for Medicaid, CHIP and Survey and Certifications, speaking at a recent AHIP meeting, “Preparing for Exchanges.”

    Lots Of Consumers Looking For Generic Lipitor

    Assuming my blog volume is any indicator, it seems like consumers are increasingly looking for information on generic Lipitor.  My blog volume doubled last week.

    If you type “Lipitor going generic” into Google, I’m the first page returned (after paid search).  [I always love finding these Search Engine Optimization (SEO) results.]

    Will The Stars Align To Drive Adherence?

    We all know that adherence to prescriptions is a problem.  People don’t start on their medications.  People don’t stay on their medications.  But, another problem also exists which is finding the ROI on adherence.  While the ROI is clear to the manufacturer or even to the pharmacy, it’s often less clear to the payer.

    This is not true in every category.  Diabetes and several other conditions have been shown to have an ROI associated with intervention programs that improve adherence.  But what about all the others.

    In the short-term, I expect you’ll see the CMS Star Ratings and bonus payments drive behavior in three critical categories that are now measured in the 2012 for MAPD and PDP plans.  (see technical notes on 2012 measures)

    If you’re not familiar with the Star Ratings system, you should read this.  In 2012, there were three new adherence measures added.  Not only are they now part of the evaluation process, but they were weighted more heavily than some of the operational measures.  A  good indication of focus on quality of care.

    Getting more Stars is important since it is linked to bonus dollars that the plans can get.  And, there aren’t many Five Star Plans.  Only 9 plans received 5-Star Ratings for 2012 (see article).  [Interestingly, I think one of the unique assets that Express Scripts is buying in the proposed Medco acquisition is one of the 4 Five-Star PDP plans.]

    “The Medicare star quality rating system encourages health plans to improve care and service, leading to better patient experiences across the board,” Jed Weissberg, a senior vice president at Kaiser Permanente.  (from 5-star article above)

    The adherence measures focus on diabetes, high cholesterol, and hypertension and use Proportion of Days Covered (PDC) rather than MPR for their measurement.  Certainly, one of the things we’re seeing at Silverlink with our Star Power program is that many of these Star Measures can be influenced by communications.  Adherence is certainly one of those big areas of opportunity for plans to focus on.

    While the benefit is obvious to the plan in terms of reimbursement, the big question is whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications.  A Kaiser study that was done seems to indicate that the answer is no.

    Conducted by Harris Interactive, the survey showed that only 18 percent of Medicare-eligible seniors said that they are familiar with the government’s rating system. Of those that are familiar, less than one-third have used the system to select their health plan. Moreover, only 2 percent of respondents were aware of how their current plans rates. 

    Since we’re in open enrollment for Medicare right now (see to evaluate options), perhaps we’ll get some data in early 2012.  2012 will also be the first year for the 5-Star plans to be able to market all year round and not be limited to the OEP (open enrollment period).

    But, one of the things I found interesting as I looked on the site to “select” a plan in my area is that there is an option to “Select Plan Ratings” but even I wasn’t sure what that was.  It’s not intuitive to the consumer that this is a quality rating for them to pay attention to.  And, it appears that the default order of options which is presented to you is based on price.

    %d bloggers like this: