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Trust As The Foundation For Healthcare Communications

March 31, 2011 by George Van Antwerp 3 Comments

Trust improves medical outcomes. It is the number one predictor of loyalty to a physician’s practice. Patients who trust their doctors are more likely to follow treatment protocols and are more likely to succeed in their efforts to change behavior. (Introduction of The Trust Prescription)

I just finished reading The Trust Prescription For Healthcare by David Shore. I would recommend it. It definitely framed things in a differently light. I also had a chance to talk with David on the phone and pick his brain a little. He sounds like a great speaker, and I’m looking forward to his new book coming out around building trust as an intermediary (i.e., managed care company or PBM).

A few of my highlights from the book are:

  • Trust can be a differentiator.
  • Trust is good business.
  • The physician to patient relationship is where the baseline of trust exists today. Although he brings up the question of whether that trust erode as you get more and more time pressure.  [I don’t remember the book specifically addressing the pharmacist – patient trust relationship although one would assume it is a similar foundational element.]
  • Trust is critical in healthcare because you’re asking a vulnerable patient to believe you can help them.
  • Profits may be negatively correlated with trust in healthcare (but not in other industries).
  • He pointed out the fact that it’s ironic that while pharmaceutical companies do so much good they get such a bad rap.
  • It was the first time I had seen someone introduce the issue of how healthcare entities are portrayed in TV shows and how while this is generally neutral that managed care organizations in the early 2000’s were portrayed negatively (and probably still are).
  • He talks about the concept of “response shift” which I think it an important phenomenon about how our expectations change over time and the effect of expectations on trust.
  • He talks about how two things happen when trust erodes – government intervention and consumer activism. [Hey…that’s where we are today!]
  • He uses two examples many times which are very relevant:
    • Volvo is known for safety not specifically for making cars. They make sure this is consistent in their branding (e.g., not funding NASCAR races). It gets to the core of defining who you are. [This concept also made me think about the new Dawn campaign about saving wildlife.]
    • You can build trust equity like Johnson & Johnson did which helps you when you have issues. [The question is how long they can draw on this given their current issues.]
  • He holds out a few healthcare power brands but says there are very few – Mayo Clinic, Cleveland Clinic, BCBS, Kaiser, Massachusetts General.
  • He talked about the concept of a Brand Architecture which made me think about some of the recent rebranding efforts at United Healthcare.
  • He talks about how consumer understanding and communications are key to building trust.

Communication in healthcare typically runs into a series of obstacles related to listening, clarity, and confidence.

Some of the interesting research data was [noting that this was a book from 2005]:

  • 56% of consumers say they will pursue something simply because it was made by a company they trust. (Macrae and Uncles 1997)
  • About half of people agree that “doctors are not as thorough as they should be” and “doctors always treat patients with respect”. (National Opinion Research Center 1998)
  • Race was a highly significant variable in trust correlation even when researchers controlled for other variables. (Corbie-Smith, Thomas, and St. George 2002)
  • Patients are more likely to take a drug that they have requested than a drug with which they are unfamiliar. (Handlin et al 2003)

It book made me think of some interesting questions:

  • Does transparency build trust with consumers?
  • Does concierge medicine build trust overall?
  • Does the use of technology by physicians enable or erode trust? [I believe he said that a lot of physicians didn’t think so.]
  • Do non-profit systems have more consumer trust?
  • What does all the news about drug problems, medical errors, and other issues do to the overall trust of the system?
  • What are the trust queues for consumers by type of healthcare entity? (For example, a dirty bathroom at a hospital might make you worried. What’s true for insurers, PBMs, pharmacies, etc.?)

One key point to pull out that he makes is that

Without branding, healthcare becomes a retail industry, and in retail, as in residential real estate, the three most important factors are location, location, and location.

Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

You Need An Experience Architect

March 29, 2011 by George Van Antwerp 0 Comments

I’m often asked how my 6 years of architecture school plays into what I do right now.  I have a variety of things that I believe I learned in architecture that help me, but it wasn’t until the other day that it really clicked.  I was reading an interview about a CEO who had been trained as an architect.  She described architecture as building experiences.

All of sudden it hit me…that’s what I do.  I help companies look at an objective and architect the consumer experience to get to that objective.  And, it’s a lot of fun!

So, what are the parallels between healthcare communications and physical architecture?

  • There is no one answer.
  • You have to listen.
  • There is lots of data.
  • You have to use lots of materials. (print, e-mail, web, automated call versus concrete, glass, steel)
  • Each person’s experience is different.
  • Compliance matters. (building codes versus CMS)

Now, unfortunately, I can’t coin the term “experience architect”.  It’s been used by others.  For example, Tom Kelley from IDEO used it as one of his Ten Faces of Innovation.  He says an experience architect is one who:

Is that person relentlessly focused on creating remarkable individual experiences. This person facilitates positive encounters with your organization through products, services, digital interactions, spaces, or events. Whether an architect or a sushi chef, the Experience Architect maps out how to turn something ordinary into something distinctive—even delightful—every chance they get.

Fast Company talks about the Experience Architect in an article from 2005.  More commonly you’ll find articles or references to user experience architect. 

The point is that you need to think about things in this light, and I think the architectural paradigm is helpful in how you construct and embrace the creation of an experience for the consumer whether it’s around shopping, adherence, or managing diabetes.

Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, Methodology, Silverlink

Using the “Placebo Effect” in New to Therapy Situations

March 26, 2011 by George Van Antwerp 0 Comments

I was reading a book about trust which pointed out the concept of “remembered wellness“.  This concept is similar to the “placebo effect” in that it shows that patients who trust their physicians and their course of therapy are more likely to have better outcomes (e.g., HIV study).  WOW!!

I’ve talked before about the gap that exists when patients leave their physician’s office with a new diagnosis and we all know that health literacy is a big issue.

So…what are you doing to address this?  I’ve been talking a lot lately about “primary adherence” (i.e., getting people to start therapy) and about engaging patients when they first get a new prescription or a new diagnosis.  This concept of trust only makes this a more pressing issue.

Here’s your worse case scenario:

  • Patient is newly diagnosed with a chronic condition and given a new prescription.
  • They don’t have a great relationship with the physician and/or have limited understanding of the condition (due to literacy, fear, or other issues).
  • They fill the prescription once and stop taking the medication after a few days.

How can you step in here?

  • You can trigger an outreach based on diagnosis code.
  • You can assess their understanding of the condition and help them learn more by addressing their barriers.
  • You can engage them when they fill their first script.
  • You can follow-up with them after the first few days to make sure they stay on therapy.
  • You can enroll them in an adherence program.
  • You can enroll them in a condition management program.

But, the point here is that you need to be doing something that reinforces the decision to manage the therapy and help them to understand and believe in that course of treatment.  If they don’t believe and have trust, they are less likely to get to a successful outcome.

Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Value Propositions

How To Select What Pharmacies Are In Your Network?

March 24, 2011 by George Van Antwerp 1 Comment

This seems to be the “meta-question” that everyone is talking around. 

  • Should every pharmacy be in the network?
  • Should mail be allowed?  Should I do mandatory mail?
  • How do I design a limited network?  Is it ok?
  • What about any willing provider?  [should that just be about cost]

Let’s start with the basics…You want a network that meets access standards, has high quality, improves outcomes, keeps members happy, and offers you the best price.

So, how do you build your network to decide who is in or out (ideally)?

  1. Select the minimum number of local pharmacies required to meet access standards for acute medications (this is your baseline)
  2. Look at your best price to add more pharmacies into the network – who will meet your price for generics, brands, 90-day, specialty
  3. Evaluate your tradeoffs – will you get a lower price if you exclude certain pharmacies?  will that impact access?  will that impact care?  will that impact satisfaction?  can you manage the disruption?
  4. Look at difference in satisfaction between pharmacies – should you take a lower priced pharmacy if the satisfaction is less?
  5. Look at difference in outcomes between pharmacies – should you take a pharmacy that has a lower generic fill rate (on an adjusted population) or a lower adherence rate (on an adjusted population) at the same price? 

Network design should look like formulary design.  You have to look at the value versus the cost.  You might include a higher priced pharmacy in the network if it gives you access, better outcomes, or lower net cost (i.e., better GFR).  You might exclude a lower priced pharmacy if it can’t prove any of this or if consumers who go there are dissatisfied. 

At some point, I would think we’ll see more metrics beyond price be used to measure pharmacies – discounts, GFR, safety (quality), medication possession ratio, satisfaction.  That would make this a lot easier with some standards. 

This would make it easier to have discussions about access in NY (for example) as PCMA is doing.  It would make it easier to have discussions about the Department of Defense (for example) as NACDS and NCPA are doing. 

The DoD is a good example here…Since the military (government) buys drugs better than anyone, I can’t imagine how much better some of these metrics would have to be to justify paying the additional costs at retail for fulfillment.  The base pharmacies and the mail order pharmacy all get their drugs from the government contracts.  At mail, the supply is managed separately so that they are replenished under those contracts.  I bet the cost is $10+ on average more for a drug at retail (non-replenishment) than it is elsewhere.  How do you justify that?  In my mind, retail should figure out how to replenish and segregate their inventory to stay in the network rather than fighting the shift away to mail.

Books / Articles, Consumerism, Healthcare, Managed Care, Methodology, PBM / Pharmacy, Value Propositions

Who’s Your HOL For Improving Engagement

March 22, 2011 by George Van Antwerp 0 Comments

Following up on my post earlier today, I went to an article in PharmaVOICE from January 2011  called Engaging the Empowered Patient by Carolyn Gretton.  It has lots of interesting statistics and quotes.  Here’s a few:

These consumers have done at least one of the following based on finding information online:

  • Challenged their doctor’s treatment or diagnosis
  • Asked their doctor to change their treatment
  • Discussed information found online at a doctor’s appointment
  • Used the Internet instead of going to the doctor
  • Made a healthcare decision because of online information

I’ll have to drill into the report because I’d love to know how many have done the first two things, what the physician response was, and (ideally) if it impacted their outcome in any way.

40% of online consumers engage with social media on health sites either by reading or posting content, though frequency of engagement varies widely.  (based on a survey from Epsilon and eRewards)

That last part is where the issue is (IMHO).  Consumers do use lots of these tools BUT sustaining their interest and engagement over time is difficult.

The Epsilon report – A Prescription For Customer Engagement: An Inside Look at Social Media and the Pharmaceutical Industry – pointed out that consumers use healthcare social media for:

  • Support
  • Sense of intimacy with others with a similar experience
  • Foundational information about their condition and symptoms
  • Information about drugs and supplements
  • Health news

Many of the individuals who are highly engaged in social media feel better equipped to manage their health.  (Mark Miller, SVP, Epsilon)

I was really surprised that the Epsilon study said that consumers viewed product sites to be as important as healthcare provider interactions.  I could argue both sides here.  Obviously, the product site is going to have some bias.  On the other hand, given the complexity of treatments and therapies these days, it has to be close to impossible for the provider to stay up on all the latest information. 

Not surprisingly, the author of the article talks about people having mixed feelings about the product managers participating in a social media site.  BUT, I think everyone would agree that with proper disclosure and the right person, this can work very well. 

The article introduces a new term (for me) here – HOLS or Health Opinion Leaders.  It talks about them becoming active parts of the pharma brand team.  That sounds like an interesting role. 

It was also interesting that they talked a lot about gaming as an engagement mechanism.  It’s not something I’ve spent as much time with, but it keeps coming up (even more than incentives).  They talk about several examples:

They also bring up an older game as a cautionary tale – Viva Cruiser – which riled critics for trivializing ED. 

At the end of the day, it’s the same old challenge – how to get the consumer to act and stay engaged?

Books / Articles, Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Social Media

Hillary and Abe Talk Healthcare Communications

March 20, 2011 by George Van Antwerp 1 Comment

I’ve wanted to try this Xtranormal technology for a while.  It was pretty simple.  I’m interested in your feedback on whether this is an interesting delivery mechanism, annoying, or fun (see anonymous survey).  Here’s the video.  [BTW – If you get this in e-mail, you might have to come to the web to view this.]

Consumerism, Healthcare, Marketing / Communications

Rules Based Communications

March 16, 2011 by George Van Antwerp 1 Comment

After working with data warehouses, configuration engines, and workflow management systems, I’m a big believer in embedding rules into a process. Communications is no different.

Let’s look at a few rules:

  • Don’t communicate with someone more than X times per week.
  • Don’t call these people.
  • Use Spanish for people with that language preference.
  • Send a text message to people who have provided their mobile number and opted in to the program.
  • When applicable, use a preferred method of communication for reaching out to someone.
  • If a caregiver is identified and permission is on file, send the caregiver a copy of all communications to the patient.
  • Call the patient if the amount being billed for their prescription is greater than $75.
  • For patients between these ages, use the following messaging.
  • If the patient hasn’t opened the e-mail after 48 hours, then call them.
  • For clinical information, use this channel of communications.
  • For John Smith, only call them on Tuesdays between 5-6 pm ET.
  • For Medicare recipients, use this font in all letters.
  • For Hispanic consumers, use this particular voice in all call programs.
  • If the patient doesn’t respond after two attempts, send a fax to their physician.
  • For patients with an e-mail on file, send them an e-mail after you leave them a voicemail.
  • For patients who are supported by Nurse Smith, only call them when she is on duty and use her name in the caller ID.

I could go on. But, the point is that communications, like healthcare, is a personalized experience. We have to use data to become smarter (historical behavior, segmentation, preferences). We have to use customization to create the right experience. AND, probably the most difficult thing for lots of companies, we have to coordinate communications across modes (i.e., e-mail, direct mail, SMS, automated call, call center, web).

Ultimately, I believe consumers will get to a point where they can help set these rules themselves to create a personalized profile for what they want to know, how they want it delivered, and ultimately provide some perspective on how to frame information to best capture their attention.

To learn more, you should reach out to us at Silverlink Communications.

Business Tools, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Silverlink, Technology, Value Propositions

The Rider, the Elephant, and the Path

March 10, 2011 by George Van Antwerp 0 Comments

If you haven’t read the books by Chip and Dan Health (Switch and Made to Stick), you should.  I was reading a story they had in the Experience Life magazine by Lifetime Fitness the other day.  I pulled out a few things here to share:

“For anything to change, someone has to start acting differently.”

Such a simple phrase, but it’s the key of most marketing programs.  I was talking to a friend the other day, and he asked why do people bother sending marketing pieces.  In today’s world, people know all their options so if they want to change they will.  For some people, that might be true (at least on a finite list of things that matter). 

In this article, the Health brothers talk about Jonathan Haidt’s book The Happiness Hypothesis where he argues that our emotional side is an elephant and the rational side is its rider.  We have to find the balance between the two. 

It’s interesting that they talk about the rider as wearing out easily pointing out that exerting self-control and focusing on the next thing to do can leave you worn out.  You need to create a path that makes it easier to be successful.  This is relevant around adherence.  This is relevant for addressing obesity. 

All of these articles and books on behavioral economics have fascinating studies in them.  In one story they talk about a group of maids which were split into two groups.  One group was told that all the work they did cleaning was great exercise.  The other group went upon their job as normal.  Four weeks later, the group that thought they were exercising had lost an average of 1.8 pounds compared to the other group.

Or they talk about the book Mindless Eating which shows that “people eat more when you give them a bigger container.  Period.”

They then introduce 3 surprises which can be helpful in framing messages:

  1. What looks like resistance is often lack of clarity.  Don’t say eat healthier.  Say eat more dark leafy greens.
  2. What looks like laziness is often exhaustion.  Change is hard…acknowledge it.
  3. What looks like a people problem is often a situational problem.  Make sure to think about their environment and support system. 
Books / Articles, Consumerism, Healthcare, Marketing / Communications, Research

Physicians Want A Long-Term Patient Relationship

March 7, 2011 by George Van Antwerp 1 Comment

In a recent survey by Consumer Reports, 76% of physicians say that a longer-term relationship with their patients would be very helpful.

Is that feasible in today’s environment with consumers more likely to move cities and states?

Assuming it is, this would seem to make EMRs more important especially as they could act as a CRM system for the physician. The average physician probably supports about 2,000 active patients (“physician panel“). It would be difficult for them to remember and personalize their experiences without some mechanism for capturing notes about the patient. Certainly this can and has been done on paper for years, but technology would make this much more efficient.

“A primary-care doctor should be your partner in overall health, not just someone you go to for minor problems or a referral to specialty care,” said Kevin Grumbach, M.D., professor and chair of the department of family and community medicine at the University of California at San Francisco.

The article says that there is research that supports the fact that patients who stick with one physician over time have less healthcare issues and lower healthcare costs. I would assume that it therefore holds that patients who like their physician begin to trust their physician and therefore stay with their physician longer.

Physicians said that respect was the second thing that could help patients get better care. Does that mean that disrespect causes you to get worse care or simply that you’re less likely to engage the physician in a dialogue and understand their recommendation?

There were lots of surprises to me in the data:

  • 33% of patients track their changes and activity between visits. I’m guessing those are the chronically ill patients with complex diseases not the average patient.
  • 80% of MDs thought that patients would be better off with a family member or friend joining them for the visit…but only 28% of patients have someone with them.
  • Only 8% of MDs thought that online research was very helpful with the majority of them thinking it provided little to no value.
  • 9% of patients had e-mailed their physician in the past year.
  • ¼ of patients indicated some level of discomfort with their physician’s willingness to prescribe medications.
Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, Research, Value Propositions

Intel Health Video On Using Smartphones and Facebook For Health

March 4, 2011 by George Van Antwerp 1 Comment

(Note: Videos and slides may not appear in your e-mail summary. You may have to visit the website to see them.)

Consumerism, Healthcare, Leadership, Marketing / Communications, Research, Social Media, Technology

You Have Cancer…Blah Blah Blah

March 3, 2011 by George Van Antwerp 0 Comments

After you get diagnosed with a serious disease like cancer or even a chronic condition like diabetes, do you remember anything the physician says?  Someone once told me that patients remember something like 12% of what the physician says after that (I couldn’t find the source).  Another person shared with me that their physician told them to go home and call them later to talk about all their questions. 

This is the extreme example, but a situation that repeats itself day after day.  Patients learn that they have a disease.  In some cases, they’ve been searching for an answer to their symptoms for a while, and there is a sense of relief followed by anxiety.  In other cases, they had a minor problem which leads to identification of a much more serious issue. 

I talk about this because in some cases we start this patient on a course of therapy that they don’t understand or a drug which has side-effects they didn’t expect.  Health literacy is a big enough issue, but not understanding the receptiveness of the patient based on environmental issues such as shock is a big deal. 

We (as a healthcare system) have to continue to help close this gap to educate consumers and leverage the broader care team including physician, pharmacist, and caregivers to help patients understand their condition and the next steps they need to take.  Trisha Torrey does a good job of laying out a series of steps for you to take beginning with acknowledging your fear.

Books / Articles, Consumerism, Healthcare, Marketing / Communications

Book Review: Drive by Daniel Pink

March 2, 2011 by George Van Antwerp 0 Comments

I just finished the book Drive by Daniel Pink. It’s a great book. I’d recommend it from both a personal and professional perspective because it challenges so much of what we normally think. But, it’s both logical and based on tons of research.

He lays out three reasons why people act:

  1. Food, water, or sexual gratification (Motivation 1.0)
  2. Rewards and punishment (Motivation 2.0)
  3. Intrinsic reward (Motivation 3.0)

The concept of intrinsic reward was new to people. The concept of having this drive challenges all which we believe around incentives. And, his examples reinforce this point. People performed worse on certain tasks when a clear reward was identified.

“When money is used as an external reward for some activity, the subjects lose intrinsic interest for the activity.” Edward Deci

He uses open source collaboration as a great example of this. His example is whether you would have expected Encarta , an encyclopedia by Microsoft, or Wikipedia to succeed. Why wouldn’t a big company with unlimited resources beat out a collection of volunteers?

Business today is based on the whole concept of Motivation 2.0 (i.e., carrots and sticks). He talks about the historical presumption that absent some reward or punishment that people are inert.

“Enjoyment-based intrinsic motivation, namely how creative a person feels when working on the project, is the strongest and most pervasive driver” Lakhani and Wolf

He goes on to explain the difference between algorithmic and heuristic problems. Algorithmic problems can be solved based on a single path while heuristic problems have different options. [It’s like when I went to business school and architecture school.]  He quotes a McKinsey study which says that 70% of job growth in the US is around heuristic work. Therefore, applying a traditional model of motivation to creative work creates a major issue. It turns creative work which we feel passionate about into a disutility (something we won’t do without payment).

Now of course, creative “work” isn’t “play” if the basics aren’t addressed – i.e., fair pay. This has application in lots of areas including how we get kids to learn. Paying kids for specific activities pushes them to focus on completing those but not necessarily learning how to apply the knowledge. I think it’s a key issue which should be getting debated in when, if, or how to use incentives in health care. This is why you may see a short-term improvement that falls off over time.

This will be very relevant as P4P becomes more important. If rewards narrow the focus of solutions and limit creativity, will that be good in that it focuses people on specific processes? Or will it be a problem because in complex cases or cases where there are alternatives, the creativity of solutions and consideration of options will be limited?

But, he’s careful to make sure you don’t think that rewards are always bad. They have to be used appropriately and for the right tasks.

“If we watch how people’s brains respond, promising them monetary rewards and giving them cocaine, nicotine, or amphetamines look disturbingly similar.” Brian Knutson

He lays out “The Seven Deadly Flaws” of using carrots and sticks:

  1. They can extinguish intrinsic motivation.
  2. They can diminish performance.
  3. They can crush creativity.
  4. They can crowd out good behavior.
  5. They can encourage cheating, shortcuts, and unethical behavior.
  6. They can become addictive.
  7. They can foster short-term thinking.

He suggests that for tasks that don’t inspire passion nor requires deep thinking that there are three things that are important:

  1. Offer a rationale for why the task is necessary.
  2. Acknowledge that the task is boring.
  3. Allow people to complete the task their own way.

He talks about how using bonuses can work even for creative tasks when it’s not an “if-then” reward, but it’s a “surprise”. (Which is hard to repeat multiple times.)

He goes on to talk about Type A personalities. Theory X and Theory Y. Type I and Type X. It makes some key points about how we perceive people. Do we believe in the “mediocrity of the masses” or do we believe in people’s interest in succeeding? This is where Motivation 3.0 begins to come in and there is a focus on people’s desire to success or to master something.

He makes a lot of points that remind me of Malcolm Gladwell’s book Outliers.  Mastery is hard work.

“The most successful people, the evidence shows, often aren’t directly pursuing conventional notions of success. They’re working hard and persisting through difficulties because of their internal desire to control their lives, learn about their world, and accomplish something that endures.” (pg. 79)

He talks about how these frameworks can be applied at an organizational level and cites a Cornell University study of 320 small businesses. Those that offered autonomy grew at four times the rate of control-oriented firms and had one-third the turnover. He talks about ROWE (Results Oriented Work Environment) and gives examples of companies that really give their employees freedom. It’s a radical change for many people…imagine a work environment where you set your own hours.

He introduces the concept of “flow” from work by Csikszentmihalyi which was new to me. It describes this state where people are challenged but have an opportunity to stretch to get there.

He talks about mastery as a mindset and how what people believe shapes what people achieve. This belief is critical especially in addressing things like obesity (my opinion) and plays into a lot of what you see on The Biggest Loser. Losing weight (mastering being in shape) is a lot of work, and you have to believe you can do it. You also have have to have some motivation other than financial goals.

There is an interesting discussion of “entity theory” versus “incremental theory” which talks about whether you believe you have a finite intelligence or an opportunity to expand your intelligence. There is lots of talk about education in the book which I think is really important. Are we creating kids that want to “prove their smart” by getting A’s or who are really trying to learn?

“West Point grit researchers found that grittiness – rather than IQ or standardized test scores – is the most accurate predictor of college grades.”

He has a whole chapter on purpose. I think this is key to healthcare. He talks about autonomy and mastery, but without purpose, we don’t have balance. Think about someone who is obese. They want to be autonomous and master being in shape, but when you listen to them talk, it is typically a focus on being there for their family that motivates them to actually take action.

He made me wonder about linking health outcomes to lower costs (i.e., value based). If I know that my healthcare premiums go down if I manage my BMI or cholesterol or get certain tests done, am I just checking a box or am I really changing my lifestyle in a sustainable way?

Books / Articles, Consumerism, General Business, Healthcare, Leadership, Research, Value Propositions

Medical Data From Thomas Goetz

January 26, 2011 by George Van Antwerp 0 Comments

Here is a video of Thomas Goetz (Wired magazine) from TEDMED…

He talks about redesigning medical data and how to present it for people to understand.

He talks about a key notion of helping people see their way to better health.

He talks about the feedback loop of Personalized Data – Relevance – Choices – Options.

He talks about how Captain Crunch can inspire information delivery for prescription drugs.

And, then he shared the Wired article on redesigning information.

Books / Articles, Consumerism, General Thoughts, Healthcare, Innovation, Marketing / Communications, Research, Technology, Value Propositions

Wireless Healthcare Quote

January 24, 2011 by George Van Antwerp 0 Comments

This is from a Qualcomm marketing piece so take it in context, but I thought it was a good quote by Dr. Paul Jacobs (Chairman and CEO):

Consumers have already adopted a wireless lifestyle and the phone in their pocket is not just for voice communications anymore – it’s also becoming the most personal device for information access.  Since the mobile phone is always on and always with you, it is the most logical platform for monitoring and maintaining personal health.  And new types of mobile devices and services have tremendous potential to improve productivity for medical professionals and help consumers manage their own health.  Mobile technology has the potential to improve public health overall and ultimately to make health care more accessible and affordable for all of us. 

Consumerism, Healthcare, Marketing / Communications, Technology

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

January 17, 2011 by George Van Antwerp 4 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blogroll, Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research

Pharmacy Customer Experience

January 10, 2011 by George Van Antwerp 0 Comments

When most people start to this about segmentation in the pharmacy space, it becomes quickly overwhelming:

  • Age
  • Gender
  • Plan design
  • Geography
  • Income
  • Condition
  • Drug
  • New to therapy or ongoing therapy
  • Co-morbidities
  • Depression
  • Physician relationship
  • Support system
  • Education
  • Literacy
  • Etc.

I want to spend some time over a few posts beginning to break this down.  Today, let’s look at the five logical customer types:

  1. New Nancy:
    • Newly diagnosed
    • Not very familiar with her condition, the medication, the pharmacy process, or the PBM
    • Needs lots of hand-holding and education
    • Need to address gaps in the physician-patient encounter
    • Need to help her build a routine
  2. Caring Carin:
    • Caregiver for either dependents or parents
    • Picking up prescriptions for them and responsible for translating (sharing) information with them
    • Important to educate, but not the patient
    • Likely to be the “e-patient” but also stressed out (see sandwich generation)
  3. Sporatic Sam:
    • Someone who gets some acute medications occassionally (e.g., antibiotic)
    • Understands the healthcare system somewhat but not overly interested or engaged in the semantics
  4. Forgetful Frank:
    • Chronic medication user
    • Likely to have or develop multiple conditions
    • Not great with adherence to therapy
    • Understands their condition, but not worried about it (even if they should be)
  5. Steady Suzy:
    • Chronic medication user
    • One or more conditions
    • Understands the value of medication
    • Feels better when taking her medications
    • Actively managing her health
    • Generally adherent
    • Engaged with MD and pharmacist

I guess I could add Corrupt Cindy to talk about patients that abuse the system (a pharmacist friend of mine was telling me about a patient they caught this weekend with 6 different names across different pharmacies and a fake prescription pad). 

From a basic segmentation framework, are there others without getting into demographic attributes?

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Silverlink, Value Propositions

New Pharmacy Whitepaper: Innovate Or Be Commoditized

January 7, 2011 by George Van Antwerp 2 Comments

In early 2009, I published an initial whitepaper on the PBM industry.  With all the changes going on in the industry, it seemed relevant to put out a new whitepaper although the total impact of reform and the definition of MLR is still TBD.  As I did before, I’m putting a summary here, and I welcome your comments.

You can download the whitepaper by registering on the adherence site at Silverlink Communications.  Thanks.  [If you’re a regular reader but not a logical client, you can request the whitepaper by contacting me.]

I think a quote from Larry Marsh (Managing Director, Equity Research) at Barclay’s Capital does a good job of summarizing it:

“Innovation will be increasingly important in the PBM world, as these companies seek to solve a greater set of pharmaceutical cost issues for their customers over the next 10 years.”

[BTW – If you want to get updates e-mailed to you as I post them, you can sign up here.]

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

Innovate Or Be Commoditized: The PBM and Pharmacy Challenge for 2011

Doing more with less; dealing with constant change; and having technology be a part of everything…  Those are things that the next generation will take for granted.  For the rest of us, those are dynamics that are changing our personal and professional lives.  We’re constantly bombarded with information and decisions to make.

While the pharmacy industry has generally avoided the collapse of the automotive industry and the radical change of the health insurance industry, we’ve seen unprecedented change in the past few years.

It’s almost impossible to go a few days now without seeing information about prescription drugs in the mainstream news.  You might hear a financial analyst talking about the lack of blockbuster drugs in the pipeline.  You might read about a drug recall in USA Today.  You might see a new report talking about the $290B cost of non-adherence[ii] to the country.  Or, it might simply be water cooler discussions around how more than 25% of kids[iii] now take a prescription medication or how non-adherence can lead to hospital readmissions[iv].

This has raised the average consumer’s awareness of the industry and continues to push the trend of consumerism with which the entire healthcare industry is dealing.  Most of us in the industry already knew that pharmacy was the most used benefit (12 Rxs PMPY for PPO members[v]) and believed that pharmacists were a critical part of the care continuum.

The challenge now is for the industry to demonstrate their value beyond simple trend management.  The growth in generics will slow down while specialty spending grows.  Pharmacy and pharmacists have to become critical path in the care continuum and demonstrate how they engage consumers to improve outcomes.  It will become increasingly important to link outcomes and reimbursement as CIGNA Pharmacy did in their diabetes deal with Merck[vi].

[i] “Still More Pharma Jobs Go By The Wayside”, Pharmalot blog, posted on Nov. 3, 2010, http://www.pharmalot.com/2010/11/still-more-pharma-jobs-go-by-the-wayside/

[iii] Berkrot, Bill, “Prescription Drug Use By Children On The Rise”, Reuters, accessed on 1/4/11, http://www.reuters.com/article/idUSN1924289520100519?type=marketsNews

[iv] Leventhal MJ, Riegel B, Carlson B, De GS., Negotiating compliance in heart failure: remaining issues and questions, Eur J Cardiovasc Nurs., 2005;4:298–307 (abstract online at http://www.escardiocontent.org/periodicals/ejcn/article/S1474-5151(05)00038-1/abstract)

[v] Managed Care Digest Series: Key Findings, last updated Nov. 2010, http://www.managedcaredigest.com/KeyFindings.aspx?Digest=HMO

[vi] “CIGNA and Merck Sign Performance-Based Agreement”, CIGNA Press Release from April 23, 2009, http://newsroom.CIGNA.com/article_display.cfm?article_id=1043

Books / Articles, Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Predictors of Non-Adherence

December 29, 2010 by George Van Antwerp 0 Comments

From the literature…(NEJM 353:5 August 4, 2005, page 491) with my comments about how to address them.

  • Predictor: Presence of psychological problems, particularly depression
    • Study: vanServelien et al., Ammassari et al., Stilley et al.
  • Predictor: Presence of cognitive impairment
    • Study: Stilley et al., Kino et al.
  • Predictor: Treatment of asymptomatic disease  [Need aggressive reminder system to initial create habit]
    • Study: Sewitch et al.
  • Predictor: Inadequate follow-up or discharge planning.  [Educational follow-up]
    • Study: Sewitch et al., Lacro et al.
  • Predictor: Side effects of medication  [MD or RPh education of patient]
    • Study: van Servellen et al.
  • Predictor: Patient’s lack of belief in benefit of treatment
    • Study: Okuno et al., Lacro et al.
  • Predictor: Patient’s lack of insight into the illness  [New to therapy educational content]
    • Study: Lacro et al., Perkins
  • Predictor: Poor provider-patient relationship  [Tips to patients on how to interact with MD]
    • Study: Okuno et al., Lacro et al.
  • Predictor: Presence of barriers to care or medications  [Barrier survey and personalized info to address barriers]
    • Study: van Servellen et al., Perkins
  • Predictor: Missed appointments  [Appointment reminders]
    • Study: Servellen et al., Farley et al.
  • Predictor: Complexity of treatment  [MTM type services]
    • Study: Ammassari et al
  • Predictor: Cost of medication, copayment, or both  [Value based plan design]
    • Study: Balkrishnan, Ellis et al.
Books / Articles, Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Value Propositions

Did You Pay Too Much?

December 28, 2010 by George Van Antwerp 0 Comments

I was looking at a few hints from Money Magazine about ways to shop smarter this season.  They are interesting from a communication perspective, but not always directly transferable to healthcare.

1. We pay more for items that we can touch…41% more.  And, the more time you spend holding the object, the more you were willing to pay for it later.  (How do we make healthcare services more tangible?)

2. Ever wonder why companies give you free chocolate?  It’s because people who eat even one increase their desire for luxury goods by 25%.  (What’s the “free chocolate” of healthcare?  How do we make consumers appreciate cognitive services by MDs and pharmacists more?)

3. People pay more when they’re distracted both online and offline.  And, how many of us aren’t distracted with kids and electronics these days?  (How do we get consumers to really focus to understand how to optimize their healthcare dollar?)

Books / Articles, Consumerism, General Thoughts

My Favorite Blog Posts of 2010

December 16, 2010 by George Van Antwerp 0 Comments

Sometimes I am surprised at what gets people to find the site and read a post.  My favorite posts are very different from the most visited (not sure how to interpret that).  [Note – I excluded my detailed reviews of publications (e.g., books and trend reports) which I do enjoy.]

Blogroll, Books / Articles, Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy

My AHIP Podcast On Adherence

December 14, 2010 by George Van Antwerp 0 Comments

I did a podcast with AHIP on adherence.  I was hoping to embed it here, but I couldn’t so here’s the link.

http://www.ahiphiwire.org/Innovations/Feature.aspx?doc_id=722249

Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Social Media, Value Propositions

Why Don’t You Get A Thank You From Your Provider

December 10, 2010 by George Van Antwerp 0 Comments

From someone in the industry, this is going to seem like a silly question.  BUT, from a customer perspective, I think it makes a lot of sense.

  • Why don’t I get a thanks from my physician for coming to them?
  • Why don’t I get a thank you from the hospital after choosing them for my surgery?
  • Why don’t I get a thank you from the pharmacy for choosing them?

Is it that we’ve grown away from such niceties?  Is it that we don’t think we should thank the customer?  Is it that we think we deserve their business?

People often ask about topics like retention or loyalty or satisfaction.  I was just thinking wouldn’t it be nice if one of my initial experiences was a quick thank you card from the provider that I just used for the first time.

Consumerism, General Thoughts, Healthcare, Marketing / Communications

Express Scripts To Grow The “Select” Programs

December 10, 2010 by George Van Antwerp 0 Comments

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

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

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

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

Blogroll, Books / Articles, Consumerism, Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Value Propositions

Pharmacy 2011 – 11 Things To Consider

December 2, 2010 by George Van Antwerp 0 Comments

I pulled together (in Prezentation Zen style) 11 Things to Consider in the Pharmacy industry.  It’s certainly a matter of opinion, but it’s a point of view meant to cause you to think.  I spend a lot time with clients thinking about the industry, and I thought this was a fun way to put some of those thoughts out there. 

I divided these up into two areas:

The Consumer:

  1. Patient Centric approach is critical path. (i.e., create an experience)
  2. Be proactive not reactive. (think Obesity)
  3. Literacy and health disparities need to be addressed. (simple and direct)
  4. People are different…act appropriately. (mass customization)
  5. Genomics are fascinating…but can be confusing. (and healthcare in general is already very confusing)

Business Strategy:

  1. The pharmacist role has to change from refills to outcomes. (see prior post)
  2. Blend high touch and automation in specialty. (they have the same needs about information)
  3. Integrate your physician and consumer strategies. (the HIT focus will make this more pressing)
  4. You need a STAR strategy for your PDP. (hottest topic in Medicare right now)
  5. Mobile is here to stay. (but may not be a business model unto itself)
  6. Social media will change the conversation. (so what are you doing)
Blogroll, Consumerism, General Thoughts, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Silverlink, Technology

Wal-Mart and Humana for Medicare Part D

November 23, 2010 by George Van Antwerp 0 Comments

Again, I’m a little late on this story (too much work), but I was thinking about it after the CMS news recently that they were going allow plans with a 5-star rating to have an open enrollment season all year round.  That’s a huge deal. 

(If you’re don’t know what the Star Ratings are about,  see the Kaiser Family Foundation piece on What’s In The Stars or if you’re working on improving your Star Ratings, you can see Silverlink’s Star Power solution.)

Humana Walmart-Preferred Rx Plan

If you missed it earlier this year, Humana announced that they were partnering with Wal-Mart to offer the lowest national plan premium for 2011 for standalone PDP plans (see details).  Consumers who select the plan will get a lower copayment when they use Wal-Mart pharmacies.  (I’ve talked about limited networks before so it will be interesting to see if this gets more to be offered in the marketplace.)

“The basics of the preferred network – tight formulary and a low premium – offer an affordable value proposition for patients.”  William Fleming, Vice President of Humana Pharmacy Solutions (from Drug Benefit News on 10/8/10)

This creates a network with 4,200 preferred pharmacies and 58,000 non-preferred pharmacies.  Personally, I’m still surprised more people haven’t gone to the $0 copay for prescriptions at mail which Humana offers in this plan (for tier-one and tier-two).  United Healthcare has recently rolled out a program called Pharmacy Saver which has some similar attributes to the Humana plan. 

So, has it made a difference?  We won’t know yet.  I would expect it would.  The economy is still tight.  Seniors are budget conscious.  Humana has good brand equity.  Wal-Mart, especially in certain geographies, is frequented heavily by this population.

Medicare open enrollment is from November 15th thru December 31st.  This certainly caught everyone’s attention when it launched.  (You can see some of Adam Fein’s comments when it first was announced and here’s a more recent AP article on the topic.)  In a few months, we will know a lot more.

Blogroll, Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Silverlink, Value Propositions

Legitimate Online Prescribers

November 20, 2010 by George Van Antwerp 0 Comments

From an article in USA Today, it sounds like tele-prescribing or virtual prescribing is making some steps forward.  It’s no longer a scam business set up to allow people to skirt the system but a legitimate set of online companies leveraging technology to make it easier for patients.  It will be interesting to see how this plays out.

With big companies and start-ups working in this space, it will likely take the same route as the clinics have taken in getting physician support although most of these described in the article seem to have physician involvement.  Will they protest their peers?

Eventually, this won’t even be a debate as we can use home monitoring devices that plug into our computer or smartphone or iPad app to tell temperature, blood pressure, and other key statistics.  I can see some cool scenarios being explored about how to allow the physician to do a virtual physical exam to complement the patient reported data.  I can also believe that an online record of the patient’s symptoms will be easier to pull into an EMR / PHR than the physician’s notes.

The one thing the article doesn’t bring up is why the physician isn’t accessing a PHR (personal health record) to conduct the exam.  I would think that should be a requirement for patients to use this.  Make them go thru the step of pulling their history into an online tool and adding data about OTCs and allergies.  Then, the virtual consultation would have a physician with all (most) of the data readily available.

You match that with some specific symptoms, some realtime data, and you have a recipe for improved care.

The three companies that the article mentions are:

 

Books / Articles, Consumerism, Healthcare, Innovation, Managed Care, PBM / Pharmacy, Technology

CVS Caremark Insights 2010

November 17, 2010 by George Van Antwerp 0 Comments

I’m catching up on a few things this week. One of those is sharing my notes from the CVS Caremark Insights 2010 publication (their drug trend report). While this year’s report outlines all of the traditional things you would expect – trend, spend by condition, market conditions, generic pipeline, I really thought the exciting information was at the end where they really begin to stitch together the retail / PBM model. I’ve talked about why I believe in this model so strongly in the past (you can also see some of their executive’s comments here). And, I think my perceptions about the future of pharmacists create lots of opportunity for a combined entity. I also think they hint at some of the insights they gained from research around non-adherence and around abandonment which is important and creates a foundation for them around predictive modeling and focused interventions.

  • I like that this year’s publication starts with a letter from Per Lofberg (the new President). He has brought them a renewed perspective on the PBM within the overall CVS Caremark enterprise which I think has been very helpful for them in this year’s sales cycle. [I personally haven’t met him yet, but I’ve heard a lot of good things about him.]
  • This introduction talks about:
    • Generics, specialty, and genetic testing as key trends
    • Controlling costs thru – plan design, clinical strategies, and negotiations with the manufacturers and retailers
    • Executing flawlessly
    • Improving outcomes
  • I like the fact that they introduce the outcomes focus early on. I think that linking themselves to outcomes given their unique footprint (retail, PBM, clinic) is critical for long-term differentiation.
  • Much like I see at Prime, CVS Caremark is a company that is blending its long-term team with some new leadership from outside the company and from the retail side of the business to drive innovation and change. I believe the clients and market has seen some of those changes already.
  • A quarter of their clients maintained a gross trend of less than 3%.
  • I found it interesting at the beginning of the document where they talk about the recession and macro-economy where they mention the effect that the COBRA subsidy had on health consumption.
  • They say that their member contribution is 15.7% which seems really low to me, but that is pulled down by the Medicare average.
  • As everyone has talked about, one of the big drivers of cost this past year was significant price inflation (9.7%) for brand drugs.
  • Their generic dispensing rate (GDR) in Q1-2010 was 70.4%.
  • Their average specialty trend was 11% with a best-in-class trend of 7.3% which seems really low.
  • Not a big surprise, the top classes are similar to other PBMs with large commercial populations. Here’s the list of the top 10 categories:
  • They mention later on their managed Medicaid lives (which I didn’t even know that they had). I think this should be a good growth area along with their Medicare Part D (PDP) lives.
  • They introduce a new methodology which I like which looks at trend by group – employers, health plans, TPA, and Medicare. There are differences in each so being able to compare to a relevant peer group is valuable.
  • They also talk about another change which is looking at book-of-business (BOB) which represent their top clients which represent 65% of total drug spend.
  • Their average gross trend was 3.4% (or 2.4% if you exclude specialty).
  • Digging into the best-in-class numbers is interesting. For example, for employers, 78.6% of their days supply was filled at preferred channel pricing (mail order or 90-day retail). I assume this is essentially for just maintenance drugs, but it seems really high (which is good) and is a new metric for me to think about.
  • They talk about 77.7% of hypertensives (in employers) being optimally adherent (which I assumes means having and MPR > 80%). This seems pretty good, but I don’t have an industry number to compare to.

“With overall goals of reducing health care cost and improving member outcomes, health plan respondents in our 2010 benefit planning survey placed high value on proactive member outreach (93 percent), multi-channel access for members (87 percent) and opportunities for face-to-face consultation (73 percent)—all factors that can help keep members on prescribed therapies and satisfied.” (page 14)

  • For each segment, they give the distribution of trend numbers. Here’s the one for health plans:
  • The best-in-class Medicare and Medicaid number for Generic Dispensing Rate are high and set a high goal:
    • 78.2% Medicare Part D
    • 86.8% Medicaid

Member retention is critical and involves a balance of copay levels, premiums and drug coverage as well as less tangible factors. Member satisfaction plays a significant role in loyalty and re-enrollment. High-performing plans focus on effective member communication and outreach as well as added-value services such as the CVS ExtraCare Health card.

  • They talk about using a split generic tier design for Medicare to allow for different member copays for higher priced generics. I think this makes a lot of sense, but I don’t know all the details or member data and feedback to really understand how it plays out.
  • I’ve never spent much time on Managed Medicaid, but they give a few numbers here:
    • Their average age is 17.6.
    • The average PMPY spend is $288.
  • Several times they use the term “evidence-based” which I really like. I recently was using that term to refer to communications and talking about how to leverage data to create “evidence-based” communications to consumers.
  • They provide a nice 2-page summary of reform.
  • They put out a short list of recommendations:
    • Prepare to take advantage of pending new generics; evaluate plan design and communication strategies for quick mobilization when new launches are pending. (This will be a big year for this with Lipitor.)
    • Many specialty pipeline products are for orphan diseases and will have narrow indications; have plans in place to ensure appropriate utilization. (This will continue to be a bigger and bigger issue.)
    • If you haven’t already done so, investigate the use of genetic testing to help guide treatment decisions. (Given their relationship with Generation Health this is an area that I expect to hear a lot more about in future Insights publications.)
    • Newer, more expensive pharmaceuticals may offer little advantage over existing products in the class; consider step therapy or preferred product strategies. (I think Utilization Management (UM) activities like Step Therapy (ST) will be a continued focus for the next few years especially as biologics allow these “traditional” techniques to be applied to specialty.)
    • Use wellness and preventive programs to identify people at high risk for chronic disease and help them lower their risk profile. (This is an area that I would have liked them to talk more about. As I’ve said many times, this is an opportunity for them to shine and differentiate.)
    • Members with chronic disease who are non-adherent tend to have higher health care costs; evaluate your population’s adherence levels and the support you provide to help people stay adherent. (Differentiation in this area is a huge opportunity. I think they are doing some interesting work in this area as they’ve talked about in some recent press releases – Rx abandonment, barriers to diabetes care, US Airways program, and behavioral research.)
  • They provide a forecast on trend for overall, non-specialty, and specialty. Here’s their forecast for the overall trend.

  • They give a clear chart on the generic opportunity and likely impact on overall generic fill rates for 2010-2012.

  • They go on to talk about specialty drugs which could be as much as 50% of the total spend by 2013…a scary prospect.
  • They have a good “state of the union” for specialty in the deck:
    • As of January 2010, 57 percent of all late-stage pipeline drugs fell into the specialty area.
    • 71 percent of applications for supplemental indications are for specialty products.
    • The number of new specialty drugs approved in 2009 was more than double the number of 2008.
    • Provenge, the first therapeutic vaccine—which utilizes the patient’s own DNA and stimulates the immune system to fight prostate cancer—was approved early in 2010.
    • Potential approvals 2010-2012 include four new products for multiple sclerosis (all oral), three for hepatitis C, and three for cystic fibrosis.
    • 18 of the products pending approval in 2010 target orphan diseases, which currently have few or no treatments.
    • While health care reform legislation provides for a pathway for approval of biosimilars, it also mandates a 12-year minimum exclusivity period for brand innovators with the possibility of additional exclusivity in 12-year increments for the development of new uses.
  • They then talk a little about pharmacogenomics (PGx). Again, I expect this to be a much bigger area in the future. It’s interesting. It’s changing rapidly. BUT, there is a huge education mountain for patients and MDs.

For a 1M member population, ~$12M is spent each year on 18 drugs that are administered to patients who do not respond and/or who are more likely to experience drug-induced medical complications.

  • I think some of the hidden gems begin on page 27 where they talk about their study on electronic prescribing:
    • 22.1% never filled their first claim. (why – samples?)
    • They found that those who had an eRx were most likely to fill than those with a paper Rx. (I personally would have bet on the other…i.e., that I have something physical in my hand that it would serve to remind me to go to the pharmacy.)
  • Another study towards the end was on abandonment (which they recently released more information on). It showed that copay, income, and whether it was an NRx (new start on Rx) were predictors of abandonment.
  • They also share work done around adherence focused on complexity of therapy – number of Rxs, number of MDs, number of pharmacies, and synchronization of refills. They talk about using this to score patients and predict risk of non-adherence. (I look forward to seeing more here since this seems very interesting especially in terms of focusing resources and developing a triage model.)
  • They shared the results of a deep dive on reasons for abandonment of prescriptions. Being able to respond and position messaging around these reasons is important.
  • They share some of the work from their Pharmacy Advisor program:
    • IVR messaging improved the odds of refills by up to 70.6% when members answered the phone.
    • Early IVR refill reminders were 2x as effective for first fill persistency rates at mail as compared to reminders after refill due dates.
    • Physician directed fax alerts about gaps in care nearly doubled gap closure rates.
    • Pharmacist interventions were most effective at improving adherence.
    • Members in VBID (value based insurance design) in which copays were lowered or eliminated were more likely to initiate therapy, less likely to discontinue therapy, and had better adherence.

“Diabetes is one of the most prevalent and expensive chronic diseases in the nation, costing the U.S. an estimated $174 billion a year,” said Troyen Brennan, MD, MPH, EVP and Chief Medical Officer of CVS Caremark. “The Pharmacy Advisor program improves clinical care because we are able to identify and address pharmacy-related care issues that if left unattended could result in disease progression and increased health care costs. We are also better able to engage the member in their care through multiple contact points, providing counsel that can improve adherence and help members optimize their pharmacy benefit and find the most cost effective options.” (quote from press release)

  • They talk about a pilot program they did in Polk County were patients signed a contract for care and was focused on diabetes care. It had some great results:
    • Reduction in blood glucose levels from 52% under or equal 7% at the beginning to 72% after one year.
    • 30% reduction in hospitalizations.
    • 24% reduction in ER visits.
    • Only 3.4% of enrolled members had poorly controlled diabetes (compared to national average of 29.4%).
    • Improved patient care – identification of potential adverse events, streamlined medication regimens, and formulary support.
    • (I personally would think this would get other plans (or PBMs) to partner with them on regional strategies where they have a strong retail presence.)
  • This also coincided with their announcements about their Pharmacy Advisor program which officially launches in January 2011. I’m very interested to see the uptake here which I would imagine will parallel the success of Maintenance Choice. This is a program which leverages their Consumer Engagement Engine (see image from last year’s report) and their retail presence to engage consumers.

Overall, it was an easy read without a lot of fluff. It cuts to the chase and gives you a good perspective on how they think. You begin to get a feel for what they are doing differently, but I imagine that you’ll continue to see a lot more research and case studies come out in the next year about some of the work they are doing.

(Note: In the sense of disclosure, CVS Caremark is a stock that I own.)

Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Technology, Value Propositions

Todd Park (HHS CTO) On Unlocking Innovation Mojo (#mhs10)

November 8, 2010 by George Van Antwerp 0 Comments

I came out to the Mobile Health Summit (Twitter hashtag #mhs10) in DC today, and I had the opportunity to interview Todd Park who is the Chief Technology Officer (CTO) for the US Department of Health & Human Services (HHS). Todd is a great resource for the country and perhaps a surprising bureaucrat (in the nicest sense of the word) given his background as a consultant and then co-founder of athenahealth.

It was an interesting discussion starting around what his role is. The CTO role is a new role in the US government which he describes as an internal change agent who is responsible for working with HHS leadership. He described his objective as forming virtual start-ups to advance new solutions. [A radical departure for those of us that view government as a monolithic organization which is slow to change and full of red tape.]

He said that one of the first questions people ask when they see the new initiatives such as HealthCare.gov is who were the consultants he brought in from Silicon Valley to do the work. He says that it was all internal people. We talked about that being a cultural change which he described as “creating the right vision” and a “work pathway”. That sounds exactly like what one might see a change agent being responsible for – better leveraging internal assets by changing the framework for service delivery.

We talked about several of the initiatives that HHS has worked on lately:

  1. HealthCare.gov which is a focused on helping consumers find public and private options for healthcare. He said this was a 90-day implementation. I think if you go to the site you’ll see a few things:
    1. Easy navigation
    2. Content for multiple personas
    3. Links to social media
    4. Videos, widgets, blog postings, iPhone app, etc.

    This is much like what you would expect from a direct-to-consumer company or your health plan.

  2. The Open Health Data Initiative which is focused on taking data which HHS has and making it available for use by companies for FREE. The idea is to stimulate an eco-system around the data and enable better health thru better decisions. He uses the NOAA framework as an example for how they share data to sites like weather.com. He then mentioned that they had done a brainstorming session earlier this year to think about what could be done with this data (some of which was new to everyone). You can learn more and see the 2-hour YouTube video here, but a talk by Todd Park at another event is below.

     

  3. The Blue Button Initiative which was launched in October and focuses on getting Medicare members and veterans to get a copy of their own data to print, download, share, upload, etc. Already more than 100,000 have downloaded their data. This should certainly be an enabler for PHR adoption.

We then went on to talk about HHS as a “reservoir of innovation mojo” which needs to collaborate with the public sector. In Todd’s words, he sees government as needing to be a catalyst and enabler. When he joined, his idea was not to fly in like aliens and change HHS, but to come in and find ways to unlock the mojo which already existed.

I asked him if he sees this as being a model for the private sector. Obviously, one of the challenges we have everywhere is figuring out the right way to balance co-opetition and competition. If we’re going to “solve” our obesity epidemic, we need to have some collective knowledge and insights rather than constantly re-creating learnings in a microcosm. On the flipside, companies want to create intellectual property and sustainable differentiation. It’s not easy to balance.

But, Todd mentions that several companies are already following in the “blue button” model such as Gallup / Healthways which is making their Well Being Survey data available publicly (for FREE) for the top 200 cities.

Of course, there is a lot of work to do here. I asked him about what the government was doing to address some things at a national level (e.g., obesity) where in my mind we almost need a reframing such as that which happened with littering, smoking, or wearing our seat belts. He brought up three things that were happening:

  1. National Quality Initiatives
  2. HealthyPeople 2020
  3. Community Level Dialogues

One of the other things that we talked about was the challenge of making changes to health outcomes with the health literacy levels in the US. I suggested that we need to address this systemically as I believe we need to address financial literacy…beginning in the schools and the home. He talked about needing to making learning fun through educational games. He mentioned that the First Lady had been promoting the creation of apps to accomplish this as part of a competition. (This made me think of the iTots article in today’s USA Today.)

We closed with a quick discussion on other things that he’s monitoring that will drive healthcare innovation. He talked a lot about improvements in the provider payment system – think Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMH). The goal with these is the change from “pay for volume to pay for value”.

Talking to Todd gives you a positive view on what government can do. I can see him motivating his team and his prior teams to follow his vision and embrace change.  I’d have to agree with Matthew Holt’s article on Todd Park from earlier this year.

Books / Articles, Consumerism, Events, Healthcare, Innovation, Leadership, Politics, Research, Technology, Value Propositions

PBMs and Social Media

October 20, 2010 by George Van Antwerp 1 Comment

I always get pulled into the discussions about what PBMs are doing, should be doing, or could be doing in social media. For now, let’s just look at the current state – i.e., who is doing what.

I’m going to focus on the big channels – Twitter, Facebook, YouTube, and blogging.

 

Twitter

Other (Facebook, YouTube, Blogs)
CVS Caremark @CVS_Extra

@CVS_Health

@CVSCaremarkFYI

 http://www.youtube.com/user/CVSPharmacyVideos

http://www.facebook.com/CVS
Medco @DrObviousPhD

@LibertyMedical

@Medco

 http://www.youtube.com/DrObviousPhd

http://www.facebook.com/DrObviousPhD
Walgreens @Walgreens

@WalgreensNews

@WalgreensHealth

 http://www.facebook.com/Walgreens
Express Scripts @BobNease

@EScripts

 http://www.consumerology.com/blog
MedImpact @MedImpact  

 

To make it easy, I created a Twitter list on my profile of the PBMs, pharmacies, and several other key resources in this area – http://twitter.com/#!/gvanantwerp/pharmacy-pbm.

I welcome your links to other PBM or pharmacy social media assets. I looked under CatalystRx, Prime Therapeutics, and SXC also. I also checked Cigna Pharmacy, Humana Pharmacy, Prescription Solutions, and Kaiser Pharmacy. I couldn’t find more, but I’m sure there’s a few I missed.

The question of course is how to judge if these are successful. Is it the number of followers or fans? I would argue no. The goal of social media is to create a dialogue and engage the patients or consumers. Given the traditional focus on the PBM on the business-to-business relationship and the pharmacy on the business-to-consumer relationship, there is an interesting question of how the mail order pharmacies (owned by the PBMs) make that leap. Can social media create a forum for discussion about plan design, drug trends, and other things in straightforward language that engages consumers? Will consumers be willing to use these channels to interact with the PBMs or only with their pharmacist? This could be an area where companies like Walgreens or CVS Caremark who have a large physical footprint can leverage a real-world connection with consumers to a virtual one easier than others.

As you can see, there are not a lot of people doing a lot yet. This area will change a lot in the next 5 years.

Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media

CVS Adds Mobile Application

October 15, 2010 by George Van Antwerp 0 Comments

Communications continue to evolve.  Mobile health in the form of applications has either crossed the chasm or is crossing the chasm.  I expect in 5 years that most communications in healthcare for people under 45 will start with a mobile application.  It may “escalate” to other modes, but using a secure application on the ubiquitous mobile phone will be a primary starting point to engage them.

Caremark rolled out their mobile application earlier this year.  Now CVS has rolled out there application.  Several other companies have rolled out their applications also.  Humana’s application is out (mobile site).  Another big PBM is piloting their mobile application with one employer right now. 

So, what does the CVS mobile application do:

  • Find nearby CVS/pharmacy locations using the GPS-based store locator with integrated driving directions and maps;
  • Refill prescriptions from a personalized prescription history for pickup at any CVS/pharmacy;
  • Transfer prescriptions from another pharmacy to CVS/pharmacy;
  • Access the Drug Information Center to retrieve critical details about medication management, including instructions for use, dosing information, side effects and relevant safety warnings;
  • View and manage sales circular to create a custom shopping list and identify money-saving deals each week; and
  • Schedule a flu shot at any local CVS/pharmacy location.

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Social Media, Technology
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