May 25, 2010 
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As someone pointed out to me today, there is now a character called Dr. Obvious which is featured on the Medco site – www.medcopharmacy.com. He’s also on Twitter and Facebook. So, who is he? What’s the twist here? What’s the Institute for the Incredibly Obvious?
You might get some idea by watching the video on Facebook or some of the videos on YouTube.
Here’s one on automated refills (which is the push for most pharmacies – retail and mail).
May 17, 2010 0 Comments
It’s an interesting question since there is quite a lot of bad debt. I’ve certainly believed the default hypothesis which is that people can’t afford their healthcare out-of-pocket costs, but I know I’ve had several instances where I had delayed payment due to misinformation or provider billing errors that I tried numerous times to get fixed.
McKinsey’s new research suggests that I’m the norm (i.e., most people would AND could pay their bills).
May 11, 2010 0 Comments
Don’t believe the hype – its a sequel
As an equal, can I get this through to you
I talk about it all the time as most people do…non-adherence to prescription drugs is a real issue. People don’t fill their initial script. People who do fill their first script drop off after the first several fills. By 12-18 months after a patient starts therapy, less than 50% of them are still taking their medications. Here’s a few key articles on this:
Common barriers to adherence are under the patient’s control, so that attention to them is a necessary and important step in improving adherence. In responses to a questionnaire, typical reasons cited by patients for not taking their medications included forgetfulness (30 percent), other priorities (16 percent), decision to omit doses (11 percent), lack of information (9 percent), and emotional factors (7 percent); 27 percent of the respondents did not provide a reason for poor adherence to a regimen. Physicians contribute to patients’ poor adherence by prescribing complex regimens, failing to explain the benefits and side effects of a medication adequately, not giving consideration to the patient’s lifestyle or the cost of the medications, and having poor therapeutic relationships with their patients. (NEJM article)
Depending on what study you look at cost is certainly an issue, but it typically isn’t the primary issue. I typically see cost as being a factor in 5-15% of the cases. I think if you look at how Merck weighs cost in their Adherence Estimator that it is only a small factor. A lot of this plays out in VBID (Value Based Insurance Design) which while not purely about copay waivers that certainly is an element of most solutions.
A few friends of mine formed their own company (CareScientific) and had a paper published in AMCP recently. From that article:
VBID is receiving attention as a tool to increase medication adherence and lower medical costs. However, applying a “plausibility calculation” method to data generated from a recent VBID study involving reduction of drug copayments, this evaluation found that health plan sponsors are highly unlikely to experience net savings by implementing VBID programs, even under generous assumptions, for 2 reasons. First, the price elasticities of medications are too low to generate meaningful increases in medication adherence when copayments are lowered. Second, the potential reductions in the avoidable hospitalization and ER utilization rates across a commercially insured population with varying risk levels are generally not large enough to offset the additional plan costs of lowering copayments to increase medication adherence.
I would also suggest looking at some of their tools that they’ve developed.
So, getting back to how I’m tying in my reference to Public Enemy (rap musicians)…
When I look at the upside for pharmaceutical manufacturers to grow the pie (get more Rxs through adherence), I often wonder why one of the default solutions is to fund copay waivers. That happens by employers, health plans, and even the manufacturers. There are many less expensive ways to get that lift by addressing things like reminders and tailoring information to individuals based on their personalized barriers.
There are lots of high cost solutions that will make an impact. The question is how to triage those resources to focus them on the right people. It’s important to identify adherence risks (pro-active intervention) and adherence gaps (retrospective) and intervene with the patient.
Here are a few of my other posts on this:
May 10, 2010 0 Comments
I think we all venture a guess on why we feel bad – cold, flu, rash. And, at least from my perspective, that might lead to an OTC (over-the-counter) medication. BUT, apparently 30% of people use that self-diagnosis to self-prescribe and borrow medication from friends and family. That has some more significant risks associated with it and can lead to an incomplete medical record if something happens to you (i.e., a severe side effect).
According to the recent survey:
I think we all know that borrowing medications is wrong. The only time I would think you might be okay is you were prescribed the identical chemical entity and strength and had a friend that had changed medications and had some extra. Since the reality is that there is a lot of excess medication out there given all the non-adherence.
May 9, 2010 0 Comments
I am a big believer in experiential learning. To that effect, every time I’ve decided to change behavior I only have to envision myself at some future state affected by my current state decisions. When I believed that my drinking caffeine would impact my future health, I quit cold turkey for 15 months. (I observed no meaningful difference in health and allowed myself to drink caffeine again.)
So… I guess my question is why can’t this be harnessed in all of us. Would we make different decisions if there was a way to reflect on our decisions in a “magic mirror” of sorts that showed us how these would impact our lives? Is this a role for a “Future Life” play on Second Life?
Imagine:
Or, if you focus on the carrot versus the stick maybe there’s more motivation to change by letting them dream what is possible if they change behavior:
May 5, 2010 1 Comment
When I think of the current generation that is coming into the workforce, I think of people who:
I think the more typical perception of many of them is an overly privileged generation who can’t focus on one thing, expect everything (money, position, title, responsibility) regardless of whether they deserve it, don’t follow basic protocols (like a thank you after an interview), have been coddled their whole life, and have no respect for what others have done. But I think every generation thinks that of the next generation.
I guess the official definitions are: (see good presentation)
The Millennials are also called Generation Y, GenNext, the Google Generation, the Echo Boom, or the Tech Generation and are 76M strong. With immigration they are likely to surpass the Baby Boom generation in the 2010 census. [Note – Comments derived from reading an exerpt of The M Factor by Lynne Lancaster and David Stillman in the May 2010 Delta Sky Magazine.]
Their book – The M Factor – is focused on this generation. They talk about the fact that this generation is talking about and searching for “meaning” in their work. They’ve been raised by working parents that struggled with life balance and want more out of work for their kids. They see how work has become so engrained in our lives with Blackberries and other tools.
More than 90% of US Millenials said having opportunities to give back thru their company was somewhat to very important when considering joining an organization.
51% of young workers surveyed as part of the Kelly Global Workforce Index were prepared to accept a lower wage or lesser role if their work contributes to something “more important or meaningful”.
The question that a lot of this drives at is how do you leverage the passion and tech savvy Millenials as part of your workforce. They are going to drive changes. They are going to be innovators. And, they’re not going anywhere. Here’s a good blog on Generation Y.
It reminds me of some mock interviews I did a few years ago at my business school. I was stunned by some of the accomplishments of these people. They had founded companies and businesses. They had volunteered in the community. They were well read and had passion for things that I didn’t care about at their age. I was glad to have made it thru school with my peers. But, on the flipside, I talked with my friends who are the Dean of the School and run the Career Center to point out that not one of those people wrote me a thank you or sent me an e-mail. None of them ever asked me to help them find a job leveraging my network.
The article talks about this Millenial generation growing up at a time when the divorce rate had dropped and parents spent more time with their kids and transformed from authority figures to mentors and friends of their kids. This whole concept of “helicopter parents” has been explored in other areas and still amazes me. [Are you a helicopter parent test.] For example, 11% of US Millenials said they would feel comfortable involving their parents in salary negotiations. [If I had the option legally and a parent showed up with their kid for a salary negotiation, I would rescind the offer. If they can’t do that by themselves, how can I trust them to drive my business in pressure situations?]
In healthcare, the best example I always use for a company focusing on this generation or the “Young Invincibles” is Tonik Health which is a Wellpoint brand. I’m always surprised how few people know them. Take a look at their website (below) – the colors, the words, and the positioning is all so different than how most of us think about our health insurer. Here’s a good blog entry on the “millennial patient“.
Why is this relevant to my healthcare communications blog – because segmentation is so key to effective messaging. You have to understand this generation and how to engage them and drive them to take care of their health. Traditional language, modes, techniques, and messages may not work. The article (from the book) talks about their focus on feedback and scoring. They are used to constant [positive] stroking and having a score to evaluate success. They grew up being rewarded for everything. How does that manifest itself in a wellness system that tracks their good deeds (exercise, diet, preventative actions), provides them with rewards, frames their effort as contributing to the greater good, and integrates technology (e.g., connect devices)?
Only 3% of the people they surveyed said that Millenials handled negative feedback well. They haven’t been allowed to fail. This makes me think about one of my favorite quotes from IDEO – Fail Often To Succeed Sooner. You have to understand how to try, fail, learn, and try again to make improvements.
Here’s some recent research we’d done at Silverlink on the “young invincibles” and “Why I Have Health Insurance”:
May 5, 2010 0 Comments
I have heard some dialogue about consumers freeing up their spending even without their salaries going up or their house value going up (although their portfolio may have recovered by now). But, the question is how the frugality that was learned in the past year will impact consumers long-term. Will it change the way they buy? Will that be true across generations or will this just have a major impact on certain generations that are just coming of age?
An article released by Booz & Company a few weeks ago has some interesting data in it. For example, in the chart below, it shows 22% of people spending less on healthcare (drugs, supplies). What does that imply – pill splitting, more generics, more mail order, lower adherence, less preventative care? So are they more receptive to cost messages from healthcare entities?
Most of the consumers surveyed said they continue to consider saving more important than spending (65 percent). They sacrifice convenience for price (65 percent), frequently use coupons (65 percent), and, to a lesser extent, prefer the best price to the best brand (55 percent).
Maybe it’s time for the PBMs to emphasize convenience more – simplify your life, use mail order…one less errand to run. I’m still skeptical that this would beat a traditional cost savings message. BUT, perhaps it’ time to reconsider coupons / incentives. They’ve been tried with limited upside over the years in pharmacy. They do drive up results, but they don’t always pay for themselves. Maybe a lower value incentive would have the same yield thereby increasing ROI. ???
They identify six segments of the population with this frugality filter:
May 2, 2010 0 Comments
I’ve talked about pieces of this before, but I really believe that pharmacy is the cornerstone of a successful healthcare communication strategy.
Pharmacy is the most used benefit. On average people have over 12 pharmacy claims per year. And, if you take out the people that don’t have any, the number rises to around 20 pharmacy claims per year.
That’s 20 opportunities to intervene at a logical event and educate the patient about their condition, talk to them about saving money, stress the importance of adherence, capture feedback from them, drive them to take an action, etc.
Additionally, pharmacy is a very tangible event that consumers can control. They get to choose (in most cases) their pharmacy – retail, mail, specialty. They can talk with physicians about the options – generics versus branded. It’s a space with lots of DTC (direct-to-consumer) information.
I don’t think most of us (even those in the healthcare field) would feel as open to debating one surgery versus another type or talking about the quality differences between one location and another. The data’s not as accessible and therefore we’re more dependent upon the system to drive us to good decisions.
May 1, 2010 0 Comments
As one of my favorite annual projects during my time at Express Scripts, I love the drug trend report. It has been a historical benchmarking tool for the industry and become a normal deliverable for many of the PBMs. Here are my initial thoughts after reading this year’s document which looks at 2009 data.
Individuals often are not rational.
I like it. Very humanized versus purely statistical document. Good job Emily, Steve, Yakov, Andy, Bob, Brian, and Chris. (That’s the core group that I know well.)
April 29, 2010 0 Comments
I just came upon this infographic based on information from almost 1,000 people in the depression community on CureTogether.
April 28, 2010 1 Comment
In today’s budget conscious economy, people are constantly evaluating where to spend their time and money from a conference perspective. Some conferences are good networking events. Some of requirements to work in an industry. Some are educational. Some give you new ideas on how to run your business. Some are in great fun locations with fun events. Very few fit all of those.
I think our Silverlink Communications client event called RESULTS2010 does all of those. [Hint – the conference is called RESULTS since that’s what we focus on with our customers.] It takes on all the key issues we see in the market. It brings in industry experts and clients to talk about what they are doing to address these issues. Those problems are framed out by our industry experts that have line experience with these roles. [Our leadership team comes from places such as Express Scripts, CVS Caremark, Gorman, and HCSC and our team includes people from McKesson, Humana, United Healthcare, IMS, DigitasHealth, Medco, and WebMD. I challenge anyone to find a more knowledgeable vendor team.] It gives people a chance to network and talk to their peers. And, there’s some fun mixed in there.
This year’s event is focused on THE HEALTH CONSUMER. I’m pretty sure it’s the only conference focused on communicating with consumers in healthcare. The objective is to provide clients with ideas about how to educate, support, and motivate consumers to take actions which support health outcomes.
Honestly, it was the original event that convinced me to come to Silverlink. I was a consultant at my first event working with the company. I met 75 users who were passionate about the company and had great first hand experience using the technology to make a difference in their companies. I was able to ask them about the competition and understand why they choose Silverlink for their member communication partner.
So, what does this year’s event have in store:
There are several more speakers who you would know and I’m very excited to have come and speak…BUT, I want to leave something inside the package for you to want to rip it open and learn more.
How much does it cost? Nothing (as long as you’re a Silverlink client).
Where is it? Boston (a great city).
How do I learn more? Well…if you work for a large managed care company, a population health company, or a pharmacy / PBM, you may already be a client. We have over 80 clients today. So, if you’re not on our invite list, think you might be a client, and want to learn more, let me know. I’m at gvanantwerp at silverlink dot com. [spelling it out avoids spam]
This year’s event is in late May so I hope to see many of you there!
April 20, 2010 0 Comments
I knew the new report must be out when I had about 40 hits this morning on my blog based on Google searches for it. Here’s the banner showing some segmentation. I haven’t had the chance to read it and comment, but I will in the next 2 weeks. You can search my blog to see my comments on all the PBM drug trend reports from the past few years.
[added later…my comments are now posted here.]
April 19, 2010 0 Comments
Merck did research that was published last year showing that their 3-question Adherence Estimator (TM) was 86% accurate in identifying patients at risk for nonadherence. Pretty impressive.
A copy of the questions are below and were on the Tuft’s website which also shows the scoring mechanism. This is something patients can take to determine their risk or plans, PBMs, pharmacies, MDs, disease management companies, or others could use.
April 15, 2010 3 Comments
This was definitely my favorite and most interesting presentation and discussion from the World Health Care Congress in DC. Ingrid presented and subsequently spent some time talking with me. She has what I would consider one of the coolest jobs – transforming a large company to be consumer centric and radically changing the way they think, speak, and act.
From her presentation, here were a few notes:
And, they’ve shared some of this information in their press kit. There is also an IBM white paper about some of the technology they’ve implemented.
I think the following slide from her deck sums it up well.
Then I sat down with Ingrid to talk with her. I had a thousand questions which I limited to about 10. This is a topic I love and is why I love what I do – work with companies to help them develop consumer communication strategies and implement those strategies to improve the consumer experience and drive better health outcomes.
We then bounced around on a couple of interesting topics:
April 13, 2010 0 Comments
I had a quick dialogue with Andrew Webber (President and CEO of the National Business Coalition on Health) earlier today at the WHCC (see #whcc10 twitter feed). I wanted to talk with him about how we create a unified consumer experience in today’s healthcare environment.
Today, a consumer gets messages from their employer, their physician, their pharmacy, their PBM, their managed care company, their hospital, their disease management company, healthcare sites such as WebMD, and probably several other places. Very little of that is coordinated, and it’s certainly not always consistent in messaging and direction.
Mr. Webber explained that the employers need a “supply chain management” solution to share data across vendors and develop a consistent message. We talked about how the Accountable Care Organization (ACO) concept will try to get us back to some type of solution where there is a primary “owner” of the relationship and that this would be with the trusted key in the solution – the MD.
We talked about the fact that the employers have created this system which pushed the BOB (best-of-breed) over a consolidated, centralized solution. And, we discussed the fact that employers continue to love these “boutique solutions” that develop niche plays (think Health 2.0 companies) which address an acute need. They create great case studies but are often difficult to scale.
It made me think of some old IT models I worked on where clients had to decided whether to pick an ERP system like SAP or go with the best-of-breed and manage the infrastructure to connect them. I think the current employer based system even went a step past this. In the IT world, the company had to manage a connected infrastructure (think enterprise data warehouse and service oriented architecture). BUT, in healthcare (or benefits), that infrastructure doesn’t exist. Each entity owns their piece of it completely with limited interaction and connectivity.
This was the first time where I could see the point of a “employee centric model” versus an “employer centric model”. I’m not sure I believe it could effectively be done, but it reminded me of a company that was trying to create a web-application that was a type of next generation PHR (personal health record) where the member could consolidate communications, designate preferences, and would adapt general (vanilla) communications to the consumer based on behavior, preferences, demographics, etc.
April 12, 2010 0 Comments
I’m at the WHCC 2010 in Washington DC, and I got to sit down with Greg Parston from the Institute for Health & Public Service Value from Accenture. They just released the results of their global study – Accenture Citizen Experience Study: Measuring People’s Impressions of Health Care.
How do citizens rate the quality of health care in their countries? How do they view government’s role in supporting – and improving – health and health care? What actions do individuals consider important to making improvements, and how do they rate government’s performance in supporting these actions?
They looked at Australia, Brazil, Canada, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Mexico, Norway, Singapore, Spain, UK, and the US.
Some of the takeaways from the survey:
But, you can read the study…My value here is the conversation with Greg. Some of the things we discussed were:
From the US survey:
April 4, 2010 0 Comments
It seems like whenever I talk to companies about adherence one of first things they want to discuss is copay relief. It’s a solution I’ve used before so it’s certainly rationale. But, let’s not forget that cost is not the primary reason for non-adherence. Forgetfulness and lack of health literacy are often big drivers of non-adherence with medications. This is easily validated when comparing lift in medication possession ratio (or more tactically refill rate) by looking at copay waiver type program (value-based design) versus communication programs.
Given that copay waivers often require $10+ per month and other programs can be conducted for much less, I question the ROI. I’d love to see a head-to-head test. Try education and refill reminders versus copay waivers to see which yielded a greater MPR improvement.
March 29, 2010 0 Comments
This article appeared in HealthLeaders (3/3/10) by two of my co-workers based on some very interesting work they’ve been doing.
It’s not what you say, but how you say it that matters. The “how” includes a number of specific voice attributes, such as inflection, rate of speech, and intonation—all of which contribute to an overall perceived “voice personality.”
Voice is a powerful lever in the ability to effectively communicate your message to ultimately motivate behavior. Would you be more apt to trust the voice of James Earl Jones or the voice of your local car dealer? How do you perceive these voices overall? Which voice personality most effectively delivers a message? The answers, of course, depend on the listener, what is being communicated, and the behavior you’re trying to motivate.
In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging.
Specifically, this research analyzes voice selection for interactive automated calls, an effective outreach channel widely used in healthcare to reach and motivate individuals.
Subjectivity in Voice Selection
If you put a small group of people in a room and ask them to describe the voice they hear, the answers will be wildly different: “This voice sounds too perky.” “That one sounds robotic.” “This voice sounds friendly and cheerful.” Reaching a final conclusion about which voice is “best” often is a highly subjective process.
While we don’t consciously listen to an individual’s voice attributes, we do subconsciously assess the voice’s characteristics and create inferences about the speaker. Over the telephone or on the radio, when voice is the focus, we paint a picture of how someone looks, what kind of person they are, their age, gender, and generally whether or not you trust them.
We’re sometimes surprised in the end at how different the person is when we meet him or her face-to-face. By itself, voice impacts our perceptions, which affect how well we understand a particular message.
In healthcare, it is a common belief that people prefer a female voice when receiving messages about their health. Perhaps this is because female voices are perceived as more nurturing and caring; and women are often the caregivers in the home.
But is a female voice equally effective when communicating to all people, of every age, in every region, and for every type of health related behavior? For instance, is a female voice as effective for people of poor health status hearing a message about an important health screening? What about seniors hearing a reminder to take their cholesterol-lowering medications?
Voice Research
To answer these questions, we created a framework to map specific voice attributes with voice personality. We conducted an attitudinal study to learn how people of different age, gender, and region perceive and respond to different voices. We surveyed 3,000 people across the country, in a statistically representative sample of the commercially insured U.S. population.
Participants heard the same short informational wellness message spoken by several different voices representing a variety of ages, gender, and unique voice characteristics. Survey responders were asked to provide their opinions on the following:
The survey results provide a powerful depiction of how different voices are perceived by different segments of a population.
What’s in a Voice?
High trust and care/sincerity ratings are important factors when trying to motivate healthcare behaviors. Medication adherence, for example, is associated with the quality of relationship between the patient and the physician. When people trust the voice they hear, and feel that the person speaking to them is sincere, they are more likely to change their behavior.
There are many interesting attitudinal findings from our study including:
The use of voice to motivate health decisions
The results of this study provide us insight into how people of varying gender, age, region, and health status perceive the voices they hear. Our goal is to validate how specific voices can be used as a lever to change behavior.
Voice, like other communications levers, such as messages and timing, can be selected based on the demographics, purpose, tone, and intent of communication, as well as how voice supports brand identity. By validating attitudinal voice responses against behavioral activity, voice can ultimately become a measurable behavioral best practice in healthcare communications.
While the bulk of our experience supports the conventional wisdom that a woman’s voice is more effective for healthcare communications, our voice research suggests that there are opportunities to use a male voice to measurably move health behavior. A recent outreach program to educate individuals about the importance of colorectal cancer screenings supports our attitudinal research.
The outreach asked if the individual had received a screening during the past two years, and if they planned to schedule a consultation with their doctor. The same message was delivered by a male and a female voice. All population segments, including men, women, Caucasians, Hispanics, and Asians, answered the survey at a higher rate when a male voice was used versus when a female voice was used.
Conclusion
By applying science and measurement, we can determine the voice qualities that are the most impactful for a specific health behavior and for a group of people. There are measurable patterns in overall voice preference. Communications programs aimed at driving individual behavior should include voice analysis.
By measuring and understanding perceived voice personality, our research sheds light on an objective way to effectively apply voice in healthcare communications to ultimately impacts behavior change.
Jack Newsom, ScD, is vice president of analytics at Silverlink Communications, and Ryan Robbins is voice production manager at Silverlink Communications.
March 21, 2010 0 Comments
I’m just catching up with this announcement from a few weeks ago. Google Health has added Surescripts to their partner list. This is interesting to me on a few fronts.
1 – Can this solve the portability issue? Today, if you change employers, your prescription history gets reset. If your employer changes health plans or PBMs, your prescription history gets reset. While this isn’t always a major issue, that history is important both for a DUR (i.e., drug-drug interaction) perspective but also from a research perspective (e.g., Medication Possession Ratio).
2 – Google is going to message users about potential DUR issues. That is a big value proposition of the PBMs. Given the other threats to their business model ($4 generics, direct-to-consumer mail order, claims administrators, legislation, pharmacy to employer contracting), is this another issue?
March 3, 2010 0 Comments
Yesterday, CVS Caremark announced an expansion on their research partnership with Harvard to include three people focused on behavioral economics and social media. The focus of both these efforts is around prescription compliance (an almost $300B problem).
The work is going to be focused on three areas:
February 18, 2010 0 Comments
You hear this argument a lot especially within the context of value based design. There are two reasons that people consider dropping drug copays to $0 for a commercial population – (1) they believe it will increase adherence and (2) they believe it will incent people to move to generics or to mail order.
First, I am fundamentally against providing prescription medications for free. People have no vested interest in things that are free. And, I strongly believe that people need a vested interest in their healthcare. A temporary $0 copay or a rebate is okay, but I prefer a clear and simple message like “all generics are $4”. (Not even Wal-Mart can say that…most $4 generic programs are only for 300 or so drugs.)
Tonight, I want to drill down specifically on using this to incent people to move to a generic drug. I don’t believe this is a cost effective solution. Here’s my quick model which says that a company with a 60% generic fill rate would have to increase their generic fill rate by 8 percentage points to breakeven. I would argue that it is too big of jump to happen (at least within one-year).
Why? Because the 60% of people that are currently paying a copay which reduces the net cost to the client stop contributing.
February 9, 2010 0 Comments
This morning is a perfect example of why integrated communications are better. What do I mean by this? I mean where a communication campaign is designed using rules to coordinate events across multiple channels. Still too mumbo-jumbo…Where companies can interact with consumers across channels (e-mail, voice, print, web, call center) and create a seamless experience.
Here’s an example…
This morning, my kid’s school is closed due to snow. [Although the snow has passed and they’ve already plowed the side streets.] When I checked the Internet at 5:15, it wasn’t closed. At 5:40, I got the call that it was closed. BUT, the call comes on my home line, our home business line, and both our mobile phones. Somehow it didn’t wake the kids, but it could have.
I don’t really care about the over-communication in this example, but in a professional setting, this would seem like overkill and potentially a waste of money. In an integrated communications example, it might work like this:
This is always one of the big discussions we [Silverlink Communications] get in with clients in healthcare. What are the rules for escalation of communications? How do I track data in an integrated data set? What is the right timing between communications?
This is critical. Sending people a letter and a call or a letter or a call (for example) is pretty easy. Determining the next action based on their final disposition in the initial outreach is not.
Of course, the other question this begs is how many companies actually track return mail. I know a lot of companies don’t. If it keeps getting returned, they’re not processing this return mail and taking the bad addresses out of their member database.
February 3, 2010 0 Comments
A few weeks ago, I was staying at a very nice hotel and was shocked to find out that they had cleaned my room while I had a do not disturb sign on the door. [My general mode when I travel is to just leave everything out in my room and not have them clean until I check out.] I immediately called downstairs to ask what the heck happened. They told me that they just assumed that I’d made a mistake and keyed themselves in.
I was honestly shocked. I’ve spent a lot of nights in hotels and never had this happen. They said that if the sign is up both in the morning and afternoon they assume that the guest had forgotten about it. They then offered to put me on the “honor the do not disturb sign list”. Are you kidding me?
I guess my argument (linking it back to healthcare and communications) is that aren’t there some implied preferences. Unless you tell me different, shouldn’t you honor my requests? If I sign up for e-mails, you should send me e-mails.
For example, if a consumer (member / patient) gives a company their mobile phone number, don’t they expect to receive calls on that phone? I think so. Now, I don’t think that giving a mobile phone number as a “phone number” implies that the consumer is saying it’s okay to send them text messages.
The other issue here is around “educated preferences”. If a company knows that the best way to get someone to stay adherent with their medications is to remind them to refill them, should they make it easy for consumers to opt-out of that program? I don’t think so. I think they have to offer that option, but why make it easy. Patients think they will be adherent. Heck, a lot of patients think they ARE adherent.
Don’t corporate entities have a role in leveraging their data and experience to help people even if people don’t know they need help.
January 30, 2010 0 Comments
A few years ago, I think it was a lot harder to differentiate the positioning of the big 3 PBMs – Medco, Caremark, and Express Scripts. Over the past few years, I think they’ve taken different positioning paths.
Look at how their corporate descriptions how evolved over the past few years. They all used to focus on the PBM core services. Now, Medco talks about making medicine smarter; CVS Caremark talks about health services; and Express Scripts talks about Consumerology.
Medco 2010
Medco Health Solutions, Inc. (NYSE: MHS) is pioneering the world’s most advanced pharmacy(R) and its clinical research and innovations are part of Medco making medicine smarter(TM) for more than 60 million members.
With more than 20,000 employees dedicated to improving patient health and reducing costs for a wide range of public and private sector clients, and 2008 revenue exceeding $51 billion, Medco ranks 45th on the Fortune 500 list and is named among the world’s most innovative, most admired and most trustworthy companies.
For more information, go to http://www.medcohealth.com.
Medco 2006
Medco Health Solutions, Inc. (NYSE: MHS) is a leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy healthcare for private and public employers, health plans, labor unions and government agencies of all sizes. With its technologically advanced mail-order pharmacies and its award-winning Internet pharmacy, Medco has been recognized for setting new industry benchmarks for pharmacy dispensing quality. Medco serves the needs of patients with complex conditions requiring sophisticated treatment through its specialty pharmacy operation, which became the nation’s largest with the 2005 acquisition of Accredo Health. Medco, the highest-ranked prescription drug benefit manager on Fortune magazine’s list of “America’s Most Admired Companies,” is a Fortune 50 company with 2004 revenues of $35 billion. On the Net: http://www.medco.com.
CVS Caremark 2010
CVS Caremark is the largest provider of prescriptions in the nation. The Company fills or manages more than 1 billion prescriptions annually. Through its unmatched breadth of service offerings, CVS Caremark is transforming the delivery of health care services in the U.S. The Company is uniquely positioned to effectively manage costs and improve health care outcomes through its more than 7,000 CVS/pharmacy and Longs Drugs stores; its Caremark Pharmacy Services division (pharmacy benefit management, mail order and specialty pharmacy); its retail-based health clinic subsidiary, MinuteClinic; and its online pharmacy, CVS.com. General information about CVS Caremark is available through the Investor Relations section of the Company’s Web site, at www.cvscaremark.com/investors, as well as through the press room section of the Company’s Web site, at www.cvscaremark.com/newsroom.
Caremark 2005 (pre-acquisition by CVS)
Caremark Rx, Inc. is a leading pharmaceutical services company, providing through its affiliates comprehensive drug benefit services to over 2,000 health plan sponsors and their plan participants throughout the U.S. Caremark’s clients include corporate health plans, managed care organizations, insurance companies, unions, government agencies and other funded benefit plans. The Company operates a national retail pharmacy network with over 60,000 participating pharmacies, seven mail service pharmacies, the industry’s only FDA-regulated repackaging plant and 21 licensed specialty pharmacies for delivery of advanced medications to individuals with chronic or genetic diseases and disorders.
Additional information about Caremark Rx is available on the World Wide Web at www.caremarkrx.com.
Express Scripts 2010
Express Scripts, Inc., one of the largest pharmacy benefit management companies in North America, is leading the way toward creating better health and value for patients through Consumerology(SM), the advanced application of the behavioral sciences to healthcare. This approach is helping millions of members realize greater healthcare outcomes and lowering cost by assisting in influencing their behavior. Headquartered in St. Louis, Express Scripts provides integrated PBM services including network-pharmacy claims processing, home delivery services, specialty benefit management, benefit-design consultation, drug-utilization review, formulary management, and medical and drug data analysis services. The company also distributes a full range of biopharmaceutical products and provides extensive cost-management and patient-care services. More information can be found at www.express-scripts.com and www.consumerology.org.
Express Scripts 2005
Express Scripts, Inc. (Nasdaq: ESRX) is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to over 55 million patients through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans.
Express Scripts provides integrated PBM services, including network pharmacy claims processing, mail pharmacy services, benefit design consultation, drug utilization review, formulary management, disease management, medical and drug data analysis services, and medical information management services. The Company also provides distribution services for specialty pharmaceuticals through its CuraScript specialty pharmacy. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.
January 28, 2010 0 Comments
Express Scripts has been using Consumerology as their framework for member communications. I hadn’t heard much about what they were doing in the adherence area so I turned to the web. I found a few things that I thought people might be interested in. [Google is a wonderful tool.]
Last year, they had talked about the study in California with the power company and the influence that social norms had on power utilization. They were testing this. I found a presentation online that shows a cool graphic with some of the messaging. I’m not really sure if patients will get the concept of medication possession ratio (MPR) so I’m anxiously awaiting the results.
I also found a screenshot of sample adherence report which they’re using in a pilot with Vitality. [I’ll assume the data is mocked up and not real PHI.] I really like the report. I’m still torn on the GlowCaps concept in terms of whether consumers will use them, but they seem to have some good results. [And, I always try to remember that I’m not the average consumer so my opinion is just my opinion.]
The last thing that I found which was interesting was some FAQs on their auto-refill program. I remember pushing for this back when I was there, and I could never get the operations people and clinical people to approve it. This type of program is becoming the norm now for many mail order and retail pharmacies so I’m glad to see they have it in place.
December 28, 2009 0 Comments
I got this question e-mailed to me today. The patient has been using the same drug for years and it lost it’s patent about 6 months ago. They just found out that they could have saved a lot of money and wondered who should have told them. Here’s my thoughts.
So, with lots of nuances, my reply was that no one had a legal obligation to tell her, but they all had good incentives to do it. I suggest talking to the physician and/or the pharmacist.
October 21, 2009 0 Comments
The concept of preference-based marketing has been around for a long-time and continues to become a hotter issue especially in healthcare. The challenge, of course, is balancing what consumers know they want versus what they actually use. Ask anyone if they want an automated call, and the immediate answer is no. People think about those annoying “robo-calls” that use text-to-speech (TTS), have a pause when you pick up the phone, and are not personalized at.
On the flipside, look at the data and outcomes which intelligence, voice-based call systems produce…it’s amazing. People pick up the phone. People interact with the technology. And, the calls are highly personalized.
But, we are at an interesting crossroads about companies beginning to think thru and capture information about you. Do you want to be called at home or on your mobile phone? When is it okay to text you? What communications should come in print versus e-mail?
“Just 32% of marketing decision-makers surveyed in July 2009 said they knew how their customers behaved across channels, and only 37% were aware of consumers’ channel preferences.” (ExactTarget 2009 Channel Preferences Survey)
The survey also showed changes in channel choice.
October 20, 2009 0 Comments
As expected, employers are going to push more cost to employees (those lucky to still have coverage) in 2010. Everyone should have been expecting this. In an article on CNNMoney.com, a consultant from Watson Wyatt predicts 10-20% increased cost. A consultant from Mercer says the catch phrase will be “taking responsibility”.
If anything, this should help Obama and health reform. Having a huge cost burden pushed to you in one of the worse economies will force people to make tougher decisions and could have a negative impact on overall health. Additionally, it will push more people into high-deductible plans which require more transparency around cost and quality which while better these days still isn’t there for the masses.
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Contact me at gvanantwerp @ mac.com.
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