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Flooding

March 23, 2008 by George Van Antwerp 0 Comments

I am fortunate to live in high ground in Missouri, but this is definitely the closest the flooding has come.  As close as 2 miles away, my friends neighborhoods are almost inaccessible.  They had to have a fire department park in their neighborhood for a few days since once the water crested, there neighborhood would be unaccessible if there was a fire.  Very scary.

It reminds me of when I first moved to St. Louis in 1993 which was the worse flooding ever.  I have only begun to hear some concern for later in the spring when the record snowfalls up north begin to raise the water levels of the Mississippi.

Here is a few pictures from our local news site KSDK.

flooding1.jpgflooding2.jpgflooding3.jpg

Events, General Thoughts

Health 2.0: The Companies

March 6, 2008 by George Van Antwerp 1 Comment

This is the third of three posts that I intended on the Health 2.0 conference which just ended in San Diego. This one is really just a laundry list of some of the companies that participated.

For sponsors, I was able to grab their logos:

 


For other companies, here is a quick list of some of the ones that participated that I don’t think I already mentioned:

Consumerism, Events, Healthcare, Software, Technology
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Health 2.0: Observations

March 5, 2008 by George Van Antwerp 0 Comments

(Note that this is a follow-up post to my summary of the conference.)

First, I have to say that I feel old. At Monday night’s reception, someone guessed that I was late 40’s (not that there’s anything wrong with that but it’s a decade off). For years, I wanted to be older (as a young consultant). Now, I am happy to slow that process down. Then, I had dinner last night with people in their 40’s and 50’s that are talking about Twittering and online music services and blogging for years. I felt like I was a parent listening to their teenagers talk even though I consider myself pretty technology savvy.

Second, I think it was a great conference although the next step has to include the involvement of the establishment.

Third, as I heard several people say, this is very different than your typical healthcare conference. No suits. Lots of sharing across seemly competitive companies. Fairly pointed. Patients involved.

Finally, here are a few of the thoughts / comments:

  • How can we create data that stays with the individual (i.e., portability)? As patients build content and networks and document their disease online, what happens with the logical consolidation and shakeout in the space? Do they lose their records as companies eventually go out of business?
  • Are we inevitably going toward a two tier system of healthcare for the health literate and/or wealthy and all others?
  • Where are the VCs? There were a few here. Even if they don’t buy that there is a model yet. I would think they could get great market data from attending and listening to companies.
  • Can we avoid the dotcom issue of creating things that are important to us but not scalable? Given the lack of a mechanism for systemically engaging patients in product design, this myopic view is a risk.
  • There is a definite funding question here. Do you make these DTC (direct-to-consumer) models where they pay? Do you go to the payors and ask them to fund it for their members on some PMPM basis? Or, do you take advertising dollars? And, if you take pharma advertising (for example), does that change people’s trust in the site?
  • There was a brief discussion which I think is really important. Do consumers trust a site that is “anti-establishment” and less slick or are they okay with a more “corporate” feel to a site that gives them better functionality and a better user interface?
  • Corporate blogs and personal blogs seemed to be the norm. A lot of these are companies built by passionate people that are either patients or caregivers driven into the Health 2.0 space by some event in their life. They actively use blogging and other social media to engage with a community. I mentioned the blog a few times and felt like … “of course…who doesn’t have a blog.”
  • I brought it up over lunch and heard someone else bring it up over dinner, but there was not a lot of discussion around lifecycle / phase. Patients move from newly diagnosed to ongoing care and eventually into a late stage. The solutions and their needs are different.
  • There has been talk about the hospitality industry (i.e., hotels) using employees, family members, etc. to pump up their ratings. Not sure how you control this, but is this an issue for MD ranking sites?
  • I heard very little about how to address the unengaged. Most of these solutions are on those active patients that care about their health, know they have a disease, and are willing to spend the time and effort to manage it. Just like with prescription non-compliance, the biggest issue is not managing those who don’t refill but identifying those that should be getting a prescription based on medical claims (or eventually genetic markers). This is clearly where the establishment can help. Managed care companies could use medical claims to identify people that would be benefit from these solutions and drive them use them. Assuming an ROI based on less hospital visits or some other criteria, it should pay for itself.
  • There was some discussion about mandated care for the uninsured and whether that was just a gimmee for the existing infrastructure. So, is the government rewarding those that haven’t fixed the system so far? It’s interesting. It made me draw an analogy to the auto industry. Certainly, we could fix the industry by limiting public transportation, developing a low cost car option (e.g., SmartCar), and having the government require every family to purchase a car.
  • There was a little discussion around what I would consider a typical business IT issue. Should the best-of-breed survive or is it better to settle for some lowest common denominator but provide one, integrated solution to patients. Right now, you have to use lots of sites to get different things done.
  • I thought about that Robin Williams movie about Patch Adams several times. Is our model changing to be less about administrative efficiency and more about care? [Not that I believe for a minute that we are efficient in healthcare.]
  • It made me realize that I need to think through the “Patient 2020” about what they will look like in 12 years. Transparent access to data. Integrated online tools. EMR. PHR. Community and care network tools. It won’t look anything like what we are trying to solve today.
  • Not enough talk about wellness and prevention. Some. It came up at the end around the fact that technology is typically focused on end stage solutions that are very expensive and can’t scale. Most of what was talked about here is focused on early stages and is very scalable. Clearly, this space faces the same issues as disease management. It’s logical. It seems to work in many cases, but clearly proving ROI on comparative populations while avoiding regression to the mean is difficult.
  • I think it was a person from Digitas that brought it up, but there was a comment about whether Beta is okay in healthcare. I think as long as the Beta (i.e., unfinished product) is about the UI (user interface) and not the clinical content then it should be fine.
  • iMetrikus brought up the idea of “activity based plan design” which conceptually I like.
  • Some of the models presented seemed focused on the payors as customers but would get traction with individuals that would pay. It would be interesting to see a model focused on the payors but with a DTC option which was completely automated for sales and payment in order to make it scalable.

It is important to find more patients than those that were there to be involved and help shape the future solution. It’s like HealthCentral “kick-starting” their communities by finding and recruiting (and possibly paying) 100 patients to be their super-users. As long as they are actual patients with the disease, I don’t mind.

Events, General Thoughts, Healthcare

Health 2.0: My Notes

March 5, 2008 by George Van Antwerp 5 Comments

I am just flying back from the Health 2.0 conference out in San Diego. I feel like there is a ton of information that I want to share so kudos to Matthew and Indu for the great job. (And, if you make it to the end of this post, you must really like the topic.)

I decided the best way to do this is in three posts: (1) Notes; (2) Companies; and (3) Observations. [Some people were doing live blogging which I just couldn’t do and keep focused.]

Here are a few of the other blog postings about the event:

So, let me begin here with my notes from the conference which began Monday with some informal sessions (user driven) and a deep-dive on a new vendor American Well. [I missed this event since it was so packed that it was standing room only in the hallway, and I was 5 minutes late getting off a conference call. That being said, they were in there for 3 hours so there must be something pretty interesting.] Tuesday was pretty much packed from breakfast (7:00) until I got back from dinner (11:00).

Matthew Holt:

  • Talked about his Health 2.0 picture of search, social networks, and tools. And, at the end of the conference, he showed a preliminary sketch of the model for the fall Health 2.0 conference where each of these are blown out into smaller segments.
  • Talked about the challenge of wrapping context around transitions. [In a side conversation, I thought someone else made a great point of saying that one of the biggest challenges will be how to drive change.]
  • Talked about the four stages of Health 2.0. I was soaking it in versus scribbling notes madly so all I got were phase 1 (user-generated content) and phase 2 (users as providers). But, I believe the later phases do (or should) show these models integrating into the establishment.

Susannah Fox (Pew Internet & American Life Project):
[Who by the way was a very good speaker and refreshingly gave a 30-minute presentation w/o any slides.]

  • Talked about an early 2000/2001 quote from the AMA on not trusting the Internet and a push to the physician. [That seems to have softened a bit over the years.]
  • Said that 40% of adults in America have a high school education or less which gets right to the issue of health literacy.
  • Talked about validity of online data. Researchers want to see date and source, but patients don’t look for that.
  • Talked about an article in a cancer magazine about misinformation which said the most highly correlated factor was a discussion around alternative medicine. Those sites often had misinformation on them.
  • She set the tone for the day by using the concept of a seven word expression to summarize your talk. Her’s was “Go Online. Use Common Sense. Be Skeptical.”
  • Pointed out that only 3% of e-patients report bad outcomes based on online data. [I think this whole discussion around what patients want in terms of research versus experiential data from their peers is very interesting.]
  • Talked about the white space between a “physican is omnipotent model” (my words) versus a “patient self-diagnosis world”. That is where we have to find a solution.
    • [A person from Europe who I talked with said that not only is their model different but the fact that they hold the physician on a pedestal makes some of these things impractical there.]
  • Talked about a new term for me – “participatory medicine”.
  • Said that Pew had classified people into three groups not on the concept of do you own a mobile device (for example) but on how you use it (e.g., do you feel like the device interrupts your life when it buzzes you, do you require help in setting up your devices).
    • 1/3 of Americans are “elite tech users” who own lots of devices
  • There is still minority distrust of some of these online tools. Some of this is generational.
    • The memory of the syphilis experiment is failing.
    • There is limited discussion of faith in these discussion areas which is important.
    • The older generation typically has less technical skills.
  • Her next seven word expression was “Recruit Docs. Let E-Patients Lead. Go Mobile.”
  • She described African American and Latino users of mobile devices as leveraging it as a Swiss Army knife versus a spoon. [I hope I use it more as a spork…which I assume is evolutionary over the spoon.] They use it more than TV or computers.

Patient Videos:

  • One of the most engaging segments was a series of video clips from patients.
    • The founder of i2y.org (I’m Too Young For This) spoke about being diagnosed with cancer at an early age and how he overcame the physical challenges and has become a go to destination for people about cancer.
    • The founder of Heron Sanctuary in Second Life talked about how she has limited mobility in real-life and her ability to create a world in second life where she can help people and gave examples of how people are using this virtual reality tool.
    • A young woman with RSD talked about how she has used ReliefInsite to manage her disease and pain. She also had the same issue of being “too young” to have RSD and the challenges of finding a physician to help her and believe her.

The format for most of the day was to have 3-4 founders or executives from companies get up and talk for 4 minutes on their company. Then a panel of people would comment and questions would get asked. On the one hand, it was a compelling, fast-based approach that kept your attention. [No nodding off at this conference.] On the other hand, it was heavy on marketing and light on really drilling down on the problem. [Although I am not sure that was the purpose or even achievable without making this a multi-day conference.]

So…here were a few of my quick notes on some of the companies. I will post another one trying to look at some screen shots and other observations. If you didn’t get mentioned here, it’s likely because I was simply watching or distracted. Hopefully, I catch everyone on the Health 2.0 Company post.

  • WEGO Health – allows consumers to rank content…i.e., directed search…gave example of search for some health topic that returned 98,000 links on Google, but only 50 here…option to score after consumer uses the link
    • Seems interesting. How often is it updated? How do you build awareness? Can it be part of a broader search engine? Seems like a likely acquisition to be another option like images or desktop from a search criteria within Google.
  • HealthCentral – biggest brand you don’t know (or something to that effect)…have 40+ sites around specific disease states…6M unique visits per month…new VC money…100 “expert patients” found to create initial communities…ability to create inspirational cartoons that summarize your story…good GUI
    • I really liked some of the features they demonstrated (in 5 minutes). They talked about creating micro-communities (e.g., spouses of people with a disease).
    • The idea of “recruiting” 100 “expert patients” to build an active community was one of the best I saw.

In preparation for discussion on patient-MD solutions, someone shared that only 2-3% of MDs allow appointments to be booked online. There was discussion that patients don’t really look to the Internet to find a physician or hospital. They look at what’s in-network and they ask their friends. There was an example given for Yelp which is used to rank restaurants, but allows people to review the physician. [A comment I heard later was when will we see a site ranking the sites that rank physicians.]

  • Carol (company name) – talked about mall concept in that people shop for something like a physical or allergy test not necessarily a specific type of MD…provide cash prices and insured prices
    • Seemed interesting. I will have to think more about how I search.
  • Vitals.com – I talked about this company on the blog a few weeks ago…still like the graphics…saw a few other features that I hadn’t noticed such as customizing the search criteria and using slider bars so that you get weighted recommendations

I thought there was a good discussion on why would an MD participate in a ranking site.

  • Help them sub-specialize (i.e., I want to treat knee pain not neck pain).
  • Allow them to attract the right type of patient that matches their style and focus.
  • Ego…allowing them to manage comments.

IDEO, the famous industrial design, company facilitated a lunch workshop and talked at the conference. For simplicity, I will blend both notes here. (see old post about IDEO book)

  • Talked about user-centric design which is key. At lunch asked us to come up with a solution to address the problems of diabetes patients. Showed us four interviews with diabetics. But the stress was not on solving what we thought was their problem, but trying to actually listen to what they say and do in order to find something. Key point.
  • Talked about empathic research showing that we don’t say what we think, do what we should logically do an online car loan, or even do what we think we do.
  • Talked about a book called Thoughtless Acts.
  • Gave examples of project with Bank of America that showed how most people round up their credit card payments so they started a “Keep the Change” campaign which allowed them to attract 2M new members.
  • Walked through an example of creating the Humalog pen for Eli Lilly.
  • Talked about creating a new bike design.
  • All of them were common in the framework they use and their focus on the person/user/patient/member.
  • Lunch was an interesting workshop where you listened to the videos, identified issues, brainstormed solutions, picked a solution to “pitch”, and then shared your idea with your neighbor. At our table…
    • Saw problem largely as educational / informational
      • Don’t know what to expect
      • Don’t know where to get information
      • Don’t understand lifecycle and treatment plan options
      • Don’t know what to do with the pump
    • Talked about everything from portal to device solutions
    • Settled on an iPump concept that would blend an iPod with an insulin pump and foster a community around it to develop cases (e.g., a belt that it fit into as part of a formal dress), videos to download to it on education, connectivity to trigger auto-refills, etc.

Then we had several discussions by physicians that were blending the old model of house calls with technology. Seems very cool (for those that can afford it). Although one example was relevant, it missed the masses. One showed a trader who was too busy to leave the trading floor, but he had a sore throat so the physician came to his office, took a culture, and gave him an antibiotic.

  • One great point that they made was the benefit of seeing the patient’s environment (i.e., home) in helping them manage a disease.
  • I loved the fact that they would send me an e-mail with my notes from the visit rather than trying to scribble things down while they are talking.
    • Of course, this begs the question of literacy and teaching physicians how to communicate in simple, non-medical language.
  • Another great point was the issue of technology as a good unidirectional solution. For example, if the physician wants to know whether something works, an e-mail is very efficient if it does. Leaving a voicemail so that you play tag back and forth only to realize the patient is feeling better is a waste of time.
  • Jay Parkinson referred to himself as the “Geek Squad” for healthcare (think Best Buy computer technicians). Great analogy. He also showed this seemingly very intuitive and easy to use EMR called Myca which I believe he has built.
  • Somebody tied this back to the physician ranking discussion by asking how this new flexibility of business model would be captured and tracked on those sites (e.g., does MD respond to e-mail).
  • I can remember if I jotted this down or one of them said it but I have “More Time. Save Money. Less Costs.” I think this was in response to a question I e-mailed in about how these new models were affecting the compensation and lifestyle of the physicians.

Phreesia talked about their tablet solution (i.e., electronic clipboard) for the physician’s office. They had an interesting statistic that 49M Americans move each year so address data is constantly changing. (Not to mention plan coverage, drug use, etc.) They are getting 200-300 new MDs a month to sign-up for this.

I don’t see myself using it, but this is an interesting option. Organized Wisdom talked about their product LiveWisdom which allows users to leverage a live person (I assume MD or RPh or RN.) via chat to address questions they might otherwise contact their MD about. They pay $1.99 per minute.

  • As they admitted, they are limited in scope and often have to refer the patient to an MD. They seemed to me limiting, but creating an opportunity to partner with American Well who helps you find an MD, sees if they have time to talk, and launches an interactive video session and chat session with the MD right then for a pre-agreed upon rate.

There were two patients there that were involved in lots of feedback sessions. The first was a woman who has lost 144 pounds (w/o going on The Biggest Loser) and has become an online advocate and support mechanism for lots of people using DailyStrength. The second was Amy Tenderich who is a very active diabetic and blogs at DiabetesMine.

Amy’s story was great. Her blog is very engaging and as Matthew said it is “thought by many to be the #1 blog for patients“. I had a chance to talk with her and her husband and heard a lot about how it started and the response. It is a great story, and she is very knowledgeable and was willing to really push the patient-centric agenda at the conference.

Someone made the point about linking patient costs to compliance with their care plan which I have blogged about before. I completely agree that the patient should be rewarded for using self-service options (web vs. live agent) and for staying compliant.

ReliefInsite talked about their solution and shared that 1 in 6 Americans suffer from chronic pain. No matter what the CEO said, he couldn’t do better than the opening patient video which used their solution. (Which he said was a surprise to him.)…seemed like a good, interactive tools with nice reporting.

Emmi Solutions showed their online educational tool which had videos built in a conversational tone and used animation to help people understand procedures and their disease. Seemed great. Said that informed patients are less likely to sue.

MedEncentive is one that I will have to spend more time looking at. It plays to the incentive question and rewarding patients and MDs. They talked about a 10:1 ROI and said the medically literate patients have less hospital visits.

[Completely off topic, but from the conference, I heard someone talking about CouchSurfing which is apparently a “network” where you allow people (that you don’t know) to come sleep on your couch. I thought that died with hitchhiking in the 60s.]

A consultant from Mercer commented that some large employers with physicians on staff are more effective [at health and cost management] than small health plans. Not sure if that was a complement to employers or an insult to health plans.

BenefitFocus which automates the set-up of your benefits (imagine no more paperwork to enroll) had a great video showing the future with personal consultants (via hologram), biometric signature, and other cool things. [I have heard good things about them for years although they never returned my phone calls several years ago even with name dropping one of their biggest investors.]

Virgin Healthmiles was there and talked about their pedometer which is tracked online. They also have an employer kiosk for tracking weight and body fat. Offline, he also told me that they are rolling out connections which will be on the treadmills and other machines at participating gyms. I am a big fan of what they are doing. I believe he said they recommend 7,000 steps a day per person (and think he told me that 2500 is a mile).

Stan Nowak (my boss) presented the Silverlink story talking about using technology to engage patients, the importance of capturing data, extreme personalization, and showed recent success improving compliance by 3x by rapidly doing a series of pilots.

  • I am not sure I have figured out our seven word description but here’s a few attempts:
    • Patients Are Different. Personalization Matters. Be Proactive.
    • Preference Based Communications Engage Patients & Drive ROI.
    • Segment. Learn. Interact. Empower. Use Communications Appropriately.

iMetrikus talked about their solution which connects over 50 biometric devices today into backend healthcare systems. They charge $3 PMPM which caused me to raise an eyebrow. It is a great solution and integration is a nightmare, but that seems like a lot of money. But, I am all about ROI. If I can get better return on this than on another project and it exceeds my cost of capital, why wouldn’t I do it.

iConecto didn’t present but had a booth and introduced a section. But, I love the concept of using play (e.g., Wii) to drive health.

To be fair, I will even include my notes about Eliza Corporation (our competition). Their CEO and our CEO did a podcast with Matthew the weekend before which you can listen to here. The messaging is fairly similar (although I have a strong bias about why us). She talked about tailoring [of messaging] being the new black. She talked about using clinical and demographic data to drive programs. They are a good company, and it was well done. [I was even flattered that several of their employees said that they read my blog.] Both companies commented on how they feel old (~7 years) compared to a lot of the companies presenting here (~2 years).

  • One thing that I find strange is for two companies that pretty evenly split the healthcare marketplace for Strategic HealthComm is that we are located within 10 miles of each other near Boston.

At one point, there was a discussion around ROI especially on new technologies and how to get that first big project. One of the panelists said that a 1:1 ROI over two years would be sufficient. [Not true for any company that I have worked at or consulted to.]

The final panel discussion and closing statements had a lot of good content:

  • Discussion of the patient as a provider and what that could mean.
  • Discussion of importance of sharing information across solutions.
  • The concept of citizen (European) versus patient.
  • From the Wired magazine participant, discussion around fidelity versus flexibility:
    • Disk versus MP3
    • HDTV versus Tivo
    • Microsoft versus Google
  • Importance of moving upstream in care
    • Disease management
    • Wellness
    • Prevention
    • Diet
  • As part of upstream discussion, talked about involving the food companies and used the analogy of inviting the oil companies to a green conference. [I wondered where the MCOs were, the hospital networks, and the politicians.]
  • The author of the book “Demanding Medical Excellence” (who I believe is part of the Health 2.0 staff talked about “random acts of doctoring” and the issue of solving healthcare for the few or the masses.
  • Indu talked about building a new system versus extending and improving the existing system. [A great question]
  • I think it was Matthew that brought up the issue of designing for credibility.

Wow! If you made it through this thesis, good for you. I hope it’s helpful. It is certainly easier than me trying to find my notes two months from now or sending a bunch of e-mails to people on sections they might find interesting.

Books / Articles, Business Tools, Consumerism, Events, General Thoughts, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Software, Technology, Value Propositions, Weblogs

Webinar: Prescription Trend Mgmt Through Communications

February 28, 2008 by George Van Antwerp 0 Comments

I must admit that one of my favorite things to do is give presentations. I used to do a lot of webinars at Express Scripts and have done a few others as a consultant. So, with that, I am really excited to schedule my first webinar as a Silverlink employee which I am going to do on my favorite topic – pharmacy trend management (i.e., brand-to-generic, retail-to-mail, utilization management).

So, if you’re a managed care company, PBM, or pharmacy that is interested, sign up for the event. I will talk about some of the common myths in driving patient behavior, talk about how to use speech recognition technology, and share some lessons learned and results and ROI examples.

I can’t post HTML here so the link below won’t work, but you can click here to register. Thanks.

webinar-pharmacy.jpg

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Technology, Value Propositions

A Second Look – Eli Stone Controversy

February 28, 2008 by George Van Antwerp 2 Comments

I must admit when I saw there was controversy over the content for the premier of the new show Eli Stone that I was really surprised. My view was that it was a show with an interesting story line not a news report. I honestly didn’t realize that the topic of vaccines causing autism was a real topic. (Maybe I just haven’t paid attention.)

I saw several blog entries about it:

I think the quote from another About.com section sums it up pretty well from what I have read:

“I personally believe that the vast majority of people involved in this debate are telling the truth as they see it. But those truths are in direct conflict with one another. That’s where the writers of Eli Stone got it right: today, in the autism community, we are living through what feels almost like an epic battle. Whose truth is truer? Until some as-yet-undefined event provides absolute certainty one way or another, people will continue to take sides based on their beliefs and on the evidence – valid or not – of their own eyes.”

I am clearly not a clinician and haven’t done the research on this topic, but I find it interesting. I likely would have let it slip by me except when I picked up the USA Today on Tuesday I saw a full-page advertisement titled “Are we poisoning our kids in the name of protecting their health?”. It caught my attention so kudos to the designer. So, I read the advertisement and went to the website for Generation Rescue to learn more.

“We surveyed over 9,000 boys in California and Oregon and found that vaccinated boys had a 155% greater chance of having a neurological disorder like ADHD or autism than unvaccinated boys.” [see their study details here]

From the advertisement, it points out that the autism rate in the US in 1883 was 1 in 10,000 and in 2008 is 1 in 150. That is pretty scary. When I was a kid, I don’t remember knowing kids with autism or ADD/ADHD or peanut allergies or lots of other conditions. Today, I know and have friends with kids with each of these conditions. It certainly is more prevalent (or more diagnosed).

The point of the advertisement is that we have increased the number of vaccines we give our kids from 10 to 36 since 1983 and that the over-immunization with toxic ingredients (mercury, aluminum, formaldehyde, ether, antifreeze) and the live viruses have caused this. Of course, the Centers for Disease Control (CDC) and the American Academy of Pediatrics dispute this. I don’t know the answer, but I know that it’s not easily going to get resolved and no magic trial like the show is going to resolve it. It’s not different than many issues in healthcare where there isn’t great comparative data and things are not black and white.

Anyways, watch the show. It’s good. On what the right answer is. I don’t know.

generation-rescue.png

Events, Healthcare, Marketing / Communications, PBM / Pharmacy, Research, Weblogs

PBMI Day One Notes

February 27, 2008 by George Van Antwerp 0 Comments

Just getting back from the first day of my first PBMI conference. Very pleased.

Here are some notes / observations:

  • PBMI was bought in the past 2 years by PSG (Pharmaceutical Strategies Group) which interestingly has numerous ex-Express Scripts people working there.
  • Great opening speaker (E. Kinney Zalesne) who is the co-author of Microtrends (a few blog comments about it). Fascinating set of facts about small (and often influential) groups within the US. You can learn more at their website www.microtrending.com. [Note: I have not read the book yet.]
    • Compared today’s Starbucks economy (everything customized) to the Ford Economy
      • How you look ($12B cosmetic surgery market)
      • Who you marry
      • How you pray
      • Your gender
    • Talked about moving from Megatrends to Tipping Points to Microtrends (versus fads)
    • Said we drink 10x more water today than in 1980 BUT at the same time, the fastest growing beverage segment is energy drinks
    • There are 2-3 new religions formed everyday
    • There are 5M people over 65 working today…which will have huge benefit implications
    • Talked about DIY (do it yourself) Doctors as a group of people who use the Internet to self-diagnose and treat MDs as an ATM (here’s is what I need from you). Described the group as mostly woman and typically younger. Linked the growth in OTCs from $2B to $15B to this trend.
    • Said 3/5 people worry about hospital errors.
    • Good quote: “Better we understand people; the better we can serve them.”
    • Said young people today think of being on prescriptions as normal.
    • Talked about the “30 Winkers” or 16% of adults that get less than 6 hours of sleep a night.
      • 2/10 adults say lack of sleep has led them to make an error at work
      • Sleeping only 6 hours a night increases your probability of being obese by 23% and if you only sleep 4 hours then it goes up to 70+%.
    • Talked about looking for microtrends versus fads.
    • Said they might have a microtrend spotting competition on their website soon.
  • There was a VP of HR who talked about the importance of communications around benefit information.
    • Repeat the message but change it so you don’t de-sensitize the audience.
  • Matt Gibb (Chief Clinical Officer) from Medco presented on Extreme Generic Dispensing with several interesting comments:
    • Talked about how insulin and coumadin are the top two drugs that drive HR admissions
    • Called Therapeutic MAC a “draconian” benefit structure.
      • Therapeutic MAC means that the plan covers $X for a class.  (E.g., you have $30 per month for cholesterol lowering drugs.)
    • Showed a sliding scale of programs which a company could use to influence trend ranging from low impact on consumers and low savings potential to high on both.  Here are a few from low to high.
      • Decision support tools
      • Copay waivers
      • Coupon mailing
      • Maintenance medication program
      • Generous generics (which I guess is a benefit plan with a low copay for generics)
      • 3-tier
      • Co-insurance with POS rebates
      • Brand only deductible
      • Mandatory generics (which I can’t believe is this far up)
      • Mandatory mail
      • PA
      • ST
      • High Performing Formulary (which sounds a lot like the product I ran at Express Scripts called High Performance Formulary)
      • Therapeutic MAC / Reference-Based Pricing / Reverse Copay
    • Showed their 2006 generic fill rate at 58% with the remaining 42% being broken into 4 categories:
      • 17.4% where there was a brand with no generic alternative
      • 4.5% where the brand is less expensive than the generic alternative
      • 11.1% where the brand has a generic alternative (i.e., you should be at 68% GFR today)
      • 9.0% where there will be a generic alternative by 2009 (i.e., you should be at 77% GFR in 2009)
    • I must admit I was confused / surprised when he revealed that their “emerging solutions” for driving generics included the following which I think of as basic programs:
      • Mandatory generics
      • Co-pay waivers
      • Generic step therapy
      • Co-insurance
    • I did think their idea of a benefit design where generics and mail order prescriptions don’t count against your deductible was interesting.
    • I was a little surprised when he mentioned (without discouraging) clients offering generics at $0.
      • The economics (every time I modeled it for clients) don’t work since you have 50% of people getting generics and paying a copay which you just lost.  You would have to improve generics significantly to even breakeven.
    • I (and many people I asked) was surprised with his response to the question of what was a “significant” difference in copays between brand and generic to drive behavior.  His answer was $15-$20 which he said was based on what pharma believes is important to get rebates.
    • I did like the fact that they had clients fund a free first fill of OTC Zyrtec to promote moving to the OTC rather than another Rx.
    • He walked through some of the great statistics they have had from their MyRxChoices web tool.
      • Versus a control group, those that got a letter encouraging them to go to the web and used the website.  58% more likely to change to lower cost drug or channel.  51% conversions from brand-to-generic.
    • He also talked about the importance of rebates in PBM pricing which seemed out of place in the generic discussion.

Several things that came to mind listening to the presentations and perhaps for another post were:

  • Would / could we ever get to an individualized benefit which allocated X dollars and allowed the patient to choose what was included (e.g., tatoos)?
  • What would be the implication for recruiting / hiring if we could create a healthcare cost index similar to a credit score that didn’t tell potential employers what your medical conditions were but gave them an estimate of your medical costs?
  • What are the implications of driving consumerism to web tools which patients use at work when more and more companies use monitoring tools to track keystrokes and web visits?  Will they accidentally learn about private healthcare information?
Books / Articles, Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

Medicare COB Conference

February 21, 2008 by George Van Antwerp 0 Comments

If you are a Medicare provider, you might be interested in a conference Silverlink is hosting on Coordination of Benefits (COB). It is open to potential clients only, but here is the general information. If you are a potential provider, here is the basic information about the event.

Medicare Compliance: Strategies & Tactics for Complying with Medicare COB/Working Aged Survey Requirements

  • Wednesday, February 27, 2008 at 1:00 EST or
    Thursday, March 13, 2008 at 1:00 EST
  • 1 Hour

With Medicare requiring annual surveys of all members on alternative insurance coverage by September 1st, Medicare Advantage and PD plans need to develop their strategies now. These COB and Working Aged Surveys can be complex and lengthy for the member and operationally challenging for plans due to specific data formats CMS mandates. Learn how Silverlink and industry leaders are handling these requirements through active data management and proactive comprehensive communications campaigns that deliver measureably better results.

If you’re interested, here is a link to submit your information.

Events, Healthcare, Managed Care, Methodology, Research, Value Propositions

Drug Mix – Saving You $300

February 20, 2008 by George Van Antwerp 1 Comment

You can go and buy the AIS audio conference on drug mix for $300, or I will give you my executive summary of what you likely would hear.  (Note: I did not listen but used to do these presentations.)

Here is what they say they will address:

  • How an optimal drug mix can result in significant savings
    • Brand drug = $100 less network discount plus dispensing fee less copay less rebates…let’s call it$60.
    • Generic drug = $40 less network discount plus dispensing fee less copay…let’s call $5.
    • You save $55 for each prescription you move to a generic.
    • Each 1% improvement in generic fill rate = 0.75% – 1.00% reduction in pharmacy spend.
    • 14 Rxs PMPY * $50 average cost per Rx = $700 PMPY
    • 1% of $700 = $7 PMPY for a 1% improvement in generic fill rate
    • 100,000 member plan saves $700K per year
    • And, inflation on generics is much less than inflation on brands year-over-year
  • How drug mix has become a  factor in selecting a pharmacy benefit manager
    • First, I have to say that this is great positioning.  For years, we tried to convince clients and consultants to weigh this in proposals with limited luck.  So, change it to imply that it is what’s done.
    • You would much prefer a PBM that guaranteed you that it would improve your generic fill rate by X points that simply getting a slightly better discount.
  • What PBMs and plans must do — and NOT do — to develop the best drug mix
    • Make sure you have at least a $15 difference between your generic copay and brand copay
    • Lower your generic copay to less than $10
    • Have a mandatory generic plan in place (i.e., the patient pays the difference if they want the chemically equivalent brand…unless they can prove they have a rare allergy to the dye)
    • Use a 3-tier formulary
    • Reach out to patients and tell them when they should discuss generic alternatives within the class with their physician
    • Offer to waive the patient’s copay if they switch to the generic (Don’t just drop your generic copays to $0…you’re just wasting money.)
    • Consider implementing a step therapy program which requires generics as first line agents
    • Drive web utilization of tools that show patients how they can save money
  • What types of member incentives are most effective in driving optimal drug mix
    • You’re saving $50 times all their refills…share some of it – points, coupons, copay waivers, gift certificates
  • How plan sponsors can evaluate drug mix
    • Not easy.  There are no apples to apples.
  • How contractual mechanisms can ensure accountability for achieving drug-mix goals
    • Look for a trend guarantee or a GFR guarantee tied to beating the overall market
    • Or look for an average price per Rx guarantee holding your copays constant
  • How other factors, including drug pricing and discounts, must be evaluated by plans and PBMs at the same time as drug mix
    • Discounts are important
    • Rebate share is important…at this point you should be getting 100% of rebates
    • Understand how your PBM makes money

I am not in the business anymore so I don’t have all my traditional back-up slides to cover it, but there are some simple tools that will really drive your savings.  Set-up the right plan design and then communicate and promote the lowest cost solution to your patients in a convincing way that they take action.

Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Value Propositions

Are You Going To PBMI or Health 2.0?

February 15, 2008 by George Van Antwerp 4 Comments

If you are going to either the PBMI conference in Phoenix (2/26-2/29) or the Health 2.0 conference in San Diego (3/3-3/4), I will be there.  Drop me a note ahead of time or look me up when you are there.  Thanks.

Consumerism, Events, Healthcare, PBM / Pharmacy

On Vacation

January 17, 2008 by George Van Antwerp 0 Comments

I keep thinking I will get through my pile of draft posts to do a big data dump of ideas in the blog, but I have been crunching all week to get some major deliverables pulled together.  It’s now almost 11:00 for the 4th night in a row.

Given that I leave tomorrow and have one big item to finish up, I am not sure I will get all (or any of) my ideas posted.

Events

The Next Health 2.0 Conference

January 8, 2008 by George Van Antwerp 0 Comments

If you’re interested, the next Health 2.0 conference agenda has been released.  It looks like it will be even more interesting than the first conference.  From the agenda, you will see that Matthew and Indu have organized a good mix of large healthcare companies (McKesson, Kaiser, Regence) with new and rapidly growing healthcare companies (BeWell Mobile, Silverlink, ReliefInsite, Xoova) and one of my favorite companies IDEO.

If you work in healthcare, you should think about attending.  If you’re a patient, you will find some of the ideas and the new companies interesting.

Consumerism, Events, Healthcare, Technology, Weblogs

BCBSA President Interview on Forbes.com

December 29, 2007 by George Van Antwerp 0 Comments

If you are interested in what the president of the Blue Cross Blue Shield Association is talking about, you can see a quick 5 minute video interview on Forbes.com.  He talks about his original vision when he joined of wrapping a strong national support organization around a group of companies that are embedded in the local areas and serve 100M people nationally.  He talks about working with the government to figure out the “superhighway” needed to drive interoperability across plans to allow Electronic Health Records, Personal Health Records, and e-prescribing to be successful.  He also touches on the issue of how to better use and share the data across plans to improve healthcare quality.

Events, Healthcare, Managed Care

The ESI Outcomes Conference

December 13, 2007 by George Van Antwerp 1 Comment

It was always fun to prepare for our annual Outcomes conference at Express Scripts. What research did we have? Who would it surprise? How would it impact us or clients? Anyways, all of these presentations and even some audio are on the website (2004, 2005, 2006, 2007). I pulled a few slides / graphs with some key points below.

Is there compliance elasticity with prescription drugs? Of course. The research team replicated a published study and found results that were much less dramatic and echoed prior research supporting the following. (elasticity in this case meant that for each 100% increase in the cost of the drug what was the decrease in utilization of the drug)
elasticity-esi.png

The differential between your brand and generic copays makes a difference in your generic fill rate (GFR). The data supports the null hypothesis that would say that the greater the difference (i.e., the more the patient saves) the higher the use of generic drugs.

Why are people non-compliant (actually from the WSJ)?

A question I often hear is what percentage of people call into the call center. Obviously this varies by population, but as shown below, it also greatly matters by how aggressive the plan design is and how many changes they are making.

The next question should be whether disruption (measured by the proxy of inbound call volume) is worth it. So, the slides show the trend versus the call volume.

Sticking with the theme, the question is how long does the disruption last. Not too long.

It is never easy to get information out to patients in a timely and effective manner, but the question that also had to be asked is whether they wanted the information. From a 2002 Express Scripts survey:

  • 74% “feel more valued” when they understand the rationale behind their benefit design.
  • 85% “want information” about how to save money on their prescription drugs.
  • 80% feel “more in charge” when they understand choices
Books / Articles, Events, Healthcare, PBM / Pharmacy, Research, Value Propositions

Shot Across the Bow or First Blow – Walgreens

November 30, 2007 by George Van Antwerp 0 Comments

arrow.jpgI expected to see a lot more buzz yesterday after Walgreens announced that they were going to pull out of several contracts with CVS/Caremark over reimbursement.  Obviously, the two are huge competitors so I don’t find it surprising at all.

I assumed CVS would push on Walgreens through their PBM contracts.  What I wonder is whether this is a shot across the bow by Walgreens in a very public manner or whether this is the beginning of multiple blows back and forth between the two companies.  It should be very interesting.

The announcement: “After many months of talks over unreasonably low and below-market payment rates by CVS Caremark Corp. for four prescription plans, Walgreens today withdrew as a pharmacy provider from the plans.”

Affected Plans: ArcelorMittal, Johnson Controls, Inc., Progressive Casualty Insurance Co. and Wisconsin Education Association Trust.

A few quotes from Trent Taylor (president of Walgreens Health Services):

“This is not where we wanted negotiations to lead”

“We’re sorry that our pharmacy patients and CVS Caremark’s clients are caught in the middle, and we’ll do all we can to ensure a smooth transition for our patients to another pharmacy.”

“Leaving a benefits plan is an extraordinary step for us, but it demonstrates how extraordinarily low our payments were from CVS Caremark. We can’t continue accepting reimbursement rates that are drastically below market, while offering patients needed special services such as 24-hour pharmacy access and drive-thru pharmacies.”
“In an effort to be as open and transparent as possible in negotiations, we even offered to open our books directly to the employer groups and show them how much our pharmacies are paid by CVS Caremark,” said Taylor. “Unfortunately, CVS Caremark wouldn’t allow us to do that.”

A few editorial comments…

  • Why does this play out in the press?  This is the same thing that both of them did when they opted out of the mandatory mail networks for several clients.

  • I can’t imagine that the individual pharmacist who actually has the patient relationship at Walgreens is going to be really happy about this.  It is one thing at a corporate level, but very different in the trenches.

  • I don’t buy the argument of “special services” such as 24-hour and drive-through pharmacies being a reason to justify higher cost.   Nice features.  I am surprised he wouldn’t have talked about value delivered – generic substitution, formulary compliance, medication therapy management, etc.

  • I love the last comment about opening the books.  Would he do the reverse and open up the books for how much their PBM pays CVS, how many lives they have on mandatory mail, their costs, etc.?  It’s always great to offer something that you know can’t happen.

Events, Healthcare, PBM / Pharmacy

The Express Scripts Outcomes Conference

November 28, 2007 by George Van Antwerp 1 Comment

In my time at Express Scripts, one of the most interesting events was our Outcomes conference. We invited about 700 clients to come to beautiful St. Louis for 3 days to hear from our research group on trends and new programs to manage pharmacy benefits. All the large PBMs (Medco, Caremark, Express Scripts) put out annual publications on their research.

Express Scripts puts the publication along with the slides and audio out on the Internet. Here is a quick summary from 2007 which I took from the website.

  • Brand prices rose 6.9% in 2006, while generic prices fell 5.7%, which shows how generics continue to play a major role in managing prescription-drug trend.
  • 2006 drug trend of 5.9% – lowest in a decade.
  • More than $50 billion worth of brand drugs are scheduled to lose patent during the next five years. Important examples include Prevacid® in 2009 and Lipitor® in 2010.
  • Twenty percent of drug spend comes from specialty medications, but relatively few people use these types of drugs. This portion is projected to grow to 26% by 2010.
  • There are over 600 biopharmaceuticals products in the pipeline. This trend is being driven by the Human Genome Project, breakthroughs in the field of biopharmaceuticals, and a philosophical change in the pharmacy industry.
  • A growing number of members are becoming engaged in their decisions about prescription drugs, seeking information on drug-therapy alternatives and the prices of these alternatives. For example, 21% of the users on Express Scripts’ website used the Price Check feature during Q4 2006.
  • What Patients Don’t Know About Their Prescription-Drug Benefit
    • 64% could not correctly identify the type of pharmacy benefit plan they enrolled in.
    • 60% could not correctly identify the amount of their generic copayment.
    • 50% indicated their physician or pharmacist never or seldom talked to them about generics.
  • Several active ingredients work to influence the effectiveness of the information that plan sponsors provide to members:
    • Opportunity – Making sure you provide the information at the time in which the member is most engaged in the decision-making process.
    • Incentive – Members sometimes need an additional short-time incentive to choose the lower-cost option.
    • Assistance – Changing medications requires considerable assistance, which provides a barrier in making this adjustment.
  • The hypothesis was that Part D beneficiaries would take advantage of lower-cost generics to avoid hitting the donut hole. However, the reality is that many beneficiaries are hitting the donut hole unnecessarily and could take advantage of lower-cost generics.
  • Express Scripts’ research has shown that there is a direct correlation between a higher generic fill rate and the lower percentage of members reaching the donut hole.
  • The hypothesis from Wal-Mart was that low prices on selected generics would result in more volume of other generics and brands as well as increased nonpharmacy store sales. However, their market share increased by just 1% overall, which lead to a minimal market impact on prescription-drug use. Three reasons for this minor effect:
    • Members didn’t always save as much as advertised, and the payment was closer to $6 due to program limitations.
    • Members did not want to unbundle their prescriptions and use multiple pharmacies.
    • Many patients do not consider Wal-Mart a convenient choice.
Books / Articles, Consumerism, Events, Healthcare, PBM / Pharmacy, Research

Student Ideas

November 23, 2007 by George Van Antwerp 0 Comments

entrepreneur_2002_cover.jpgWhen I got my MBA at Washington University, we had a business plan competition.  [Which I won one year and took second the other year.]  It was fun and challenging.  You got to present to a group of CEOs at the end.  (Mine included Chuck Knight (Emerson Electric) and Andy Taylor (Enterprise Rent-a-Car)  But, it was more an exercise than starting a company.

As entrepreneurship has become a big focus in business school, this has taken on a life of its own.  Wash U, like many schools, has staff dedicated to this.  The business plan competition has corporate sponsors and now VCs come to look at the ideas.  Additionally, entrepreneurs give their ideas to students to work on for 6 months and flush them out for them. 

What I found interesting was the number of business plans written this year that had a healthcare focus.  They have a website called IdeaBounce where all of these are posted.  I took a few bullets from there to highlight here: [to see the specific ideas from this competition on IdeaBounce sort it based on programs [Olin Cup] on the right hand side of the screen]

  • Medi-bite is a medical device company that has developed technology to facilitate the recovery of people affected by temporomandibular (jaw) joint injury.   Temporomandibular joint injury affects 100,000 people in the U.S. annually. Injury makes eating difficult, interferes with speech, and often reduces one’s effectiveness on the job. The standard of care involves physical therapy sessions, and is often painful, inconvenient and insufficient to treat the condition fully. Medi-bite has developed technology to address these unmet needs.

  • Medobo is a company that provides services and tools for medical patients to holistically manage their health online. medobo retrieves medical records and consolidates them into an easy-to-use, secure, and private online personal health record (PHR). medobo also provides appointment and prescription management tools, a library of medical research, and a targeted medical web search engine.

  • Over 6,000,000 patients enter US emergency rooms annually complaining of abdominal pain. Current method of diagnosis of appendicitis is difficult because of considerable overlap with other clinical conditions, (15-40% error rate)! We are developing a blood test to accurately diagnose appendicitis within 5 minutes. Our company is working on identifying biomarkers from clinical samples. We hope to develop low cost, point-of-care, disposable diagnostic strips to clinicians in emergency room. We are an early stage company looking for financial, business & logistical support to execute our plan

  • You’re sick and at your doctor’s office – why not pick up your prescription while there? MedBox offers a Web-enabled, robotically controlled, videoconferenced dispensing pharmacy for doctor’s offices, run by local pharmacies. In the $200 billion prescription marketplace, where no company has more than 10% market share, this new paradigm places diagnosis and treatment in the same place – convenient for consumers. MedBox is easier for patients and doctors, attractive to insurance companies and profitable for pharmacies by streamlining an antiquated healthcare system.

  • Personal Pediatrics is a platform by which pediatricians in its network can dramatically take control of their practice. Physicians who adopt its retainer-based house call practice method provide HIPAA-compliant, boutique, patient-focused health care. Dr. Hodge has developed the Personal Pediatrics care model in her St. Louis practice for more than two years, tailoring offerings to consumer needs and designing technology solutions to replace high physician overhead.

Some of the biotech ideas were also impressive.  It has come a long way from where it was in the early 90s.

Events, General Business, Healthcare, Innovation, Technology

Zyrtec to Go OTC

November 21, 2007 by George Van Antwerp 1 Comment

By now, everyone should be familiar with Claritin (loratadine) and Prilosec going OTC.  They were really the first two blockbuster drugs to go OTC (over-the-counter).  Motrin / Advil is available both as a prescription strength and OTC.  Zantac (ranitidine) is also available OTC.

From a personal perspective, I am happy.  I have two kids with allergies that are on Zyrtec (which is off formulary) and where I pay $50 / month per kid.  I also find this an interesting DTC (direct-to-consumer) challenge for managed care plans and PBMs.  I had the opportunity to run both of our programs (Claritin and Prilosec OTC) at Express Scripts for this which included coordinating with modeling and clinical teams, designing the communication strategy, talking with clients, and helping drive OTC utilization where clinically appropriate.

From some initial research, I found the following:

  • Zyrtec (5 and 10mg tablets and 5 and 10mg chewables) and Zyrtec-D (1mg syrup and extended release) were approved by the FDA to go OTC. (article)
  • McNeil Consumer Healthcare (subsidiary of J&J) will be responsible for the OTC products.
  • McNeil has said the products will be available in late January 2008 and will be less than 1/3 the price of the prescription.
  • Non-Sedating Antihistamines (NSAs) represent 7.8% of the commercial Rx market and Zyrtec had about 37% marketshare in 2006 (generics had greater than 50%) with a typical member using 3.65 Rxs per year (or 0.29 Rxs PMPY).  (per Express Scripts Drug Trend Report)

Taking common Rxs to OTC status makes a lot of sense, but also creates a lot of questions:

  • If there are interactions with the drug but it no longer shows up as a claim, does this create a DUR (drug utilization review) problem?
  • Do pharmacies make more money on the generic Allegra or on the OTC?
  • For PBMs that make spread on claims and/or get a claims administration fee, how do they align their incentives with their clients (employers, managed care) that would prefer to see the patient use the OTC?
  • Which costs less out-of-pocket…the generic Rx or the OTC?

So, what should you do?   If you’re a consumer, you will likely hear something from your employer, managed care company, PBM, or pharmacy.  If your a company, you need a creative plan to execute against.  Contact me to learn more about how we (Silverlink) are going to help our clients.  [I can’t give away all the secret sauce here.]

But, if you are generally interested in this topic, here are a few links for you:

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research
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AHIP Panel

November 13, 2007 by George Van Antwerp 0 Comments

I am at the AHIP meeting here in Chicago. This morning, I had the opportunity to facilitate a panel which included three speakers on the topic of communicating with members:

It was a great discussion with strong attendance. I think we had 20 people standing in the hall outside the room listening for an hour. Here are some of the questions we discussed. Since I normally give my opinion (and couldn’t this morning), I will here. [And, since ½ the questions were ones that I thought of on the spot, the panel did great on their feet.]

  • How has Medicare Part D changed the way that healthcare companies interact with consumers?
    • It has forced them to think about members as consumers. They can vote 100% with their feet (within a window). And, this is the group with the most spend and highest utilization. They require segmentation and new services to drive behavior. All of this is new.
  • Healthcare is a front page topic in the news and the upcoming election. How has this changed consumer expectations for healthcare communications? And, what are the top 3 challenges for dealing with this consumer?
    • Consumers know what to expect and what to ask for. They want transparency (whatever that means to them). They want information. They expect companies to do more than simply react to claims. There is a proactive expectation and patients are comparing them not to healthcare companies but to retail companies like Nordstroms or Disney. (see blog entry on “If Disney Did Healthcare“)
    • The top challenges – understanding what is valuable to them, understanding how they digest and react to information, and providing them with a single face that isn’t disjoined across functional areas, business units, and external companies.
  • In most companies, there if no “patient ombudsman” that drives branding and message consistency. How can healthcare companies overcome this functional or process “silo” approach to communications?
    • Companies need to do a communication audit to understand how communications get out the door and how many communications a patient receives. They need to integrate their programs (inbound and outbound) and set a series of rules and triggers to manage communications across all medium. They also need to establish processes that are integrated cross-functionally to initiate communications but reference them back to a corporate set of rules.
  • Up until recently, much of the members experience with the plan was based on the service experience they got from the inbound call center. How has that changed and what are the elements in this new world that will drive satisfaction and loyalty?
    • I don’t think much has changed. The high utilizers of heathcare are still seniors. As someone else first said “pushing Health2.0 to a 1.0 population is difficult”.
    • But, I think that retention and loyalty are new and important. Most companies don’t understand satisfaction at an individual level. Nor have many health plans embraced loyalty type programs. Personalizing the value proposition, constant communications, and establishing incentives to drive healthy and cost effective behavior is essential.
  • Every company struggles with budget and ROI. The key is getting more for less. How are companies optimizing their communications and are they embracing a permission based approach as in the right message to the right person at the right time via the right channel?
    • Companies are aggressively looking at communication objectives and think through how to use multi-modal approaches. No one has really figured out permission based marketing (that I know of). Having a clear purpose for touching a patient and finding a metric to study the impact of that communication is essential to developing an ROI. Communications (and your vendors) have to have shared incentives that drive the right behavior which is focused on clear ROI.
  • Give me your craziest idea about how technology can change the healthcare communication framework over the next 5-10 years?
    • Integration of health, Rx, and lab data into a PHR that is embedded in a smartcard and which launches proactive communications to the health team using intelligent, learning algorithms which are personalized based on individual genetics
  • Since MDs, RPhs, and RNs are some of the front line contacts for patients, how do companies engage them to drive behavior?
    • This is still the problem. These people are so focused on care and so bombarded with information from multiple payors that unless there is a concentration from a single payor or technology that doesn’t impact their workflow it is hard to get them involved. And, in many cases, without P4P (pay for performance), there may not be much of an economic incentive for them to do things differently.
  • How will things like JD Powers and HEDIS focusing on communications and measuring satisfaction impact communications?
    • I think this is the key. Plans need to get scored, ranked, compared, and published relative to what they do, how they do it, effectiveness, cost per success, complaints, and patient satisfaction with the communications.

I am getting a little wordy here so let me move on. The point is that this is a great topic with lots of passionate people figuring it out. I have seen more consumer packaged goods people coming into healthcare over the past few years than anyone could have imagined a few years ago.

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology

Mental Health

November 1, 2007 by George Van Antwerp 0 Comments

I meant to post this during Mental Health Week (Oct 7-13), but I obviously missed the window.  This was from an American Airlines magazine (Hemispheres) that I read a few weeks ago. 

“Many physical conditions are a result of mental issues, for instance, sleeping too much or too little and having low energy.”

Obviously, this is a sensititive issue to discuss at work.  No one wants to be seen as having problems.  But there are lots of treatments and many conditions such as depression and ADD/ADHD can be treated.  The article goes on to mention several other things:

President Bush said “Americans must understand and send this message:  Mental disability is not a scandal – it is an illness.  And like physical illness, it is treatable, especially when the treatment comes early.”

  • 1 in 5 adults will experience a diagnosable mental illness in any given year (and 15% of those will experience a co-occurring substance use disorder)
  • Among those of working age, about 25% have a mental illness and/or substance abuse
  • The cost to employers is $80-$100B/year
  • More workers are absent from work because of stress and anxiety than because of physical illness or injury
  • Less than 1/3 of adults with a diagnosable mental disorder receive treatment in any given year

Mental illnesses include – depression, anxiety disorders, substance abuse, bipolar disorder, eating disorders, sleep disorders, attention deficit hyperactivity disorder, and personality disorders.

If you’re interested in the diseases or solutions for addressing them, there are lots of resources online.  Individuals can take tests.  Companies can educate employees.  Many companies off EAP (Employee Assistance Plans) from companies like Magellan to help with these issues in a confidential, third-party setting. 

Some other links:

Not my typical topic, but I think these are important issues in terms of how companies spend their resources to address patients. 

Events, Healthcare

AHIP Business Forum 2007

October 27, 2007 by George Van Antwerp 0 Comments

Are you going to the AHIP Business Forum in Chicago – November 12-14th?  If yes, let me know or look me up. 

ahip1.jpg

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications

ConnectYourCare Acquired by Express Scripts

October 17, 2007 by George Van Antwerp 0 Comments

connectyourcare.jpg

I was glad to see my former employer – Express Scripts – jump into the CDHC space with an acquisition.  They bought ConnectYourCare which is a fairly new company that had jumped into the market over the past few years with money from RevolutionHealth.  It provides online tools and a card for managing your HSA / FSA type funds.  It will be interesting to see how this plays out.  It may be a little late in the selling season to affect 2008 but it could play prominently in the spring for renewals or new business.

As an aside, ConnectYourCare provides a nice glossary of terms you might here around consumerism and benefits.

You can also get access to some of the Forrester research through their site – here.

Consumerism, Events, Healthcare, Marketing / Communications, PBM / Pharmacy, Software, Technology

Indu Subiaya with Health 2.0 quotes

October 6, 2007 by George Van Antwerp 0 Comments

Matthew Holt commented about his partner in the Health 2.0 conference – Indu Subaiya, MD.  I haven’t talked with her, but I didn’t want to ignore her.

Here is a link to her blog with a video summarizing some of the best quotes from their recent conference. 

  • People are the new algorhithm
  • P&G knows more about my laundry preferences than pharma knows about my drugs

BTW – I think they already announced that another Health 2.0 conference will be coming so you may want to register to get the notifications now. 

Consumerism, Events, Healthcare

iGuard Offering and Drug Safety Webcast

September 28, 2007 by George Van Antwerp 0 Comments

West Glen logo

I always enjoy getting e-mails from readers promoting new ideas or suggesting sites or events to look at.  I received an e-mail the other day about iGuard which is a new company which is focused on delivering patient information about drugs as new information is identified. 

It is interesting although I am not sure how much new information is discovered that is material, but when it is, I agree that I would want to know.  Now, reading the website reveals that they have several concepts:

  1. Alert you and your doctor (if you choose) about important safety information for the drugs you are taking.  [Could be interesting depending on frequency of material new information.  Of course, most generic drugs which are tried and true will have little updates.  New drugs may have a lot of updates in the initial years.]
  2. Distribute risk ratings that help you understand drug risk today, and in the future as new safety information emerges. [You should get this today with any prescription although you probably don’t read it.]
  3. Facilitate communication between you and your physician about medication risks and monitoring.  [Interesting.  Not sure how this will be done.  Helping capture side effects and track them would be good data for MDs, pharma companies, and patient communities.]
  4. Provide an easily accessible summary of your medicines and conditions for your own records and to use in coordinating care across all your physicians.  [Ok, but this is another site for this.  Plugging this offering into a PHR or EMR probably is the long-term opportunity.]
  5. Help researchers identify safety problems faster.  [Interesting]
  6. Support family members and caregivers who are responsible for dependents in monitoring safety.  [Helping capture new drugs, side effects, new research, etc. and sharing that with the care team is an opportunity.]

Now, it is important to blend this with a multi-modal delivery strategy which allows the patient to integrate this data into other systems they use and allows them to chose the channel for delivery – e-mail, SMS, fax, live call, automated call, letter, etc. 

So, if interested, visit the website (www.iguard.org) and/or listen in to the webcast (see below):

iGuard
Live Webcast POWER TO THE PATIENTS!
The Most Up-to-Date Drug Safety Information
Sent Directly to You When You Need ItThursday, October 4, 2007 2:00 PM Eastern
Register Here!

Consumerism, Events, Healthcare, Technology

Health 2.0 Conference – Blogs

September 21, 2007 by George Van Antwerp 2 Comments

This week was the Health 2.0 Conference in San Francisco.  I was not there, but I am sure it generated a lot of good discussion.  Numerous bloggers were there and put there comments up.  Here are a few sites for content.  It is certainly worth the read if only to keep up on new technology and new buzz words.  But, getting together a group of technologists focused on changing healthcare can only lead to some new ideas.

The Health Wisdom Blog

The Healthcare Blog

Francine Hardaway’s Blog

The Healthcare Law Blog

The eHealth Blog

Healthcare IT Blog

Consumerism, Events, Healthcare, Weblogs

Customer Event

September 14, 2007 by George Van Antwerp 0 Comments

What a great week. I have been so busy that I haven’t had time to blog, but I will try to catch up over the next few days.

I always love to mingle with customers and talk to them about their experiences with a company. As a former client, a current consultant, and a future employee of Silverlink, I got to join their customer event this week where 40 customers talked about how they use the technology and services to lower costs, increase efficiency, and grow revenue. Talk about empowering.

Some of the key content / discussions revolved around the following:

  • JD Powers study on healthcare company satisfaction including a great non-healthcare example.
    • It showed how satisfaction with auto insurance actually went up and was higher when the company raised rates but pro-actively told the consumer versus when they lowered rates. Talk about the power of communications.
  • Lots of talk about how marketing and data analytics are going to drive healthcare and how non-healthcare companies are setting the expectations for patients very high compared to the current state.
  • How disjointed healthcare communications are – provider, pharmacy, PBM, MCO, DM companies. No consistency.
  • A great presentation by Liz Boehm from Forrester research which made a few key points:
    • She reinforced the loss avoidance point I blogged about the other day stating that savings is equal to one unit of happiness while loss is equal to two units of unhappiness. So, for many, losing money is a bigger factor than saving money.
    • She pointed out the fact that any healthcare site that quotes a price always has some disclaimer about the accuracy. Why can’t we simply guarantee a price (like any other industry)?
    • She showed that member services (IVR, web) are the 3 most important factor in chosing a carrier after price and network.
    • She showed research that consumers are generally dissatisfied with contacts across all channels from their health plan.
    • She talked about using a persona to design programs and prioritize efforts.
    • She compared channels across cost, reach, engagement, and immediacy.
    • It was obvious that we have a long way to go.
  • Heard from a few customers that talked about how they allow Customer Service Representatives (CSRs) to go “off the clock” to help patients so that they can still track average call time but allow for flexibility.
  • I talked about process innovation and how to apply that to your communication process. I also talked about business process outsourcing.
  • We heard about best practices in driving response rates. Everyone always seems so amazed when they hear about response rates of 50, 60, or 70%. Very difficult to get and/or measure that in other channels.
  • Talked about how MCOs are using the automated call technology – ANOC (Annual Notification of Change) for Medicare, Collections, Lead Management, COB, Missing Information, Wellness Program Recruitment, Reminders, Surveys, and many others.
  • We heard about calculating the ROI with a detailed methodology.
  • We talked a lot about models from other industries that could apply.
  • We talked about data mining and analytics.
  • We talked about member satisfaction, loyalty, and how to survey and capture that information.
  • An outside consultant talked about experience based branding and how sounds can be your brand – Harley‘s engine, Sprint‘s pin drop, Ford‘s door chime, AOL‘s “You’ve Got Mail”.
  • Had several clients talk about how they use Silverlink‘s technology to enhance their product suite

All of the conversations and presentations reinforced how critical successful communications are to healthcare and how big of a hill we have to climb. It was great to see how effective, timely, and personalized the Silverlink technology could make the process. It is worth looking into if you are a managed care company, a device supplier, a PBM, a pharmacy, or even a provider.

Business Tools, Consumerism, Events, Healthcare, Innovation, Marketing / Communications, Research, Technology
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