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Real-Time PBM “Pricing” From Prescription Solutions

April 13, 2011 by George Van Antwerp 1 Comment

I don’t do a whole lot in the PBM pricing world these days, but I remember some of the process and the underwriting steps.  That being said, I was really impressed with the new Prescription Solutions online Pharmacy Benefit Advisor Tool (go to http://mybenefitpreferences.com). 

You go through a few basic steps to get an idea of how much you (payer) could save (with a very nice GUI). 

  1. Rank the features that matter to you – net cost, compliance, shifting cost to the consumer
  2. Rank the importance of different clinical programs
  3. Make some trade-offs in programs (A is more important than B)
  4. Enter some baseline data

Now, in reality, PBM pricing is never that simple, but what it effectively does is help articulate the savings that different decisions can create in a real-time setting.  It also forces some dialogue around issues – adhererence versus drug cost…which matters more to you?

I also think it could be a great way to help consumers understand the costs and savings associated with certain decisions.  I would also guess that the sales team at Prescription Solutions will find it helpful especially in the smaller, self-funded world.

Business Tools, Healthcare, Innovation, Marketing / Communications, Methodology, PBM / Pharmacy, Technology, Value Propositions

The Express Scripts 2010 Drug Trend Report – Waste and Intent Focused

April 11, 2011 by George Van Antwerp 2 Comments

As I’ve talked about in the past, after working on the Express Scripts Drug Trend Report (recent copy here), I really enjoy getting the chance to read through them every year (see 2009 review or 2008 review). Over time, they’ve become less about the clinical side of the business and more about the programs used to engage the consumer with consolidated class specific data still included.

This year’s report is similar, but it is built around a new study that Express Scripts just completed with Harris Interactive. It comes to a rather surprising but interesting conclusion –

We discovered that the majority of people want to engage in the same behaviors plan sponsors seek to promote, but these desires often remain dormant. That is, there is a persistent intent–behavior gap. The key is structuring interventions that close the gap between what patients already want and what they actually do.

What’s the key point here? The point is that this says that consumers really want to move to generics and move to mail order, but they don’t do it. Is it that simple? I’d love to think so. And, for generics and mail order, I’m more likely to believe that inertia is a large factor. BUT, as I’ve talked about before, adherence has lots of complicating dimensions.

They focus on the gap between the physician and the optimal outcomes. This is certainly a major factor, but beyond consumer intent, there are issues of health literacy and physician beliefs that have to be addressed. Regardless, the point is correct…how do we engage and motivate consumers to change behavior especially if they are pre-disposed to change (when presented with the right facts).

They did continue to build on last year’s focus on WASTE. They estimate that the waste in 2010 was over $403B as broken down below:

As adherence is a key issue here, they highlight the difference in adherence rates between retail pharmacy and mail pharmacy.

The focus of the report and the early press I’ve seen has been on the following chart. What it shows is some of the data from the Harris study saying that 82% of people would chose a generic (that are on a brand) and (depending on copay savings) 55-71% would chose retail.

One topic that I was glad was in the survey was limited networks. This is a topic everyone’s talking about from ReStat to Wal-Mart to Walgreens to CVS. Here’s what the research said with some explanation for what it means:

Of note is that about 40% said they would be willing to switch retail pharmacies to save their plan (or employer, or country) money. This fi gure is not as low as it fi rst appears because before a plan implements a more narrow retail network, a large fraction of members already use these pharmacies and therefore don’t have to switch pharmacies. It is not unusual, for example, for a client using a broad network to have 70% of prescriptions processed through pharmacies that are in the narrow network; members currently using these pharmacies do not have to make any changes. When a narrow network is implemented, if 40% of the users of the remaining 30% of prescriptions would willingly move to a lower-cost network pharmacy (as suggested by the survey), we estimate that the resulting overall market share within the narrow network would rise to 82% {70 % + (30% x 40%)}. (page 14 of the DTR)

All of this tees up their family of “Select” offerings (see Consumerology page) which builds on the success of Select Home Delivery and applies the concept of “Choice Architecture” from the book Nudge.

They talk about some of their work with adherence and their Adherence IndexSM. This metric is certainly one that has the industry’s attention as people wonder about the predictive value, how this is used, and how to craft solutions around such an index. My perception has been looking at studies like this one by Shrank and colleagues that past behavior remains the best predictor of future behavior, but I’m happy to be wrong.

So…what were the trend numbers?

  • 1.4% in the traditional (non-specialty drugs)
  • 19.6% in specialty
  • 3.6% overall

One of the other lists that I always find helpful to have is what are the top 15 drug classes and the PMPY spend.

Of course, in today’s world, you really want to know this for specialty medications:

So, as always, I would recommend you read the report. Lots of great information in here. Interesting research. Good thoughts on consumer behavior and how to change it.

I think this week is their Outcomes conference which was always a good event.

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

How does luxury “framing” impact decision making?

April 10, 2011 by George Van Antwerp 0 Comments

Are people who travel in town cars and on corporate jets different—on a psychological level—from you and me? Does the availability of luxury goods “prime” individuals to be less concerned about or considerate toward others? The answer from new research seems to be yes.

It’s an interesting question with relevance for us in healthcare.  Does the environment in which we work and make decisions impact our decisions?  Is that true for day-to-day work?  For conferences?  For delivery of care?

In general, I believe most of us that work in healthcare are passionate about improving outcomes.  We want to understand how people make decisions.  We want to understand why things happen.  This isn’t just a job.  Given that, these types of studies are important as we think about healthcare communications.  What types of images should we use in our print media, web, and e-mail?

It also makes me wonder about verbal queues or sonic branding.  Can certain words or noises make us more or less likely to make choices that are in the best interest of the group.  For example, if we framed decisions as savings money which would be provided to a charity would more people respond to take that action (e.g., moving to a generic drug) than if we framed it as saving money for the company and therefore allowing more earnings-per-share (EPS). 

“people who were made to think about luxury prior to a decision-making task have a higher tendency to endorse self-interested decisions that might potentially harm others.” (HBS professor Roy Y.J. Chua on what they found in their research)

Books / Articles, Consumerism, Healthcare, Marketing / Communications, Research, Value Propositions

Save Lennox Campaign Points To Two Health Issues

April 10, 2011 by George Van Antwerp 0 Comments

Have you heard about the Save Lennox campaign?  It’s a sad story of a little girl’s dog in Ireland that’s been incarcerated.  The girl is disabled and the dog is her service dog.  I had the chance to hear Victoria Stillwell from It’s Me or The Dog (TV show) talk about this last night.

What struck me (beyond the story) were two things:

  1. The importance of service dogs within healthcare.  They now do a lot of things beyond simply help the blind.
  2. The rising issue of dog bites and the fact that breed specific legislation (BSL) doesn’t work.  Dog bites have gone up in areas where pit bulls have been banned.

 

Books / Articles, Events, Healthcare, Leadership

Hosted IVR In Healthcare – Go To Silverlink

April 9, 2011 by George Van Antwerp 0 Comments

This is a term I’ve never used before when thinking about what we do at Silverlink Communications, but it seems relevant since people use it as a search term.

We talk about:

  • Speech recognition
  • Personalized communications
  • Preference-based marketing
  • Automated calls
  • Outbound IVR
  • Coordinated multi-channel communications
  • Data driven communications
  • Intelligent interactions
  • Smart calls
  • Interactive dialogues
  • Technology enabled disease management
  • Condition management
  • Campaign management
  • Rules-based communications

I could go on, but my point is that if you’re looking for a “hosted IVR” solution for healthcare you should call us at Silverlink.

[For my regular readers, sorry about the “advertising” but have to mix it in here once and a while.]

Healthcare, Marketing / Communications, Silverlink, Technology, Value Propositions

Increasing Specialty Drug Refill Rates

April 9, 2011 by George Van Antwerp 0 Comments

Adherence is one of the primary topics of discussion today both within pharmacy and (after reform) within other areas of healthcare.  Adherence drives costs.  Adherence impacts productivity.  And, with a few rare exceptions (CBO type budget analysis looking only at fiscal year returns), everyone’s interests are aligned on the value of improving adherence.

For now, let’s skip over the traditional pharmacy market which is rapidly becoming generic. Let’s look at specialty where the average cost is $1,800 per month and can run into the $10,000’s.

So, what if I told you there were simple solutions that could improve your monthly refill rate on your drugs by 20-40%?  What if that also reduced the gaps-in-care and improved patient awareness of their condition?  What if that also incorporated a feedback mechanism to the care team?

How much would that we worth?  What about all that for $2 / month per member?  Much less that copay waivers or many other solutions out there on the market.

Sound interesting…Go learn more at Silverlink.

Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Health, Wealth, and Extreme Couponing

April 8, 2011 by George Van Antwerp 2 Comments

Have you seen this new show – Extreme Couponing?  Here’s a clip –

We all know that poverty can have a great impact on health. From limiting your access to fresh food and access to housing and including risks associated with work environment. Health and wealth are intertwined. Preventative medicine, dental care, and simply filling medications can be an issue for people with limited means.

So, what does this have to do with Extreme Couponing…

Well, it go me thinking about how charities and food banks really need these people. If they can buy thousands of dollars of goods for $50, imagine the impact that could have in a community. A single resource could activate a network of people to provide coupons and go pick up goods at no cost. Those goods could be shared with those that need them thereby reducing their out of pocket costs and improving their access to healthy foods.

Much like the pharmaceutical manufacturers have PAP programs and clinics that help patients get access to drugs, we need to look at what the food companies are giving us in a more organized way to help get this to those that need it most.

And…that can impact our overall health as a nation.

Healthcare

Interview With Dr. Olivier Raynaud At #WHCC11

April 6, 2011 by George Van Antwerp 0 Comments

I had an opportunity to sit down with Dr. Olivier Raynaud from the World Economic Forum while I was at the 8th Annual World Healthcare Congress in DC. If you don’t know them, they put on DAVOS.

It was a great discussion as Dr. Raynaud brings a wonderful macro-economic view of the healthcare problem with lots of global experience. Let’s start by talking about three areas of focus:

  1. Better health from better data
  2. Creating the right health ecosystem connecting different players
  3. Building leadership

These all sound so simple – right?

The first one – data. This is critical and something that the World Economic Forum worked on to create a data charter for healthcare. Getting multiple constituents to agree even conceptually would be a battle (in my assessment).

The second one – ecosystem. His prospective was so much broader that the typical – patient, provider, pharmacist, payer. For example, he talked about the city mayor as critical. He talked about how addressing smoking, exercise, and food choices was systemic and had a profound impact on our work, our lives, and ultimately our taxes. He talked about employers and how 54% of the world’s population is an employee.

We talked about how employers or cities are more likely to take a long-term view of health than an entity that has to show Fiscal Year results. We talked about the impact on productivity, reputation, and loyalty that health can have for a company and how those things impact costs like recruiting costs.

The third topic – leadership. Here we talked about the need to think differently and create global efforts. We spent a lot of time talking about starting Electronic Health Records during pregnancy since there are certain behaviors (smoking, drugs, eating) that can impact the child and ultimately their health. This framework is just starting to be discussed by people and is becoming easier with the proliferation of technology and low-cost of data.

We talked about the fact that 60% of costs are preventable. He suggested that the history of how AIDS has been addressed offers some great lessons learned around Access, Awareness, and Education. Just getting people to get tested has had a big impact.

[Meanwhile, someone else at the conference talked about the general failure of health programs across the world and the percentage of spend that doesn’t contribute to improved outcomes…a complicating factor.] The World Economic Forum has an opportunity to identify and spread best practices by getting all the constituents together and aligned.

We then finished up talking about engagement and trust. He had a great perspective about different search algorithms. For example, if you search for vaccines in the US, the CDC has most of the top placements. But, that’s not true outside the US. You might see lots more about fear of vaccines. There is a need ultimately for some type of “trust certification”. But, that has to meet the academic’s and clinician’s needs but be useable by the general public and take into account peer-to-peer and other data that is now appearing.

It was an interesting discussion that just helped open my eyes to a broader perspective. I wish them a lot of luck in pulling these groups together to expand the ecosystem and create leaders that know how to use data to make a difference.

Events, Healthcare, Leadership

The 2010 Express Scripts Drug Trend Report Is Out

April 6, 2011 by George Van Antwerp 1 Comment

The new report is out.  I haven’t read it yet, but here’s the teaser graphic from the website.

Books / Articles, Healthcare, PBM / Pharmacy, Research

Specialty Rx Offerings Not Rxs Only

April 6, 2011 by George Van Antwerp 0 Comments

I’ve spoken about this for a while, but I was pleasantly surprised to hear one of the Chief Medical Officers in the industry make this point to a large number of manufacturers. He was talking about lots of the changing dynamics in the industry from personalized medicine to new research. He talked about the challenge of adherence and how we needed to think differently. He even suggested that pharma should start talking with payers much earlier in the pipeline so that their research tracked metrics that the payers cared about.

At the end, one of his summary perspectives was that they should stop thinking about just bringing a drug to market and think about how they bring an offering for the condition to market which centers around a drug. This goes back to what the book BLUR presented years ago. You have to blend products and services to create offerings.

In the case of specialty, you have a very sick patient who often has a symptomatic condition that they are living with everyday that might affect their ability to live or potentially debilitate them. It affects their family. And, there may be additional co-morbidities associated with the condition.

Right now, there are solutions that try to engage these patients especially in clinical trials or when a drug is first launched, but over time, that “energy” decreases. It’s important to think about these specialty patients from an experience perspective.

  1. Diagnosis – What happens after they’re diagnosed? How much do they really remember from the physician encounter? Do they understand the drug they’ve been prescribed? Do they know where to go to find more information? Do they understand what resources are available to support them?
  2. First Fill – Do they understand the drug’s side effects? Do they believe that this is going to help them? Do they know how to get the prescription? Do they understand how to use the specialty pharmacy?
  3. Ongoing Therapy – Do they continue to refill the medication? What are their barriers (cost, convenience, literacy, beliefs, side effects)? Can they afford the medication? What support is there (financial, education, counseling) and how do they access it? Does their physician understand the disease? Have they gotten engaged with a community or support group?
  4. Changes In Condition – As they progress, what should they expect? How do you monitor these changes? Do these changes have an impact on the drug or strength? How does adherence affect this?

This creation of a solution blending services and pharmaceuticals creates some new ways for a manufacturer to differentiate themselves in the marketplace. Imagine the power of going to the physician, pharmacy, or PBM and telling them that you have a solution which does the following:

  • Provides a highly effective drug (cue traditional data)
  • Improves awareness and understanding of the condition for the patient
  • Decreases the likelihood of abandonment
  • Helps the patient with their out-of-pocket costs
  • Increases the patient’s likelihood of refilling
  • Helps the patient become an e-patient and engages their support system
  • Provides ongoing monitoring of changes in their condition

Interested? I have some ideas if you’re a brand manager.

Healthcare, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Silverlink, Value Propositions

The Physician As Island Versus Support From Intermediaries

April 6, 2011 by George Van Antwerp 0 Comments

Should physicians have the final say in patient care?

Someone tweeted me this question the other day. It made me start to think…

Logically, individuals trust their physician to act in their best interest and make the best decisions (based on the information they have).  But, this has shifted from the MD as the primary source of knowledge to the MD as a part of a care team.

There are probably more, but I can think of 5 important things that need to be fixed for the physician to be seen as an ‘information island’ where they can make the best decisions without intermediaries (PBMs, managed care, disease management companies) intervening:

1.  They have to be able to not practice defensive medicine.

2.  They have to understand my costs.

3.  There have to be no meaningful differences based on geography or income or race.

4.  They have to adopt best practices quickly.

5.  They have to be able to be paid based on outcomes.

Some of these are systemic changes that have to be addressed (#1 and #5). The other three can be addressed thru technology (as long as physicians are willing to embrace the science of medicine not just the art).  As a quick example, look at Dr. Atul Gawande’s book. – The Checklist Manifesto or look at some of the work by companies like Health Dialogue on shared decision making.

Now, maybe the person that asked the question is taking a more radical stand and physician’s embrace the support these companies provide them, but that hasn’t historically been true.

Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, Methodology, Politics, Value Propositions

The New Kaiser Center For Total Health (#WHCC11)

April 6, 2011 by George Van Antwerp 1 Comment

While I was at the World Healthcare Congress yesterday, I had the opportunity to go into DC to visit the new Kaiser Center for Total Health. This is their showcase in the East to facilitate discussions around improving healthcare. It’s not a replacement for the Garfield facility in CA, but it will create an more accessible forum for dialog with policymakers and international visitors. (NYTimes post about the opening)

It’s one of those fun places where you can go and interact with technology. It’s full of technology like telemedicine and telemonitoring. It provides you with demos of the world’s smallest ultrasound device and connected devices. It showcases Kaiser’s rich history and their MyHealthManager tool.

Their online tools have some great stats:

  • 3.3M members signed up
  • 25.8M test results viewed in 2010
  • 10.7M emails sent to MD’s in 2010

There are a lot of videos where you can hear employees, members, clinicians, and others talk about what they think “total health” is. And, they have a massive interactive mural about their walking initiative.

It seems like this type of interactive, high technology space is becoming an asset at several companies. We used to have this innovative, brainstorming space at E&Y years ago and clients loved it. I believe IDEO has this type of space.

I enjoy it. It’s interesting, inspiring, and creates a dynamic work environment. I look forward to see how this space gets used and what others think.

Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Research, Technology

Interview With Dr. David Wennberg At #WHCC11

April 5, 2011 by George Van Antwerp 0 Comments

I had the opportunity to sit down with Dr. David Wennberg (Chief Science & Product Officer, Health Dialog) at the 8th Annual World Healthcare Congress (Twitter hashtag #WHCC11).  David is a fascinating and engaging speaker.  He has lots of publications, works with the Dartmouth Atlas, and leads the Health Dialog Analytic Solutions group. 

David and I began our time talking about “informed choice”.

In this environment, doctors need tools that identify patients lacking evidence-based care. They also need to ensure that patients undergoing surgery have been exposed to informed choice, not just informed consent, when there is more than one legitimate treatment path. With these resources in place, physician groups can ensure that they are in control of their own destiny when it comes to performance evaluations.  (source)

This is an important issue in healthcare.  Giving patients (1) complete information in (2) language that they can understand and helping them (3) frame their options relative to their preferences is at the core of this issue. 

Health Dialog calls this Shared Decision Making and focuses on how to engage targeted consumers and help them make their best decision.  Their customer support personnel go through a certification process and use decision aids to enable the process. 

This led us into a discussion about “trust” (see prior post) and then into a discussion about “embodied conversational agents“.  Obviously, if you’re going to help consumers make decisions, they need to trust you.  We talked about the need to have transparency, the need to for disclosure, and the importance of using clinicians in the engagement and discussion process.  In many cases, nurses and the empathy that they have are critical to this process.

But, I know from prior exposure to Health Dialog that they have figured out ways to blend technology and agents.  They do a lot with data and analytics to really understand the popluation.  They’ve worked hard to avoid the traps that “disease management” has fallen into over the years.  He shared with me some amazing engagement statistics. 

We talked about the value of peer-to-peer videos for people to understand their condition and talked about some recent studies around storytelling and distributing that information via DVD to patients (see more on study).  We went on to talk about how engaging the consumer in the decisions about their care increase success, but that many models have been a challenge to scale.  Health Dialog just published an article in the NEJM called A Randomized Trial of a Telephone Care-Management Strategy which demonstrated an ability to scale the solution and get results. 

At baseline, medical costs and resource utilization were similar in the two groups. After 12 months, 10.4% of the enhanced-support group and 3.7% of the usual-support group received the telephone intervention. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% ($7.96) lower than those in the usual-support group ($213.82 vs. $221.78, P=0.05); a 10.1% reduction in annual hospital admissions (P<0.001) accounted for the majority of savings. The cost of this intervention program was less than $2.00 per person per month.

Before I could even jump to my next question about ACOs, he made the natural transition to the fact that the new ACO regulations mention shared decision making 8 times.  I believe we both agreed that whatever actual form these new practice settings take that they will accelerate the importance of leveraging technology and things like shared decision making to engage the consumer.  The key is to leverage the PCP setting whether it’s the MD or someone on their staff as the foundation for engagement.

This led me to ask him about physician acceptance of technology as part of their practice (more on this later).  He felt that they had moved from resistance to understanding the technology and “guides” can enable them to practice better medicine.

Books / Articles, Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, Research, Technology, Value Propositions

Does virtual exercise count towards physical activity?

April 5, 2011 by George Van Antwerp 0 Comments

I remember when I first played Wii Boxing and was sweating like I just went for a lite run.  It made me believe that there was something about using games to get kids to exercise even if they weren’t playing outside (which is ideal). 

A new study published in the Archives of Pediatrics & Adolescent Medicine confirms this.  I guess the category is formally called “exergames”, but they looked at several games including (with their Metabolic Equivalent Task value):

  • Wii Boxing: 4.2 METs
  • Dance Dance Revolution: 5.4 METs
  • Cybex Trazer: 5.9 METs
  • LightSpace: 6.4 METs
  • Xavix: 7.0 METs
  • Sportwall: 7.1 METs

Here’s the summary:

[the researchers] found the games “compared favorably with walking on a treadmill at three miles per hour, with four out of the six activities resulting in higher energy expenditure”

Books / Articles, exercise, Healthcare, Research

Data: Should You Be Paranoid?

April 4, 2011 by George Van Antwerp 0 Comments

I think we all know or are quickly realizing that everything we do leaves a trail of breadcrumbs.  That trail is a series of data points which now can be aggregated to create a record of you.  What you do?  What you buy?  What ads you respond to?  Who your friends are?  The list goes on. 

The question of course is whether you should be paranoid and worried about it. This video below shows you the extreme scenario of how data could be abused.

In a more balanced view, Time Magazine had an article call Your Data, Yourself which just appeared on March 21, 2011.

Oddly, the more I learned about data mining, the less concerned I was. (Joel Stein, author of article)

The article talks about a variety of companies that collect and sell data:

  • Google Ad Preferences
  • Yahoo!
  • Alliance Data
  • EXelate
  • BlueKai
  • RapLeaf
  • Intellidyn

The author makes a key point…a lot of the things we get for free are free because people collect and sell our data.  Otherwise, these “free” business models wouldn’t exist.  Would you pay for all the content and other things you get today or do you just want to understand what happens to your data?

On the other hand, the author shows you how data put together adhoc can paint erroneous pictures of you.  Should you care?  Do you want to fix this?  Can you control it?

This is all important since there is some do-not-track legislation being discussed.  (See Joe Manna’s post on this for some additional perspective)  Several people bring up the good question…

While we say that we don’t like to know that our data is being used to target ads at us, do we really want to have to sort through all the irrelevant advertisements?

Of course, we all become a lot more sensitive around healthcare data.  But, somehow, I doubt many of us think about what happens when we use our work PC to research a condition (see article on 10 ways to monitor your employees).

The article also suggests some sites for protecting yourself:

Don’t expect this one to go away.  With issues like the data breach at Epsilon, people are concerned.  Additionally, as data gets co-mingled and your credit score is used to determine health programs (for example), there may be limits about what and how information is used.

Blogroll, Books / Articles, Consumerism, General Thoughts, Healthcare, Marketing / Communications, Methodology, Politics, Technology, Value Propositions

The Changing Specialty Drug Pipeline

April 4, 2011 by George Van Antwerp 0 Comments

In 2010, only 30% of the specialty drugs were oral solids or eye drops. 65% required clinical administration. Only one was a self-injectable drug. (Summary data and chart below c/o BioPharmRx Consulting.)

 

This is important since it changes the PBM and pharmacy paradigm as we know it. If increasingly specialty drug spend is managed by the PBM, this creates a greater need for a relationship between the PBM and/or the pharmacy and the provider. Or, it requires infusion services as several specialty companies provide.

It’s expected that this trend will continue, and specialty will quickly become the focus in the payer world (from a pharmacy management perspective). You’ll have low cost generic drugs for most common conditions and high cost biologics for the more rare conditions.

I’ve heard several projections now that specialty will move from ~15% of spend today to about 40% of spend in the next 5 years (from a PBM perspective). You combine that with generics making up 80-90% of all non-specialty prescriptions in that timeframe, and you have a very different world.

On a related note…Will that change the manufacturer to PBM relationship? Maybe. I personally believe that the PBMs will get closer to the pharmaceutical manufacturers in the specialty space like they used to be with the manufacturers when branded drugs were the majority of prescription drug spend. Given the detailers (i.e., feet on the street) that the manufacturers have versus very small academic detailing teams or even the provider relations teams that payers have, there will be a need to figure out how to interact with the physician in new ways. And, with the cost of these drugs averaging $1,800 per month and running into the $100,000s, there is a lot more money to be spent on supporting the patient.

Healthcare, PBM / Pharmacy, Research

Drink Chocolate Milk After Workout

April 4, 2011 by George Van Antwerp 0 Comments

I found this very interesting. A swimming coach suggested to my daughter that she look at drinking chocolate milk instead of water or Gatorade after working out. He said that it led to better recovery.

Of course, I was intrigued. But, it looks like there are several studies and references out there to back it up.

If you swim, run, or do other endurance sports, you should check this out.

Healthcare

A Few Points On Generics

April 1, 2011 by George Van Antwerp 1 Comment

I’m sharing a few quotes from the recent Drug Benefits News on generics here:

“Despite the fact that generics use has long been mainstream, a recent survey we conducted found nearly one-third of Americans still do not know or believe that generics have the same active ingredients and effectiveness as brand name drugs,” Brian Solow, M.D., senior medical director for clinical services at Prescription Solutions, the PBM subsidiary of UnitedHealth Group

It would be interesting to look at that data based on age, gender, number of prescriptions used, physician, geography, and several other factors.  That 1/3rd is similar to what I’ve seen in terms of skeptical physicians which would then make a lot of sense as patients of those physicians would be skeptical of generics.

“We are advocating an increase in the differential between generic and brand name copays,” David Lassen, Chief Clinical Officer at Prime Therapeutics LLC says. “Right now the average differential between Tier 1 generics and Tier 2 preferred brands is about $15. We think this difference should be bigger.  We’ve seen research suggesting consumers need to save an average of $25 in order to select a generic over a brand name drug.”

An interesting point on copay differentials that a friend of mine recently made is what is the actual differential after grandfathering and formulary overrides which happen.

Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Research

Cured After The First Fill!

April 1, 2011 by George Van Antwerp 1 Comment

I was at a presentation recently where a Chief Medical Officer from one of the PBMs was talking about a survey they did on statin users and why they didn’t refill.  Amazingly, he said that 21% of people said they thought they were cured after the first fill.  Talk about a problem.

This data reminds me of a barrier survey from a statin adherence program that we did where 37% said they didn’t know they were supposed to refill their medication. 

This topic then reminded me of a study that was published in the Archives of Internal Medicine in 2006 which looked at the frequency with which physicians did certain things when talking with patients.  So, how often did they explain the duration of therapy to the patients – 34%!

Sometimes, we spend so much time trying to solve the complexities of adherence when there are baseline activities which can make a huge difference.

Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Research, Silverlink

Trust As The Foundation For Healthcare Communications

March 31, 2011 by George Van Antwerp 3 Comments

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

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

A few of my highlights from the book are:

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

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

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

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

It book made me think of some interesting questions:

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

One key point to pull out that he makes is that

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

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

Only 56% Want To Set MD Appointments Online – Why Not?

March 29, 2011 by George Van Antwerp 0 Comments

To me, this survey has three major themes:

  1. People are still hesitant to communicate with their MDs using social media [not that surprising].
  2. People are slow to use the web even for administrative functions [why].
  3. Hispanics are much more willing to use technology to engage their provider [why].

Some of the data:

  • 85% would not use social media or instant messaging channels for medical communication if their doctors offered it.
  • Only 11% of respondents said they would take advantage of social media such as Twitter or Facebook to communicate with their doctor.
  • Only 20% said they would use chat or instant message.
  • 52% said they would confer via e-mail.  (versus 89% of Hispanics)
  • Only 48% said they would pay their physician bills online. 
  • 72% would take advantage of a nurse line if it was offered by their doctor.
Books / Articles, Healthcare, Marketing / Communications, Research, Social Media, Technology

Social Media Is A Health Issue?

March 29, 2011 by George Van Antwerp 0 Comments

Social media as hazardous to your health!  Talk about a nice counterintuitive report.  I think we all worry about our kids spending too much time online and not getting enough exercise, but what about “Facebook depression”, cyberbulling, and sexting…not to mention age-inappropriate material?

In yesterday’s USA Today, there’s an article about how social media can enrich children’s lives but can also be hazardous to their mental and physical health.  It’s focused on a report by the American Academy of Pediatricians, but I think this also builds on the Kaiser report out earlier this year about the amount of time kids spend in front of electronic media – 7.5 hours PER DAY. 

because tweens and teens have a limited capacity for self-regulation and are susceptible to peer pressure, they are at some risk as they engage in and experiment with social media, according to the report. They can find themselves on sites and in situations that are not age-appropriate, and research suggests that the content of some social media sites can influence youth to engage in risky behaviors. In addition, social media provides venues for cyberbullying and sexting, among other dangers. Youth who are more at-risk offline tend to also be more at-risk online.

Interesting.  Do you agree?

Books / Articles, Healthcare, Research, Social Media

You Need An Experience Architect

March 29, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

The Changing Pharmacy Marketplace

March 29, 2011 by George Van Antwerp 0 Comments

I had the opportunity to listen to a few executives talk about how the marketplace is changing.  While I don’t think any of it was surprising, it did bring up some interesting discussion points.

The discussion focused on five themes:

  • The fact that the small molecule market is essentially going generic and will be a low cost market.
  • The fact that biologics is the focus and is where innovation and the spend will be.
  • The challenge of wiring healthcare to get that last mile to the physician.
  • The unknown implications of health reform and exchanges.
  • The continued focus on the consumer as central to healthcare.

I thought it was very interesting that several people talked about this evolution from brand to generic to biologics as the “circle of life” where there was a natural redistribution of cost.

I thought the discussion around personalized medicine was interesting especially as it dealt with the non-biologics and looking at where there were still opportunities to differentiate in the small molecule world.

One of the more interesting discussions was on whether bio-similars were really a “generic” type strategy or a new type of innovation.  Given the clinical work and other hurdles that are imagined for bringing bio-similars to the market, it isn’t expected that you’re going to see massive price drops.  And, if they aren’t therapeutically equivalent, then they become another option within the category.  As one person pointed out, the likely scenario is more of a step therapy strategy where if the bio-similars (or bio-betters as one person called them) are less expensive that the original biologic AND there is no difference in likelihood of success with an initial patient then you would simply require patients to start with the bio-similar.

There was some interesting discussion on the use of biologics from a prevention perspective which was only touched on.

One person talked about the blurring of the brand and generic manufacturer demarkations, but I think Teva’s already done that over the past few years. 

There was some discussion of current state tactics around copay cards and how they are used.  The question being whether this is to drive lower consumer costs, avoid switching, or avoid generic substitution.  This led to the classic debate of patient – physician versus payer. 

The biggest thing that scared me was some of the discussion around how DC and politics can play a role in determining care versus allowing for evidence-based standards of care to drive decisions.  As I was taught in consulting, you should make your decisions based on facts not on opinions.

Healthcare, Innovation, Leadership, PBM / Pharmacy

CMS Treatment Of Generic Samples Offers False Hope

March 28, 2011 by George Van Antwerp 1 Comment

It’s interesting but irrelevant that CMS is now proposing that Part D plans can treat generic samples similar to OTC drugs.  Who cares?

Why do I say that?

  1. Generics represent more that 80% of the non-specialty drugs dispensed in many cases.
  2. The technique doesn’t work.

At Express Scripts, I ran a program for a year.  We hired pharmaceutical representatives to detail doctors.  We bought generic drugs and repackaged them.  And, we tracked GFR (generic fill rate) in the six categories for a year. 

Guess what?

In most cases, the GFR for the doctors with the samples barely exceeded the GFR for the doctors without the samples.  In one category, it was even lower.  The GFR was going up too fast in the general market.  If you add in the costs, it was a money loser. 

We even compared our GFR in certain geographies to the published statistics from another company doing generic sampling…our clients GFR without samples was going up faster than their GFR with samples. 

If you want to give away free drugs as a “gift” to make your academic detailing program more effective, have at it, but lets keep reality in mind here.  This is not going to make a difference.  All it’s going to do is drive up administrative costs for PDP plans.

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

Using the “Placebo Effect” in New to Therapy Situations

March 26, 2011 by George Van Antwerp 0 Comments

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

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

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

Here’s your worse case scenario:

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

How can you step in here?

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

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

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

JD Power Customer Service Leaders – Pharmacy

March 24, 2011 by George Van Antwerp 0 Comments

Understanding how top performers achieve excellence is the first step to becoming a Customer Service Champion. The rest is up to you.

This is the statement by Gary Tucker, SVP, J.D. Power & Associates at the beginning of their publication Achieving Excellence in Customer Service from February 2011. 

If you’ve never read their reports, you should understand that they look at five areas – people, presentation, price, product, and process.  Interestingly, they use several examples from pharmacy to make their points about these five categories:

  • Proactive communications
  • Private space for consultation
  • Clear information about how to save money
  • Auto-refill

Another interesting thing they look at is whether the gap between high performing and low performing company has increased or decreased over time.  In the product industries, the gap has decreased due in many ways to quality improvements.  In the service industries, the gap has increased…WHY?

First, advances in technology have created new expectations among customers, resulting in new challenges for services. For instance, customers expect multi-channel service delivery and expect to choose whether to interact with their service provider in person, via the phone or e-mail, through online chat, or via Web-based self-service, among others. More challenging is that they expect the same level of service across communication channels. With ever-improving technology, it has been difficult for companies to keep all systems up to date and to remain equally effective in each.

They are preaching to the choir here.  This is exactly what I tell clients all the time. 

One of their examples that I’ve used for years is around the power of communications.  They show satisfaction with auto insurance based on whether your premium stayed the same or increased.  For those that it increased, they look at whether you were pro-actively informed and whether you had the option to discuss it.  What group do you think had the highest satisfaction?

  • Decreased premium
  • Increased premium, pro-active notification, and chance to discuss
  • No change
  • Increased premium, pro-active notification
  • Increased premium, no notification

Worried about satisfaction or churn?  Have lots of changes to plan design?  Here’s why you communicate.

In this report, they call out 40 companies as exceptional out of the 800 that were ranked.  7 of those 40 were pharmacies:

  • Good Neighbor
  • Health Mart
  • Kaiser Permanente
  • Publix
  • Veteran’s Administration Mail Order
  • Wegmans
  • Winn-Dixie
Books / Articles, Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Value Propositions

How To Select What Pharmacies Are In Your Network?

March 24, 2011 by George Van Antwerp 1 Comment

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

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

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

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

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

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

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

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

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

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

Who’s Your HOL For Improving Engagement

March 22, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Should Drug Makers Take Action Off Social Media Comments?

March 22, 2011 by George Van Antwerp 5 Comments

I think it’s a fascinating question that was raised around Actos. Here’s the text about a wool.labs report:

In this month’s report on social media’s influence in the world of diabetes, wool.labs presents an analysis of social media conversations beginning as far back as 2002 and continuing to the present, noting a significant shift in patient attitude toward the drug.

Early on, the presenting side effects such as weight gain and edema drew concerns and warnings from some patients. Some questioned whether the drug should be used in combination with insulin. But even while the debate raged on, wool.labs’ analysis showed the conversation could have been shifted had drugmaker Takeda meaningfully interceded before 2006 when comments about the drug began to turn sarcastic, and before long, angry and hostile.

There are enough tools and companies out there that IMHO companies (and brands) should be able to actively manage social media sites to understand what consumers think.  I don’t know this case specifically so I won’t comment on it, but certainly, companies need to have a robust Voice of the Customer process by which they understand what consumers think of them.  And, if it avoids future litigation, leads to add-on products, or even helps re-position a current product, this mechanism can be very valuable.

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