Enabling Healthy Decisions

I have a whole pile of articles that I’ve meant to blog about. I’m going to try to clear out some of these with a bunch of quick mentions here.

USA Today Gallup Poll (7/14/09)

• Majority say controlling costs should be legislation’s top goal regarding healthcare, but more than 9 in 10 oppose limits on getting whatever tests or treatments they and their doctors think are necessary.
• 26% of those polled say that Congress passing a major health care reform bill this year is extremely important – 24% say it’s very important; 22% somewhat important; and 25% say not important.

Google Rolls Out Google Voice

• You can use one new phone number to tie together your various numbers – cell phone, home phone, and business line.
• People call one number which rings all the numbers. You can switch back and forth between lines. Voicemail flows to all of the phones and you get free transcription.

Linguistic Profiling (Washington University alumni magazine, Summer 2009)

• Interesting article on the work by John Baugh, professor of psychology, linguistics, English, education, and anthropology.
• He first documented the “discrimination based on the sound of someone’s voice”.

Article “A Battle Over Mail Order Drugs” (Boston Globe, 2/2/09)

• Owners of mail-service pharmacies (i.e., PBMs) say Medicare could save billions if more people used mail. Right now it’s only 10% of all Medicare recipients who use mail according to the PCMA.
  • The PBMs estimate that the savings is $1B over 10 years for every 1% of patients that move to mail…or $40B over the next decade.
• Community pharmacists see mail orders as “shady operations”.
• David Snow, CEO of Medco, says about PBMs – “The real truth is, we’re an intensive clinical company with thousands of pharmacists who take care of patients each and every day in a very advanced way.”

Good article “The Importance Of Deciphering Your Insurance” (WSJ, 6/4/09)

• The most surprising statement in the article – “researchers at Georgetown University found that several health plans required consumers to inform the insurers when they reached their out-of-pocket totals.” Is that really possible??

Article “Depression, Anxiety Pass From Parents To Kids” (USA Today, 6/3/09)

• Group therapy was able to break the cycle.
• Depressed children are more likely to have trouble in school and are at increased risk for suicide or substance abuse.

Article “Conflicts Of Interest Bedevil Drug Research” (USA Today, 6/3/09)

• Good discussion with some specific examples about the people who evaluate criteria for when drugs should be used and their ties with the companies that manufacture the drugs.

Article “Layoffs Cost More Than You Think” (Fortune, 3/30/09)

• Good reminder of some of the additional costs of laying people off.
  • Brand equity costs
  • Leadership costs
  • Morale costs
  • Wall street costs
  • Rehiring costs
• One of my early consulting projects looked at this years ago and it was amazing how much it cost also looking at lost productivity as you ramped up a new hire.

A perfect example of one of the big issues with healthcare reform.

We all know that hospital readmissions is an issue.  We have been working with several clients to address this issue.

I called a few senior people in some hospital systems to talk about it.  I think one of their responses summarized it up nicely:

It’s not something we are focused on.  We still make positive contribution margin on these readmissions.

As many people have pointed out, misaligned incentives make it hard to improve the system.

I’ve just begun reading and thinking through the book Predictably Irrational.  So far, I’ve found it fascinating.  Additionally, for those of you without the time to read, I’d recommend following Dan Ariely’s blog.

One of his posts from last month is interesting and lays out three ways that conceptual consumption affects people’s physical consumption (and provides a link to the details on the research):

1. Consuming expectations
2. Consuming goals
3. Consuming memories

I think this area of behavioral economics is critical to Enabling Healthy Decisions (SM).  Since in most cases, we already have a framework or anchor price for our healthcare it becomes increasingly challenging to reframe the issue and change behavior.  But, these insights around peer pressure and message framing that evoke different memories or emotions are significant insights for us in the communication space.

One area where healthcare has definitely lagged other industries like consumer products and financial services has been in the area of analytics. Silverlink Communications is the first company to bring analytics to the area of healthcare communications.

We have been doing this for years and focus on the different ways to use analytics to improve results. This is not simply custom reporting which is what lots of people mean when they talk about analytics. And, it’s a lot more than simply best practices like co-branded communications (i.e., employer plus health plan) work better than communications simply from a health plan to a member (patient / consumer).

Interested in learning more…We are hosting a webinar series this month that might interest you. The first one is tomorrow.

It includes Stephen Baker who wrote The Numerati; Kinney Zalesne who wrote Microtrends; and Tom Davenport who wrote Competing on Analytics. You can register here.

If you enjoy this topic, I would also encourage you to register and read our white paper on Adaptive HealthComm Science (which is what we call our approach to healthcare analytics for communications). We also have a video on engaging consumers in their healthcare. Both can be found at the bottom of our homepage at www.silverlink.com.

I hope you all had a good Fourth of July. One thing I always think about this time of year is my perception of fireworks. I’ve never been a big fan.

Of course, like most young boys, I had my fascination with fireworks, but after two incidents, I began to view them as more dangerous.

When I was about 10, I had a pack of firecrackers go off right near my ear just as I threw them. Then, in high school, I remember watching bottle rockets hit someone’s house and worrying about it catching fire (which it didn’t).

Why should you care (this is a health care blog – right)?

I think it’s important because our frameworks about going to the doctor, going to the dentist, eating healthy, exercising, preventative care, and so many other things are set in place as we grow up. As a parent, you need to think about the example you are creating. As a communicator to the patient later in life, you need to think about what their attitudes are towards health.

According to the latest research from a Kaiser Health Tracking Poll of 634 respondents from June 1-8^th:

Since, I strongly believe responses are biased by context, I wonder how many people respond that way when they realize that they will be pushed to this plan. [The Lewin Group estimates that as many as 118.5M people (2/3rds of those who have insurance today) would be shifted to public coverage.]

We had our client event a few weeks ago (and I am finally digging out). Additionally, I had the privilege to attend one of our client’s big internal events last week. They both gave me lots to think about. I am grouping them all together here to share.

• Payors are becoming more interested in BPO (business process outsourcing) today. (Is that an economic reality or a competitive need?) Disease Mgmt is the exception here as plans are moving it back in-house.
• Even thought over 30% of payors have more than 4 backend systems, some of them are looking for new claims systems for their individual business.
• Marketing is the #1 investment area for 2009 (and hasn’t been in the top 10 for the past decade).
• One plan out there has 72 different business intelligence tools they are using.
• 67% of members haven’t been contacted by their plan in the past 18 months. (Is that good or bad?)
• 80% of members get information from general healthcare sites not the health plan website.
• Payors are starting to get into (or investigate) the social media world.
• Reducing 3 risk factors (e.g., smoking) would reduce 80% of diabetes and 40% of cancers.
• Safeway has kept their healthcare costs flat for 4 years by using incentives.
• Over 80% of Americans are on 3-tier plans.
• Only 10% of MDs aware of the cost of a drug to the patient…
  • And most think it’s the RPh’s job to address this
  • But 70% of patients don’t know the cost before it’s adjudicated
  • And 60% of patients w/o coverage don’t talk to MDs about cost
• Just following guidelines would improve care and costs dramatically (e.g., hypertension by 25%)
• Starting patients on generics increases their likelihood of reaching an MPR > 80%
• For the same location, Marriott makes 8% more revenue than competitors based on personalization and use of data
• The Royal Bank of Canada is beginning to use the value of your social network in determining things like your interest rate (e.g., John has a high net worth cousin that we want to retain).
• Your IQ score plus your credit score can explain 95% of your success as an employee
• At NetFlix, they found that people like their recommendations better than the movies people chose themselves
• High performing companies are 5x more likely to consider analytics a key part of their strategy
• One CEO is so focused on analytics that they talk about firing people for not using a control group.
• Analysis is not an ideal but a truism. You have to both have the data and the intelligence to interpret it.
• Healthcare is just realizing that consumers can be “convinced” to use specific products or services.
  • Behavorial economics (fear) versus inspiration (love).
• There are more fast food restaurants in states with higher obesity – vicious cycle.
• You have to engage consumers on their terms.
• Do consumers really know what they want? If you ask them about receiving health care communications, what would they say? Can you honor those preferences? When do you override them?
• Is communications and member insights really the only way to differentiate versus competition?
• Your brain takes in more information than it can process…this is why sleep, exercise, relaxation, etc. is necessary for your brain to process all of it. (If true, do you forget more if you don’t do those things?)
• You have to have both the Hedgehog (people that dig deep on data) and the Fox (people that connect the dots) to be successful. (Good to Great)
• Personalization and pro-active communications are key.
• 65% of healthcare products will be personalized in the next 5 years. (What are you doing to get there?)
• BWM offers a great example of customization:
  • You could name your mini-Cooper
  • Your personalized key fob would activate billboards that showed a personal message (Hi Herbie!)
• Interesting discussion on using automated member satisfaction solutions versus live agents. Do you get different outcomes? Which is more accurate?
• Do members want to be “treated like a friend”? Wouldn’t some view this as too intrusive / presumptive?
• Can you really motivate your employees if you have no personal relationship with them? I was surprised to hear some people say yes.
• The most difficult thing is to stop doing what we’ve been doing.
• Do you want to be part of a corporation or a movement?
• 65% of employees are looking for another job (even in today’s economy).
• 80% of employees don’t look forward to Monday (and heart attacks and strokes are higher on Monday mornings).
• 25% of big company CEOs would meet the clinical guidelines to be defined as a psychopath.

Hopefully, like me, these give you a few things to think about and chew on.

(Continued) Here are my highlights from Medco Health’s 2009 Drug Trend Report:

• They continue to be very aggressive about discussing David Snow’s blueprint for healthcare reform.
• They also seem to be very focused on personalized medicine with several documents out there discussing it.  They mention it here along with GINA.
• They also talk about Prevacid potentially making the Rx-to-OTC switch which we know has recently been approved.

Half of all Americans are under treatment for at least one chronic disease.  For patients initially diagnosed with chronic or complex conditions, drugs are the first choice for medical intervention 88% (131 out of 149) of the time. Care of patients with chronic and complex diseases accounts for 75% of medical costs and 96% of total drug spending in the U.S.  However, about half of all patients abandon their prescribed therapy in the first year of treatment. Indirect costs linked to absenteeism, short- and long-term disability, and presenteeism (i.e., present at work but less than fully productive) can exceed associated direct healthcare costs by two to three times—making even more critical the rigorous management of these patients and tighter adherence to ongoing care.

Major contributors to these numbers include the epidemic of obesity, the persistence of tobacco and substance abuse, and physical inactivity. As the average age of our population rises, without a paradigm shift that changes the status quo, it is expected that the number of individuals with chronic disease will similarly increase (see figure below). – for original sources go to page 85 in the document)

• I was a little surprised that it wasn’t until page 97 that they showed results from the Medco Therapeutic Resource Centers (TRCs).

Alright, after a few crashes of the blog entry, that wraps it up…one more drug trend report to go.