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The Innovator’s Prescription – Christensen Book

April 19, 2009 by George Van Antwerp 0 Comments

I haven’t had the chance to read the book yet, but for those of you interested, I thought I would point you to the review from a few months ago on The Health Care Blog.

The book is mistitled. It should have been titled “The Innovator’s Diagnosis”. The book does a fantastic job at diagnosis (Dx) of problems in the U.S. health care system. It presents many new, innovative analytical frameworks and lenses through which to view the U.S. health system.

However, it’s weak on prescription (Rx): many of the proposed solutions are speculative, ungrounded, and/or defy political reality.

Books / Articles, Healthcare, Innovation, Managed Care, Research, Weblogs

Waxman at the AMA

April 18, 2009 by George Van Antwerp 0 Comments

I am finally catching up on some notes from Rep. Henry Waxman (D-CA) when he spoke to the AMA in March 2009.  (From “The Pink Sheet”, March 16, 2009, pg. 27)

“We all know we have to get costs under control, but the way to do that is not to tell physicians what they can and cannot do or put them in a position where they cannot put the needs of their patient first.”

“I am not interested in trying to put a public plan in place that would drive out competition.  I believe we must have a significant role for private insurers.  We must allow them a fair opportunity to compete.”

“We have to reward quality and outcomes, not just reward volume.”

Books / Articles, Events, Healthcare, Managed Care, Politics

The $40B HealthCare Opportunity Around Retention

April 18, 2009 by George Van Antwerp 1 Comment

It’s obvious to anyone close to it, but harder to align the goals to take advantage of it.  With people “aging-out” from group plans to Medicare and people leaving their employer coverage to go to the individual market, managed care has a huge opportunity to retain that business by providing them a transition path.  According to McKinsey (and from what we see), that’s generally not happening.

A few facts from their report:

  • 68 percent of all members aged 60 to 64 have never been approached by their current insurers to discuss retirement options.
  • more than 80 percent of respondents aged 60 to 64 said they would consider purchasing an individual product from their current carrier if they left their jobs or retired.
  • Only 33 percent of 60- to 64-year-olds thought that their insurers offered Medicare products, for example, when in fact almost all major carriers do.

It’s also a simple economic problem.  They are less expensive to retain and convert while their a member than once they are on the open market.  You may even save on broker fees.  Developing a data driven approach to create timely and personalized communications along with a service to transition them should be a priority.

mckinsey-conversion-opp

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

Tipping Point for eRx

April 18, 2009 by George Van Antwerp 0 Comments

David Snow said that Medco had achieved over 10% of Rxs being electronic a few months ago.  Now Walgreens put out a press release that in March they had 15% of all their Rxs sent in electronically.  Perhaps we are reaching the “tipping point”.

Walgreens pharmacies filled 3.1 million electronic prescriptions in March, a 211% increase over the same period a year ago. Still, that represents only about 15% of all eligible prescriptions.

Walgreens estimates it will fill more than 40 million electronic prescriptions in 2009, compared with 15 million last year.

Healthcare, PBM / Pharmacy, Technology

Upcoming Book By George Halvorson From Kaiser

April 16, 2009 by George Van Antwerp 3 Comments

I had the privledge of previewing George Halvorson‘s new book “Health Care Will Not Reform Itself” this week.  My book cover quote would go something like this:

“Opinions supported by facts all wrapped up in a narrative.  It’s like a fireside chat with one of the greatest leaders in healthcare.”

I won’t pull things from the book yet, but I found it a logical follow-up to his other book “Health Care Reform Now! A Prescription For Change“.  He talks about the need for bold goals and a clear set of metrics to drive change.  He talks about why healthcare costs go up and the fact that we need universal coverage.  And, he also hits on what seems to be the key theme of the day – reducing costs while improving outcomes.

While I was at the WHCC09, I got to sit down with George Halvorson and talk about healthcare for an hour.  It was a great privledge that I enjoyed a lot, and I could have talked for hours.  We hit on a bunch of topics so let me share some of them.

  • We talked about him writing books.  I was commenting on how much I like his writing style and was intrigued to learn that he said some professors don’t like using his books because they’re “too easy to read”.
  • We had a fascinating discussion around leadership and diversity and how he has created a very diverse leadership team at Kaiser.  I was also impressed to hear that one member of team does an international fellowship each year where they spend time abroad learning about how healthcare is delivered and managed in other countries.  [very progressive]
  • We talked about how healthcare was going to change.  He spent a lot of time on the need to create aggressive goals especially around the 10-20% of things that drive 80% of the costs.  For example, he asked why we don’t try to reduce asthma attacks or congestive heart failure by 90%.  And, he pointed out the fact that we don’t have a common set of goals that allows enterprises to reverse engineer the process and identify points of variance.  Without that process analysis and a specific goal, it is hard to drive improvements.

“We need to change our expectations of what is possible.”

  • We talked a little bit about where innovation will come from.  He talked about how Deming, a statistician, revolutionized manufacturing as a lead into the point that innovation will likely come from outside the industry.  [I think this is interesting as I have seen more and more executives at healthcare companies that are coming from outside of healthcare.  I also think things like the X-Prize may attract others to try their ideas.]
  • He gave some great examples of how Kaiser has deployed their 30 black belts.  The one I quickly jotted down had to do with how nurses change shifts.  This shift change is where all the information was exchanged about different patients and when accidents sometimes happened.  By changing the process, they dropped the accident rate and reduced the communication time from 40 minutes per shift to 12 minutes per shift.
  • We also talked about HIT (Healthcare Information Technology) and the need not only to drive utilization but to mandate system integration.  This tied in with an earlier conversation where we spoke about coordinated care versus uncoordinated care and the need to create a “virtual Kaiser”.  I think there is a lot to learn from the Kaiser model and some of the things they are doing with technology to drive care.  [I was pleasantly surprised that he believes physicians will embrace technology as a tool to help them standardize care.  I think that is critical path to successfully reducing costs while improving outcomes.]
  • I couldn’t jot down all the statistics fast enough, but he talked about how they were testing different “panel systems” in different geographies to see what the best process and technology solution would be.  They had had some great results.  [One fact he shared that jumped out at me was that 25% of people over 65 that break a bone die within a year.]
  • The last thing we talked about was probably the most insightful to me.  Given the amount of money spent in the last months of people’s lives, I was interested in his global perspective on whether that was a cultural issue.  He said that he thinks it is mostly that the care system in the US lacks honesty or the ability to be brutally honest.  We talked about one scenario where people who do nothing live an average of 140 days and those that get invasive surgery live an average of 100 days…but they are hoping to be that 1 in a 1,000 that live an extra year.  [Is it worth all that pain, surgery, and medicine for the last few months?]  We also talked about the new $100,000 breast surgery drug which extends the patient’s life on average for 1 month.  [Again, is that an appropriate use of money?  Would we spend it if it came out of our pockets?]

When the book comes out, I will try to pull out some of the key points, but I would recommend you pick it up and read it for yourself.  I think you will really enjoy it.

Events, Healthcare, Innovation, Leadership, Managed Care, Research, Value Propositions

WHCC 09 Interview with Ed Batchelor (Humana)

April 15, 2009 by George Van Antwerp 1 Comment

I had an opportunity to sit down with Ed Batchelor from Humana yesterday.  He has an interesting role driving the Stay Smart / Stay Healthy program for them as part of his Corporate Web Strategy role.  From what I could tell, it’s a program done for the greater good of educating consumers about key healthcare topics.  To accomplish that, Ed has a direct reporting relationship to the operating committee at Humana and was brought in from outside the industry.

Here is an example of one of the videos that they are pushing out on YouTube.  I really like the whiteboard communication approach.

Some of the big takeaways from my discussion were:

  1. You have to meet the consumers where they are – Facebook, YouTube, Blogs.
  2. If you create a neutral educational message, consumers will trust information (even from health plans).
  3. You can only deliver information in “bits”.  Don’t overwhelm them.
  4. Fun is good.
  5. Regardless of what many (including myself) might think, seniors don’t all shy away from these social media.  [20% of the 1.1M views on YouTube have been from people over 55 years old]
  6. Success on YouTube doesn’t translate to blogs.

One question that I had was how to get away from the “healthcare speak” so that consumers could actually understand it.  He talked about 3 things:

  1. Bringing in an external person
  2. Using focus groups
  3. Using an outside agency

The other thing we talked about is that pull through that they are getting around employers and brokers.  They are pulling the videos in (like here) and re-using them.

This was a program they were highlighting in their booth and one of the public areas here so I appreciated the opportunity to sit down and learn more.

Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Social Media, Value Propositions

Keynote Sessions at the 6th Annual WHCC

April 14, 2009 by George Van Antwerp 0 Comments

 

 

Well, it’s hard to do any “real-time” blogging with no plug for my laptop and no Internet access. I’m glad I actually began to try Twitter the other day. Here were the quick Twitter updates that I threw out there. To see all the “tweets” about the conference, you can go here (#whcc09).

  1. Information transparency is a waste of time if you don’t have choices. #whcc0927 minutes ago from txt
  2. Audience smiled less, gets less sleep, and less happy via gallup well-being survey done before event. #whcc0931 minutes ago from txt
  3. India $14 pmpy hc costs. #whcc09about 1 hour ago from txt
  4. Consumer reports rolling out safety and effectiveness comparisons to site tonight. Could be big deal and big first step. #whcc09 about 1 hour ago from txt
  5. #whcc09 highest selection on data to disclose is providing information on comparing mds (via audience poll). about 1 hour ago from txt
  6. Are consumers really willing to trade convenience for savings and broader coverage? Not real til it affects me. about 1 hour ago from txt
  7. #whcc09 healthcare is either engine for growth or anchor about 2 hours ago from txt
  8. #whcc09 ceo of kelly svcs says surveys show that greatest issue to starting company is access to hc about 2 hours ago from txt
  9. #whcc09 – ceo of wpt just said they sold nextrx to esrx as a way to lower costs. True in economy of scale perspective. What about coor …about 2 hours ago from txt
  10. #whcc09 only 10% of audience believe costs will be managed with legislation in 10 years. About 50% skeptical. about 2 hours ago from txt
  11. #whcc09 – reform w/o public plan an option if meet admin’s 8 objectives. about 3 hours ago from txt
  12. #whcc09 – MA connector has 80% of purchases online in under 25 minutes. Will broker model die? about 3 hours ago from txt
  13. #whcc09 person from MA connector – waste is someone else’s income – one challenge. Their trend is only 5%. Not bad. about 3 hours ago from txt
  14. #whcc09 bs of ca ceo – hc is a right. Can’t achieve coverage w/o controlling costs. Involve constituents more often. about 3 hours ago from txt
  15. #whcc09 good speaker from administration…laid out principles…no secret sauce…costs, quality, coverage about 3 hours ago from txt

 

These are my notes from the sessions. As time allows, I will work on some “stories”, but I thought I would share this.

Dr. Hughes from the Obama administration:

  • HC costs are “crushing the budgets” of families and government
  • Businesses finding it difficult to maintain coverage and be competitive internationally
  • HC reform not just a moral imperative but an economic imperative (Obama says)
  • Not whether every American deserves coverage but how we get there
  • How we get there
    • Expand coverage
    • Prevention and expansion of public health
  • Hosting of localized healthcare session – 9,000 volunteers; 30,000 participants; 4,000 reports
    • Very similar findings
    • Affordable, high-quality coverage
  • CHIP plan
  • American Recovery and XXX Act
    • Billions for research and other health priorities
      • $19B to modernize system w/ HIT
      • $1.1B comparative effectiveness
      • $1B Prevention
      • $2B Community Health Centers
      • $500M for health workforce training and education
    • $87B to states for Medicaid and CHIP
      • Protect 20M Americans
    • HC tax cut of 65% for COBRA
      • 7M Americans
  • $630B healthcare reserve fund for next 10 years
    • 50/50 by increasing revenue and cutting costs
      • Tax the rich
    • Reduce overpayments to MA
    • Reduce drug prices
      • Expanding access to generics
      • Follow-on biologics
    • Medicare / Medicaid payment accuracy
    • Improving care for those that have been hospitalized
      • 1/5 Medicaid rehospitalized w/I 30 days
    • Align incentives for quality not just quantity of services
    • LT investment
  • No written plan…approaching with open mind to collaboration
  • President has endorsed 8 principles
    • Protect family health
    • Affordable
    • Prevention
    • Quality and safety
    • Portability
    • Choice of MDs
    • No pre-existing conditions
    • End LT health cost growth for business

Bruce Bodaken – CEO of BS California

  • Lessons learned from failed CA experiment
  • Principles:
    • Healthcare is a right (can’t turn a blind eye)
    • Can’t achieve coverage w/o controlling costs
  • Been working on CA legislation since 2002
  • Need to touch base w/ constituents more often
  • Need unions and business in lock-step
  • May not want to take this all on at once [big bang vs. incrementalism]
  • Can’t be globally competitive w/o addressing cost issue
  • The right time to see this happen…”capture the moment”
  • Change happens when things are up in the air

John Kingsdale – MA Health Connector

  • Moral challenge that the country has to win
  • Passed 198-2 in MA (across both houses)
  • Bit of genius to how they did it
    • Bit off what they could chew
    • Almost universal (2.6% uninsured)
    • Universal insurance in Europe is closer to 1% uninsured
  • Costs no more worse than CA and other places
  • Didn’t worsen costs (5% annual trend)
  • Didn’t do radical attack on costs…health care reform 2
  • Pay ~600% more than industrialized countries for administration of health
  • Pay ~300% more per day in hospital than other countries
  • “Waste is someone else’s income”
  • Moving away from fee for service model
  • How does the federal government do it in depth of recession?
    • Premium increases still going up 10% while in recession / depression…how is that possible.
  • Connector
    • Educate and inform buyer
    • Put forth high value option
    • Facilitate comparison for “shopping”
  • Connector can create a modern way to distribute health insurance…but this will threaten some of the existing players [i.e., brokers]
    • Should be all online
  • 80% of their purchases are online in 20-25 minutes

 

Q&A:

  • Need for bi-partisan support. What’s president’s perspective – important or will he ram it through?
    • Wants bi-partisan support.
    • President will do what he has to do to get it passed.
  • One of the big elements of discussion is having a big public plan. Does it drive private plans out of business? Don’t take away from what people have. How does administration think it will play out?
    • There are lots of good plans out there. Administration open to change / discussion. Plan doesn’t have to have public plan if it meets his 8 objectives.
    • Having regulation w/ teeth important. Risk pool vs. head-to-head competition.
    • Proposals for single payor in CA has failed multiple times.
    • Need to do something other than putting ½ T business out of business

 

Audience Polls:

  • Believe legislation will be passed
  • 50% believe we will make marginal progress in next 10 years
  • ~ 50% feel that cost mgmt unlikely
  • 40/40/20 audience split btwn republican/democrat/independent

 

 

Second Session – Facilitated by Vanessa Fuhrmans (WSJ)

Health and Money

Angela Braly (WPT), Carl Camden (CEO of Kelly Services), and Mark McClellan (Brookings Institute)

 

Audience Poll: 42% believe individuals should pay the most for HC

 

Angela:

  • Jeopardy question ” what does WPT provide to 1 in 9 americans?” answer was life insurance which was wrong
  • Needs to be a game-changer.
    • Need solution for uninsured
    • Don’t think gov’t plan is the right answer
    • Think need to make changes in individual market
    • Enforceable
    • Reward healthy behavior
    • Guaranteed issue
    • Focus on cost and quality
  • Sold PBM since it’s a way to drive to lower cost

 

Poll – what % of 17M adults going to MD will receive recommended course of care – 55%

 

CEO of Kelly Svcs

  • 26% of workforce is “free agent”
  • Expected to grow dramatically
  • The group that produces the most new business start-ups
  • US falling behind others in start-ups per 1,000
  • Greatest impediment to starting business in US survey is access to HC
  • Total costs of employment in US is driving move to offshore
  • Question should we where jobs are growing vs. whether companies moving offshore

 

Mark McClellan:

  • HC can be engine for growth or anchor
    • Is spending getting more or due to inefficiencies?
      • Life expectancy goes up 1 year per decade
  • Have to change the system not just buy more people into the current system
  • Lots of examples of getting much more with less
    • Cleveland Clinic
    • Geisinger
  • Key steps:
    • Major emphasis on measuring quality and cost
      • Consistent, meaningful, patient level, outcome based
    • Create accountability in payment systems and benefit systems

 

Audience Poll – Do you support reforms to the current payment system – 82% support major reform.

 

Audience Poll – Do you support reforms to the current delivery system – 84% support major reform.

 

Audience Poll – Would you still support if it affected access to your md, policies and cost – 67% yes. [this is a major variance from public response]

 

Angela – Private insurers will take proactive role in driving healthcare payment reform. Aligning reimbursement w/ outcomes may be the result. Compensating for prevention is important.

 

Mark – Lots of worry about comparative effectiveness being over simplified and mis-applied.

Mark – Need to focus on value in HC.

Angela was asked the “tough” question on why hasn’t healthcare reformed itself. I thought she had a great answer…”because people want convenience”. Members don’t want to have smaller networks or restricted access. They want everything, but at a lower cost. [Not a likely scenario.]

Healthcare

Selling NextRx to Express Scripts

April 14, 2009 by George Van Antwerp 0 Comments

I was hoping I might get a chance to sit down with Angela Braly (CEO at Wellpoint) at the WHCC 2009 in DC to talk about the sale they announced yesterday NextRx to Express Scripts).  I think it’s a very logical decision, and I think they got a good price.  For my old team at ESI, there is a huge opportunity for them to drive mail volume.

In her keynote discussion this morning, she briefly mentioned the sale saying that they sold it to help lower healthcare costs.  While I completely agree in the short-term (i.e., rebate contracting, network negotiations), I remain mixed in my long-term view.

I talked briefly with Les Masterson about this yesterday for the article he just published – “PBM Sale Highlights Dilemna for Health Plans“.  I do expect this will push for the development of a new business model which will highlight automation, member engagement, and a greater role in driving outcomes.

George Van Antwerp, vice president, solutions strategy, at Silverlink Communications, Inc., in Burlington, MA, says health plans can benefit from having their own PBMs if they use them properly.

“I think that it’s beneficial to plans to own their own PBM if they can integrate data and create a better member experience; make the tradeoff between increased pharmacy spend and lower medical loss ratio; and manage to get most of the economies of scale in terms of operations and negotiation. That has proven hard to do within health plans, and therefore, there will be short-term interest in capitalizing on the valuation of the PBM business,” says Van Antwerp.

With three large PBMs left after the pending purchase, Van Antwerp says the trio will “race to the bottom in terms of negotiating scale leverage.” Van Antwerp predicts the remaining PBMs will ultimately try to differentiate themselves by offering healthcare management through member engagement, greater transparency, and a renewed focus on health outcomes.

Books / Articles, Events, Healthcare, Managed Care, PBM / Pharmacy, Silverlink

Podcast on Saving Money in Pharmacy

April 14, 2009 by George Van Antwerp 0 Comments

Les Masterson from HealthLeaders Media posted an audio recording of a conversation we had a few weeks ago about how plans should save money by driving mail, generics, and programs like pill splitting.

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

Express Scripts (ESRX) buys NextRx from Wellpoint

April 13, 2009 by George Van Antwerp 1 Comment

Express Scripts is buying NextRx from Wellpoint (press release).  Key points:

  • $4.675 B
  • 10 year deal w/ Wellpoint
  • 25M lives
  • 265M adjusted Rxs managed annually

This makes them bigger than CVS Caremark and almost as big as Medco in terms of Rx volume.  The challenge will be whether these lives stay with Express Scripts when they come up for renewal or not.  Just having a deal with Wellpoint doesn’t require them to stay.  (I hope they have an earn out tied to retained lives.)

BTW – This is almost at the top of the $1-$5B range which will bring anyone else contemplating selling their PBM to the table.

Here is the mention with script counts from the WSJ Blog.

Healthcare, PBM / Pharmacy

Medicaid Communications

April 10, 2009 by George Van Antwerp 0 Comments

Interested in hearing more about this topic.  You can hear Margot Walthall from my team talking about this on an upcoming webinar.

The Medicaid Communications Lifecycle:  From Onboarding through Redetermination
April 28, 2009 | 1:00 PM ET | 10:00 AM PT

Introducing your Medicaid members to your plan’s benefits as well as their responsibilities is critical to developing a successful member / health plan relationship. Sustaining positive impressions over the course of the member’s eligibility is equally important to retaining Medicaid members.

Silverlink has developed a broad set of communications outreach programs that have yielded strong results for Medicaid and CHIP populations. Join us for this complimentary webinar where we will explore how Silverlink can help you cost-efficiently support:

  • The Medicaid onboarding process with welcome/HRA outreach
  • Targeted messages about health screenings to drive HEDIS results
  • Communications approaches that can reduce health disparities
  • Effective methods for educating members about the redetermination process that can inspire loyalty

Register Here

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, Silverlink, Value Propositions

Sprint: What’s Happening Now

April 9, 2009 by George Van Antwerp 0 Comments

I am not sure how this helps Sprint sell more phones and/or services, but I enjoyed the advertisement. The concept of leveraging data to understand consumer behavior is essential. This is a topic we [Silverlink] are constantly working with our healthcare clients to address.

  • How do you know what members or patients are doing?
  • Do you understand their preferences?
  • What have they historically done?
  • Can you predict how they will act in the future?
  • What data is needed to do analysis and create a predictive algorithm?
  • How do you leverage that to create interactive and compelling communications?
  • How do you study their behavior change?  (e.g., did they get a flu shot after being reminded)
Business Tools, Consumerism, Healthcare, Innovation, Marketing / Communications, Silverlink, Technology, Value Propositions

X-Ray Vision Carrots

April 8, 2009 by George Van Antwerp 1 Comment

Behavioral economics can apply in many instances.  It is the “hot” discussion topic in healthcare about how to understand how members (consumers / patients) make decisions and what factors influence their decisions.

In this article in Newsweek about getting kids to eat healthy, they talk about three things:

  1. Verbal encouragement
  2. Descriptive labels
  3. Improved access

Rather than calling them carrots, they talk about calling them “x-ray vision carrots”.  These 3 “principles” are relevant to a lot of communications.  You have to be proactive and provide encouragement to members to get a flu shot or do other preventative health actions.  You then need to find a way to describe the action in a way that is compelling.  And, finally, you have to make the action easy.

Books / Articles, Consumerism, Healthcare, Innovation, Marketing / Communications, Research, Silverlink

Flaspohler PBM Survey

April 8, 2009 by George Van Antwerp 0 Comments

I was not familiar with this survey and stumbled across it the other day – 2008 Flaspohler PBM Survey. For those of you that follow the space, it has some interesting data in it. Here were a few of my notes:

  • It was a survey of 259 executives from MCOs (health plans), self-insured employers (SIs), third party administrators, and consultants.
  • This is the 2008 survey, but it has been conducted annually since 2000.
  • 70% of MCOs and 90% of SIs were either somewhat or very satisfied with their PBM.
  • 86% of the MCOs had been with their PBM for more than 2 years.
  • 75% of the MCOs cover OTC (over-the-counter) drugs compared to only 25% of SIs.
  • Both MCOs and SIs reported “relationship oriented” being the most important factor in selecting a PBM. (Really? It seems like price is always how the decision gets made.)
  • They rate the highest PBMs by a bunch of factors:
    • Attractive pricing
    • Relationship oriented
    • Effectively uses technology
    • Effective tools to manage drug benefit costs
    • Flexibility
    • Mgmt reporting
    • No “conflict of interest”
    • Unique programs and services
    • Superior specialty pharmacy
  • They gave the top 5 in each of those categories. What stuck out to me is that Express Scripts only appeared once out of the 18 possible boxes (9 categories ranked by both MCOs and SIs). That surprises me given my familiarity with them.
    • Later, in the rankings by consultants, they did appear more which says they are doing a better job there of getting the word out and education.
    • Several other companies appeared only once which was surprising (Aetna and UHC), but they were unlikely to be ranked by other MCOs.
  • It also surprised me that Medco only appeared 3 times and Cigna 4 times.
  • The other companies that appeared were Argus, Catalyst, MedImpact, SXC, Wellpoint Next Rx, Prime Therapeutics, CVS Caremark, Humana, NMHC (now SXC), UnitedHealthcare, Walgreens, Partners Rx, and Prescription Solutions.
  • Only 10% of SIs but 27% of MCOs have an exclusive specialty pharmacy provider.
  • They then looked at the specialty pharmacies across 5 categories:
    • Use and have an exclusive relationship with
    • Would consider using
    • Know little or nothing about
    • Use but not exclusively
    • Know but would not consider using
  • The three categories that interested me were exclusive relationships, ones that the MCOs know little or nothing about and those they would not consider using.
    • Exclusive relationships were with CVS Caremark, BioScrip, and Express Scripts (CuraScript) primarily.
    • Of the biggest names, it was surprising that people knew little about PrecisionRx (Wellpoint) and Wal-Mart.
    • Of those they would not consider using, two were in excess of 30% – Walgreens and Accredo (Medco).
Healthcare

Big Month For Vasectomies

April 8, 2009 by George Van Antwerp 0 Comments

Based on several articles over the past year, this should be a big month for vasectomies.

Last year, Forbes pointed out that the scheduling of vasectomies jumps dramatically before big sports events – The Masters, Final Four, Football.  Apparently, people want to get “snipped” on the Friday and have a good reason to sit around all weekend and recover while they watch their favorite sport.  Talk about planning.

And, last month, there was an article about the spike in vasectomies due to the economy.  No hard data about why, but the article hypothesizes that people are concerned about the additional costs of children and want to get the procedure done while they have health insurance.

Consumerism, Healthcare, Managed Care, Research, Value Propositions

Impact of Rising Health Care Costs

April 8, 2009 by George Van Antwerp 0 Comments

These are straight from the National Coalition on Health Care (NCHC), but they represent a sobering view of the impact of our rising costs. For the broader list of facts, you can go to their website.

  • In 2008, health care spending in the United States reached $2.4 trillion, and was projected to reach $3.1 trillion in 2012.1 Health care spending is projected to reach $4.3 trillion by 2016.1
  • Premiums for employer-based health insurance rose by 5.0 percent in 2008. In 2007, small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.2
  • Health care spending is 4.3 times the amount spent on national defense.3
  • Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by the end of 2008.4
  • The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 – a 16 percent increase.5
  • A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.6 Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
  • A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.7
  • About 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. 8
  • A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.9

Notes

  1. Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.
  2. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008.
  3. California Health Care Foundation. Health Care Costs 101 — 2005. 02 March 2005.
  4. McKinsey and Company. The McKinsey Quarterly Chart Focus Newsletter, “Will Health Benefit Costs Eclipse Profits,” September, 2004.
  5. Agency for Heathcare Research and Quality. Out-of-Pocket Expenditures on Health Care and Insurance Premiums Among the Non-elderly Population, 2003, March 2006.
  6. Himmelstein, D, E. Warren, D. Thorne, and S. Woolhander, “Illness and Injury as Contributors to Bankruptcy, ” Health Affairs Web Exclusive W5-63, 02 February , 2005.
  7. The Access Project. Home Sick: How Medical Debt Undermines Housing Security. Boston, MA, November 2005.
  8. Robertson, C.T., et al. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures,” Health Matrix, 2008
  9. Selzer and Company Inc. Department of Public Health 2005 Survey of Iowa Consumers, September 2005.
Books / Articles, Healthcare, Managed Care, Research, Value Propositions

Kaiser Family Foundation Health Care Data

April 4, 2009 by George Van Antwerp 0 Comments

The Kaiser Family Foundation always has some great data points on health surveys, data trends, and other topics. In some cases, they have made these into slides that you can download and re-use.

I grabbed a bunch of them which you can see below. To download them yourself, go to their website.

Healthcare, Managed Care, Marketing / Communications, Research, Value Propositions

Getting Kids Active

April 3, 2009 by George Van Antwerp 0 Comments

In today’s computer world, this is as much a challenge for some kids as it is for us adults to find the time. But, it’s important to start the practice early. I liked Dr. Dolgoff’s blog entry on this. It’s pretty straightforward but a good reminder for all of us.

Step One: Let your children see you enjoying exercise.

Step Two: When your child is old enough (around age 3), allow them to participate in very small amounts. You don’t want to overwhelm them.

Step Three: Don’t say no!

Step Four: Step it up!

Step Five: Keep it up!

exercise, Healthcare, Weblogs

OTC Equivalents to Prescription Drugs

April 1, 2009 by George Van Antwerp 0 Comments

In some cases, there are OTCs (over-the-counter) medications which a consumer can choose to use in place of a prescription drug. Financially, it’s a question of what your copay is versus the cost of the OTC medication.

The biggest drugs in the past few years to go OTC have been Claritin and Prilosec which are now both available as brands and generics over-the-counter.

I found this list that BCBS of TN had put out which I thought I would post as a link. It does a good job of creating a clean wall chart of some of the alternatives.

Healthcare, PBM / Pharmacy, Value Propositions

Teva On Year Of Affordable Healthcare

March 30, 2009 by George Van Antwerp 0 Comments

Teva (a generic drug manufacturer) has rolled out a new site call Year of Affordable Healthcare to celebrate the 25th anniversary of the significant generic legislation (Hatch-Waxman Act). As part of that, they have rolled out a few videos in the Mac vs. PC approach.

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Consumerism, Healthcare, PBM / Pharmacy, Politics, Value Propositions

Taxing Cigarettes – For Health or Financial Purposes?

March 30, 2009 by George Van Antwerp 0 Comments

I heard this discussion on the radio this morning and found it very interesting.  Do we keep raising taxes on cigarettes to reduce smoking (i.e., improve health and long-term liabilities) or is it to drive money into our government since we don’t think people will quit?

It’s an interesting question because if it’s for health purposes then there might be lots of different things that could be done – subsidize patches (for example).

General Thoughts, Healthcare

Do Google Searches Tell Us Anything About Wellpoint Buyer?

March 30, 2009 by George Van Antwerp 0 Comments

I doubt it, but it is interesting.  After I first posted about Wellpoint’s PBM (NextRx) being for sale, most of the Google searches that came to my blog came from people searching using some string about Express Scripts buying NextRx.  Now, there are more searches coming from people searching about Medco buying NextRx.  I get some occasional ones about Wal-Mart and Walgreens but that’s about it.

Unfortunately, I don’t have much more context on the searches to know who’s doing them.

Healthcare, PBM / Pharmacy

Marathon / Triathalon Deaths Per Million

March 29, 2009 by George Van Antwerp 1 Comment

An article that came out yesterday points out that there is a much higher risk of heart problems in the triathalon especially around jumping into the cold water for the open swim.  It puts the deaths per million participants at 15 compared to 4-8 deaths per million marathon participants.  Certainly, if you are jumping into either sport, you should train appropriately and talk with your physician about any concerns or ideally get checked out for any potential heart complications.

But, I think it’s also important to put these in perspective.  According to FARS (Fatality Analysis Reporting System), the statistics on fatalities from car accidents are:

  • 13.61 per 100,000 people
  • 16.05 per 100,000 registered vehicles
  • 19.96 per 100,000 licensed drivers
Books / Articles, exercise, Healthcare, Research

Some of The Worse Lunches

March 28, 2009 by George Van Antwerp 0 Comments

This whole article on restaurants is worth reading to show you just how bad some meals are for you.  Let me pull out a few of the scariest meals:

QUIZNO’S

Large Prime Rib Cheesesteak Sub

  • 1,490 calories
  • 92 g fat (22.5 g saturated, 2 g trans)
  • 2,620 mg sodium
  • Fat equivalent: Like eating four Dunkin Donuts cheese danishes!

CHILI’S

Crispy Sweet Chile Glazed Chicken Crispers

  • 1,930 calories
  • 112 g fat (17 g saturated)
  • 4,190 mg sodium
  • Calorie equivalent: Like eating an entire medium Pizza Hut 12″

PANERA

Italian Combo on Ciabatta sandwich

  • 1,050 calories
  • 47 g fat (18 g saturated, 1 g trans)
  • 3,050 mg of sodium
  • Fat equivalent: Like eating 6 slices of Papa John’s cheese pizza!

HARDEE’S

2/3-lb Monster Thickburger

  • 1,420 calories
  • 108 g fat (43 g saturated)
  • 2,770 mg sodium
  • Saturated fat equivalent: Like eating 43 strips of Oscar Mayer bacon!

BURGER KING

Triple Whopper Sandwich with cheese and mayo

  • 1,250 calories
  • 84 g fat (32 g saturated, 2.5 g trans)
  • 1,600 mg sodium
  • Fat equivalent: Like eating 10 slices of Papa John’s cheese pizza!

Books / Articles, General Thoughts, Healthcare

Drug Importation

March 26, 2009 by George Van Antwerp 0 Comments

From what I saw this morning, it looks like the administration is going to go down this path.  I don’t think it’s a good idea.  I will point to my post from a few months ago on why.

My prediction is that it’s an arbitratage opportunity which will appeal to the public, but will cost us more in the long run.

On the flipside, I guess it’s better than having people take buses to Canada to buy drugs and sneak them into the country risking arrest.

bus1

General Thoughts, Healthcare, PBM / Pharmacy, Politics

Responsibility Based Healthcare

March 25, 2009 by George Van Antwerp 1 Comment

Are we finally to a point economically where healthy people will get tired of bearing the cost burden of supporting their sicker coworkers?  As costs continue to skyrocket, most people probably don’t realize that those are from a minority of their coworkers who have chronic conditions.  (Or in the case of Medicare, are from the costs incurred in the final year of life.)

If you’re like me, I generally don’t mind the risk pool concept (since I don’t know where I might end up any year).  And, I certainly don”t mind paying for people who are genetically pre-disposed to some condition (we all may be in that bucket someday), but I could take issue with paying for people who don’t comply with their physician’s recommendations (most of us), don’t act preventatively (most of us), abuse their body with things like smoking, and I could go on.

It got me thinking this morning about a model where we were able to push costs to people based on them taking responsibility for their care (i.e., “responsibility-based care”).  While we certainly won’t be at a place in the near future where genomics dominates and we can pull out people who can’t control their health, we can track things like compliance and adherence once we get an integrated HIT (healthcare information technology) system in place.

Additionally, we might get someday to a place where we can offer incentives based on active management and results which are self-reported by remote devices that track blood pressure, weight, cholesterol, etc.  But, many of these have issues around confidentiality and would challenge the risk pool process that we use today to underwrite medical costs.

I am not sure what the right answer is, but I think it’s about time for this debate to rear its head again with more energy.

Consumerism, Healthcare, Managed Care, Politics

PCMA Carve-Out Advertisement

March 24, 2009 by George Van Antwerp 0 Comments

I was a little surprised to see the latest PCMA advertisement that goes for the jugular on pharma companies that support generic carve-out legislation.

pcma-ad

What is the “generic carve-out” concept – legislation which proposes making certain classes of drugs exempt from the ability of the pharmacy to substitute an A-B rated generic for its brand equivalent when the physician has not marked the prescription – Dispense As Written (DAW).

Healthcare, Marketing / Communications, PBM / Pharmacy, Politics, Research, Value Propositions

Correlation or Causality

March 23, 2009 by George Van Antwerp 0 Comments

This is a typical mistake that many people make.  They see correlation and mistake it for causality.

From Dictionary.com:

  • Correlation = the degree to which two or more attributes or measurements on the same group of elements show a tendency to vary together.
  • Causality = the principle of or relationship between cause and effect.

I see the difference as correlation shows two things that appear to be related (i.e., I ate a strawberry and had a rash the next day therefore I must be allergic.)  Causality is a direct relationship that is proven where one clearly causes the other (i.e., I went to the allergist and had a bunch of studies done.  I am allergic to strawberries).

There was an article in USA Today called “Many think they have drug allergies” on March 9, 2009.  Apparently many people think they have allergies when they don’t.  In one study discussed in the article, 90% of those people who said they were allergic to penicillin where not when a skin test was done to check.

  • People often mistake side effects with allergic reactions. (e.g., stomach ache)
  • People trust their mothers (i.e., relying on hearsay versus facts).
  • People trust their doctors (when tests may not have been conducted).
  • People grow out of some allergies.

The point of all this is that you need to rely on facts and isolate them to prove causality.  Don’t just look for things that happen at the same time.

Books / Articles, Healthcare, Research

How Easy It Is To Overeat

March 21, 2009 by George Van Antwerp 0 Comments

This is a good article that I saw on MSN this morning talking about calories in pizza, ice cream, orange juice, rice, and other foods and how quickly we overeat by simply not managing portions.

How many of us eat one slice of pizza for a meal (for example)?

Books / Articles, Healthcare

$2.3T on Healthcare and 47M Uninsured – National Disgrace

March 21, 2009 by George Van Antwerp 1 Comment

Kaiser Permanente recently launched a series of advertisements that drive this message around health disparities home. It is (or should be) a concern for most of us.  Health outcomes and especially preventative care is driven by health literacy, our attitudes towards health, and our access to the healthcare system.  We should all be working with our families, our communities, and our country to try to make this better.

I am a firm believer that one of the best ways to start to manage cost is to find a viable strategy to get universal coverage.  The costs of emergency care and absenteeism all get passed on to us in one way or another.  And, as the government is the dominant payor of healthcare (Medicare, Medicaid), long term costs are a significant issue for our economy.  If there is a systemic way of improving it, we should seek that out.

So, a cause that is both moral and economical…what more do you need?

Today, more than 50 percent of Americans and 75 percent of Californians without health care coverage are people of color.  Uninsured men, women, and children are far more likely to get sick and forego care simply because they lack coverage.  This is a national disgrace. We spend 2.3 trillion dollars on care in this country. Securing health care coverage for every American is the next great civil rights issue of our time. We can and should achieve universal coverage.

kaiser-ad

Some of the facts highlighted on their new website about disparities include:

  1. Disparities in health and health care impact everyone. African Americans, American Indians, Alaska Natives, Asians, Pacific Islanders, and Hispanics are most affected.

  2. 27% of adults report having no usual source of care. African-American (28%), Hispanic (51%), and Asian (23%) adults are all more likely to report not having a usual doctor.

  3. Uninsured adults are disproportionately, young, and minorities; 82% are between 19-49 years of age, and 41% identified themselves as black, Hispanic, or other.

  4. American Indian and Alaskan Native death rates from sudden infant death syndrome are the highest of any population groups.

  5. Asian Americans have the highest tuberculosis case rates of any racial and ethnic population.

  6. During 1996-2000, Native Hawaiians were 2.5 times more likely to be diagnosed with diabetes than non-Hispanic white residents of Hawaii of similar age.

  7. In 2005, African Americans accounted for 18,121 (49%) of the estimated 37,331 new HIV/AIDS diagnoses in a national poll which encompassed 33 states.

  8. 21.9% of U.S. children live in poverty, far and away the worst in the industrialized world. Comparable figures for the Nordic countries are 4.2% and less.

  9. Adults who have not finished high school are almost two times more likely than college graduates to be obese.

To learn more about the topic, you can go to their community of information.

Books / Articles, Healthcare, Leadership, Managed Care, Marketing / Communications, Politics, Research, Value Propositions
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