Archive | Healthcare RSS feed for this section

Medco on Future of Pharmacy

April 8, 2008 by George Van Antwerp 2 Comments

Medco has introduced a new publication called Perspectives. The one I just read was by Dr. Robert Epstein who is their Chief Medical Officer and is about how pharmacy will become personalized, specialized, and consumer driven. It is a well written piece with some good and interesting facts. Here are a facts and takeaways:

  • “Over the past five years we’ve seen a 60 percent increase in adult ailments diagnosed in children and treated with adult medicines.”
  • “The use of proton pump inhibitors (PPIs), drugs for heartburn and acid-reflux disease, increased by 60 percent in children between the ages of 1 and 4. This is despite studies revealing that as many as 95 percent of young children who present with symptoms of reflux self-correct for the condition in 12 to 16 months. Furthermore, some recent research suggests the long-term use of these products – particularly in the early years of life – can lead to infections, pneumonia or gastroenteritis.”
  • “Blockbuster medicines in three new major therapeutic categories – Fosamax® for osteoporosis, Risperdal®, an antipsychotic, and Imitrex® for migraines – soon lose patent protection.” [He then suggests that payors begin to look at strategies for driving Fosamax and Imitrex marketshare now, especially for new patients, so that when they go generic they are positioned to take advantage of the savings.]
  • He talks about the changing guidelines for hypertension, asthma, and cholesterol and points out that “It’s estimated that 25 percent of Americans have hypertension, and another 25 percent have “pre-hypertension” – which means half of the U.S. population will become candidates for treatment.”
  • He talks about nano-technology and gives the following example:

“One company, based in Houston, has taken nano-sized particles of gold, which are injected into the bloodstream and leach from the leaky blood vessels associated with rapidly growing tumors. When exposed to infrared light – these gold particles literally absorb the heat and destroy the tumor. Called AuroLaseTM Therapy, within 10 days of a single treatment this therapy caused, laboratory rats with prostate cancer to attain a 90-percent survival rate.”

  • “More than one in five people placed on Coumadin® are hospitalized by side effects, many of which could be averted by genetic tests to more accurately guide proper dosing”
Books / Articles, General Thoughts, Healthcare, Innovation, Managed Care, PBM / Pharmacy, Research, Technology, Value Propositions

Stop Sweating With Botox

April 8, 2008 by George Van Antwerp 0 Comments

I was just listening to the local news out here in Phoenix and was surprised to hear them talk about the increased use of Botox by people to stop sweating in their armpits. Apparently, stars have used this for a while but now average people are doing it. The report said that one set of injections lasts 6-9 months which for the people with overactive armpit sweating.

I am not sure I believe it, but the news reporter said that these are usually covered by insurance.

CBS News Story

Books / Articles, Healthcare, PBM / Pharmacy, Value Propositions

Running Shoes Cheaper Than Medicine

April 8, 2008 by George Van Antwerp 0 Comments

When I was running the St. Louis half-marathon this past weekend, I kept thinking about something I saw recently which was a story about a patient arguing that it was cheaper for them to buy running shoes and exercise than to pay for medication. It’s an interesting point. If a patient would be willing to exercise outside (low cost), all they need is a good pair of running shoes. You probably have to replace them every 3-4 months so at $80-$100 per pair you are talking about $240 – $400 per year. It would probably be a wash for 12 copays for a brand drug on formulary, but cheaper if you had multiple drugs.

It would be a lot cheaper for the payor to provide the running shoes in return for the commitment to workout. How would you measure it? Easy. You could use a GPS and as long as the patient walked or ran X miles per month then they got the benefit of free shoes. Not likely to happen, but I think the point is that there are many creative ways to incentivize patients to be healthy which create a clear win-win.

For example, why not provide them with free (or heavily discounted) Prilosec or Zyrtec as over-the-counter (OTC) drugs? The reaction is always that this is opening Pandora’s Box to coverage of OTC (e.g., vitamins and aspirin). It doesn’t have to be. It can be controlled by requiring the patient to get a prescription for the OTC from their physician. Once they get the Rx, they fax it in as a sort of prior authorization for the drug. If the PA is on file, they can either pick it up at the pharmacy for the $0 (or discounted) copay or get reimbursed after they purchase it.

Healthcare

Going to WHCC

April 8, 2008 by George Van Antwerp 0 Comments

I am excited that I get the opportunity to go to the World Healthcare Congress in DC later this month. This looks to be a great conference, and I am going to blog from the event. If you’re there, look me up. I will be sitting at the bloggers table at the front of the event.

Books / Articles, Healthcare, Innovation, PBM / Pharmacy, Research

Maternal-Fetal Surgery: Trade-off Examples

April 7, 2008 by George Van Antwerp 0 Comments

One of the key parts of healthcare is the need to make tradeoffs especially when it comes to treatment plans. Exercise requires a commitment and can make you sore. Some drugs have side effects that may impact other parts of the patient’s life. Surgeries carry risk.

With that in mind, I found an article in the American Way magazine interesting in its discussion of maternal-fetal surgery. This is a technique where a doctor uses a fetoscope (telescope with a small camera at the end) to go into the uterus through a tiny incision (0.15 inches wide) to stabilize life-threatening blood-supply imbalances (e.g., twin-twin transfusion syndrome) and through larger incisions to remove rapidly growing and life threatening tumor masses. As you can imagine, this is controversial. There are risks for the mother and no guarantees that it will be successful.

There were less than 1,000 surgeries between 2005 and 2006, and it sounds like it is used for extreme cases today (i.e., less than 10-20% chance of the fetus living). A clear example of why transparent information is necessary and clear communications make a difference. Patients need to understand their options, the risks, the tradeoffs, and the implications.

Books / Articles, Healthcare, Innovation, Technology

73-Page PDL – Simplicity?

April 7, 2008 by George Van Antwerp 0 Comments

I hate to pick on a friend of mine, but I was looking at the PDL (Preferred Drug List) (aka Formulary) that his company puts out. It was 73-pages long. Not likely to be carried by many patients to their appointments. In today’s world of simplicity, it would seem like there must be a better answer.

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy

Pharmacists to Prescribe?

April 4, 2008 by George Van Antwerp 0 Comments

Someone asked me if I thought pharmacists would be allowed to prescribe medication to patients. I’m not familiar with any legislation on this topic (although there well might be some).

My opinion is that the better model is that physicians are responsible for diagnosing and basically writing a prescription for the type of drug (e.g., statin). I think the pharmacist is in the best position to talk with the patient about which drug within that category they should use looking at drug-drug interactions, form of the medication, formulary status, costs, side-effects, and other things that usually result in a follow-up call to the physician. Given that 40% of scripts written today hit some type of edit as an exception, I can’t imagine pushing that responsibility to the physician.

One of the most creative scripts I saw at Express Scripts around this was a physician that had just written all the PPIs (e.g., Prilosec, Nexium, Protonix) on the script and said pick one. I don’t know if it was legal, but I thought it made the point that they didn’t want the call back.

General Thoughts, Healthcare, PBM / Pharmacy

Communications As Trend Mgmt Tool for Pharmacy: Cliff Notes

April 4, 2008 by George Van Antwerp 0 Comments

Here are a few points from my recent webinar on this topic. If you are interested and a potential client, I would be happy to share the detailed content with you offline.

[Since all our competitors tried to sign up to listen in, I won’t give away everything here.]

  1. Talked about all the value sitting on the table that could be captured (>$30B per year).
  2. Talked about how communications can both be the trend management tool and enable utilization of other trend management tools (e.g., utilization management).
  3. Talked about things like loss aversion versus cost savings, the placebo / price correlation, and the transition from the Ford framework to the Starbucks framework in the healthcare industry.
  4. Talked about how people are different and the need for a systemic approach to dynamically optimizing program success using a scalable model.
  5. Talked about some frameworks for retail-to-mail and brand-to-generic along with the importance of asking the right questions in program design and measuring ROI.
  6. Finally, we talked about some results and the different levers to play with to impact results.

Consumerism, General Thoughts, Healthcare, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Technology, Value Propositions

Example of Misalignment

April 4, 2008 by George Van Antwerp 0 Comments

One of the points in George Halvorson’s book Health Care Reform Now! is about misalignment of incentives.  Providers are not paid for better outcomes.  They are paid per activity (i.e., to keep people coming back).  It’s a key point which deserves a much longer discussion.  That being said, I couldn’t help but think of this when reading yesterday’s WSJ article “Flu Economy Takes Unexpected Turn“.  A few quotes that it mentions include:

  • CEO of Walgreens at shareholder meeting – “If attendees of the meeting needed to cough, he joked, they should leave the room and ‘go to a movie theater or on a bus’ to spread their germs. ‘We’re really hoping for a very strong flu season’.”
  • “Unfortunately, people have not been getting sick at a rate that we would all like yet.” P&G CEO
  • “On the pediatric side, young kids coming into the hospital, that’s a nice margin for us, as well.” CFO of LifePoint Hospitals

Now, the easy discussion here would be to criticize these executives for being insensitive, but that’s not the problem.  The problem is that we have incented our healthcare system so that people make money when people are sick.  To my earlier post, this doesn’t mean people shouldn’t make money, but it means we should find a way to incent them to make people better.  We have decades of benchmark data (somewhere).

Books / Articles, Healthcare, Leadership, Managed Care, PBM / Pharmacy

Questions On Health Care Policy For McCain

April 4, 2008 by George Van Antwerp 0 Comments

Elizabeth Edwards (wife of former presidential candidate John Edwards) provides some thoughts on John McCain’s healthcare plan on the The Wonk Room blog.  It will be interesting to see if his team engages in the conversation and provides a response.  Regardless, I think the key points are good ones for any candidate to answer:

  1. How are we going to address pre-existing conditions?  We can’t exclude or gouge people that have chronic diseases.  On the other hand, it is often the fact that they don’t manage these diseases that drive up costs.  Would it be reasonable to charge them more if they didn’t take responsibility for their disease?
  2. What is the long-term market mechanism to make sure that the solution doesn’t increase costs?
  3. Will this really be cheaper for everyone in America?  Does the estimate include all the patient’s out-of-pocket costs for healthcare – copays and deductibles?  If the plans being proposed talk about shifting away from employer sponsored, do you really think that those dollars are going to be shifted to higher wages?   

These are my generalizations of her questions.  The Kaiser Family Foundation has put out a PDF which compares the plans of the three candidates – Clinton, Obama, and McCain.

Healthcare, Managed Care, Weblogs

Healthcare As A Non-Profit Industry

April 4, 2008 by George Van Antwerp 0 Comments

I am a big believer in the fact that our healthcare system needs to be more focused on outcomes, but I am not ready to jump on the bandwagon of making healthcare a non-profit industry. I had to throw in my comments on one of the entries on The Health Care Blog to talk about this.

A couple of the key points that I think are worth repeating are:

We need to address healthcare as a profession. We are facing a shortage of PCPs, RNs, and RPhs over the next decade.

I don’t think it’s a bad thing to see more business school people getting into healthcare. This new perspective can only help. It doesn’t mean that the industry will become less health focused.

I think ROI is an important metric even in healthcare. The reality is we don’t have good data to look at ROI in any holistic way in healthcare. We don’t know outcomes. We don’t know the impact of outcomes on absenteeism and other metrics. We don’t have an activity-based costing system to understand the costs of treatment.

The author says that “by law, a corporation’s first obligation is to make a profit for its shareholders. Its customers come second.” I am not sure that A makes B true. There is lots of proof out there in the business world that shows that a focus on customers sometimes at the short-term expense of profits will drive a sustainable business model.

I think we just need a different system with passionate leadership (from whatever background) who understand the long-term management model and are committed to impacting outcomes through financially aligned incentives. This likely may need to be a combination of public and private especially when you realize that 1% of the population drives 35% of the cost meaning that a small focus can make a big difference.

Healthcare, Managed Care, Value Propositions, Weblogs

Next Webinar – Retention

April 3, 2008 by George Van Antwerp 1 Comment

The webinar I did last month on using patient communications to drive pharmacy trend went very well. We are continuing our educational series. I also have the honor of giving the next one on a topic I have discussed here a little, but one which I feel very strongly about. Here it is below. [I will try to post some notes that give some of the highlights without disclosing any “secret sauce”.]

If you are a pharmacy, PBM, managed care company, PDP, disease management company, or other provider of care to a group of patients, I would encourage you to sign up.

How Communications Can Influence Member Satisfaction, Loyalty, and Ultimately Retention

When: April 15th & 24th, 1:00 PM EST

We’ve all been told for years that it costs five times as much to win a new member as it does to retain an existing one. With the big focus on consumerism in healthcare, the continuing evolution in Medicare Part D and new growth and innovation happening in support of individual markets, it is time for the science of member communications to take center stage within healthcare companies.

Join Silverlink as we discuss ways of addressing this opportunity through comprehensive communications solutions that connect with your members and increase their advocacy for your insurance product.

We’ll look at some non-healthcare examples and some leading edge ideas in healthcare, while grounding it all with short-term actions that you can implement to achieve measurably better results.

Register now >

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

Market Summary From Humana

April 3, 2008 by George Van Antwerp 1 Comment

I was looking at a recent Humana public presentation and thought this slide gave a good summary of where we are today.

humana-slide.jpg

Healthcare, Managed Care

Patient Ping-Pong: Cholesterol

April 2, 2008 by George Van Antwerp 0 Comments

As if it’s not already difficult for patients to navigate their benefits, DTC advertising, and all the healthcare information on the web, it seems we are structurally trying to make it more difficult. With the recent news around Vytorin and Zetia, the drugs used to treat high cholesterol have gone through some dramatic changes over the past few years. (Here is the formal study.)

In an editorial by the New England Journal of Medicine:

“Until such data are available, it seems prudent to encourage
patients whose LDL cholesterol levels remain elevated despite
treatment with an optimal dose of a statin to redouble their
efforts at dietary control and regular exercise. Niacin, fibrates,
and resins should be considered when diet, exercise, and a statin
have failed to achieve the target, with ezetimibe [Vytorin] reserved for
patients who cannot tolerate these agents.”

For several years, Lipitor was clearly the market leader with Zocor as a close second. Even with one drug (Mevacor) available generically, most plans (other than Kaiser) had single digit utilization. Kaiser was able to drive significant use of generic Mevacor as a first-line agent. When Zocor was going to lose it’s patent protection in 2006, most plans began moving Lipitor to the 3rd tier and introducing programs to move Lipitor patients to Zocor (generic name simvastatin). These included step therapy programs along with simple copay incentives by having a large copay differential between the 1st or 2nd tier and the 3rd tier.

Then, last year, Pfizer, which makes Lipitor, began to offer aggressive discounting to encourage some plans to actually encourage Lipitor utilization over generic Zocor. All the while, Vytorin and Zetia were gaining marketshare to capture a $5B piece of the market. Now, with the recent study, the authors are suggesting that these patients should be on generic Zocor or another drug in the statin class. I am sure there are some clinical nuances here, but the quote above seems to limit them.

And, of course, patients should discuss this with their physicians. They shouldn’t stop taking their drugs. And, generally, when you switch drugs, you want to get lab work done in this class. So, are we asking patients to change drugs again? Do they incur an office visit copay? Do they need to pay for the lab test?

Talk about confusing. And, at the same time, the Improve-It study around Vytorin and Zetia is enrolling more patients. Seems counterintuitive to the data just released.

I’m not a pharmacist, but after working in the industry, if I can’t figure out what to do, how can your average patient. At this rate, healthcare will be as confusing as our taxes.

Note: There are a handful of entries on this out at the WSJ Health Blog.

Consumerism, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions, Weblogs

Convergence: The White Space Between Ford and Starbucks

April 2, 2008 by George Van Antwerp 1 Comment

I recently read a great book called Microtrends. If you haven’t seen it, I highly recommend it for its interesting analysis of trends and the way it makes you think. For example, it talks about how people are drinking more water and more caffeine drinks. It talks about how people have much shorter attention spans yet there is a rise in knitting and books are getting longer. It talks about obesity and young vegans. It plays on the power to see small trends (i.e., 1% of the population) and how they can impact the overall framework. (You can read my detailed notes here.)

One of the frameworks that the authors use is to compare the world as moving from a Ford economy (one choice) to a Starbucks economy (personalization). As healthcare typically lags other industries, I think we this analogy works to show where healthcare was and where we are going over time. Historically (at least in the modern era), we had one choice for healthcare coverage which was offered through our employer. Over time, that has changed to where most people have more than one option for healthcare coverage from their employer. And now, more and more people are losing coverage and the fastest growing segment is individual health insurance.

We have evolved to personal healthcare, but we aren’t yet to personalized healthcare which I think will be largely driven by genomics and some radical change to our healthcare system. Unfortunately, I think we are stuck somewhere in between right now where to personalize your healthcare you need to go to a series of providers or tools which aren’t integrated. There are a few scenarios out there where there is some integration of medical, pharmacy, lab, and other data (Kaiser jumps to mind). But, even in an integrated environment, they haven’t yet fully digitized the offering and created a seamless patient experience (to the best of my knowledge).

As George Halvorson says in his latest book, Health Care Reform Now!, “We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited Microsystems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients.”

In a likely scenario, you have the following for a sick patient who is actively managing their health:

  • A primary care physician and their staff to interact with
  • A specialist and their staff to interact with
  • A pharmacist (or likely multiple pharmacists)
  • A specialty pharmacy and their nurse
  • A managed care company (and possibly Medicare) which offers a member portal and tools
  • A PBM which offers a member portal and tools
  • A disease management company and their health coach
  • Health portals or information sites (e.g., WebMD, RevolutionHealth)
  • A gym and potentially a trainer
  • A series of vitamins and OTCs that no one has visibility to (other than maybe their grocery frequent buyer card program)
  • One or more disease specific communities that they participate in (i.e., some of the Health 2.0 companies)
  • Blogs and news feeds they subscribe to for information on their disease

The reality is that they have to go out and build a series of interactions to create this semi-personalized offering with no hope of the data being integrated, getting consistent messages, or any true learnings being generated. Each party has a 1:1 relationship with them (best case) and knows a piece of the puzzle. Without an integrated infrastructure, aligned incentives, and a mechanism to engage each patient according to their preferences, we have a very difficult challenge (as an industry) and each patient bears the brunt of this.

Until we can create physical or virtual convergence (i.e., integration of data and tools into one framework), we won’t be able to move from buying coffee at one store and skim milk at another store and our muffin at another store to a Starbucks world where we have one interface to select and personalize our healthcare experience. I wish I had the answer. Unfortunately, as more and more people are talking about, it seems like we have to make a radical change to be successful. Evolution from the status quo will likely not work. Much like GE had a program in the dotcom days called DestroyYourBusiness.com where they encouraged their leadership to figure out how to develop a new model, that is what healthcare needs with the support to initiate the skunkworks organization which might eventually become the norm.

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

Compliance / Persistency / MPR

April 1, 2008 by George Van Antwerp 1 Comment

Non-compliance is a significant issue in healthcare.  You have the issue of whether people fill the prescriptions that their physician writes; whether they use them once they pick them up; and whether they continue to refill them and stay compliance over time.

You will hear several terms used:

  • Compliance is “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen”. (source)
  • Medication Possession Ratio is the days supply of medication divided by the days between refills.
  • Persistence or length of therapy (LOT) is the number of days elapsed between the date of the first claim and the date when the days supply of the last claim is depleted.
  • Medication Possession Ratio (MPR) is the days supply of all fills minus days supply of last fill / days elapsed between first and last fill.
  • Adherence to therapy can be defined as being both compliant and persistant.
  • The medication ownership ratio (MOR) is calculated as the proportion
    of patients on each initial prescription on a given day. It was
    used to describe the percentage of patients within a treatment cohort
    who had the medication in their possession on any given day.

Here are a few good sources for information:

I found the following chart in PWC’s publication Pharma 2020: The Vision a good graphic.

noncompliance-pwc2020.jpg

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

Another Health Blog Ranking System

April 1, 2008 by George Van Antwerp 0 Comments

I have followed and used the eDrugSearch.com ranking system for healthcare blogs for the past few months as a way of identifying new blogs.  [Side note…My rankings move dramatically week to week.  Last week, I was 121 (my personal best).  This week, I dropped to 249.]  It is a good tool to see an objective rating system.

I recently stumbled upon another blog ranking site at http://www.wikio.com/blogs/top/health.  I haven’t studied it as well, but it is another good tool to see a list of healthcare blogs.

BTW – If you are a fellow blogger, I have started a healthcare bloggers group in LinkedIn.   

Healthcare, Weblogs

International Opportunities

April 1, 2008 by George Van Antwerp 1 Comment

The other day, Medco announced that they were going to work with Apoteket to develop a drug safety system for Sweden.  Apoteket currently manages all the pharmacies there, but they are going to be deregulated in 2009.

It’s not likely to make a financial difference for Medco, but I think it’s an interesting step.  US healthcare is often looking for ways to grow in a fairly mature US market.  Going abroad has always been attractive, but a challenge given the different models.  It made me think of some of the other moves over the past few years.

I am sure there are a lot more, but those are the ones that I am familiar with.

General Business, Healthcare

Where Is “The Best Care”?

March 31, 2008 by George Van Antwerp 0 Comments

In a great post on the HealthBeat Blog, Maggie Mahar talks about research from The Commonwealth Fund called “Aiming Higher: Results from a State Scorecard on Health System Performance.” It provides a comparative state-by-state study of care in the U.S. (States in white are in the top quartile…ND, SD, NE, MN, IA, WI, ME, VT, RI, MA, HI.)

statehealthcarerankings.jpg

As she points out, the researchers used 32 indicators which look at “Access”, “Quality”, “Potentially Avoidable Use of Hospitals and Cost of Care”, and “Healthy Lives”.

She also goes on to talk about the lack of connection between quality and cost of care. She talks about research from Dartmouth Medical School that supports the data from this study.

“If insurance rates nationwide reached that of the top states, the nation’s uninsured population would be halved,” the Commonwealth report observes. “If all states could approach the low levels of mortality from conditions amenable to care achieved by the top state, nearly 90,000 fewer deaths before the age of 75 would occur annually. Matching the performance of the best states on chronic care would enable close to four million more diabetics across the nation to receive basic recommended care and avoid preventable complications, such as renal failure or limb amputation. By matching levels achieved in the best-performing states, the nation could save billions of dollars a year by reducing potentially preventable hospitalizations or readmissions, and by improving care for frail nursing home residents. If annual per-person costs for Medicare in higher-cost states came down to median rates or those achieved in the lowest quartile of states, the nation would save $22 billion to $38 billion per year. While some savings would be offset by the costs of interventions and insurance coverage expansions, there would be a net gain in value from a higher-performing health care system.”

As the economy continues to be challenged and with the election coming, this will certainly be an issue that those planning the future of our healthcare system need to analyze. There are lots of opportunities for improvement to the system, but we have to realize the challenge of aligned incentives within the system and external to the system. I predict it would take three election cycles (12 years) for us to make fundamental change. How we get politicians aligned and committed to something that outlasts them may be as difficult as changing the system itself.

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

Cigna’s Digital Coupon

March 31, 2008 by George Van Antwerp 0 Comments

Cigna recently announced some changes to their website. The one that caught my eye was the ability for a patient to print a coupon for a reduced copayment on their first fill of a generic drug.

I think it is a great step. My hope and questions would be as follows:

  • Is it to promote therapeutic switching or simply for movement from a multi-source brand to its chemical equivalent?
  • Is the coupon for anyone who is using a generic? Or is it only for new starts on a generic? Or is it only for those switching from a higher cost brand to a generic?
  • How do you drive awareness of the coupon and adoption of the web?
  • If all they really need is a coupon code, can you send it to their phone (much more likely to have it with them at the pharmacy)? Or could you trigger a fax to the pharmacy?

Anyways, I think couponing and incentives have a role in driving behavior, and it is good to see a MCO jumping into the digital age with this.

Books / Articles, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy

Aging Impact on Communication Strategy

March 31, 2008 by George Van Antwerp 0 Comments

We all know that healthcare spending is concentrated and often very highly correlated with age. Yet, aging has several impacts on people that change their ability to receive information. I found the following statistics very enlightening as to why a multi-modal strategy (i.e., mail plus phone plus Internet) is important.

  • Impact on reading – slower reader, reduced contrast perception (source: www.preventblindness.org)
    • 17% of people over 40 have cataracts
    • 50% of people over 80 have cataracts
    • 2% of people over 50 have AMD (age-related macular degeneration)
    • 3% of people over 40 have a visual impairment (including blindness)
  • Impact on hearing – can’t hear certain sounds, need hearing aids
    • 30-35% of people between 65 and 75 have presbycusis
    • 40-50% of people over 75 have presbycusis
  • Impact on cognition – slower learning time (source: International Journal of Experimental, Clinical, and Behavioral Gerontology)
    • 1% of people age 60-64 have dementia
    • 30-50% of people over 85 have dementia
  • Impact on mobility – challenges operating a mouse or car
    • 37% of people over 55 have tremors

All this data was part of a Forrester teleconference on December 13, 2007 called The Customer Experience Review, Q4 2007.

I couldn’t find a link to the Journal listed above, but I did find a nice set of links to information on aging.

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

Two Solutions For Cholesterol: No Room For Vytorin / Zetia

March 31, 2008 by George Van Antwerp 0 Comments

In another study to debunk popular prescribing habits, the American College of Cardiology said that Vytorin and Zetia should only be used after other cholesterol lowering drugs have failed (e.g., Mevacor, Lipitor, Zocor). They actually went so far as to recommend patients on these two drugs go back to the other drugs.

The study was also released in the New England Journal of Medicine and is a disaster for these two drugs who had grown in marketshare through Direct to Consumer (DTC) advertising, aggressive physician detailing, and timing of their launches with the brand drugs in the class getting close to losing patent protection.

It makes me wonder what my reaction would be if I was one of the 18,000 participants in the Improve-It study which is looking at whether Zetia and Vytorin prevents heart attacks and deaths.

See follow-up in USA Today.

Books / Articles, Healthcare, PBM / Pharmacy, Research

The Patient Experience Matters

March 30, 2008 by George Van Antwerp 5 Comments

It is a topic I am just hearing about although I heard my architecture friends talk about it 15+ years ago. Forrester even has a patient experience ranking now called the Customer Experience Index. They ask consumers 3 questions:

  1. Thinking about your recent interactions with these firms, how effective were they at meeting your needs?
  2. How easy was it to work with these firms?
  3. How enjoyable were the interactions?

Perhaps not surprisingly, but certainly unfortunately, healthcare ranks at the bottom. (Note: They ranked 112 companies.)

forrester-hc-customer-experience.jpg

So, it begs the question of how many of us think about things from an experience perspective.

One of the more interesting experiments I saw in architecture school was where some students set up a display where different areas of the building had color and sound that where activated by motion. The smiles and reactions from people were interesting. But, how often are we sitting down and mapping out the process and experience of the patient from open enrollment through different scenarios?

If we are, are we looking at all their different senses? Are we thinking about how different they are and how they will react to different information, events, colors, sounds?

One interesting think that a friend of mine introduced me to last year was the concept of sonic branding (i.e., branding a sound). I immediately think of Harley Davidson, but she talks about how Ford‘s door chime is viewed by them as a unique brand sound. I would guess Pringles has a unique sound when you open the can.

But, I can’t think of any healthcare organizations with a unique sonic brand (think AOL‘s “You’ve got mail”). Another missed opportunity…perhaps?

Healthcare, Innovation, Marketing / Communications, Research

Real Life Biggest Loser

March 30, 2008 by George Van Antwerp 0 Comments

We all know that being in shape has lots of health benefits.  The issues of being overweight drive healthcare costs through the roof.  There is plenty of data out there about the obesity trends in the US.  The reality is that losing weight is hard.

The show The Biggest Loser does a great job of showing what exercise and diet can do.  The challenge of course is that most of us don’t live in a controlled environment with a personal trainer and 3 hours to workout per day.  So, a good friend of mine who has done it all on his own provides a great story.  He was just featured in our local paper here, but he has gone from 270 pounds to almost 200 pounds and from not exercising to running half-marathons.

In the end, it is basic…take in less calories than you burn per day.  Good luck.

From the World Health Organization (WHO):

Overweight and obesity lead to adverse metabolic effects on blood pressure, cholesterol, triglycerides and insulin resistance. Some confusion of the consequences of obesity arise because researchers have used different BMI cut-offs, and because the presence of many medical conditions involved in the development of obesity may confuse the effects of obesity itself.

The non-fatal, but debilitating health problems associated with obesity include respiratory difficulties, chronic musculoskeletal problems, skin problems and infertility. The more life-threatening problems fall into four main areas: CVD problems; conditions associated with insulin resistance such as type 2 diabetes; certain types of cancers, especially the hormonally related and large-bowel cancers; and gallbladder disease.

The likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fatness. Confined to older adults for most of the 20th century, this disease now affects obese children even before puberty. Approximately 85% of people with diabetes are type 2, and of these, 90% are obese or overweight. And this is increasingly becoming a developing world problem. In 1995, the Emerging Market Economies had the highest number of diabetics. If current trends continue, India and the Middle Eastern crescent will have taken over by 2025.Large increases would also be observed in China, Latin America and the Caribbean, and the rest of Asia.

Raised BMI also increases the risks of cancer of the breast, colon, prostate, endometroium, kidney and gallbladder. Chronic overweight and obesity contribute significantly to osteoarthritis, a major cause of disability in adults. Although obesity should be considered a disease in its own right, it is also one of the key risk factors for other chronic diseases together with smoking, high blood pressure and high blood cholesterol. In the analyses carried out for World Health Report 2002, approximately 58% of diabetes and 21% of ischaemic heart disease and 8-42% of certain cancers globally were attributable to a BMI above 21 kg/m2.

Books / Articles, General Thoughts, Healthcare

Fast Friday: First Edition

March 28, 2008 by George Van Antwerp 0 Comments

The good and bad of loving information is that you get a lot of it and hate to throw it away until you skim it and take some notes. But, I am getting backed up so I think I am going to start a Friday edition that will be less thorough and more a data dump of things that I have set aside. I welcome feedback on whether this is interesting, helpful, or just dumping.

  • ChangeNow4Health – I stumbled upon this website which interesting has a Humana copyright at the bottom. [Simplify, Prevent, Educate]

How do we go about fixing the nation’s health care system? Where do we start? ChangeNow4Health believes we begin with small first steps. We’re looking for changes we can confidently make in the short term, using existing resources in creative ways … changes that will result in genuine improvement.

    Books / Articles, Consumerism, Fast Friday, Healthcare, Research, Technology, Weblogs

    Facebook Application To Drive Blood Donations

    March 27, 2008 by George Van Antwerp 1 Comment

    I must admit I am pretty conservative so it was with some reluctance that I finally joined Facebook.  After the Health 2.0 conference formed a group out there, I decided to join earlier this week.  First, my brother reached out to me.  Then, a roommate of mine from college who I hadn’t talked to in almost 20 years contacted me.

    Then, I became mildly interested.  So, I spent a few hours early this morning playing around.  But, I was most interested to find a post on Vijay’s Consumer Focused Healthcare blog about a non-profit using Facebook as a way to drive blood donations.  Will it work?  I don’t know, but it is a worthy cause and an interesting use of social technology.

    When a patient is in need of blood that isn’t available, it becomes a life and death situation. Historically the Red Cross will make efforts to alert the public during a shortage. But there may be a better way – leverage the social networks to get the word out. If shortages of a certain type of blood occur in a certain zip code, having a database of willing donors in that zip code to contact may be the most efficient way to solve the problem quickly.

    That’s where Takes All Types (TAT), a non-profit organization, comes in. Users install their just-released Facebook application, tell it their location and blood type, and say how often they are willing to be contacted to donate blood (maximum is every 57 days). If a shortage occurs, they’ll contact you via the methods that you authorize (Facebook, email, text message, etc.)

    Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Technology, Value Propositions, Weblogs

    Health Transformation 2.0: Follow-up

    March 27, 2008 by George Van Antwerp 0 Comments

    The other day, I provided a few comments on this book (manifesto) that I picked up, and I reached out to the author. He got back to me last night and was kind enough to provide the PDF of the publication.

    In his words:

    “These are simply my thoughts and thoughts inspired by a community of friends. It’s written as a kind of manifesto with the hope to inspire more good minds to tackle a very major challenge facing our society.”

    I would encourage you to reach out to him if interested. (E-mail Scott Danielson – author)

    Here is the book for you to view. I hope you will enjoy the hard work his community put in both in terms of content and graphic design.

    Don’t forget to sign up for e-mail updates or put the blog in your reader. Thanks.

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

    Future of Marketing and Advertising

    March 27, 2008 by George Van Antwerp 0 Comments

    Here is an interesting presentation on a view of marketing from outside healthcare.  I think it is a healthy way of thinking of the challenge.

    Business Tools, Consumerism, General Business, Healthcare, Marketing / Communications, Value Propositions

    Drug Benefit News: Highlights / Comments

    March 26, 2008 by George Van Antwerp 0 Comments

    I just flipped through the February 29, 2008 DBN edition.  A few things caught my eye:

    •  There is a whole article on PBMs and health plans focusing on physicians to manage Rx costs.  [Is this really new news?  The problem is not the focus, but on the incentives, the communications, and the age old question of who is in charge.]
      • As I pointed out in my recent webinar, most physicians agree that out of pocket spend is an issue for patients BUT most of them think it is the pharmacists role AND most of them are upset with the amount of calls they get from the pharmacists [who are trying to manage the spend].

    Brian Solow, MD, medical director at Prescription Solutions says
    “Physicians in the past have seen PBMs as maybe interfering with the practice [of medicine], but now they understand that [PBMs are] here and here to stay.  We’re trying to get the word out that the PBM is there to maximize the patient’s benefit, which hopefully in turn will make the physician’s life easier by helping the patient control the disease and get the proper medications.”

    A physician who they interviewed summed up the confusion well saying:

    “You just sort of pick [a drug], hope it flies, and if it doesn’t, somebody has to deal with it.” 

    Short of common formularies or working in a captive model (e.g., Kaiser) it will be hard to eliminate the confusion of different plans and different information.  Simplifying processes like Prior Authorizations could help.  Pushing information to the point of prescribing via electronic tools could help, but you are asking the MD to own the benefit management task which they don’t today.  (i.e., let me prescribe drug A…it has $x copay…would you prefer a cheaper alternative)

    It talks a lot about the CVS/Caremark settlement which is a lot like the Medco settlement from a few years ago.  The outcome [which is what I think they do today] is that they agree to:

    • Not move people to a more expensive drug (net cost or copay).
    • Not move from a MSB (multi-source brand) to a SSB (single-source brand).
    • Not move away from a drug whose patent is likely to expire in the next 6 months.
    • Inform patients and prescribers of the impact on copayment.  [very difficult]

    It also gives the latest on Medicare Part D lives:

    The total enrollment is 17.4M (as of January 2008).

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

    Poll Shows Real Issues

    March 25, 2008 by George Van Antwerp 2 Comments

    survey_logo.gifThe AFL-CIO conducted a poll of almost 27,000 people about healthcare earlier this year. (The population was slightly biased with over 50% belonging to unions … which I don’t think is representative of the country.)

    The results I think are very telling about how the average person thinks about healthcare in the US:

    • One-third of respondents to the online survey, sponsored by the AFL-CIO and Working America, report skipping medical care because of cost, and a quarter had serious problems paying for the care they needed.
    • Ninety-five percent say they are somewhat or very concerned about being able to afford health insurance in the coming years.
    • Almost half overall (48 percent) and 60 percent of Latinos say they or a family member has stayed in a job to keep health care benefits when they would have preferred changing jobs.
    • Ninety-five percent of respondents say America’s health care system needs fundamental change or to be completely rebuilt.
    • Seventy-nine percent say health care is a very important voting issue, and 97 percent say they plan to vote in the November elections.

    I pulled a few of the patient quotes, but they are stunning in terms of the challenges and the hardship people are enduring due to healthcare costs.

    “What would you do if you had to choose between food or medicine? Because of rising health care costs, that is a question that is frequently asked in my home. I work full time and have health care through my employer, but only a percentage is paid by them….I recently needed medication for an ailment, but did not get the medicine—I couldn’t. What would I choose? I choose my children and what they need, whether it be food or medicine. I am the one who will go without before they suffer.”

    “My son joined the National Guard and went to Iraq so his wife could have health insurance. A very heavy price to pay though luckily he survived his first deployment and we fervently hope he will survive future deployments as well. ”

    You certainly should read the report and/or the website summary. I hope our presidential candidates and elected officials do.

    dissatisfaction.gif

    system-broken.gif

    election-priority.gif

    Healthcare
    Newer Entries
    Older Entries