Enabling Healthy Decisions

PBMs and Social Media

October 20, 2010 by George Van Antwerp 1 Comment

I always get pulled into the discussions about what PBMs are doing, should be doing, or could be doing in social media. For now, let’s just look at the current state – i.e., who is doing what.

I’m going to focus on the big channels – Twitter, Facebook, YouTube, and blogging.

	Twitter	Other (Facebook, YouTube, Blogs)
CVS Caremark	@CVS_Extra @CVS_Health @CVSCaremarkFYI	http://www.youtube.com/user/CVSPharmacyVideos http://www.facebook.com/CVS
Medco	@DrObviousPhD @LibertyMedical @Medco	http://www.youtube.com/DrObviousPhd http://www.facebook.com/DrObviousPhD
Walgreens	@Walgreens @WalgreensNews @WalgreensHealth	http://www.facebook.com/Walgreens
Express Scripts	@BobNease @EScripts	http://www.consumerology.com/blog
MedImpact	@MedImpact

To make it easy, I created a Twitter list on my profile of the PBMs, pharmacies, and several other key resources in this area – http://twitter.com/#!/gvanantwerp/pharmacy-pbm.

I welcome your links to other PBM or pharmacy social media assets. I looked under CatalystRx, Prime Therapeutics, and SXC also. I also checked Cigna Pharmacy, Humana Pharmacy, Prescription Solutions, and Kaiser Pharmacy. I couldn’t find more, but I’m sure there’s a few I missed.

The question of course is how to judge if these are successful. Is it the number of followers or fans? I would argue no. The goal of social media is to create a dialogue and engage the patients or consumers. Given the traditional focus on the PBM on the business-to-business relationship and the pharmacy on the business-to-consumer relationship, there is an interesting question of how the mail order pharmacies (owned by the PBMs) make that leap. Can social media create a forum for discussion about plan design, drug trends, and other things in straightforward language that engages consumers? Will consumers be willing to use these channels to interact with the PBMs or only with their pharmacist? This could be an area where companies like Walgreens or CVS Caremark who have a large physical footprint can leverage a real-world connection with consumers to a virtual one easier than others.

As you can see, there are not a lot of people doing a lot yet. This area will change a lot in the next 5 years.

Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media

Healthcare, Innovation, Marketing / Communications, Silverlink, Social Media, Software, Technology, Value Propositions

Stop By The Silverlink Booth At The Forum 2010 (DMAA)

October 7, 2010 by George Van Antwerp 0 Comments

Next week in DC is The Forum 2010 which is the annual event for The Care Continuum Alliance (formerly known as The Disease Management Association of America). If you’re there, you should stop by the Silverlink booth and attend the presentations that we’re giving with some of our clients and other industry leaders.

	Aligning Employee, Employer & Provider Research to Maximize Value-Based Benefits October 13, 1:00 – 2:00 p.m. Jan Berger, MD, MJ, Chief Medical Officer, Silverlink Communications Cheryl Larson, Vice President, Midwest Business Group on Health (MGBH)

	Improving Statin Adherence through Interactive Voice Technology & Barrier-Breaking Communications October 13, 2:15 – 3:15 p.m. Ananda Nimalasuriya, MD, Chief of Endocrinology & Complete Care, Kaiser Riverside George Van Antwerp, MBA, General Manager, Pharmacy Solutions, Silverlink Communications

	Addressing Colorectal Screening Disparities in Ethnic Populations October 14, 12:30 – 1:30 p.m. R. Reid Kiser, MS, National Director, Clinical Excellence Special Projects and Reporting, UnitedHealthcare Jack Newsom, MBA, MS, ScD, Vice President, Analytics, Silverlink Communications

	Addressing an Epidemic – Improving Diabetes Care with Personalized Communications October 14, 3:00 – 4:00 p.m. Jan Berger, MD, MJ, Chief Medical Officer, Silverlink Communications William Shrank, MD, MSHS, Instructor, Harvard Medical School and Associate Physician, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital

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

Pharma Manufacturers Need To “Blur” The Rx

October 5, 2010 by George Van Antwerp 0 Comments

Years ago when I was at Ernst & Young as a consultant, several of the partners wrote a book called BLUR. The concept (that I took away) was that products and services were being combined into offerings. That one could not stand without the other. A quick example for me is General Motors with OnStar, but there are numerous examples out there.

In pharmacy, I think this has been the standard around specialty drugs for years. Manufacturers produce the drugs and sell them to a pharmacy for distribution. With that, they provide educational materials, adherence programs, or other “services”.

I think going forward that there is going to be increasing need to differentiate even oral solids (traditional small molecule products) that are less expensive and focus on chronic conditions. Formularies are only going to get more narrow. Comparative effectiveness is going to push companies to compare overall outcomes of products. Why not find a way to wrap a similar service strategy around these medications in a more technology driven, scalable manner?

It seems like a great way to show that not only is your product effective when taken, but that patients on your product are more engaged with their condition and more likely to stay adherent.

Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Silverlink, Value Propositions

Seven Myths Of Social Media

August 26, 2010 by George Van Antwerp 1 Comment

I’m just finishing up a book on social media (book review to come shortly). As I was reading it and based on my experience, I came up with a few myths:

You have to be everywhere. It’s impossible. There are so many sites out there. You have to know your audience and determine where to spend your effort. You MIGHT have to stake your claim to avoid someone else using it and provide information for consumers to reach you, but you can’t actively contribute and add value across the social media spectrum.
Set it and forget it. Social media is about dialogues and continuous information. You can’t put up static content like a website and come back every week, month, year and update it. The best companies respond (for example) to a Twitter comment about them in 24-hours while some never respond.
Build it and they will come. There is a constant dialogue about whether you have to “own” the community or simply participate in it. There is certainly reason to create content (i.e., blog posts, tweets), but you have to find a non-marketing environment to interact with your customers and influencers and understand their needs. In many cases, that environment might already exist and you need to join it. Additionally, you can’t simply launch something or join something without pushing out information about it. For example, if you have a Facebook page, you need to have a link on your website, put it in your LinkedIn profile, include it in your press releases, etc.
Marketing should own social media. Traditional marketing has been about the controlled message. Social media is about participatory messages. There’s a big difference. Additionally, social media can be and needs to include any employees who are actively engaged in social media. We’ve seen numerous examples of employees who comment inappropriately only to jeopardize their job. (I’ll agree that there are issues here to still be defined regarding privacy versus freedom of speech.) Marketing can’t reply real-time about operational issues. Ownership is a collective effort.
You can outsource your social media. This is a big mistake. There are lots of consultants who will tell you what you want to hear. They will talk about some channel or channels that work (e.g., Twitter experts, Facebook experts). They’ll talk about search engine optimization (SEO) and what to do. They’ll tell you that you need an iPhone app or a YouTube channel. The reality is for your solution to be genuine and timely that it needs to be someone(s) who understands the company, feels passionate, and is empowered to do something quickly.
Tell me..tell me…tell me. This works great for presentations. But, you’re now a part of the audience (although an informed member with an agenda). You need to tailor your objectives to what the audience wants / needs. In a community, they’re there for a reason. They are discussing a topic and sharing their thoughts. They want you to add value not sell your products or agenda. They want to be valued.
You can avoid it. This is an obvious one. With 500M users on Facebook and YouTube being the second most popular search engine, you have to understand how people find you on the Internet. Google is a verb. Current generations will grow up with theses modes, smart phones, and be uninhibited by our sense of privacy. Technology is and will continue to be more ubiquitous. The way people learn about companies is changing. The way people learn about people is changing. Relationships between people are changed based on technology. Companies have to understand what’s being said about them and embrace it not run from it.

There are tons of infographics out there that symbolize some of this. I pulled a few of my favorites together here, but you can find more.

Consumerism, Healthcare, Innovation, Marketing / Communications, Methodology, Social Media, Technology, Value Propositions

NCPDP Nov 2010 Event: The New Economy And …

August 24, 2010 by George Van Antwerp 0 Comments

On November 2nd, NCPDP is hosting an educational event called “The New Economy and It’s Impact on Healthcare, Pharmacy, and the Patient.” Sounds pretty cool! It’s a topic we all talk about.

What does the new sense of frugality mean? What will new forms of insurance mean? How will pharmacy evolve? Will MTM work? Will MTM become a product for commercial? How is the consumer’s behavior changing relative to information and compliance?

The agenda includes yours truly along with people from:
* Kaiser
* Walgreens
* AARP
* Sanofi-Aventis
* North Carolina Association of Pharmacists
* Eaton Apothecary
* American Society of Consultant Pharmacists
* RegenceRx

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Choices: Grande Skim Mocha With Whip @ 140 Degrees

August 5, 2010 by George Van Antwerp 0 Comments

Choices. We can all become overwhelmed with them. As several studies have shown, more choices are not better…they paralyze us and limit our ability to make a decision.

So what do we do with this. Choice is a double-edged sword. On the one hand, you want to offer choice to everyone. On the other hand, this can make implementation very difficult.

Like my Starbucks example. I can customize almost everything off a pretty basic menu…even the temperature. (BTW – they suggested using 140 degrees rather than saying kiddy temperature) But that makes it more difficult to standardize and should increase the risk of error. Imagine doing this efficiently and in scale.

Mass customization has been a challenge for years.

People can have the Model T in any color – as long as it’s black. (Henry Ford)

While technology allows this to a certain degree, it all has to be moderated. Let’s take communications. I could let every consumer tell me their preferences and other facts about them.

I want you to send me automated calls unless the information is clinical in which case I want a letter than I can share with my physician. I’d like the calls made to my home number between 5-7 pm or on Saturday’s between 10-4. I’d like you to leave a message and don’t call back unless I don’t act for seven days. If I interact with the call, please text me the URL or phone number for follow-up. I like to be addressed by my first name. I’m an INTJ so please use that as for framing the message.

You get the point. Where do you stop? And, do you really think that I know what’s best. I tell almost everyone to e-mail me, but depending on when it comes in, it could be days before I respond or even read the e-mail. That’s if it passes the spam filter.

I’m sure if I asked 10 people whether they wanted automated calls then 7 of them would say no, BUT you know what…good calls work (voice recorded, speech recognition, personalized). The vast majority of people interact with good, automated calls (some for 10+ minutes). Most people think about those annoying robocalls that use TTS (text to speech) we all get around the elections. But, good technology with a relevant message from a relevant party get people to care. It’s all about WIIFM (what’s in it for me). The other half of the equation is being able to coordinate the multiple modes. (e.g., I missed you so I’m sending you a letter. Let me text you the URL.)

So, should I let the consumer pick their preferences? Sure for certain things. But, what about a drug recall (for example)? Do I have to wait a week to get a letter? What can I personalize versus what should the company own. I pay for them to “manage” my health. Why don’t I let them?

There is no perfect system. You need a series of things to be successful.

A database to track consumers – demographic data, claims data, preferences, interaction history, …
A workflow engine with embedded business rules to manage communication programs with rules about what to do when certain situations arise
Reporting to track basic metrics
Analytics to understand and analyze programs

And, of course all this requires expertise to interpret and leverage the data for continuous improvement.

Are you doing all that? I doubt it…but you can be.

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

DMAA Client Presentations

July 28, 2010 by George Van Antwerp 0 Comments

We (Silverlink Communications) are very excited to see three of our clients get selected to present at DMAA this year. That is a tribute to all their hard work, creativity, inspiration, and willingness to leverage technology to improve outcomes.

Here are the presentation summaries from online:

Reducing Blood Pressure in Seniors with Hypertension Using Personalized Communications
CONTINUUM OF CARE SERIES
Wednesday, Oct. 13, 1-2 p.m.

Examine how an integrated communications program that utilizes remote monitoring and interactive voice response components combine for an easily scalable, cost-effective solution to reduce hypertension.
Review a program where 18 percent of participants transitioned their hypertension from out-of-control to well or adequate control.
Identify best practices for how personalized, automated, interactive communications can be leveraged to control hypertension in a scalable manner.
Evaluate how high blood pressure readings alerted patients with immediate feedback and education to help them better manage hypertension.

Improving Statin Adherence through Interactive Voice Technology and Barrier-Breaking Communications
Wednesday, Oct. 13, 2:15-3:15 p.m.

Examine how interactive voice response (IVR) and barrier-breaking communications can measurably improve statin adherence.
Review key barriers to statin adherence, including several barriers that are more significant than cost.
Identify best practices for using IVR technology to improve statin adherence by addressing specific barriers.
Evaluate how continuous quality improvement processes were used to drive higher response rates to IVR prescription refill reminder calls.

Addressing Colorectal Screening Disparities in Ethnic Populations
Thursday, Oct. 14, 12:30-1:30 p.m.

Examine how interactive voice response (IVR) technology and personalized messaging improves the rate of colorectal cancer screening for different populations.
Review the impact of ethnic-specific messaging on colorectal cancer screening rates and how this differs by ethnicity.
Examine how engagement is influenced by the gender of the voice in communications outreach.
Identify how to use predictive algorithms to project race and ethnicity to support tailored communications.

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

Member ID Card Application on iPhone

July 8, 2010 by George Van Antwerp 1 Comment

Priority Health (which I find to be a well run and progressive managed care plan) announced their new iPhone application. I suspect many will follow. It’s simple today, but imagine all the information you can put there – copays, drug history, lab values.

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

Pay For Full Service

July 7, 2010 by George Van Antwerp 0 Comments

In several industries (e.g., travel), you pay when you access a customer service representative. That forces you to use the self-service options of the Internet and/or the automated call line. Could this work in healthcare?

I doubt that people would be so directive as to penalize people for talking to a representative or a clinical person especially on such a sensitive and personal a topic as healthcare.

BUT, on the other hand, a disproportionate amount of calls are for mundane issues or questions would could be solved using other channels. The fact is that these channels have to be efficient and easy to navigate (which they aren’t always today). But, technology continues to become more ubiquitous so it’s not unreasonable to expect people to self-service more often.

One idea that I tried to sell years ago at Express Scripts was more around incentives for self-service. Why not offer large employers a discount if their use of the call center decreased? They have some opportunities to influence this. They could put a link to the website on their intranet. They could leverage their e-mail network to push out messaging. They could encourage people to use the PBM (or health plan) website.

On thing that several CFOs told me years ago was that they would frame the problem differently for their employees. It wasn’t about just saving money to reduce cost, but it was about re-directing funds to cover more things. For example, one company had to cut $10M in expenses. They were looking at plan designs to accomplish some of that. But, they also thought they were going to have cut on-site daycare. We looked at one strategy that might save them $15M so they could achieve their savings and actually grow both the daycare program and their 401K matching program.

What great positioning to the employees! Here are two things we are going to give you…all you have to do is help us shift costs from point A to point B by taking the following actions.

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

Is Specialty Pharmacy Management Frozen?

July 5, 2010 by George Van Antwerp 0 Comments

Someone asked me an interesting (but I suspect somewhat rhetorical) question last week. They asked if I had seen meaningful innovation in specialty pharmacy management in the past 5 years beyond simply increased automation. It immediately made me think of this picture of Hans Solo frozen in time.

I had to say no.

Specialty has been focused on leveraging the PBM lessons from the past decade and implementing them. How to manage spend? How to get rebates? How to push generics? How to implement technology? How to distribute drugs more efficiently? What are the right plan designs?

Do you disagree?

I think the one area where you could easily argue is around pharmacogenomics. This is an interesting one since it will have a big effect on specialty medication and you have two of the big 3 PBMs (Medco and CVS Caremark) who have embraced it while you have Express Scripts talking a little about it. They seem to be taking a wait and see approach until it is clear how they make money in this space.

Healthcare, Innovation, PBM / Pharmacy

Innovation Has To Respect The Past

July 2, 2010 by George Van Antwerp 1 Comment

Cars provide us with some interesting examples of innovation which has had to adapt to fit our norms.

For example, we have keyless cars, but if you notice, several of them have places for you to put the key in. It’s really just a holder for the key since it doesn’t activate anything, but otherwise, we don’t know what to do with the key once we get in the car. [This may be more of an issue for me since I use this when I rent cars and don’t have such a car everyday.]

Another example is the silence of hybrid cars. US lawmakers are considering making manufacturers put sound back into the electric cars so that the visually impared who rely on sound to help them navigate can tell when a car is coming.

I’m sure there are other examples.

Consumerism, General Thoughts, Innovation, Value Propositions

Does Age Matter in Adherence?

June 22, 2010 by George Van Antwerp 0 Comments

Certainly age could be a confounding factor for many reasons – health literacy, length with a condition, co-morbidities, number of medications, tolerance for side effects – but I like this chart that the people at Vitality (aka GlowCaps) (www.rxvitality.com or www.roseology.com) just put out.

Of course, like any survey, there is sample bias so I would hesitate to extrapolate this, but I would say something like…

“for people who have and use a refill reminder device in their homes for hypertension medications, older people are more likely to be adherent.”

Of course, I’d love to know their MPR (medication possession ratio) before using the device. Which had the higher lift?

Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Research, Technology

Sensory Friendly Films

June 16, 2010 by George Van Antwerp 0 Comments

I was reading about a great idea this morning in our local county paper – “Sensory Friendly Films”. This is an idea for families affected by autism or other conditions so that they can take their kids to the movies. Apparently, our local movie theater (AMC West Olive 16) has partnered up (at the corporate AMC level) with the Autism Society to design this program.

The movies are shown with the lights turned up and the sound turned down. There are no previews. Families can bring their own snacks. And, kids are able to move around and talk during the movie if needed.

There are an estimated 30M people in the world (1.5M in the US) with an autism spectrum disorder.

Books / Articles, Healthcare, Innovation

2010 Medco Drug Trend Report

June 9, 2010 by George Van Antwerp 2 Comments

I can’t believe it’s taken me a few weeks to catch up on my notes from a conference call with David Snow and Dr. Rob Epstein from Medco Health Solutions about their 2010 Drug Trend Report. I captured some of Dr. Epstein’s comments in a quick blog post, but I have a lot of respect for David Snow and wanted to capture a few of his comments here and pull out some of the interesting data from the Drug Trend Report.

David Snow mentioned a few things:

Reform has to address all three legs of the stool – Access, Quality, and Cost. Right now, it’s focused on access.
Of the $2.4T we spend in the US on healthcare, $1T of it was unproductive.
One of the big issues in the system is poorly designed systems for the people that deliver care.
Pharmacy is ahead of the curve since it’s already wired and uses evidence-based care.
We have to focus on the chronic conditions. 96% of the pharmacy spend and 75% of the medical spend is here.
Prescriptions are used as first line solutions 90% of the time. (See my comments on why trend shouldn’t matter.)
$350B of the waste is due to poor management of chronic solutions.
We still have to address medical liability and defensive medicine.

He also answered questions. A few of my notes from the Q&A:

Patent expiration doesn’t fully explain the increase in brand pharmaceutical costs. (Traditionally these drug costs go up once the patent expires.) You can correlate the tax on pharma (in reform) to the increase in prices. (Not dis-similar to the increases around Part D if memory serves me.)
Adherence is a key issue. The Therapeutic Resource Centers (TRCs) are their answer to this. They drive adherence in the classes that matter and we report to clients on this. (While I think a lot of people viewed the TRCs as marketing strategies when they first came out, I believe they have demonstrated a clinical focus with some case studies and clinical leads over the past 18 months.)
The pathway to biosimilars is very fair to the innovator.
Class competition in specialty is increasing.

His most interesting comment which I’ll repeat from my earlier post was that if the FDA really understood true adherence they might make different decisions on approving drugs whose effect is tied to a person staying on a medication over time.

I won’t repeat some of the core data elements from my prior post, but here are some new ones from reading the document:

Mail order penetration was 34.2% (which I believe is industry leading for the PBM sector with only Walgreens showing a 90-day utilization number that’s higher).
Interestingly, they show trend for clients with over 50% mail use (and clients with less than 50% mail use). [Most PBMs would love to have any clients with over 50% mail use.]
- 0.1% for those with over 50% versus 5.3% of those under 50%

Reported trends are based on 2 years’ data on pharmaceutical spending. Drug trend percent includes 201 clients representing approximately 65% of consolidated drug spending. The sample comprises clients who offer integrated (mail-order and retail) pharmacy benefit options for members. Clients with membership enrollment changes > 50% were excluded from the analysis. Plan spending is reported on a per-eligible per-month (PEPM) basis, unless otherwise specified. An “eligible” is a household, which may include multiple members who are covered under the same plan. Plan spending comprises the net cost to plan sponsors less discounts, rebates, subsidies, and member cost share. Generic dispensing rates and mail-order penetration rates represent the total consolidated Medco client base.

Diabetes is obviously a critical category for everyone. I found it interesting that they saw fewer patients filing claims for diabetes but more drugs per patient in 2009.
Respiratory therapies (driven by those <19 years old) jumped in contribution to trend from 8^th to 2^nd.
In patients aged 35 to 49, antiviral drugs are the greatest contributors to cost – 8.3% of plan pharmacy costs. [Some of this driven by flu although this is not the at risk age group.]

Antiviral drugs (Formulary Guide Chapter 1.8) include oral treatments for HIV/AIDS, influenza, herpes, hepatitis C, hepatitis B, and injectable treatments for respiratory syncytial virus (RSV), and cytomegalovirus.

Utilization growth for ADHD drugs for those age 20-34 grew 21.2%. [Is this for people not diagnosed as kids, people who have adult-onset ADD (if that exists), or just an over-diagnosis of the condition?]
Specialty drugs…I’m always surprised that all the PBMs still have to caveat the fact that they only adjudicate some of the claims since some specialty drugs are filled and billed under the medical benefit. That seems like something that should / could be fixed, but I know it’s been tried and is hard since people are making money off them being billed elsewhere.

Cancer is already a huge driver of specialty costs AND:
- Much of the spending is still under medical;
- Most drugs approved in the past 4 years costs over $20,000 for a 12-week course; and
- There are over 800 drugs in the pipeline.

Spending growth has outpaced spending for nonspecialty, or traditional medications because:

A high proportion of newly approved drugs are designated as specialty.
Unique manufacturing processes make specialty drugs expensive to develop.
Fewer drugs within a therapeutic category limit competition.
There may be only one specialty treatment for an orphan condition.
Few drugs are therapeutically equivalent to others in the category, reducing interchange and related cost savings opportunities.
It is more difficult to transition existing patients from one specialty drug to another preferred specialty drug because often these drugs are large, unique proteins that are not considered interchangeable.
Most small-molecule specialty drugs are relatively new with few generic alternatives.
No defined approval pathway exists for follow-on biologics (also known as biosimilars).
Drugs used to treat cancer represent a large portion of new drugs in both the pipeline and marketplace; most are specialty drugs and some can cost more than $20,000 for a 12-week therapy course.
It was the first time I noticed anyone caveating the specialty trend. They proactively addressed different calculation methods to point out that their method yielded a 14.7% specialty trend, but if you did things differently (as I assume others must), then their trend would have been 12.1%.

Trend in children exceeded trend in other age groups for the second year in a row. (I think this is an interesting perspective and a scary indicator for the future health of our country.)
They provided some examples of drugs that had new indications for younger patients approved:
- WelChol, Crestor—for low-density lipoprotein cholesterol (LDL-C) reduction in children aged 10 to 17 with heterozygous familial hypercholesterolemia.
- Atacand—for hypertension in children aged 1 to 17.
- Axert—for acute treatment of pediatric migraine.
- Protonix—for erosive esophagitis in patients aged 5+.
- Abilify—for irritability associated with autistic disorder in children aged 6 to 17.
- Seroquel—for schizophrenia in children aged 13 to 17, and for acute manic episodes in children aged 10 to 17 with bipolar I disorder.
- Zyprexa—for schizophrenia and for acute mania (bipolar I) in children aged 13 to 17.

An interesting perspective that I’ve talked about many times (without the research capabilities to analyze) is the correlation between sleep and chronic disease. They looked at this across states based on drug utilization and found a correlation (not necessarily causation).

So what do they say to watch:

Continued inflation in brand drug prices.
Majority of trend will come from specialty – oncology, orphan conditions.
Personalized medicine.
Biosimilars.
Generic pipeline.
Obesity epidemic.

They bring up an interesting issue relative to OTC (over-the-counter) product which is DUR (drug utilization review) which looks for drug-drug type interactions. They talk about the Medco Health Store integrating that data to monitor patients. [Do plans care? Do patients care? Should retail OTC purchases be integrated? How great are the interactions?]
They talk a little about obesity although I would love to understand more about how a plan sponsor should manage this.
- 68% of adults are overweight; 34% obese
- 32% of children are overweight; 17% obese
- Medical spending on obesity related conditions is $147B
- 19.5M adults (24-85) have diagnosed diabetes and other 4.25M are undiagnosed
- Diabetic medical claims are forecasted to grow from $113B to $336B over the next 25 years.
I’m not going to spend a lot of time on personalized medicine here. (A recent post of mine on this topic.) They’ve been very active in this space for years talking about it. I think one of their interesting points in the Drug Trend Report is how Comparative Effectiveness will dovetail with Personalized Medicine.
Almost 2/3rds of people at risk for CHD in the next 10 years and eligible for lipid lowering drugs (e.g., Lipitor) were still not using them. (A common gap-in-care program run by many companies is to target these people (e.g., diabetics).)
Only 29% of patients treated for high cholesterol reach their cholesterol goal.
They have a section on wiring healthcare which David Snow has talked about for a while. It’s a critical area to address and has lots of opportunity.
They also talk about the concept of collaborative care (aka medical home…aka accountable care organizations).
I’m a big believer that poly-pharmacy creates issues (as does poly-physician). I don’t hear much talk about it. I was glad to see them talk about a study they did which identified poly-pharmacy issues, talked to MDs, and ended up with 24% of cases where medications were changed.

A Medco survey reported that 81% of participants with a new diagnosis, who received services at a traditional retail pharmacy, either did not receive counseling or were dissatisfied with the prescription drug counseling they received. When given the opportunity to speak with a Medco Specialist Pharmacist, 75% of these patients accepted the offer of immediate telephone support.

I thought it was really interesting to see a screen shot of their application used by the TRCs to create their Health Action Plans for consumers.

I was also interested in their focus on women’s health and some data on caregivers and the gender differences in healthcare. One of their TRCs is dedicated to addressing these differences.

Books / Articles, Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Technology, Value Propositions

Drug Trend Report, Medco, PBM

Text4Baby (or Bebe)

June 3, 2010 by George Van Antwerp 0 Comments

This seems to be one of the more successful texting programs in the healthcare space. This public-private partnership with sponsors like J&J and Pfizer is leveraging texting technology to try to address the US infant mortality rate (with is 30th worldwide).

With 25% of people not having a landline and more and more people (especially younger generations) depending upon the mobile phone, this makes a lot of sense. In general, the sick population for the healthcare companies are not the younger generations, but this is typically different for pregnancy. What I didn’t know until reading an article about this is that Hispanics and African Americans are 2.5x as likely at Whites to put off prenatal care until the 3rd trimester or skip it altogether.

So what do you do? Text BABY (or BEBE) to 511411 and punch in your due date.

Who writes the content? The National Healthy Mothers, Healthy Babies Coalition.

Is there a charge? No.

What is the content? You get up to 3 texts a week until the baby’s first birthday. They talk about seeing their doctor. Keeping their appointments. Get immunizations. Put babies on their backs to sleep.

What do they hope to learn? Will users have different outcomes? Will they go to more appointments? Will they stop smoking? Will the incidents of low birth weight and pre-maturity decline?

Consumerism, Healthcare, Innovation, Marketing / Communications, Social Media, Technology, Value Propositions

Some of my notes from RESULTS2010

May 28, 2010 by George Van Antwerp 0 Comments

This week was our [Silverlink Communication’s] annual client event – RESULTS2010 (click here to see the final agenda). I’ve talked about this before as one of the best events. It was great! Educational. Fun. Good networking.

Here’s a few of my notes along with a summary of the twitter feed (using hashtag #results2010). Unfortunately, the two of us twittering were also fairly involved so there are some gaps in coverage. And, my notes are sporadic due to the same issue.

Overall themes:

Communications are critical to driving behavior change.
We have to address cost and quality.
Reform creates opportunity.
Systemic problems require systemic solutions.
Measure, measure, measure.
Automated calls – while not the whole solution – work in study after study.
People are different.
There is a gap in physician – patient interactions.

Notes:

Reform basics – guarantee issue, requirements for coverage, income related subsidy.
Independent payment advisory board has an aggressive goal – get Medicare spending to equal GDP growth + 1% each year.
½ of the $1 trillion needed to pay for health reform comes from Medicare savings / reform…the rest from taxes.
Everyone’s fear is that MCOs become “regulated utilities” that just process claims…unlikely.
Need to address underuse, misuse, overuse, and limited coverage.
Need to measure quality and cost at the person level.
CMS pilots around shared savings are working – outcomes improved.
Medicare Part D only got one complaint per thousand for therapeutic interchange programs / drug switching.
The decision around defining MLR (medical loss ratio) and what fits in there is critical.
Healthcare is like anything else…it’s not great and needs to change, but don’t touch mine cause it works ok. [frog in the pot]
How do we make each healthcare decision an informed decision.
Decision aids.
Pull, push, or pay – 3 ways to drive awareness.
Moving from information about your care to information being care.
The incentive rebound effect…what happens when you take away an incentive.
Social interaction affects our behavior.
Solving for how to change consumer behavior cost effectively and in a sustainable manner is a good challenge to work on.
How do we move people from desires to action? From “I’d like to exercise” to actually doing it.
The fact that some European programs take 3-5 years to see an impact makes me wonder what that means for our US investment strategy given the member churn across plans.
Great examples of ethnographic interviews
Good McKinsey data on people’s perceptions – Annual Retail Healthcare Consumer Survey.
Inform / Enable / Influence / Incentivize / Enforce
One way of categorizing – willingness to change versus barriers to change (rational, emotional, psychological).
Attitudinal segmentation – cool…but how to scale?
Provider staffs attitudes are important.
Design – delivery – measurement
Readiness to coach
A culture of health
Have to mix up your tools (incentives, channels)
“Communication Cures”
The chief experience officer is a new role in plans and PBMs.
The only experience you have with health insurance is via communications. Make it count.
Loyalty is a result of cumulative experiences.
People have to trust you so they listen to your message
Communication maturity model
Price is what you pay; value is what you get. (Warren Buffett quote…he wasn’t there)
Shifting paradigms:
- Consumption to sustainability
- Possessions to purpose
- Retirement to employment
- Trading up to trading off
- Perceived value to real value
Simple…less is more
- 1/3 of people feel their lives are out of control.
Inflamation causes 80% of diseases (really)?
If only 10% of outcomes are driven by costs, why do we spend 100% of our time trying to fix that problem. [tail wagging the dog] [It’s the same point on adherence.]
There are 45M sick days per year from 5 conditions – hypertension, heart disease, diabetes, depression, and asthma.
Have to look at clinical efficacy and elasticity of demand.
Commitment, concern, and cost.
Five components – plan design, program, community, communication, and provider engagement.
Need a multi-faceted approach to create a culture of health.
MDs much more likely to talk about pros than cons.
There would be 25% less invasive procedures if patients fully understood the risks.
Foundation of Informed Decision Making
Huge gaps in patient view versus physician views around breast cancer.
Preference-sensitive care
Dartmouth Atlas
Genomics tells you the probability of being on a disease curve, but not where you are in the potential severity.
Only 60-70% of women get at least one mammogram their entire life.
Statin study – barriers to adherence:
- 37% didn’t know to stay on the Rx
- 27% side effects
- 15% convenience
- 15% MD instructions
- 11% cost
In healthcare, we’re all taught to speak a language that no one else understands.
It takes a village.
Challenge – Use communications to cure cancer.
Collaboration. Innovation. Evaluation.
Adherence is a great example of where everyone’s interests are aligned.
There is no magic bullet for adherence.
You need a multi-factorial approach to address adherence…Physicians are rather ineffective at addressing adherence.
Evidence-based plan design works to impact adherence (although I think another speaker said no).
You have to think about operant conditioning. (Look at dog training manuals and kid training manuals – very similar)
- My example here is using clicker training for humans.
Think about all the failure points in the process.
What is the relative value to the patient.
Reward system has to reward at the failure points not just at the end of the process.
Using a point system successfully increased the use of a select (on-site) pharmacy by 57% at one employer.
75% of PBM profits are from dispensing generics…that’s why Wal-Mart was able to be a threat to the industry.
Drugs only work in 20-80% of people.
There are people with a gene that doesn’t break down caffeine.
3% of people are ultrafast metabolizers of codeine (which turns to morpheine in the body)…that can be a problem.
Epigenetics – turning DNA switches on and off.

“Tweets”

Rebecca from ProjectHEALTH closes #results2010 with a remarkable talk on this crucial program; they work with 5,000 families/year.

Reid Kielo, UnitedHealth: 93% of members validated ethnicity data for HEDIS-related program using automated telephony #results2010

25% of Medco pt take a drug with pharmacogenetic considerations. Robert Epstein, CMO Medco #results2010

Bruce Fried: the “California model” of physician groups facilitate efficiencies that improve delivery; an oppty for M’care #results2010

Bruce Fried on Medicare: 5 star ratings have strategic econ. importance, med. mgt. and cust serv. key #results2010

Fred Karutz: members who leave health plans have MLRs 2 standard deviations below the population. #results2010

Fred Karutz: Market reform survival – retain the young and healthy #results2010

Poly-pharmacy has negative impact on adherence. #cvscaremark
#results2010

1 in 3 boys and 2 in 5 girls born today will develop diabetes in their life. SCARY! #results2010

20% of all HC costs associated with diabetes. #results2010. What are you doing to manage that?

Messages to prevent discontinuation of medication therapy far more effective than messages after discontinuation. CVS #results2010

25-30% of people who start on a statin don’t ever refill. #CVSCaremark
#results2010

Maintenace of optimal conditions for respiratory patients increased 23.4% with evidence-based plan design. Julie Slezak, CVS. #results2010

Value-based benefits help control for cost sensitivity for medications; every 10% increase in cost = 2% – 6% reduction on use. #results2010

Pharmacists who inform patients at the point of dispensing are highly influental in improving adherence. William Shrank #results2010

The game of telephone tag in HC is broken. Pt – MD communications. #results2010

37% of Pts were nonadherent because they didn’t know they were supposed to keep filling Rx. #results2010

Last mile: 12% of Americans are truly health-literate; they can sufficiently understand health information and take action. #results2010

Only 12% of people can take and use info shared with them. #healthliteracy
#results2010
#DrJanBerger.

We need to improve the last mile in healthcare… clear, effective conmunication. Jan Berger #results2010

#McClellan used paying drug or device manu based on outcomes as example of “accountable care”. #results2010

72% of those with BMI>30 believe their health is good to excellent; as do 67% of those w/ chronic condition. #McKinsey
#results2010

Are incentive systems more likely to reward those that would have taken health actions anyways (i.e., waste)? #McKinsey
#results2010

Only 36% of boomers rate their health as good to excellent. #results2010

27% of people believe foods / beverages can be used in place of prescriptions. #NaturalMarketingInstitute
#results2010

Why do we spend so much time on impacting health outcomes thru the system when that only explains 10%. #Dr.JackMahoney #results2010

Using auto calls vs letters led to 12% less surgeries & 16% lower PMPM costs in study for back pain. #Wennberg
#HealthDialog
#results2010

MDs are much more likely to discuss pros with patients than cons. #Wennberg
#HealthDialog
#results2010

Should physicians be rewarded as much for not doing surgery? How do economics influence care decisions? #results2010

Physicians were 3x as concerned with aesthetics than breast cancer patients in DECISIONS study. #results2010

Fully-informed patients are more risk-averse; 25% fewer of informed pts in Ontario choose angioplasty. #results2010

Patients trust physicians over any other source (media, social connections) but only receive 50% of key knowledge. #results2010

Informing Patients, Improving Care. 90% of adults 45 or older initiate discussions about medication for high BP or cholesterol. #results2010

What is #results2010? #Silverlink client event.

#results2010 – #Aetna Medicare hypertension program leads to 18% moved from out of control to in control using auto calls (#Silverlink) …

About 2 of 3 medicare pts have hypertension. #results2010

John Mahoney describes how he connects payors, providers, and care via research. #results2010

As information becomes commoditized in healthcare, sustainability enters the vernacular. #results2010

Segmentation innovations of today will be tomorrow’s commodities. Measurement and learning must be “last mile” IDC insights #results2010

Plans are strategically investing in bus. intel to reach wide population for wellness, not just the low-hanging fruit. #results2010

The single most significant future market success factor is measurable results. Janice Young, IDC Insights. #results2010

Knowing our attendees’ preferences could have fueled segmented, precise invitations to #results2010. Dennis Callahan from Nielsen Media.

Drivers of those sereking alternative therapies: stress, lack of sleep and energy, anxiety, inflammation. #results2010

Only 2% of people don’t believe it’s important to lead a healthy lifestyle. Their behavior could’ve fooled me. #results2010

Are purity and simplicity the new consumption? Steve French of Natural Marketing Institute explores. #results2010

Gen Y is the most stressed out generation. #results2010

Less is more. 54% say having fewer material possessions is more satisfying. Natural Mktg Institute #results2010

Loyalty is a result of a cumulative set of experiences. Individual intervention ROI is sometimes difficult. #results2010

Sundiatu Dixon-Fyle of McKinsey; understand how beliefs shape an individual’s ability to change behavior. #results2010

Don Kemper: each of 300M HC decisions made each year need to be informed. #silverlink
#results2010

Medicare Part D: 40% lower cost than projected, seniors covered through tiered coverage powered by communication. #silverlink
#results2010

Mark McClellan: Brookings is engaging private insurers to pool data to understand quality of care. #silverlink
#results2010

Mark McClellan at RESULTS2010; bend the curves, provide quality care efficiently. HC reform >> insurance reform. #silverlink
#results2010

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Social Media, Value Propositions

Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media, Value Propositions

Who’s Your Date To The Genetic Testing Prom?

May 18, 2010 by George Van Antwerp 1 Comment

Genetic testing (aka pharmacogenomics, personalized medicine) is certainly a hot topic these days. There is lots of research around how to use the testing to manage drug spend by appropriately matching drugs with genetics at the individual member level.

I find it interesting to see who’s going to the “prom” with whom here. Another interesting perspective is how physicians feel about these (see survey).

Medco acquired DNA Direct.
CVS Caremark hired Per Lofberg from Generation Health and invested in the company.
P&G invested in Navigenics.
Walgreens was going down the path with Pathway Genomics before the FDA intervened.

So…what is Express Scripts doing? I’ve heard some talk at a conference about their strategy which involves a broader focus on integrating data from multiple sources including genetic testing to help drive clinical decisions. It seems like they’re either late to the party or smart in staying away. The question is whether this is a nice to have, a differentiator, or something that consultants will start requiring the PBM to provide. From their 2009 Outcomes conference:

[Genomics and personalized medicine] The potential for improved outcomes and cost savings are attractive but still unproven.

Healthcare, Innovation, Managed Care, PBM / Pharmacy, Research, Technology, Value Propositions

Could You Change Behavior With Virtual Reality?

May 9, 2010 by George Van Antwerp 0 Comments

I am a big believer in experiential learning. To that effect, every time I’ve decided to change behavior I only have to envision myself at some future state affected by my current state decisions. When I believed that my drinking caffeine would impact my future health, I quit cold turkey for 15 months. (I observed no meaningful difference in health and allowed myself to drink caffeine again.)

So… I guess my question is why can’t this be harnessed in all of us. Would we make different decisions if there was a way to reflect on our decisions in a “magic mirror” of sorts that showed us how these would impact our lives? Is this a role for a “Future Life” play on Second Life?

Imagine:

Inputing your food decisions for a month and having it show you your weight, physical attributes, diseases, impact on your kids, etc in 10-years and do that in a 3D virtual reality environment.
People who smoke observing themselves thru the eyes of others and smelling the smell that others smell when the smoke is saturated into their clothes.
People who chew tobacco seeing what their mouth would look like in 20 years without teeth and having dentures and the things they could no longer do.
People who drink and drive imagining themselves in a car crash where they die and the impact that has on their friends and family.

Or, if you focus on the carrot versus the stick maybe there’s more motivation to change by letting them dream what is possible if they change behavior:

Running a marathon at age 70.
Seeing their grandchildren and being able to chase them around.
Being without any medications.

Consumerism, Healthcare, Innovation, Technology

The Best Healthcare Conference

April 28, 2010 by George Van Antwerp 1 Comment

In today’s budget conscious economy, people are constantly evaluating where to spend their time and money from a conference perspective. Some conferences are good networking events. Some of requirements to work in an industry. Some are educational. Some give you new ideas on how to run your business. Some are in great fun locations with fun events. Very few fit all of those.

I think our Silverlink Communications client event called RESULTS2010 does all of those. [Hint – the conference is called RESULTS since that’s what we focus on with our customers.] It takes on all the key issues we see in the market. It brings in industry experts and clients to talk about what they are doing to address these issues. Those problems are framed out by our industry experts that have line experience with these roles. [Our leadership team comes from places such as Express Scripts, CVS Caremark, Gorman, and HCSC and our team includes people from McKesson, Humana, United Healthcare, IMS, DigitasHealth, Medco, and WebMD. I challenge anyone to find a more knowledgeable vendor team.] It gives people a chance to network and talk to their peers. And, there’s some fun mixed in there.

This year’s event is focused on THE HEALTH CONSUMER. I’m pretty sure it’s the only conference focused on communicating with consumers in healthcare. The objective is to provide clients with ideas about how to educate, support, and motivate consumers to take actions which support health outcomes.

Honestly, it was the original event that convinced me to come to Silverlink. I was a consultant at my first event working with the company. I met 75 users who were passionate about the company and had great first hand experience using the technology to make a difference in their companies. I was able to ask them about the competition and understand why they choose Silverlink for their member communication partner.

So, what does this year’s event have in store:

An amazing list of external speakers including Mark McClellan, David Wennberg, Don Kemper, Jack Mahoney, and Janice Young.
A long list of client case studies – 14 so far.
Specific tracks to cover our different client groups and allow for smaller discussion versus formal presentations – Pharmacy, Population Health, Medicare, and Managed Care.
Industy experts on key topics such as consumer engagement, use of data in healthcare, consumer data, behavior change models and incentives, pharmacy economics, pharmacogenomics, medicare market dynamics, and the evolving retail healthcare model.
Adherence experts such as Dr. Will Shrank from Harvard and Valerie Fleishman who led the NEHI adherence study that is widely quoted.
Several fun events including golf, morning runs, and a few special sports related surprises.

There are several more speakers who you would know and I’m very excited to have come and speak…BUT, I want to leave something inside the package for you to want to rip it open and learn more.

How much does it cost? Nothing (as long as you’re a Silverlink client).

Where is it? Boston (a great city).

How do I learn more? Well…if you work for a large managed care company, a population health company, or a pharmacy / PBM, you may already be a client. We have over 80 clients today. So, if you’re not on our invite list, think you might be a client, and want to learn more, let me know. I’m at gvanantwerp at silverlink dot com. [spelling it out avoids spam]

This year’s event is in late May so I hope to see many of you there!

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

The Adherence Estimator by Merck

April 19, 2010 by George Van Antwerp 0 Comments

Merck did research that was published last year showing that their 3-question Adherence Estimator (TM) was 86% accurate in identifying patients at risk for nonadherence. Pretty impressive.

A copy of the questions are below and were on the Tuft’s website which also shows the scoring mechanism. This is something patients can take to determine their risk or plans, PBMs, pharmacies, MDs, disease management companies, or others could use.

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

Ingrid Lindberg, Chief Experience Officer, Cigna

April 15, 2010 by George Van Antwerp 3 Comments

This was definitely my favorite and most interesting presentation and discussion from the World Health Care Congress in DC. Ingrid presented and subsequently spent some time talking with me. She has what I would consider one of the coolest jobs – transforming a large company to be consumer centric and radically changing the way they think, speak, and act.

From her presentation, here were a few notes:

There are 337 languages spoken in the US today. (health literacy issue?)
Only 23% of people understand what their health insurance policy means.
Most patients appear to be unaware of their lack of understanding in physician instructions and are inappropriately confident.
35% of consumers spend less than 30 minutes reading their health benefit information.
Only 7% of people trust their insurer.
Trust translates to loyalty and satisfaction.
It’s a mix of quantitative and qualitative research.
They spent time monitoring sites like – www.pissedconsumer.com. (do you?)
Their senior staff has to spend time listening to member calls each week.
They spent lots of time on ethographic research and identified 6 personas that they use for defining products – Busy Mom, Skeptic, CareGiver, Controller, Athlete, and Bargain Shopper.
They identified the #1 dissatisfier was language. Plans talk to them in a language they don’t understand. (For example, consumers think of providers as the insurer not a physician.)
Consumers didn’t want to be called members since it’s not a health club. They didn’t want anyone other than their physician to call them patient. They’ve elected to go with “customer”.
She talked a lot about how they’ve changed their EOB (explanation of benefits) and their plan overview to address things like what’s not covered. She talked about how customers think of the EOB as the “this is not a bill form”.
They identified 10,000 separate letters that could go out to a customer. They’ve re-written 9,000 of them.
She talked about changing their call centers to 24/7 and the fact that they’ve now taken their 1M call in what used to be considered “after hours”.
She talked about re-designing their IVR to offer you a self-service option (press 1) or a talk to agent option.
She talked about their website and YouTube channel – www.ItsTimeToFeelBetter.com.
She talked about their understanding level being around 70% while the industry average is around 15% [of communications sent out].
This was in a 15 minute presentation and summarized only 2 years of work.
She also shared some metrics that they use and improvements such as a 8 point improvement in one year of “values me as a customer”.

And, they’ve shared some of this information in their press kit. There is also an IBM white paper about some of the technology they’ve implemented.

I think the following slide from her deck sums it up well.

Then I sat down with Ingrid to talk with her. I had a thousand questions which I limited to about 10. This is a topic I love and is why I love what I do – work with companies to help them develop consumer communication strategies and implement those strategies to improve the consumer experience and drive better health outcomes.

How long did it take? This is about a 3-5 year effort which is complicated by the fact that people in these types of roles typically only last about 28 months.
Did you do it all internally? No. They worked with Peppers & Rogers on a Touchpoint Map and used an IBM tool called Moment of Truth. They also worked with IBM on a new desktop solution. BUT, she was quick to talk about the fact that those were enablers while the majority of work had to be done by internal change agents since this is a cultural change. She said that now almost 80% of Cigna people are using their recommended language and are aware of the changes made by her group.
Why haven’t others followed? It’s hard work.
How do you deal with consumer preferences? This is one of my favorite topics to debate. Should you offer consumers options on how you communicate even if you know that they might not pick one that is the most effective. For example, I might say to send me an e-mail, but they get lost, they can’t contain PHI, etc. She said that you have to ask but you have to navigate the path. She seemed to agree with me that there are some communications where you want to ask (e.g., order status at mail) and others where you want the right to contact them (e.g., drug-drug interaction). She talked about the fact that it’s all in the framing (e.g., if we have a message for you that could affect your safety, is it okay if we ignore your do not call request?).
Are you changing Cigna’s physician communications also? Yes. The changes have become the “language of Cigna”. Physicians are people, and they are also trying to educate physicians on what they’ve learned about how to communicate with customers. She mentioned that the most difficult groups to change were the people that were knee deep in this healthcare language – internal people and consultants.
Based on my discussion with Andy Webber, I asked her if she thought that today’s fragmented environment would allow for a coordinated consumer experience. She agreed that it’s difficult and that the consumer sees everything as their benefit. They don’t see the piecemeal parts. She mentioned that one of their clients had held a “vendor fair” to kickoff the plan year where she presented their learnings and all the vendors were told to use them immediately. [Maybe that’s part of the solution.]

We then bounced around on a couple of interesting topics:

We talked about the fact that lots of companies are hiring non-healthcare people to help them better understand the consumer. These include consultants, database people, marketing people, and innovators. My personal opinion is that you need people that have worked in or around healthcare AND outside healthcare. They also need to have consulting and line management experience.
She talked about their war room (she used another term) where they had a current state and future state (of patient experience) and showed all the 10,000 current communications as a waterfall.
We talked a little about some of the things we’d done at Express Scripts when I was there including changing the way we referred to members at the call center to patients and the impact that had.
I shared with her that our biggest difficulty was making web changes at Express Scripts which I thought would be the easiest to do. She shared that changes on the web were one area where they were lagging and is difficult.
She talked about trying to get innovation from customers by understanding what they want and giving it to them.

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, Research, Silverlink, Value Propositions

BOB vs. ERP Concept For Patient Experience

April 13, 2010 by George Van Antwerp 0 Comments

I had a quick dialogue with Andrew Webber (President and CEO of the National Business Coalition on Health) earlier today at the WHCC (see #whcc10 twitter feed). I wanted to talk with him about how we create a unified consumer experience in today’s healthcare environment.

Today, a consumer gets messages from their employer, their physician, their pharmacy, their PBM, their managed care company, their hospital, their disease management company, healthcare sites such as WebMD, and probably several other places. Very little of that is coordinated, and it’s certainly not always consistent in messaging and direction.

Mr. Webber explained that the employers need a “supply chain management” solution to share data across vendors and develop a consistent message. We talked about how the Accountable Care Organization (ACO) concept will try to get us back to some type of solution where there is a primary “owner” of the relationship and that this would be with the trusted key in the solution – the MD.

We talked about the fact that the employers have created this system which pushed the BOB (best-of-breed) over a consolidated, centralized solution. And, we discussed the fact that employers continue to love these “boutique solutions” that develop niche plays (think Health 2.0 companies) which address an acute need. They create great case studies but are often difficult to scale.

It made me think of some old IT models I worked on where clients had to decided whether to pick an ERP system like SAP or go with the best-of-breed and manage the infrastructure to connect them. I think the current employer based system even went a step past this. In the IT world, the company had to manage a connected infrastructure (think enterprise data warehouse and service oriented architecture). BUT, in healthcare (or benefits), that infrastructure doesn’t exist. Each entity owns their piece of it completely with limited interaction and connectivity.

This was the first time where I could see the point of a “employee centric model” versus an “employer centric model”. I’m not sure I believe it could effectively be done, but it reminded me of a company that was trying to create a web-application that was a type of next generation PHR (personal health record) where the member could consolidate communications, designate preferences, and would adapt general (vanilla) communications to the consumer based on behavior, preferences, demographics, etc.

Consumerism, Healthcare, Innovation, Marketing / Communications, Technology

Voice Personality Is A Powerful Lever To Motivate Health Behavior

March 29, 2010 by George Van Antwerp 0 Comments

This article appeared in HealthLeaders (3/3/10) by two of my co-workers based on some very interesting work they’ve been doing.

It’s not what you say, but how you say it that matters. The “how” includes a number of specific voice attributes, such as inflection, rate of speech, and intonation—all of which contribute to an overall perceived “voice personality.”

Voice is a powerful lever in the ability to effectively communicate your message to ultimately motivate behavior. Would you be more apt to trust the voice of James Earl Jones or the voice of your local car dealer? How do you perceive these voices overall? Which voice personality most effectively delivers a message? The answers, of course, depend on the listener, what is being communicated, and the behavior you’re trying to motivate.

In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging.

Specifically, this research analyzes voice selection for interactive automated calls, an effective outreach channel widely used in healthcare to reach and motivate individuals.

Subjectivity in Voice Selection
If you put a small group of people in a room and ask them to describe the voice they hear, the answers will be wildly different: “This voice sounds too perky.” “That one sounds robotic.” “This voice sounds friendly and cheerful.” Reaching a final conclusion about which voice is “best” often is a highly subjective process.

While we don’t consciously listen to an individual’s voice attributes, we do subconsciously assess the voice’s characteristics and create inferences about the speaker. Over the telephone or on the radio, when voice is the focus, we paint a picture of how someone looks, what kind of person they are, their age, gender, and generally whether or not you trust them.

We’re sometimes surprised in the end at how different the person is when we meet him or her face-to-face. By itself, voice impacts our perceptions, which affect how well we understand a particular message.

In healthcare, it is a common belief that people prefer a female voice when receiving messages about their health. Perhaps this is because female voices are perceived as more nurturing and caring; and women are often the caregivers in the home.

But is a female voice equally effective when communicating to all people, of every age, in every region, and for every type of health related behavior? For instance, is a female voice as effective for people of poor health status hearing a message about an important health screening? What about seniors hearing a reminder to take their cholesterol-lowering medications?

Voice Research
To answer these questions, we created a framework to map specific voice attributes with voice personality. We conducted an attitudinal study to learn how people of different age, gender, and region perceive and respond to different voices. We surveyed 3,000 people across the country, in a statistically representative sample of the commercially insured U.S. population.

Participants heard the same short informational wellness message spoken by several different voices representing a variety of ages, gender, and unique voice characteristics. Survey responders were asked to provide their opinions on the following:

Is the voice perceived negatively or positively overall?
Which attributes do people generally use to describe a particular voice? (e.g., rate, volume, and age)
Is the voice perceived as introverted, extroverted, formal, or conversational?
Is the voice perceived as coming from someone who is more caring and sincere, or someone who is trying to sell something?
Do people believe and trust the voice?

The survey results provide a powerful depiction of how different voices are perceived by different segments of a population.

What’s in a Voice?
High trust and care/sincerity ratings are important factors when trying to motivate healthcare behaviors. Medication adherence, for example, is associated with the quality of relationship between the patient and the physician. When people trust the voice they hear, and feel that the person speaking to them is sincere, they are more likely to change their behavior.

There are many interesting attitudinal findings from our study including:

Both men and women across all age groups preferred a male voice to a female voice overall.
Voices described as fast paced, young, highly extroverted, perky, and animated rated poorly in the trustworthy and caring categories.
Voices described as moderately paced, middle-aged, and well-spoken/educated, were rated most trustworthy and caring.
Seniors (those 65+ years old) aren’t as sensitive to voice age as other groups and don’t perceive older voices as necessarily older sounding. By contrast, younger groups perceive “older” voices more negatively.
Seniors aren’t as sensitive to the rate of speech as younger populations; therefore, slowing the pace may not be as impactful as was once thought for older populations.
Younger people (18- to 34-year-olds) are significantly more sensitive to voice age and rate of speech, which means very careful selection of voices for young audiences is important to drive behavior.,/li>
Young people showed stronger opinions overall between men and women when rating the voice gender they prefer. In other age groups, there is general agreement on voice gender preferences. Gender selection is therefore a more important factor for the 18-to-34-year-old age group.

The use of voice to motivate health decisions
The results of this study provide us insight into how people of varying gender, age, region, and health status perceive the voices they hear. Our goal is to validate how specific voices can be used as a lever to change behavior.

Voice, like other communications levers, such as messages and timing, can be selected based on the demographics, purpose, tone, and intent of communication, as well as how voice supports brand identity. By validating attitudinal voice responses against behavioral activity, voice can ultimately become a measurable behavioral best practice in healthcare communications.

While the bulk of our experience supports the conventional wisdom that a woman’s voice is more effective for healthcare communications, our voice research suggests that there are opportunities to use a male voice to measurably move health behavior. A recent outreach program to educate individuals about the importance of colorectal cancer screenings supports our attitudinal research.

The outreach asked if the individual had received a screening during the past two years, and if they planned to schedule a consultation with their doctor. The same message was delivered by a male and a female voice. All population segments, including men, women, Caucasians, Hispanics, and Asians, answered the survey at a higher rate when a male voice was used versus when a female voice was used.

Conclusion
By applying science and measurement, we can determine the voice qualities that are the most impactful for a specific health behavior and for a group of people. There are measurable patterns in overall voice preference. Communications programs aimed at driving individual behavior should include voice analysis.

By measuring and understanding perceived voice personality, our research sheds light on an objective way to effectively apply voice in healthcare communications to ultimately impacts behavior change.

Jack Newsom, ScD, is vice president of analytics at Silverlink Communications, and Ryan Robbins is voice production manager at Silverlink Communications.

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

Can’t Wait For My Augmented Reality Glasses

March 20, 2010 by George Van Antwerp 0 Comments

With Droid and other technologies, the augmented reality concept is becoming real. Never heard of it. Here’s a definition from Wikipedia:

Augmented reality (AR) is a term for a live direct or indirect view of a physical real-world environment whose elements are augmented by virtual computer-generated imagery. It is related to a more general concept called mediated reality in which a view of reality is modified (possibly even diminished rather than augmented) by a computer.

In the case of Augmented Reality, The augmentation is conventionally in real-time and in semantic context with environmental elements, such as sports scores on TV during a match. With the help of advanced AR technology (e.g. adding computer vision and object recognition) the information about the surrounding real world of the user becomes interactive and digitally usable. Artificial information about the environment and the objects in it can be stored and retrieved as an information layer on top of the real world view.

The simple examples that many of us may be familiar with are the simulated first down line in football or the line of the hockey puck. They are graphics that are applied in real-time to a reality.

Here’s a couple of cool examples:

Dialing using your hand.

Yelp via Monocle on your iPhone. (Just look thru your camera phone)

Travel Guide using Wikitude. (Just look thru your camera phone.)

First off, the geeky side of me finds this fascinating. Practically speaking, as someone who struggles with names especially at large social events, this would be great in my glasses. If I had pictures of everyone I knew and had ever met and that could pop up into my view in my glasses with some basic information on them (John, works at X company, went to University of Michigan, has two kids, last spoke on April 09).

Maybe at some point this becomes the Matrix meets SecondLife meets Wall-E where everyone’s obese and the only thing you see of them is their Avatar as they move thru some augmented reality.

Innovation, Technology

12 of Top 50 VC Backed Firms In Healthcare

March 9, 2010 by George Van Antwerp 0 Comments

The Wall Street Journal had a list of the top 50 venture capital backed firms today (3/09/10). 12 of them were from healthcare.

1. Pacific Biosciences
7. Complete Genomics
11. Portola Pharmaceuticals
12. NeuroPace
14. Ventana Health Services
21. Xanodyne Pharmaceuticals
24. Small Bone Innovations
27. Satiety
31. CVRx
33. Oceana Therapeutics
40. PhotoThera
50. Acceleron Pharma

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

Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media

Will Paying You To Be Adherent Work?

February 3, 2010 by George Van Antwerp 0 Comments

United Healthcare is launching a new program (Refill and Save) that is a different spin on the value-based designs we’ve typically seen. In a lot of value-based healthcare programs, companies lower copayments (or waive copayments) for patients in certain conditions to drive up adherence. This has been shown to work and improve results by about 10% which is great. [Although less than some of the adherence programs we’ve done at Silverlink.]

In this case, United is paying patients $20 for every refill they fill for certain medications starting with asthma and depression. I’m very interested to see the results. There continues to be no silver bullet for adherence which is a problem which drives $290B in cost per year and results in 100,000 deaths.

“Patients with chronic diseases such as asthma and depression who take their medicines regularly and who comply with prescribed treatments are likely to stay healthier. They not only feel better, they can potentially avoid costly medical problems that could result from delaying appropriate therapy,” said Tim Heady, CEO of UnitedHealth Pharmaceutical Solutions

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

Interview with Cyndy Nayer from the Center for Health Value Innovation

January 22, 2010 by George Van Antwerp 1 Comment

I had a chance yesterday to sit down and talk with Cyndy Nayer (President, CEO, and co-founder) from the Center For Health Value Innovation. For some of you, this is a new buzzword for others it has been around a while. I remember back in the early 2000s when stories of Pitney Bowes kept popping up and then working with a few of our clients (like Marriott) when I was at Express Scripts on what were being called “value-based designs”. [I even had an offer to go to ActiveHealth (now part of Aetna) and work on their Value Based offerings several years ago.]

And, it’s a small world. Several people from my past are involved: (1) Peter Hayes was a client at Express Scripts and (2) Roy Lamphier played soccer with me in high school.

What is the Center For Health Value Innovation?

The center is an “information exchange” for value based design which as she points out is much more than just a prescription benefit and not simply giving people free drugs to make them more compliant. [If only it were that easy!]

What do you mean by Information Exchange?

A place where people can share stories, trends, info, and research. They see their job as getting information out there and providing support around modeling, analysis, and identifying gaps. [And, I know they do a lot of education as you can see Cyndy at many conferences.] She talked about educating the marketplace on an “actionable format” for implementing value-based design.

Can you describe Value Based Design?

Value Based Design is a suite of insurance design, incentives, and disincentives that support prevention and wellness, chronic care management, and care delivery. It is focused on linking stakeholders across the care continuum and developing structures like outcomes-based contracting where all stakeholders benefit from better health outcomes.

She mentioned that in an upcoming edition of the Journal of Benefits and Compensation that there will be a paper that builds on some adherence concepts to discuss the 5 Cs of Value Based Design: [Noting that the first 3 come from some work from Merck.]

Commitment
Concern
Cost
Communication
Community

We talked about the need for communications to be multi-directional and include the patient, the physician, the pharmacy, and other caregivers. We talked about community needing to expand on that to include family, the employer, and other entities. [As we all know, health care is local and value based design is no different.]

We spent a little time here talking about community, and the need for this to happen at a community level. [Much like e-prescribing and other things have found out that localized momentum is important.] One question in my mind is who is the catalyst – the hospitals, the physicians, the local managed care companies, employers, grocery stores, wellness companies, pharmacies.

We talked about the fact that this isn’t the same as Accountable Care Organizations, but like that concept, this has to be developed as part of the fabric of the community not imposed on the community.

Being from Detroit, I asked if this was a model for them to help develop around. That is an area of focus and there has been some work done in the Battle Creek, Michigan area.

Why are employers so interested in Value Based Design?

Originally, employers were interested since it was something new, but the recession forced them to look at this more seriously. But, this is a long-term process and something which they benefit from. Better health lowers absenteeism, and businesses need health communities and healthy workers for growth.

Why don’t companies implement Value Based Design programs?

Companies don’t implement them because they’re not prepared for the amount of work needed to get started and it’s not a cheap fix. [If you want to save money, just drop the benefits…not that anyone really advocates that.] We talked about that lots of people react to the urban legends of just giving out free drugs [which isn’t Value Based Design] which would be easy. Companies need to realize there is work to be done to communicate this, design it, and manage the implementation across the community. BUT, once it’s installed, it’s completely sustainable.

Is there a certification (i.e., URAC) for value-based design?

She told me that nothing exists today and that it would be hard to do. Today, there isn’t alignment in the marketplace around incentives and a standard model. They spend a lot of time working with different groups to drive education and training to link health and productivity measurement with value and functional performance.

What’s next for 2010?

In 2010, they will be bringing much more information forward on how to support and extend the work done in the 1^st book (Leveraging Health…which Dr. Jan Berger, Silverlink’s Chief Medical Officer co-authored with the Center) and the decision matrix that they recently published. They will continue to serve more as a guide helping interested parties in private, invitation only events to design solutions and then bring those solutions to market.

How does someone learn more about Value Based Design?

The simple answer is to go to the Center For Health Value Innovation website. They have a whole library of information there.

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

Stop By The Silverlink Booth At The Forum 2010 (DMAA)

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DMAA Client Presentations

Member ID Card Application on iPhone

Pay For Full Service

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Innovation Has To Respect The Past

Does Age Matter in Adherence?

Sensory Friendly Films

2010 Medco Drug Trend Report

Who’s Your Date To The Genetic Testing Prom?

Could You Change Behavior With Virtual Reality?

The Best Healthcare Conference

The Adherence Estimator by Merck

Ingrid Lindberg, Chief Experience Officer, Cigna

BOB vs. ERP Concept For Patient Experience

Voice Personality Is A Powerful Lever To Motivate Health Behavior

Can’t Wait For My Augmented Reality Glasses

12 of Top 50 VC Backed Firms In Healthcare

Will Paying You To Be Adherent Work?

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