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10% Discount On DMAA Registration

August 5, 2010 by George Van Antwerp 0 Comments

As a speaker at the upcoming conference, they sent me a discount code…

Register Now for The Forum 10

DMAA: The Care Continuum Alliance, the leading trade association for wellness, prevention, disease management and other services across the continuum of care for chronic conditions, invites you to its 2010 annual meeting, The Forum 10, Oct. 13-15, in Washington, D.C. Join leading health plans, wellness and care management organizations, physician groups, health IT companies, state and federal programs and other stakeholders as they discuss health care reform, share best practices and network. Keynote speakers include best-selling author and motivation and engagement expert Dan Pink; and a panel presentation by nationally recognized consultants on workplace wellness strategies. View complete programming details

Special Registration Offer: Viewers of this notice can receive 10 percent off standard Forum pricing by using discount code “FRIENDS-FORUM” during the registration process. Go to online registration

Events, Healthcare, Leadership, Marketing / Communications, Silverlink

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

Back To The Future: The Role Of The Pharmacist

July 29, 2010 by George Van Antwerp 0 Comments

Between the focus on differentiation and the focus on adherence, we have seen (and will continue to see) greater use of them as a strategic asset. CVS Caremark is leveraging them in their Pharmacy Advisor solution. Walgreens continues to leverage them at the POS. Medco is using them in their Therapeutic Resource Centers. And, the independent pharmacists have stressed this story for years.

In Medicare, the Medication Therapy Management (MTM) process begins to recognize the power of pharmacists and actually rewards them for their efforts. I was quoted in Drug Benefit News today about this topic. Here were a few quotes:

“The pharmacist is an under-utilized resource today,” George Van Antwerp, vice president of the Solutions Strategy Group at Silverlink Communications, tells DBN. “They go to school to work with patients and often end up simply filling bottles.”

While the benefits of pharmacist intervention are undeniable, Van Antwerp says, the challenge is finding the right balance of face-to-face interaction and automation. Issues also include getting a good return on investment for such services by condition and the fact that only an estimated 60% of the people picking up prescriptions are the patients themselves. In addition, “the staffing model right now would be stressed if pharmacists were spending significant time on cognitive services,” he maintains.


 

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

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

Caremark iPhone App – Will Others Follow?

July 26, 2010 by George Van Antwerp 1 Comment

CVS Caremark announced today that they were releasing a Caremark iPhone application. First, I think it’s about time (for some PBM to do this). I would think the other PBMs will follow suit.

Second, I think this is a great opportunity for an expanded CVS Caremark iPhone application which expands the functionality of the app and is like Maintenance Choice in that it offers a benefit of the integrated company.

Today’s application is PBM centric and focused on ordering refills (I assume at mail only); checking prescription order history (I assume mail only); viewing prescription history; requesting a new prescription (retail-to-mail I believe); checking drug cost; and finding a nearby network pharmacy. Checking drug cost could be the coolest feature since it would give patients what they don’t have today – an ability to check the cost while they’re at the physician’s office. Finding a network pharmacy is an important tool if companies were to promote limited networks, but it’s only a nice to have if all the pharmacies are in the network.

So, of course the question that I would have is when will they add the retail components to request retail refills (at CVS stores or all locations); check status of prescriptions (e.g., prior auth required); request a renewal of an Rx; request a lower cost alternative; find a CVS with a MinuteClinic; or identify opportunities to save money (e.g., a generic alternative).

There are lots of other things to push out via the application, but I agree with the strategy of focusing on the core applications first. Caremark (or other PBMs) could push clinical suggestions; send adherence reminders; do satisfaction surveys; collect barrier data (why not adherent); and collect information (why not using generics). I also see it as a great way to push tools – e.g., 5 questions to ask your physician when you get a new Rx.

It would be interesting to see the statistics in a year – how many downloads of the app; how frequently is it used; patient satisfaction with the Caremark for those with the app (vs those without); adherence for those that use the application; what functions work best; savings versus other modes of communication; and effectiveness of their appliction versus other health applications.

Books / Articles, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Technology

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

5 Keys To Health Plan Survival

July 8, 2010 by George Van Antwerp 0 Comments

I thought I would re-post these from the Corporate Research Group.   

Bertolini outlined  five keys to surviving reform: 1. Payment reforms that shifts incentives from volume to outcomes; 2. Information technology that improves quality, lowers cost; 3. Wellness: engaging consumers with incentives and decision-support tools; 4. Transparency tools that provide information and improve accountability; 5. Revamped benefits and plan designs.

 These seem pretty logical and echo some of the things I brought up in my pharmacy white paper last year. 

1. The need to better engage the consumer in understanding their benefits and ultimately responsibility for their care;
2. The effort to automate and integrate data across a fragmented system and across siloed organizations; and
3. The shift from trend management to being responsible for outcomes.

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

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

New Health Insurance Ideas

July 6, 2010 by George Van Antwerp 0 Comments

Just two ideas that I was playing with for health insurance.

1. Complete transformation from group to individual

Why not change the entire market to be an individual purchase…There are obviously some reasons such as adverse selection and group buying power, but I would think those were things where the government could add value.  If individuals selected the health insurance companies and products that they liked, it would create a very different dynamic. 

You could then change the employment paradigm not to a provider of health insurance, but make it more a part of your compensation.  Company A might fund up to $5,000 per year in health insurance while Company B provides up to $7,200 for family coverage.

One of the big benefits of this (beyond making individuals into consumers with power) is that health insurance companies could start to invest in outcomes.  Today, they are hesitant to make long-term investments (i.e., if I do this for 5 years, it will reduce the cost of this individual in 20 years) because their membership turns over.  This is a real issue in my mind.

2. Free insurance for healthy people

There is obviously an issue with funding and hyperbolic discounting, but what if we simply said that people who maintain some set of health standards (BMI btwn 20-25; HDL less than 180; able to run a mile in under 8 minutes) got free health insurance.  Would that make a difference?  I think so.  Companies would be better off – less absenteeism.  The US healthcare costs would drop.

Of course, it would take it’s toll on the providers while being a boom for gyms.  But, it’s hard to find that win-win-win. 

I know there’s a big issue of funding, but I was thinking about some radical ideas of what the money being raised by Gates and Buffet could be used to do and how it could motivate people.

Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Politics

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 8th to 2nd.
  • 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
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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)
  • 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

Medco 2010 Drug Trend Report

May 19, 2010 by George Van Antwerp 1 Comment

Today, Medco Health Solutions released their 2010 Drug Trend Report (which looks at 2009 data). I haven’t had time to read the entire report, but here are a few highlights and comments from a conference call:

  • Overall drug trend was 3.7%. [They use their top 200 clients for analysis.]
    • Trend was 0.1% for clients with greater than 50% spend at mail.
    • Trend was 1.7% for Medicare.
    • [I still point out here that the question is whether trend is good or bad.] Dr. Epstein and David Snow pointed out that they work with clients on this to track metrics on adherence at the TRCs (Therapeutic Resource Centers) and report on this. The key here is knowing what classes show measurable impact to overall costs and outcomes by improving adherence and increasing costs.
    • Another point I thought was interesting was a comment that if the FDA saw the actual adherence on some drugs that require sustained utilization to achieve an outcome that they might make different decisions about drug approvals.
  • Inflation for branded drugs was 9.2% which was the highest in a decade. Generic inflation was 0.3%.
    • On a conference call, David Snow validated that this was associated with the tax on brand pharma so yes the high inflation on brand drugs was tied to reform. Someone asked a question about patent expiration (which historically drives prices up), but that doesn’t explain all the inflation here.
  • They saw a 3.4% increase in generic utilization.
  • Prescription utilization was up a minor 1.3%.
    • 5% for children 0-19.
    • 0.2% for seniors.
  • Specialty drug spending continued its rapid growth with a 14.7% increase including a 2.6% utilization increase.
  • Diabetes continues to be the largest driver of drug trend representing 16.7% of all drug spending and grew by 11.1%. [We can expect to see this continue to grow as more pre-diabetics are diagnosed.]
  • H1N1 drove up antiviral spending by 15.7%.
  • Pediatric use of medications grew faster than other groups.
  • 1 in 4 insured kids now take a medication for a chronic condition.
  • Increased utilization in kids occurred in diabetes, asthma, antivirals, ADHD, cancer, and rheumatology drugs.
    • There was a huge increase in diabetes over the decade (5x the adult population) and this was especially true with adolescent girls.
    • It’s amazing to me that you now have kids on lipids (high cholesterol), but it’s clearly an indication of the obesity issue. [We’re just at the tip of iceberg.]

  • ADHD surged for those under 35 – 9.1% increase in use leading to a 23.8% increase in spending.
    • The CDC says that 5M kids age 3-17 have and ADHD diagnosis.
    • [The other issue here is abuse of ADHD drugs.]
  • They also mention Nuvigil as a drug that could gain popularity for treating jet lag.
  • They forecast the drug trend will rise 18% thru 2012 driven largely by diabetes, oncology, and rheumatology.
  • About $46B in brand drug sales are scheduled to go generic by 2012.
  • They don’t expect biosimilars to impact the market until after 2012.
  • Not surprisingly, they showed a high correlation between states with frequent sleep deprivation and high drug utilization. As I’ve talked about many times, lack of sleep drives obesity which is highly correlated with many conditions. They also found a notable overlap of the use of Provigil (as stimulant used to treat daytime sleepiness associated with sleep apnea). [Seems like a drug that could get abused by college students like ADHD.]

“While H1N1 caused a spike in antiviral use among children last year, the far more alarming trend since the beginning of the decade is the increasing use of medications taken by children on a regular basis and in some cases, for conditions that we don’t often associate with youth, such as type 2 diabetes,” said Dr. Robert S. Epstein, Medco’s chief medical officer and president of the Medco Research Institute.  “The fact that one-in-three adolescents are being treated for a chronic condition points to the need for additional health education and lifestyle changes that can address the obesity issue that is likely a driving force behind such conditions as type 2 diabetes and even asthma.”

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

AIS Quote Of The Day – 25 Years Of Health Efforts Wasted

May 3, 2010 by George Van Antwerp 0 Comments

 

“Other than on cancer, we’ve spent 25 years wasting our time on trying to reduce health risk. I think it’s been a disaster….We weigh more than we did 30 years ago, we exercise less than we did 30 years ago and we have more diabetic people than we did 30 years ago….” 

— Dee Edington, Ph.D., director of the University of Michigan Health Management Research Center, at the recent World Health Care Congress in Washington., D.C. [From today’s quote of the day from AIS]

Books / Articles, Healthcare, Leadership

Thoughts On Express Scripts 2010 Drug Trend Report

May 1, 2010 by George Van Antwerp 0 Comments

As one of my favorite annual projects during my time at Express Scripts, I love the drug trend report. It has been a historical benchmarking tool for the industry and become a normal deliverable for many of the PBMs. Here are my initial thoughts after reading this year’s document which looks at 2009 data.

Individuals often are not rational.

  • As driven by their Consumerology initiative over the past few years, Express Scripts has shifted the dialogue around the B2C components of the PBM industry to one of behavior change versus simply plan design. This report continues to reinforce that messaging.
  • Waste has been an ongoing drum beat since my days there. This continues to be the message with a shift to include non-adherence to channel mix and drug mix.
  • They talk about the Healthy People 2010 initiative and that key to closing “the last mile” in achieving our objectives is the ability to influence behavior.
  • One of my favorite charts is below showing the waste by class. Not surprising, plan sponsors should focus on heart disease, depression, high cholesterol, and ulcer disease. [Diabetes is not in the top four but is one of the typical areas of focus.]
  • Key Performance Indicators (KPIs):
    • Overall drug trend – 6.4%
    • Specialty drug trend – 19.5%
    • Traditional (non-specialty) drug trend – 4.8%
    • $800.23 PMPY average drug spend
  • The top five classes are:
  • Specialty drug spend is up to $111.10 (processed under the prescription benefit) with a belief that this is only 50% of the total spend which includes specialty drugs processed under the medical benefit.
  • The top specialty classes include inflammatory conditions, MS, and cancer which represent 67% of total specialty spend.
  • I was surprised to see the member contribution to the drug costs had gone down while the actual dollars had stayed flat.
  • I was also surprised that they found adherence (as measured using Medication Possession Ratio) stayed flat from 2008-2009. I think most of the information available had implied thru survey data that it was going down with the recession.
  • I’m having some difficulty reconciling the MPR analysis below with the waste argument. If 80% MPR is ideal and most classes are above 80% MPR, I’m not sure I see the crisis in the data.
  • One of the key charts that I always copied and hung on my wall is the one below. It shows the classes by rank, the utilization, the average cost, and now the estimated behavioral waste (generics and mail).
  • You should certainly go into the document and look at the class level detail. They’ve included a utilization chart by gender by age which I really like. The sections also give some insight into future pipeline. I think I’ll pull diabetes out into a separate post.
  • It’s interesting that they identify only three segments for non-adherent patients with specialty medications versus more on the traditional side:
    • Active Decliner
    • Refill Procrastinator
    • Sporadic Forgetter
  • They project that utilization will continue to go up at about 3% per year and that trend will be mitigated with new generics coming to market.
  • Another interesting analysis is where the waste is by state:
  • They have some information on their Consumerology approach, but I’ve talked about that before.
  • I liked their simple plan design primer:
  • Towards the end, they talk about some of the changes they’ve made over the past few years to their programs to reflect their consumerism approach:
    • Step Therapy Choice
    • Formulary Rapid Response
    • Call4Generics
    • Select Home Delivery (which is gem of their new programs in my assessment)
    • First Generic Fill Free
    • Select Curascript
  • A simple graphic that points to the importance of understanding the consumer and developing programs to effectively drive behavior is below. [This is very similar to all the work we do at Silverlink with clients to help them drive health outcomes and behavior.]

I like it. Very humanized versus purely statistical document. Good job Emily, Steve, Yakov, Andy, Bob, Brian, and Chris. (That’s the core group that I know well.)

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

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:

  1. An amazing list of external speakers including Mark McClellan, David Wennberg, Don Kemper, Jack Mahoney, and Janice Young.
  2. A long list of client case studies – 14 so far.
  3. Specific tracks to cover our different client groups and allow for smaller discussion versus formal presentations – Pharmacy, Population Health, Medicare, and Managed Care.
  4. 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.
  5. Adherence experts such as Dr. Will Shrank from Harvard and Valerie Fleishman who led the NEHI adherence study that is widely quoted.
  6. 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

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. 

  1. 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.
  2. 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.
  3. Why haven’t others followed?  It’s hard work. 
  4. 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?).
  5. 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. 
  6. 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

CVS Caremark, Behavioral Economics, Social Media, and Adherence

March 3, 2010 by George Van Antwerp 0 Comments

Yesterday, CVS Caremark announced an expansion on their research partnership with Harvard to include three people focused on behavioral economics and social media.  The focus of both these efforts is around prescription compliance (an almost $300B problem).

The work is going to be focused on three areas:

  • Providing Appropriate Incentives: Research how appropriate financial incentives – in the form of lower copays and immediate up-front rewards – motivate consumer decisions to help improve health care behavior.
  • Developing education tools: Determine how education materials and programs targeting consumers can be applied to persuade positive behavior that will affect meaningful change for patients.
  • Tailoring Communications: Studying how specific messages resonate with individuals to promote improved health outcomes, adherence and personal care.
Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Social Media, 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 1st 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

CxPi Scores For Healthcare Companies

January 16, 2010 by George Van Antwerp 0 Comments

CxPi is the Customer Experience Index from Forrester. 

The CxPi is based on consumer evaluations during November 2009 across three areas: 1) meeting needs; 2) being easy to work with; and 3) enjoyability.

As expected, pure healthcare companies fall towards the bottom here, but some of the retail pharmacies are much higher up.

There weren’t a lot of excellent scores in the survey, and I’m sure we can all debate where the companies fall.  But, I think the point that healthcare clusters at the bottom (and has since the beginning) is a problem.  How do we improve that consumer experience?

Blogroll, Healthcare, Leadership, Managed Care, Research

My Healthcare Strategy For Obama

August 15, 2009 by George Van Antwerp 2 Comments

So, this is getting messy quickly.  Support is waning.  The public is confused.  It’s time to do something.

If I put myself in your shoes [President Obama] here’s how I would have proceeded:

  1. Make 2009 about the uninsured.  Focus on one problem which is achievable – coverage for all.  You would have people rallying around you.  And, if the numbers that I have seen are right, the net costs to the insured population would be the same.  Right now, they pay for the uninsured through higher bills from the providers who ultimately have to cover their bad debt. 
    • Challenge – getting the providers to agree to lower their rates once their bad debt dropped.
    • Financing – short-term coverage of the 12-18 month lag between coverage and rates dropping.  long-term mandate with costs covered by taxes for those who can’t pay.
  2. In 2010-2011, I would take on the issue of evidence-based medicine, comparative effectiveness, and health IT.  I would save health reform for my second term (if I got one). 

    Everyone knows the system is broken.  BUT, I would stop talking about a trillion dollars in cost to fix the system.  Think like when we stretched to put a man on the moon. 

    Set a goal of “designing a healthcare system in which the total cost per individual is no more in 2020 than it is in 2010.” 

    Now, you can get people to rally around your efforts to save a trillion dollars and get us out of debt as a country. 

    The goal of keeping everyone happy and taxing the rich plays well on TV, but it’s not reality.  People can’t have their cake and eat it to.  People are going to have to give up some of the luxuries in the healthcare system.  We can’t have defensive medicine.  We have to have some limits on litigation.  We have to have health IT to push evidence-based medicine.  We have to reward people for actively managing their health. 

One of the winning strategies for you in the campaign was a simple focus on change.  You can’t change everything at once.  People have limited capacity.  Think like a program manager – phased implementations; goals people call rally around; simple wins.  People don’t understand what a trillion dollars is.  People can’t focus on 10 year plans. 

Healthcare is complex.  Focus on making it simplier:

  • Get universal coverage.
  • Establish standards of care which are driven by technology.
  • Hold costs flat.
Healthcare, Leadership, Marketing / Communications, Politics, Value Propositions

Nick Jonas And His “Diabetes Buddies”

July 30, 2009 by George Van Antwerp 1 Comment

I was with my kids at the Jonas Brothers concert in St. Louis the other night. They put on a great show, but my healthcare takeaway for the night was that Nick Jonas has diabetes and is a great spokesperson on the topic.

As seems to be more and more common these days, he (as a public figure) is out talking about his health and management of his condition. I think this is a great way to help kids learn about diabetes from someone they adore. It also normalizes the condition so patients don’t feel they are alone.

I also like his concept of giving guitar picks to his “diabetes buddies” or people he meets. I could see a Facebook application where you can get a virtual guitar pick from Nick Jonas.

“To newly diagnosed kids with diabetes, Nick would say, ‘Don’t let it slow you down at all.  I made a promise to myself on the way to the hospital that I wouldn’t let this thing slow me down and I’d just keep moving forward, and that’s what I did. Just keep a positive attitude and keep moving forward with it. Don’t be discouraged.’ ” (article)

During the concert, they stop to let him do a piano solo to the following lyrics from their song “Don’t Know What You Got Till It’s Gone”. During the song, he pauses to talk about how he made a promise to not let it hold him back and all the things he has accomplished since being diagnosed.

Got the news today
Doctor said I had to stay
A little bit longer
And I’d be fine
When I thought it’d all be done
When I thought it’d all been said
A little bit longer
And I’ll be fine

But you don’t know what you got
Till it’s gone
And you don’t know what it’s like
To feel so low
And every time you smile or laugh you glow
You don’t even know
No, no
You don’t even know

All this time goes by
Still no reason why
A little bit longer
And I’ll be fine
Waitin’ on a cure
But none of them are sure
A little bit longer
And I’ll be fine

But you don’t know what you got
Til it’s gone
You don’t know what it’s like
To feel so low
And every time you smile or laugh you glow
You don’t even know
No, no
You don’t even know
No, no
You don’t even know
No, no

Yeah

But you don’t know what you got
Til it’s gone.
Don’t know what it’s like
To feel so low, yeah
And every time you smile or laugh you glow
You don’t even know
Yeah oh
Yeah oh
Yeah yeah
You don’t even know
No, no

So I’ll wait ’til kingdom come
All the highs and lows are gone
A little bit longer
And I’ll be fine
I’ll be fine

Healthcare, Leadership, Social Media

The 5 Questions (Regence Group)

July 25, 2009 by George Van Antwerp 0 Comments

Regence Group recently put out an interesting website – www.whatstherealcost.org.  It takes an unorthodox (for a health plan) approach to delivering several important points.  It reminds me of what Wellpoint has done with Tonik or some of the things Humana is doing at HumanaGames.

One of the things I found interesting and very straightforward for patients to think about were their 5 questions:

  1. How much does that cost?
  2. Is that really necessary?
  3. Is there a cheaper option?
  4. Is there a generic for that?
  5. Has anyone out there had this before?

Imagine if every time we were asked to take a test or start a new therapy that we (patients) asked these five questions of our provider.

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

New CMO – Dr. Jan Berger

June 23, 2009 by George Van Antwerp 0 Comments

I’ve had the chance to read Dr. Berger’s research over the years when she was at CVS Caremark. After having a chance to spend some time with her on a few topics, I am very excited that she is coming on board at Silverlink Communications as our Chief Medical Officer.

From the press release:

DR. JAN BERGER JOINS SILVERLINK AS CHIEF MEDICAL OFFICER

June 23, 2009

Burlington, MA – Silverlink Communications® Inc., the leader in healthcare consumer communications, today announced that Dr. Jan Berger, former Senior Vice President and Chief Clinical Officer for CVS Caremark, joins Silverlink as Chief Medical Officer. In her role, Dr. Berger will focus on setting the company’s overall vision and strategy for population health and clinical communications programs within the managed care, population health, and pharmacy benefit management space.

Dr. Berger brings more than 25 years of business and clinical expertise in healthcare, including more than 15 years as a medical director at both a health plan and a major regional hospital. She is actively involved in quality initiatives, participating in numerous committees for National Committee for Quality Assurance (NCQA); medication safety, participating in steering committees at National Quality Forum (NQF); and population health management through her Executive Board position at DMAA. She also serves on several influential editorial and healthcare company boards, including Editor in Chief of American Journal of Pharmacy Benefit. Her expertise expands Silverlink’s focus in population health and clinical outreach – specifically related to engaging and connecting with healthcare consumers in a variety of lifestyle management, disease management and preventive health activities.

“Jan is clearly one of the leading innovators in healthcare, with tremendous clinical acumen and an ongoing track record of business execution in programs that drive down healthcare costs and improve health outcomes,” said Stan Nowak, Silverlink’s co-founder and CEO. “We are extremely proud to have her join our executive team at a time when behavior change is critical to our national healthcare reform process.”

“Silverlink is at the forefront of using communications and analytics as strategic assets to help consumers make more effective healthcare decisions,” said Dr. Jan Berger. “With the consumer at the center of our healthcare cost equation, we have the opportunity to improve the health of our country and eliminate hundreds of billions of dollars that relate to preventable conditions. This is a complex but solvable problem and I’m passionate to be part of a team that is already making an impact.”

Healthcare, Leadership, PBM / Pharmacy, Silverlink

Gov’t Reduce HC Costs: Rx Decisions Say No

June 23, 2009 by George Van Antwerp 0 Comments

I have nothing against the pharmaceutical companies.  We need medications.  Development of medications costs money.  There are lots of failures to find one that works.  They deserve to make money.

That being said…they are smart and apparently the administration is inappropriately (IMHO) paying attention to what they suggest is right.

  • For Medicare PDP, the plans can no longer require the member to pay more when they choose a brand drug which is available as a generic.  WHY NOT?  It’s the same drug.  There may be a few exceptions called Narrow Therapeutic Index (NTI) drugs, but just make them exceptions.  This was a bad decision which will cost us taxpayers money.  (See prior posts – Potentially Ridiculous Decision and Uproar Over “Reference-Based”…)
  • Now, they jump on the savings that are offered for members who hit the “donut hole” and stay on the brand medication.  Why not just require MDs to give out samples?  Of course this will effect behavior and drive brand utilization.  Pharma is not stupid.  This is another decision which will cost us taxpayers money.

On the one decision where they go against pharma – drug reimportation, they make a bad decision.  Why import drugs?  Why not implement a therapeutic MAC (maximum allowable cost)?  This will definitely impact drug costs AND generic drugs (which make up almost 70% of the claims filled) are cheaper in the US.

This is the government that we want to manage the costs of our healthcare system when they can’t even make the logical decisions that anyone close the business could make.  Come on!

[IMHO = In My Humble Opinion]

Sold to Pharma

Blogroll, Healthcare, Leadership, PBM / Pharmacy, Politics, Value Propositions

Introverts versus Extraverts

June 2, 2009 by George Van Antwerp 1 Comment

I thought this was a nice summary in the American Way magazine (5/1/09).  It also talks about Jennifer Kahnweiler’s book “The Introverted Leader: Building on Your Quiet Strength“.

Extravert-Introvert

I think understanding this about your team and peers is critical.  It’s also important just to understand that recepients of your messaging may analyze the information very differently.  From a quick scan on Google, I found that 25% of the overall population is considered introverted.

Books / Articles, Leadership

CVS Caremark TrendsRx Report 2009

May 5, 2009 by George Van Antwerp 1 Comment

This is one of my favorite times of year. After working on the Drug Trend Report at Express Scripts for several years, I love to get all the trend reports from the PBMs and read them. The first one that I have had a chance to review is the one from CVS Caremark. I found it an easy to read document with good case studies and a mix of strategy and tactics.

Here are some of my highlights and observations:

  • 3 out of 4 clients cited “reducing health care costs” as their primary measure of PBM success…AND 2 out of 3 prioritized “plan participant behavior change” as the way to reach that goal. [Maybe the plan design bigot is finally dead.]
  • With pharmacy spend approaching $1,000 PMPY, I found their chart on potential cost reduction a simple way of pointing people to things they should think about.
    cvs_caremark_savings-opportunities-09
  • A 10% improvement in diabetes adherence can save $2,000 in annual health care costs. [I assume this is based on improving MPR and would definitely like to learn more on how the health care costs are quantified.]
  • They layout three objectives – improve use of lower cost drugs, improve adherence, and get people to take better care of their health. [Similar to the concept I laid out in my white paper of needing to be broader than just Rx benefit management.]
  • They talk about two of their solutions:
    • Consumer Engagement Engine (CEE) which is very similar to what Silverlink does and provides business logic for targeting the right member at the right time with the right message.

      consumer-engagement-engine

    • Proactive Pharmacy Care is their “medical neighborhood” concept to stitch together their entities – Mail Order, CVS retail, Specialty, MinuteClinic, and their disease management company.
  • Their trend was 3.9% PMPM in 2008 (or 2.8% excluding specialty drugs).
  • Medicare Part D utilization was up 4.1% compared to 0.8% for the rest of their BOB (book of business).
  • Their GDR (generic dispensing rate) averaged 65.1% for 2008 and was 66.3% in December 2008.
    • Best in class employers = 68.2%
    • Best in class health plans = 73.4%
  • As they remind you, a 1% increase in GDR is roughly equal to a 1% reduction in pharmacy spend.
    • [What I would like to see is improvements in GDR from new drugs coming to market in 2008 versus improvements that came from clients implementing plan design.]
  • They say [which I preach all the time} – “proactive consumer engagement improves results and lowers the risk of disruption. For best results, provide personalized actionable information at a range of touchpoints.”
  • I saw a few interesting things in one of the case studies they share about their “Generous Generics” program. [Does that name get used with consumers? What’s their reaction to it?]
    • $0 generic copay at mail [that should drive volume]
    • 10% coinsurance penalty for not shifting to mail after the second fill [similar in concept (I believe) to the Medco “retail buy-up” concept]
  • Top Ten Therapeutic categories (53% of spend):
    • Antihyperlipidemics
    • Ulcer drugs
    • Antidiabetics
    • Antidepressants
    • Antiasthmatics
    • Antihypertensives
    • Analgesics, Anti-inflamatory
    • Anticonvulsants
    • Analgesics, Opioid
    • Endocrine and Metabolic Agents
  • They state that the population of diagnosed diabetics is growing by roughly 1M a year.
  • They state that a generic for Lipitor is now expected in Q4 2011 [which I think is about a year later than originally expected]
  • They show some data from their Maintenance Choice program which I think has a lot of opportunity.
    • This is where you can get a 90-day Rx from either mail or a CVS store for the same copay. [The key here is for them to understand member profitability and for CVS Caremark to understand how to drive consumers to the preferred channel.]
    • [I would really need to understand their profitability by channel because if I read the chart in here right, it would appear that given the choice 45% of those at mail would choose 90-day at retail…a scary concept for mail order pharmacy.]
      maintenance-choice
  • They give a case on Maintenance Choice which leaves me looking for a key fact. They state that a recent implementation has a goal of 70% of the client’s day’s supply will go through the preferred network (CVS) or mail and that 20% of it goes through mail today. [What percentage goes through CVS today? If it’s a client in Boston, that one scenario. If it’s a client in Chicago, that would be another feat.]
  • Specialty pharmacy trend was 13.5%.
  • They say that pharmacogenomic testing is being used more frequently for specialty drugs. [I would love to know more…how often? For what drugs? Has it improved outcomes? Are their clients covering it? How are they playing in this space?]
  • They talk about adherence which continues to be one of the hottest areas in the Rx arena today. They give stats showing 15-48% improvement across different metrics and up to $142 in cost avoidance in one case. [Are these again control groups? What was the cost / benefit analysis or ROI? Is this improvement in average MPR (Medication Possession Ratio) or improvement in the % of people with an MPR of >80%?]
  • They talk about 88% of heart failure patients maintaining optimal prescription adherence compared to a norm of less than 50%. [My questions here (which isn’t apparent) is whether this was an opt-in program so the 88% is for engaged and active participants or whether it was across all targeted members.]
  • They provide a quick list of factors that will impact drug trend:
    • Driving costs:
      • Aging
      • Obesity
      • Diabetes
      • Specialty pipeline
      • More aggressive treatment guidelines and earlier diagnosis [which hopefully would lower total healthcare costs]
      • DTC advertising
    • Reducing costs:
      • Economy – reduced utilization and improved GDR
      • Increased availability of generics
      • FDA safety reform
      • Lackluster non-specialty drug pipeline
      • Utilization and formulary management
      • Consumer price transparency
Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Communication Strategy Regarding H1N1 (Swine) Flu

May 1, 2009 by George Van Antwerp 0 Comments

“There is a lot of media, a lot of news, a lot of rumor – the sooner you can get correct and accurate information to consumers, the better – otherwise people will look to other sources that may not always be accurate.”  (Jan Berger, President of Health Intelligence Partners on podcast)

We have been hearing a few things from our clients and have put some information up on the Silverlink website.  Some of the comments have been:

  1. I have seen a spike in call center volume about this topic.
  2. Clients want to change plan design to make sure Relenza and Tamiflu are covered and don’t require a prior authorization or have a quantity level limit on them.
  3. We want to proactively reach out to at risk populations – children, seniors, or people with a compromised immune system.
  4. We want to be able to flexibly target certain geographies.
  5. We want to remind people not to panic, drive them to quality information sources, and make sure they know the basics – wash your hands.

At a minimum, everyone is adding information to their websites.  Many consumers are Googling the topic or following updates from @CDCEmergency (on Twitter).

Healthplans, PBMs, and population health companies are at the heart of this.  They need a coordinated strategy to inform people appropriately as this issue continues to be top of mind.

We recorded a podcast last night with the Medical Director from Healthwise and Jan Berger who is the former Chief Medical Officer from CVS Caremark and is now president of Health Intelligence Partners.  In here, they answer some general questions about the situation and what companies should be doing to educate members.

The two standard solutions Silverlink is offering clients are:

  1. Offer an inbound FAQ (Frequently Asked Questions) line with CDC content and specifics about their plans.  This can help with overflow from their call center and/or be used as a direct line from their website or outbound communications.
  2. Selectively target populations (age, zip code, disease state) with a brief message reminding them to wash their hands and telling them where to get qualified information.

As with all our communications offerings, these can be customized (messaging, channel, targeting, etc.) to meet client requirements.  Additionally, since one of our technology advantages over others in the space is our flexibility, we can work with clients to keep these messages up-to-date as the situation changes and as new information has to be added.

Business Tools, Consumerism, Events, Healthcare, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Silverlink, Social Media, Value Propositions

Express Scripts Outcomes Conference Begins

April 21, 2009 by George Van Antwerp 0 Comments

As with each annual Outcomes conference, Express Scripts (ESRX) has released their annual trend numbers. Here are a few of the highlights from the press release:

  • Overall pharmacy trend = 3.0% (down from 5.5% in 2007)
  • Estimate consumers and employers are paying $42B too much in 13 therapy classes by not optimizing generics.
  • On average, a generic drug is over $90 cheaper than a brand name drug.
  • Generic drug usage increased by 7.5 percent, while utilization of brand name medications decreased 11 percent.
  • 67.3 percent of all prescriptions that Express Scripts filled were for generic drugs by the end of 2008. [I didn’t like the comparison which was an average across the 12 months ending in Sept 2008 from IMS of 63.7%…not apples to apples.]
  • In 2009, at least 20 branded drugs are expected to become available generically.
  • Over the next five years, more than $66 billion worth of branded drugs are expected to lose patent exclusivity.

“Using generic drugs that are safe and effective can help lower costs while still driving value for patients and employers,” said Steven Miller, MD, senior vice president and chief medical officer at Express Scripts. “Our results indicate that cost control is achievable through careful management of appropriate use of drugs and delivery channels, without shifting costs to consumers. Although the trend is the lowest it has been in over a decade, significant opportunity to lower spending still exists.”

“Finding ways to reduce spending without compromising health outcomes is the top priority for healthcare reform, as the Obama administration recognizes,” said Alan Garber, MD, PhD, Henry J. Kaiser Professor and director of the Center for Health Policy at Stanford University. “We have long used financial incentives to try to eliminate waste. Now we’re finding that tools that build upon the insights of behavioral economics and psychology can have powerful, positive effects.”

“In today’s economy, we are not only tracking wasteful spending across the country but developing strategies to reduce it,” said George Paz, chief executive officer at Express Scripts. “By applying the principles of behavioral economics we are helping consumers make better and more cost-effective healthcare decisions. We understand we cannot eliminate waste alone and we are committed to working alongside likeminded organizations, such as the Federal Coordinating Council for Comparative Effectiveness Research, to continue to identify strategies to improve our healthcare system.”

“Studies have repeatedly shown that people work much harder to avoid losses than to pursue gains,” said Bob Nease, PhD, the company’s chief scientist. “This suggests that a ‘stop wasting money’ message is more effective than a message focused on potential savings. In addition, by applying evidence-based segmentation, we have practical insight into which members are likely to be most sensitive to loss aversion. One size does not fit all.”

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

The $40B HealthCare Opportunity Around Retention

April 18, 2009 by George Van Antwerp 1 Comment

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

A few facts from their report:

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

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

mckinsey-conversion-opp

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

Upcoming Book By George Halvorson From Kaiser

April 16, 2009 by George Van Antwerp 3 Comments

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

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

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

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

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

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

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

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

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