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New And Easier Version of Medicare.gov

April 13, 2010 by George Van Antwerp 0 Comments

Got this from CMS…(looks better to me, but it’s been a while since I was there)

Today, the Centers for Medicare & Medicaid Services posted a new and easier to use version of www.medicare.gov, the Medicare consumer-focused Web site.  The updated Web site is part of the steps Medicare is taking to make using www.medicare.gov easier for seniors and people who care for them to find the information they need about Medicare. The improved Web site provides users with a summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions about Medicare.

The updated Web site reflects Web 2.0 design principles and concepts.  The new design was focus tested with seniors, caregivers and operators at Medicare’s helpline, 1-800-MEDICARE, some of the most frequent users of www.medicare.gov.  The new design gives Medicare more flexibility to quickly update information that is important to users, especially people with Medicare and family members who care for them. 

Take a tour of the new online face of Medicare by clicking on www.medicare.gov.

Healthcare, Managed Care, Marketing / Communications, Technology

Accenture Study: Global Perceptions On Health

April 12, 2010 by George Van Antwerp 0 Comments

I’m at the WHCC 2010 in Washington DC, and I got to sit down with Greg  Parston from the Institute for Health & Public Service Value from Accenture.  They just released the results of their global study – Accenture Citizen Experience Study: Measuring People’s Impressions of Health Care. 

How do citizens rate the quality of health care in their countries?  How do they view government’s role in supporting – and improving – health and health care?  What actions do individuals consider important to making improvements, and how do they rate government’s performance in supporting these actions?

They looked at Australia, Brazil, Canada, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Mexico, Norway, Singapore, Spain, UK, and the US. 

Some of the takeaways from the survey:

  • People around the world want government to address health disparities – access for people with difficulties and fair and equal access.
  • Accountability is a big issue.
  • Access to information is essential or very important (although only one of the top three actions for government in India).
  • Taking prompt, effective actions to resolve problems or difficulties had the largest gap between expectations and performance…75% rated this as essential or very important with only 26% believing that government performs this well.

But, you can read the study…My value here is the conversation with Greg.  Some of the things we discussed were:

  1. Will the US perceptions and expectations of government shift post-reform?  I hope they do the same survey again in a few years for comparitive purposes.  In the US, 62% (at time of survey) wanted government to improve healthcare but only 41% trusted the government to do a good job. 
  2. Men have a higher regard for US quality than women.  (The US was the only country more focused on cost than quality.) 
  3. The elderly (who have more frequent use) have a higher regard for the quality of the US system than younger people…so, where do the low utilizers form their opinions.
  4. People feel disengaged and are relatively uninformed in the US.  (But, how can this be given all the data that’s out there.  And, if the data was available, would people access it and use it?)  He believes that people are inquisitive and would use it.  The difference between other countries and the US is that there isn’t an integrated system for data.  Consumers would have to go to multiple systems to find data.  [I’m honestly more of a skeptic here in that the engaged people would soak up more data, BUT the people who drive costs today and in the future (e.g., pre-diabetics) who don’t engage today will still fall thru the cracks.]
  5. Today, conditional type data (i.e., diabetes 101) is better in the US than abroad, but localized data (MD 1 has better outcomes than MD 2) is worse.
  6. What would you do if you were the “Chief Experience Officer” at a plan?  He talked about focusing on transparency and pushing data out to the members which would build trust and loyalty.  [The question is how to value this and whether it’s relevant in a group market versus an individual market.]
  7. I told him I’d love to see politicians views (or healthcare workers views) versus the general public.  He said they’ve done some of that research in other areas and generally the issue is that politicians are looking for the short-term wins while the consumers have longer thresholds than we given them credit for.
  8. We talked about generation divides on expectations and technology.  The example he used was around EMRs where in general 58% of MDs expect to adopt the technology in the next 24 months, but it jumps up to 80% if you exclude the senior MDs that were surveyed.  (On the flipside, 65% of patients want MDs to have EMRs.)
  9. We talked about the value of metrics and scorecards and the need to publish this data.  The risk is making sure they stay useful, get used for decision making, and aren’t dropped randomly in the future. 

From the US survey:

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

Why Are Copay Waivers So Popular?

April 4, 2010 by George Van Antwerp 0 Comments

It seems like whenever I talk to companies about adherence one of first things they want to discuss is copay relief.  It’s a solution I’ve used before so it’s certainly rationale.  But, let’s not forget that cost is not the primary reason for non-adherence.  Forgetfulness and lack of health literacy are often big drivers of non-adherence with medications.  This is easily validated when comparing lift in medication possession ratio (or more tactically refill rate) by looking at copay waiver type program (value-based design) versus communication programs.

Given that copay waivers often require $10+ per month and other programs can be conducted for much less, I question the ROI.  I’d love to see a head-to-head test.  Try education and refill reminders versus copay waivers to see which yielded a greater MPR improvement.

Consumerism, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Silverlink

Voice Personality Is A Powerful Lever To Motivate Health Behavior

March 29, 2010 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There are many interesting attitudinal findings from our study including: 

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

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

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

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

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

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

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

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

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

Are You Pouring On The Pounds?

March 26, 2010 by George Van Antwerp 0 Comments

Now here’s an example of an ad campaign from NY that my change the way you think about soda.

And, from a recent article in Fast Company:

  • Drinking one can of soda per day can add as much as 10 pounds to your weight in a single year
  • People do not eat less food when the drink more calories…these are just more calories.
  • For every glass of sugared beverage consumed per day, the likelihood of a child become obese increases by 60%

“Snickers is a nutritional wonderland compared to a Coke.”

As someone who has evolved from a 12-pack of Mountain Dew per day in college to 7 Diet Cokes per day until a few years ago to 1-2 Cokes per day now, this may finally push me over the edge.  [Although I did go to zero per day for a year, and my weight didn’t change at all.]

Books / Articles, Healthcare, Marketing / Communications, Research, Value Propositions

Diabetes Alert Day

March 22, 2010 by George Van Antwerp 0 Comments

Tomorrow (March 23rd) is Diabetes Alert Day. Here is some information that CMS shared around diabetes.

Medicare provides coverage of the following diabetes-related services for qualified Medicare beneficiaries:
• Diabetes screening tests,
• Diabetes self-management training (DSMT),
• Medical nutrition therapy (MNT),
• Glaucoma screening (e.g. dilated eye exam with an intraocular pressure (IOP) measurement), and
• Diabetes supplies (e.g. glucose monitoring equipment and therapeutic shoes) and other services (e.g. foot care).

What Can You Do?
As a trusted source of health care information, your patients rely on your recommendations. CMS requests your help to ensure that all of your eligible patients take advantage of diabetes-related preventive services covered by Medicare.

For More Information
The Medicare Learning Network® (MLN) has developed several educational products related to diabetes-related preventive services covered by Medicare:

o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ this comprehensive resource provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including diabetes-related services.
o The MLN Preventive Services Educational Products Web Page ~ This website provides descriptions and ordering information for MLN preventive services educational products and resources, including diabetes-related services.
o Quick Reference Information: Medicare Preventive Services ~ this chart provides coverage and coding information on Medicare-covered preventive services, including diabetes-related services.
o Diabetes-Related Services Brochure ~ This brochure provides an overview of Medicare’s coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes.
o Glaucoma Screening Brochure ~ This brochure provides an overview of Medicare’s coverage of glaucoma screening tests, including the dilated eye exam with an IOP measurement.

To order hardcopies of available Medicare Preventive Services products, including the brochures mentioned above, click on “MLN Product Ordering” in the “Related Links Inside CMS” section of the MLN Preventive Services Educational Products Web Page listed above.

Additional Resources
• National Diabetes Education Program (NDEP) ~ This website offers numerous resources to help your patients delay or prevent the development of type 2 diabetes, as well as resources to help your patients manage diabetes to prevent serious complications. Check out “Your GAME PLAN to Prevent Type 2 Diabetes: Information for Patients,” a 3-page booklet to help people assess their risk for developing diabetes and take steps to prevent diabetes. For patients with diabetes, “The Power to Control Diabetes is in Your Hands”, contains information about diabetes and related Medicare benefits.
• DiabetesAtWork.org ~ This website contains information for employers to help them reduce health care costs and improve productivity by keeping employees healthy
• American Diabetes Association ~ This website contains a wealth of information about diabetes, treatment, and prevention.

Healthcare, Marketing / Communications

Gender Bias Of Statins

March 22, 2010 by George Van Antwerp 0 Comments

Statins are cholesterol lowering drugs (i.e., Lipitor, Crestor, Zocor). Millions of people take them and they account for about 10% of drug spend.

There is now some discussion of whether they work equally in men and women. I guess genomics would make you believe that it’s unlikely, but I’ve never heard anything about this discussion before the recent article in Time Magazine.

I don’t have the time to read all the research in depth and there appears to still be some debate so let me simply pull a few interesting things from the story:

* There is little evidence that statins prevent heart disease in women.
* There is evidence that women are more likely to experience the serious side effects of statins than men are. Those include memory loss, muscle pain, and diabetes.
* The data suggests that statins can reduce heart-related deaths but not deaths overall.
* For females to prevent one event (e.g., heart attack), 36 women would have to take Crestor for five years (from Jupiter study).

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

Addressing Hospital Readmission Rates

March 18, 2010 by George Van Antwerp 0 Comments

High hospital readmission rates are a real source of concern for health plans, from both a quality and cost perspective. With 20% of Medicare patients being readmitted within 30 days of discharge, health plans and their partners have a significant opportunity to reduce readmission rates across all populations. Even just a half-point drop in readmissions for a Medicare plan with 1 million members can yield $10 to $15 million in annual medical cost savings.

In a new podcast, Dr. Jan Berger, Silverlink’s Chief Medical Officer, discusses how health plans can address this costly, growing issue affecting our healthcare system. Dr. Berger offers best practices for reducing readmissions such as:
• Expanding outreach to entire discharged population
• Reaching out within 24-72 hours of discharge
• Coordinating communications among members, physicians and care managers
• Identifying members at risk for readmissions

Download this podcast and visit our new Post Hospital Discharge Microsite to access other valuable resources on this important healthcare topic.

Books / Articles, Business Tools, Managed Care, Marketing / Communications, Methodology, Research, Silverlink, Technology, Value Propositions

Pharma Marketing Presentation

March 5, 2010 by George Van Antwerp 0 Comments

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

DBN On Mandatory Mail

March 5, 2010 by George Van Antwerp 0 Comments

I’ve talked a few times about mandatory mail on the blog and after talking with Drug Benefit News (DBN), a few of my comments appeared in today’s publication.  One of the hypotheses in the article is that mandatory mail is growing (which doesn’t surprise me in this tough economy), and Ken Malley from Medco is quoted several times in there talking about their growth in the program.  He says they have 11M lives in the program which I believe would be more than anyone else.  I also think the Medco program with RiteAid which is described is probably something that clients would like a lot and similar to the Maintenance Choice product that CVS Caremark is offering. 

My comments in the article are mostly about the importance of communications which can ease the transition to mail.  The article also quotes Claire Marie Burchill from Cigna about communications and branding.  They called mandatory mail the “pharmacy of choice” which is not unusual.  When I was at Express Scripts, my team changed it to “Exclusive Home Delivery” and Medco calls it “Retail Refill Allowance”.  [This is the whole concept of framing which is core to communications.]  

The fact is that once members start using mail pharmacy, the overwhelming majority of them like it, “but the challenge is more the inertia of getting them started,” Van Antwerp says. “They need a good boarding experience at mail around first fill, and then it becomes more automatic.” Depending on the payer, mail-order customer retention rates vary from 75% to 95%. 

He adds that if more plans start implementing mandatory programs, “initially you’re going to get some disruption, because people push back against change.” However, once patients realize that they can receive 24/7 support and save money, “most people will be pretty happy,” Van Antwerp says. 

 

All of this plays into the other benefits of mail order – faster generic substitution, adherence, convenience, and savings.  The other key is aligning pricing and plan design to drive mail order which remains a challenge across the industry but is critical.  

The one thing we didn’t get into in the DBN article was the science of communications and how important it is to understand consumers and what motivates them.  I think this is the future of pharmacy.  A good segmentation and targeting strategy allows you to personalize communications and deliver the right message at the right time to the right person using the right channel with the right message to motivate them.  It’s not that easy to do, but it can be done.

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

Communications Key To Mandatory Mail

March 1, 2010 by George Van Antwerp 0 Comments

I had an interesting question today about whether I thought mandatory mail would make a comeback.  I haven’t heard much lately about mandatory mail.  Rather than mandatory mail, I hear more people talking about restricted networks or programs like Maintenance Choice.  The follow-up to the question was why clients don’t implement mandatory mail.  It’s an easy question…they don’t implement mandatory mail because it’s disruptive.

So, how can clients make it less disruptive?  Use communications.  No one likes change.  But, people who understand change and why change is happening are less likely to be upset.  (BTW – You’ll never make everyone happy.)  So, why don’t people use communications with mandatory mail?  Because they see it as an unnecessary expense since those people will be forced to mail anyways.  That’s old school.

If you effectively communicate with members before the plan is implemented and each time they fill a prescription at retail, you can make it an easier process.  The goal should be to drive adoption of the plan and avoid point-of-sale (POS) rejects which might impact adherence.

Healthcare, Marketing / Communications, PBM / Pharmacy

Pottery Barn Example Of What Not To Do

February 28, 2010 by George Van Antwerp 1 Comment

One of the things that I’ve long talked about is the fact that loyalty of customers is not simply attributed to perfect service.  You can make a mistake as long as you quickly respond and fix the issue.  Last year, I was singing the praises of Pottery Barn for doing just that.  But, now they’ve blown it again.  [BTW – Pottery Barn is owned by William Sonoma.]

In 2008, I bought a couch from them.  Love the couch.  Loved the store.  Felt it was over-priced, but I was okay with that for the quality and service.  But, when it was delivered, there were a few issues.  Honestly, pretty small, but I had high expectations.  I sent a few messages and got a flurry of activity leading to a 10% discount on my purchase.  I was happy.

A year later, I decided that I was going to buy another couch and went back to Pottery Barn.  This time, it was a comedy of errors.  The 6-week delivery took 16-weeks.  The deferred payment terms which were supposed to be 12-months from delivery started immediately.  So, again I raised the issue, saw a flurry of activity, felt it was fixed, and received a discount (credit) on my purchase price.  I felt happy until after getting my next month’s bill only to find out that everything was still messed up.  They had simply gotten me to go away without fixing anything.  And, I also found out from the new installers that the original installation on my couch from last year was messed up and that was the reason why it constantly was disconnected (it’s a sectional). 

So, this time, my anticipation was another discount.  Would that have really made me feel better?  I’m not sure this time.  Now, I’ve actually spent time and been frustrated dealing with lots of credit people and customer service people.  It’s actually cost me money (in time).  But, I didn’t get another discount.  For a company that offers it’s employees a 40% discount, I know there’s lots of room to “reimburse” me for my time. 

Yes, I know this isn’t at all about healthcare, but it is about communications and customer service which are important.  [And, yes…I’m using my “bully pulpit” to voice my frustration.]

General Thoughts, Marketing / Communications

50,000 Adults Die Each Year Of Vaccine Preventable Diseases

February 28, 2010 by George Van Antwerp 0 Comments

Diseases easily preventable by adult vaccines kill more Americans each year than car wrecks, breast cancer, or AIDS.

I found this article from WebMD to be both interesting and surprising.  According to the article, the diseases are flu, Hepatitis B, pneumococca, meningitis, shingles, human papillomavirus, tetanus, and whooping cough.

According to the CDC survey:

  • Pneumococcal vaccine is used by 25% of Americans at high risk of severe illness and by 60% of Americans aged 65 and older.
  • Hepatitis B vaccinations were completed by 32% of high-risk U.S. adults under age 50 and for 34% of non-high-risk adults under age 50.
  • HPV vaccinations have been given to only 10.5% of American women 19-26 — and only 6% got all three shots.
  • Tetanus shots are current for only 60% of U.S. adults under age 65 and only 52% for older adults.
  • Flu shots are taken by fewer than two-thirds of adults at high risk of severe flu complications.
  • Shingles vaccines are taken by only 7% of U.S. adults 60 and older. 

    • So, that begs the question of whether consumers should be responsible for costs if they don’t take preventative measures.  I’m sure there are lots of reasons why they shouldn’t be, but let’s assume that the cost of vaccines were covered AND that their healthplan communicated to them the need to go get vaccinated.  In that case, if someone doesn’t get vaccinated, becomes sick, and causes thousands of dollars in cost to be incurred (which all of us pay for), is that ok?

    I have no problem bearing costs for people who are uninsured and support universal coverage.  I have no issue paying more if I can’t control my weight or chose to make bad decisions.  I see healthcare as covering things that I can’t prevent – accidents, genomics, etc.

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

    New Player – Drug Trend Report – InformedRx, an SXC Company

    February 24, 2010 by George Van Antwerp 3 Comments

    The list of PBMs producing drug trend reports continues to grow with InformedRx entering the research publication area.  Now we have Express Scripts, Medco, CVS Caremark, Walgreens, and Prime Therapeutics. 

    • Their book-of-business trend for 2007 and 2008 was 0.5% PMPY.
    • Their GDR was 69% (a 7.8% increase over the prior year).
    • Their non-specialty trend was -0.5% in 2008.  [This makes me wonder if they had become more aggressive on plan designs in that period to drive negative trend.]
    • Their specialty trend was 9.6%.
    • They have a list of options to mitigate drug trend.  I was pleasantly surprised to see the first one was preferred or restricted retail network arrangements.  (The 3rd thing was targeted member communications.)
    • Their costs per Rx were: (not sure if this is AWP, client billed amount, or something else)
      • Total – $52.47
      • Brand – $110.82
      • Generic – $18.09
    • Their utilization trend was 0.3%.
    • They have a brief therapeutic class section on the top 5 classes.
    • 80% of the new chemical entities that are expected to reach the market in the new year will fall in the specialty category.
    • They state that the goal on 4th tier (specialty) and 5th tier (life style and cosmetic) is the have an equal cost share between clients and members.  [I’m not sure I understand if this means to continue the same percentage cost share or to split the costs 50/50 on that tier.]
    • They mention that an approach to use is pplacing DAW penalties in place.  [I can’t believe that companies don’t have this in place today…shame on an account manager who hasn’t convinced their client of the logic of this.]
    • I’m a little confusioned on pg. 25 when they talk about adherence and drug cost savings.  I thought that costs would go up on the pharmacy side but produce savings on the medical side.
    • I was also surprised to see that they were recommending a mail copay for 90-days equal to two 30-day retail copays.  I thought that this had to be closer to 2.5 retail copays to make sure the client saved money.

    Overall, I think it’s a good first document.  It reads easily, but I think it needs more primary research.  I also think the forecast at the end has to be a little more visionary.

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

    09-10 Prescription Drug Benefit Report

    February 23, 2010 by George Van Antwerp 0 Comments

    As they have for the past few years, Takeda has sponsored a study by PBMI on employers and their prescription drug plans.  The report is called the 2009-2010 Prescription Drug Benefit Cost and Plan Design Report.  It has some interesting data.  (The survey is of 417 employers representing over 7M members and was completed in May/June 2009.)

    • 87% of respondents have a multi-tier formulary.  (Closed formularies are almost disappeared.)
    • 97% offer access to mail order.
    • 17.4% use mandatory mail.  (22% of self-insured and 8% of fully insured)
    • 84% allow for 60+ days supply to be dispensed at retail.  [surprisingly high to me]
    • 60% of employers offer a specialty benefit.
    • Members pay an average of 25.2% of retail Rxs and 19.2% of mail Rxs.
    • Almost 1/2 of employers have adopted a value-based design.
    • Only 89.5% use a refill too soon edit.  [Why not 100%?]
    • One question I found very interesting was who was responsible for plan design:
      • Fully insured – 49.3% rely on insurance carrier (makes sense); 25.4% HR staff; and 12.7% consultant.
      • Self-insured – 56.4% rely on HR staff; 18.6% use consultants; and 7.1% use PBM. 
      • [Very surprised that PBM use was so low.]
    • Almost 10% of respondents said that drug benefits were >50% of their job responsibility.  [I didn’t realize this was true any place other than the top few employers.]
    • 3.8% have a maximum annual benefit for drugs.
    • 30% use their PBM as an exclusive provide for specialty, but 54% require dispensing thru select specialty pharmacies. [I think this speaks to more PBMs and PBAs which don’t own their own specialty pharmacy.]
    • For employers concerned about affordability, they asked what they were doing:
      • 47% do employee education – generics, mail order, network pharmacies, and preventative drugs
      • 29% don’t know
      • Only 3% use step therapy [really surprising]
    • The average copays were:
      • Retail – Generics ($9.94); Preferred ($28.18); and Non-Preferred ($47.71)
      • Mail – Generics ($22.06); Preferred ($61.80); and Non-Preferred ($106.94)
    • They captured low, average, and high data points for each level.  Some crazy client has a $50 generic copayment.  [Why bother?]
    • MAC (Maximum Allowable Cost) is only used by 71% of clients at retail and 46% of clients at mail.  [Every client should have MAC set up.]
    • Their average pharmacy reimbursement was:
      • Retail Brand – 16.4% off AWP
      • Retail Generic – 45.8% off AWP
      • Mail Brand – 23.7% off AWP
      • Mail Generic – 57.3% AWP
    • The PMPM utilization numbers are interesting:
      • 1.06 active employees
      • 2.05 retirees
    • 58.5% of employers cover OTCs.
    • Their list of utilization management tools and usage surprises me:
      • 11% use academic detailing
      • 20% use copay relief / waivers
      • 69% use disease management
      • 44% use dose optimization
      • 38% use face-to-face pharmacist consults
      • 16% use generic sampling
      • 44% use outbound phone calls
      • 29% use pill splitting
      • 23% use prescriber profiling
      • 81% use prior authorization
      • 89% use quantity level limits
      • 47% use retrospective DUR (drug utilization review)
      • 59% use step therapy
      • 55% do therapeutic substitution
    Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Research

    Should Drugs Be Free?

    February 18, 2010 by George Van Antwerp 0 Comments

    You hear this argument a lot especially within the context of value based design.  There are two reasons that people consider dropping drug copays to $0 for a commercial population – (1) they believe it will increase adherence and (2) they believe it will incent people to move to generics or to mail order.

    First, I am fundamentally against providing prescription medications for free.  People have no vested interest in things that are free.  And, I strongly believe that people need a vested interest in their healthcare.  A temporary $0 copay or a rebate is okay, but I prefer a clear and simple message like “all generics are $4”.  (Not even Wal-Mart can say that…most $4 generic programs are only for 300 or so drugs.)

    Tonight, I want to drill down specifically on using this to incent people to move to a generic drug.  I don’t believe this is a cost effective solution.  Here’s my quick model which says that a company with a 60% generic fill rate would have to increase their generic fill rate by 8 percentage points to breakeven.  I would argue that it is too big of  jump to happen (at least within one-year).

    Why?  Because the 60% of people that are currently paying a copay which reduces the net cost to the client stop contributing.

    Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Value Propositions

    Why Integrated Communications Are Better?

    February 9, 2010 by George Van Antwerp 0 Comments

    This morning is a perfect example of why integrated communications are better.  What do I mean by this?  I mean where a communication campaign is designed using rules to coordinate events across multiple channels.  Still too mumbo-jumbo…Where companies can interact with consumers across channels (e-mail, voice, print, web, call center) and create a seamless experience.

    Here’s an example…

    This morning, my kid’s school is closed due to snow.  [Although the snow has passed and they’ve already plowed the side streets.]  When I checked the Internet at 5:15, it wasn’t closed.  At 5:40, I got the call that it was closed.  BUT, the call comes on my home line, our home business line, and both our mobile phones.  Somehow it didn’t wake the kids, but it could have.

    I don’t really care about the over-communication in this example, but in a professional setting, this would seem like overkill and potentially a waste of money.  In an integrated communications example, it might work like this:

    • An update was put on the Internet and everyone was sent an e-mail
    • At 5:50, the system would identify anyone who had either not opened their e-mail or had not visited the website (assuming they had cookies on their PC for tracking website visitors)
    • At 5:50, the system would call the primary number to play the recorded message by the principal
    • If there was no answer by a live person or the entire message was not listened to, the system would move on to additional numbers

    This is always one of the big discussions we [Silverlink Communications] get in with clients in healthcare.  What are the rules for escalation of communications?  How do I track data in an integrated data set?  What is the right timing between communications?

    This is critical.  Sending people a letter and a call or a letter or a call (for example) is pretty easy.  Determining the next action based on their final disposition in the initial outreach is not.

    Of course, the other question this begs is how many companies actually track return mail.  I know a lot of companies don’t.  If it keeps getting returned, they’re not processing this return mail and taking the bad addresses out of their member database.

    BPM / Process, Business Tools, Consumerism, Healthcare, Marketing / Communications, Silverlink, Technology

    Prime Therapeutics Drug Trend Report 2009

    February 5, 2010 by George Van Antwerp 1 Comment

    It’s been a while since I did all my analysis on the drug trend reports last year. It’s almost time for some of them to start coming out again. Prime Therapeutics typically publishes their document at the end of the season (see press release). (see my review of their 2006 trend report)

    In general, I liked the report. It was an easy read and something that I think anyone could pick up and understand.

    General Notes:

    • Prime is owned by 11 Blues plans and partners with 5 additional plans.
      • $8.3B in drug spend under management.
      • 27% annual membership growth
      • 94% member satisfaction
    • Prime’s drug trend (PMPM cost) decreased by 0.5% in 2008. (Specialty trend was only 0.9%.) This is their 6th year of single-digit trend which is great. [I really want to dig in and know why – population, drug mix, plan design.]
    • Their generic fill rate was 63.7% (in December 2008). [This seems low…CVS Caremark’s for the same period was 66.3%.]
      • Some of this is plan design, but I think their average age is lower than other PBMs which would drive a lower GFR with higher acute drug use…which is more likely to be generic. [I’m speculating on age, but they share that their average age is 33 which seems low.]
    • 1.1% of their total Rxs were specialty drugs.
      • Neither here nor there, but they are the first company I’ve seen to show ingredient costs per day for specialty. (It was $75 vs. $2.50 for traditional drugs.) Most show costs as a 30-day supply.
    • Their average costs per Rx were $61.87.
      • Brand = $132.65
      • Generic = $19.20
    • Their Rxs PMPY remained flat at 11.5 which still seems low to me. [They state that the average number of retail Rxs per capita was 12.6…does that mean it’s actually higher once you add in the mail Rxs and adjust for days supply?]
    • Their average member cost share was 26.4%.
      • 27.2% for brands
      • 40.1% for generics
      • 5.0% for specialty
    • For Medicare, the utilization is much higher at 47.9 claims PMPY.
    • Their average age was 33.3 (commercial) and 72.7 (Medicare).
    • The GFR for their Medicare business went up 8.7 percentage points to 71.3% which is a huge jump.
    • I like how they break traditional drugs into two buckets – Spectrum (not my favorite name) and Focus. This allows them to show different strategies on these two (vs. specialty).
      • Focus are drugs for high blood pressure, high cholesterol, diabetes, respiratory disorders, and depression.
    • They say they have a GFR of 34.9% in specialty. [This seems incredible. I didn’t realize there was that much generic opportunity but maybe I’m outdated here.]
    • They show a chart on page 30 around generic fill rate which seemed strange to me. It shows the best in class sometimes exceeding what they consider the theoretical maximum. I think I understand why, but I’d have to challenge whoever came up with the theoretical maximum if I already have clients exceeding it.
    • They have a Generics Plus drug list which I imagine is a lot like the High Performance Formulary which we had at Express Scripts and was part of my GenericsWork solution that I launched when I was there.
    • They are the first PBM that I’ve seen recommend a $5 generic copay to try and avoid prescriptions being processed for cash and losing those claims for DUR purposes. I think this is great.
    • I was surprised to find out they have a generic drug alert program. [A program telling me the drug that I’m on is now available as a generic.] They might be the only PBM I know with this. From a consumer perspective, I think this is great. From a business perspective, I know that almost all of these people will get switched by their pharmacy to the generic without doing anything so the value of that mailing is pretty limited.
    • I was surprised to see them quote the Harris Interactive study from March 2005 on barriers for refilling medications. I like to see their data to compare.
    • They have a section on value-based plan designs and provide three types of pharmacy solutions – drug-based, behavior-based, or risk-based. Sticking with their focus on risky patients, they recommend a risk-based model. I like this concept although I’m more of a behavior based advocate myself. They other question I have is can you offer lower copays for people at risk without having any type of “equity” issue with the other employees within the same plan?
    • They have an Adherence Report which conceptually I like although it only goes out every 6 months. There is research out there that says intervening after a 14-day gap-in-care (i.e., lack of adherence) is important to get people back to therapy.
    • One of my favorite images that they’ve been using for a few years is the one below. It shows using a predictive model to focus on at-risk members and allows you to especially focus on those that are at risk based on medical data, but have no Rx claims. (Something they can do with the ownership by the Blues and access to medical data.) [They say these people are zero percent adherent which is a term I’ve never heard anyone use before.]

    Key Research Points:

    • For high risk patients (survived a heart attack or show signs of heart disease), one heart attack can be prevented for every 16-23 members who regularly take cholesterol lowering medication.
      • 3.2% membership is high risk and not on a cholesterol medication.
      • Patients who receive a targeted outreach are 3x more likely to begin therapy
    • Every one percent increase in GFR (generic fill rate) has the potential to reduce pharmacy expenses by 1-2%. [Walgreens also used 2% in their drug trend last year which is higher than what I’d seen before.]
    • They talk about increasing generic usage as likely to increase member’s adherence. [I think Dr. Will Shrank has shown in some of his research that those that start on generics are more likely to be adherent.]
    • I’d love more detail on the case study on page 9 so maybe I’ll have to read the references…BUT what it says is significant:
      • By getting 5,000 high risk members with high blood pressure to be compliant with a statin for 1 year, they saved $2.1M in potential medical costs.
        • Avoided – 44 heart attacks, 5 strokes, 20 heart failure hospitalizations, and 8 kidney failure hospitalizations requiring dialysis
    • There are currently 183 medications in development to treat diabetes and related conditions.
    • Patients with type 2 diabetes are 2.5x more likely to be hospitalized if they do not adhere to their medication therapy.
    • Those who report being non-adherent to their cardiovascular medications have a greater than two times the likelihood of having a heart attack, stroke, or other cardiovascular event.
    • For every heart attack avoided thru proper use of high blood pressure or cholesterol medication, a plan sponsor could save approximately $30,000.
    • Drugs for MS (multiple sclerosis) patients have a monthly cost of $2,200 (wholesale). 1 in 5 members with an out-of-pocket cost > than $250 declined to fill and they were 7x more likely to decline than members with costs of <$100.

    Potentially Conflicting Statements: (you have to read these things closely to find this stuff)

    • On pg. 21, they recommend a $10 copay for generics, but on pg 32, they say adherence is best when your generic copay is less than $10. Maybe two different questions, but seems inconsistent.
    • On pg 32, at one point they say that every $10 difference in Tier 2 copayments leads to a 2.3% higher GFR and in another point, they say a 2-3%. [I might be missing something here since the two are worded slightly different.]
    • On pg 35, they say that step therapy encourages members to use a generic alternative before a “second line, usually more costly brand medication.” I think this is meant to imply that it’s usually a brand drug versus it’s usually more costly. But, then on pg 46, they say before a “more costly medication”. It’s possible to have a generic as step one (or an OTC) than a more expensive generic as a step two, but I don’t think that’s very common. [For you clinicians, think H2 before generic PPI before brand PPI from a few years ago.]
    Books / Articles, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

    Implied Preferences / Educated Preferences

    February 3, 2010 by George Van Antwerp 0 Comments

    A few weeks ago, I was staying at a very nice hotel and was shocked to find out that they had cleaned my room while I had a do not disturb sign on the door. [My general mode when I travel is to just leave everything out in my room and not have them clean until I check out.] I immediately called downstairs to ask what the heck happened. They told me that they just assumed that I’d made a mistake and keyed themselves in.

    I was honestly shocked. I’ve spent a lot of nights in hotels and never had this happen. They said that if the sign is up both in the morning and afternoon they assume that the guest had forgotten about it. They then offered to put me on the “honor the do not disturb sign list”. Are you kidding me?

    I guess my argument (linking it back to healthcare and communications) is that aren’t there some implied preferences. Unless you tell me different, shouldn’t you honor my requests? If I sign up for e-mails, you should send me e-mails.

    For example, if a consumer (member / patient) gives a company their mobile phone number, don’t they expect to receive calls on that phone? I think so. Now, I don’t think that giving a mobile phone number as a “phone number” implies that the consumer is saying it’s okay to send them text messages.

    The other issue here is around “educated preferences”. If a company knows that the best way to get someone to stay adherent with their medications is to remind them to refill them, should they make it easy for consumers to opt-out of that program? I don’t think so. I think they have to offer that option, but why make it easy. Patients think they will be adherent. Heck, a lot of patients think they ARE adherent.

    Don’t corporate entities have a role in leveraging their data and experience to help people even if people don’t know they need help.

    Consumerism, General Thoughts, Healthcare, Marketing / Communications

    Will Paying You To Be Adherent Work?

    February 3, 2010 by George Van Antwerp 0 Comments

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

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

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

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

    A Few Adherence Examples of Communications

    January 28, 2010 by George Van Antwerp 0 Comments

    Express Scripts has been using Consumerology as their framework for member communications.  I hadn’t heard much about what they were doing in the adherence area so I turned to the web.  I found a few things that I thought people might be interested in.  [Google is a wonderful tool.]

    Last year, they had talked about the study in California with the power company and the influence that social norms had on power utilization.  They were testing this.  I found a presentation online that shows a cool graphic with some of the messaging.  I’m not really sure if patients will get the concept of medication possession ratio (MPR) so I’m anxiously awaiting the results.

    I also found a screenshot of sample adherence report which they’re using in a pilot with Vitality.  [I’ll assume the data is mocked up and not real PHI.]  I really like the report.  I’m still torn on the GlowCaps concept in terms of whether consumers will use them, but they seem to have some good results.  [And, I always try to remember that I’m not the average consumer so my opinion is just my opinion.]

    The last thing that I found which was interesting was some FAQs on their auto-refill program.  I remember pushing for this back when I was there, and I could never get the operations people and clinical people to approve it.  This type of program is becoming the norm now for many mail order and retail pharmacies so I’m glad to see they have it in place.

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

    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

    Latest Data Shows Low % Of Seniors Online

    January 21, 2010 by George Van Antwerp 0 Comments

    Everyone always wants to move to electronic communications (e-mail, portal) in healthcare (along with other industries) based on cost and data availability.  Unfortunately, seniors aren’t online as much as we think.  Yes, there are exceptions.  We all have stories about our grandparents being online or some blogger whose 80 years old.

    But, the latest data from Pew shows that they aren’t online.  Their not using high speed connections.  And, when they do go online, they’re dipping their toes in the water not jumping in the deep end to use all the cool tools. 

    This is certainly reinforcing of the data we observe at Silverlink when we interact with Seniors.  They are used to the phone.  They like to talk on the phone.  They know how to navigate and interact with automated telephony (especially intelligent telephony not annoying IVR trees).  And, since we can provide similar data to the web and e-mail about how Seniors interact with the communications, it has been a growing area for healthcare companies.

    Healthcare, Marketing / Communications, Research, Silverlink, Technology

    10 Events That Changed Marketing This Century

    January 20, 2010 by George Van Antwerp 0 Comments

    We all find lists and good graphics interesting.  This one caught my attention.  The article is in Advertising Age.  Their timeline is pictured below:

    Books / Articles, Marketing / Communications, Social Media, Technology

    How Do Physicians Want To Hear From Their Pharmacy/PBM?

    January 19, 2010 by George Van Antwerp 0 Comments

    In the pharmacy and PBM business, there are lots of reasons to reach out to a physician:

    • Drug-drug interactions
    • A chemically equivalent version of the drug prescribed is available
    • A therapeutically equivalent version of the drug prescribed is available
    • The prescribed drug is not covered
    • A prior authorization is required
    • The patient is required to try an alternative drug first (step therapy)
    • The prescribed drug costs too much and the patient would like a new drug
    • The prescribed drug had unplanned side effects
    • The patient’s prescription has to be renewed
    • The patient is required to move to mail

    The question is always how to best do this. Here are some options:

    1. Call the physician’s office.
      1. Using call center agents would be expensive, and after navigating an IVR tree and talking to the front office staff, they would simply leave a message. This would just lead to an ineffective back-and-forth in many cases.
      2. Automated technology won’t effectively navigate the IVR tree, sit on hold, and deliver a message.
    2. Send a letter to the physician.
      1. This allows for the proper level of information to be provided so the physician has time to look up the patient record and respond.
      2. For most of the cases above, the time lag on this would be unacceptable.
    3. Fax the physician.
      1. This is the default solution since you can deliver mail type content in a timely fashion.
      2. But, there is no great physician fax database.
      3. And, do physician’s read the faxes?
    4. E-mail the physician.
      1. This isn’t really an option since there’s no physician e-mail database (that I know of) and you can’t send PHI via e-mail.
      2. Your only option here would be to send e-mails that alerted the physician to log into a portal where all these messages were waiting for them.
    5. Use the EMR or eRx application.
      1. As physician’s get more automated and technology becomes the default workflow solution, everyone sees this as the holy grail. A pop-up can tell the physician about inbound messages for them to respond to.
      2. Some solutions hope to push this messaging to the time the prescription is written which I think is fascinating, but I don’t imagine a physician wants to deal with all that during the patient encounter. (Maybe I’m wrong.)

    So, what I’m interested in hearing from physicians on is what works. I’m sure you want to say that most of these messages aren’t things you want to deal with, but plan design is here to stay and works to control costs. I’m sure some of you feel this is the “managed care system” telling you how to prescribe, but we know that the amount of information needed to keep current on everything is overwhelming. And, cost matters to patients which means getting them on the right drug that they can afford will impact adherence and ultimately outcomes.

    So…How should PBMs and pharmacies communicate with physicians?

    Healthcare, Marketing / Communications, PBM / Pharmacy

    2010 Banned Words?

    January 9, 2010 by George Van Antwerp 0 Comments

    I think of Lake Superior State University as a place I expect to see list for NCAA hockey championship, but not the literary location that would be producing the 35th annual List of Words Banished from the Queen’s English for Mis-use, Over-use, and General Uselessness.

    But, it seems to get lots of media play, and in the spirit of helping you trim your communication choices in the new year…

    1. Shovel-ready [I’ve never heard anyone use this.]
    2. Transparent / transparency [about time]
    3. Czar [doesn’t seem like a democratic term]
    4. Tweet [seems too early to kill this]
    5. App [might also be a little early]
    6. Sexting [n/c]
    7. Friend, as a verb [I think social media will keep this around for a while]
    8. Teachable moment [I actually like this one and didn’t realize it was a commonly used term]
    9. In these economic times…
    10. Stimulus
    11. Toxic assets
    12. Too big to fail
    13. Bromance
    14. Chillaxin’ [Never heard this one…maybe just not that cool]
    15. Obama, as a prefix [Agree…I was never a fan of Obamanomics, etc.]
    Books / Articles, Healthcare, Marketing / Communications

    Interesting Articles I Didn’t Make It To In 2009 (Part II)

    January 6, 2010 by George Van Antwerp 0 Comments

    Here’s the next set of articles that I flagged as interesting and hoped to blog about, but I never made it to.

    Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Research, Social Media, Technology

    Why Can’t I Text My [Application]

    January 6, 2010 by George Van Antwerp 0 Comments

    I forgot to grab a receipt earlier today when I used my debit card.  Since I keep a record of all my transactions in Quicken, I quickly realized that I needed to e-mail myself the amount so I could enter it when I got home.  That got me thinking…why couldn’t I just text it to home home PC.  The PC is on the web.  It could “listen” for my message; receive it; and integrate it. 

    I’m sure there’s more to it, but this could work for healthcare updates – weigh, blood sugar, blood pressure.  Sure, ideally my bank would update my Quicken and my bluetooth connected WiFi health monitoring devices would do it for me.  BUT, in the interim…

    General Thoughts, Healthcare, Innovation, Marketing / Communications, Technology

    How Quickly Framing Changes Your Perception of Information

    January 4, 2010 by George Van Antwerp 0 Comments

    After I posted my weak attempt at humor (I should learn to never try) about Dogs versus Kids (sent to me by someone else), I was thinking about it last night, and I figured out a connection.  It’s a great example of framing. 

    Before you have kids, your perception of people with kids is very different.  When you’re in the grocery store (and you don’t have kids), you wonder why those parents can’t control their kids and why their kids are crying uncontrollably for some cereal or some other thing they want.  After you have kids, you realize that you can’t give in just to shut them up in public.  You might stop and tell them no.  You might even put them in timeout, but if you give in to their temper tantrum, then it will be worse next time.

    So, what does this have to do with healthcare communications?  Well, it’s a simple question of framing.  We all have a frame of reference for how we receive information.  Before you’re diagnosed with a disease (e.g., diabetes), you may hear facts about the condition but they generally go in one ear and out the other.  After you’re diagnosed (or someone close to you), you start to listen differently to that same information. 

    While for general communications, our segmentation may be relatively static and tied to things like education, geography, or income there are many other drivers in healthcare – plan design, condition, length of time with condition, …

    Healthcare, Marketing / Communications
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