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Words Matter – Bitter and “Hope Bong”

April 15, 2008 by George Van Antwerp 0 Comments

If you ever needed proof that communications matter, here are a few recent examples:

1 – Look at all the “flap” that Obama is taking over the use of the word bitter. It may cost him the nomination.

2 – In another example, look at Colbert on Larry King Live last night (go to 5:20 on this YouTube video) where he talks about Obama passing around his “Hope Bong” to the young people of America.

3 – And back in healthcare, Express Scripts finally announced their Center for Cost-Effective Consumerism in the WSJ today.

“Express Scripts’ experiment with incentives is rooted in a discipline called behavioral economics, which draws heavily from principles of social and cognitive psychology. The field attempts to understand why people make economic decisions that aren’t based solely on saving or making money.”

I have talked about this HMG (or cholesteral lowering drugs) program before on the blog, but they have some results revealed in the article. The article goes on to talk about the research done and some of the findings:

“So Express Scripts surveyed thousands of customers to understand better their concerns about generics. It learned some were uncomfortable with how to tell their doctors they wanted to switch, or felt it wasn’t their role as patients to bring up the topic. Others found the whole topic too complicated to bother with.

With those concerns in mind, Express Scripts made several changes to how customers were informed about simvastatin, such as shortening the text in its literature and changing its color and including a letter that patients could just hand to their doctor requesting a switch.

The company also framed the message to focus not merely on cost savings, but on how generics can be the better value — explaining that drugs that cost more but don’t do more aren’t a better value. People often believe branded or costlier drugs simply are better, says Dr. Nease, whereas Express Scripts’ new message stated that the “best buys” are drugs that cost less and do the same thing.”

This is important. Driving personalization through multi-modal messaging that helps simply complex messages into digestible information that links the constituents in healthcare isn’t easy.

As the article points out, Medco and Caremark are going down similar paths as are many of the managed care plans. Communications is becoming the key area of differentiation in healthcare as it has been in other industries for years.

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy

Transient Insurance

April 12, 2008 by George Van Antwerp 0 Comments

According to an article in the Detroit News, 1 in 6 Americans lack insurance for some part of the year. They could be chronically uninsured or simply in transition between jobs. Today, the individual health care market is certainly one of the fastest growing (if not the fastest growing) market for managed care companies.

Forrester estimates that this is a $115B market today.

With an average annual premium of $5,520 per family (or $2,400 per person assuming 2.3 people per family), that means the average premium per day is $6.58. Will we ever get to a point where you can buy short-term (i.e., less than 30-day) health insurance? And, if we did, can you set it up so that people don’t go on and off just as they feel ill?

The Forrester article talks about a Prudential model in Europe that is pay-as-you-go around health insurance.

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

Several Good Entries On Other Blogs

April 9, 2008 by George Van Antwerp 0 Comments

I was doing some blog surfing this morning and found a few entries worth going out and reviewing:

On EverythingHealth:

On HealthCareReformNow!:

On e-patients:

On The Sentinel Effect:

On Running a Hospital:

And to wrap up, on the Forrester Marketing Blog, you can get links to all the information being captured at their event on Engagement.

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

73-Page PDL – Simplicity?

April 7, 2008 by George Van Antwerp 0 Comments

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

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy

Communications As Trend Mgmt Tool for Pharmacy: Cliff Notes

April 4, 2008 by George Van Antwerp 0 Comments

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

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

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

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

Next Webinar – Retention

April 3, 2008 by George Van Antwerp 1 Comment

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

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

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

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

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

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

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

Register now >

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

Patient Ping-Pong: Cholesterol

April 2, 2008 by George Van Antwerp 0 Comments

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

In an editorial by the New England Journal of Medicine:

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

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

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

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

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

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

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

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

Convergence: The White Space Between Ford and Starbucks

April 2, 2008 by George Van Antwerp 1 Comment

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

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

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

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

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

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

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

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

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

Compliance / Persistency / MPR

April 1, 2008 by George Van Antwerp 1 Comment

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

You will hear several terms used:

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

Here are a few good sources for information:

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

noncompliance-pwc2020.jpg

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

Cigna’s Digital Coupon

March 31, 2008 by George Van Antwerp 0 Comments

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

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

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

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

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

Aging Impact on Communication Strategy

March 31, 2008 by George Van Antwerp 0 Comments

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

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

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

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

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

The Patient Experience Matters

March 30, 2008 by George Van Antwerp 5 Comments

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

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

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

forrester-hc-customer-experience.jpg

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

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

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

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

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

Healthcare, Innovation, Marketing / Communications, Research

Facebook Application To Drive Blood Donations

March 27, 2008 by George Van Antwerp 1 Comment

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

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

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

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

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

Health Transformation 2.0: Follow-up

March 27, 2008 by George Van Antwerp 0 Comments

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

In his words:

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

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

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

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

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

Future of Marketing and Advertising

March 27, 2008 by George Van Antwerp 0 Comments

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

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

Drug Benefit News: Highlights / Comments

March 26, 2008 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

It also gives the latest on Medicare Part D lives:

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

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

EPS for EPS

March 25, 2008 by George Van Antwerp 0 Comments

Express Scripts used to have a business line called Practice Patterns Sciences (PPS) which focused on using medical and pharmacy data to predict trends, improve costs, and improve outcomes.  This was back in the late 90s and probably ahead of its time.

cog.gifI was talking with one of the people that was on that team yesterday and thought how similar that was to a lot of what I talk about.  So, I will call it Employee Pattern Sciences or Patient Pattern Sciences.  But, if I stick with the EPS, then it makes a clear point about focusing on Employee Patterns of behavior to drive Earnings Per Share.

Any communication should have a clear ROI on it.  Building those and working to understand how to improve the business is where a lot of the fun is.  When you really understand data and metrics, you can start to see how one action can drive another action.

For example, does better communications drive healthy outcomes?  If yes, does that decrease absenteeism?  If yes, there is a clear ROI.

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

Value Based – Impact on Pharma

March 24, 2008 by George Van Antwerp 0 Comments

Kip has a good posting about the impact of value-based benefit design on the manufacturers.  He doesn’t allow comments so I will post some thoughts here.

For many firms, this will require a significant, even scary change in thinking and tactics; payor-centric communications; comfort with a massive increase in transparency; and a greater willingness to partner. Therefore, while the financial risks of moving to a value-based world are daunting, ultimately the greatest challenges are intellectual.

Value-based drug benefit designs will pose the greatest challenges to manufacturers with product lines (or pipelines) dominated “me too” drugs; rigid, risk-adverse organizational silos; and out-dated, prescriber-centric communications.

While I certainly think the industry has been tip-toeing towards value based benefits for a while, it still will beg several key questions:  [Note: When I think about value based, I think about a grid showing outcomes mapped out versus costs similar to a quality over price analysis.]

  1. How do you value certain things – less pain, convenience, minor variations in outcomes, extension of life?
  2. How does genomics play in here when you realize that a drug may be better for one patient but worse for another?
  3. How do you communicate this to patients without making benefits more difficult to understand?
  4. Can patients “buy-up” to pay the difference to allow them to get an alternative that keeps the company neutral?
  5. Will we ever get standards and clean data?  We can’t even agree about whether anti-depressants work.

I agree it’s a key trend and one to watch, but I think the implemented reality will be radically different than the solutions out there.

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

Health Transformation 2.0

March 24, 2008 by George Van Antwerp 0 Comments

I grabbed this little book off the table at Health 2.0.  I am finally getting around to flipping through it (rather than sleeping).

I can’t figure out if it’s associated with a company.  If yes, they have done a great job of disguising it.  [For what purpose, I don’t know.]  It is very well laid out with great graphics and is called:

Health Transformation 2.0
Can A Better Healthcare Operating System Make Us Healthier?

The author’s name (Scott Danielson) and e-mail are in the cover so I have shot him a note to see if I could add it here as a flash or some other visual.  Here are a few of the comments from the book:

  •  Healthcare 2.0 uses emerging technologies to transform an archaic, disease-treating system into a progressive health-enhancing one.
  • In the past 4 years, healthcare costs have doubled.  Are we twice as healthy?
  • Today, we have the ability to create a set of tools, a healthcare operating system that will help people find and manage information, research and control costs, and get and/or stay healthy.
  • Connected.  Helpful.  Secure.  Organized.  Informed.
  • Personal + Health + Power = Personalized Health Empowerment
Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology, Value Propositions

Mistake or Deliberate?

March 24, 2008 by George Van Antwerp 0 Comments

I must admit that I tend to be pretty compulsive about spelling and other mistakes.  I can’t read a book without circling errors or correcting grammar.

So, I found it intriguing when visiting a company’s website that they talked first about the confidentiality of their clients, but all the links have the clients names in the URL.  It made me wonder if this was an innocent mistake or someone finding a deliberate workaround.  People clearly see that Healthways and Medco are their accounts without getting corporate approval to use their names.  [BTW – I whited out the company name since who it is isn’t the point.]  

example1.jpgexample2.jpgexample3.jpg

General Business, Marketing / Communications

Does 1% Matter?

March 23, 2008 by George Van Antwerp 1 Comment

The whole theory behind Microtrends is the 1% of the population matters and can form a force that can drive change.  Look at all the talk about marathoning in this country when only 0.17% of people have run one.

From a healthcare perspective, I found it interesting that genetically “any two people are more than 99% the same at the genetic level” yet obviously genomics matters.  [We want to know what genes do.]

If small gene differences can make the difference in how our body uses medicine, it could be a breakthrough, but (as the WSJ article suggests) will it bee too much for medicine to really master and take advantage of.  Great question.

All of this made me think back to healthcare communications…does 1% matter?  Yes.  If you could develop communications that were specific to each segment, even if they varied by 1%, wouldn’t that improve results.  And, if you’re focusing on the measures that matter to drive your results, won’t that have an impact.

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

Medication Adherence Devices

March 23, 2008 by George Van Antwerp 1 Comment

I think we all can predict that the medical device industry should explode over the next few years.  USA Today had a recent article on a “smart pillbox” which caught my eye.

According to Forrester Research, the market for home health monitoring technologies is expected to reach $5 billion by 2010 — and $34 billion by 2015.

As the article stresses, this technology will be important with over 30M Americans taking more than 3 medications per day and over 100,000 dying from adverse drug reactions.

Usually, I hear about things like glowing bottle caps to remind people to take their medications.  Although the Med E-Monitor is a little bulkier, I like the fact that it does more than simply remind you.  It also looks for adverse drug events and provides information.  Ideally, one of these devices will simply generate refills through a simple click.  [I have not read the studies but they claim to have raised adherence from 35-40% to 90% which would be significant.]

med-e-monitor.gif

My big questions from looking at the website are:

  • It holds up to 5 medications.  What about those patients on 30 medications?  Can it be modularized?
  • Even if it can’t have modules, can it store the data and serve as the central reminder for medications not in there?
  • Who programs it with every medication change?  The MD.  The patient.  The company.
  • Can it generate a refill request to the pharmacy?  Can it generate a request for a renewal (i.e., a new prescription for my existing medication)?
  • Will people pay $60 a month?  Is the buyer, the children that live out of town and want their parent to be safe or the actual patient themselves?

Some of the other sites out there talking about solutions include:

Books / Articles, Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Research, Technology

Great Book – Microtrends

March 22, 2008 by George Van Antwerp 1 Comment

microtrends.jpgAt PBMI, one of the best speakers was Kinney Zalesne who with Mark Penn wrote the book Microtrends. I just finished reading the book – all 370+ pages. I found it to be one of the most engaging non-fiction books I have read in a long time…which says a lot. I have boxes and book shelves of books that I have bought, skimmed, and stopped reading. I get something out of them, but it is often not enough to continue reading the whole book.

I found Microtrends to be interesting both personally and professionally. Let me throw out a few of the things that I highlighted and noted during my reading along with some of the potential implications within healthcare.

Some of the topics they cover:

  • Love, Sex, and Relationships (Sex-Ratio Singles, Cougars, Office Romancers, Commuter Couples, Internet Marrieds)
  • Work Life (Working Retired, Extreme Commuters, Stay-at-Home Workers, Wordy Women, Ardent Amazons)
  • Race and Religion (Stained Glass Ceiling Breakers, Pro-Semites, Interracial Families, Protestant Hispanics, Moderate Muslims)
  • Health and Wellness (Sun-Haters, 30-winkers, Southpaws Unbound, DIY Doctors, Hard-of-Hearers)
  • Family Life (Old New Dads, Pet Parents, Pampering Parents, Late-Breaking Gays, Dutiful Sons)
  • Politics (Impressionable Elites, Swing Is Still King, Militant Illegals, Christian Zionists, Newly Released Ex-Cons)
  • Teens (The Mildly Disordered, Young Knitters, Black Teen Idols, High School Moguls, Aspiring Snipers)
  • Food, Drink, and Diet (Vegan Children, A Disporportionate Burden, Starving for Life, Caffeine Crazies)
  • Lifestyle (Long Attention Spanners, Neglected Dads, Native Language Speakers, Unisexuals)
  • Money and Class (Second-Home Buyers, Modern Mary Poppinses, Shy Millionaires, Burgeois and Bankrupt, Non-Profiteers)
  • Looks and Fashion (Uptown Tatooed, Snowed-Under Slobs, Surgery Lovers, Powerful Petites)
  • Technology (Social Geeks, New Luddites, Tech Fatales, Car-Buying Soccer Moms)
  • Leisure and Entertainment (Archery Moms?, XXX Men, Video Game Grown-ups, Neo-Classicals)
  • Education (Smart Child Left Behind, America’s Home Schooled, College Dropouts, Numbers Junkies)
  • International (Mini-Churched, International Home Buyers, LAT Couples, Mammonis, Eurostars, Vietnamese Entrepreneurs, French Teetotalers, Chinese Picassos, Russian Swings)

Second, the countertrends are very interesting. More caffeine and more water. Shorter attention with a rise in knitting. More technology and more people abandoning technology. Obesity and intentional starvation. More sun tan parlors and more people afraid of the sun.

“Microtrends is based on the idea that the most powerful forces in our society are the emerging, counterintuitive trends that are shaping tomorrow right before us.”

Sample facts:

  • Less than 25% of the households in the US are married-with-kids. 26% are households of one person.
  • At birth, there are 90,000 more boys born per year than girls. By age 18, it has switched to a 51% female mix. Exclude out the gay men and lesbian women, you get a straight sex ratio of 53 women to 47 men.
  • 3M American adults in a long-term relationship or married met online which is the same number that met in church.
  • There are already 5M people 65 or older in the workforce and that number is expected to grow.
    • According to an economist at the Urban Institute, “if everyone worked just one year beyond expected retirement, we’d completely offset the anticipated shortfall between benefits and taxes in the old age insurance portion of Social Security.”
  • 3% of workers work from home. The average commute is 25 minutes. 3.4M people commute at least 90 minutes each way to work.
    • Researchers at Georgia Tech found that “every thirty minutes spent driving increases your risk of becoming obese by 3 percent.”
  • In a Gallup poll in 2006, when people were asked about how they feel about religious groups, Jews rated the highest with a net positive of 54%. There are more Christian evangelicals in the US that support Israel than Jews.
  • 5.4% of marriages are interracial which led to the US Census allowing people to select multiple races in 2000.
  • There are 10M Protestant Hispanics in the US which is more than the number of Muslims or Presbyterians.
  • 81% of American Muslims support gun control (compared to barely half of Americans).
  • There are 3x as many tanning parlors in the US as Starbucks.
  • 1 in 10 children aged 12-18 uses a sunlamp and only 1 in 3 uses sunscreen. And, at least 25% of skin damage occurs before a person is 18 years old.
  • 16% of American adults sleep less than 6 hours a night. But, this causes injuries, accidents, and health problems. Lack of sleep triggers hormones that boost hunger and appetite.
    • She calculated out what I have argued for years that this creates an extra 8.2 years of life for someone who lives to 82.
  • DIY (Do-It-Yourself) Doctors is a whole new group of people that self-diagnose, self-medicate, and challenge their physicians.
  • OTC sales are now $15B per year.
  • In 1997, Americans spend more out-of-pocket on Complementary and Alternative Medicine (CAM) that on hospitalizations.
  • 3 in 5 Americans worry about medication errors at the hospital.
  • Women make healthcare decisions in over 70% of households.
  • 81% of people would like to use e-mail with their doctors but only 8% say they do today. [If they were controlled and reimbursed for this without increasing risk, I think they would welcome it.]
  • 1 in 10 Americans have some hearing loss. Nine seconds into a rock concert, you experience hearing loss. [I have been to several concerts even in the front row so that seems like a problem.]
  • 1 in 18 births were to men over 50. [Changes your underwriting profile.]
  • 63% of American households have pets. And, the top 1% of pets live better than 99% of the world’s population.
    • Studies have show health benefits of pet ownership including lowering blood pressure, reducing stress, preventing heart disease, and warding off depression.
  • Only 15% of parents would take away their kids privileges if they found out their 15 year old was using illegal drugs. [And most of us think we are strict?]
  • Only 4% of people over age 65 live in nursing homes or assisted living arrangements.
  • 40% of the people providing unpaid care for infirm adults are men. [Counter this to the assumption that women make most healthcare decisions.]
  • 650,000 ex-cons enter society every year. [Have we increased their health literacy while in prison.]
  • Childhood autism has increased 9-fold since 1992.
  • The number of kids being treated with antipsychotic drugs shot up 138% between 1997 and 2000.
  • In 2005, the main medical manual on the mental health of infants added two new subsets of depression, five new subsets of anxiety disorders and six new subsets of feeding behavior disorders.
  • There are 20M knitters in the US and more than ½ of them are under 34 with almost 6M of them being under 18.
  • In 2000, over 8% of teens were making money on the Internet.
  • There are 1.5M kids (between 8-18) that are vegetarians. 3M more who pass up meat but each chicken or fish. And, 3M more that each just chicken. 11% of girls aged 13-15 don’t eat meat.
    • Vegetarian men have been shown to have a 37% lower risk of heart disease.
    • Vegetarians of both genders are ½ as likely to develop dementia.
  • There are 9M morbidly obese people in the US (100 pounds overweight). Women are 2x as likely as men to be morbidly obese, but 1 in 6 black women are morbidly obese.
  • There is a small group of people practicing Calorie Restriction diets (1,200 – 1,800 calories).
    • Scientists have found that this lowers blood pressure, LDL, clogging of arteries, and body temperature (which may slow aging).
  • 6 of 10 Americans drink coffee every day. And, Americans drink 23 gallons of bottled water per year and 52 gallons of carbonated soft drinks.
  • The average age of caffeine overdosers was 21 in a study done around the Chicago Poison Center.
    • Caffeine causes insomnia, anxiety, headaches, stomach problems, cardiac arrhythmias, and weight gain.

“It is almost as though marketers see today’s society as an Amazon tribe, where women make all the decisions and men just go along for the ride.”

  • There are 12M “linguistically isolated” households in the US (i.e., no one speaks English well). And, in 2/3rds of these households, the head of household was born in the US. [Is multi-lingual soon to be a requirement?]
  • 1 in 3 Americans age 25-29 have a tattoo. 13% of Americans aged 18-24 have a tattoo and a body piercing.

Sample Healthcare Questions:

  1. How do we respond to the change in the family – older dates, commuter couples?
  2. With people working longer, what does this mean for health benefits? Are your needs and expectations different at age 75?
  3. When people are doing things that influence their health – sun tanning, sleeping too little, drinking too much caffeine, will companies step in and try to control this? (I know one large company in the South that has decided they won’t serve any fried food in the cafeteria.)
  4. Why don’t we do things like encourage pet adoption to help people become healthier?
  5. What are the implications of vegan children and low calorie diets and should the industry embrace, reward, or monitor them?
  6. When people don’t want to indicate a gender, will healthcare forms have to offer a “neither” category?
  7. With so many people getting tatooes, how long until that is a covered benefit or where there is a negotiated discount like the gym.
  8. There are lots of messy people. How do you communicate with them knowing they will misplace many things?
  9. For the people that have tried the Internet and chosen not to use it again, do you risk offending them with your constant push to self-serve?
  10. If America wants numbers, should we communicate more details not less?
  11. Should we be tracking lots of other factors (diet, caffeine, commute) in our Personal Health Records?

istock_000005278005medium.jpgI could go on, but I don’t want to give it all away. It is worth reading. It really makes you realize the value of targeting and personalization within a HealthComm framework.

Books / Articles, Business Tools, Consumerism, General Thoughts, Healthcare, Innovation, Marketing / Communications, Research

Don’t You Know Me

March 20, 2008 by George Van Antwerp 1 Comment

A Harris Interactive poll published in AdAge a few weeks ago, talked about the value people put on companies knowing who they are. We have all had that experience where you put in your phone into the IVR then get asked to verify it when the person picks up the phone and asked again for the number and your name when you get transferred. How annoying!

I always joked with our VP of Call Centers that Dominos was more likely to know who I was based on my caller ID then we were. There are so many technologies out there that there isn’t a good reason for companies not to take advantage of them. There is technology that based on your voice can tell if you are depressed. There is technology that based on your voice can tell if you’re angry. There are plenty of screen pops and technology that can pull in the caller ID.

Even the companies that do that don’t often have a consolidated view of the customer. They don’t know that you called yesterday; visited the website earlier; got a call last week; had a mailing sent to you last month; filed a complaint about the same issue you are calling about; etc.

So, how do consumers feel…

  • 95% believe it is at least somewhat important that companies know “who I am, my buying history, past problems or complaints, preferences, and billing record”
    • 37% said personal history is important
    • 27% said it’s very important
  • 62% said they would not hesitate to cancel or switch services if they had a negative experience

Of course, healthcare makes this hard. With employer sponsored healthcare, I can only switch annually or with certain events. With individual healthcare, I might not switch for fear of having some condition excluded. Plus, companies worry about trading privacy for personalization.

But, the reality is that this is going to continue to be an issue. Technology is putting more and more information out there and raising the bar.

On the flipside, doing something wrong quickly gets put on people’s Facebook pages, their blogs, or other tools where the experience ripples real-time and never disappears.

Books / Articles, Business Tools, Consumerism, Healthcare, Marketing / Communications, Research, Technology

Savings From Wal-Mart Program

March 18, 2008 by George Van Antwerp 1 Comment

I must admit that the $4 generics programs across the country cause me to have a mixed reaction.  On the one hand, it’s great.  It saves patients money.  In theory, it should encourage compliance.  On the other hand, if they get processed as cash transactions, I worry about them not showing up as claims which could limit the effectiveness of the POS (point-of-sale) DUR (drug utilization review) process.  [DUR includes things like drug-drug interactions.]

But, I was very interested to see some of the Wal-Mart data being published.

“While $1 billion in savings is an astonishing achievement, the real savings to America – and its health care system – are even larger. That’s because many of our competitors have also lowered their prices.  [Four dollar] prescriptions now represent approximately 40 percent of all filled prescriptions at Wal-Mart. Nearly 30 percent of $4 prescriptions are filled without insurance – significantly higher than the 10 percent industry trend.”  Dr. John Agwunobi, Wal-Mart‘s senior vice president and president of health and wellness

You can go drill down on some of the data (e.g., state by state savings) here.  Some of the top states were:

  • Texas ($132,628,224)
  • Florida ($72,443,467)
  • North Carolina ($48,241,530)
  • Georgia ($42,279,383)
  • Missouri ($40,213,963)

It is also great to see that 30% of all the $4 generics are being filled by people without insurance.   It was also good to see that they are focusing on bringing new generics into this group faster which was another historical criticism that I had.

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

Trusted Source of Healthcare Information

March 18, 2008 by George Van Antwerp 1 Comment

I often wonder who people trust for information.  So I was glad to come across this  article in Employee Benefit News.
I must admit that I was surprised by several of the results.

  • Only 2% trust their employers?
  • More people trust their PCP versus their specialist?
  • More people trust general information portals versus content sponsored on their health plan website?

ebn-trusted-source-info.jpg

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

Non-PC: Is Recession Good For HealthCare?

March 18, 2008 by George Van Antwerp 3 Comments

I am sure this is not a politically correct topic to discuss, but the thought crossed my mind.  Since 75% of the US thinks we are in a recession, I think we can assume that people will act as if we are in a recession.  Never mind the economist definition of whether it’s a recession.

So, what are the implications for healthcare:

  • If I am cost conscious, I should be more willing to accept generics and mail. (pro)
  • If I am cost conscious, I may be more willing to go to a clinic versus a physician or urgent care.  (neutral)
  • If I am cost conscious, I may be more likely to skip doses or not refill my medications. (con)
  • If I am cost conscious, I may not join a gym but instead workout outside.  (neutral)
  • If I am cost conscious, I may not be preventative in my care.  (con)
  • If I am cost conscious, I may be more willing to accept free services offered through my employer or plan. (pro)
  • If I am cost conscious, I may take advantage of all the web tools and member portals which exists.  (pro)

In the big picture, there is a chance that a recession could push individual health insurance faster.  Just like Medicare Part D was a catalyst, a recession could change the employer sponsored healthcare paradigm and drive people to find insurance for themselves.  Making that happen quickly will be an issue.

Consumerism, General Thoughts, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research

Blinded By The Voice

March 18, 2008 by George Van Antwerp 0 Comments

I heard an interesting arguement the other day.  Someone was saying that the only thing that matters in the automated voice space is the voice.  They suggested listening to a call and thinking about what the patient heard.

This reminds me of advice from business school that the paper on which your resume was written makes all the difference.  Or that the font or color on your marketing materials is the key thing to get right.  It certainly matters.  But different people want different voices.  Ultimately, it’s about how you deliver that 1:1 personalized communication to the patient based on their preferences, their historical interaction pattern, and a blend of their claims and demographic data.

The other thing that surprised me was the implication that voice was more important than reporting and technology.  If I have a great patient interaction, but I can’t mine the data and I can’t easily modify the program to be better than I am blind to the success.

One of the things that I experienced when I ran campaigns is the need for in-flight modifications.  I may predict that I get a 20% response rate to a particular copay waiver program, but if I only get 5%, I rather stop it day one and tweak a few things rather than wait 30 days and miss a lot of opportunity.  On the other hand, if I get a 40% response rate, I may want to dial down the volume to manage my transfer rate to my call center and not mess up my ASA (Average Seconds to Answer) which probably has some SLAs tied to it.

Think about your communications solution from every angle…the interaction, set-up, ease of change, flexibility, reporting.

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

What Does Spitzer Teach Us About Sharing Information?

March 18, 2008 by George Van Antwerp 0 Comments

While staying away from some of the issues around Spitzer, there is one that I found very interesting.  How does someone spend $4,000 (or $80,000) total without their spouse knowing?  I guess maybe when you have too much money that can happen.  I talked with 10 of my friends about it and in general they typically had shared accounts where many of them had their wife helping or managing the bills.  (My wife manages everything for us…thank goodness.)

But, it brought a question to my mind which is how much information and when do people share with their spouses about their health conditions.

  • When you’re dating, should you disclose all your medical conditions?  What about your family history?
  • When you’re diagnosed, how quickly does the average spouse disclose that information to their family?  How does this vary by disease?
  • And, what happens in the future when you can get a genomics test to tell you what diseases you are genetically prone to get?  Should you disclose that to a future spouse and at what point?

They were showing 23andMe on the Today Show a few days ago where you could pay $1,000 to get a test done that showed you your likelihood of getting certain diseases.  It also showed you interesting things like where your ancestors were from and whether you tasted bitter things or sweet things.  It is worth going to their site and looking at, but it brings lots of interesting questions to the table.  Do you get your kids tested?  Once you have the information, can you influence the future or do you take a fatalistic view of having no control?

23andme.jpg

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

Guest: 5 Ways an iPhone Can Improve Doctor-Patient Relationships

March 15, 2008 by George Van Antwerp 2 Comments

I feel lucky to have people want to post on my blog. Susan Jacobs is a part-time teacher and regular reader. She is also a regular contributor for NOEDb, a site for learning about and selecting an online nursing degree program. Susan invites your comments and freelancing job inquiries at her email address susan.jacobs45@gmail.com .

Ever since Apple announced that third party companies are developing medical applications for the iPhone, predictions on how this will impact the medical industry have run wild. Indeed, the possibilities are endless when doctors have so much information in the palm of their hands.

  1. Easy Drug Reference – One of the biggest names in medical iPhone applications is Epocrates. This company has developed a massive, free online drug reference guide. When prescribing medication, a doctor can quickly double-check any concerns about side effects, drug interactions and more. Also, it is possible that a situation may arise where a patient doesn’t know the name of the medication they are on; only what the pill looks like. Epocrates’ drug reference has a search feature based on a medication’s appearance.
  2. Access to Health Records – More and more patients are allowing their health records to be stored online. With an iPhone, doctors can quickly access a new patient’s health records, should they not be physically available on site. This could be more than convenient; it could save lives.
  3. Quick Second Opinions – How better to serve a patient’s needs than by getting instant advice from another doctor, perhaps a specialist? For instance, a general physician could take a picture of a patient’s skin condition, email it to a dermatologist, and get a quick second opinion. That is just one of the many possibilities available with an iPhone.
  4. Clinical Decision Support – Similar to contacting another doctor, there are applications being designed that offer reliable, clinical decision support. Again, this could improve a doctor’s ability to give a patient the best care possible.
  5. Little Interference – Although physicians could have accessed online information with a personal computer before the advent of the iPhone, this would have certainly interfered with the more intimate communication between doctor and patient when someone’s face is behind a computer. Now, with the aid of a handheld device, the doctor will experience little interruption while seeing a patient.

iphone.jpg

While the iPhone depends on wireless Internet access to take advantage of online applications, this won’t be a problem for doctors in many medical facilities. Hospitals, in particular, are often wired for broadband access and this kind of support is spreading. Communication between offices is also becoming simpler, more reliable and is using less and less paper. (Many medical administrators would be happy to through their fax machine out the window, no doubt.)

The end of the month holds the iPhone Developer Summit in New York City. With more medical applications to possibly be discussed and showcased, even more possibilities will arise. With a vast database of knowledge at a doctor’s fingertips, patients should feel even more secure with the medical treatment they are receiving.

Consumerism, Guest Post, Healthcare, Innovation, Marketing / Communications, Technology
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