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Incentives in Healthcare

December 10, 2007 by George Van Antwerp 2 Comments

Will incentives be a focus in healthcare? Certainly in lots of other industries, they are a minimum requirement to play at the table – hotels, airlines, banking, consumer products, and casinos. Consumers expect them in many cases. One of the big challenges that any presidential candidate hoping to change healthcare will have to solve is alignment of incentives.

There is lots of data out there validating this as a focus. In The Road Ahead: Emerging Trends in 2007
by Hewitt Associates, they say that 48% of employers offer or plan to offer incentives to employees who participate in wellness or health related initiatives. Health plans have started to tier payments based on patient activities around wellness. Companies are paying patients to take HRAs (Health Risk Assessments) and results have shown that the more they pay the better the participation in taking HRAs.

Wellpoint offers employers credits to offset deductibles when members engage in certain activities. Highmark has an outcomes program where members get points for taking classes and participating in other programs. And, IBM offers employees as much as $300 a year for exercising regularly and logging into the companies preventative-care website.

On the other hand, companies like Target have used gift cards as an incentive to get patients to fill their prescriptions at the Target pharmacy for several years. Many companies have used copay waivers or $0 copay programs to encourage patients to try generic drugs. Earlier this year, Democrats in MN recommended giving publicly insured patients $20 gift cards for following their physician’s orders.

Several traditional companies that have worked in other industries are focusing on healthcare. IncentOne is the one that appears to be the market leader with Hallmark Insights and Maritz quickly ramping up.

So, when could you use an incentive:

  • If you’re an MCO, you could use incentives for:
    • Health Risk Assessments
    • Disease Management Program Engagement
    • Health Education Class Enrollment
    • Brand to Generic Programs
    • HEDIS Reminders
    • Multi-step Milestone-Oriented Wellness Programs (many employer-group driven)
    • Member Portal Registration or Utilization
    • Personal Health Record Registration
    • Product Design Surveys
    • Satisfaction Surveys
    • Refer a Friend Programs
  • And, if you’re a PBM, you could use incentives for:
    • Retail to Mail (or Specialty)
    • Retail to Retail (Limited Retail Network)
    • Brand to Generic
    • Brand to Preferred Brand
    • Rx to OTC
    • Dose Consolidation Programs
    • Pill Splitting
    • Cross Sell opportunities with supplies companies—transportation services, DME, etc
    • Refer a Friend
Consumerism, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Value Propositions

Cariten Article on Silverlink

December 10, 2007 by George Van Antwerp 0 Comments

There was a nice article in today’s Knoxville News Sentinel about a program that one of our clients did. The client is Cariten Healthcare, the insurance arm of Covenant Health. They used Silverlink to get a flu shot reminder out to their patients. The article includes several comments from Linda Lyle, VP of Operations.

“The words may be recorded, but real thought went into the message.”

“An effective way to get the message out in a timely manner.”

She points out that it would have taken their live agents 100 days to get out the message which Silverlink did in six days. (contacting 44,000 people)

The article also talks about the tweaking that they went through in trying to find the right voice. They are now using automated calls to seniors for other purposes (e.g., reminders for mammograms, cholesterol screenings and colonoscopies; brief information about diabetes and osteoporosis; a customer-satisfaction survey; and reminding patients with dual coverage to let them know).

“There’s not currently a way to track how many members follow the messages’ advice, but numbers from another national company indicate Cariten is having a 73 percent “reach rate” among seniors, compared to a national average reach rate of around 40 percent.”

Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, Technology, Value Propositions
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Medicare Pilot Results

December 10, 2007 by George Van Antwerp 0 Comments

I saw some amazing results the other day for a Medicare pilot program (not a Silverlink or automated call program). The company was showing us their analytical solution and how a health plan had used it to drive enrollment in a disease management program. They were targeting a Medicare population to get them enrolled to see if they could control spend around the disease.

This vendor broke the population into 7 “clusters” based on similar attributes and then tested different messaging patterns (e.g., disease name then benefits then process versus benefit then process then disease) across 8 different messaging components. They were able to get an 83% enrollment rate within the population. From what I understand separately, several of the companies that signed up for the pilot dropped out since they couldn’t get any meaningful enrollment.

In this case, they used lifestage, household type (e.g., single), household size, race, and income as the five variables that defined a cluster.

And, you still wonder about the benefits of data-driven communications that use segmentation? As you append external data to your claims information, you can create a robust data set that allows you to create personalized messaging to a targeted niche of patients that is designed based on a predictive model of getting them to take action. That should be the key for your communications and marketing programs.

Here is a good blog entry on e-CareManagement on the pilot program. My quick take is that the pilot won’t serve to prove the DM has an ROI, but that doesn’t discount the success that this company had using targeting to drive enrollment.

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

Do Seniors Use Automated Calls?

December 10, 2007 by George Van Antwerp 0 Comments

Without hesitation, that is the number one question I get from people in healthcare. Since seniors make up ~45% of the spend in healthcare, it would be difficult to promote a solution that didn’t work for that portion of the population. We have had some great success with the calls we have done around Medicare Part D and can provide a detailed set of data offline if you’re interested.

Here are a few of the key observations:

  • If you use the Medicare Part D experience, you can see from the data that the CMS website was very busy during the week and much less so on the weekends. [Implying that the target population doesn’t use the Internet at home or had their caregivers or some public access facility helping them.]
  • If you compare the 800# for Medicare Part D to the website volume, it is 4-5x as high. [Implying seniors use the phone primarily.]
  • Comparing authentication by age for a refill program and a COB (coordination of benefits) program, the senior population (>64) responded best.
    • Authentication means people that received an automated phone call and confirmed that they were the intended recipient (“are you bill jones?”).
  • Once seniors started receiving the calls, they continued to be receptive over time to additional calls.
  • The likelihood of saying “repeat” during a call rose very slowly from 60 to 90 years of age.
    • On an automated call, the patient has the opportunity to say “repeat” to hear the prior message again.
  • We followed up on one call program and surveyed 70,000 seniors…95% said the messages were easy to understand and 91% said the calls were quick and helpful.
  • Seniors answer calls all day, but more at night. [Gives you a good option for smoothing inbound call volume or transfers from outbound call programs.]
Consumerism, Healthcare, Marketing / Communications, Research, Technology

$200K Word Change

December 10, 2007 by George Van Antwerp 1 Comment

I was talking with a friend last week who has spent all his time at small, nimble companies. He was amazed at the challenge of getting something prioritized and completed in a big IT shop where process can often kill flexibility. There are lots of reasons for this – doing all the small projects would use all the time, the big projects have great ROI, the risk of something going wrong is much higher, etc. There are also dozens of reasons why you want to figure out how to be big and nimble.

When I was focused on this technology challenge (see old blog), I used to talk about SOA (service oriented architecture) and BPMS (Business Process Management Systems) where you could create a process abstraction layer that sits above your existing legacy environment. This abstraction layer allows companies to make rapid changes within a controlled environment.

The one example I always use is when we decided to move from the word “member” to “patient”. To do this systemically, you have to change call scripts, job titles, system fields, metadata, contracts, letters, etc. Of course, you also want to change the website. When I put this request into IT, I got back an estimate of $200,000 to make that change (or 2,000 hours at $100 internal cost transfer per hour). How do you justify the business case for this other than strategically and qualitatively? And, given a shortage of resources, why would you focus on this rather than some other web development project?

It was an interesting and frustrating process. We obviously wanted to show clients that we had fully transitioned to focusing on patients. We wanted to show consumers that we were thinking of them differently. But, we were stuck in the project prioritization process for scarce resources.

This ability to drive branding through every interaction and evolve your branding as you learn about your consumers will be an interesting challenge to an industry like healthcare where companies are slow to change and change takes time.

BPM / Process, General Thoughts, Healthcare, Marketing / Communications

Stanford Study: Automated Calls

December 7, 2007 by George Van Antwerp 0 Comments

Stanford just published a report called “Computer calls can talk couch potatoes into walking” which is a great valuation of the automated call technology. The study compared calls by real people to automated calls encouraging sedentary adults to exercise.

It is interesting since it is conceptually similar to the technology which we provide at Silverlink Communications. They used Text to Speech (TTS) which can sound a little “computer-like” while we record our calls with voice talent. In their study, participants had to respond using the dial pad (e.g., press “1” if you have exercised today) while our calls respond to voice (e.g., say “one” if you have exercised today). We have studied the improvements in success rates on calls simply from using all recorded voice versus some TTS and seen a very positive lift. [It is obviously hard to record variable fields such as first and last name, but we have done some of that to improve results.] Additionally, given all the variables you can play with in a more sophisticated system – different voices, different speed of the message, dynamic paths, etc., it would be interesting to do that head to head comparison.

A couple of key takeaways from the article:

  • Many of the participants in the program were over 55. [Which are your primary users of healthcare services.]
  • Initially 80-85% of those in the program said that they preferred or needed a human after listening to the computer program. [What you hear from lots of people until they use it a few times.]
  • Participants who lacked confidence in their abilities to be successful and who were less comfortable interacting with people did better with the computer voice. [A client of ours in the specialty pharmacy space was emphasizing this for certain therapy classes recently.]
  • The computer voice was just as helpful for men and women.

“The goal was to get participants out walking at a brisk pace for 30 minutes most days of the week, or some other form of medium-intensity physical activity, for about 150 minutes a week, as recommended by the U.S. Surgeon General. They were divided into three groups: a control group that didn’t get calls, a group called by trained health educators and a group called by a computer delivering an interactive, individualized program similar to that being delivered by the health educators. Exercise levels were measured with the use of an accelerometer, which provides an estimate of physical activity amount as well as intensity.”

Books / Articles, Healthcare, Innovation, Marketing / Communications, Technology

Access, Price, Service…The Next Phase for MCOs

December 7, 2007 by George Van Antwerp 0 Comments

It seems a logical evolution of the marketplace. Have we moved to a point where MCOs can really differentiate themselves based on their service? (The indicator for me on this would be whether consumers are willing to pay more out-of-pocket to have one plan versus another simply because of service.) It will certainly happen. Web tools. Pro-active communications. Personalized messaging. Educational programs. Friendly call center reps. Consumers care about these things.

Coverage, the AHIP magazine, had a recent article called “Creating a Culture of Service” which is about this topic. It talks about a health plan where the average call is picked up in 12 seconds, the call abandonment rate is 2%, and 88% of questions are resolved on the first call. I am not sure this is a sustainable model of differentiation since there is a floor to improvement. It is similar to the Kano Model which is used in Six Sigma. This model points out that there are different curves of expectations. Initially, you can delight a customer with something new, but it quickly becomes a standard expectation in the marketplace.

The article does point out a key point which is that patients expectations of service are not based on healthcare companies. They look at Starbucks, Nordstrom’s, Amazon, Dell, Disney, and other companies for what they expect in terms of online presence, response time, and service culture. In many companies, the call center agent is the first (and potentially only) point of contact for a patient (or member). They are not highly paid and often take the brunt of complaints all day long. Finding a way to make them happy and patient centric is essential.

Another challenge which exists in any human centric function like customer service is consistency. As benefits get more complex and companies have huge turnover issues at their call center, getting the same answer every time is difficult. Which is massively frustrating as a consumer. We used to have to do “secret shopper” calls constantly to determine what parts needed more training. This is of course one area where automated voice solutions are being used both inbound (reactively) and outbound (proactively) to address consistency and timeliness. In many cases, you can predict events that will drive a call and see a patient’s history to understand their probability of calling (versus using the web). Why not launch a call to them before the call which is less expensive?

One hiring model we saw work very well in specialty pharmacy was hiring people who had a family member with a chronic condition. They were empathetic. They understood the patient’s frustrations. And, they could project their family member’s experience. They were great.

BTW – The article has a great sub-story about what Connecticare has done in their call center to address recruiting and turnover.

Other things I have seen work are empowering the end agent to resolve an issue up to a certain level. If a person is complaining about a $5 copay change, it may be worth waiving it one time and sending them some information rather than taking 3 calls from them at $5 per call. Or, it may be worth providing a one-time override rather than spending 8 hours trying to resolve it.

Incentives along with metrics are also another obvious tactic. Definitely don’t incent them to get off the phone quickly. That always creates issues. Look at ways of turning them into “sales agents” for the company and reward them for getting patients to change behavior or based on satisfaction scores.

And, one thing to avoid that drives patients crazy is having different information on the web than at the call center. And, even worse is not letting the call center agents have Internet access so they can’t see what the patient sees.

There are a few words on technology such as CRM (customer relationship management) and voice recognition software (e.g., routing to a different agent based on an angry voice). This surprises me a little since I think using data to segment and address different patients differently. Are they a frequent caller that we should route to a live agent without IVR (interactive voice response)? Do we know why they might be calling and have an answer?

As I have talked about before, I believe MCOs and other healthcare companies will be differentiated based on communications. How do they use their data and a permission based marketing approach to understand the patient, push information to them at the right time using the right medium, and support their needs? That is what I am focused on building with clients.

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

Biometrics – Role in HC – What About a Voice Print?

December 5, 2007 by George Van Antwerp 0 Comments

I have always found biometrics a fascinating topic (i.e., fingerprint recognition, retinal scans). Usually, you only see them employed in James Bond type movies or movies like The Bourne Identity. But, my first job out of undergraduate school was at SH&G which is a large architecture firm in Detroit. We designed US embassies and access to that area of the building was only through a retinal scanner.

Healthcare, much like financial services, is massively paranoid about security. [For good reason.] Just like you don’t want fraud on your credit card, you don’t want all your private healthcare information being shared with the world. One of the challenges in healthcare communications is therefore authentication. When you send a letter, technically it can’t be opened by anyone other than the recipient (without breaking the law). With the phone, you typically ask a question or questions – is this “John Smith” and/or “what is your member id”. The more questions (aka layers of authentication) or the more unique the question (e.g., give me the prescription refill number off your bottle) then the more sure you are of who are speaking with. Of course, as you make the questions more specific the questions or add more questions, you increase the difficulty for the consumer.

So, would consumers use a voice print? It is easier than fingerprinting or retinal scans in that you don’t need hardware at the patient’s location. You simply have to match an audio file against a prior file. It seems like an easy solution. Perhaps, once all computers are touchscreen, we could use handwriting recognition to send secure e-mail.

Healthcare, Innovation, Marketing / Communications, Technology

IBM on HC 2015 – Part II

December 3, 2007 by George Van Antwerp 0 Comments

I think the entry got too long.  I got a system error that made me think I should split this up.  So, continuing on my review of the IBM publication on the future of healthcare, here are some additional notes I took:

  • They envision the growth of a “health infomediary” that helps people navigate their benefits and options within the healthcare marketplace:
    • A “health coach” – expert in lifestyle and behavioral change
    • A “value coach” – expert in benefits, pricing options, and cost-quality tradeoffs
    • A “wealth coach” – expert in financial planning for health related needs
  • They say that health plans as well as physicians could step into this role (along with new players).
    • 80% say hospitals are “doing a good job”
    • 60% say health plans are “doing a bad job” [which may challenge them in some of these future roles]

“Today, healthcare delivery is overly focused on the episodic treatment of acute care.  However, the emphasis of the healthcare system will contine to expand from episodic acute care services to include prevention, chronic condition management and better care coordination.”

value-based-ibm.png

  • There is good discussion about the needed change in the healthcare system to be more focused on wellness and greater alignment of incentives.  They say “today, there is more variability at the point of contact with the consumer (that is, the point of care) than in virtually any other industry.”
  • If you read the report, figure 8 summaries the current state versus future state that they envision along numerous dimensions – sponsorship, competition, innovation, revenues, networks, etc.  The things that captured my eye were:
    • Competition being based on information access [and in my opinion…easy of use of these tools across multiple channels]
    • Competition being drives by targeted products and services [one of my favorite topics…microsegmentation]
    • A wellness ROI
    • Value-based reimbursement [which I am sure is much more than P4P]
  • They talk about the blending of product and service (i.e., the offering as I would call it).  This has been a topic in other industries for years.  [Look at the book Blur from 1999.]
  • They layout four different roles for health plans:
    1. Health / Wealth Service Advisors – personal health concierges
    2. Health Services Optimizers – guide individuals to wellness and through healthcare maze
    3. Applied Research Advisors – aggregate knowledge to help patients
    4. Transaction Processors – clearinghouse
  • I didn’t know that the top 6 healthplans cover 60% of all insured Americans while their are another 500 plans.
  • They go on to propose some questions and sample indicators of readiness for the new healthcare environment.  Here are a few indicators:
    • single view of the member across products and business partners
    • proactive contact center
    • real-time analytics regarding wellness calls
    • member loyalty
    • value-based arrangement with providers
    • consistent answers across multiple channels

Hopefully, this is a helpful summary and enough for you to read the document.  Is a quick 18 pages with good facts and realistic proposals for the future.

Books / Articles, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, Research, Technology, Value Propositions
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IBM on HC 2015 – Part I

December 2, 2007 by George Van Antwerp 0 Comments

I had a chance to catch up on a bunch of reading on the plane including an IBM brochure I picked up the other day on “Healthcare 2015 and US Health Plans“. I found it to be a good piece with several good frameworks although it doesn’t take any radical views on the future (which I would have liked to see).

Here were a few of the facts / takeaways from the brochure:

  • US healthcare expenditures per capita are 2.3 times higher than other developed countries and projected to increase 83% over the next 10 years
  • Medical errors cause between 48,000 and 98,000 patient deaths per year
  • Medication errors cost the US over $3.5B per year
  • On top of the 47M uninsured, there are 15.6M underinsured
  • There are five issues that will make change difficult for healthcare:
    • Funding constraints
    • Societal expectations and norms
    • Lack of aligned incentives
    • Inability to balance ST and LT perspectives
    • Inability to access and share information

    “We believe that the U.S. healthcare system will not achieve a comprehensive “win-win” transformation by 2015 because of political gridlock and inability of key stakeholders to work collaboratively to reach solutions for the ‘greater good’.”

  • They do predict that some form of universal coverage will be enacted by 2015 and will be focused on the individual not the employer to address the “job lock” challenge.
  • They see a key role for health plans and call upon them to lead the transformation to a “more patient-centric, value-based, accountable, affordable and sustainable U.S. healthcare system”.
  • They predict that employer-sponsored health benefits for family coverage will increase from $8,167 in 2005 to $17,362 in 2015.
  • In 2006, PPOs (preferred provider organizations) accounted for 60% of private insurance enrollees (up from 41% in 2000).
  • Employers offering coverage has dropped from 69% in 2000 to 61% in 2006 and is predicted to go below 50% by 2015.
  • They talked about employers putting a lifetime cap on retiree benefits which was a new concept to me, but they said that 49% of employers polled in 2005 had a cap (of which 59% of those on the plan had already hit the cap).
  • They talk about lifestyle choices impacting premiums which would lead to increased wellness and preventative programs.
  • There is some scary data about money needed post retirement. They say that half of all bankruptcies are in part due to medical expense. They also say that “a couple retiring in 2016 at 65 years of age would need US$560,000 if they lived an average lifespan. They would need US$1.05 million if they lived to 95 years.” This is specific savings for healthcare costs in addition to Medicare. WOW!! And, they say that 40% of people over 55 have $50,000 or less saved.

ibm-retirement-health-savings.png

 

“The health–wealth intersection is already taking shape. Players from each sector are experimenting with offerings that cross the boundary between the two, such as reverse mortgages to finance nursing-home costs and arrangements that let individuals tap into their life insurance policies to cover medical costs. But the new health–wealth business will evolve and change shape for at least the next couple of decades, as the retail health-care market coalesces and consumers take on more responsibility for their medical needs.”

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

HBR Health Consumer Segmentation

December 1, 2007 by George Van Antwerp 0 Comments

Harvard Business Review has an article “What Health Consumers Want” by Caroline Calkins and John Sviokla (both from Diamond Consultants) in the December 2007 issue.  I think they sum up one of the problems that I talk about with a couple of quick comments in the beginning:

“Yet the idea that companies might profit by segmenting customers to address their varied needs seems almost foreign to the health industry.”

“Companies can uncover areas of untapped value by analyzing patterns in demand for health products and services.”

They point out that looking at people from a health and wealth perspective at the same time is very revealing.  Which certainly makes sense as many people are predicting that these two markets will come together at some future stage.  Their research pulled out four consumer groups [with my summary of their text]:

  1. Healthy Worriers – receptive to new things, willing to change, look at dynamic between wage inflation and healthcare costs, look to employers for information, overwhelmed by choices
  2. Healthy, Wealthy, and Wise – fit, health conscious, financially confident, want choices, not scared of complexity, self-service tools important, service focused
  3. Unfit and Happy – manage own money but overconfident on health issues, don’t trust MDs, need tools and incentives to drive action
  4. Hapless Heavyweights – not particularly health or financially oriented, typically overweight, need support groups and penalties

Personally, I find it nice that they point out the fact that some groups want incentives and some need penalties.  I have blogged about this a couple times as one of the simplest examples of why segmentation and message flexibility is so key.  I think the first two have a nice opposite with simplicity versus choice.

Books / Articles, Business Tools, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions
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Tivo For Your Communications Program

December 1, 2007 by George Van Antwerp 0 Comments

What I have been completely surprised by over the past few months at Silverlink has been the amount of calls from companies who need to execute an automated call program ASAP to address something wrong in a written communication.

  • The mail merge failed.
  • There was a spelling error that no one caught.
  • The date has changed.
  • The letter went to some group that wasn’t supposed to receive them.

[One client I mentioned this to was glad to know that their peers had the same challenges.]

That is certainly one of the benefits of a flexible application which allows us to execute call programs using recorded voice (not text to speech (TTS)) as quickly as same day. But, I have struggled with how to position that “feature” of speed as a benefit.

It’s a benefit when you make a mistake or when something big happens – e.g., black box warning issued by the FDA, drug recall, natural disaster. But, hopefully that is the minority of the time.

Finally, it hit me. As anyone that uses Tivo or another DVR (Digital Video Recorder) knows, it is very convenient to just pause a program to do something else and come back to it later. (There is also the benefit of being able to fast forward through advertisements and just watch your program but that’s not the point here.) So, in the world of communications, rapid implementation with the right application framework actually gives you the benefit of “real-time play calling”. [If you’re a football fan, this would be like the quarterback calling a new play at the line of scrimmage when they see the opponents defense.]

Imagine being able to launch your communication program to your target group of patients.

  • First, you don’t have to send out all million letters at once which crushes your call center with an inbound call spike. You actually can “dial” the rate of calls so that inbound calls are moderated based on your existing volume and ASA (average seconds to answer).
  • Second, you can send out 10,000 calls and watch the response rate to determine if it’s working.
    • How many patients answer?
    • How many stay on through the entire message?
    • How many take action (e.g., answer yes, ask to get transfered to a live agent)?
  • Then based on what you see you can “pause” the program and make modifications – change a word, incorporate a different message for one segment, use a different voice.

And, of course, if you make a mistake and catch it, you can stop the program at any time to fix it. This saves you money as does improving a program midstream to make it more effective. It still probably needs a little work on positioning.

Healthcare, Marketing / Communications, Technology, Value Propositions

PHR – Key for Improving Senior Care???

November 30, 2007 by George Van Antwerp 3 Comments

In the AHIP (America’s Health Insurance Plans) magazine Coverage (Sept+Oct 2007), there is an article on using Personal Health Records to improve healthcare for seniors. I am reading it as I type my commentary here, but I start with some skepticism.

  • Apparently CMS (Centers for Medicare & Medicaid Services) commissioned a 18-month pilot to help design a user-friendly PHR for Medicare beneficiaries.
  • The article gives a good, simple definition of PHR as being “designed for use by individual consumers and contain a core set of medical information that includes physician office visits, medications, lab results, and general health information.”
  • It talks about advance PHRs having a care alert which is a signal to consumers that they are due for a treatment of test. [I have talked with a few PHR vendors about this. I can’t agree more. It is great to have the data, but the systems need a proactive communication mechanism to push timely content to consumers so that they take action. (shameless plug…what a great opportunity for someone like Silverlink to offer an automated call program that takes automated triggers from the PHR and launches a pre-defined, personalized call to the consumer)]
  • It offers an interesting statistic that I haven’t seen before – 100M people (of the 249M insured) have at least one chronic disease.
  • CMS previously rolled out a bare-bones PHR at www.MyMedicare.gov which had 2M of the 42M Medicare beneficiaries register. [Of course, registration means nothing. How many actively log-in, update information, and use the information?]
  • Plans participating in the pilot include HIP of NY, Arkansas BCBS, BCBSLA, Humana, Kaiser Permanente, UPMC Health Plan, Aetna, and Medcore Health Plan.

“Health information technology will improve health outcomes and contain costs and help provide meaningful dialogue between members and providers so tests are not conducted unnecessarily.” (Laura Landry, Director of IT, BCBS Louisiana)

  • It talks about AHIP and the BCBSA (Blue Cross Blue Shield Association) collaborating to make PHRs transferable across plans which is vital for success.
  • Apparently, the groups have also collaborated to define a model PHR which would include physician encounters, names of clinicians and facilities, medications, lab results, family history, immunizations, health risk factors, advance directives, allergies, alerts, and physician directed plans of care.
  • The article also highlights another issue which is true for many solutions which is density of utilization by provider. For example, if the physician is expected to use a tool but only 5% of their patient base uses it, it will be hard to get them to change their workflow. If 90% of their patients use the same tool or a tool that provides a common interface to the physician, then they will be more likely to interact using the technology.
  • A representative from Humana says that seniors are using the data to enhance their dialogue with physicians. [I think this is a key point. I spearheaded the rollout of a “physician kit” at Express Scripts which was a set of forms that the patient could download to take to the physician’s office to discuss generics, mail order, and their condition. The key was that us communicating with either party was only so effective. We had to drive the two parties most involved in care to talk together with the facts in front of them.]
    • The article later talks about several of the demonstration projects that offer printouts for discussion or putting in the patient’s chart.
  • Humana members can also give access to family members and providers through their user names and eventually direct access.
  • Kaiser’s PHR allows the member to see when a lab was done, the results, and send questions to the physician directly through the tool.
  • It talks about one of the PHRs which automatically hides certain information from the provider but can be unhidden by the patient.
  • I thought the article was going to skip the subject of whether this population would adopt this technology, but towards the end it points out that according the US Census Bureau only 35% of people over age 65 have computers and only 29% have access to the Internet. [Of course, this will change as the Baby Boomers move into this phase of their life.]

senior-w-computer.jpgThe other critical component in my mind is that these things have to be automatically populated. The patient can contribute family history, allergies, and OTC utilization, but why should I have to type in my physician visits or prescriptions. That should all come directly into a system. There is a lot to prove here. The concepts are sound and rationale, but it’s a complex system with limited historical adoption of consistent technologies. People won’t stand for having to rebuild a new PHR every year as vendors and companies cycle through trying to settle on a few core products.

Books / Articles, Consumerism, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Software, Value Propositions

Retail Clinician Survey

November 30, 2007 by George Van Antwerp 0 Comments

Back when I visited a retail clinic (i.e., MinuteClinic, RediClinic, TakeCare), I grabbed a copy of the Retail Clinician magazine that they had. Finally, I am getting to the bottom of that reading pile to browse through it. It had a survey of 150 nurse practitioners that work in the clinics which revealed the following:

  • 57.2% of them work in clinics that are in chain drug stores
  • 63.7% of them came from a physician’s office or hospital / ER
  • 58.1% of them see more than 10 patients per day
  • Their busiest days are Mondays and Saturdays
  • 57.2% said that they write prescriptions for more than 70% of the patients they see
  • 53% said that they give OTC recommendations to less than 40% of their patients
  • 56.2% said that more than 40% of the patients they see don’t have a medical home (i.e., a primary care physician)
  • 21.2% of them saw their challenge as health care claims adjudication and 24.6% of them saw their challenge as public awareness
  • 79% said they would be receptive to handing out patient education materials
  • 67% said they would be willing to hand out product samples
  • 50% of them said that they consult the pharmacist 1-5 times per day for questions

I don’t have the data right now to compare this to physician’s practices, but it would be an interesting comparison in terms of percentage of times Rxs are written, etc. As I mentioned the first time I went to a clinic (I have been back since), I agree that this is a great avenue for information distribution. It is much less rushed than the physician’s office.

 

 

 

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

Healthcare Marketing

November 28, 2007 by George Van Antwerp 1 Comment

I have talked about it a few times here.  Healthcare marketing lags the industry.  We don’t use technology creatively.  We don’t traditionally think outside the box.  We are risk adverse.  We are historically focused on business-to-business (B2B) not business-to-consumer (B2C) sales.  We don’t have sophisticated data mining.  This has certainly been validated for me when I go out to meet with payors and find out that the person I am meeting with just came from a consumer products company.

Today, the World HealthCare Blog talks about a healthcare marketing model.   It talks about possible models to apply.  It suggests the automotive industry as one rather than financial services or service industry.  I think financial services is a good model since people view their financial data as confidential like their health data.  I think the service industry is relevant since it is about the experience and support which for many patients is how they experience healthcare.  The automotive industry doesn’t work for me.  It is generally a luxury good with lots of variability.

The challenge in general is that healthcare marketing is selling a product that people don’t understand and don’t want to people who believe they are generally entitled to it.  Not any easy problem to solve.

“Until providers expand their horizons to see their “products” in terms of life meaning and impact, health care marketing will be mired in myopia, focused on features and attributes, or rare and episodic encounter experiences.”

Consumerism, Healthcare, Marketing / Communications, Weblogs

Patient (Customer) Value – Social Dimension?

November 28, 2007 by George Van Antwerp 0 Comments

I was reading an interesting entry on Forrester’s Marketing Blog about redefining the value of your customer away from ROI to something that reflects their social value.  The author defines social value as:

1) A customer’s knowledge and involvement – in short, his level of expertise and interest in the category and brand. 

2)  How he participates, and the value of his connections – what social activities is he involved with (both on and offline) and where (on what networks is he active).  The value refers to the value of the connections themselves:  are the communities more tightly-knit or diffused, are they public or more intimite.

3) The number of contacts the customer has in each network. 

It made me think about two things: (1) how would we value a patient in healthcare and (2) how do we drive and evaluate social value.

Different constituents would value patients differently [these represent logical hypotheses but not fact]:

  • To a pharmacy, it is the high utilizer that they want.  And, they make the most money off a cash paying customer who buys generic drugs at something close to their AWP (Average Wholesale Price) which is about 70-90% too high.
  • To a PBM, it is the chronically sick patient who fills lots of drugs but is very active in their healthcare so they use the website, use mail, use generics, and don’t call customer service very often.
  • To a managed care company, their highest value customer (or patient) is the healthy individual who is insured so that they collect the premium but don’t actually pay anything out.
  • To the physician, their highest value patient is the sick consumer who needs specialized care which they have to provide (e.g., injections done by the physician).  In a capitated model, this is different because they want to create healthy patients and are incented to promote wellness.
  • To the hospital, their highest value patient is the insured patient who has a complex illness that requires lots of tests or who has an elongated hospital stay.

Driving and evaluating social value is a different animal.  I do believe that providers and insurers should be promoting communities of care where people with diseases can share experiences and information.  That will be a powerful tool in promoting consumerism.  A managed care company (e.g., United, Humana, Wellpoint, BCBS) has enough scale that they could create an anonymous discussion area for their covered lives which was moderated by an expert.  (Not too dissimilar to the disease specific pharmacies that Medco is creating with their Therapeutic Resource Centers.)

Assigning value is more difficult, but it could be a composite score of activity on the web, registration in certain groups, etc. It won’t be perfect, but it is clear that some people are outspoken advocates which can promote or hurt your brand.

Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Value Propositions, Weblogs
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It Seems So Simple…

November 27, 2007 by George Van Antwerp 0 Comments

In the CVS/Caremark 2007 TrendsRx report, they present a compelling yet simple story about people with chronic diseases.

“Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.” World Health Organization 2003 Special Report “Adherence to Long-Term Therapies: Evidence for Action“

If every four people at risk for a chronic condition such as diabetes, hypertension or stroke:

  • One is unaware that he/she is sick
  • Of those who are diagnosed, one in three doesn’t get the prescription filled
  • Of the two who begin therapy, one stops taking medications within six months.
  • One is compliant with prescribed treatment

This clearly points to issues – the need for wellness programs and preventative medicine, the need to link compliance across MDs/Pharmacies/Patients, the need to drive adherence, and finally helping consumers understand why this important. It seems like simple problems to address, but if you’ve tried, you will realize it is a challenge and would be even if incentives were aligned.

[Sources: Caremark data combined with third-party references including the US Census, Centers for Medicare and Medicaid Services (CMS), the World Health Organization (WHO) among others.  Compiled by Jan Berger, MD, Chief Clinical Officer at Caremark.]

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

Teaching Kids About Health

November 27, 2007 by George Van Antwerp 1 Comment

Having kids makes you think about things differently. I was playing an online game with my kids this weekend when I started thinking about how it could be used to influence them. The game is called Webkinz. It is an interesting business model where kids buy stuffed animals which have a code. They go to the Webkinz website and use the code to register their “pet”. They then can work and play games to earn money. They have to feed and care for their pet to keep it happy. They pick the food.

My first take was how to use the tool to teach kids about good food (e.g., veggies and fruit) versus junk food. I didn’t study it intently, but I believe the “pets” are filled up better off the good food in the game. It also has little advertisements like the following:

webkinz-fruit.png

But, why not also use the game to teach the kids about exercise. If you don’t take the kid for a walk, it gains weight. Or, it already has a physician that you can visit, but why not improve that to give the kids preventative actions that they need to take for their pet. Since many people learn through action and experience, this could be a technique to start improving the next generation’s understanding of healthcare and wellness.

Healthcare, Innovation, Marketing / Communications, Software
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Comments to a Few Posts

November 24, 2007 by George Van Antwerp 1 Comment

I went out to the Hospital Marketing Journal this morning and looked a few recents posts. 

One entry is about “The Other CEO” which is the Chief Experience Officer.  I agree completely.  Healthcare is such an experiential business that we should be thinking about this from our process design through our architectural design.  There are many things that can be done physically to improve the experience not to mention service levels, communication techniques, and other levers that people could pull.

The other entry which is about a topic I have struggled with several times is called “Just Put It On My Card” which is about a credit card for patients that can’t afford their out-of-pocket expenses.  On the one hand, great.  I would hate for money to push someone to not be compliant or miss a physician’s visit.  On the other hand, how sad.  We have to loan people money to afford their healthcare??  Do we offer to excuse the loan if they become sick and can’t work?  Are we charging them outrageous interest on the credit?

For whatever reason, the social democrat in me finds the concept of loaning people money (which means they ultimately pay more with interest) for their basic healthcare costs a very slippery slope. 

Consumerism, Healthcare, Marketing / Communications, Weblogs

CVS / Caremark / MinuteClinic Article and Comments

November 24, 2007 by George Van Antwerp 0 Comments

I will stick with Drug Store News (Nov. 12, 2007) for now.  They had a good long story on the CVS Caremark acquisition building momentum.  They also talk about MinuteClinic which was a separate acquisition by CVS.  As I have said for a while, I think this was a good move.  It creates a lot of opportunity.  The combined entity now has touch points at several stops along the care continuum.  The question (of course) is how to capitalize on this without compromising the core businesses and without making people feel to “controlled” along the path.

From a top down view, the biggest things that jump out at me are:

  • How to expand the care model at the retail pharmacy using MinuteClinic.
  • How to get patient’s to grant access to share data across business units (PBM, retail pharmacy, MinuteClinic).
  • How to provide Medicare Part D type services like MTM (medication therapy management) through MinuteClinic facilities (even if the pharmacist were coming over to use them).
  • How to “value” each patient and determine the optimal mix of services and facilities for them.  For example, if they don’t impulse buy, you might as well get them to use mail.  Or, if they have a lot of maintenance medications that are generic, but they tend to buy a lot of other goods at retail, you might want to pre-fill their prescriptions at mail and ship them to the retail store for pick-up.  Or, if they have kids, you may want to encourage them to use the CVS that is an extra 2 miles away because it has a clinic.

Here are a few things from the article:

  • “So far, the moves are paying off as the company already has realized $660 million of cost savings and continues to anticipate about $1 billion of revenue synergies to be achieved by the end of 2008, with the later coming primarily as it rolls out new PBM offerings” (from Lehman Brothers analyst Meredith Adler in a research note)
  • Chris Bodine was named president of CVS Health Services earlier this year which is where the PBM and MinuteClinic business report up through [by the name of the group it would imply that there are more things to come once they digest these deals].
  • There hasn’t been much about what these new PBM offerings will be, but Tom Ryan (President and CEO) talked about them actively working and trying things that are “integrating our PBM capabilities with our strong consumer connections through our retail business”.  A few opportunities mentioned in the article are:
    • Therapeutic Interchange – [If the retail POS (point-of-sale) system can deliver formulary alternatives to the pharmacists, CVS should be able to help their PBM customers make different decisions to drive formulary compliance (rebated brands and generics) while lowering patient’s copayments.  This would be a big deal to plan sponsors and patients.]
    • Flexible Fulfillment – They talk about allowing traveling patients that use mail to get short fills at retail.  [I think some retail-at-mail solution here will be more creative.  They could do central fill which is a concept where scripts are filled at a mail order facility and delivered to the retail pharmacy for pick-up.  They could split scripts to fill a 7-day at retail and the remaining 83-days at mail (depending on their cost structure).  There are lots of trade-offs here around whether they want foot traffic (for cross-sell) or not.]
    • Specialty at Pharmacy – CVS retail stores fill about $3B worth of specialty prescriptions (think about injectible drugs and drugs that are very expensive).  But, most people want more support and move to a dedicated specialty pharmacy.  [I am not sure of the economics and logistics of storing specialty medications across a broad retail base versus simply using retail as a referal source for their specialty pharmacy.  Now, some specialty drugs are still shipped directly to MDs and billed under a different fee schedule on the medical side.  If they could use MinuteClinic as a dispensing location for specialty drugs, they could offer a convenient service to patients, lower costs for their clients, and gain visibility into drugs being coded as medical services.]
    • MinuteClinic is in the process of creating a pilot program to monitor health assessments and screen for illness just for PBM clients.  [If they could figure out a way to offer preventative care, they might be able to figure out how to take risk.  It would be a powerful story to offer clients a service that bore risk around spending, trend management, and overall care / outcomes.  With a few other acquisitions or partnerships, they could begin to look very different.]
    • Corporate Clinics are briefly mentioned.  [This is another interesting pitch for me.  If you put a MinuteClinic on-site at many of their large corporate clients and/or in areas where they have a dense population, they could provide health services and use the clinic to “steer” (as legally allowed) patients to CVS, mail-order, or their specialty pharmacy.  For companies, this increases their stickiness to CVS on the PBM side while reducing time away from work for their patients.]
    • One-third of their PBM business is up for renewal in 2009 [so they have about 6-months to demonstrate the uniqueness of this story to those clients to easily renew them without major price concession.  As I sure their competitors will be focused on conflicts of interest, too much turmoil, and other FUD (fear, uncertainty, and doubt).]
    • On a fairly different note, another article about CVS talks about their new advertising campaign focused on women as caregivers including a new website for people to share personal stories.  (www.ForAllTheWaysYouCare.com)   The initiative seems to have an impressive group of panelists.

 forallthewaysyoucare.png

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

Insider’s View is Too Close

November 23, 2007 by George Van Antwerp 0 Comments

As I think it can be in any industry, a big challenge is immersing yourself in your field while at the same time maintaining and outside-in perspective.  The challenge of losing that perspective is (A) using language that people don’t understand or (B) creating elequoent solutions that aren’t practical.

(A) From a communication perspective, the issue of language is one where I am sure most of you could come up with examples.  There are numerous times when I have gotten something and had to read it a few times to understand whether it was an EOB (explanation of benefits) or a bill.  I remember trying to write letters to patients and having to re-write them numerous times to get them ready to be sent out.

For example, in the PBM world, we would talk about refills versus renewals.  (e.g. glossary) I don’t think many consumers know what a “renewal script” is…but that wasn’t intuitive to us.  [BTW – It means your prescription has no more refills left.]  We would talk about DAW prescriptions [aka Dispense As Written].  Even worlds like formulary caused people problems when we used it on the website or in a letter [preferred drug list sometimes worked better].  Another one that threw everyone off was saying “this drug is not covered”.  Did that mean the patient couldn’t get the drug?  Did that mean the patient had to pay cash for the drug, and if they did, did they receive the client’s negotiated discount at the pharmacy?  Did that mean it required a Prior Authorization? 

I think the point where this really threw people off was when we communicated to physicians.  In my job driving generics, I remember reviewing the physician letters and seeing that we always called the drugs by their generic name – omeprazole (Prilosec), fluoxetine (Prozac).  When I pointed out that physicians don’t always know the drug by its chemical name, people were shocked.  Sending a letter to a physician saying you should switch from Nexium to omeprazole was pretty ineffective if they didn’t know what drug we were recommending.  I always tried to get us to say “the generic version of Prilosec (omeprazole)”.

hmo_blue_card.gif

(B) On the side of an overly eloquent solution, I have been stymied by my insurance card.  It is a national coverage card from BCBSMA.  It may work great in Massachusetts, but in Missouri, the providers can’t find the group ID on the card.  This has happened everytime we use it.  If they hadn’t been a client at Express Scripts and I knew their group IDs by heart, then each provider would have to call them. 

The other challenge with the card is that they give you one for each person in the family.  So, if you have 5 kids, you would have 7 cards (which you are expected to carry).  At the doctor for our kids the day, we simply tried to give them the patient IDs for the kids.  They were upset since apparently they have a swipe card system for the BCBS cards and don’t know how to manually enter the patient ID. 

To me, this is a great example of something that has been totally reengineered and become less effective.  I am sure they were putting more information on the card and pushing the group number to a corner wasn’t a big deal.  I am sure individual cards is great for older kids that carry their own.  I am sure smart cards is a great thing.  Unfortunately, all it has done is make it harder not easier. 

On the positive, I like BCBSMA’s general approach, service model, and many other things so the card is a hassle but not likely to impact my overall satisfaction.

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

Patient as Googler

November 22, 2007 by George Van Antwerp 0 Comments

This story seems almost unbelievable to me, but I am sure it is true.  Time Magazine published this story “When the Patient is a Googler” on November 8th.

It is basically a physician’s perspective on an aggressive patient that uses the Internet to find out lots of information about him.  The patient treats the physician with total disregard (which is unacceptable in any situation).  The physician on the other hand rants about patients and doesn’t grab control of the situation but simply “punts” her to another doctor.

“A seasoned doc gets good at sizing up what kind of patient he’s got and how to adjust his communicative style accordingly. Some patients are non-compliant Bozos who won’t read anything longer than a headline. They don’t want to know what’s wrong with them, they don’t know what medicines they’re taking, they don’t even seem to care what kind of operation you’re planning to do on them. “Just get me better, doc,” is all they say.

At the other end of our spectrum are patients like Susan: They’re often suspicious and distrustful, their pressured sentences burst with misused, mispronounced words and half-baked ideas. Unfortunately, both types of patients get sick with roughly the same frequency.”

In my opinion, they are both wrong.  Patients should certainly do their research before and after meeting with a physician.  They also need to give the physician a chance to use their training and experience to help the patient.  Physicians need to be open to patients doing research and asking questions.  They should be willing to suggest sites to patients for research.  This is not a subject that will go away.

There are several other discussion streams out there about this article if interested:

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

Identifying Your Generation

November 22, 2007 by George Van Antwerp 0 Comments

This discussion of using texting in healthcare (and other new channels) reminded me of a posting from earlier this year on Penelope Trunk’s blog.  [A great blog if you’re interested in career type topics and work / life balance with a focus on Generation X and Generation Y.]

Penelope introduces a quick “test” to determine whether you are a Baby Boomer, Generation Jones, Generation X, or Generation Y.  It made me feel old, but it is a good reminder of how technology and communication has changed radically. 

General Thoughts, Marketing / Communications, Weblogs

Literacy Adds Additional Challenges

November 21, 2007 by George Van Antwerp 1 Comment

I have some other seniors statistics that I will add later, but this morning I was researching seniors and healthcare communications.  I was surprised to see some of the data around how literacy presents a big challenge for them.  Here are a few facts and some links for more information:

  • “People aged 70 years and older with limited literacy skills are one and one half [1.5x] to two [2x] times as likely to have poor health and poor health care access as people with adequate or higher reading ability, according to a study led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.” (source)
  • “One in four [seniors] had limited literacy. In practical terms, these elders ‘may have trouble reading basic health information or pill bottle instructions'” (source)

  • “Although only 12 percent of the U.S. population was age 65 and older in 2003, they accounted for one-third of all patients admitted to the nation’s community hospitals in that year – over 13 million hospital stays, according to the Agency for Healthcare Research…The elderly also accounted for 44 percent of all hospital charges  nearly $329 billion.” (source)

  • “Senior citizens (65+) scored far lower than younger people in a 2003 literacy test. The test had a maximum score of 500.” (source)

literacyhlth-6-09-12.gif

  • “Less than one out of six U.S. adults have “proficient” health literacy, according to the report released this week, but for seniors it is only about three out of a hundred.  A staggering 29% of senior citizens do not even have “basic” health literacy.” (source)

I think this is an interesting angle that you don’t hear much about.  We spend all this time trying to think about what to say and other creative aspects, but sometimes we have to simplify the story to get to the point of being usable.  Here are a few other links if interested in the topic:

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

Zyrtec to Go OTC

November 21, 2007 by George Van Antwerp 1 Comment

By now, everyone should be familiar with Claritin (loratadine) and Prilosec going OTC.  They were really the first two blockbuster drugs to go OTC (over-the-counter).  Motrin / Advil is available both as a prescription strength and OTC.  Zantac (ranitidine) is also available OTC.

From a personal perspective, I am happy.  I have two kids with allergies that are on Zyrtec (which is off formulary) and where I pay $50 / month per kid.  I also find this an interesting DTC (direct-to-consumer) challenge for managed care plans and PBMs.  I had the opportunity to run both of our programs (Claritin and Prilosec OTC) at Express Scripts for this which included coordinating with modeling and clinical teams, designing the communication strategy, talking with clients, and helping drive OTC utilization where clinically appropriate.

From some initial research, I found the following:

  • Zyrtec (5 and 10mg tablets and 5 and 10mg chewables) and Zyrtec-D (1mg syrup and extended release) were approved by the FDA to go OTC. (article)
  • McNeil Consumer Healthcare (subsidiary of J&J) will be responsible for the OTC products.
  • McNeil has said the products will be available in late January 2008 and will be less than 1/3 the price of the prescription.
  • Non-Sedating Antihistamines (NSAs) represent 7.8% of the commercial Rx market and Zyrtec had about 37% marketshare in 2006 (generics had greater than 50%) with a typical member using 3.65 Rxs per year (or 0.29 Rxs PMPY).  (per Express Scripts Drug Trend Report)

Taking common Rxs to OTC status makes a lot of sense, but also creates a lot of questions:

  • If there are interactions with the drug but it no longer shows up as a claim, does this create a DUR (drug utilization review) problem?
  • Do pharmacies make more money on the generic Allegra or on the OTC?
  • For PBMs that make spread on claims and/or get a claims administration fee, how do they align their incentives with their clients (employers, managed care) that would prefer to see the patient use the OTC?
  • Which costs less out-of-pocket…the generic Rx or the OTC?

So, what should you do?   If you’re a consumer, you will likely hear something from your employer, managed care company, PBM, or pharmacy.  If your a company, you need a creative plan to execute against.  Contact me to learn more about how we (Silverlink) are going to help our clients.  [I can’t give away all the secret sauce here.]

But, if you are generally interested in this topic, here are a few links for you:

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research
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WSJ on Texting in Healthcare

November 20, 2007 by George Van Antwerp 3 Comments

Obviously my entries about texting in healthcare are timely. Today’s WSJ includes an article (pg D1) by Rachel Zimmerman called “don’t 4get ur pills: Text messaging for Health”.

She points out several compliance type programs where this is being used (outside the US)…birth control pills (England), AIDS (Australia), psychological support for bulimics (Germany), and smoking cessation (New Zealand).

Apparently, the American Telemedicine Association is developing guidelines for the appropriate use of text messaging in healthcare (along with other new media). The executive director, Jonathan Linkous, was quoted as saying “There are obviously times when telemedicine is inappropriate. Texting someone to tell them they have cancer is one of them.” [I think we can all agree.]

Of course, with health costs being concentrated in a small percentage of the population which is typically older, can texting make a difference? It isn’t easy to type on those small mobile phones with arthritis. Lots of seniors don’t even carry mobile phones. Plus texting is a whole different message as the article points out. My kids will probably get it much better than me.

Plus, using condense information can be risky. We had this problem in sending messages to pharmacies where we had a finite amount of characters to say “Drug A is not covered but the following drugs are covered but if medically required then the physician has to call 800-xxx-xxxx to request a prior authorization”. Other than reminders or pushing them to a very specific action it may be a challenge.

I think sending links or phone numbers via text message could be helpful. For example, using co-browsing, a company could trigger a message a message suggesting the patient call-in for more information or also go to another site. [What is co-browsing…this is when a company (typically a call center agent) can see where an individual is on the web and what they are looking at to help them.]

She mentions a few companies:

There certainly is a need for something that is quick and ubiquitous around healthcare. For someone under 40, I think texting could work great. For people over 40 (an arbitrary line), I think automated voice is better. It is just as quick. It is ubiquitous. And, it can be personalized and change during the call versus going back and forth via text messages.

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

Reverse Auction for MDs / Hospitals

November 20, 2007 by George Van Antwerp 1 Comment

auction.jpgIn healthcare, you sometimes hear people talk about waiting (at the pharmacy, for an appointment) while other people seem to get right in.  A lot of this has to do with geography (remember ‘healthcare is local’) but it also has to do with cycles.  For example, Mondays are always busier after the weekends.  [I have heard ERs are often busier during a full moon, but I don’t have research on that (and didn’t look).]

Certainly, another driver of healthcare costs are some of the large capital purchases at hospitals for imaging or other diagnostics.  If every hospital has to have the latest and greatest but they are only use 20% of the time, that isn’t an efficient use of capital across the healthcare system.  If you have to spread that cost for the equipment across 1/5th of the potential patients, it means you are overcharging by 5x.

Reverse auctions wouldn’t be easy, but BidRx pulled it off in pharmacy.  [I am not sure how successfully.]  The reverse auction model would be consumerism at its best.  The consumer would post their needs – a CAT scan, a PCP, a neurosurgeon, open heart surgery.  Physicians or hospitals would bid on their business based on the parameters – timing, price, etc.

In a theoretical sense, it would be interesting to test and see if it would work.  But, my objective was not to sit in the ivory tower, but to look at a model that would improve healthcare capital efficiency by better utilizing fixed costs.  If hospitals and MDs could bid for patients to fill their slow times, wouldn’t the following be possible:

  • Less need for capital redundancy (i.e., every hospital would not need to have the same equipment)
  • Less wait times for patients since they would be slotted in to open times
  • Less peaks and valleys at doctor’s office and hospitals since they would be offering a “discount” for you to come on Wednesday versus everyone wanting to come on Monday

Participation wouldn’t be easy, but ultimately, changing our healthcare model won’t be easy.  Just an idea.  There is something here to make the system more efficient.

Business Tools, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology

Mashing Two of My Posts

November 19, 2007 by George Van Antwerp 1 Comment

I was thinking about Google’s SMS service earlier today (see post on this).  Separately, I was thinking about my post on remembering health information (e.g., drugs, strength, previous lab values).

So I went to one of the Google Health Blogs to suggest the idea.  Unfortunately, the e-mail they list bounces back and you can’t leave comments…strange.  Why not combine the two comments from my earlier blogs was my suggestion?  Obviously, it only appeals to a piece of the population, but I would love to be able to text message my PHR (Personal Health Record) with “Rx name, strength” or “PCP name, phone” or “HCL scores and dates”.  [Look at myPHR, iHealthRecord, ActiveHealth, Microsoft, or Google for PHR solutions.]

It is always so difficult to remember that information, but if I could get it texted to me in a few seconds, it would be great.  I have to believe there is some unique code in my Blackberry that could serve as a unique identifier for security purposes.  Just a thought…

BTW – If you try to find Google blogs on health, you find out there are dozens of Google blogs:

“There’s all this hubub about what Google and Microsoft are doing,” Aetna CEO Ron Williams (pictured) said this afternoon on a visit to Health Blog HQ. “We’re perplexed by the fact that their vaporware gets all this attention and we get very little.” (comment on the WSJ Health Blog)

Don’t forget to add this blog to your reader or sign up for e-mail updates whenever a new entry is posted. 

Business Tools, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy, Software, Technology, Weblogs

New (to me) Blog – Consumer Focused Care

November 19, 2007 by George Van Antwerp 1 Comment

I found a new blog this morning called Consumer-Focused Healthcare written by an ex-McKinsey consultant which seems to have a very similar focus to my blog – “refocusing healthcare on serving consumer needs“.  [As a sidenote, the benefit here of LinkedIn was that I could quickly look him up and see that we have a mutual friend which instantly gives him some validation.]

Vijay has a lot of posts that I liked.  Here are a few exerpts:

  1. “the consumer often pays MORE for a visit to a retail clinic than a physician’s office. The implications are that they really prize the convenience and time taken far over the extra training provided by the physicians.”  In this blog entry, he shared some data about out-of-pocket expenses for clinic visits.
  2. “It is pretty clear that many doctors don’t know how to tell their patients that they have no idea”  In this blog entry, he talks about the inexact aspects of patient advice.  Determining a diagnosis or the right advice is very situational.
  3. “why are people willing to spend $3.50/ pill on sleep meds when they’re discouraged by $10 co-pays to take other, potentially life-saving medication?”  In this entry, he talks about consumerism.
  4. He also points out an assumption from Google that technology will push physicians to spend less time with patients which I think isn’t logical based on the work I did around e-prescribing.  I already put a comment in this blog entry this morning.

And, these are just his most recent entries.  I am interested to flow his blog more.

Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, Research, Technology, Weblogs

Tonik Health Insurance

November 18, 2007 by George Van Antwerp 2 Comments

I always smile when people ask about using SMS (or text) messaging to communicate with patients. Interesting. Perhaps even “cool”, but not real practical. You have limited message length. You have to have cell phones for people, and with all the privacy issues, can you control it.  There are a lot more opportunities to communicate better with patients than use SMS.

So, I was intrigued to find out about Tonik Health Insurance which is an offering by Wellpoint for the Generation X or Generation Y population. If you go to the site, you will see things like:

  • Edgy graphics
  • Slang / informal language (e.g., “Tonik offers three straight-up affordable health insurance plans to cover your A-Z“
  • At one point, the site mentions Borat (not typical in a healthcare website)

I don’t know much about it, but it seems very interesting.  I am a little surprised to see it offered by such a mainstream company.
I even came across a publication called “NOT ur parents’ healthcare anymore: The 411 on selling health via new media” which is a 35-story report on targeting this young population. I have not read the report, but it sounds interesting. (Order Here)

Consumerism, Healthcare, Managed Care, Marketing / Communications
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