May 12, 2011 
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I love infographics so I’m sharing this. I personally don’t know anything that thinks social media is a fad. I think there is lots of debate about its proper use in different types of businesses especially in patient care, but I think it’s proven it’s here to stay in some form.
May 5, 2011 1 Comment
One question I frequently get is “what should I know about adherence”. This is then followed by “so what should I do about it”.
Here’s my starter list of what you need to understand about medication adherence.
May 5, 2011 0 Comments
Here’s a great simple picture of the drop off rates for medication adherence from Medco.
May 3, 2011 0 Comments
In case you (or me) need another reason to lose weight…A study in Surgery for Obesity and Related Diseases showed improvements in scores for recall and attention after patients lost weight with bariatric surgery.
Why would body weight have anything to do with brain function? It turns out that obesity works on a number of different metabolic pathways that can affect the way we process information. “Obesity affects a number of physiological mechanisms that can have an adverse effect on the brain,” says [John] Gunstad. “Hypertension, Type 2 diabetes, sleep apnea, all of which are consequences of being overweight, are all bad for the brain.” (source)
May 3, 2011 0 Comments
One of the big questions I’m often asked is how automated calls can impact Medication Possession Ratio (MPR). This is both a technology question, but also a messaging question. I was happy when I recalled this image from an Express Scripts investor presentation.
April 26, 2011 3 Comments
Drug abuse has been an issue for years. I think the advertisement on TV that has a drug dealer talking about getting less calls makes a point that I hear more and more – patients selling their prescription drugs to make money. Some of this is intentional, but some of this is opportunistic. You don’t have to go far to hear about seniors being arrested for selling their prescriptions to make money to pay bills (recent article).
And, recreational use or overuse of controlled substances is a growing problem.
“Unintentional drug overdose is a growing epidemic in the U.S. and is now the leading cause of injury death in 17 states,” Center for Disease Control Director Dr. Thomas Frieden was quoted as saying in a statement from the White House’s Office of National Drug Control Policy. (source)
There are lots of stories about kids using prescriptions drugs for ADHD recreationally to help them study. There has probably been a switch over the years from stealing liquor from parents liquor cabinet to borrowing a few of their prescriptions (see story on 5 drugs kids steal most often). It’s a scary thought. (Or, this article says that 20% of the time adults are asking kids if they can use their ADHD medicine.)
The Partnership For a Drug-Free America‘s latest survey has 61 percent of teens reporting prescription drugs are easier to get than illegal drugs, up significantly from 56 percent in 2005. And 41 percent of teens mistakenly believe abuse of medicines is less dangerous than abuse of illegal street drugs.
April 25, 2011 0 Comments
The American Customer Satisfaction Index (ACSI) is out with their new data.
One area they track is providers. In that group, satisfaction has generally continued to rise over the past 15 years Here’s what they found:
– patient satisfaction is 78.4 overall
– satisfaction for ambulatory care including visits to MDs and dentists is 80
– ER satisfaction is a drag on the sector at 72 which is up 13%
“Improvements in ER wait times and the quality of inpatient care, combined with a trend toward more outpatient treatments and shorter hospital stays, appear to have contributed to a better overall experience for patients.”
April 22, 2011 0 Comments
One of the big tools that PBMs use to manage drug trend and improve generic fill rate is step therapy. Another one is therapeutic substitution. Both of them rely upon the patient to change medications.
Based on a study published last year, one of the issues identified for adherence was the patient’s belief or trust in their physician. Switching medications (I.e., trial and error) was viewed as eroding that trust.
It creates an interesting question about these tools. Do they erode trust? Do they impact adherence? I think the standard perception would be that lower cost medications would improve adherence. I know research by Shrank has shown that starting on generics leads to better MPR. Is that true for patients that start on a brand and move to a generic?
On the other hand, the research points to the need for the physician to explain to the patient about the plan for care which might include “trial and error”. Certainly personalized medicine may change this need in the long-term, but in the interim, does this create a chance for PBMs to support MDs in a new way by providing this context to the patient?
More questions here than anwers, but an interesting topic.
Patient Educ Couns. 2010 Jul 30.
“Practicing medicine”: Patient perceptions of physician communication and the process of prescription.
Ledford CJ, Villagran MM, Kreps GL, Zhao X, McHorney C, Weathers M, Keefe B.
George Mason University, Fairfax, VA, USA.Abstract
OBJECTIVE: This study explores patient perceptions of physician communication regarding prescription medications and develops a theory of the effects of perceived physician communication on the patient decision-making process of medication taking.METHODS: Using a grounded theory approach, this study systematically analyzed patient narratives of communication with physicians regarding prescription medications and the patient’s resulting medication taking and adherence behavior.
RESULTS: Participants described concern about side effects, lack of perceived need for medications, and healthcare system factors as barriers to medication adherence. Overall, participants seemed to assess the utility of communication about these issues based on their perceptions of their physician as the source of the message.
CONCLUSION: The theory generated here includes patient assessments of their physician’s credibility (trustworthiness and expertise) as a critical influence in how chronically-ill patients process information about the need for prescribed therapy. Trial and error to find appropriate medications seemed to deteriorate patients’ perceptions of their physicians’ credibility.
PRACTICE IMPLICATIONS: A practical application of this theory is the recommendation for physicians to increase perceived expertise by clearly outlining treatment processes at the outset of treatment, presenting efficacy and timeline expectations for finding appropriate medications.
April 21, 2011 1 Comment
I’m not really sure if this surprises anyone, but it seems to be making news. Generics drug prices increase much slower than brand drug prices, and with the huge increase in GFR over the past 5-10 years, trend has slowed down.
The total 2010 spend on prescriptions was $307B. This was up just 2.3% from 2009.
The interesting point in this recent data from IMS is that the utilization growth rate for Rxs has slowed to historically low levels also.
One might attribute some of this to saturation although I think we’re far from that. Others might see a backlash against medicine and a search for more natural remedies. But, the key fact that they talk about is the drop in MD visits which can certainly be correlated to the economy. In 2010, there were 1.54B office visits…a decline of 4.2%.
“Pharmacies filled 0.5 percent fewer prescriptions in 2010 than in 2009 for pills, capsules and nasal spray medications — about 60 percent of total spending on medications. For medicines that are injected or infused, total volume rose even less, just 0.2 percent.”
April 19, 2011 1 Comment
While I didn’t get to meet Victor at the World Healthcare Congress in DC, I got a chance to do a phone interview with him last week. For those of you that don’t know who he is, here’s a quick bio:
| Victor J. Strecher, PhD, MPH Professor, Health Behavior & Health Education; Director, Health Media Research Laboratory; Director, Cancer Prevention and Control, University of Michigan School of Public Health; Chairman & Founder, HealthMedia, Inc. |
| Dr. Victor J. Strecher graduated in 1983 with an M.P.H. and Ph.D. in Health Behavior & Health Education from the University of Michigan. After positions as Assistant and Associate Professor in the School of Public Health at the University of North Carolina, Dr. Strecher moved back to the University of Michigan, where he became Professor of Health Behavior & Health Education and Director of Cancer Prevention and Control in the University of Michigan’s Comprehensive Cancer Center.
Dr. Strecher also founded the University of Michigan’s Center for Health Communications Research (CHCR): a multidisciplinary team of behavioral scientists, physicians, computer engineers, instructional designers, graphic artists, and students from a wide variety of disciplines. For over a decade, Dr. Strecher’s center has conducted research studies and demonstration projects of computer-tailoring and interactive multimedia programs. In 1998, Dr. Strecher founded HealthMedia, Inc.– a company designed to create interactive health communications solutions for medical care, employer, pharmaceutical, and government settings. The intention of HealthMedia, Inc. is to bring the highest quality science, operational capabilities and creativity to the marketplace. |
My key takeaways from the conversation were:
Intrigued? You should be. Dr. Strecher was a fascinating person to talk with (see some of his insights). We only spent 30 minutes together, but I could easily imagine sitting with him in at my alma mater (University of Michigan) and talking for hours about healthcare communications and how this can impact the country and our outcomes.
We started off by talking about the shift in focus to the consumer over the past decade and how even while this has happened we (healthcare companies) have been guilty of seeing the patient from our perspective not from their perspective. This took us down the path of talking about motivation and what gets people to take action. We focused on the fact that health (in and of itself) isn’t a big motivator, but being healthy to see your kids or grandkids certainly is. We talked about how financial rewards aren’t the right (or only answer) and how there is a need to really understand and articulate intrinsic motives (see write-up on Drive by Daniel Pink).
We talked about his company HealthMedia (owned by Johnson & Johnson) and what they do to collect information on motivation. We talked about the use of stories (a topic that keeps coming up) and providing the right amount of help at the right time. He talked about how HealthMedia monitors consumers, provides them with coaching, and continuously evaluates their goals. He also talked about how they use online technology and mobile technology to get the right connection at the right time.
This led us into a discussion about how important behavior is in health outcomes. He mentioned that 70% of cancers are related to behavior – scary. But, at the same time, we don’t chose candidates for medical school based on their abilities to engage patients or show empathy. We choose them based on their organic chemistry scores. (As a physician, he could say that while I’d probably get tomatoes thrown at me for that comment.)
At this point, I really wanted to understand what HealthMedia has learned to get people off the couch and engaged. It all sounded a little too theoretical to me. He talked about their core process:
But, one of the keys in getting them to engage is to work through their intermediaries – employers and payers. For example, while you might encourage consumers to take an HRA for a financial reward, you may need a “health champion” at the employer site to really motivate people at a personal level. Or in another example, he talked about how Kaiser uses Epic and how HealthMedia integrates there. This creates an opportunity for “information therapy” which can be given to the consumer as a follow-up action from their encounter.
We went on to talk about social media which is one of those big topics in healthcare today. Obviously, there is lots of research that talks about the “peer pressure” effect on weight and smoking and other topics. (He mentioned the book Connected here.) But, how to you build trust (see recent post on this) and route consumers to the relevant information. He brought up a concept which was new to me called “collaborative filtering”. My interpretation of this is essentially having an expert monitor and guide consumers to relevant information within the social media realm. You want to find relevance in the data which means it has to be from “friends” who have experience with the topic.
I was asking him about the challenge of building trust given how many companies are out there and the amount of information which consumers are bombarded with. This is when he created the great visual of most companies as being hitchhikers in the behavior change world while others like PBMs are tollbooths. The tollbooths create a pause in the process which is triggered around an event. This event is an opportunity to get the consumer engaged. Of course, in general, these “golden moments” (my phrase) aren’t taken advantage of as much as they could be.
But, if they were, consumers would understand what they want and how a particular behavior maps to those desires. This would lead to improvements in adherence and other outcomes.
We wrapped up by talking about preference-based marketing and the impact of choice. He had some great points here which is an area of interest for me since there’s not much research. He pointed out that choice is instrumental since it appeals to autonomy. BUT, not everyone wants autonomy. Too much choice can be overwhelming. In summary, he suggested that less choice is best early on when the consumer is overwhelmed (e.g., newly diagnosed), but as they become more of an engaged patient over time, more choice is better.
April 14, 2011 0 Comments
The new CVS Caremark Insights 2011 report (Drug Trend Report) is out. I haven’t read it yet, but here’s the summary from the press release:
“The continuing increase in the use of expensive specialty drugs, as well as the growing prevalence of chronic disease, calls for innovative health care solutions such as an integrated pharmacy home to help patients deal with complex therapy regimens and stay adherent,” says Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark. “Developing a pharmacy home was one of the recommendations raised by our recent research conducted with Harvard Medical School and Brigham & Women’s Hospital. That work and this report make it clear we must devise better ways to serve the chronically ill. This trend report shows we are making headway in that fight.”
April 11, 2011 2 Comments
As I’ve talked about in the past, after working on the Express Scripts Drug Trend Report (recent copy here), I really enjoy getting the chance to read through them every year (see 2009 review or 2008 review). Over time, they’ve become less about the clinical side of the business and more about the programs used to engage the consumer with consolidated class specific data still included.
This year’s report is similar, but it is built around a new study that Express Scripts just completed with Harris Interactive. It comes to a rather surprising but interesting conclusion –
We discovered that the majority of people want to engage in the same behaviors plan sponsors seek to promote, but these desires often remain dormant. That is, there is a persistent intent–behavior gap. The key is structuring interventions that close the gap between what patients already want and what they actually do.
What’s the key point here? The point is that this says that consumers really want to move to generics and move to mail order, but they don’t do it. Is it that simple? I’d love to think so. And, for generics and mail order, I’m more likely to believe that inertia is a large factor. BUT, as I’ve talked about before, adherence has lots of complicating dimensions.
They focus on the gap between the physician and the optimal outcomes. This is certainly a major factor, but beyond consumer intent, there are issues of health literacy and physician beliefs that have to be addressed. Regardless, the point is correct…how do we engage and motivate consumers to change behavior especially if they are pre-disposed to change (when presented with the right facts).
They did continue to build on last year’s focus on WASTE. They estimate that the waste in 2010 was over $403B as broken down below:
As adherence is a key issue here, they highlight the difference in adherence rates between retail pharmacy and mail pharmacy.
The focus of the report and the early press I’ve seen has been on the following chart. What it shows is some of the data from the Harris study saying that 82% of people would chose a generic (that are on a brand) and (depending on copay savings) 55-71% would chose retail.
One topic that I was glad was in the survey was limited networks. This is a topic everyone’s talking about from ReStat to Wal-Mart to Walgreens to CVS. Here’s what the research said with some explanation for what it means:
Of note is that about 40% said they would be willing to switch retail pharmacies to save their plan (or employer, or country) money. This fi gure is not as low as it fi rst appears because before a plan implements a more narrow retail network, a large fraction of members already use these pharmacies and therefore don’t have to switch pharmacies. It is not unusual, for example, for a client using a broad network to have 70% of prescriptions processed through pharmacies that are in the narrow network; members currently using these pharmacies do not have to make any changes. When a narrow network is implemented, if 40% of the users of the remaining 30% of prescriptions would willingly move to a lower-cost network pharmacy (as suggested by the survey), we estimate that the resulting overall market share within the narrow network would rise to 82% {70 % + (30% x 40%)}. (page 14 of the DTR)
All of this tees up their family of “Select” offerings (see Consumerology page) which builds on the success of Select Home Delivery and applies the concept of “Choice Architecture” from the book Nudge.
They talk about some of their work with adherence and their Adherence IndexSM. This metric is certainly one that has the industry’s attention as people wonder about the predictive value, how this is used, and how to craft solutions around such an index. My perception has been looking at studies like this one by Shrank and colleagues that past behavior remains the best predictor of future behavior, but I’m happy to be wrong.
So…what were the trend numbers?
One of the other lists that I always find helpful to have is what are the top 15 drug classes and the PMPY spend.
Of course, in today’s world, you really want to know this for specialty medications:
So, as always, I would recommend you read the report. Lots of great information in here. Interesting research. Good thoughts on consumer behavior and how to change it.
I think this week is their Outcomes conference which was always a good event.
April 10, 2011 0 Comments
Are people who travel in town cars and on corporate jets different—on a psychological level—from you and me? Does the availability of luxury goods “prime” individuals to be less concerned about or considerate toward others? The answer from new research seems to be yes.
It’s an interesting question with relevance for us in healthcare. Does the environment in which we work and make decisions impact our decisions? Is that true for day-to-day work? For conferences? For delivery of care?
In general, I believe most of us that work in healthcare are passionate about improving outcomes. We want to understand how people make decisions. We want to understand why things happen. This isn’t just a job. Given that, these types of studies are important as we think about healthcare communications. What types of images should we use in our print media, web, and e-mail?
It also makes me wonder about verbal queues or sonic branding. Can certain words or noises make us more or less likely to make choices that are in the best interest of the group. For example, if we framed decisions as savings money which would be provided to a charity would more people respond to take that action (e.g., moving to a generic drug) than if we framed it as saving money for the company and therefore allowing more earnings-per-share (EPS).
“people who were made to think about luxury prior to a decision-making task have a higher tendency to endorse self-interested decisions that might potentially harm others.” (HBS professor Roy Y.J. Chua on what they found in their research)
April 9, 2011 0 Comments
Adherence is one of the primary topics of discussion today both within pharmacy and (after reform) within other areas of healthcare. Adherence drives costs. Adherence impacts productivity. And, with a few rare exceptions (CBO type budget analysis looking only at fiscal year returns), everyone’s interests are aligned on the value of improving adherence.
For now, let’s skip over the traditional pharmacy market which is rapidly becoming generic. Let’s look at specialty where the average cost is $1,800 per month and can run into the $10,000’s.
So, what if I told you there were simple solutions that could improve your monthly refill rate on your drugs by 20-40%? What if that also reduced the gaps-in-care and improved patient awareness of their condition? What if that also incorporated a feedback mechanism to the care team?
How much would that we worth? What about all that for $2 / month per member? Much less that copay waivers or many other solutions out there on the market.
Sound interesting…Go learn more at Silverlink.
April 6, 2011 1 Comment
The new report is out. I haven’t read it yet, but here’s the teaser graphic from the website.
April 6, 2011 1 Comment
While I was at the World Healthcare Congress yesterday, I had the opportunity to go into DC to visit the new Kaiser Center for Total Health. This is their showcase in the East to facilitate discussions around improving healthcare. It’s not a replacement for the Garfield facility in CA, but it will create an more accessible forum for dialog with policymakers and international visitors. (NYTimes post about the opening)
It’s one of those fun places where you can go and interact with technology. It’s full of technology like telemedicine and telemonitoring. It provides you with demos of the world’s smallest ultrasound device and connected devices. It showcases Kaiser’s rich history and their MyHealthManager tool.
Their online tools have some great stats:
There are a lot of videos where you can hear employees, members, clinicians, and others talk about what they think “total health” is. And, they have a massive interactive mural about their walking initiative.
It seems like this type of interactive, high technology space is becoming an asset at several companies. We used to have this innovative, brainstorming space at E&Y years ago and clients loved it. I believe IDEO has this type of space.
I enjoy it. It’s interesting, inspiring, and creates a dynamic work environment. I look forward to see how this space gets used and what others think.
April 5, 2011 0 Comments
I had the opportunity to sit down with Dr. David Wennberg (Chief Science & Product Officer, Health Dialog) at the 8th Annual World Healthcare Congress (Twitter hashtag #WHCC11). David is a fascinating and engaging speaker. He has lots of publications, works with the Dartmouth Atlas, and leads the Health Dialog Analytic Solutions group.
David and I began our time talking about “informed choice”.
In this environment, doctors need tools that identify patients lacking evidence-based care. They also need to ensure that patients undergoing surgery have been exposed to informed choice, not just informed consent, when there is more than one legitimate treatment path. With these resources in place, physician groups can ensure that they are in control of their own destiny when it comes to performance evaluations. (source)
This is an important issue in healthcare. Giving patients (1) complete information in (2) language that they can understand and helping them (3) frame their options relative to their preferences is at the core of this issue.
Health Dialog calls this Shared Decision Making and focuses on how to engage targeted consumers and help them make their best decision. Their customer support personnel go through a certification process and use decision aids to enable the process.
This led us into a discussion about “trust” (see prior post) and then into a discussion about “embodied conversational agents“. Obviously, if you’re going to help consumers make decisions, they need to trust you. We talked about the need to have transparency, the need to for disclosure, and the importance of using clinicians in the engagement and discussion process. In many cases, nurses and the empathy that they have are critical to this process.
But, I know from prior exposure to Health Dialog that they have figured out ways to blend technology and agents. They do a lot with data and analytics to really understand the popluation. They’ve worked hard to avoid the traps that “disease management” has fallen into over the years. He shared with me some amazing engagement statistics.
We talked about the value of peer-to-peer videos for people to understand their condition and talked about some recent studies around storytelling and distributing that information via DVD to patients (see more on study). We went on to talk about how engaging the consumer in the decisions about their care increase success, but that many models have been a challenge to scale. Health Dialog just published an article in the NEJM called A Randomized Trial of a Telephone Care-Management Strategy which demonstrated an ability to scale the solution and get results.
At baseline, medical costs and resource utilization were similar in the two groups. After 12 months, 10.4% of the enhanced-support group and 3.7% of the usual-support group received the telephone intervention. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% ($7.96) lower than those in the usual-support group ($213.82 vs. $221.78, P=0.05); a 10.1% reduction in annual hospital admissions (P<0.001) accounted for the majority of savings. The cost of this intervention program was less than $2.00 per person per month.
Before I could even jump to my next question about ACOs, he made the natural transition to the fact that the new ACO regulations mention shared decision making 8 times. I believe we both agreed that whatever actual form these new practice settings take that they will accelerate the importance of leveraging technology and things like shared decision making to engage the consumer. The key is to leverage the PCP setting whether it’s the MD or someone on their staff as the foundation for engagement.
This led me to ask him about physician acceptance of technology as part of their practice (more on this later). He felt that they had moved from resistance to understanding the technology and “guides” can enable them to practice better medicine.
April 5, 2011 0 Comments
I remember when I first played Wii Boxing and was sweating like I just went for a lite run. It made me believe that there was something about using games to get kids to exercise even if they weren’t playing outside (which is ideal).
A new study published in the Archives of Pediatrics & Adolescent Medicine confirms this. I guess the category is formally called “exergames”, but they looked at several games including (with their Metabolic Equivalent Task value):
Here’s the summary:
[the researchers] found the games “compared favorably with walking on a treadmill at three miles per hour, with four out of the six activities resulting in higher energy expenditure”
April 4, 2011 0 Comments
In 2010, only 30% of the specialty drugs were oral solids or eye drops. 65% required clinical administration. Only one was a self-injectable drug. (Summary data and chart below c/o BioPharmRx Consulting.)
This is important since it changes the PBM and pharmacy paradigm as we know it. If increasingly specialty drug spend is managed by the PBM, this creates a greater need for a relationship between the PBM and/or the pharmacy and the provider. Or, it requires infusion services as several specialty companies provide.
It’s expected that this trend will continue, and specialty will quickly become the focus in the payer world (from a pharmacy management perspective). You’ll have low cost generic drugs for most common conditions and high cost biologics for the more rare conditions.
I’ve heard several projections now that specialty will move from ~15% of spend today to about 40% of spend in the next 5 years (from a PBM perspective). You combine that with generics making up 80-90% of all non-specialty prescriptions in that timeframe, and you have a very different world.
On a related note…Will that change the manufacturer to PBM relationship? Maybe. I personally believe that the PBMs will get closer to the pharmaceutical manufacturers in the specialty space like they used to be with the manufacturers when branded drugs were the majority of prescription drug spend. Given the detailers (i.e., feet on the street) that the manufacturers have versus very small academic detailing teams or even the provider relations teams that payers have, there will be a need to figure out how to interact with the physician in new ways. And, with the cost of these drugs averaging $1,800 per month and running into the $100,000s, there is a lot more money to be spent on supporting the patient.
April 1, 2011 1 Comment
I’m sharing a few quotes from the recent Drug Benefits News on generics here:
“Despite the fact that generics use has long been mainstream, a recent survey we conducted found nearly one-third of Americans still do not know or believe that generics have the same active ingredients and effectiveness as brand name drugs,” Brian Solow, M.D., senior medical director for clinical services at Prescription Solutions, the PBM subsidiary of UnitedHealth Group
It would be interesting to look at that data based on age, gender, number of prescriptions used, physician, geography, and several other factors. That 1/3rd is similar to what I’ve seen in terms of skeptical physicians which would then make a lot of sense as patients of those physicians would be skeptical of generics.
“We are advocating an increase in the differential between generic and brand name copays,” David Lassen, Chief Clinical Officer at Prime Therapeutics LLC says. “Right now the average differential between Tier 1 generics and Tier 2 preferred brands is about $15. We think this difference should be bigger. We’ve seen research suggesting consumers need to save an average of $25 in order to select a generic over a brand name drug.”
An interesting point on copay differentials that a friend of mine recently made is what is the actual differential after grandfathering and formulary overrides which happen.
April 1, 2011 1 Comment
I was at a presentation recently where a Chief Medical Officer from one of the PBMs was talking about a survey they did on statin users and why they didn’t refill. Amazingly, he said that 21% of people said they thought they were cured after the first fill. Talk about a problem.
This data reminds me of a barrier survey from a statin adherence program that we did where 37% said they didn’t know they were supposed to refill their medication.
This topic then reminded me of a study that was published in the Archives of Internal Medicine in 2006 which looked at the frequency with which physicians did certain things when talking with patients. So, how often did they explain the duration of therapy to the patients – 34%!
Sometimes, we spend so much time trying to solve the complexities of adherence when there are baseline activities which can make a huge difference.
March 31, 2011 3 Comments
Trust improves medical outcomes. It is the number one predictor of loyalty to a physician’s practice. Patients who trust their doctors are more likely to follow treatment protocols and are more likely to succeed in their efforts to change behavior. (Introduction of The Trust Prescription)
I just finished reading The Trust Prescription For Healthcare by David Shore. I would recommend it. It definitely framed things in a differently light. I also had a chance to talk with David on the phone and pick his brain a little. He sounds like a great speaker, and I’m looking forward to his new book coming out around building trust as an intermediary (i.e., managed care company or PBM).
A few of my highlights from the book are:
Communication in healthcare typically runs into a series of obstacles related to listening, clarity, and confidence.
Some of the interesting research data was [noting that this was a book from 2005]:
It book made me think of some interesting questions:
One key point to pull out that he makes is that
Without branding, healthcare becomes a retail industry, and in retail, as in residential real estate, the three most important factors are location, location, and location.
March 29, 2011 0 Comments
To me, this survey has three major themes:
Some of the data:
March 29, 2011 0 Comments
Social media as hazardous to your health! Talk about a nice counterintuitive report. I think we all worry about our kids spending too much time online and not getting enough exercise, but what about “Facebook depression”, cyberbulling, and sexting…not to mention age-inappropriate material?
In yesterday’s USA Today, there’s an article about how social media can enrich children’s lives but can also be hazardous to their mental and physical health. It’s focused on a report by the American Academy of Pediatricians, but I think this also builds on the Kaiser report out earlier this year about the amount of time kids spend in front of electronic media – 7.5 hours PER DAY.
because tweens and teens have a limited capacity for self-regulation and are susceptible to peer pressure, they are at some risk as they engage in and experiment with social media, according to the report. They can find themselves on sites and in situations that are not age-appropriate, and research suggests that the content of some social media sites can influence youth to engage in risky behaviors. In addition, social media provides venues for cyberbullying and sexting, among other dangers. Youth who are more at-risk offline tend to also be more at-risk online.
Interesting. Do you agree?
March 28, 2011 1 Comment
It’s interesting but irrelevant that CMS is now proposing that Part D plans can treat generic samples similar to OTC drugs. Who cares?
Why do I say that?
At Express Scripts, I ran a program for a year. We hired pharmaceutical representatives to detail doctors. We bought generic drugs and repackaged them. And, we tracked GFR (generic fill rate) in the six categories for a year.
Guess what?
In most cases, the GFR for the doctors with the samples barely exceeded the GFR for the doctors without the samples. In one category, it was even lower. The GFR was going up too fast in the general market. If you add in the costs, it was a money loser.
We even compared our GFR in certain geographies to the published statistics from another company doing generic sampling…our clients GFR without samples was going up faster than their GFR with samples.
If you want to give away free drugs as a “gift” to make your academic detailing program more effective, have at it, but lets keep reality in mind here. This is not going to make a difference. All it’s going to do is drive up administrative costs for PDP plans.
March 26, 2011 0 Comments
I was reading a book about trust which pointed out the concept of “remembered wellness“. This concept is similar to the “placebo effect” in that it shows that patients who trust their physicians and their course of therapy are more likely to have better outcomes (e.g., HIV study). WOW!!
I’ve talked before about the gap that exists when patients leave their physician’s office with a new diagnosis and we all know that health literacy is a big issue.
So…what are you doing to address this? I’ve been talking a lot lately about “primary adherence” (i.e., getting people to start therapy) and about engaging patients when they first get a new prescription or a new diagnosis. This concept of trust only makes this a more pressing issue.
Here’s your worse case scenario:
How can you step in here?
But, the point here is that you need to be doing something that reinforces the decision to manage the therapy and help them to understand and believe in that course of treatment. If they don’t believe and have trust, they are less likely to get to a successful outcome.
March 24, 2011 1 Comment
I found this test in Money Magazine (Sept 2010) interesting especially when you dig into the research behind the questions and the scoring.
So, this may be neither hear nor there, but I’m fascinated by tests like this as they are data that can be used to predict and segment people from a communication perspective. Understanding their behavior within sub-segments is critical in understanding why they act or don’t act.
March 24, 2011 0 Comments
Understanding how top performers achieve excellence is the first step to becoming a Customer Service Champion. The rest is up to you.
This is the statement by Gary Tucker, SVP, J.D. Power & Associates at the beginning of their publication Achieving Excellence in Customer Service from February 2011.
If you’ve never read their reports, you should understand that they look at five areas – people, presentation, price, product, and process. Interestingly, they use several examples from pharmacy to make their points about these five categories:
Another interesting thing they look at is whether the gap between high performing and low performing company has increased or decreased over time. In the product industries, the gap has decreased due in many ways to quality improvements. In the service industries, the gap has increased…WHY?
First, advances in technology have created new expectations among customers, resulting in new challenges for services. For instance, customers expect multi-channel service delivery and expect to choose whether to interact with their service provider in person, via the phone or e-mail, through online chat, or via Web-based self-service, among others. More challenging is that they expect the same level of service across communication channels. With ever-improving technology, it has been difficult for companies to keep all systems up to date and to remain equally effective in each.
They are preaching to the choir here. This is exactly what I tell clients all the time.
One of their examples that I’ve used for years is around the power of communications. They show satisfaction with auto insurance based on whether your premium stayed the same or increased. For those that it increased, they look at whether you were pro-actively informed and whether you had the option to discuss it. What group do you think had the highest satisfaction?
Worried about satisfaction or churn? Have lots of changes to plan design? Here’s why you communicate.
In this report, they call out 40 companies as exceptional out of the 800 that were ranked. 7 of those 40 were pharmacies:
March 22, 2011 5 Comments
I think it’s a fascinating question that was raised around Actos. Here’s the text about a wool.labs report:
In this month’s report on social media’s influence in the world of diabetes, wool.labs presents an analysis of social media conversations beginning as far back as 2002 and continuing to the present, noting a significant shift in patient attitude toward the drug.
Early on, the presenting side effects such as weight gain and edema drew concerns and warnings from some patients. Some questioned whether the drug should be used in combination with insulin. But even while the debate raged on, wool.labs’ analysis showed the conversation could have been shifted had drugmaker Takeda meaningfully interceded before 2006 when comments about the drug began to turn sarcastic, and before long, angry and hostile.
There are enough tools and companies out there that IMHO companies (and brands) should be able to actively manage social media sites to understand what consumers think. I don’t know this case specifically so I won’t comment on it, but certainly, companies need to have a robust Voice of the Customer process by which they understand what consumers think of them. And, if it avoids future litigation, leads to add-on products, or even helps re-position a current product, this mechanism can be very valuable.
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Contact me at gvanantwerp @ mac.com.
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