March 6, 2009 
2 Comments
According to Ethnologue, there are 6,912 languages in the world. Lots of these are at risk of being lost. It is estimated that one “disappears” every two weeks as the last person who can speak the language dies.
The Living Tongue Institute for Endangered Languages is rapidly trying to capture and document them before they disappear.
February 25, 2009 1 Comment
I am finally getting around to writing this up. I mentioned the book – Buyology – a few weeks ago. It is definitely the best book I have read this year. It is by Martin Lindstrom and is all about neuromarketing.
For those of you that don’t think it’s relevant to healthcare, think again. Healthcare is all about compelling individuals to take action and become responsible for their health. That is about understanding how they interpret information and what drives them.
Here are some of my notes from the book:
“Our irrational minds, flooded with cultural biases rooted in our tradition, upbringing, and a whole lot of other subconscious factors, assert a powerful but hidden influence over the choices we make.”
“I predict that soon, more and more companies (at least those who can afford it) will be trading in their pencils for SST caps. That traditional market research – questionnaires, surveys, focus groups, and so on – will gradually take on a smaller and smaller role, and neuromarketing will become the primary tool companies use to predict the success or failure of their products.”
Some interesting facts:
Some of the interesting companies mentioned:
I thought he had a great story about a rock. If I gave it to you for your birthday, you’d be offended until I told it was from the Berlin Wall. And then when I told you it was from the moon, you would be even more impressed.
For more information, there is also a neuroscience blog.
February 25, 2009 1 Comment
The Kaiser Family Foundation has released a report and video that they did on several families looking at their struggles to pay bills and survive.
The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security and households teetering on the financial brink, stretching to pay for basics such as food and housing and ill-equipped to cope with unexpected costs for things such as a medical emergency or a necessary home repair.
Health care costs were of particular concern, with many families forgoing doctor visits, skipping prescription medications and postponing needed care. Even those with health insurance reported delaying care in order to avoid co-payments, rising deductibles and out-of-pocket expenses for uncovered services. Despite barely being able to meet the cost of basic needs, many families did not qualify for public programs like Medicaid and the Children’s Health Insurance Program.
February 25, 2009 0 Comments
USA Today had an article earlier this week called “Doctors Take Decider Role” which is about the fact that patients are often not asked about their opinions. This is a problem on many fronts. If you’re not discussing the pros and cons, you are not as likely to buy into the recommended treatment plan leading to lower compliance.
“In the real world, people agree to take drugs, have surgery and undergo tests after a much more one-sided process, new studies show. As a result, researchers say, too many people get care they don’t want or need and miss out on options that make more sense for them.”
In a scary example, the research showed the 69% of men heard the procs of taking a blood test for prostate cancer, but only 18% heard about the downside. The research also showed that only 41% of patients were asked how they felt about taking blood pressure medications. But, this obviously varies since 76% were asked to weigh in on their back surgery.
It begs the question of how aware doctors are of patients concerns and priorities.
February 25, 2009 1 Comment
Based on IMS data, prescription growth continues to slow especially at mail order where it’s negative. Interestingly, in a report by Barclay’s Capital, they estimate that Caremark will grow mail by 10% next year, Express Scripts will lose mail scripts by about 0.5%, and Medco will only grow by 0.8%.
Medco is easy to understand since they are currently the market leader in terms of mail order penetration. The Express Scripts number requires some additional analysis. Is it due to client loss? Is mail just not growing? The Caremark growth is meaningful.
February 21, 2009 0 Comments
Anyone whose read my blog knows that I find Penelope Trunk’s insights both interesting and unique. She cuts to the chase and talks about things very directly. As always, I think you will find some of her comments about how the economy is changing our behavior interesting.
She lays out 5 items here and they talk about it being cool to be cheap and women earning more than men.
February 21, 2009 0 Comments
In recent discussions, I was talking with some clients about helping members or consumers save money in healthcare. On the one hand, you can educate them about all the different opportunities. On the other hand, you can focus them on one or two opportunities. Those could offer the most value, be the simplest to execute, be the easiest to understand, or have some other logic in prioritization.
The question in my mind was what would drive the best results. If you look at the research around consumer products and 401K’s (for example), it is clear that choice is not always best. When presented with more options, people don’t always make a decision. They get overwhelmed.
So, think about focus and simplification.
February 19, 2009 0 Comments
I don’t have anything to do with this, but it sounds pretty interesting. Medco and Regence are talking. Here is the teaser. (Click here for more info and registration.)
Personalized medicine is moving rapidly. The FDA in December considered requests to require genetic testing for the colon cancer drugs Vectibix and Erbitux. Approval of such labeling changes could pave the way for a slew of other personalized therapies and diagnostics now waiting in the wings. Stakeholders anticipate significant clinical and financial savings. Recently approved genetic testing for the blood thinner warfarin, for instance, is projected to avoid 85,000 serious bleeding events annually and save roughly $1.1 billion a year!
On the other hand, questions remain whether the model actually provides a favorable return on investment (ROI). A new study finds that genetic testing for warfarin does not appear to be cost-effective in certain patients. And health plans and PBMs are trying to sort out which of the numerous diagnostic tests on the market actually provide clinical utility and improved results. One large health plan, for example, says its costs for diagnostic testing are growing at nearly 20% a year.
So where does all of this leave Rx payers in February 2009?
February 16, 2009 0 Comments
A friend shared this video this morning with me. Very cool. This is a presentation by David Merrill from MIT about Siftables. He has integrated new technologies with our traditional building blocks to build interactive, high tech blocks that can be used for spelling, math, music, and other ideas.
Imagine the ability to use these to teach people.
February 8, 2009 0 Comments
People are always talking about where to focus to reduce costs in the US health care system…Here’s a hint from the January 2009 Health Affairs Health Policy Update:
“Now three-quarters of the $2 trillion-plus that we spend on U.S. health care each year goes to paying the bills for chronic illness: cardiovascular and pulmonary disease, cancers, diabetes, arthritis, high blood pressure, depression. Globally, the World Health Organization estimates, three out of every five deaths – four out of five in low- and middle-income countries – stem from chronic disease.”
February 7, 2009 0 Comments
You can find more out on the website, but I liked a few of their predictions for 2009+.
February 7, 2009 0 Comments
According to one article, there are about 70M registered organ donors which is a number that has increased as 31 states now allow people to register online. Considering the wait list for donations – just over 100,000 today according to The Organ Procurement and Transplantation Network – this is an important thing to consider.
Here is some of their data:
February 6, 2009 1 Comment
Since I very much believe in our capitalist society (even with all the mistakes that have taken us down this recession / depression path), I was a more than a little surprised that in a survey in yesterday’s USA Today 59% of the people surveyed thought government would do the same or better job than private health insurance companies.
February 6, 2009 0 Comments
I don’t know what the statistics were before, but these statistics published this morning in the USA Today seem high.
73% of people 40-49
And, 57% of people 50+.
With unemployment expected to come out today at 7.5% (the highest in 17 years), we shouldn’t be expected, but it certainly puts new focus on using incentives to drive healthy behaviors.
February 2, 2009 0 Comments
According to McKinsey…
McKinsey research shows that the United States spends about $650 billion more than might be expected given its level of wealth and the experience of similar countries.
Here is a chart that breaks this down in a typically McKinsey framework (which I love BTW):
February 2, 2009 1 Comment
I came across this fact the other day from Systemed Group, a division of Medco. According to the 300 health plans they surveyed, 38% of them said they will definitely (3%) or probably (35%) cover genetic testing within five years.
Interesting. What will this mean? What will these test consist of? What will they cost? How will they be used? Will they cover the drugs that are personalized based on genetic makeup?
January 29, 2009 2 Comments
Thanks to e-patient Dave’s reminder on the e-Patient blog…
Here are 7 conclusions from the white paper that came out last year on this topic. Very important in diffusing some of the myths around the role of social networking in healthcare and the use of the Internet for information.
1. e-patients have become valuable contributors, and providers should recognize them as such.
“When clinicians acknowledge and support their patients’ role in self-management … they exhibit fewer symptoms, demonstrate better outcomes, and require less professional care.”2. The art of empowering patients is trickier than we thought.
“We now know that empowering patients requires a change in their level of engagement, and in the absence of such changes, clinician-provided [information] has few, if any, positive effects.”3. We have underestimated patients’ ability to provide useful online resources.
Fabulous story of the “best of the best” web sites for mental health, as determined by a doctor in that field, without knowing who runs them. Of the sixteen sites, it turned out that 10 were produced by patients, 5 by professionals, and 1 by a bunch of artists and researchers at Xerox PARC!4. We have overestimated the hazards of imperfect online health information.
This one’s an eye-opener: in four years of looking for “death by googling,” even with a fifty-euro bounty for each reported death(!), researchers found only one possible case.* “[But] the Institute of Medicine estimates the number of hospital deaths due to medical errors at 44,000 to 98,000 annually” … [and other researchers suggest more than twice as many]
* We can only conclude, tentatively, that adopting the traditional passive patient role … may be considerably more dangerous than attempting to learn about one’s medical condition on the Internet.” (emphasis added)5. Whenever possible, healthcare should take place on the patient’s turf. (Don’t create a new platform they have to visit – take yourself wherever they’re already meeting online.)
6. Clinicians can no longer go it alone.
* Another eye-popper: “Over the past century, medical information has increased exponentially … but the capacity of the human brain has not. As Donald Lindberge, director of the National Library of Medicine, explains ‘If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
* In contrast, when you or I have a desperate medical condition, we have all the time in the world to go deep and do every bit of research we can get our hands on. Think about that. What you expect of your doctor may shift – same for your interest in “participatory medicine.”7. The most effective way to improve healthcare is to make it more collaborative.
“We cannot simply replace the old physician-centered model with a new patient-centered model… We must develop a new collaborative model that draws on the strengths of both systems. In the chapters that follow, we offer more suggestions on how we might accomplish this.”
January 28, 2009 0 Comments
I am just finishing up a book that has been a fascinating read…It’s called Buyology and is by Martin Lindstrom. I will post my notes shortly.
January 28, 2009 1 Comment
What if obesity were a virus that once you caught it you couldn’t manage it with simply diet and exercise? That would be a very discouraging fact.
Well, some recent research is finding a link between a virus and obesity and claiming just that. Of course, the primary issue is overeating especially with limited exercise, but this presents a new wrinkle in solving the obesity crisis.
So, to manage obesity, you need to sleep more and eat better. Exercise has an impact, but it may not be the best way to try to lose weight (see article).
January 13, 2009 1 Comment
I always find some great nuggets in the AIS daily news. I thought I would pass on this one from the head of pharmacy at RegenceRx.
“Unfortunately, we find that only 15% to 20% of pharmaceutical studies are reliable. Our findings are not unusual. For example, Pitkin, R. et al (JAMA. 1999; 281:1110-11) found that 18% to 68% of abstracts in six top-tier medical journals contained information not verifiable in the body of the article. To assure Regence doesn’t disregard valid studies, we request full study information from pharmaceutical manufacturers in addition to reviewed published information. Unfortunately, it’s rare for manufacturers to provide information beyond what’s in the published study.”
— Helen Sherman, Pharm.D., senior director of pharmacy services and chief pharmacy officer at The Regence Group, which operates BCBS plans in the Northwest, told AIS’s DRUG BENEFIT NEWS.
January 6, 2009 1 Comment
PBMI (Pharmacy Benefit Management Institute) put out its 14th report on employer satisfaction with their PBMs. Here are some of the highlights from the report:
Looking at the ranking of key factors:
|
Highest Ranked Function(s) |
Lowest Ranked Function(s) |
|
| Aetna | Retail pharmacy network
ID card production |
Mail service pharmacy
Disease mgmt programs |
| Argus | Retail pharmacy network
ID card production |
Formulary mgmt and rebates
Account mgmt |
| Catalyst | Retail pharmacy network
Claims processing |
Disease mgmt programs
Mail service pharmacy |
| Cigna | Account mgmt
Member services |
Delivering promised savings
Disease mgmt programs |
| CVS Caremark | Retail pharmacy network
Claims processing |
Formulary mgmt and rebates
Disease mgmt programs |
| Envision | Overall service and performance
Account mgmt |
Disease mgmt programs |
| Express Scripts | Retail pharmacy network
ID card production |
Member services
Formulary mgmt and rebates Disease mgmt programs |
| Innoviant | Formulary mgmt and rebates
Delivering promised savings |
Utilization and benefit mgmt consulting
Member website |
| Medco | Retail pharmacy network
ID card production |
Utilization and benefit mgmt consulting
Mgmt reports Disease mgmt programs |
| MedImpact | ID card production
Claims processing Retail network |
Formulary mgmt and rebates
Drug utilization mgmt Specialty pharmacy Delivery promised services |
| NMHC | Retail network
Plan implementation and changes Specialty pharmacy |
Mail service pharmacy
Disease Mgmt programs |
| Prime Therapeutics | ID card production
Retail network |
Disease Mgmt programs
Specialty pharmacy Formulary mgmt and rebates |
| Walgreens | Retail pharmacy network
Mail service pharmacy |
Mgmt reports
ID card production Member website |
| Wellpoint | Retail pharmacy network
Claims processing |
Acct mgmt
Disease mgmt programs Mgmt reports Utilization and benefit mgmt consulting |
So…my overall assessment is that it is a good report. It is limited by response and limited by the fact that there aren’t major differences between PBM scores (with a few exceptions). But, it certainly would give me some clues on what to expect, where to push, and how I should evaluate my PBM.
December 31, 2008 0 Comments
Optum Health, a part of United Healthcare, has released a book called 100 Smart Choices. It lays out tips, advice, and tools to help you take control of your health. Since 87.5% of health care costs are due to individual choices, this is a big deal.
We don’t need to create the most medicated generation, we need to find a way to eat better, exercise more, have less stress, and act preventatively.
“Individuals can feel healthier and happier, avoid unnecessary trips to the emergency room or a doctor’s office, and cut their health care expenses by tapping the information in this book,” said Dr. Michael Rosen, national medical director for OptumHealth Care Solutions and consultant on the book. “As we developed the book, we made sure that all of the content was consistent with evidence-based guidelines and assisted members in making informed health care decisions.”
December 30, 2008 0 Comments
Here are a few insights from Mercer’s Annual Survey of Employee-Sponsored Health Plans:
1 – Less than 1% of all employers have provisions where smokers pay more (but 15% of employers with over 10,000 employees have such provisions).
2 – 32% of large employers off on-site or near-site clinics. (WOW! That surprised me.)
3 – 8% of large employers have provisions preventing coverage of spouses who have other coverage.
4 – A $1,000 health plan deductible is the norm.
December 30, 2008 1 Comment
A new study that came out looked at utilization of drugs by seniors and raises the flag that people are mixing drugs with other drugs or vitamins that may put them at risk. Since pharmacists and doctors don’t always know all the things their patients are taking, it is a lot harder to catch these issues than traditional drug-drug interactions which are caught at the pharmacy.
A couple of the most common combinations that they cite are:
Warfarin, a potent prescription clot-fighting drug, was often taken with aspirin. Both increase the risk of bleeding, so the odds are even higher when both drugs are taken. The researchers said these risks also occur when warfarin is taken with garlic pills, which some studies have suggested can benefit the heart and help prevent blood clots.
Aspirin taken with over-the-counter ginkgo supplements, increasing chances for excess bleeding.
Lisinopril, a blood pressure drug, taken with potassium, which combined can cause abnormal heart rhythms. Potassium is often prescribed to restore low levels of this important mineral caused by certain blood pressure drugs.
Prescription cholesterol drugs called statins [Lipitor, Crestor, Simvastatin/Zocor] taken with over-the-counter niacin, a type of vitamin B that also lowers cholesterol. This combination increases risks for muscle damage.
December 30, 2008 0 Comments
I found this blog entry on Dr. Gupta’s blog very interesting. It talks about the fact that being mean is more likely to stick with someone and effect them than being nice. Isn’t that frustrating? Wouldn’t we all like to believe that we could make things better by being nice when all it takes is a few rude people to change that.
That’s because, it seems being inconsiderate and rude to people has a much bigger impact than being nice. A recent study, conducted at the University of Chicago Booth School of Business, found feeling slighted can have a bigger impact on how a person treats another, than being the recipient of someone’s generosity.
Working with college students who were tasked with exchanging money in an orchestrated test of taking and sharing, researchers found the young people were willing to share at beginning of the study. But when they felt they were being taken advantage of, or that their fellow students were cheating them, they became more aggressive and greedier, rather than stepping back and appreciating what they were given.
Psychologists say this is not unusual. The meaner deed has the greater impact. Give something to someone and they may appreciate it. Take it away and they’ll fight you or at least object strongly.
As the doctor says “All this anger and hostility not only leads to unhappy people, but can cause anxiety, which raises our blood pressure, and puts stress on our hearts.”
December 19, 2008 1 Comment
In looking at recent investor decks from both Medco and Express Scripts, I was surprised to find almost identical charts each claiming victory on drug trend management. Here are the two charts…you can judge for yourself.
(Express Script’s from Credit Suisse Healthcare Conference 11/13/08)
(Medco’s from 2008 Analyst Day 11/21/08)
December 18, 2008 0 Comments
The BCBS Association released a study a few months ago on Consumer Driven Care. Here is the presentation and a few highlights. In general, it appears to show that it is working to save costs and get members engaged without negative side effects of them not using needed care.
December 9, 2008 0 Comments
Earlier in the year, there was a study that showed how your friends and social network can affect your weight loss. I blogged about this and quiting smoking as part of your network earlier. Now, in Penelope Trunk’s blog, she talks about how your friends can make you happy and that happiness is linked to better health. Interesting, she also says that if you say you are happy then you get the same benefits.
“optimism, a trait shown to be associated with good physical health, less depression and mental illness, longer life and, yes, greater happiness” Time Magazine article
It brings me to two thoughts:
November 25, 2008 2 Comments
Once a drug is approved, it can be prescribed by physicians for any reason. Those reasons can include conditions that were not studied by the manufacturer in the clinical trials. And, those off-label uses are not things that can be marketed to the physican.
Some of this is controlled by prior authorizations (PAs) which require a physician to call into the managed care company or the pharmacy benefit management (PBM) company to justify the use of the medication. This is often used on high cost medications with a high percentage of off-label prescribing.
For example, it is estimated that 76% of the prescriptions writen for Seroquel are for off-lable purposes. (See article on this and other information here.) This article also lays out the top drugs that are used off-label.
November 25, 2008 0 Comments
(Getting a few things out here and off my desk)
This is a question I often wonder about. I was glad to see that e-patients put a report online. I haven’t read it yet, but I think it is something that many of you would want to know.
I think that the main issue Given hit upon in the report (but I’m not sure she recognizes as the primary challenge of doctor rating sites) is the numbers issue. With over 700,000 physicians in the U.S., a ratings database of 10,000 or even 20,000 is pitifully and woefully small.
WSJ Health Blog Drug Channels KevinMD Blog Health Populi e-Patients
Contact me at gvanantwerp @ mac.com.
Enabling Healthy Decisions 