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Should You Care That Obesity Is Now A Disease?

The AMA has opened an interesting discussion in the past few days with their decision to recognize obesity as a disease.  On the one hand, we all know obesity is a problem that’s impacting our overall health and productivity across the world.  On the flip side, will this actually change anything?

Key discussion points:

  • What is a disease?
  • Is BMI a good metric to use?  If not, what should be used to measure obesity – waist?
  • How do you treat it?

Here’s a few quotes from some articles:

“Right now, physicians will treat high blood pressure, diabetes, give patients medications and say, ‘Oh you also need to lose weight,’” Khaitan told FoxNews.com. “I think (this) gives the physicians a little more credibility in pushing patients to address obesity and become healthier. It’s recognized as a disease…not just something that (because) you have poor lifestyle habits, this is your problem.”  (Fox News)

Obesity is not just a health risk but a disease. Estimates of the genetic contribution to weight gain in susceptible families range from 25—40% with a greater heritability for abdominal fat distribution of 50%1>2.  Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the disease category.  (British Medical Bulletin 1997)

“The American Medical Association’s recognition that obesity is a disease carries a lot of clout,” says Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. “The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity.”  (USA Today)

Telling all obese people that they have a disease could end up reducing their sense of control over their ability to change their diet and exercise patterns. As experience with addictions has shown, giving people the sense that they suffer from a disease that is out of their control can become self-defeating. So the disease label should be used sparingly: just as not all drinking is alcoholism, not all overeating is pathological. (Time)

Here’s a few facts from the Obesity Action Coalition:

  • In the United States, it is estimated that 93 million Americans are affected by obesity.
  • Individuals affected by obesity are at a higher risk for impaired mobility and experience a negative social stigma commonly associated with obesity.
  • Socioeconomic status plays a significant role in obesity. Low-income minority populations tend to experience obesity at higher rate and are more likely to be overweight.
  • In 2001, the states with the top five percentages for obesity were Mississippi, West Virginia, Michigan, Kentucky and Indiana.
  • Almost 112,000 annual deaths are attributable to obesity.
  • In the United States, 40 percent of adults do not participate in any leisure-time physical activity.

Here’s also a few things you might not realize about obesity from Yale:

  • Finding 1: Obesity can raise some cancer risks
  • Finding 2: Obesity is tied to heart attacks in younger adults
  • Finding 3: Obesity can ruin your day
  • Finding 4: Obesity speeds up girls’ puberty
  • Finding 5: Obesity is a cause of diabetes in kids
  • Finding 6: Obesity in middle age increases risk for dementia

Let me give my hypotheses on why this might matter:

  1. In theory, this is supposed to increase the likelihood that physician’s talk about obesity with their patients.  This would be great, but I think most research shows physician’s aren’t prepared or comfortable with this discussion.  Will the fact that it’s a disease make this easier?  Maybe.
  2. This may be a boon for the obesity Rx market (assuming any of them work and have minimal side effects).  Physician’s may be much more likely to write an Rx for a disease than a lifestyle issue.
  3. This may help get obesity Rxs and bariatric surgery to be covered by health insurance.  The downside of this is that more people may not actually change behavior (diet, exercise, sleep) but instead look for a “quick” fix through drugs and surgery.

In my mind, there is a best case scenario here:

  • Calling it a disease drives awareness among the healthcare community.
  • This increases investment in resources to treat obesity.
  • Treatment is viewed more like mental health to include drugs and behavioral therapy.
  • Physician’s get trained on the disease.
  • Pharma details physicians on the disease and creates CME programs.
  • Patients start to take this more seriously.
  • Plans cover obesity – insurers, employers, CMS.
  • Obesity becomes a broad program including diet, exercise, coaching, Rx, and bariatric surgery following a progressive approach to treatment tied to your starting point.
  • Companies link incentives to managing weight.
  • New metrics are designed that are better than obesity.

Of course, one of the more recent articles which was depressing on this topic was that exercising regularly may not overcome the impact of sitting the rest of the day.  That makes it very hard to increase caloric burn while having a job that requires lots of desk, computer, and meeting time.

Costs Of Obesity In America

Pharmacy Non-Adherence Infographic

While I’ve moved most of the infographics I find to my Pinterest account, I wanted to capture and share this one from Stephen Wilkin’s blog since it hits so many of the points that I try to make with people.

patient-non-compliance-infographic3

Why Do People Think Adherence Is So Easy?

I think we all know that medication adherence is a big deal. The most common number quoted is the $290B waste number from NEHI. There are numerous studies that confirm the value of non-adherence even one that just came out.

The amount of money spent on trying to improve adherence is huge! Pharma has worked on. Retail pharmacies have worked on it. Providers have worked on it. Insurance companies have worked on it. Employers have worked on it… And all of these have happened across the world.

At the same time, you see people get so excited about things don’t make any sense to me.

Let me take an easy example. A few months ago, a company called MediSafe put out a press release around moving medication adherence on statins up to 84.25%. Nothing against the company, but I read the press release and reached out to them to say “this is great, but it’s only 2 months of data…most people drop therapy after the first few months so who care…call me back when you get some good 12 month data.”

But, a lot of people got all excited and there was numerous press about this – see list of articles about them.

Now, tonight, I see another technology getting similar excitement. Fast Company talks about the AdhereTech technology which integrates a cellular phone with a pill bottle. And, it costs $60 a month. In my experience, companies wouldn’t even spend $2 a month to promote adherence so $60 is just impractical. The argument is that this is good for high cost specialty drugs that are oral solids not injectables. But, this isn’t a new idea. Glowcaps already built this model with a very slick interface and workflow.

And, I don’t know about you, but I think this would be obnoxious. And, I love data and am part of the QuantifiedSelf movement. I’m not sure I understand the consumer research here. I would have to believe all of the following to buy into this model.

  • Non-adherence people are primarily not adherent due to no reminders to take their medication on a daily basis.
  • People with chronic conditions that require high cost specialty drugs are going to change behavior because some bottle sends them a text message.
  • Manufacturers or some other healthcare company is willing to pay $60 a month for this service.
  • There won’t be message fatigue after a few months (weeks) of messaging.
  • Pharmacies would be have to be willing to change their workflow to use these bottles.

Yes. Will this work for some people…sure. But, if it helps 10% of people, then my cost is really $600 per success.

Should we be working on better solutions to address adherence…of course.

But, let’s stop trying to figure out some gimmick to fix adherence. Let’s look at root cause.

For example:

  • People don’t know why they’ve been given a medication.
  • People don’t understand their disease.
  • People can’t afford their medication.
  • People don’t know what to expect in terms of side effects.
  • People don’t see value in improving adherence.
  • People don’t know they have to refill their medications.
  • People aren’t health literate.

We have a lot of problems.

How The CVS Program Will Change The Employer – Employee Contract

Have you heard that CVS Caremark is requiring employees to go get biometrics and going to take action on it? OMG!

I’m not sure I understand why people are all upset. Let’s look at the facts:

And, by the way, have we forgotten how much healthcare costs have gone up over time and who pays that bill. It’s either the employer or the government. Both of those things impact our pay as individuals either in terms of lower raises to cover healthcare costs, shifting healthcare costs to us, or taxes. It’s not sustainable so the person who pays the bill has to step in since we’re not. (Which is also why I support the NY ban on soda.)

Now, let’s look at our healthcare system where in the current fee-for-service model, there isn’t an incentive for physicians to address this.

For now, people should be happy. They’re only being required to do the biometrics. The penalty isn’t linked to whether they’re fat or have high blood pressure or smoke or have high cholesterol or have diabetes. A recent study by Towers Watson shows that while 16% of employers do this type of outcome based incentive program today (2013) that this is going to jump to 47% in 2014. So, this will be the norm.

And, guess what…sticks often work better than carrots in some cases.

And, healthcare costs are making us uncompetitive globally as a country.

  • The cost of healthcare is greater than the cost of steel in a car.
  • The cost of healthcare is greater than the cost of coffee in a Starbuck’s cup of coffee.

And, health reform is allowing (even enabling) this to happen. It says that you can treat people differently and create up to a 50% differential in costs associated with their health. (Not a legal definition so read the fine print.)

But, what I think all of us (consumers and employers) will need to realize is that moving to this (which I agree with) will change the employer and employee relationship in several ways.

  1. You can’t put these programs in place without something to help me manage my obesity, cholesterol, and/or other chronic condition. This will drive wellness and disease management programs to be more engaging and successful.
  2. This will put pressure on employers to create a culture of health since we spend so much time at work and work contributes to our health conditions.
    1. Need more time to be active. Less sitting. Treadmill desks. Standing meetings. Nap time. Walking breaks. Use of devices to track steps. Incentives. Gym discounts. Healthy food discounts.
    2. Need less stress.
    3. Need more sleep.
    4. Better food choices at work.
  3. This will drive a lot of the new tools and run counter to some trends about limiting dependent coverage since you can’t address obesity without engaging the entire family and the social network.
  4. This will also create a whole exception process by which people who gain weight due to certain drugs have to be excluded. People who can’t exercise may have to be excluded. People may have to see short-term goals (i.e., dropping BMI from 35 to 32). Physicians will have to be engaged.
  5. Coaching will have to expand to include dieticians, social workers, and others to help people beyond the historical nurse centric coaching model.

If none of this motivates you, then just think about the “gift” we’re giving our kids and maybe that will be a wake-up call why someone has to do something here. (As I shared the other day, I struggle with my weight so don’t think I’m some super skinny, high metabolism person who thinks this is easy.)

Why It’s So Hard To Improve Consumer Engagement In Healthcare?

I spend a lot of my personal and professional time trying to figure out how to better engage consumers in healthcare.  If you can’t engage them, you can’t improve outcomes.

Never mind the fact that people experience about 5,000 messages a day so you have to cut through that clutter.

Even if we do cut through the clutter, people are busy living their lives.  They’re worried about their family.  They’re worried about the economy.  They’re trying to keep food on the table.  They are generally overwhelmed with too little sleep and too much stress.

But, let’s even assume that you can cut through the clutter and get them to listen, you still struggle with getting a person at a time when they are open to change.  These “golden moments” require them to see value in the change and feel like the short-term effort is worth the long-term gain.  This “value exchange” doesn’t often exist.  And, with 30% variance in the healthcare system, people often don’t trust the system.

Even with all that in mind, people still don’t engage.  They don’t get flu shots.  They don’t fill their medications.  They don’t understand the messages that are delivered to them.

Here’s a quick image I created for a presentation later this week.

Consumer

A few of the sources for this are:

A Compelling Argument As To Why You Need More Germs

“In our modern effort to eradicate disease, we pop antibiotics like candy, apply hand sanitizers with abandon, and gargle mouthwash by the gallon. But this carpet-bombing of germs takes a huge toll on good microbes as well as bad. The March/April issue of The Saturday Evening Post, on newsstands now, reveals recent research pointing to medical problems including asthma, obesity, and chronic sinusitis that might be caused by the absence of certain microbiota in our bodies.”  (From a press release about the article Why We Need Germs.)

What if the bacteria in our body was a determining factor in chronic conditions?  Would you try to get more bacteria into your body?  Would you stop doing things to kill the bacteria?  Would this change our eating habits?

This is a fascinating article by The Saturday Evening Post, it shares some research that might explain why two people can have the same food habits and one be skinny and one be fat.  (A frustrating thing for many of us.)

You can even learn about a crowdsourcing project that will take your feces and tell you the bacteria in your gut.  

In the meantime, you might want to eat more asparagus and garlic.  Yummy!  And, be less stressed out.

For instance, Bacteroidetes—the microbes linked to slimness—proliferate in the presence of fructans, a form of fructose found in asparagus, artichokes, garlic, and onions, among other foods, notes microbiologist Andrew Gewirtz of Georgia State University. A diet high in fructans might support a good crop of slimming Bacteroidetes. On the other hand, he notes, stress decreases the abundance of Bacteroidetes, suggesting one more way stress causes obesity.

Healthcare Fails Again In Experience Survey

The fact that most people would rate their experience with their health insurer low isn’t a big surprise to most of us in healthcare.  But, with the Triple Aim and other quality metrics, the customer experience is becoming an increasingly important metric.  Several recent surveys have talked about this as one of the top priorities for hospital systems.  And, as use of CAHPS continues to grow, this will be more closely linked with incentives.

“Patient experience is on the radar of hospital executives, especially since Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores will soon affect reimbursement,” said Jason Wolf, executive director of the Beryl Institute. “However, the data shows that executives are still grappling with how to implement change within their organizations.” (source)

Like in years past, health insurers just barely nudge out TV service providers to prevent being the bottom of the industry in Bruce Temkin’s Benchmarking work.  While I’d love to see healthcare broken out into hospitals, physicians, pharmacies, insurance companies, PBMs, and care management companies, I think we can assume some similar concerns would fall out.

Healthcare companies need to find ways to address this.  I think there are several key first steps:

  1. Defining your customer;
  2. Mapping their experience;
  3. Creating personas or segments to think about (i.e., healthy, sick, insured);
  4. Identifying influences on their experience (some of which you might not control);
  5. Determining what matters versus doesn’t matter;
  6. Capturing baseline metrics; and
  7. Building a continuous improvement process.

Temkin Group 2013 Satisfaction Temkin Group Satisfaction

 

59% Of MDs Want To Know About Employer Care Mgmt Efforts

I just came across this survey data from January of 2010 where the Midwest Business Group on Health (MBGH) did a survey of physicians. I found it really interesting. Let me pull out a few points with some comments…

  • 72% of physicians agree that employers should have a role in improving and maintaining the health of their employees with chronic disease. [Since they ultimately are the one paying the bill, this seems like a reasonable expectation in today’s world.]
  • 59% believe that they should be informed about employer efforts to help their patients manage chronic conditions. [This is increasingly becoming important as we move from a Fee-For-Service (FFS) world to a value-based or outcomes-based healthcare environment.]
  • 46% agree that employers should have a role in helping employees adhere to their medication and treatment regimes. [Since MDs generally don’t view this as their task, if it’s not someone acting on behalf of the employer, I wonder who they think should be doing this.]
  • 32% agree that employers should play no role in the health of patients. [With healthcare impacting productivity and global competitiveness, I think this is an unreasonable expectation.]
  • 61% want the employer to provide physicians with information on what is available to patients so they can counsel them on the value of participation. [How would they want this information and what would they do with it?]
  • 49% would like to receive workplace clinical screening results to reduce redundancies in testing. [Do the other 51% want duplicative testing?]
  • 48% want to receive actionable reports (e.g., screening results, health coaching reports) to support them in treating patients. [I would hope so. If the employer (or really their proxy) is managing the patient in a chronic program, why wouldn’t the physician want this data?]
The study went on to say that physician’s want employers to provide support around weight loss, smoking cessation, flu shots, and other broad programs. They also want the employer to focus on lifestyle change and health improvement not the chronic disease itself. This makes sense, but in general employees are more focused on trusted information coming from their physician not their employer so there’s a clear gap here. (See graph from Aon Hewitt’s 2011 Health Care Survey, New Paths. New Approaches.)

Only 50% Of Healthcare Companies Respond To Twitter Messages – Test Results

12 Of 23 Companies

As I mentioned a few weeks ago (2/2/13), I wanted to test and see if healthcare companies would respond to consumers via Twitter. To test this, I posted a fairly general question or message on Twitter to see the response (see below). Of the 23 companies that I sent a message to, only 12 of them ever responded even after 6 of them received a 2nd message. Those results are shared below. What I also wanted to look at was the average time to respond along with which group was more likely to respond.

  • PBMs – All of the 3 PBMs that I reached out to responded. (This could be biased by my involvement in this space since two of them e-mailed me directly once I posted a comment.)
  • Pharmacies – Only 2 of the 4 retail pharmacies that I reached out to responded.
  • Disease Management Companies – Only 1 of the 3 that I reached out to responded. (I was surprised since Alere often thanks me for RT (re-tweeting) them, but didn’t respond to my inquiry.)
  • Managed Care – 5 of the 7 companies that I reached out to responded. (For Kaiser, they responded once I changed from @KPNewscenter to @KPThrive.)
  • Health Apps or Devices – Only 1 of the 5 companies that I reached out to responded. (This continues to surprise me. I’ve mentioned @FitBit on my blog and in Twitter numerous times without any response or comment.)
  • Pharmaceutical Manufacturers – Only 1 of the 3 companies that I reached out to responded. (This doesn’t surprise me since they are very careful about social media. @SanofiUS seems to be part of the team that has been pushing the envelope, and they were the ones to respond. I thought about Tweeting the brands thinking that those might be monitored more closely, but I didn’t.)

I will admit to being surprised. I’m sure all of these companies monitor social media so I’m not sure what leads to the lack of response. [I guess I could give them the out that I clearly indicated it was a test and provided a link to my blog so they could have chosen not to respond.]

Regardless, I learned several things:

  1. Some companies have a different Twitter handle for managing customer service.
    1. @ExpressRxHelp
    2. @AetnaHelp
    3. @KPMemberService
  2. Some companies ask you to e-mail them and provide an e-mail.
  3. Some companies tell you to DM (direct message) them to start a dialogue.

From a time perspective, I have to give kudos to the Prime Therapeutics team that responded in a record 2 minutes. Otherwise, here’s a breakout of the times by company with clusters in the first day and approximately 2 days later.

Company

Response Time (Hrs:Min)

Prime Therapeutics

0:02

Aetna

1:12

LoseIt

1:19

Healthways

2:07

Walmart

3:01

Express Scripts

8:35

Kaiser

29:22

BCBSIL

47:32

OptumRx

47:39

BCBSLA

48:18

Sanofi

53:30

I guess one could ask the question of whether to engage consumers via Twitter or simply use the channel more as a push messaging strategy. The reality is that consumers want to engage where they are, and there are a lot of people using Twitter. While it might not be the best way to have a personal discussion around PHI (Protected Health Information) given HIPAA, it certainly seems like a channel that you want to monitor and respond to. It gives you a way to route people to a particular phone number, e-mail, or support process.

As Dave Chase said in his Forbes article “Patient engagement is the blockbuster drug of the century”, this is critical for healthcare companies to figure out.

The CVS Caremark team told me that they actively monitor these channels and engage with people directly. I also talked with one of the people on the Express Scripts social monitoring team who told me that they primarily use social media to disseminate thought leadership and research, but that they actively try to engage with any member who has an actionable complaint. They want to be where the audience is and to quickly take the discussion offline.

If you want to see the questions I asked along with the responses, I’ve posted them below…

The Prescribing Apps ERA – Will Clinicians Be Ready? #mHealth

Dr. Kraft (@daniel_kraft) recently spoke at FutureMed and talked about the prescribing apps era.  I’ve talked about this concept many times, and I agree that we are rapidly moving in that direction.  And, there’s lots of buzz about whether apps will change behavior and how soon we’ll see “clinical trials” or published data to prove this.

From this site, you can get a recap, but here are the key points that he made:

1) Mobile Phones (quantified self) are becoming constant monitoring devices that create feedback loops which help individuals lead a healthy lifestyle.  Examples include; monitoring glucose levels, blood pressure levels, stress levels, temperature, calories burned, heart rate, arrythmias. Gathering all this information can potentially help the patient make lifestyle changes to avoid a complication, decrease progression of a particular disease, and have quality information regarding his physical emotional state for their physician to tailor his treatment in a more efficient manner.

2) The App prescription ERA:  Just as we prescribe medications prescribing apps to patients will be the future. The reason why this is important is that apps created for particular cases can help the patients understand their disease better and empower them to take better control.

3) Gamification: using games in order to change lifestyle, habits, have been mentioned before. A very interesting concept was that created in the Hope Labs of Stanford. The labs created a game in which children would receive points after there therapeutic regiment, once points were optioned they could shoot and attack the tumor. Helping with the compliance rate of the treatments

4) Lab on a chip and point of care testing

5) Artificial Intelligence like Watson and its application in medicine.

6) Procedure Simulation: Several procedures done by medical professionals follow (not 100%) a see one, do one teach one scenario.  Probably very few people agree with this concept and that is why simulation has great potential. In this case residents, fellows in training can see one, simulate many and then when comfortable do one.

7) Social Networks and Augmented Reality

At the same time, a recent ePocrates study hammered home the point that while this is taking off physicians don’t have a mechanism for which ones to recommend and why.

According to the Epocrates survey, more than 40 percent of physicians are recommending apps to their patients. In terms of the apps being recommended, 72 percent are for patient education, 57 percent are lifestyle change tools, 37 percent are for drug information, 37 percent are for chronic disease management, 24 percent are for medical adherence and 11 percent are to connect the patient to an electronic health record portal.

Physicians also have several different sources for identifying which apps to recommend to their patients. According to the survey, 41 percent get advice from a friend or colleague, while 38 percent use an app store, another 38 percent use an Internet search engine, 23 percent learn of an app from another patient or patients, and 21 percent use the app themselves.

That said, the survey also notes that more than half of the physicians contacted said they don’t know which apps are “good to share.”

As I’ve discussed before, this is somewhat of the Wild West.  Patients are buying and downloading apps based on what they learn about.  They’d love for physicians, nurses, pharmacists, and other trusted sources to help them.  But, those clinicians are often not technology savvy (or at least many of the ones who are actively practicing).  There are exceptions to the norm and those are the ones in the news and speaking at conferences.

IMHO…consumers want to know the following:

  1. Which apps make sense for me based on my condition?
  2. Will that app be relevant as I move from newly diagnosed to maintenance?
  3. Should I pay for an app or stick with the free version?
  4. Is my data secure?
  5. Will this app allow me to share data with my caregiver or case manager?
  6. Will this app have an open API for integration with my other apps or devices?
  7. Is it intuitive to use?
  8. Will this company be around or will I be able to port my data to another app if the company goes away?
  9. Is the information clinically sound?
  10. Is the content consumer friendly?
  11. Is it easy to use?
  12. Is there an escalation path if I need help with clinical information?
  13. Will my employer or health plan pay for it for me?
  14. Is my data secure?

And, employers and payers also have lots of questions (on top of many of the ones above):

  1. Is this tool effective in changing behavior?
  2. Should I promote any apps to my members?
  3. Should I pay for the apps?
  4. How should I integrate them into my care system?
  5. Do my staff need to have them, use them, and be able to discuss them with the patient?  (Do they do that today with their member portal?)

mhealth_infographic_large

Less Than 1/3rd Of Health Insurers Very Confident In Their Big Data Value To Consumers

With all the discussions these days on Big Data and how to use information to create insights and wisdom, I was really shocked when I looked back at this PWC survey from 2011.  In it, less than 1/3rd of health insurers were very confident in their use of informatics to add value around case management, disease management, wellness, and consumer health tools.  WHAT???

This seems crazy to me.  In this interconnected world where everyone is talking about connected devices, mHealth, and ENGAGEMENT, health insurers are in the optimal position to leverage their data to provide insights, to provide transparency, to create algorithms, to be preventative in their actions, etc.  Maybe their technology platforms are too old?  Maybe they’re too silo’d?  I’m not sure.  But, I find this an interesting arbitrage opportunity.

With a system that integrates data from claims, labs, patient reported sources, HRAs, and biometrics, you can add value by creating a personalized patient experience that adapts with their needs.

Clinical Informations for Care Mgmt

Two Examples Of How Healthcare Is Going Local

I remember when I first started working in the healthcare industry in 1998, people kept reinforcing for me that “Healthcare is Local”.  As we move into a national effort to transform healthcare, the question is how will healthcare transform to gain scale efficiencies while still taking advantage of this simple reality.

With that in mind, I found a WSJ article today about hospitals trying house calls very interesting.  It talks about how insurers and health systems are using the old fashion model of house calls to engage patients to reduce re-admissions and improve outcomes…while lowering costs.  Since healthcare costs are massively concentrated with 1% of patients driving 22% of healthcare costs, this becomes possible.  Additionally, as you focus .  on people at high risk based on some model like the Johns Hopkins ACG model or people who have been recently discharged or people with multiple co-morbidities and other risk factors, you have a chance to make a difference.  It will be interesting to see how this takes off.

Another example of how healthcare is going local is the use of health apps.  I saw a number earlier today where someone was saying there’s now 50,000 health apps.  I usually talk about 16,000, but it’s obviously going up all the time.  Employee Benefit News recently had an article about how health apps were changing the engagement rates for wellness programs.  Obviously, the phone is the ultimate in local allowing the creation of an app that’s with us all the time and can be real-time in terms of interactivity.

Wellness In The Workplace – Optum Research

I found a summary of this Optum Study – Wellness In The Workplace in the January 2013 Employee Benefit News:

  • 56% of companies (surveyed) have a formal, written strategic plan for wellness
  • 28% of companies have an onsite clinic
  • 49% of eligible employees participate in company wellness programs (seems really high to me)
  • 90% of companies with 3,000+ employees say wellness solutions are an important part of their benefits (compared with 79% of employers with 2-99 employees)
  • 83% of companies use coaching to address weigh management
  • The top barriers to employee participation are:
    • Lack of time / energy
    • Lack of interest
    • Effective communications
  • 52% of companies offer wellness programs to employee’s family members
  • Onsite clinics are offering:
    • 77% flu shots
    • 56% wellness communications
    • 43% fitness challenges
    • 42% preventative care
    • 41% health risk assessments

wellness participation

Would A Robot Therapist Solve Your Problem?

Wired had an article recently about how robots are replacing people over time.  The article talked about TUG which is a robot used in hospitals.  It also mentioned MindMentor.com which it called the site of the world’s first robot therapist.  Interestingly, it says that after a 1-2 hour session, that 47% of patients said that their problems were solved.  From the 2008 article, it sounds like there’s some opportunities for improvement in terms of NLP, avatars, and other technologies.

That seems high.  I would think it would take more sessions.  Additionally, I would think that people don’t get their problems solved that easily.

While this solution is on sabatical (due to lack of funding), the article went on to talk about USC’s Bandit robot for kids with autism.

How Quickly Do Healthcare Companies Respond To Twitter Comments? (Test)

I was intrigued by this test done over in the UK to look at how quickly retailers responded to comments via Twitter (you can see an infographic about similar US data below).  Obviously, more and more consumers are using social media.  And, we know that comments can go viral quickly especially when they’re negative.

“A recent Spherion Staffing Services survey shows that when consumers have a good customer service experience, 47 percent are likely to tell a company representative; 17 percent will express their opinions via social media; and 15 percent will write a review. The same survey from 2010 showed that only 40 percent of consumers were likely to share a great experience with a company representative—proving that consumers are becoming more vocal with companies they interact with. If consumers have a poor experience, 36 percent are willing to write a complaint directly to the company, and one in four will express their opinions on social media. Nineteen percent, the same statistic as last year, will choose to write a review online.” (December 2011 Study)

Of course, some people actively monitor their social media feeds while others view them more as a PR channel.  It also depends on whether the feed management is outsourced or insource and whether it’s monitored by marketing, operations, customer service, sales, or some combined team.

Here’s a good post on measuring response and activity within Twitter accounts.

So, what I’ve decided to do is a Twitter test similar to the one above.  I’m going to post the following to different categories of healthcare companies and see how quickly they respond.

  1. To retail pharmacies:  Are you using social media to handle customer service?
  2. To PBMs:  Are you using social media to handle customer service?
  3. To Managed Care: Where’s the best place to find out about your Medicare products?
  4. To mHealth companies:  Can you share examples of how employers are promoting your products?
  5. To pharma:  Are you doing any value-based contracting with PBMs?
  6. To device companies:  Can you share examples of how employers are promoting your products?

Who do you think will be the fastest to respond?  Will the bigger companies simply have more resources to monitor and staff their teams or with more digital companies be more in tune with social media?

KeepingUpWithTwitter_2

PHM Is The New Black Post At CCA Blog With Diabetes Examples

This is a partial copy (teaser) of a guest blog I did on the Care Continuum Alliance blog earlier this week.

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With all the talk about Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), the adoption curve for the Care Continuum Alliance (CCA) model for Population Health Management (PHM) should move beyond the innovators in 2013 and begin to “Cross the Chasm.” I believe there are several preconditions that would set the stage for this to occur, for instance:

  1. Technology advances leading to the “Big Data” focus;
  2. The changing paradigm from fee-for-service to outcomes-based care;
  3. The realization of the role of the consumer led by the e-Patient movement, the idea of the Quantified Self, and the focus of large healthcare enterprises on being consumer centric; and
  4. The budget crisis that is driving employers and other payers to embrace PHM, wellness, and other initiatives that impact cost and productivity.

Of course, most companies are still in the infancy of designing systems to address this coordinated care model, which does not view the patient as a claim, but longitudinally aggregates demographical, psychosocial and claims data.  Additionally, training staff using Motivational Interviewing and integrating external staff into the virtual care team in partnership with the provider will continue to evolve as do our care delivery models.

To read more especially the diabetes examples that I shared, please click over to their blog.  Thanks.

 

CVS Caremark Adherence Study – Is Facebook The Solution To Adherence?

A new study funded by CVS Caremark as part of their ongoing research into medication adherence was recently published.

“Association Between Different Types of Social Support and Medication Adherence,” December 2012 issue of American Journal of Managed Care

In this, researchers reviewed 50 peer-reviewed articles about studies which directly measured the relationship between medication adherence and four categories of social support, including:

  • Structural support – marital status, living arrangements and size of the patient’s social network
  • Practical support – helping patients by paying for medications, picking up prescriptions, reading labels, filling pill boxes and providing transportation
  • Emotional support – providing encouragement and reassurance of worth, listening and providing spiritual support
  • Combination support – any combination of the three support structures detailed above

According to the study, greater practical support was more often linked to improved medication adherence, with 67 percent of the studies evaluating practical support finding a significant association between the support and medication adherence.

It drives some interesting questions as you dig into the actual research.  I sent several questions to Troyen A. Brennan, MD, MPH, who is the Executive Vice President and Chief Medical Officer of CVS Caremark, and heads the research initiative that conducted the study.  Here are his responses:

1. How will this research change CVS Caremark’s approach to medication adherence such as your Adherence to Care program? 

CVS Caremark’s Adherence to Care program is all about engaging patients more consistently and directly to ensure they are following their medication regimes. We understand that our patients’ social networks and communication preferences are diverse, and we know that multi-dimensional interventions help to change behaviors. Given these factors, this research can be an important reference point as we develop new approaches to our adherence programs, challenging us to look beyond traditional engagement strategies in an effort to most effectively support patients on their path to better health. We are planning to test some interventions along these lines in 2013.  As a pharmacy innovation company, we want to make sure we are anticipating patient needs and remaining relevant to them especially given the changing face of social communication and networks.  

2.  The data points required to assess these support factors aren’t readily available in the eligibility file or claims file.  Are you collecting that data at the POS or during the enrollment process and using it in any way to determine the correct intervention cadence or level of effort at an individual level?

While this may not be the standard today, it is clear from the research that a patient’s social network and resulting support can be important factors in helping them take their medications as directed. This research can help us and others in the industry think about how best to incorporate new approaches to identify and leverage social networks for greater medication adherence.  For now, we will rely on POS as a way to collect this type of information.

 

  • 3.  To me, it appeared the data was less conclusive than I would like.  There were lots of conflicting data points and qualitative data.  Do you plan to refine this testing within your population to look at differences across disease states and relative to other factors?

 

This study relied on a comprehensive analysis of current literature linking medication adherence to social support networks – so we recognize that there are limitations in being able to draw concrete conclusions on certain factors, such as disease-specific conditions. Regardless, we still believe these findings – which look at clinical, peer-reviewed studies – contribute to the knowledge base in our field. As with all of the research we conduct, we challenge our teams to consider how we might be able to use the information to find practical supports for patients, while at the same time contributing to awareness about the implications of adherence on the broader health care landscape. The best way to understand this research is as hypothesis generating, which we can use in the design of real interventions that we can then test definitively in subsequent studies.

4.        Some of these social factors might be correlated with depression.  Was there any screening done to look at how depression as a co-morbidity might have affected adherence rates?

The methodology of this study relied on literature review and analysis of fifty peer-reviewed research articles which directly measured the relationship between medication adherence and forms of social support. A full review of the medical conditions associated with these studies can be found in Appendix 1. While depression, alone, was not one of the conditions featured in these studies, several did look at mental health conditions and the linkage between adherence and social networks. We did not however stratify by existence of depression—it may be a factor we have to take into account in future studies.

5.   The one thing that I read between the lines was the need for a caregiver strategy.  This has been missing in the industry for years.  Does CVS Caremark have an approach to engaging the caregivers?

 

Our study found that practical support such as picking up prescriptions, reading labels and filling pill boxes – all within the realm of a given caregiver’s role – were the most significant in driving greater adherence. Considering this finding, and acknowledging the role caretakers have in the lives of our patients, there is certainly space for us to develop solutions that engage caretakers more effectively. Recent analyses of “buddy” programs do suggest such interventions do work- -we just need to consider how to scale it.

 

  • 6.        With all this talk about social networks, it naturally leads you to a discussion about Facebook (or Google+).  Neither of them have big focuses in the healthcare space.  In your opinion, will these tools offer an intervention approach for changing behavior around medication or will that be occur at the disease community level in tools like PatientsLikeMe or CureTogether where there’s no social bond but a connectivity around disease? 

 

 The role of social media has changed the way we communicate and connect with one another dramatically over the past decade. What we can say, based on this particular study, is that the more practical the support, the more significant the impact on medication adherence. Perhaps further studies looking into solutions that effectively combine online/social media platforms to complement practical support would help clarify their impact on medication adherence.

If interested, here are some of their other presentations on adherence:

New mHealth App – Interactive HRA – Recommendations – Zuum

In the Winter 2012 Innovate Magazine from Barnes-Jewish Hospital and Washington University Physicians, they talk about a new iPad app that they developed that calculates disease risk and offers a customized plan.

I just downloaded it and used it.  Here’s my quick summary:

  • Nice GUI (graphical user interface)
  • Easy to use HRA (health risk assessment)
  • Cool interactive tool (you can see how your risk for certain diseases changes with your changes in behavior)
  • Content seems to be well written with basic health literacy taken into account
  • Links out to more research and content
  • Messaging feature (which I guess will push me updates and other messages over time)

Overall, it seems like a nicer than normal HRA with the ability to interact with it.  My question would be how it integrates with my care team and how it gets used over time.  If this integrated into my other devices and monitored my data, it would seem more valuable than a standalone app, but I certainly think it’s great for a one-time use.

If you’re interested in downloading it, you can go to iTunes here.

Zuum 2 Zuum 1

3500 Calories To Lose A Pound – Myth?

Well, it’s not that straightforward (of course), but 3,500 calories does equal a pound of fat so it’s a good rule of thumb (in my non-clinical opinion).

So, to figure out when this does or doesn’t work, I looked at the this article in the Journal of Obesity which was very difficult to understand, but here’s a discussion on MyFitnessPal that discusses it in something closer to plain language.  You can also see this article in the NY Times about de-bunking this myth.

So, if it’s wrong, why use it as a rule of thumb?  IMHO  I believe it gives you some numbers to track just understand that it’s not a perfect correlation.  But, if you take in less calories than you burn and focus on creating a deficit, then you’ll be doing the right things – being active and watching what you eat.  Of course, you can go work with a Registered Dietician to help you actually understand and refine your plan to address the gap between this assumption and reality.

mythbusters

17 Healthcare Blogs You Should Read

This is just a list of my favorites.  Feel free to add your own recommendations.  I broke them into 3 categories.

(BTW – I’m sure I missed a few of you so I’m sorry.)

1. Key Foundational Blogs To Follow

2. One’s I Read Frequently

3. Good Blogs That I Use For Certain Topics

I’ll also give a shout out to a new blog that has started that I have high hopes for based on their initial content – http://hoopayzblog.com/.

Favorite Health Infographics In Pinterest

While I’m sure I’ll still integrate some health infographics into my blog posts, I’ve decided to use a different tool for simply sharing the infographics that I like.  I built a Pinterest account and put 70+ infographics in there to get it started.  Most of those are ones that I’ve used before in the blog, but there are some new ones.  Enjoy.

http://pinterest.com/gvanantwerp/health-infographics/

Healthcare Infographics

 

Childhood Obesity Quiz On The Biggest Loser

This season, on The Biggest Loser, they’ve invited 3 kids to be ambassadors for childhood obesity. They aren’t living on the ranch, but they are coming out for some of the challenges. In last night’s show, they quizzed the contestants on several facts about childhood obesity. They were pretty scary. I thought I’d share them here with the research to support them (or at least as close to the questions as I can remember).

There are lots of efforts in this area. Here’s a few links to resources:

Childhood Obesity Epidemic Infographic
Brought to you by MAT@USC Masters in Teaching

Limiting Factor For Behavior Change is We Don’t Believe We Will Change

One of the biggest challenges in healthcare is getting people to change behavior or as Express Scripts would frame it – activating intent.  Since approximately 75% of healthcare costs are due to preventable conditions, it’s important that we can help people see the future value of change.  People often discount that future value of change based on the amount of effort required to get there.  They see the short-term pain not the long-term gain.

A new study puts an interesting perspective on this.  It shows that people can generally see the amount of change they’ve made in the past decade, but they fail to realize that change will continue for the next decade.  They appear to see themselves as stable at the current moment without significant change in the future.  I believe this is really important as we think about Motivational Interviewing techniques and communications for engaging consumers.

So, as you think about behavior change in healthcare for things like diabetes, you will likely continue to see more and more emphasis on behavior change and research in this area (see example from RWJF last year or Cigna whitepaper).

To learn more about this topic of behavior economics, you might look a few places:

And, here’s a good list of books to start with.

Saturday Evening Post On The Placebo Effect

Do you know what the Placebo Effect is?  There’s lot of information out there.  For example, here’s what WebMD says about it.  Here’s my definition of it.

In general, it’s when someone is told they are given a medication (or procedure) that will work but instead are given a sugar pill or otherwise “deceived” into believing they’ve gotten the prescribed treatment.  It is often used in clinical trials for drugs to establish the baseline of side effects.  The amazing part is that it shows the power of the mind to influence our healing ability.  

Below is a video that I’ve used a few times before.  It’s also been a concept I’ve built on in a few other posts – New To Therapy, Price And Placebo Effect, Guest Post on the Topic.

The amazing thing that captured my attention a few months ago is that this can work not only for medication but also for surgery.  (Maybe this is the key to saving money in the US healthcare system.)  This was tested in the case of knee surgery in a trial that was published several years ago.  This article also points out another trial on patients with Parkinson’s.  The reality appears to be that this is happening in trials but also in real life according to an article in American Medical News (see quote below).

Nearly half of physicians use placebos in clinical care, and only 4% tell their patients the truth about it, according to a survey of Chicago academic physicians that was published this month in the Journal of General Internal Medicine.

This begs all types of questions about who will respond to placebos and when or if it’s ok to use them with patients.

The Saturday Evening Post just published an article on this topic.  They touch on a few of the same studies I’ve looked at, but they also point out several new things that I put below – conditioned response and ritual.  They also share a video on the placebo effect.

Conditioned responses are a third way the placebo response works. In one elegant experiment demonstrating this phenomenon, scientists showed 40 volunteers two male faces on a computer screen for 0.1 second. When the volunteers looked at one face, they got a mild burn on their forearm; when they looked at the other, they got a more painful burn. The volunteers became as conditioned as Pavlov’s dogs. In the next round when they saw the high-pain face and felt a burn, they rated it as more painful than when they saw the low-pain face and felt a burn—even though the applied heat was identical the second time around.

The perception of pain, says Ted Kaptchuk of Harvard Medical School, who helped lead the 2012 study, depends on “what the nonconscious mind anticipates despite any conscious thoughts.”

The placebo effect doesn’t even depend on deception. It can kick in even when people are told they are receiving an inactive drug. For instance, in a 2010 study led by Harvard’s Kaptchuk, scientists recruited 80 people with irritable bowel syndrome, or IBS, and gave half no treatment and half what they were told were “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body, self-healing processes.” It was full disclosure. Even without the deception, the placebo-takers’ IBS symptoms improved over the course of three weeks. That response suggests another avenue for the placebo response: ritual.

The author (Sharon Begley) asks the key question which is how does this placebo effect play out in the 21st century.  With all this technology that we have and the physician shortage, is there a greater opportunity here?  Can we tap into this in a positive way?  She also points out how doctors are using other techniques such as relaxation therapy to address the power of the mind.

Consume Cocoa Like The Kuna (aka Chocolate is Good For You)

For years, we’ve all heard pieces of information about cocoa being good for us.  Here’s a few articles about that:

And from Cleveland Clinic, here’s a key point about selecting your chocolate:

your best choices are likely dark chocolate over milk chocolate (especially milk chocolate that is loaded with other fats and sugars) and cocoa powder that has not undergone Dutch processing (cocoa that is treated with an alkali to neutralize its natural acidity).

It appears in a recent meta-analysis that the data generally supports this fact although some longer terms studies are needed.  One of the most interesting things mentioned in both of the hyperlinked studies above are the Kuna.

The Kuna, an indigenous group of approximately 50,000 people who live predominantly on small islands off the coast of Panama, are virtually free of hypertension and cardiovascular disease. Kuna who migrate to nearby Panama City, however, lose this advantage, a loss that cannot be attributed to changes in salt intake (1) or stress (2). The Kuna who live on the Caribbean archipelago, however, consume a striking amount of natural cocoa drinks, whereas those who migrate to the mainland do not (1).

I also got an e-mail from a PR firm about the meta-analysis saying the following:

Recent research published in The Journal of Agricultural and Food Chemistry found that a mug of hot cocoa had nearly twice the antioxidants as a glass of red wine and up to three times the antioxidants as a cup of green tea. Compared to black tea, cocoa had up to five times the concentration of antioxidants.
 
“The results of this Cornell University study corroborate earlier research showing the extensive health benefits of cocoa,” says Harvard nutritionist and epidemiologist Eric Ding, Ph.D. Dr. Ding was lead researcher of a landmark Journal of Nutrition meta-analysis on cocoa’s multiple benefits for cardiovascular and metabolic health. The study incorporated 24 papers with 1106 participants.
 
“Cocoa flavonoids are protective against heart disease,” says Dr. Ding. “We’ve found that they lower blood pressure, lower bad LDL, raise good HDL, improve insulin sensitivity, and improve blood flow and, in a long term study, lower the risk of heart disease.” Journal of Nutrition meta-analysis on cocoa’s multiple benefits for cardiovascular and metabolic health. The study incorporated 24 papers with 1106 participants.
 
“Cocoa flavonoids are protective against heart disease,” says Dr. Ding. “We’ve found that they lower blood pressure, lower bad LDL, raise good HDL, improve insulin sensitivity, and improve blood flow and, in a long term study, lower the risk of heart disease.”
So, don’t feel bad about enjoying chocolate.  Not only is it good for your mood, but it can be good for your health (if you pick the right kinds).  But, this shouldn’t be an excuse for binging on it since it’s also high in fat.

Guest Post: I’m Ready To Lose Weight!

Guest Blogger Lynn Gieger is a contributor to Everyday Health and its calorie counter and fitness tools.
The signs were all there, but until the doctor commented, “You’re overweight and your weight is negatively impacting your health,” it was no longer easy or healthy to ignore the too-tight belt, too-small jeans, and the steering wheel poking into the stomach.

Now what are you going to do about it?

Ignore the hype of the hundreds of weight loss programs that promise effortless weight loss. If it was that easy, you wouldn’t be in this shape right now, would you?

To truly take charge of your weight and health, start by giving yourself some time to think about why weight loss is important to you. What will be different in your life when you lose weight? Look at the health implications: decreased cholesterol, lower blood pressure, reduced risk of type 2 diabetes, less pressure on your knees and hips. Also think about personal reasons why weight loss is important to you: do you want to get on the floor and play with your grandchildren, go hiking with your kids, dancing with your spouse, or just look smashing? List all of the reasons how losing weight will improve your life to increase your motivation to make changes.

The National Weight Control Registry, established in 1994, tracks over 10,000 people who lost an average of 66 pounds and kept it off for 5.5 years. The NWCR research identifies 3 key steps to lose weight and keep it off:

1. Keep a journal detailing what, when and how much you eat. 78% of the NWCR participants report eating breakfast every day, and the majority decreased both calorie and fat intake to lose unwanted pounds. Use your journal to identify specific places to make changes, such as using lower fat salad dressing, choosing water instead of a high-calorie sweetened beverage, and swapping fruit for chips at snack time. Need help figuring out where to make changes? Find a weight management specialist with the knowledge and skills to streamline your food choices and encourage you to make lasting changes in your eating habits.

2. Keep track of daily exercise. 90% of NWCR participants exercise for an average of one hour each day. Create a habit of daily exercise to burn calories and improve your fitness – plus give you something else to do besides eat. Find a certified fitness expert to get you started or ask at your local gym.

3. Decrease the number of hours of non-work screen time (TV, video games, movies, computer). NWCR recommends less than 10 hours of screen time per week. If Sunday at your house means 6 hours of TV football, change your weekly screen-time habits and guess what – you just found time for exercise!

If you’re stuck and can’t figure out how to get started losing weight, work with a certified wellness coach to help you set realistic goals and hold you accountable.

Avoid a weight loss/gain rollercoaster by clearly identifying why weight loss is important to you and focus on the long-term. It doesn’t matter if it takes you 6 months or 6 years to reach your weight goal: the key is changing your habits so you stay at a healthy weight.

And the next time you see the doctor, think of this comment, “Wow, you’re looking great!”

How To Improve Good Cholesterol (HDL) If Drugs Don’t Work

The Wall Street Journal on 1/8/13 had an article called “New Rules for Boosting Good Cholesterol” which shared the results of a recent study on medications that improve HDL (or Good Cholesterol).

“Not all HDL are created the same” was what Roger Newton, chief science officer of Esperion said.

“If you raise HDL in non-pharmacologic ways, it really does help you” says Steve Kopecky, a Mayo Clinic cardiologist.

The points made in the article can be summarized in the following:

  • Improving good cholesterol is important.
  • People with high HDL face fewer heart attacks (according to the Framingham Risk Score)
  • Multiple trials to improve HDL with drugs have failed
  • People may need to raise good cholesterol by behavior change

This should lead to 3 questions:

  1. What should be my HDL or Good Cholesterol? From the Mayo Clinic on Good Cholesterol:

  1. What can I do to improve my Good Cholesterol without drugs? From the WSJ article:

Activity

HDL Increase

Exercise

4 mg/dL

Drink Alcohol (in Moderation)

2-4 mg/dL

Quit Smoking

5 mg/dL

Lose Weight

1 mg/dL per 3-6 lbs

Eat Fish And Olive Oil

3-5 mg/dL

Avoid Carbohydrates

8 mg/dL

  1. What are my risks and the value of medications? For that, I found two online risk tools.

Here’s a simple one that uses the Farmingham study to estimate your risk of having a heart attack.

Here’s another one from over in Europe that’s focused on the value of statins and hosted by the Cleveland Clinic. It takes more inputs but then gives you several outputs. (A nice algorithm to integrate with something like iBlueButton or your care management system perhaps to warn you of risks without having you input a bunch of data.)

Fortune Article Questions Generic Equivalency Of Drugs

A new Fortune article “Are Generics Really the Same as Branded Drugs?” (1/14/13) sets a dangerous tone for something that has become a standard across the pharmaceutical industry.  This is either:

(a) giving consumer credibility to a long-standing rumor with a case study or

(b) a dangerous perspective which will only further activate the conspiracy theory consumers and clinicians.

Let’s start with a few basics from the Generic Pharmaceutical Association:

  • There are over 4B prescriptions filled in the US per year.
  • Of those, over 80% are generic medications.
  • Generic medications saved over $190B last year.

For facts on generics, I would point you to the FDA website.  I posted some of their slides years ago on SlideShare which I put below along with their latest infographic.

The article in Fortune focuses on a case regarding an anti-depressant called Wellbutrin and its generic counterpart.  The article goes on to point out that the active ingredients in the generic (compared to the brand) can vary from 80% to 125%.  (I think a good more detailed explanation of this is available here).

But, the author goes on to point out the risks associated with the fillers (or inactive ingredients) and talks about the issue of NTI (Narrow Therapeutic Index) drugs that no one substitutes for anyways.

One big thing that I was always taught was to understand that the difference in active ingredients between brands and generics was similar to the differences in different lots of the same brand drug.  And, given the fact that traditionally, 50% of generic drugs were made by the brand manufacturers, it would seem difficult to believe that they were simply throwing caution to the wind by producing substandard product.

I would hope that Express Scripts, CVS Caremark, Walgreens, PCMA, and many other groups will come out strongly to address this article. This is the type of article that could be a significant setback to the generic industry which has proven itself under lots of scrutiny over the years to save money and have very few negative impacts with the FDA’s scrutiny.

ucm305899

Are Females More Or Less Adherent? Big Data Question

FICO adherence image

Certainly, the push around Big Data should drive more companies to look into predictive algorithms.  You already have Fair Issac (above), ScreenRx by Express Scripts, and RxAnte.

I’d always been under the impression that women were less adherent than men to prescription drugs.  I’d heard several very logical reasons:

  1. As the caregiver, they often took care of their children, spouse, and/or other people first before being adherent themselves.
  2. They took more medications on average which is highly correlated with non-adherence.

But, some researchers recently told me that their data showed women to be more adherent.  And, I then noticed that the infographic that Express Scripts put together showed something similar.  (see zoomed in picture)

Express Scripts Adherence Infographic Zoom

So which is it?  I can find lots of research online to support females being less adherent.  Here’s a few links:

BTW…If you want to see a good presentation on some adherence data from CVS Caremark from a few years ago, you can follow this link to a presentation that was given.  Here’s a more recent one from URAC.

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