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Retail Rxs By State

The Kaiser Family Foundation recently published an interactive chart that lets you look at the number of retail prescriptions filled in each state based on Verispan data.

This is interesting, but it doesn’t tell you much until tied to population or compared by disease state or some other metric.  So, here is their view by retail Rxs per capita.

There are lots of other data point out there by state for you to look at.

[BTW – Since I heard from one “ex-fan”, I will apologize for some distraction with the political process.  It is hard not to comment on timely events that will affect healthcare such as the US presidential race.  I appreciate readers interest in focus, but that’s not always possible.  Thank you for reading!]

Skip The Patch…Send Them To Church

“Overall, 21% of Americans interviewed in our Gallup Daily tracking program this year say that they smoke.  (By the way, that’s down from an all-time high of 45% back in 1954).

But the percentage of smokers is only 12% among those who attend church once a week.  Smoking rises to 15% among those who attend almost every week.  Then 22% for those who attend once a month, 26% for those who seldom attend church, and finally 31% among those who never attend church.” (see 7/31 entry on USA Today Gallup blog)

I am always fascinated by correlations such as this.  Who thinks of the null hypothesis to look at this?  (Null hypothesis being that people who go to church smoke less which is what they collected the data to prove or disprove.)

With smoking being a huge health driver, what can you do with this information?  It’s hard to believe your employer or health plan could drive church attendance.  Perhaps this gets us back to social networking and your peer group.  Groups of friends or others coordinating and talking about quiting smoking may be more successful if someone active in a church was part of the team helping them.  (I am grasping at straws here.)

Smart People Doing Stupid Things

I was reading a post on the Foghound blog which made me think of an article I saw this morning on medical administrators using homeless people to defraud the government.  Lois points out eight things that smart people do that are stupid – impulsiveness, indulgence, and tempting fate (for example).

Why is it that seemingly intelligent people so easily and frequently seem to skirt the law to try to make money.  Do they think they are above the law?  Are they that greedy?  Do they believe (like the common criminal) that they won’t get caught?

It’s cases like this one with the homeless that cause distrust in the system.

Median US Age Now 37.9

The USA Today reports this morning on the shifting demographics of the US.  I found the map of the US showing the different variances from the median interesting.  (Note: Median means that half the people are below that age and half are above that age.)

It appears that some of the states like North Dakota, South Dakota, and Kansas are increasing their median age quicker than other states. (Source: Census Bureau, analysis by Paul Overberg, USA TODAY)

Cell Phones and Cancer…Cautious?

In another confusing story to us the public, everyone has picked up the story about the head of a prominent cancer research agency telling the employees to limit their mobile phone usage.

“Really at the heart of my concern is that we shouldn’t wait for a definitive study to come out, but err on the side of being safe rather than sorry later,” Herberman said.  [Dr. Ronald B. Herberman, director of the University of Pittsburgh Cancer Institute]

The suggestion is to limit use for children to emergencies, use hands-free devices, and use speaker phones.  The article cites several studies and the FDA saying that there are no issues.

Of course, this makes me think of autism and vaccines.  Is it an issue or not?  It also begs the question and the social responsibility of the health care system on whether to encourage us to be cautious or wait the decades for definitive research.

Love What You Do

We had an annual company event today, and I must admit that all day long I kept thinking about when can I get back to my hotel to work on several ideas that I have and get a couple of deliverables out the door.  Not that I wasn’t having fun since it was one of the best company events I have been to.  But, I love what I do.  And, since I have had the chance to work several places and even more as a consultant, I think being happy at work and enjoying your corporate culture is very important.

I love that fact that the company takes the time to celebrate and discuss the future.  And, it is great to be at a company that is still of a size that everyone can interact with each other, but big enough that you can make investments in the future.  Anyways, working on a few things for some of you clients and enjoying every minute of it.

But making it relevant for the rest of you…it made me think of the correlation between job satisfaction and health.  We all know the problems with stress and the impacts on health, but I found what looks like a good meta-study that shows the correlations.  Here is the abstract fromOccupational and Environmental Medicine 2005;62:105-112.

The relationship between job satisfaction and health: a meta-analysis

E B Faragher, M Cass, C L Cooper

Background: A vast number of published studies have suggested a link between job satisfaction levels and health. The sizes of the relationships reported vary widely. Narrative overviews of this relationship have been published, but no systematic meta-analysis review has been conducted.

Methods: A systematic review and meta-analysis of 485 studies with a combined sample size of 267 995 individuals was conducted, evaluating the research evidence linking self-report measures of job satisfaction to measures of physical and mental wellbeing.

Results: The overall correlation combined across all health measures was r = 0.312 (0.370 after Schmidt-Hunter adjustment). Job satisfaction was most strongly associated with mental/psychological problems; strongest relationships were found for burnout (corrected r = 0.478), self-esteem(r = 0.429), depression (r = 0.428), and anxiety(r = 0.420). The correlation with subjective physical illness was more modest (r = 0.287).

Conclusions: Correlations in excess of 0.3 are rare in this context. The relationships found suggest that job satisfaction level is an important factor influencing the health of workers. Organisations should include the development of stress management policies to identify and eradicate work practices that cause most job dissatisfaction as part of any exercise aimed at improving employee health. Occupational health clinicians should consider counselling employees diagnosed as having psychological problems to critically evaluate their work—and help them to explore ways of gaining greater satisfaction from this important aspect of their life.

New Drug Trend Blog

In a new blog called DrugTrendsToday by DestinationRx, you can find some good initial posts and some good data such as the following on generic Zocor (aka simvastatin).  What this shows you (that I have blogged about before) is the massive difference between AWP and actual cost for a generic.  In this case, the AWP is $136, but Costco pays 2% (or $2.72) for the drug.  This huge difference is only true on generics, but unfortunately, the industry has come to depend on generic pricing as the profit engine to subsidize the brand pricing which is some cases is a loss leader.

460,000,000 Vacation Days

Just a nugget I came across.  (If you can’t tell, I am trying to clean up my inbox today.)

According to Expedia.com, US employees will leave 460M vacation days on the table in 2008.  Pretty sad considering the value of those days and their ability to help us manage our lifes and stay balanced.

PBM Competitive Intelligence

TMA, a group that was doing a PBM study, called me with questions a few months ago.  They sent me some of the results of the work last week.  A few interesting observations from them looking at CVS Caremark, Medco, Express Scripts, Wellpoint NextRx, Prescription Solutions, Aetna Pharmacy, and CIgna:

  • Aetna was cited as having the best online capabilities.
  • Express Scripts was cited as having the best generic drug conversion.
  • Medco was cited as having the best disease management.
  • Medco was cited as having the best sales channels.
  • CVS Caremark was cited as having the best practices for implementation.

“As competition among PBMs is forecasted to remain high, customer service will continue to become more and more important as members/patients have greater expectations.”

Avoiding Calls Then Texting

CNet has an interesting article about teens avoiding live calls only to text back the person immediately so they can continue their current activity.  I do it all the time when I am in meetings or on conference calls.

They provide some interesting statistics on text messaging (see below) for this young group.  Not a prime focus for healthcare, but it will be interesting to see how this use of technology applies as they grow older.

More broadly, nearly one out of every two U.S. tweens (or kids between 10 and 13 years old) and 83 percent of teens own a cell phone, according to new research from Chicago-based C&R Research. And with that many kids using mobile devices, the text messages are flying.

The average teen, according to C&R, generates between 50 and 70 text messages a day, or as many as 18,000 a year.

What Driving Teaches Us About Wellness

We all understand the challenges in getting people to take their healthcare seriously which manifests itself most prominently in a obese society which leads to numerous other conditions – heart disease, diabetes, high blood pressure.

I was reading an article earlier today about driving slower to maximize your fuel usage and thought what a great example of how people don’t do what’s best for them. You can reduce your fuel needs by driving slower, but most of us are too hurried to do that. We don’t follow practical, fact-based suggestions. It’s just like the challenges of eating well. It is much easier to go to the fast-food restaurant than to plan your lunch, buy healthy foods, pack a lunch and bring it to work.

Another good link is between using a phone when driving and wellness. Again, we know that people being distracted by their conversations (voice and text) while driving can lead to accidents. Certainly, headsets and voice technology should reduce those distractions (although the data doesn’t support that). For example, when I am driving, I simply press the button on my Bluetooth headset, speak the person’s name, and then the phone calls them. Much less distracting for my eyes on the road…but I am still talking to someone and multi-tasking. So, again, why don’t we do what’s best for us and stay off the phone? It’s generally not efficient…we are pressed for time…we have become a country of multi-taskers. A similar reason to why lots of people don’t exercise…too busy.

“There are limits to how much we can multi-task, and that combination of cellphone and driving exceeds the limits,” says David Strayer, a University of Utah psychologist who has found that by many measures, drivers yakking on cellphones are more dangerous behind the wheel than those who are drunk, whether the conversation is carried on by handset or headset.

McKinsey On Automated Calling Technology

McKinsey and Company published a report called “Using IT To Boost Call Center Performance” in the Spring of 2006 which had a few relevant comments for those of you looking at how to leverage automated communications in the healthcare space. Here are the two primary quotes that I took away:

Customers are getting used to automated transactions – in fact, some prefer them. Our research suggests that more than 60 percent of customers favor an automated option for many types of simple interactions (for example, balance inquiries or payments); the rest said they didn’t mind being presented with an automated option as long as they could connect with a live agent if they wanted one.

Investments in new VR (voice recognition) and IVR (interactive voice recognition) technologies can help automate an additional 5 to 30 percent of incoming calls while maintaining or even enhancing customer satisfaction and revenue.

I always love finding those 3rd party verifications of the value propositions that we see at clients.

IDC – Healthcare Communications

Janice Young at IDC just put out a new report titled “Too Much Information? The Irony of the Coming Information Glut and New Technologies that Help Target Communications” which focuses on several fast-follower announcements about what we have been doing at Silverlink Communications. Here are a couple of quotes from the report.

The final mile of the current healthcare information blitz is not just getting at or to the information, though in the very fragmented, silo’d U.S. healthcare system, that is hard enough. But the real solution provides targeted and event-triggered information based on consumer interactions or events, rather than relying on the consumers to search and seek.

These two announcements join Silverlink’s earlier announcement in March 2008 of their new Adaptive HealthComm Science Platform. The Silverlink platform integrates decision support and analytics to create personalized customer communications. Unique to the Silverlink solution are behavior analytics to communications success and affect on customer behavior and outcomes.

Are Involved Patients More Compliant?

This is a study from a few years ago from Harris Interactive and BCG that I found on the BioPlus website.  If I am interpreting it right, it would imply that those that are most involved in their healthcare are most likely to be non-compliant.  It doesn’t seem logical, but perhaps those are the people that want to play doctor and are most likely to think they know better.

Three Sad Healthcare Stories

First, I think this is a very disappointing article about workplace violence in the healthcare industry.  I certainly could believe (unfortunately) in the verbal violence since people are very emotional about their healthcare and often stressed over the financial implications and unintuitive processes.  But, this story has some scary statistics which are an issue at a time when we need more healthcare service workers.  [Ask your friends in the industry.  I plan to.]

  • Health care workers are 16 times more like to face violence at their job that workers in any other service-oriented profession.
  • More than 50 percent of reports of aggression in the workplace come from the health care sector.
  • Over 9,000 nurses and other health care workers are verbally or physically assaulted on the job every day, according to the National Institute of Occupational Safety and Health.
  • A 5-year survey of 170 university hospitals showed that over half of all emergency room employees had been threatened by weapons.
  • Almost 90 percent of nurses in every specialty said they were verbally assaulted during the past year and almost 75 percent claimed they were physically attacked, according to a study published in The Journal of Emergency Nursing, which related reports of 100 percent verbal and 80 percent physical assault rates for emergency room nurses.
  • Almost half of all psychiatric physician residents reported an assault during their career and other medical residents in the hospital setting reported a 16 percent assault incidence.

The second article which I read which I think is also sad is about the rise in seniors filing bankruptcy. Sometimes, seniors don’t even have enough resources to install stairlifts in their homes. Not only is it disappointing to see people reach retirement only to have their dreams dashed away from them with crashing house prices, rising food prices, rising gas prices, and lower return on their investments, but they are facing huge healthcare costs that are pushing them over the brink.  22.3% of the bankruptcy filings in 2007 were from seniors.  We also know that even without filing this stress can get people to skip medications or not take care of themselves only worsening their health.

The third story which I saw on CNN this morning was about a group of high school girls making a pregnancy pact.  Talk about a need for sex education and health literacy.  It’s one thing to happen by accident and quite another to intentionally put yourself in that challenging situation of getting a high school diploma and raising a child.

Diabetes or Depression: Which Comes First

Since many of us understand the risk of co-morbidities (i.e., two diseases that commonly exist together), I think it makes a lot of sense to ask this question.  Dr. Gupta from CNN had an article earlier this week on his blog about a study that was recently out on the relationship between diabetes and depression.

  • Those that started with depression but no diabetes had a 42% higher risk of developing diabetes during a 3-year period.
  • Patients with type 2 diabetes but no symptoms of depression were 54% higher risk for depression during that same period.

Brand Prices Up; Generics Down

For those of you who are interested in this type of stuff, I think the AARP Watchdog reports (Brand Report, Generic Report) which track prescription drug prices over time are pretty interesting.  (Note: This is for drugs most commonly used by Medicare recipients, but I think you’ll get the point.)

Why People Choose Mail Order Pharmacy?

I was looking for something else in the Express Scripts Drug Trend Report 2005 when I came across this study referenced on page 209. I should have remembered since I wrote this section (yes I was a contributor see page 332). This is a Morgan Stanley study which talks about why people choose mail order pharmacy. Of course, the primary reason here is savings. The more savings the higher the likelihood of a person moving to mail order. This is a factor of savings per Rx multiplied by the number of maintenance drugs that an individual has that can be filled at mail order (or home delivery). This study shows the frequency of the response. If you focus on the weighted scores, you would see a dramatic cliff after savings. (I.e., 61% of people may choose mail for convenience, but they are much less likely to do it than someone with significant savings) So, why don’t all PBMs communicate exact patient savings to each individual? It’s hard. Given minimums and maximums; deductibles; percentage copays; and other benefit plan designs, the systems are stressed to produce this.

George Paz (Express Scripts) on Adherence

Paul Levy who is the CEO of a hospital has a blog called Running A Hospital.  He posted a summary the other day of a presentation by George Paz who is the CEO of Express Scripts.  It has some good facts and there are several good comments on there about defining the terms in this area (see my old post) and whether these are reasonable rates of compliance.  There is also a patient commenting about getting nurse calls and reminder e-mails which sounds great but puts them in the 1% of the population for which this happens.

The numbers do seem understated to me – 85% compliance with cholesterol lowering drugs.  That might be the amount of people that get a paper prescription and then fill the drug or it might be the amount of people that get one refill, but I believe by month 6 or certainly by month 12 most compliance rates are closer to 50%.

There is clear value in adherence.  Everyone should (in key therapeutic categories and using evidence-based standards) want to increase adherence to reduce total medical costs.

What surprised me most recently around this was what Kaiser had observed when looking at how doctors shared information with patients (Archives of Internal Medicine, Sept 2006):

  • Only 74% of the time did the physician tell the patient the name of the prescription drug
  • Only 35% of the time did the physician discuss adverse events with the patient
  • Only 58% of the time did the physician explain the frequency and timing of dosing

More On Silverlink’s Think Different Event

I am now up in Minneapolis at our 4th Think Different event on how to engage the healthcare consumer.  I talked about the first few speakers the other day, and I finally had a chance to hear the other speakers present.  This week, I had the chance to listen to  James Taylor (of Smart (enough) Systems fame not music) and Fred Jubitz (American Express).  Here are a couple of my takeaways.

[Again, if you are coming to the upcoming events, this might be a little bit of a spoiler.]

A few notes from James’ presentation:

  • He gave a great example of a program they did at Fair Isaac where they compared the standard, baseline program with one that was highly personalized.  What was the improvement – 2,000%!!
  • He gave a good real-life example of the need for channel coordination talking about buying tickets for the Chunnel and how he got different prices on the web and phone which were also different from the prices his father in England got using the same channels.
  • The Chunnel example reminded me of something that someone told me the other day.  They were using the Dell self-service example and pointed out that Dell now uses real-time chat right before you buy.  They have found that this increases the average sale by 15%.
  • The Chunnel example also made me think about how web technology allows us to do a lot of customization by visit, but most companies don’t do this.  At the simplest level, I remember a competitor of Firepond (previous employer) where if I visited their website from work it looked one way and from home looked different.
  • James talked about ATM customization as an easy example.  How much money do you normally take out.  Only showing you services that you have access to.  Some of this is starting to happen, but not much.
  • He also talked about rules creation and how that varies.  I think it is always interesting to trace the evolution of rules and policies within a company.  Are they there because of regulatory issues?  Is it because someone coded the legacy systems that way?  Is it based on a personal interpretation?  Or are they dynamic and regularly reviewed?  One of the worse examples that I have ever seen was a large healthcare company that believed that HIPAA required them to re-code everything as it moved from development to production.  (A very costly error in interpretation.)
  • He also talked about the evolution of interactions:
    • Automate decisions
    • Apply rules
    • Segment customers
    • Predict risk and value
    • Optimize
  • James hammered home the point of never stopping to try to optimize since as the environment and your customer base change the optimal solution might change.

Fred who ran the gold and green cards at AMEX talked about:

  • American Express really wanted to be a lifestyle enabler not a payments company.
  • He talked about the Centurian Card (black AMEX card) which apparently is able to charge $5,000 initiation fee plus a $2,500 annual fee.  (Surprising that people still pay it, but I have heard examples of people buying a plane with their black card so I guess that level of service requires something.)
  • He gave examples of how companies think about cards and showed a lot of affinity cards which made me think about groups and how people like to affiliate with others (e.g., by diseases).
  • He talked about the importance of several things:
    • Know your audience
    • Key metrics
    • Segmentation
    • Personalize
    • Continuous improvement
  • He showed the standard framework for segmentation looking at size of wallet (i.e., how much you charge / spend per year) versus their share of wallet (i.e., how much of that is with AMEX).  Each box on the grid then had a strategy – invest, retain, focus, divest, etc.
  • He showed a lot about how the financial services companies can personalize the web experience, but he pointed out that this took months to develop as they built up your profile.
  • I think a key point he made relative to healthcare is that a lot of a new member’s behavior was determined in the initial months which led to how they used their card.  He gave an example of his blackberry.  The first couple features he learned are all he uses.
    • What are you doing in the initial months to “train” your members or be trained by your healthplan to use the website and leverage other ancillary services (e.g., gym membership) that they might offer?
  • He stressed evolving your segments but not starting over each year or you will lose some of the lessons you have developed.
  • Finally, as you always want to stress, he said to keep it simple.

Additionally, you can see some of Matthew Holt’s comments about the event at The Health Care Blog (here and here) and Les Masterson’s comments in The Health Plan Insider.

Wisdom Of The Crowd – Socializing Wellness

You probably caught the articles last year about how obesity seemed to spread throughout social networks. Now, in an article in the Washington Post (5/27/08), they talk about another example of research showing that smoking is similarly affected by social networks. Theoretically, this research could have significant implications for using social media (i.e., Facebook, MySpace, SecondLife). I can easily imagine blogs out there following people’s efforts to lose weight or quit smoking. I can see a Facebook “badge” or “sticker” congratulating someone for not smoking.

In a study published last week in the New England Journal of Medicine, the team [Nicholas A. Christakis, a medical sociologist at the Harvard Medical School, and James H. Fowler, a political scientist at the University of California at San Diego] found that a person’s decision to kick the habit is strongly affected by whether other people in their social network quit — even people they do not know. And, surprisingly, entire networks of smokers appear to quit virtually simultaneously.

Some of the observations that they found which seem interesting included the way non-smoking spread throughout a interrelated but not always directly related group. I don’t find that too surprising. If everyone quits and it is no longer “cool” or accepted you are marginalized and likely to feel pressure to quit. This was a concern that they noted which might lead to other negative health outcomes for the group that doesn’t change.

In a small group of my friends, I have seen one person’s efforts to lose weight (which included drinking less) impact the broader group. Others lost weight. Less beer is consumed when we get together. And, there is more discussion about the gym and running and other activities. For those who aren’t interested in those topics, they miss out on part of that dynamic.

  • A person whose spouse quit was 67 percent more likely to kick the habit.
  • If a friend gave it up, a person was 36 percent more likely to do so.
  • If a sibling quit, the chances increased by 25 percent.
  • A co-worker had an influence — 34 percent — only if the smoker worked at a small firm.

“It could be your co-worker’s spouse’s friend or your brother’s spouse’s co-worker or a friend of a friend of a friend. The point is, your behavior depends on people you don’t even know,” Christakis said. “Your actions are partially affected by the actions of people who are beyond your social horizon” — but in the broader network.

“People quit in droves — whole groups of people quit together at roughly the same time,” Christakis said. “You can see it ripple through a network. It’s sort of like an ant colony or a flock of birds. A single bird doesn’t decide to turn to the right or the left; the whole flock has mind of its own.”

From a employer, health plan, or even individual perspective, the question is how do we capitalize on this? How can we create wellness programs that leverage this “viral marketing” approach to drive behavior across the “colony or flock” to quickly and efficiently drive change. Certainly, this is where I see an opportunity for some of the Health 2.0 type of companies to play a role in creating communities and enhancing dialogues on key topics to enable this process faster and make the reach broader.

NCPA Survey on Adherence

I have been talking a lot about adherence lately (or lack of). A friend sent me the results of a survey of 1,000 adults by NCPA (National Community Pharmacy Association) from October 2006. This is now the 3rd study I have read this week with different results. Of course, they all used different channels – web, mail, and phone. And, I am sure that the questions asked were slightly different.

  • While most consumers believe they are highly compliant when it comes to taking their prescription medications (64% said they follow their physician’s instructions “extremely closely”), the survey found they are not as compliant as they believe.
  • Nearly three-fourths (74%) of respondents admitted to non-adherent behaviors in the past.
  • Nearly half (49%) said they had forgotten to take a prescribed medication.
  • Nearly one-third (31%) had not filled a prescription they were given.
  • More than one in 10 (13%) had taken someone else’s prescription medicine.
  • Nearly one-quarter (24%) had taken less than the recommended dosage.
  • Nearly three out of 10 (29%) had stopped taking a medication before the supply ran out.
  • More than one in 10 (11%) substituted an over-the-counter medication instead of filling the prescription they were given.
  • Nearly four out of 10 (38%) had forgotten whether they had taken a medication.
  • Less than half of respondents (48%) said they had consulted their doctor or pharmacist before making these changes.
  • An overwhelming 90% of respondents saw non-adherence as a serious problem.
  • More than eight out of 10 (83%) respondents agree that pharmacists can play a role in improving adherence by helping to make sure patients are taking their prescription medications correctly.
  • More than two-thirds (68%) believe pharmacists are more knowledgeable than other health care professionals when it comes to information about prescription medications.
  • Two-thirds (66%) go to one pharmacy for their prescription medications, which presents an opportunity for pharmacists to advise patients how to take their medications properly.
  • Nearly nine out of 10 (86%) say they would be likely to talk to their pharmacist about their medications.

Variance In Children’s Healthcare

I think state-by-state variance in basic statistics is fascinating. It seems like we should have standardized around some fundamentals by now, but the variances continue to be significant.

In a recent report out by The Commonwealth Fund, it showed some wide variation:

  • Only 46% of kids visit the doctor and dentist at least once a year in Idaho, but 75% of Massachusetts children do.
  • Infant mortality rates are 2.5 times higher in the District of Columbia than in Maine.
  • Kids in South Carolina are 5.7 times as likely to wind up in the hospital for asthma as those in Vermont.
  • The percentage of children who received five recommended vaccinations from ages 19 months to 35 months ranges from 94% in Massachusetts to 67% in Nevada.
  • Utah has the lowest spending per person at $3,972. The District of Columbia has the highest at $8,295.
State

Overall rank

Alabama

14

Alaska

41

Arizona

47

Arkansas

44

California

34

Colorado

34

Connecticut

14

Delaware

37

District of Columbia

31

Florida

50

Georgia

38

Hawaii

7

Idaho

33

Illinois

38

Indiana

22

Iowa

1

Kansas

10

Kentucky

9

Louisiana

48

Maine

3

Maryland

27

Massachusetts

4

Michigan

12

Minnesota

23

Mississippi

49

Missouri

28

Montana

28

Nebraska

13

Nevada

45

New Hampshire

5

New Jersey

42

New Mexico

40

New York

25

North Carolina

31

North Dakota

21

Ohio

6

Oklahoma

51

Oregon

43

Pennsylvania

19

Rhode Island

8

South Carolina

36

South Dakota

16

Tennessee

30

Texas

46

Utah

26

Vermont

2

Virginia

23

Washington

18

West Virginia

20

Wisconsin

11

Wyoming

16

PBM Satisfaction Survey

It should be out soon, and it will be interesting to see the data. The WilsonRx PBM Satisfaction Survey is the only (I think) independent survey done of the industry. [Although I never remember paying attention to it at Express Scripts.] From what I know, they seem to get a good sample of more than 25,000 responses rating 18 PBMs (Pharmacy Benefit Managers).

Some of the new factors they are including:

  • Overall Medicare costs and availability
  • Annual increases in premiums or costs
  • Overall delivery of pharmacy benefit services
  • Courteousness and helpfulness of PBM plan representatives
  • Ease and timeliness regarding conversations with a PBM representative
  • Ease and ability to access prescription records and order refills
  • Resolution of denied drug claims or appeals
  • Overall quality of care
  • Adequate coverage of treatment medication needs
  • Personalized care for Rx needs

They seem like logical factors, but some of them aren’t controlled by the PBM but by either the self-insured employer or the managed care company (1, 2, 9). Depending on the service model, several others may be done by the managed care company (4, 5, 6, 7). And, I have no idea of how they are going to gauge things like overall delivery (3); quality of care (8); or personalized care (10). I hope they at least look at how responses vary by high utilizers versus low utilizers (of drugs) along with the type of coverage (which I doubt the individual knows whether their pharmacy coverage is through Aetna’s PBM or Medco (for example)).

Walgreens Health Initiatives (WHI) won the award last year and is certainly building a very competitive offering:

  • A goal of 10,000 retail locations
  • Mail pharmacy
  • Specialty pharmacy
  • 90-day at retail
  • On-site (or worksite) pharmacy
  • PBM

“While we already knew from our own surveys that members are highly satisfied with the wide selection of innovative products and services we offer, it was gratifying to have it confirmed by an independent third-party,” according to Richard Ashworth, Pharm.D., MBA, executive vice president for WHI, a wholly owned subsidiary of drugstore giant Walgreen Co.

He believes member satisfaction ultimately boils down to choice and convenience, noting how a 90-day medication option at the retail level serves as an important mail-order alternative for those who prefer face-to-face consultations with a pharmacy team they know and trust. Of WHI’s national retail network of more than 62,000 pharmacies, more than 39,000 offer this option and the number continues to grow.

Walgreens also offers worksite pharmacies on many corporate campuses across the U.S., which encourages employees to be more proactive about their health and, in turn, helps reduce absenteeism and the overall health care spend. Serving just one employer allows pharmacists to focus solely on that particular patient population, maximizing plan design and wellness strategies as part of a tailor-made approach to comprehensive care.

Pharmacists can help engage, educate and empower employees, as well as provide informed feedback on clinical prior authorizations, therapy-specific programs or the impact of formulary changes on medication options. There’s also room for leveraging a company’s core cost-containment strategies by promoting generic utilization, formulary efficiency and other key clinical programs whether or not WHI is the plan’s PBM. (Text from article by Employee Benefit News)

Pavlovian Response To Sound

We recently got a new dog (a Tibetan Terrier), and we decided to start training the dog using the clicker method.  I kiddingly commented that it would be great to have something like this to train people.  Apparently there already is such a method, and it can be used as a teaching method for autistic children (for example) along with sports training.

Basically, clicker training is an audio reinforcement for positive behavior…think whistle with dolphins.  TAG Teach is a website where you can learn more.

What I found interesting is how to link this in with sonic branding and the Pavlovian response concept.  Could I create an audio sound that drove behavior?  For example, I have my dry cleaning dropped off and picked up at my house.  They use an automated call to remind me to set it out.  All I have to do is pick up the phone and hear the voice.  Once that happens, I know what to do and hang up on the call.

TAG stands for Teaching with Acoustical Guidance and uses a sound marker to indicate correct performance.

The TAG refers to the distinctive sound made to mark or “TAG” a moment in time. This sound becomes an acoustical binary message, a sort of “snapshot” that is quickly processed by the brain.

A TAG means “yes.” Absence of a TAG means “try again.”

The student no longer has to perform a time-consuming language analysis while attempting complicated movements. The immediacy and clarity of the feedback allows the student to form a mental picture of the movement or position.

TAG points are the individual pieces of a desired response action or position. Students receive a TAG (the click sound) when the points are correctly performed.

The set up for a golf swing may have TAG points for grip, body position, foot placement, and club placement. The swing component may have TAG points for hand, arm, and club position at the top and end of the swing, TAG points for leg position, arm position, and weight transfer during the swing. With a beginning golfer a limited set of key TAG points are defined and executed individually. With an experienced golfer a diagnosis is performed and TAG points are identified based on technique errors requiring correction.

Kid’s Cancer Highest In Northeast

I think this is an interesting analysis, but I don’t think it shows any causality just correlation.  The key questions (as reported) are whether there is an issue here (e.g., greater exposure to radiation) or just a difference in reporting or access.

The study was just released by the CDC.  It showed that cancer effects 166 out of every million children or 0.017%.  Rare, but very tragic.

  • The highest rate was in the Northeast with 179 cases per million children.
  • The lowest was among children in the South with 159 cases per million.
  • The rates for the Midwest and West were nearly identical, at 166 cases per million and 165 per million, respectively.
  • The cancer incidence in boys was 174 cases per million, compared with 157 cases per million in girls.
  • In white children, the rate was 173 per million, versus 164 per million in Hispanics and 118 per million in blacks.
  • Teenagers had higher rates than younger kids.

You Only Have To Be Compliant For 10-Days…What Happened?

On the topic of non-compliance, I found this a pretty pathetic statistic:

56% of children on a 10-day course of penicillin for streptococcal infections were no longer receiving the drug by day three. (The Merck Manual of Diagnosis and Therapy)

I guess I expect it with maintenance drugs, but this is for your sick kids where you have already purchased the medication.

Deloitte Survey Of Health Care Consumers II

I posted an entry about a month ago about the Deloitte study that was out about consumer segmentation. That was from reading their website.

After someone sent me the PDF on their study, I finally read it on my flight to San Francisco today. It is full of lots of interesting facts based on their web survey of just over 3,000 adults in September 2007. Here are a few additional things that I pulled out (click on the tables to expand their size).

78% of consumers express a preference for customizing their insurance product by selecting the benefits and features they value and, in doing so, increasing or decreasing the overall cost of their coverage (Figure 18). Only 22% prefer selecting from a few pre-packaged products with defined benefits and features.

Hall of Shame – Customer Service

On the positive side, there were no healthcare companies that “won” this “competition”.  Winning being that you were rated as having poor customer service the highest percentage of times.  (On the flipside, very few were included.)  [full rankings here]

“We’ve seen a fall in customer service as we’ve gone into a recession,” said Richard D. Hanks, the president of Mindshare Technologies, a customer-service consulting company. “As the cost cutting occurs . . . they start to cut the wrong things.” (Article)

Not surprisingly, the people surveyed said that being knowledgeable, available, and friendly were very important.  As we all know, the key attribute is knowledge and with the complexity of benefits, multiple systems that healthcare reps need to access, and turnover, this is a challenge. 

It’s no wonder that everyone is trying to move people to self-service.  In a related article, some of the benefits of self-service were clearly articulated:

“What better customer service is there than self-service?” ask the marketers. “It’s fast!” “It’s accurate!” “It’s convenient!” “It’s confidential!” (No more bystanders overhearing that triple-cheese, extra-mayo order.)

 

  • People buy more. Customers spend 39% more per order at fast-food kiosks and are twice as likely to upsize than if a person takes their orders. (Machines are programmed to ask every time, and no one can overhear.) Customers also buy more at deli kiosks in supermarkets.

 

  • More people buy. Good Web self-service allows for far more customers to be adequately served.

 

  • People remain loyal. “You mean I’m going to have to upload all my data into a new bank? And learn a new system? No way.”

 

  • People give the company high marks for customer service. Yes, funny but true. It’s hard to complain about a food order that you placed yourself, a transaction that you scripted or the way you pumped your own gas. When customer service is self-service, you have only yourself to blame.