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Guest Post: Health Researchers Obtain Grants for Video Game Study

May 30, 2008 by George Van Antwerp 0 Comments

12 US research groups were awarded grants this week in order to conduct studies on how interactive video games affect players’ health. There has been a lot of press lately for Nintendo Wii and its many health benefits. It seems that the Wii isn’t the only gaming system to influence a person’s lifestyle choices where health is concerned. Of course, not all games are having a positive influence.

Grants totaling up to $200,000 were given to each research team, all of which are connected with a major US university. The generous donations come from Robert Wood Johnson Foundation (RWJF), a private foundation that is dedicated to improving the health of all Americans.

In regards to the grants, RWJF program officer Chinwe Onyekere stated:

We have been actively working in this area since 2004. Over this time, we have heard repeatedly that there is a need for stronger evidence that games can improve health and healthcare and support the growing realization that games can make a real difference in public healthcare in the United States.

Our vision is that in the coming years we will have a thriving marketplace of well designed, compelling interactive games that draw on this evidence base to become highly engaging and effective tools for improving the health and healthcare of Americans.

The 12 teams are currently working on projects that focus on different age groups and behaviors. Maine Medical Center, for example, was awarded a grant for its study, “Family-Based Exergaming with Dance Dance Revolution (DDR)”. The aforementioned game, DDR, is extremely popular with children and young adults. It involves moving on a small, portable dance floor while a video with instructions plays on the screen.

Research grants were dispersed by RWJF in order to study things like “the potential of physical activity video games to serve as innovative, cost-effective ways to help people recover motor skills after experiencing a stroke” or “health impacts of online mobile mini-games for people with type 2 diabetes.” Another group of 12 research grants will be awarded next year.

By-line: Heather Johnson is a regular commentator on the subject of CNA Classes Online. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at gmail dot com.

Consumerism, Guest Post, Healthcare, Innovation, Research, Technology, Value Propositions

Our First Think Different Event

May 29, 2008 by George Van Antwerp 2 Comments

Today was our first Think Different event in Boston. This is a road show we are doing around our new positioning and how health care companies need to get outside the box to improve the effectiveness of their communications. It has four external speakers plus our CEO.

[Spoiler Alert: If you are attending an upcoming session, I may reveal some of the content here.]

I missed ½ the session today due to a client call, but I will be at 3 of the other 5 events. In listening to the first two speakers, I jotted down a few thoughts.

From Kinney Zalesne:

  • She spoke about moving to the Starbucks economy and how we have much more choice today in what we do, who we love, religion, and our gender. Everyone immediately thinks of gender meaning sex change operations, but the point here is that there is a group of people who don’t want to be forced to select a gender identity. Before you discount it, you should know that 100 corporations, 75 colleges, and 8 states now ban discrimination based on gender identity. This was a bit of a surprise to me, but when I was talking with a large health plan about this, they informed me that their new EMR (electronic medical record) allowed for 5 possible gender options.
  • She talked about people basically starving themselves to focus on the theory that has been demonstrated in animals, but not yet in humans which says that by eating 30% less calories you can extend your life by 40%. (Not something I will be doing.)
  • She talked about the Do-It-Yourself (DIY) Doctors which are the people who use the Internet to self-diagnose and treat the MD as an ATM for drugs (i.e., I need a prescription for simvastatin can you please write it for me). I have heard a lot of talk recently about the changing perception of physicians. I haven’t seen the statistics, but one person said that they have lost the most respect over the past 20 years than any other profession. I think Kinney’s point is more about them moving from being a supervisor role (i.e., you should do this) to an advisor role (i.e., thanks for your opinion…I will take it into consideration).
  • Her statistics about 5M working retired (i.e., >65 years old) and 2M working teens (i.e., using the Internet to make money before they leave high school) says a lot about how benefit design will need to change. The implications on needs and flexibility (e.g., imagine two primary addresses for snowbirds) could be significant.
  • In her talk about micro-targeting, my mind drifted to a few thoughts:
    • How has gas prices changed our opinion of other costs? A $15 copay used to be equal to 7 gallons of gas. When it only equals 3 gallons of gas, do we view the $15 differently? [Have you caught yourself saying gas is only $3.75 at this one station near my house?]
    • Just like your segmentation can change in healthcare, it is important to consider the macro-economic and political environment when communicating. Have you listened to all the car advertisements lately…they all talk about gas mileage?
    • If you need a simple example of why personalization matters, think about buying a car. I am not a mechanical person so if I came in and someone talked to me about horsepower and cylinders then I would be turned off. I care about comfort and low maintenance.
    • Finally, getting back to health, I thought about how difficult it is to be successful. Let’s assume there were 10 primary reasons for non-adherence and 3 primary channels for delivering information (live, letter, automated call). In this case, you have 10% chance of hitting the right message and a 33% chance of using the right channel (i.e., a 3% chance to be successful).

From Liz Boehm:

  • She shared a lot of great facts about patient awareness of technology and how adherent they are.
  • She points out a scary fact that while our health care needs are going up with the boomers we simultaneously have an issue with health care workers retiring which will only make things worse in the short term.
  • She showed that 47% of people had visited their health plan’s website. [I will have to push her on this data since I believe they visited, but I think the percentage that log-in and use the site has to be very small. I would estimate 10-15%.]
  • She talked about use of social media and gave an example of a MySpace group on diabetes.
  • I found the discussion on wellness very interesting where she pointed out that things like chocolate, riding an elevator, or for some smoking gives you an immediate positive feeling while dropping your cholesterol by 10 points or even trying to lose 1 pound per week is pretty abstract.
  • I have talked about loss aversion several times, and she talks a lot about it. Using it to make a link to why incentives matter in health care.
  • Talking about motivation, I like her point that it isn’t a reasonable suggestion if you can’t achieve it. It may make good clinical sense to have a BMI of <25, but for someone with a BMI of 31, perhaps setting a goal of 28 is more reasonable and not as discouraging.
  • In her talk about trust, it made me wonder how many people that work for managed care companies and pharmacy benefit management companies reveal that fact at cocktail parties. I am not talking about professional networking events, but your neighborhood events. Do you say who you work for and address their comments about service and/or coverage issues?

I finished my client meeting in time to hear Stan Nowak, our CEO and co-founder, speak and tie together the different points of view with some potential actions that people could take. As he often does, he talked a lot about the power of data and the fact that what’s new to health care is often old in other industries. We are an industry with the most data about people, but the least ability to use it effectively.

It’s also interesting to hear him talk about some of the “data exhaust” that is created by the analysis that the team does. These are facts that get revealed which may be surprising and may be things you never even thought to look for. For example:

  • Patients with emphysema are 40% more likely to engage in a communications program related to additional coverage than patients with migraines.
  • Patients with uncommon names are 18% more likely to complete a healthcare survey than those with common names.
  • Males with depression are 83% less likely to do pill splitting than females with depression.
Books / Articles, Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Groups And Microsegments

May 28, 2008 by George Van Antwerp 0 Comments

When I was listening to Kinney Zalesne (Microtrends author) present this morning at our Think Different event, there were several things that crossed my mind:

  1. Which micro-trends am I part of?
  2. How much micro-targeting is too much?
  3. Will consumers self-identify into groups?

Without going back to the whole book, I can think of several micro-trends with which I associate:

  • Marathoning
  • Stay-at-home worker and extreme commuter
  • 30-winker (don’t sleep a lot)
  • DIY Doctor (research my own care)
  • Pet Parent (pamper my dog)
  • Video Game Grown-ups (enjoy playing Wii w/ and w/o my kids)
  • Blogger

It has come up in the past two sessions where I have seen Kinney present. The question is how much is too much. Just because I know that you like cats, subscribe to Popular Mechanics and GQ, and have 3 siblings, should I use that information?

  • I certainly think that more targeting is better although I might not always want you to tell me how much you know about me.
  • You have to be flexible enough to allow for mistakes in interpretation and/or not too presumptuous. (For example, one of our co-founders is from Brazil but has been here for years. He recently started getting all of his communications from a few companies in Spanish. He didn’t opt-in, but they assumed his last name meant he spoke Spanish (which is not what they speak in Brazil BTW).)
  • You have some issues of parity which must be either addressed or are legally required (i.e., you may have to treat everyone in a similar way). I am sure we might all like to drive high satisfaction for healthy members to increase their retention, but this deliberate adverse selection would be an issue and abuse of information.

Finally, there is a lot of discussion about capturing preferences (i.e., I prefer calls over letters) and how to segment populations. I think there is an interesting trend in social media for people to self-identify into groups. For example, I pulled up my LinkedIn profile to look for a second at all the groups to which I belong. The same thing is happening in Facebook. Until recently, this was not a huge driver of activity, but over the past 6 months, I have noticed people forming and joining groups. We want to be associated with certain things. I think if I knew how the information was being used that I would spend a few minutes during enrollment filling out information about how and when to communicate and interact with me. I think I would even reveal my Myers-Briggs category (INTJ) if it helped someone better deliver information to me that would make me healthier.

The younger generation is rapidly becoming used to revealing lots of information about themselves. I don’t think that things are considered as private as they once were.

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

Missing The First Step

May 28, 2008 by George Van Antwerp 1 Comment

When I saw Forrester’s data around Personal Health Records (PHRs), it reminded me of one of the facts we struggled with around increasing mail order utilization…most people didn’t know what it was or whether they had it as a benefit.  (From their Q2 – 2007 Social Technographics Online Healthcare Survey)

So, given all the buzz about PHRs and which one will work and what needs to be included, I wonder if we often miss the first step as people in the industry.

The first step in any “marketing” or communication approach has to be to build awareness.  Although it might sound great to say that I have 80% of chronic drug users that are aware of their mail order benefit using mail order, I am not maximizing the size of the pie.  (I.e., 50% have chronic medication x 50% aware of mail x 80% use mail = 20% penetration)

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

Additional Blog Site

May 27, 2008 by George Van Antwerp 0 Comments

I got asked to contribute to the Drug Safety Hub Blog and just posted my first entry there on patient’s awareness of technology solutions around pharmacy.

Consumerism, Healthcare, PBM / Pharmacy, Research, Technology

Book Review: Health Care Reform Now!

May 27, 2008 by George Van Antwerp 3 Comments

Health Care Reform Now! A Prescription For Change is the latest book by George Halvorson (CEO of Kaiser Permanente). I have been talking about it and using quotes from it for a few months. I finished the book a few weeks ago and figured that I better carve out the time to capture my thoughts now.

First, if you are looking for a great book on why healthcare is a big issue in this election, you don’t have to look any further. As someone running one of the biggest healthcare entities in the US, George clearly knows what he is talking about and speaks from a position of authority. I know that he has talked with all of the candidates about their policies.

If you are in healthcare and trying to be a catalyst for change, you have to read the book. It is pointed, opinionated, and supported with lots of facts and examples. If it doesn’t make you want to change what we have, I would be shocked. Some of the examples of mis-alignment are scary.

Some of the facts he shares:

  • Family health insurance rates in CA already exceed the per capita income of 147 countries.
  • General Motors now spends more money on healthcare then on steel.
  • Nearly 50% of the time, patients in the US are receiving less than adequate, inconsistent, and too often, unsafe care.
  • Healthcare costs are unevenly distributed in America.
    • 1% of the population uses 35% of the healthcare dollars
    • 5% uses 60%
  • Care linkage deficiencies abound – and can impair or cripple care delivery.
  • Economic incentives significantly influence healthcare.
  • Systems thinking isn’t usually on the healthcare radar screen.
  • Most of our costs are for chronic diseases – primarily diabetes, congestive heart failure, coronary artery disease, asthma, and depression.
  • Prevention is a lot less expensive than addressing these chronic diseases at their late stages.
  • The US ranks 35th in the world in infant mortality.
  • We could cut the complications of diabetes by 90% with best care and involved patients.
    • We could cut second heart attacks by 40%.
    • We could cut school and work days lost because of asthma by 90%.
  • Incentives work…yet while we have 9,000 billing codes for procedures and services not one of them is for curing someone or improving someone’s health.
  • There is up to a 60% difference in the 5-year mortality rate for breast cancer patients, depending on which hospital’s surgery team did the surgery.
  • 1 in 10 doctors use electronic medical records (EMR) and only 5% of hospitals use computerized physician order entry (CPOE). This means our history exists mostly in paper files with no standards.
  • Almost 50 developing nations have higher immunization rates for preventable childhood diseases than the US.
  • The Institute of Medicine showed that it takes “seventeen years before a proven new technique becomes the standard of care in a given medical specialty.”
  • There were 2,000 published clinical trials in 1985 and 30,000 published in 2005. (Can your provider really keep up without an electronic system?)
  • Diabetes is the number one cause of new blindness (90% preventable) and foot and leg amputations (85% preventable). It is the number one co-morbidity associated with death from heart failure.
  • Asthma causes – 2M emergency room visits, 500,000 hospital stays, 5,000 deaths, and 14M lost school and work days per year.
  • The vast majority of asthma attacks can be prevented.
  • If Americans were 5-10% thinner and walked just 30 minutes per day, the incidence of Type 2 diabetes could be cut by more than half. (Culture and incentives matter)
  • We spend $250,000 every minute on heart disease.
  • More than 15M Americans have depression…and on average, people with depression have 3 other chronic diseases.
  • A 10% reduction in spending for the top 0.5% of patients would create enough savings to fund universal coverage for the uninsured.
  • The most expensive acute conditions are cancer, maternity, and trauma care. (Acute conditions account for 30% of the health care spend.)
  • The median life expectancy across the 117 cystic fibrosis centers is 33, but it is 47 at the highest performing center. (This seems embarrassing that there could be such a difference here.)
  • US employers pay an average of $6,600 Per Employee Per Year compared to $600 in Canada.
  • 4% of people believe they have insurance…but they don’t. (Who are these people?)
  • Government pays 44% of the healthcare bill today; employers 26%; and individuals 30%.

Key Point – I think everyone wishes that we could address the uninsured and underinsured issue here in the US. It is ridiculous. But, I think most people feel it would further complicate the economy and be a downward drag. George presents a good case that today’s model simply cost shifts so that we are paying for care but paying at the high cost of emergency care not preventative care for those people. In the book, they say that this cost represents $922 per employee today in what is paid. Someone has to pay the providers for these real costs that they incur and can’t recoup. We could cover the costs of the uninsured without any real increases in costs.

Some of my favorite quotes:

  • “We don’t really have a health care delivery system in this country. We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited Microsystems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients.” (introduction)
  • “Performance reporting that actually exists about either processes or outcomes is almost always regarded in the current culture of American health care as an onerous, externally imposed burden, extraneous and irrelevant to the actual business and profession of care delivery.” (pg. 23)
  • “I do not want ‘rules-based’ medicine. I do want accountable care.” (pg. 29)
  • “Process reengineering will not happen on any scale in health care until there is a financial reward for doing just that.” (pg. 33)
  • From the book Escape Fire: Designs for the Future of Health Care by Don Berwick – “A patient with anything but the simplest needs is traversing a very complicated system across many handoffs and locations and players. And as the machine gets more complicated, there are more ways it can break.” (pg 86)
  • “We need highly credible doctors, nurses, and health educators talking to patients in targeted and effective ways to help people make the lifestyle changes necessary to avoid diabetes.” (pg 117)
  • “Health care can be improved. The challenge is to do it consistently and systematically, not incidentally and haphazardly.” (pg 122)
  • “Improving care by 50 percent for diabetics is wonderful, but not as wonderful as reducing the number of diabetics by 50 percent by preventing the disease.” (pg 206)

Comments:

  • He talks about studying the international models and that none of them are the same. They have all been individually developed to fit the culture and needs of the country.
  • He talks about creating a “patient-centered American health care marketplace”.
  • He is careful about not just pushing the Kaiser model of vertical integration. He focuses on virtual integration which is more achievable.
  • More care is not better care.
  • He gives several examples of how following best practices for evidence based medicine improved outcomes but reduced revenues for the providers which is a hard model to sell.
  • He compares HEDIS scores (which measure how often health plans offer care that complies with best practices) with Six Sigma:
    • Average performance for screening for colorectal cancer is 49% (or 1.5 sigma).
    • Recommended treatment of acute depression is 61.6% (average) and 70.8% (90th percentile) which are 1.8 and 2.1 sigma performance.
    • Note: 2-sigma performance means 308,000 cases of non-compliance per million patients…6-sigma means only 3.4 cases per million.
  • He talks about the fact that 5% of patients experience an adverse drug event. I think the PBM industry has consolidated a lot of data to minimize this, but I am surprised more people don’t talk about samples here. Although they are supposed to track samples, I bet most physicians don’t record them in the chart and they certainly aren’t electronically managed to look for potential drug-drug interactions. (In my opinion, there is still opportunity for improvement, but it is at the pharmacy level not the provider level.)
  • He proactively addresses one major excuse about controlling patient behavior. Yes…we can’t control the patients, but we can make sure that the right events happen to align them for success.
  • I like his suggestion that a personal health record could be a more logical first-step than a full blown EMR solution due to costs and ability to execute.
    • “That personal health record data set for each patient should show all care received by that patient, all prescriptions paid for, all tests given, all diagnosis made, and all providers who delivered care to each person as a patient. The information should be in an easy-to-use format and available to each patient on demand, either electronically or on paper.”
  • He provides a good, quick comparison of PHR and EMR:
    • EMR has the exact Rx dosage and level. PHR may just have the name of the drug.
    • EMR will have the x-rays and scans. PHR will just say the date the test was done.
    • EMR will have notes from physician visit. PHR will just know the patient visited.
  • Preventing a CHF (congestive heart failure) crisis might only generate $200 in billable revenue while treating a crisis creates $10,000 – $20,000 in revenue. (And, we really wonder why people aren’t acting preventatively.)
  • Preventative care makes me think of two examples:
    • People have to want to be healthy and manage their risk. I know numerous people who are told to be on bed rest when they’re pregnant that don’t listen to their physicians.
    • People have to know there is not a risk of discrimination. I know a friend with MS who didn’t go see a doctor for several years until she had found a job with good health insurance.
  • He talks a little about it, but I think the issue of helping patients evaluate trade-offs is a big one. Enabling them with information is important, but how do we help them compare two treatments based on both outcomes and the experience (i.e., pain, functionality). Is it always better to simply live longer even if you have limited functionality and are always in pain?
  • He talks about plan design with some very good insight:
    • Deductibles only work if the unit of care being purchased is less than the deductible.
    • Deductibles tend to discourage chronic patients from getting preventative and maintenance care.
    • Percentage copays only work on big dollar differences. Otherwise, paying 10% more of a drug or office visit that costs $20 more is only $2.
  • In talking about plan design, he talks about something that in pharmacy is referred to as Therapeutic MAC. (MAC = maximum allowable cost) This allows patients access to any drug, but the plan only pays for the lowest cost drug which produces equal outcomes. Therefore, a patient might get the first $70 of any office visit covered, and they pay the difference. Then they care about where and when they go to the doctor.
  • For all the talk about price transparency and driving decisions, he makes a great point that this is thrown out the window at times. For example, when you are having a heart attack, you don’t have time to research your options and make tradeoffs.
  • Kaiser saw first-hand what happens after seniors pass a cap on prescription coverage (pg 137):
    • 18% started skipping doses of medication
    • 9% increase in ER visits
    • 13% increase in hospital admissions
    • 22% increase in mortality
  • He talks about 8 developments that have made health care reform possible:
    • Common provider number
    • Computerized databases
    • Electronic claims data portability
    • Government transparency about payment data
    • Universal awareness of the quality issues
    • Buyers are ready for change
    • Internet functionality used for care
    • Lawmakers are ready for reform
  • He talks about blending virtual care and live care with a technology infrastructure which I think makes a lot of sense. I wonder how we change physicians to be more comfortable with the “DIY” (Do It Yourself) patient that comes in with lots of information and suggestions from other caregivers or even getting “second-guessed” by the rules engine of the EMR.
  • He talks about health care needing a Target, Best Buy, or Wal-mart to manages the buy and sell side of health care.
  • (I am going to massively over-simplify this) He talks a lot about having the buyers issue an RFP requiring certain things and creating a new type of entity – the Infrastructure Vendor (IV). “The IV should facilitate and operate electronic connectivity support tools for the patients and caregivers and should demonstrate their effectiveness to the buyers.”
    • He doesn’t see the government playing this role which limits who could do this nationwide.
    • Conceptually, I agree that a technology backbone that connects everyone would be key.
    • It sounds a little too build it, and they will come to me. This is a radically and risky change that would need everyone on board.
    • Some mandated change at a government level has to be required.
    • Could you do this at a state level first?? For example, I know a coalition that got all the employers to agree to a RFP and moved all their business to Humana for one area after they won the RFP.
  • At many points in the book, I kept thinking about the need for SLAs (service level agreements) on outcomes. (I haven’t studied the capitation modes tried in the US years ago, but there seems to be something there about paying a provider a fixed amount per year. Their job is then to act preventatively.)
  • I am a fan of using incentives and penalties in the system with one caveat. I think you need to tie this to genomics. So, someone who has high cholesterol based on their family history and tries to treat it shouldn’t be treated the same way as someone who eats junk food all the time with no family history.
  • I think making people buy-up to different providers or drugs works great for events that can be planned, but not for emergency. It would be possible to tell which one was which with a fully integrated system. Of course, you have to manage people not gaming the system, but that is where there should be incentives for being preventative. Trading off metrics in your design to balance behavior will be key.
  • Another sad fact that he relays toward the end of the book is some of the data pointing to the racial and ethnic disparities in coverage and care in the US.
    • The death rate from asthma for African American children is 4x the death rate for white children.
    • Minority Americans make up ~ 1/3rd of our population but over ½ of the uninsured.
  • One thing I didn’t see or get was whether any of the international models that he studied had a focus on outcomes.
    • I thought one interesting point he made that in a government system where votes are at stake there is a strong focus on primary care which is used by the masses (i.e., more votes) versus specialists which are used by the minority of patients. Another example of how incentives skew solution design.
  • I am always shocked when I see the Federal Poverty Guidelines. How does someone survive on $9,800 or $20,000 for a family of 4? If you ever wonder how all the tasks get done around you and still feel like addressing the uninsured and underinsured is an issue, you should try to live on that income.

My summary after reading the book was:

  • Wow! We have a lot of work to do.
  • We can make a difference pretty easily.
  • There are three things that matter – infrastructure, incentives, and culture.
  • Employers have to be willing to push incentives or penalties to their employees. The strategy of lowering costs without “disrupting” people doesn’t work.

Go read the book. Help make a change.

Books / Articles, Consumerism, Healthcare, Innovation, Managed Care, PBM / Pharmacy, Research, Technology, Value Propositions, Weblogs
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Medco’s Trend Report

May 22, 2008 by George Van Antwerp 0 Comments

Medco‘s Trend Report recently came out for 2008 (which looks back at 2007). Here are some of the graphs and information from it.

“Generic drugs have been a tremendous asset in controlling runaway health care costs,” Medco Chairman and CEO David B. Snow Jr. said. “Generic cholesterol medications have helped contain our drug trend to a new all-time low of 2.0 percent. Patients and our clients are reaping the benefits of generics as we enable them to hold down costs and make prescription drugs one of the few areas where spending trails overall health care inflation.” (Source)

  • Drug trend was 2.0%.
  • They talk a lot about what drives trend by class.
  • It shares a lot of tables and charts. (I pulled out those below that most interested me.)
  • They talk about legislative and technology issues / opportunities such as e-prescribing.
  • They talk about consumer driven health plans (CDH):
    • Lot of plans offering them; low adoption (2.6M members)
    • Mail order use is only 1.2% higher and generic use is only 1.0% higher (so much for easy ways of saving money)
  • They talk about the rapid growth of people using social networking tools to learn about diseases and medications.
    • Which presents risks and opportunities

  • They introduce a new metric…the Generic Opportunity Score.
  • They introduce a new topic to me which is “adjunct therapies”. The key to this topic here is whether plans should consider coverage of over-the-counter (OTC) drugs that are prescribed for use with prescriptions to treat a condition.
  • They talk about Medicare driving a focus on quality.
  • They talk about coverage for the uninsured.
  • They talk about biosimilar drugs (aka – biogenerics).
  • The talk about genomics (i.e., personalized medicine).
  • They talk about BTC (behind-the-counter) and OTC (over-the-counter) trends.
  • They talk about nanotechnology.

I didn’t read it word for word, but it seems to cover the landscape well and give good easy to read metrics with lots of charts.

Books / Articles, Consumerism, Healthcare, Innovation, PBM / Pharmacy, Research, Technology, Value Propositions

Silverlink HealthComm Behavioral Index

May 20, 2008 by George Van Antwerp 1 Comment

Although this new index was released in a story a few weeks ago, the official press release should be out this morning. It has been interesting to watch this transform from a concept to an initial survey with some data.

What is it? The Healthcomm Behavior Index is a quarterly survey of 1,000+ commercially insured adults in the US that measures the effectiveness of healthcare communications. It focuses on three areas – personalization, satisfaction, and action.

What are some of the key findings?

  • Effective healthcare communications (i.e., targeted and personalized) have the potential to build member affinity, loyalty and trust, and significantly drive behavior change.
  • There is a direct relationship between healthcare behavior change (the willingness to take action) and how personalized and satisfied members are with their healthcare communications.
  • Respondents are generally lukewarm on healthcare communications and there is significant opportunity for health plans to improve the effectiveness of their communications programs.
  • Unlike other consumer industries, demographics are not as predictive
    of healthcare behaviors.
  • The single most consistent
    determinant of healthcare behaviors is health status.
  • Unhealthy members (those who arguably use health benefits more actively) are the least satisfied and the least likely to take action. These are the members who are the most costly to the health plans so if the plans improve the effectiveness of their communications, they will be able to drive behaviors within this segment and thus have the opportunity to significantly reduce healthcare costs.
  • Seniors are more satisfied and take more action relative to other age groups. This was a counter-intuitive finding as it was assumed that seniors as a whole would have a higher percentage of ‘unhealthy’ members. However, we found that people tend to rate their health status relative to their age.

What are the conclusions? Personalized healthcare communications leads to better satisfaction which leads to a higher likelihood that a healthcare consumer will take action relative to their healthcare behaviors. To most effectively drive member behavior, health plans should micro-segment their populations and deliver extremely targeted and personalized communications programs.

I found the most interesting fact to be that those who took action were the most satisfied with their healthcare communications and felt that they were personalized to them. Digging in a little on the research process, those terms were based on questions that addressed the following:

  • Took action = acted on information + adopted a healthier lifestyle + improved my health
  • Satisfaction = got the right amount of communications + easy to understand + timely + useful
  • Personalization = trust the communications + specific to my needs + treat me like an individual

It will be interesting to see how we can use these results with clients to create a benchmark, compare them to a national average, and then look at how self-reported data correlates to claims data. Ultimately, this could prove to be a defining moment in creating the business case for why healthcare communications are so important beyond the obvious – patient satisfaction, lowering inbound call volume, driving behavior, improved profits, etc.

Books / Articles, Consumerism, Healthcare, Marketing / Communications, Research, Value Propositions

Most Medicated Generation

May 16, 2008 by George Van Antwerp 1 Comment

Well, we have finally broke the 50% mark of people using maintenance (or chronic) medications. It shouldn’t be a big surprise. Sit around the table with your friends and ask who takes a medication (without asking what for). Why do so many people take medications:

  • We are in worse health…think obesity.
  • There are better medications.
  • Doctors are more willing to prescribe.
  • Patients know more about using medications through DTC (direct-to-consumer) advertising.

This is all according to a Medco report that was just published looking at a sample of 2.5M customers of all ages from 2001 – 2007. A few of the facts:

  • 2/3 of women 20 and older take maintenance medications.
  • ¼ of children and teenagers take maintenance medications
  • 52% of adult men take maintenance medications
  • ¾ people 65 or older take maintenance medications
  • Among seniors, 28% of women and 22% of men take 5 or more maintenance medications

“Honestly, a lot of it is related to obesity. We’ve become a couch potato culture (and) it’s a lot easier to pop a pill” than to exercise regularly or diet. (Dr. Robert Epstein, Chief Medical Officer at Medco)

Dr. Epstein makes the point that in some cases we have turned diseases that were once a death sentence into chronic conditions – AIDS, some cancers, hemophilia and sickle-cell disease. I was just talking about this yesterday with a nurse about an adherence program where I said we needed to look at some specialty drugs because they are being used chronically.

The biggest jump was in the 20-44 year old age group where utilization grew 20% mainly for depression, diabetes, asthma, ADD, and seizures.

Medco estimates about 1.2 million American children now are taking pills for Type 2 diabetes, sleeping troubles and gastrointestinal problems such as heartburn. (This should be troubling to everyone in terms of the long-term implications to our health care system.)

Consumerism, Healthcare, PBM / Pharmacy, Research

Pharmacy Satisfaction Did You Knows

May 15, 2008 by George Van Antwerp 0 Comments

PharmacySatisfaction.com puts out a weekly factoid. They are very interesting and make some great points. I have talked about it before, but here is an updated list with the new factoids from 2008.

  • Independent drug stores continue to score highest in customer satisfaction, followed by food stores, clinics, and chain and mass merchandise pharmacies, in that order.
  • The number one concern across all pharmacy users is that their prescriptions are filled accurately.
  • Independent pharmacy customers are the most satisfied with the services their stores provide.
  • The most useful feature those Web sites offer to them, the survey found, is the ability to order refills online.
  • Nearly three in 10 order their refills online.
  • An average of 69.4% of customers own or use a computer.
  • Customers average three visits each month to their pharmacy.
  • Only about 1-in-5 pharmacy customers, overall, say that they use a loyalty card that provides points, discounts or other savings.
  • While the majority of loyalty card users are satisfied with the expected cost savings by using their card and with the ease of enrolling and understanding the benefits of their card, fewer than 1-in-4 card users are highly satisfied.
  • The drug store industry remains largely up for grabs, with nearly half of pharmacy customers saying they use more than one pharmacy to fill prescriptions.
  • Pharmacy use varies considerably by population. Chain pharmacies are most commonly used among residents of areas with more than 100,000 people. Independent pharmacies are most commonly used among rural respondents (areas with less than 100,000 people). Use of independent and mass merchant pharmacies decreases as population increases. Chain, food store, mail/online, and clinic pharmacy use tend to increase with population.
  • However, as pharmacy customers age, they are much less likely to use chains and considerably more likely to use mail/online and clinic pharmacies.
  • Seven-out-of-ten pharmacy customers indicate that they “definitely would” or “probably would” use their local pharmacy if they could receive the same amount of medication at the same price as their mail-order pharmacy.
  • The heaviest users of prescriptions are survey respondents in their 60s, averaging 5.4 new scripts and 29.2 refills per year.
  • The most preferred method for filling those prescriptions among respondents is to take them to the pharmacy and wait for them to be filled.
  • Indeed, physically handing a paper script to the pharmacist or tech in the store—or picking up a script phoned in by the doctor—remains the overwhelming choice among consumers. Most shun the use of drive-through windows.
  • How long patients have to wait for their scripts to be filled is a key component of customer satisfaction.
  • Fully 93 percent of those surveyed expressed satisfaction with the ability of pharmacies to dispense their new prescriptions in the time promised.
  • Pharmacy customers’ most commonly preferred method of refilling prescriptions (assuming prices and amounts of medication are the same) is calling an automated telephone system and picking up prescriptions at the store.
  • Independent customers are the most likely to receive prescription refills in less than 15 minutes, followed by food store, chain and mass merchant customers.
  • The average survey respondent is spending a considerable sum each month on drugs at their pharmacy—$82 on average (versus $57 a month on food and groceries at their pharmacy).
  • Customers who paid full retail price for their medications, paid an average of $81 for their most recent prescription.
  • Customers who paid the store discounted amount for their medications, paid an average of $75 for their most recent prescription.
  • Customers who paid a fixed-percent co-pay for their medications, paid an average of $56 for their most recent prescription.
  • Customers who paid a fixed-dollar co-pay for their medications, paid an average of $36 for their most recent prescription.
  • On average, respondents spend $82 a month at their pharmacy on prescription drugs, $57 on food/groceries, $18 on non-prescription (OTC) drugs and $14 on personal care/cosmetics.
  • An average of 85.9% of computer owners/users use the computer to improve their health by looking for information about diseases.
  • Much has been written about the value of closer pharmacist-patient relationships, but Americans seem to feel far more connected to their physicians, dentists and nurses than to their pharmacists. That’s clearly not all pharmacy’s fault; the same survey respondents agreed that they were usually given the opportunity to speak with their pharmacist when filling their last prescription. What’s more, pharmacists ranked a close second to doctors as sources of information about medications.
  • Only 16 percent of respondents describe their relationship with their pharmacist as “We are on a first-name basis and have known each other for a very long time.”
  • Walgreens’ “Dial-a-Pharmacist” initiative, launched in February 2006, allows non-English speaking patients to connect with pharmacists speaking 14 different languages.
  • Doctors (94%) are the most commonly referenced source of information on medications, followed by pharmacists (83%), nurses (57%), pharmacy brochures (50%) and the Internet (42%).
  • Doctors (77%) are the most trusted source of information on medications, followed by pharmacists (64%), nurses (43%) and pharmacy brochures (20%).
  • Independent pharmacy customers have the most trust in pharmacists, while mail/online customers have the least. Compared to last year, customers of all types of pharmacies place more trust in their pharmacist as a source of information.
  • More than one-third of pharmacy customers failed to fill all their prescriptions last year, and only 35 percent of all respondents said they were fully compliant on the medications they did take. Nevertheless, refill reminders from the pharmacy remain relatively rare, most patients profess.

2008 Factoids

  • In general, older patients tend to be more compliant than their younger counterparts.
  • The biggest reason for not taking all medications as directed was simply, “I forgot.”
  • Nearly 2-out-of-3 (65%) indicate that they missed a dose or took less medication than prescribed in the past year.
  • The most commonly cited reason for not filling all prescriptions is not needing (42%), followed by too costly (27%), changed by doctor (20%), side effects (17%) and insurance did not cover (16%).
  • Among the medical conditions displayed, those treated for HIV/AIDS and high blood pressure are the most likely to have filled all of their prescriptions in the past year. Those treated for RLS are the least likely to have filled all their prescriptions in the past year.
  • For competing pharmacy providers, satisfaction is a key measurement. Customers who say they are “highly satisfied” with their pharmacy are much more likely to return than those who are simply “satisfied.”
  • Pharmacy customers who are “highly satisfied” with their pharmacy overall are considerably more likely to have positive return intentions, compared to customers who are simply “satisfied” (97% definitely intending to return versus 65%). Survey results have also shown significant revenue differences between highly and poorly rated pharmacies, health plans, and PBMs.
  • Compared to last year, pharmacy customers place more importance on four of the six overall areas of pharmacy services—most notably professional services — followed by pricing and insurance, and overall convenience.
  • 31% of customers consider it “very important” that Pharmacists give advice on OTC/herbal products.
  • 38% of customers consider it “very important” that Pharmacists give advice on health conditions.
  • 57% of customers consider it “very important” that Pharmacists are friendly and courteous.
  • 65% of customers consider it “very important” that they are able to speak to a Pharmacists give clear instructions about Rxs.
  • 65% of customers consider it “very important” that they are able to speak to a Pharmacists about their concerns/questions.
  • 66% of customers consider it “very important” that their pharmacy protects the privacy of their health info.
  • The most common ailment that drives customers into your stores is high blood pressure, which afflicts nearly 50 percent of the respondents surveyed by WilsonRx. High cholesterol, allergies, ailments of the esophagus, arthritis and diabetes also are extremely common among patients.
  • When asked about their satisfaction levels, respondents who received birth control prescriptions were happiest with the medical treatment they’re getting, followed by those thyroid disorders, epilepsy/seizures and type I diabetes.
  • Among the pharmacy services customers say are most important to them is: Help untangling complicated insurance issues, and money-saving alternatives like generic drugs.
  • Consumers are generally satisfied with many of the services, medicines and health-oriented advice they find at their local pharmacy, but they’re also keenly aware of the high costs of pharmaceuticals and quick to shift outlets if they feel their needs aren’t being met.
  • Those who are covered by prescription plans—including nearly 39 million Medicare patients enrolled in some kind of coverage—often feel overwhelmed by the complexities and co-pay issues they encounter at the pharmacy counter.
  • Know your customer — whomever, wherever they are. Being able to identify different customer types is an important first step in anticipating customer needs and managing the expectations of each person.
Books / Articles, Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Research

Are You Doing Enough To Drive Generics?

May 13, 2008 by George Van Antwerp 0 Comments

From the Express Scripts Outcomes event a few weeks ago, here is an estimate of all the money left on the table by not increasing your generic fill rate in certain key categories.  Are you doing enough?

  • Utilization management programs – step therapy, prior authorization, quantity level limits?
  • Formulary coverage?
  • Plan design incentives?
  • Pharmacy incentives?
  • eRx messaging?
  • Web tools?
  • Patient communications?
  • Patient incentives?
  • Driving people to mail?

Here is a graph from CVS/Caremark‘s trend report from last year that shows correlation between certain programs and generic fill rate.

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

Addressing Medicine Adherence

May 9, 2008 by George Van Antwerp 2 Comments

There are numerous studies on this, but they all point to the same issue…compliance.

The National Council on Patient Information and Education (NCPIE) released a report last year that I just came across titled “Enhancing Prescription Medicine Adherence: A National Action Plan“. With only 50% of patients using medication as prescribed, the systemic costs are enormous – $177B annually according to their estimates.

“Besides an estimated $47 billion each year for drug-related hospitalizations, not taking medicines as prescribed has been associated with as many as 40 percent of admissions to nursing homes and with an additional $2,000 a year per patient in medical costs for visits to physician’s offices.”

  • Between 40% and 75% of older people don’t take their medications at the right time or in the right amount.
  • As few as 30% of adolescents take their asthma treatments as prescribed.

Look at this in light of the recent study that showed about a quarter of people share drugs.  Another huge problem.

Their 10-step national action plan includes:

  • Elevate patient adherence as a critical health care issue
  • Agree on a common adherence terminology that will unify all stakeholders
  • Create a public / private partnership to mount a unified national education campaign to make patient adherence a national health priority
  • Establish a multidisciplinary approach to compliance education and management
  • Immediately implement professional training and increase the funding for professional education on patient medication adherence
  • Address the barriers to patient adherence for patients with low health literacy
  • Create the means to share information about best practices in adherence education and management
  • Develop a curriculum on medication adherence for use in medical schools and allied health care institutions
  • Seek regulatory changes to remove roadblocks for adherence assistance programs
  • Increase the federal budget and stimulate rigorous research on medication adherence

I am a little surprised that they didn’t talk about technology.  Integrated electronic medical records, personal health records, etc.  Since at least 1/4 of people don’t even fill their initial script, I don’t see how we can address adherence without beginning there and providing full lifecycle data to physicians about the status of scripts and refills.  I think there is also a huge role for collecting data about why people fill or don’t fill.

Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

Poor Health Plan Satisfaction Due To Poor Communications

May 8, 2008 by George Van Antwerp 1 Comment

JD Power just finished their second annual National Health Insurance Plan Study which looks at member satisfaction.

“The study finds that the majority of health plan members rate their insurer lowest for the communications and information that are provided to help them understand their plan. Only 45 percent of members reported they fully understand how to use their health insurance coverage and member services. Enhancing member understanding with critical plan details—such as prescription coverage, co-pays, how to locate physicians and how to appeal coverage denials—can lead to higher satisfaction ratings for insurers.”

They evaluated 17 regions and publish reports like the following:

Information and communications is the third largest driver of health plan satisfaction at 17%. The only two things above it are coverage and benefits (#1) and choice of physicians, hospitals, and pharmacies (#2). So, it makes a great case for why communications is something to invest in and focus on. It drives satisfaction which drives retention. Additionally, it is something through which you can create sustainable differentiation. Benefit design and network size are pretty easy to copy.

Books / Articles, Healthcare, Managed Care, Marketing / Communications, Research, Value Propositions

Robot Animals

May 6, 2008 by George Van Antwerp 0 Comments

In the spirit of research, I found this an interesting article. It talks about using robotic squirrels to infiltrate the squirrel population and learn about their communication techniques, social queues, and survival instincts.

“Animals and humans are all affected by behaviors, body postures and signals from each other that we may not be aware of.” Sarah Partan, Asst. Professor in Animal Behavior at Hampshire College

Obviously, I don’t think we are going to build robots that mimic humans and get responses, but it is often hard to fully understand the situation response that you get especially since so much of an individual response if framed by past experiences. But, that being said, my one takeaway (other than general interest) was the need for thinking holistically about multiple channels (e.g., web and chat) or sonic branding (i.e., the voice delivering the message).

Books / Articles, Research, Technology

Drugs Down. Gas Up. Food Up.

May 3, 2008 by George Van Antwerp 0 Comments

With most of our good going up.  According to CNN, I heard them say this morning that gas is up $0.60 per gallon in the past year and earlier this week, they said that food is up 35% in the past year.  (Neither of these are scientific, but they make the point.)

That makes me wonder how our impression of price changes.  Will we become less price sensitive as we get used to higher prices on everything.  A friend of mine told me that when they had a global meeting the people from Europe were commenting about how great it is to come to the US where taxes are low and gas is cheap.  It’s all a matter of perspective.

So, with most things going up, I found this press release from Express Scripts interesting:

Last year marked the first time in at least five years that consumers paid less, on average, in their prescription drug copay, according to the 2007 Drug Trend Report released by pharmacy benefit manager Express Scripts. The average copay dropped 25 cents to $13.20 even as the average total cost of a prescription rose from $55.01 to $55.93.

Express Scripts attributed the average copay decrease to greater use of generic drugs, saying in the report that consumers saved an average of $15 per prescription each time they moved from a brand to a generic.

Where $15 was once a big deal, will that need to be increased over time to have the same effect as the price of goods increases?  My dad still talks about seeing movies for $0.10, but we know those days are gone and a dime doesn’t buy much any more (if anything).

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

Deloitte On Healthcare Consumers

May 2, 2008 by George Van Antwerp 1 Comment

Deloitte recently published their results from a survey of more than 3,000 Americans on healthcare.  Here were some of their high level findings:

  • 93 percent of consumers say they’re not adequately prepared for future health care costs
  • 79 percent say candidates’ positions on health care are likely to influence their presidential vote
  • 46 percent place health care among their top three voting concerns
  • 26 percent would pay more for online access to medical records and results
  • 84 percent prefer generic drugs to name brands
  • 39 percent say they’d go abroad for treatment if quality was comparable and the cost was cut in half
  • 66 percent either strongly support (36 percent) or might support (30 percent) state-mandated health insurance
  • 63 percent either strongly support a tax increase to provide coverage for the uninsured (29 percent), or are inclined to support one (34 percent)
  • 52 percent understand their health insurance plans
  • Only 8 percent understand their health insurance completely
  • 18 might turn down a job to retain current health care coverage
  • 34 percent would use a retail/walk-in clinic; 16 percent have already have
  • 78 percent want to customize their insurance to include the features they value, with the cost changed accordingly

“The U.S. health care system is in the midst of a transformational change that many believe is centered on consumerism — the process of enabling and engaging consumers more directly in selection and purchase decisions regarding health care services. A traditionally one-way conversation is becoming a dialogue as the health care system transitions from patient-oriented to consumer-oriented. Industry stakeholders need to prepare to address the challenges and opportunities that consumerism presents.”

They have a lot more on their website about this:

Books / Articles, Consumerism, Healthcare, Managed Care, Research

Facts About The Uninsured

April 30, 2008 by George Van Antwerp 0 Comments

The Robert Woods Johnson Foundation has a project called Cover The Uninsured.  As we all know, this is a major issue which is only getting more pressing with the economy the way it is today.  With food going up and gas going up, it is putting more and more economic pressure on people.

Granted…not all the uninsured are uninsured due to their economic condition, but even those that think they are invincible would be better off with some safety net.

I point this out since this is Cover the Uninsured Week (April 27, 2008 – May 3, 2008).

Here is a slideshow of data from their website:

Events, Healthcare, Managed Care, Politics, Research

Healthcare Retention

April 30, 2008 by George Van Antwerp 2 Comments

Retention in healthcare has become an emerging focus.  With the initial land grab for Medicare lives over, it is more and more important to retain them.  Focusing on new lives is becoming harder.  And, with one of the few green fields out there being individual lives, retention will continue to be a business driver for the next decade (or until we move to a single payor system).

Fortunately or unfortunately, there is no silver bullet.  But, this is clearly the time to act.  Figure out what works.  Set your baseline.  Learn from the consumer, customer, patient, or member.

I recently gave a webcast on this topic, and without giving away anything proprietary, I thought I would share some cliff notes.  If interested, feel free to contact me for the content or even to learn more about our retention solution.

  • Retention is a journey from employee satisfaction to customer satisfaction to loyalty and ultimately retention.
  • There are many different types of loyalty – price, programmatic, experience, and relationship.  (Forrester Research)
  • There are many lessons to be learned from outside the industry on the value of retention, how to measure retention, and what drives it.
  • A data centric approach to learning and understanding your consumers is critical path.
  • There are some basic programs emerging as foundational.
  • Health plans unfortunately start by having to build trust.
  • One way to build trust is to demonstrate that you are looking out for the best interest of the patient.
  • Your brand is affected by all the constituents in the delivery chain.
  • Price and product are the obvious drivers of satisfaction, but there are others.
  • The most satisfied are not always those with the lowest price.  (There is a great example of this in another industry.)
  • Your healthy members are the most likely to disenroll.
  • Satisfaction varies by condition.
  • There is a big difference in likelihood to renew between someone that scores you in the top box (i.e., 10 out of 10).

Lots more to come on this topic.

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

Silverlink Coming To A City Near You

April 28, 2008 by George Van Antwerp 0 Comments

I am really excited about a new initiative at work.  We have pulled together a great set of speakers and are doing a road show around the country.

The speakers include:

The topic of the event is Healthcare Communications: Think Differently and is about how to engage the new healthcare consumer and drive behaviors in scale.  Very much like what a lot of the talks were about at the World Healthcare Congress.  It’s not simply getting data and information, but it is about making that information actionable.  That is exactly what this 1/2 day session will be about.

The meetings will be in Boston, NY, Hartford, Minneapolis, Oakland, and Westlake (CA).  Click here to find out more information and to get registered.  We hope to see you there.

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

Hidden Gem at WHCC 2008

April 23, 2008 by George Van Antwerp 1 Comment

For those of you missing the World Health Care Congress 2008 in DC, you are missing a good meeting.  It has lots of networking opportunities, good speakers, lots of company booths, and good content.  I have been here and trying to run between presentations, meetings, and interviews.

I went to a presentation yesterday on PHRs (personal health records) which is a hot topic here.  I think the presentation by Jan Oldenburg (Practice Leader, Health Content, Internet Services Group, Kaiser Permanente) could be the the hidden gem of the conference.  I know a lot of people will immediately discount it for being part of an IDS (integrated delivery system) but don’t.  There is a lot to learn here.

Some of the key things include:

  • Integration of the PHR and EMR.  [Their EMR is from Epic.]
  • A focus on four key attributes – transparency, accessibility, consistency, and security.
  • Four major components: record of information (lab values, visits, notes), an interaction tool (e-mail your physician, HRA), transaction engine (refills), and links to health content.

They have an amazing 2M members on the PHR with over 60% who signed in and used the tool more than 5 times in 2007.  [They probably deserve an award just for this ability to create a sticky application.]  And, 16% signed in more than 12 times.  […which is probably all of their chronic patients with co-morbities.]

Jan talked about their promotion of the site which includes all of their materials, registration drives, and even physicians giving out cards promoting the site.  She talked about making meaningful improvements like moving from mailing out the password to the patient to instant password set-up using a similar algorythm to what banks use.  (This improved their activation to 88% over the past 2 months.  They used to lose 30% between password request and actual registration.)

And, it sounds like they have taken a very thoughtful approach to the application:

  • She spoke about the fact that they had over 3.6M e-mail exchanges between MDs and patients in 2007.  Originally, they didn’t pay MDs for e-mails since it was like returning phone calls.  But, they are looking for how to distinguish between an e-visit and an e-mail.

“E-mail helps me take better care of myself” [a quote from a patient]

  • In a published study, they showed that patients using e-mail had 7-10% less visits and 14% less use of the phone for support.  [very impressive]  But…to George Halvorson’s point on day one, this is a perfect example of misaligned incentives.  The MD uses e-mail to improve health and patient satisfaction but makes less revenue.
  • They addressed one not so obvious issue which is timing of data being released.  For sensitive lab values, they are either delayed so the physician sees it first or its only released after the physician approves it.  The key is that the physicians don’t want the patients to see the data before they get a chance to call them.
  • The patient can take an HRA (health risk assessment) and decide whether or not to share it.
  • They have some impressive statistics around changing behavior:
    • 55% lost weight
    • 58% decreased stress
    • 78% had better pain management
  • They are just beginning to analyze who the users are (e.g., chronic patients, acute patients, family).  This was a question in every PHR meeting yesterday.
  • Some of their key learnings included:
    • Information has to be timely and current
    • You have to create “in the moment” opportunities to act (i.e., e-mail your provider)
    • You have to create teachable moments
    • You have to meet members where they live
    • You have to heal the fractures of our healthcare system

“Patients who use the PHR are 65% more likely to stay with Kaiser when they have a choice of plan options.”  [WOW!  Talk about a case for adoption.]

  • They were one of the first ones that I heard talk about working with portability standards to move data from PHR to PHR and to a DTC model (i.e., Google, Microsoft).
  • The final point which was similar to what I discussed with ActiveHealth was around genomics.  Jan talked about some of the analysis they were doing thinking out years in the future about how that data could influence generations.

This is certainly worth following and looking at as a model.  Some of the things are easier because of their model (e.g., getting MDs to use e-mail and promote the web), BUT somethings are lessons that can be leveraged.

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

Consumer Engagement Tools

April 22, 2008 by George Van Antwerp 0 Comments

This next session is with James (Jim) Roosevelt (President and CEO of Tufts Health Plan) and Phyllis Anderson (VP of Marketing from Humana). It should include real-life discussions on what works.

Interestingly, Jim is making a point that he made earlier which is about how to differentiate when all the providers are in each plan. I talk about this a lot. My opinion based on what JD Power showed in their study is that communications is the differentiator. How? What? When? Personalization? Rules? Preference based? Integrated?

Jim said that 3-years ago they were in touch with 1.5% of their members on a regular basis…that number is now 22%. I am not sure there is a benchmark to know if that’s too much or too little…but it seems good. Some of the words he uses which I think are important are – cost management, quality improvement, evidence-based, self-care, comprehensive and integrated, effective, and positive ROI.

He laid out a good continuum of programs moving from low cost, healthy programs (wellness) to more expensive programs for at-risk people (disease mgmt) to high cost programs for the chronic patients. Tufts is moving to a consumer empowerment plan called My Wellness Plan which will focus on engaging 100% of their members and still get an ROI of greater than or equal to 1.5:1. He showed a chart that 50% of health costs are driven by health behaviors (good news in that it is an addressable challenge).

He talked about an example around bariatric surgery which I thought was a good case study. Rather than simply not covering it, they cover it after certain steps including a six-month lifestyle modification program. The key point he made is that surgery without behavior modification is dangerous.

They have 3 categories for engaging members:

  1. Lead a Healthly Lifestyle
  2. Manage Care and Treatment
  3. Effectively Navigate Health Care System

He made the point that it could be copied, but the question is do you act first. I think the question really is how well do you implement the vision. It’s easy to envision and know what to do. It’s very difficult to execute it well and make a difference.

Phyllis started with some patient messages which were interesting.

  • Take a deep breath. We dare you.
  • The food groups are your friends.
  • Make you next smoke break a clean break from smoking.
  • Where do you see yourself in 5 pounds?
  • Lower back under attack?

“Healthiness is a nuance.”

As the quote indicates, health information and engagement varies dramatically, and it will take a while and some trial and error.

“Incremental change will ulimately result in significant impact.”

She talked about a pilot they did and what they learned:

  1. Create real-life goals (relevant to where they are and where they live)
    • Want to fit a dress by reunion versus lose 100 pounds in the next 6 months
  2. Community is key
    • Coach
    • Peers (the participants blogged and got feedback via the blog)
  3. Rewards and incentives are necessary
    • Personalized to individual
    • Not just monetary
    • Include recognition

“It costs less to support well people.”  Phyllis went on to make the point that it’s worth spending the money now rather than waiting until people get sick.

There was a good question from the audience on whether ROI mattered.  Apparently, some of the employers here at the conference had said that they were willing to invest in programs that promoted health without any ROI.  I think the key is that there are limited resources…I would spend money first where I got a return.  I am willing to bet that I don’t have much money (or time) to address the other programs.

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

Consumerology?

April 22, 2008 by George Van Antwerp 0 Comments

Express Scripts launched their Center for Cost-Effective Consumerism just recently.  If interested, here is the site.  Impressive group of contributors.  I know and respect the staff.

Is it enough to drive differentiation?  We will see.

It has a blog.  Does it become a “corporate blog” which is just informal PR speak or does it actually have the team’s raw thoughts?

What learnings will they share publicly versus keep internally?

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

Upcoming Webinars

April 22, 2008 by George Van Antwerp 0 Comments

If you missed it last week, I am giving a repeat performance of my webinar on retention.  I am going to talk about driving customer satisfaction and building loyalty to improve retention which is and should be a hot topic for everyone in healthcare. (Sign up here for the 23rd at 1:00 EDT)

Additionally, my peers are giving a webinar on closing the adherence gap which should be another hot topic for many of you.  (Sign up here for their sessions on April 30th and May 22nd)

BPM / Process, Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Technology, Value Propositions

Reverse Engineering and the Golden Goose

April 22, 2008 by George Van Antwerp 1 Comment

I listened to part of the initial presentation by Hans Rosling from Sweden which was very interesting, but I was mostly getting coordinated for the day.

Here is the video of a similar talk he gave at TED.

I am very excited to sit down and listen to George Halvorson’s presentation called “A Practical Model to Achieve Health Reform”. [George is the Chairman and CEO of Kaiser and recently wrote the book Healthcare Reform Now! A Prescription for Change. Some of my notes on this are here although I am still finishing up the book.]

Here are some of his quotes and some of my notes. [You know you are a key person when you are able to quote yourself.]

  • Talking about Kaiser, “When we look for someone to blame, we have to look in the mirror.” He talked about how they play all the positions all of the time (payor, provider, lab, pharmacy).
  • Said that they had about 2M e-visits last year and have 92,0000 member contacts per day on the Internet. They are trying to figure out how to leverage the new toolkit in a way that makes sense.
  • He dedicated his presentation to Dr. Jerome H. Grossman who recently passed away.

“American health care could be transformed fairly quickly if a number of high leverage buyers chose to strategically use their market leverage.”

  • Reform can’t be voluntary…it needs to be a product…defined, purchased, and paid for by buyers.
  • He talked about the old market:
    • Hundreds of “slices”
    • Commodity products
    • Financial conduits rather than care delivery focused
  • He talked about the new market:
    • Sumo wrestling
    • Total replacements
    • Shrinking total market
    • Growth focus to drive stock value
  • This new market reality gives power to the employers in terms of pushing change. This is an interesting perspective really pushing the employers to drive for change.
  • It is a great, simple point that he makes around HC in America is becoming unaffordable…BUT financing reform is not enough. Most of what we hear about is financing change. He points out that the multiple payor system only explains 20% of the cost difference between the US and Canada.
  • What we need:
    • Universal coverage
    • Individual mandates
    • Guaranteed issue
    • Subsidized coverage for low income

“Care delivery in the US is uncoordinated, unfocused, inconsistent, unmeasured, extremely inefficient, perversely incented, and excessively expensive.”

  • He talked about how healthcare is the fastest growing and most profitable segment of US economy ($1.2Trillion). [Key point on profitability.]

“HC takes everyone’s money with an amazingly low level of accountability for the product it sells.” [Key point on why HC will never reform itself.]

  • Smart people don’t kill the geese that lay the golden eggs. We have lots of smart people and golden geese in the US HC system.
  • More efficient and effective caregivers simply deprive themselves of income.
  • Truths:
    • Current increases in cost are unsustainable.
    • Current rates of increase for Medicare and Medicare with eat entire budget by 2050.
    • 1% of people drive 35% of costs
      • If everyone in CA had coverage – $300 per month
      • If only 1% – $12,000 per month in cost
    • 75% of cost is from chronic care
      • Eliminating breast cancer would be create but only impact 2% of costs
    • Benefit design is clumsy and even inept
  • Some realities that drive out costs assuming we start with roughly the same base as other countries: [Although he points out that we do start at a higher base than Canada around office visits…$23 in Canada…$73 in US…$150 in NY.]
    • Inflation
    • Worker shortages – lab techs, nurses, pharmacists
    • New technology, treatments, drugs, etc. which all drive costs
    • Number of MRIs, transplants, etc. all higher…more high tech care (tertiary care)
    • No value screen for technologies or drugs…test is will someone buy it [Seems like an obvious problem]
    • Inefficient, uncoordinated, unlinked care
    • Multiple mds with no coordination
    • 10,000 codes for units of care
    • No reward for outcomes
    • Aging population

“We can’t stop aging, inflation, new technology and provider financial motivations.”

  • What we can do:
    • Focus on chronic conditions (CHR, Asthma, Diabetes, +2 others)
    • Work backwards (continuous improvement)…where do we want to get and then how do we get there

“Random reengineering doesn’t work…need a goal in mind.”

  • Tools:
    • Benefit design
    • Public messaging
    • Care tracking – PHR/EMR
    • Mandatory care registries and care linkages (tools will evolve once we have a goals)
  • Nurses spend 25% of their time on direct patient care [a pretty low amount]
Consumerism, Healthcare, Managed Care, Research

The Implication Of Choices

April 18, 2008 by George Van Antwerp 0 Comments

I have heard this theory many times, but I was glad to run across an article on it.  The basic point is that too many choices have negative implications on people.  In this article from Health Day News, it discusses a study published in the Journal of Personality and Social Psychology about the effect of multiple choices.

“If people have a day or period of time in which they are making many choices, they will be vulnerable to low self-control,” said study lead author Kathleen Vohs, assistant professor of marketing at the University of Minnesota. This could lead “to overeating, overdrinking, overspending, losing one’s temper, and procrastination.”

This has a significant implication within healthcare.  How do you empower a patient in a consumer driven world and make information transparent without overwhelming them with options and data?  How do you communicate to a patient about their options without giving them every possible scenario? 

We generally want a simple solution and to be guided to a good decision without being manipulated.  How do we accomplish that?  It reminds me of a JD Power study on the auto insurance industry that I often quote that showed that the most satisfied consumers were not those whose rates went down, but those who rates went up BUT were proactively informed and offered options. 

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

Blogging Next Week – WorldHealthcareBlog

April 18, 2008 by George Van Antwerp 0 Comments

Next week, I will be posting my blogs to this site and to the WorldHealthcareBlog as part of my press efforts at the conference in DC.  I look forward to meeting lots of industry people there and have set up a bunch of interviews to talk about topics such as:

  • Gaining mindshare with the patient / member / consumer / customer
  • Mass personalization
  • PHR adoption
  • Consumerism
  • Patient segmentation
  • Getting ready for the individual market
  • Building trust with patients
Consumerism, Healthcare, Marketing / Communications, Research, Technology, Value Propositions, Weblogs

Medco’s Customer Event 2008

April 16, 2008 by George Van Antwerp 0 Comments

Medco doesn’t host their event and release their drug trend report until mid-May. [You can see some of the highlights from the past few years online.] But, I think it is interesting to look at the agenda and topics to understand what they are talking about with their clients. As you would expect, consumerism, the election, and healthcare communications are present in both agendas.

  • The Predictions Conference: Five insights that will shape healthcare by David Snow, Medco’s Chairman and CEO
  • Emerging trends in the science of healthcare by Dr. Robert Epstein, SVP, Medical and Analytical Affairs and Chief Medical Officer, Medco
  • Wiring healthcare: Bringing personalized healthcare technology to consumers by Steve Case, founder of Revolution Health and co-founder of AOL
  • Politics of change: Preparing for a new administration’s impact on healthcare by TBD
  • Future shock: The economics of the uninsured by Former US Senate Majority Leader Bill Frist, MD and Uwe Reinhardt, PhD, James Madison Professor of Political Economy and Professor of Economics and Public Affairs at the Woodrow Wilson School at Princeton University
  • Prescription for savings: Using health literacy principles in your communications (breakout session)


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

2008 Outcomes Conference

April 15, 2008 by George Van Antwerp 0 Comments

As a follow-up to my last post, I thought I would share some of the agenda items and the new Drug Trend Report from Express Scripts‘ Outcomes conference 2008 which is happening right now.  Unfortunately, they don’t let many external people in (even on my own dime) to hear the presentations.  I have to get it off the website and talk about it 3rd hand.

I will have to read the report and will have more to share.  Here are a few things that caught my eye:

As you can see from the agenda, several topics around consumerism which is a hot topic there.

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

Medicare Part D Market Penetration

April 12, 2008 by George Van Antwerp 1 Comment

Mark Farrah Associates recently published a study through AHIP around Medicare Part D.  Here were a few of the takeaways:

  • 80 companies offer stand-alone prescription drug plans (PDP).
  • 17,409,974 people in PDP plans in 2008 (2.8% year-over-year increase).
  • Medicare Advantage (MA) plans with drug coverage had a 15% year-over-year gain.
  • Total Medicare population is 44.2M.

One of the key questions they were trying to answer is what is the untapped market size.  Their estimates put the market at 1M-4.6M.  But, I also found it interesting that they estimate that 3-11% of the eligible Medicare patients have Medicare as a secondary payor – a coordination of benefits (COB) opportunity?

Books / Articles, Consumerism, Healthcare, PBM / Pharmacy, Research, Value Propositions

Transient Insurance

April 12, 2008 by George Van Antwerp 0 Comments

According to an article in the Detroit News, 1 in 6 Americans lack insurance for some part of the year. They could be chronically uninsured or simply in transition between jobs. Today, the individual health care market is certainly one of the fastest growing (if not the fastest growing) market for managed care companies.

Forrester estimates that this is a $115B market today.

With an average annual premium of $5,520 per family (or $2,400 per person assuming 2.3 people per family), that means the average premium per day is $6.58. Will we ever get to a point where you can buy short-term (i.e., less than 30-day) health insurance? And, if we did, can you set it up so that people don’t go on and off just as they feel ill?

The Forrester article talks about a Prudential model in Europe that is pay-as-you-go around health insurance.

Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, Research
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