August 29, 2011 
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If you haven’t read through the Pharmacy Satisfaction Pulse Report, you’re missing some great information. There’s not a lot out there about consumer level expectations for pharmacies but this is a good start. (Full site with other data)
Here’s four charts I pulled out of the report to get you started…These should help you frame messaging around retail-to-mail, 90-day, and pharmacy adherence programs.
August 26, 2011 0 Comments
Prime Therapeutics published their Drug Trend Report yesterday. I haven’t had time to read it yet, but I pulled their total trend numbers and aggregated them into charts with the previously reported numbers from other PBMs. (As always, you can see detailed summary’s from Adam Fein and I on most of the reports.)
Additionally, here’s a summary from last year. AND, as always, don’t forget that these aren’t apples to apples.
(NOTE: Lower trend is better implying that the PBM is doing a better job at managing costs for their clients although as I’ve argued there may be some clinical reasons for trend going up that are good – e.g., improved adherence, identification of pre-diabetics, addressing primary adherence.)
August 25, 2011 0 Comments
Within the payer / pharmacy / PBM world, we tend to think of adherence as something that can be addressed by us. What if the problem is more systemic than that? I’m not talking about clinical issues like side effects or even cultural biases.
I’m talking about process related issues that stem from physician and patient interactions. If the patient doesn’t believe the drug will help them and doesn’t understand their condition and their medication, they’re set up to fail.
With that in mind, I appreciated the infographic that Stephen Wilkins (@HealthyMessaging) sent to me earlier today (see below):
August 18, 2011 0 Comments
Here’s a new one. People can sleep better when their head is cold.
So, how do you get your head cold…wear a cooling cap. I’m not sure where you get them (although a Google search reveals several places), but it seems like an interesting alternative for people with sleep challenges who don’t want to talk sleeping pills. (more on the topic)
According to data from a few years ago, about a quarter of people were using sleeping pills. And, while I believe many of these pills were originally seen as acute, 2/3rds of patients have been taking them for an average of 5 years.
Another study I find interesting is trying to map sleeping style to personality (see here). Here’s the six positions that they categorized.
August 18, 2011 0 Comments
A recent JAMA meta-analysis leads to some interesting data. Not surprisingly, watching more TV increases your probability of chronic conditions. This should remind you of some of the Blue Zones work about how to live longer.
The correlation between sedentary activities like watching TV and health risks has long been known, but according to the JAMA study, more than two hours a day of TV increases the risk of diabetes and cardiovascular disease by a troubling 20 percent and 15 percent respectively. More than three hours a day raises the risk of premature death for all other conditions by 13 percent. “Beyond altering energy expenditure by displacing time spent on physical activities, TV viewing is associated with unhealthy eating (e.g., higher intake of fried foods, processed meat, and sugar-sweetened beverages and lower intake of fruits, vegetables, and whole grains) in both children and adults,” write authors Frank Hu and Anders Grøntved, who studied all relevant medical literature from 1970 to March 2011.
August 17, 2011 0 Comments
Unfortunately, the issue of kids not getting vaccinated is not going away. While only 1% of infants don’t get any vaccines, there are still 30% of kids who don’t get all the recommended vaccines.
So, what should a pediatrician do about families that don’t get their vaccines? Should they continue to treat them? The number that say it’s time to find a new provider has jumped to 25% in 2011 (compared to 18% in 2005) according to research reported in a Time Magazine article. I’d bet that number might jump further as physicians bear risk or have more money tied up in performance bonuses.
It begs the question of what adults do…For example, with flu shots, do adults get them? Based on a Consumer Reports study, it’s only about 50% of adults that do.
I have a few older posts on this general topic. It’s also a very interesting topic in the pharmacy world as retailers focus on vaccinations both as a revenue source and a value-added service.
I also found this infographic on the topic which I thought I would share.
Created by: Medical Coding Career Guide
August 17, 2011 0 Comments
One of the hot topics in a lot of healthcare conversations these days is engagement. There’s the “easy” engagement for the e-patients that are actively involved in their healthcare. Then there’s the much harder engagement of those that aren’t engaged. And, finally, there’s the issue of chronic engagement. I can easily get someone to engage a few times with an incentive or some other “trick”, but how do I get them to stay engaged over time. It’s not easy.
This is one of the topics that will be discussed at the upcoming Forum 11 in San Francisco. If you’re coming, look me up. I’m presenting on Friday.
August 16, 2011 0 Comments
One of the analysts that I follow is Larry Marsh and his team from Barclays Capital. They put out a lot of great data and information on the industry. One report that I was reading earlier today is on an employer survey they did of 55 employers representing 1.75M lives. Medco and CVS Caremark were the largest PBMs in that market segment followed by Express Scripts, Catalyst, and OptumRx.
I was a little surprised that only 76% of the respondents were satisfied or very satisfied with their current PBM. That’s lower than many studies show.
On the other hand, less than 50% see the proposed Express Scripts / Medco acquisition as driving lower costs (which I generally agree with).
Also, not surprisingly, employer’s specialty trend has been high and 35% of them anticipate it will be higher in 2011.
And, finally, to beat a drum I often talk about…movement to plan designs that support mail or 90-day retail and more use of step therapy are the big changes being made and planned.
August 15, 2011 0 Comments
While it’s unlikely that we’re going to get much empathy from robots in the near future, VGo Communications is definitely making the idea of tele-presence more believable. What intrigued me when I first saw this was the ability for remote caregivers to participate in events. For example, I could imagine my parents going to a physician’s visit in Detroit. If I was able to log-in and join them using a VGo robot, it would be great. It’s unlikely I would fly from St. Louis to Detroit to join them.
Now, cost would be an issue here, but I’m guessing someone can come up with a model that allows providers or hospitals to buy multiple robots and allow a remote, web-based log-in process. (After some training by the user on controlling the robot.)
If we look at studies like the one presented by Kaiser years ago (see below), we know that there’s a huge gap between what the physician says and should say. For example, this shows that only 34% of the time did the physician tell the patient the duration of therapy. This play into what I’ve talked about before which is the gap between what the physician says and the patient hears and the questions that come up after the fact versus what questions come to mind during the office encounter. Could a tele-presence by a third-party help that? It’s an interesting concept.
August 15, 2011 0 Comments
Here’s an inforgraphic sent to me by MedicalTranscription.net.
August 14, 2011 0 Comments
A great summary of lots of the placebo research. A must watch. (remember if you get this e-mailed to you that you might have to come to the website to see it.)
August 13, 2011 0 Comments
The people at RNCentral sent me this infographic. It makes you think twice. Maybe something for clinics to think about in terms of their hours.
August 11, 2011 0 Comments
This is a video that everyone should share. It’s a funny, short, and blunt video on why to get your kid vaccinated.
There was a recent article in USA Today about vaccines which said:
Vaccines are widely available across the country, doctors say, and poor children can get them for free. The biggest impediment to vaccinating kids today is not cost, but fear, says William Schaffner, a spokesman for the Infectious Disease Society of America and professor at Vanderbilt University School of Medicine in Nashville. Around the world, millions of parents began skipping or delaying vaccines because of an infamous (and since retracted) 1998 study in the British medical journal The Lancet. The study’s author theorized that a combined measles-mumps-rubella shot caused autism.
It became one of the greatest myths in modern medicine, says Offit, author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All. He points to nearly two dozen studies showing no link between vaccines and autism. Last year, The Lancet issued the retraction after learning that information had been falsified. British health officials also stripped the study’s author of his ability to practice medicine in England because of professional misconduct.
August 8, 2011 0 Comments
P2P (or peer-to-peer) is a popular topic in healthcare today. It builds on both the social components of behavioral modification along with the social networking trends.
About one-third of Americans who go online to research their health currently use social networks to find fellow patients and discuss their conditions, and 36 percent of social network users evaluate and leverage other consumers’ knowledge before making health care decisions. Social networks hold considerable potential value for health care organizations because they can be used to reach stakeholders, aggregate information and leverage collaboration. (from Deloitte study)
One of the biggest researchers out there in this space is Susannah Fox from the Pew Research Center.
Peer-to-peer healthcare acknowledges that patients and caregivers know things — about themselves, about each other, about treatments — and they want to share what they know to help other people. Technology helps to surface and organize that knowledge to make it useful for as many people as possible. (from recent presentation from NIH – “Medicine: Mind the Gap”)
With that in mind, I found this study from a few months ago about storytelling very interesting. Imagine the power of capturing stories in some form – DVD, YouTube, written – and sharing them with newly diagnosed patients across an expanded social network. Imagine helping patients plug into a social network (ala – PatientsLikeMe).
Conclusion: The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension.
What has really surprised me is that I haven’t seen the large institutional healthcare organizations promoting the use of the social networks. Maybe I’ve missed it, but I would think they would partner up with a few of these to encourage consumers to use them. I understand on the one hand that that is “handing off” a patient to a different company, but rather than trying to build their own social networking application, I think they’re better served to leverage what exists.
August 5, 2011 0 Comments
If you look at AIS, they track total annual pharmacy costs for leading health plans. I pulled a few payers out from the table in the July 22, 2011 Drug Benefit News here to share. If you exclude two very clear outliers on the low end, they ranged from a low of 9.70% to a high of 21.86%.
Here’s a sample:
August 4, 2011 1 Comment
Are you surprised that Pfizer might have found a way to extend Lipitor? You shouldn’t be.
As I talked about before, Lipitor is scheduled to go generic later this year. Now, there are stories that Pfizer may try to take Lipitor over-the-counter (OTC). As Ed Silverman (Pharmalot) points out, this has been tried before with Mevacor. Has anything really changed since then? I don’t know much about any outcomes from the UK’s allowance of Mevacor to be sold BTC (behind-the-counter), but it would be a good point of information.
The prior questions about consumer behavior with an OTC statin all still apply:
Since statins certainly have side effects, this is a real question.
IMHO – I would think an OTC strategy is a low likelihood unless there is some new data.
On the other hand, with home monitoring of cholesterol tests, there have been some changes. This might be another source of data. Who’s using these? Have they impacted their use of medication?
August 4, 2011 0 Comments
I’ve always found the discussion of why people with certain characteristics are more likely to get ahead very interesting. This recent article from Harvard Business Review talks about the fact that managers see respect and power as mutually exclusive. I think most of us would agree that this is unfortunate from a leadership perspective.
So the question I would ask is whether consumers think the same thing in terms of physicians, pharmacists, and their health plans. Are those that are respectful of the consumer seen as less powerful and therefore less likely to get their patients to be be compliant?
On the flipside, would consumers tolerate direct sometimes abrasive messaging that was clear with them about the risks?
July 27, 2011 3 Comments
There were two new mail order pharmacy studies that were recently published. If you’re in the PBM / pharmacy space, you’ll want to dig into both of these.
The first one is from Kaiser which looked at outcomes for patients on cholesterol lowering medications based on their use of mail order or retail pharmacies (both of which are part of Kaiser). This study builds on their study last year which looked at medication possession ratio differences between mail order and retail.
After adjustment for demographic, clinical and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85 percent of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2 percent of patients who only used the local Kaiser Permanente pharmacy.
Separately, there was a study published on adherence based on whether mail order was a requirement or a choice.
Pharmacy benefit designs dictate pharmacy access, drug cost, and formulary coverage and thus are an important public health tool with the potential to improve population health. Offering a mail-service pharmacy option is an important benefit design tool that helps to control pharmacy costs and may facilitate medication adherence among those who successfully transition to 90-day-supply prescriptions. However, restricting pharmacy choice by requiring the transfer of prescriptions from retail to mail-service pharmacy causes some members to discontinue therapy early. When members choose to eschew therapy rather than switch to a lower cost alternative, the unintended consequence is a reduction in medication adherence and the potential for increased medical expenses.
While one might see a contradiction between the two and prior studies, I think the point is that 90-day prescriptions do appear to increase adherence even after adjusting for many factors. BUT, if you require people to move to 90-day especially at mail, it’s important to have a clear transition path for them so that they (a) understand their benefit; (b) realize how to move; and (c) don’t end up simply missing refills or stopping therapy.
July 22, 2011 0 Comments
This is from a WSJ article earlier this year, but I thought it made a few key points about seniors and technology (which is relevant for your Medicare strategy).
July 21, 2011 0 Comments
Here’s a quick chart from Kaiser.
July 16, 2011 2 Comments
Several people have asked me about the FICO adherence scoring tool. I (like many of you in the adherence business) am fascinated by the concept on using data to predict adherence and subsequently customize programs around that. On the flip side, consumers may be a little paranoid about this based on comments on the NY Times article.
Ultimately, there are a few questions:
I highlighted some of these things in my 15 Things You Should Know About Prescription Non-Adherence post. The one item that seems to fall across both healthcare and non-healthcare data is past behavior. This could certainly play into a credit score or even some type of preventative health score. Do you get your screenings done? Have you filled other medications on a regular basis? Do you have and use a PHR?
Lots more to come on this topic over time, but this is certainly an area with many eyes on it.
July 15, 2011 0 Comments
Companies like Klout are looking for ways of calculating people’s reach using social media. The question of course is always the tradeoff of quantity versus quality.
For example, I quit Facebook when I found it to be more distracting than productive. Yesterday, I cut over 100 people out of my LinkedIn network because it had been years since I had connected and interacted with them and didn’t feel any connection with them. I also have a requirement that I won’t connect with anyone unless I’ve talked and/or met with them IRL (in real life). It’s amazing how much of a screening mechanism that is.
But, these efforts run counter to driving up a good Klout score which looks at Twitter, Facebook, LinkedIn, and FourSquare (which I’ve never tried).
It leads you to the great question of “how many friends can you have” and the definition of friend versus business contact. On the first point, there is research that says the human mind can only manage 150 friends which seems to make sense. In the traditional sense of friendship, I doubt there are a 150 people who I frequently interact with socially. But, in the broader sense of having a friendly relationship with a large group of people both socially and professionally, I think social media definitely allows you to expand beyond the 150.
But, if technology limited us to our biological limitations that wouldn’t be any fun. I find tools like blogging and tweeting as good outlets to share information with like-minded people some of whom I know well, some who I know, and some who I’ll never know. That’s ok.
July 13, 2011 2 Comments
Prescription Copay Cards continues to be a hot topic (see list of articles at the end here), but I see a lot of FUD (fear, uncertainty, and doubt) versus a lot of facts. At the end of the day, there are certainly a few stories about cases where costs have jumped up due to copay cards overcoming formulary positioning.
But, no one knows the total market impact. I’ve spoken with six different organizations that would be well positioned to know, but they don’t. It’s not tracked or easily available in the data. Reasonable estimates from Dr. Adam Fein over at DrugChannels put the market at about 100-125M Rxs which is about 3% of the total Rx market (assuming 3.3B Rxs/year) or 12% of the total brand market (assuming 75% GFR). [I validated those numbers with a specialty pharmacy that shared that they were seeing 13% of their claims come in with a copay card.] Certainly, the market has grown as IMS estimated in one recent article.
The question of course is whether these are good or bad and whether their use is malicious or not. My conclusions are based on talking with about 30 people in preparation for my AIS webinar on this topic today. What I concluded was:
I think there are several ways that industry (especially pharmacies) should collaborate with pharma on how to leverage these copay cards at the POS with patients [call me to discuss]. But, to do that, I think the broader industry is going to require some type of rules which I am sharing shortly as a proposed “pledge”.
The other thing longer-term to watch is will this further change the PBM-Pharma relationship. I think yes. If the PBMs push for legislation on this marketing tactic or the manufacturers figure out that this is a better use of their spend than rebates, this will change the relationship.
Additional Reading:
July 10, 2011 1 Comment
I was at a swim meet yesterday and started talking about recovery drinks after working out. I then went on to share a few studies with people. I can’t promise that this make you “cool”, but you can get a few interesting discussions out of these.
July 6, 2011 0 Comments
I can tell I’m finally getting through my pile of interesting articles when I pick up an article from February 2010 in HealthAffairs, but it’s a good case study about Mexico’s use of cell phones and mobile technology.
The focus of the story is on VidaNET which is a cell-phone based system that sends text messages and e-mail to patients reminding them to take their medications, keep their physician’s appointments, and stay up to date on their lab tests. The VidaNET program is for HIV patients and also provides them with other related health information.
“VidaNET is a technology platform that helps you self-manage your health.”
This solution is a partnership between the leading Mexican cellular company (Telcel) and the Carso Health Institute. It built on their initial program called CardioNET which was focused on obesity related illnesses. CardioNet featured a risk assessment tool that then drove the consumer to health related resources and provided them with facts to lead a healthier lifestyle.
Although a few of the statistics are now a year old, they are good on the access of the mobile channel:
“Don’t let the virus continue replicating. LOOK FOR SUPPORT AND VISIT YOUR DOCTOR.”
July 3, 2011 0 Comments
Do you believe your physician is giving you better care when they are using technology? I certainly do. Here’s a few stats from a survey by GfK Roper for Practice Fusion:
July 2, 2011 0 Comments
In a paper published in the Proceedings of the National Academy of Sciences, researchers reported that they observed a roughly 2% increase in hippocampus volume for people between the ages of 55-80 who walked for 40 minutes three times a week for a year.
Why do you care? The hippocampus is the brain region critical to long-term memory.
Another point from the study – those who did aerobic exercise also had higher levels of proteins to help build new neurons.
More research is starting to suggest that exercise earlier in life could act as a protective barrier against disease and brain atrophy later in life. It’s in your brain’s best interest to start the exercise habit early. [Kirk Erickson, coauthor of the paper and professor at the University of Pittsburgh – from Experience Life magazine]
June 30, 2011 0 Comments
I just finished reading Assessing the Impact of Risk Evaluation and Mitigation Strategies (REMS) Requirements on the Pharmaceutical Supply Chain by the Center For Healthcare Supply Chain Research.
If you don’t know what REMS is, here is the FDA page on REMS. Essentially, they are programs that the manufacturer is required to provide to mitigate risks associated with certain drugs.
This study does a good job of describing the REMS landscape and sharing some challenges and opportunities. As someone who was less familiar with this than many of you in the industry, I found it a good foundational piece which got my mind thinking.
Overall REMS can be required to include five distinct elements:
“As part of the REMS submission to the FDA, a manufacturer also must show that the strategy elements will not unduly burden patient access (particularly where patients have life-threatening diseases or difficult access to healthcare providers of the drug).”
Definitely, that access issue is key. These programs add time and hurdles which need to be seamlessly worked into the workflow for physicians and pharmacies and show improvement in outcomes or reduction in risk. And, ideally that should happen with cost in mind.
Given the infrequency that some generalists might have with some specialty products, this can create communication and compliance challenges.
For distributors, this creates both a burden but also a financial upside as they charge to manage and implement the REMS. On the flipside, for physicians, this creates extra effort which isn’t reimbursed. As the study broke out different perspectives from constituents in the process, this along with several others from providers caught my attention:
Certainly from a communications perspective, REMS have led to the buildout of “hubs” that provide services around these drugs in the areas of data management, patient counseling, call center, registry, and content management.
The study estimates the economic impact of these programs on both the distributor and the provider (physician, nurse, and pharmacy). For example, they estimate that a pharmacist at a specialty pharmacy spends 100-165 minutes per patient per month for those on drugs with a REMS requirement.
They pose a question towards the end around generics and biologics which gets at the heart of the cost / benefit tradeoff for bringing a product to market which requires a REMS when part of your value proposition is a lower cost.
Anyways, for those of you interested in the topic, it’s a good read.
June 29, 2011 0 Comments
For those of you that are interested, here’s a link for a $30 discount on the AIS webinar that I’m doing with Sean Brandle from Segal Company on drug copay cards. As a teaser, here’s results from one of the survey questions that I posed earlier (noting that the sample size was small, but likely indicative of the overall market).
WSJ Health Blog Drug Channels KevinMD Blog Health Populi e-Patients
Contact me at gvanantwerp @ mac.com.
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