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Increasing Flu Shots – Several Views

September 10, 2010 by George Van Antwerp 0 Comments

Let’s start with a few facts:

  • Health officials are recommending that everyone get a flu shot except those under 6 months and those with egg allergies.
  • Last year’s H1N1 killed 13,000 and made 60M sick in the US.
  • This year’s vaccine protects against the 2009 swine flu (H1N1) and two other flu strains that are out there this year.
  • 60% of Americans are viewed as susceptible to H1N1 (still).
  • There are 165M doses slated for use in the US.
  • At least 10% of the US is estimated to have trypanophobia (fear of needles).

Retailers (and likely others) are trying different things to drive flu shot volume:

This year, the competition for administering flu shots will be aggressive among retailers:

Walgreen says it administered 7.5 million H1N1 and seasonal flu shots last season, up from 1.2 million the year before. Walgreen’s figures represent about half of all the retailer-administered flu shots, says Mr. Miller, the analyst. He estimates retail pharmacies could administer 20 million to 30 million flu shots this season. Rite Aid, which doled out 250,000 shots last year, said it has ordered a million doses for this year.

Grocery chains with pharmacies also are pushing flu shots harder. Supervalu Inc., operator of the Jewel, Shaw’s and Albertson’s, says it expects to deliver 50% more flu shots this year in its 800 pharmacies. Kroger Co., the second largest food retailer by sales, says it will have flu vaccines available in all of its 1,900 pharmacies. (From WSJ)

The logical question would be why would the pharmacies care. Money. Flu shots are a profitable business and as long as you can administer them without disruption to your workforce…then your variable costs are limited. But, that also makes me wonder why everyone is taking a general marketing approach. There is lots of marketing, but very little targeted marketing that I’ve seen around flu shots (from the retail community).

On the flipside, managed care companies have a totally different reason to drive flu shots – it’s a HEDIS measure. [And, BTW…HEDIS is a big part of the STAR Ratings that CMS is using to pay incentives to Medicare plans.] They want to limit sickness, hospitalizations, and other medical costs.

This is one where everyone is aligned so that employers also want to drive flu shots to avoid absenteeism from sick employees. This article puts the value of a flu shot to the employer at $46.50. Since flu shots cost less than $30, why wouldn’t employers just give everyone a free flu shot. They’re getting a 50% return on their investment.

A more interesting debate is whether to mandate flu shots in certain cases. The biggest one which is debated is healthcare workers (although I would also lump in teachers and day care staff). The last thing you want is someone who is already at risk and sick to be exposed to the flu when they go to receive care.

Last January, a CDC survey found that just 37% of health care workers received swine flu vaccine and 35% received both seasonal and swine flu shots. On average, flu vaccination rates hover under 50%. (USA Today article)

So, I guess my net-net here is that flu shots are going to be pushed this year. I would think pharmacies and employers and pharmacies and MCOs would pair up to drive shots to specific locations. I think the general marketing and news will increase awareness, but the question is how to you reach the at risk population and drive them to your location and get them to get the shot early before they get exposed. I don’t think a build it and they will come strategy will “win” here.

[BTW – Every Google search I did around flu shots, brought back a Walgreens link at the top of the page.]

And, if you’re interested in what we’re doing or could do around flu shots at Silverlink Communications, let me know.  (Here’s an old article on results.)

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

When Should You Ask About Auto-Refill?

September 2, 2010 by George Van Antwerp 0 Comments

Auto-refill for prescriptions is all the focus lately.  Everyone from the big PBMs to the local pharmacies are encouraging this.  It helps with adherence (or at least with adherence calculations since you can’t force someone to take the pills just because they have them).  It addresses one of the common patient reported issues with adherence which was that they forgot.  They ran out of pills or didn’t know to refill the medication.  In some cases, a few days of pills may not be a big issue, but in other categories, this could be a problem. 

In general, professionals consider taking medication 80% of the time (or 80% medication possession ratio) to be adherent.

So, what is auto-refill?  You sign up to have your medication refilled when it’s time for a new bottle and then mailed to you or ready for you at your retail pharmacy. 

One question is whether this includes auto-renewal.  To most consumers, renewal means nothing, but it does in the pharmacy business.  When you get a script, it is only good for 12-months.  That could be twelve 30-day fills or four 90-day fills.  When you’re done, you need a new prescription from your physician.  That is called a “renewal”.  To most consumers, we just think of it as we ran out of refills.  So the critical question here is whether you include renewals in the auto-refill process.  I certainly advocate for yes.  If I run out of medication and expect my prescription to be refilled (because I signed up for auto-refill), I would want my pharmacy to reach out to my prescriber proactively.  Or, even if I’m just planning on refilling, I’d like my pharmacy to let me know in advance that I need a renewal or new Rx since I don’t have any refills remaining.  That can delay the process so without doing that you can create a gap in care.

That gap-in-care is one of the reasons why patients drop out of mail (which may happen to me).  In my case, I waited until I was down to 5 days supply of my medication imagining that my pharmacy would call me to remind me to refill.  They never did so I called to refill, but I was out of refills so a renewal is needed.  Getting in touch with my prescriber could take a few days so now I’m not sure what might happen.  Ideally, I would get a confirmation from them on when it’s coming, and I could go to a local pharmacy and get a 3-day “bridge supply” for a minimal fee.  We shall see.

But, what I recently found interesting (that took me down this path) was some research from CVS Caremark that was recently presented saying that

According to Keller, new research by CVS Caremark seeks to address the fact that many healthcare decisions unnecessarily are complicated by the lack of clear and plain language. In addition, choices for such programs as automatic refill of prescriptions or generic alternatives can be overlooked because those options are not readily transparent to the consumer, Keller noted.

“Through this research we are testing options presented through four different communications channels to see how consumers react to different scenarios,” Keller said. “One of our preliminary findings looking at consumers on the Web shows that if we reach out and present a decision to choose automatic refill in advance of renewing a prescription, they sign up at twice the rate of those who were passively presented an opt-in choice after receiving a prescription.”

For those of us in the communication space, this is interesting.  How you present information…when you present information…the language you use…All of these things are important as demonstrated here.

Books / Articles, Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Silverlink, Technology, Value Propositions

NCPDP Nov 2010 Event: The New Economy And …

August 24, 2010 by George Van Antwerp 0 Comments

On November 2nd, NCPDP is hosting an educational event called “The New Economy and It’s Impact on Healthcare, Pharmacy, and the Patient.” Sounds pretty cool! It’s a topic we all talk about.

What does the new sense of frugality mean? What will new forms of insurance mean? How will pharmacy evolve? Will MTM work? Will MTM become a product for commercial? How is the consumer’s behavior changing relative to information and compliance?

The agenda includes yours truly along with people from:
* Kaiser
* Walgreens
* AARP
* Sanofi-Aventis
* North Carolina Association of Pharmacists
* Eaton Apothecary
* American Society of Consultant Pharmacists
* RegenceRx

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

10% Discount On DMAA Registration

August 5, 2010 by George Van Antwerp 0 Comments

As a speaker at the upcoming conference, they sent me a discount code…

Register Now for The Forum 10

DMAA: The Care Continuum Alliance, the leading trade association for wellness, prevention, disease management and other services across the continuum of care for chronic conditions, invites you to its 2010 annual meeting, The Forum 10, Oct. 13-15, in Washington, D.C. Join leading health plans, wellness and care management organizations, physician groups, health IT companies, state and federal programs and other stakeholders as they discuss health care reform, share best practices and network. Keynote speakers include best-selling author and motivation and engagement expert Dan Pink; and a panel presentation by nationally recognized consultants on workplace wellness strategies. View complete programming details

Special Registration Offer: Viewers of this notice can receive 10 percent off standard Forum pricing by using discount code “FRIENDS-FORUM” during the registration process. Go to online registration

Events, Healthcare, Leadership, Marketing / Communications, Silverlink

Choices: Grande Skim Mocha With Whip @ 140 Degrees

August 5, 2010 by George Van Antwerp 0 Comments

Choices.  We can all become overwhelmed with them.  As several studies have shown, more choices are not better…they paralyze us and limit our ability to make a decision. 

So what do we do with this.  Choice is a double-edged sword.  On the one hand, you want to offer choice to everyone.  On the other hand, this can make implementation very difficult. 

Like my Starbucks example.  I can customize almost everything off a pretty basic menu…even the temperature.  (BTW – they suggested using 140 degrees rather than saying kiddy temperature)  But that makes it more difficult to standardize and should increase the risk of error.  Imagine doing this efficiently and in scale.

Mass customization has been a challenge for years. 

People can have the Model T in any color – as long as it’s black.  (Henry Ford)

While technology allows this to a certain degree, it all has to be moderated.  Let’s take communications.  I could let every consumer tell me their preferences and other facts about them.

I want you to send me automated calls unless the information is clinical in which case I want a letter than I can share with my physician.  I’d like the calls made to my home number between 5-7 pm or on Saturday’s between 10-4.  I’d like you to leave a message and don’t call back unless I don’t act for seven days.  If I interact with the call, please text me the URL or phone number for follow-up.  I like to be addressed by my first name.  I’m an INTJ so please use that as for framing the message. 

You get the point.  Where do you stop?  And, do you really think that I know what’s best.  I tell almost everyone to e-mail me, but depending on when it comes in, it could be days before I respond or even read the e-mail.  That’s if it passes the spam filter. 

I’m sure if I asked 10 people whether they wanted automated calls then 7 of them would say no, BUT you know what…good calls work (voice recorded, speech recognition, personalized).  The vast majority of people interact with good, automated calls (some for 10+ minutes).  Most people think about those annoying robocalls that use TTS (text to speech) we all get around the elections.  But, good technology with a relevant message from a relevant party get people to care.  It’s all about WIIFM (what’s in it for me).   The other half of the equation is being able to coordinate the multiple modes.  (e.g., I missed you so I’m sending you a letter.  Let me text you the URL.)

So, should I let the consumer pick their preferences?  Sure for certain things.  But, what about a drug recall (for example)?  Do I have to wait a week to get a letter?   What can I personalize versus what should the company own.  I pay for them to “manage” my health.  Why don’t I let them?

There is no perfect system.  You need a series of things to be successful. 

  • A database to track consumers – demographic data, claims data, preferences, interaction history, …
  • A workflow engine with embedded business rules to manage communication programs with rules about what to do when certain situations arise
  • Reporting to track basic metrics
  • Analytics to understand and analyze programs

And, of course all this requires expertise to interpret and leverage the data for continuous improvement.

Are you doing all that?  I doubt it…but you can be.

Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Health Loyalty Lessons

August 3, 2010 by George Van Antwerp 0 Comments

Colloquy published a good article on Health Loyalty Lessons.  It pointed out 6 things that were important:

  1. Short-term incentives can mean long-term payoffs.
  2. Understand your objectives if you want to offer the right benefits.
  3. Communicate.  Communicate.  Then communicate some more.
  4. Strike a balance between hard and soft benefits.
  5. Stay relevant if you want consumers to stay motivated.
  6. Raise the bar.

These are good points (and more detail is in the article).  They’re relevant whether you’re doing a full blown loyalty or incentive program or simply focusing on the WIIFM principle (What’s In It For Me).  This is why healthcare communications is such a hot area right now. 

  • Who do I communicate with? (targeting)
  • When do I communicate with them?
  • How do I communicate with them? (letter, call, e-mail, text)
  • What message will drive them to act?
  • How do I measure success?
  • What’s worked before…for the individual or for people in the same segment as the individual (gender, age, condition, income, plan design)?
Books / Articles, Consumerism, Healthcare, Marketing / Communications, Silverlink

Back To The Future: The Role Of The Pharmacist

July 29, 2010 by George Van Antwerp 0 Comments

Between the focus on differentiation and the focus on adherence, we have seen (and will continue to see) greater use of them as a strategic asset. CVS Caremark is leveraging them in their Pharmacy Advisor solution. Walgreens continues to leverage them at the POS. Medco is using them in their Therapeutic Resource Centers. And, the independent pharmacists have stressed this story for years.

In Medicare, the Medication Therapy Management (MTM) process begins to recognize the power of pharmacists and actually rewards them for their efforts. I was quoted in Drug Benefit News today about this topic. Here were a few quotes:

“The pharmacist is an under-utilized resource today,” George Van Antwerp, vice president of the Solutions Strategy Group at Silverlink Communications, tells DBN. “They go to school to work with patients and often end up simply filling bottles.”

While the benefits of pharmacist intervention are undeniable, Van Antwerp says, the challenge is finding the right balance of face-to-face interaction and automation. Issues also include getting a good return on investment for such services by condition and the fact that only an estimated 60% of the people picking up prescriptions are the patients themselves. In addition, “the staffing model right now would be stressed if pharmacists were spending significant time on cognitive services,” he maintains.


 

Books / Articles, Healthcare, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink

DMAA Client Presentations

July 28, 2010 by George Van Antwerp 0 Comments

We (Silverlink Communications) are very excited to see three of our clients get selected to present at DMAA this year.  That is a tribute to all their hard work, creativity, inspiration, and willingness to leverage technology to improve outcomes.

Here are the presentation summaries from online:

Reducing Blood Pressure in Seniors with Hypertension Using Personalized Communications
CONTINUUM OF CARE SERIES
Wednesday, Oct. 13, 1-2 p.m.

  • Examine how an integrated communications program that utilizes remote monitoring and interactive voice response components combine for an easily scalable, cost-effective solution to reduce hypertension.
  • Review a program where 18 percent of participants transitioned their hypertension from out-of-control to well or adequate control.
  • Identify best practices for how personalized, automated, interactive communications can be leveraged to control hypertension in a scalable manner.
  • Evaluate how high blood pressure readings alerted patients with immediate feedback and education to help them better manage hypertension.

Improving Statin Adherence through Interactive Voice Technology and Barrier-Breaking Communications
Wednesday, Oct. 13, 2:15-3:15 p.m.

  • Examine how interactive voice response (IVR) and barrier-breaking communications can measurably improve statin adherence.
  • Review key barriers to statin adherence, including several barriers that are more significant than cost.
  • Identify best practices for using IVR technology to improve statin adherence by addressing specific barriers.
  • Evaluate how continuous quality improvement processes were used to drive higher response rates to IVR prescription refill reminder calls.

Addressing Colorectal Screening Disparities in Ethnic Populations
Thursday, Oct. 14, 12:30-1:30 p.m.

  • Examine how interactive voice response (IVR) technology and personalized messaging improves the rate of colorectal cancer screening for different populations.
  • Review the impact of ethnic-specific messaging on colorectal cancer screening rates and how this differs by ethnicity.
  • Examine how engagement is influenced by the gender of the voice in communications outreach.
  • Identify how to use predictive algorithms to project race and ethnicity to support tailored communications.
Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

How Blunt Should You Be?

July 15, 2010 by George Van Antwerp 2 Comments

I’ve talked about this before from my personal perspective so I found this article about shocking men into going to the doctors right on point. But, I think this begs a great question…

“Should you communicate differently with men and women?”

My short answer is yes. In reality, it doesn’t always make a difference, but there are lots of times when it does. I’m not sure I’m ready to bet the farm on shocking messages to men all the time, but I would love to try that. Imagine an adherence message that told them they were improving their likelihood of death by 27% by not taking their medications. Or, a message about going to get a prostate exam which pointed out how many people die per year.

Most healthcare companies keep the gloves on when delivering messages. They are trying to motivate them, but they are hesitant to be too blunt (or direct). I’m sure that generally makes sense, but sometimes you just have to catch someone’s attention to get them to act.

Telling someone they are overweight and should start to workout and diet is very different than saying they are obese and are likely to die in their 50s if they don’t change their lifestyle immediately.

Related story – Top 5 Reasons That Men Don’t Go To The Doctor

Consumerism, Healthcare, Marketing / Communications, Research, Silverlink

How Do You Pull, Push, and Pay?

July 8, 2010 by George Van Antwerp 0 Comments

I was reading something on Healthwise this morning.  We recently had Don Kemper (CEO) present at our client event in May.  He was talking about “Billion Dollar Decisions: Right Tools, Right People, Right Time”.  A few key things from the overview:

  • Today’s healthcare crisis can’t be solved with out helping everyone do more for themselves.
  • People need to ask for the care they need and avoid care that’s not right.  (a huge information and health literacy challenge)
  • Every year people make 300M major healthcare decisions, 50M surgeries, 100M medical tests, and 150M+ major medication changes.
  • Patient decision aids are key – http://ipdas.ohri.ca.

The summary was that to get people to uses decision aids you have to employ pull, push, and pay strategies.

Pull: Consumers pull the decision aids from the Web.

Push: Providers and payers push contextually relevant decision aids to consumers when they need them.  (What Silverlink does!)

Pay: Providers and payers create incentives to encourage the use of decision aids. 

Consumerism, Healthcare, Marketing / Communications, Methodology, Silverlink

Wal-Mart Whitepaper on Restricted Pharmacy Networks

June 28, 2010 by George Van Antwerp 4 Comments

Of all the companies that might put out a restricted network whitepaper (PBMs, retail chains, consultants), I will admit that Wal-Mart is a surprise to me. It’s not that they haven’t been trying different strategies to increase market share – $4 generics, direct-to-employer contracting, but in general, I don’t see them doing a lot of marketing or selling in this space. They participate at one industry event, but their booth is very stark compared to other pharmacies.

But, that being said, the whitepaper makes the key points that anyone would make (i.e., I agree with the framing of the opportunity) with a slight twist of focusing on member savings versus payer savings.

Some of their key points from the whitepaper are:

  • You should treat pharmacy negotiations like buying any widget. There is more supply than demand.
  • Today’s model encourages all pharmacies to offer a rate that doesn’t get them kicked out of the network.
  • Today’s model doesn’t encourage consumers to pick one pharmacy over another.
  • There’s 5x more pharmacies than McDonald’s in the US…and no one would argue that it’s difficult to get a Big Mac.
  • They quote the Medicare pharmacy access standards to make the point about what access you can survive with. They reference an Express Scripts analysis that says the Medicare access standard can be achieved with a national network of less than 20,000 retail pharmacies (compared to the 60,000 in most networks).

While limited retail networks are not a new concept, they haven’t been widely adopted historically (<10% of clients). PBMs have always offered this type of plan design to payers – “If you remove a few chains from your network, you’ll get a lower rate from the other chains in return for increased marketshare.”

With the integration of CVS Caremark and their offer of Maintenance Choice, we’ve obviously seen the focus on this increase. And, the recent public negotiations with Walgreens highlighted that this is seen as a viable model for the future.

The question now is whether this will accelerate adoption of some type of limited network. If it goes forward, there are lots of questions to answer:

  1. How small will the network be – regionally, nationally?
  2. Who do you build the network around – CVS, Walgreens?
  3. What does this mean for mail order?
  4. What rates do the retailers have to match to participate?
  5. Does it include 90-day?
  6. Does the network start to look like a formulary where you have preferred pharmacies at one copay and non-preferred at another copay or is it either in-network or out-of-network?
  7. Does this increase or decrease power for the independents that have to be in certain places?
  8. Will anyone really test the national access standards and go to a 20,000 store network?
  9. What will consumers say and do?
  10. Does this accelerate adoption of cash cards and cash business for generics?

But, again, I struggle to see Wal-Mart as the chain that you build around unless the whitepaper is a thinly veiled attempt to push the direct-to-employer model (i.e., Caterpillar) which has saved the employer lots of money, but isn’t a simple to implement program (IMHO).

Here are some marketshare numbers for Walgreens, CVS, Rite-Aid, and Wal-Mart for the top 30 MSAs. Only 9 of those markets have Wal-Mart share above 10% and none are higher than 14%. For the other three, you have markets where they have a much higher concentration around which you can build.

 

Someone was asking me the other day if I saw the PBMs essentially partnering up. I’m not sure I do since there are markets where you would want to build a limited network with Walgreens and markets where you would want to build a limited network with CVS. At least for now, I don’t see Medco and Express Scripts just picking one dance partner although they might just based on who’s willing to play with them.

The other thing that becomes important here (tying this back to my Silverlink work) is communications. You have to identify who will be affected in moving to a limited network. You have to communicate with those people and help get them to the preferred pharmacy. You have to help them understand why you are doing this (savings) and WIIFM (what’s in it for me).

It creates some great dialog between the head of benefits and the CFO. We can save $X…BUT we will have to ask Y% of our employees and their families. Will they care? Do they know their pharmacist (unlikely)? Will it be an issue of convenience? Will they complain (of course…change is hard)? Will they ultimately care (unlikely as most disruption becomes accepted after 3-6 months)?

Healthcare, Marketing / Communications, PBM / Pharmacy, Politics, Research, Silverlink, Value Propositions

DBN Article on Adherence

June 24, 2010 by George Van Antwerp 0 Comments

In today’s Drug Benefit News, I was quoted several times on the issue of incentives and adherence.  Here’s one of the quotes along with one of the quotes from Bob Nease from Express Scripts. 

Article: Should Patients Be Paid for Adherence? Strategy Could Yield Savings or Cost Hikes

Author: Renee Frojo

Medication nonadherence is recognized by most payers as a major driver of pharmacy costs, but nobody can get their hands on a foolproof solution to the problem. As a result, PBMs and health plans are experimenting with a new method that some critics view as a last resort: paying people to take their drugs appropriately. “There is no silver bullet when it comes to adherence, because it’s not that straightforward,” George Van Antwerp, vice president of the Solutions Strategy Group at Silverlink Communications, tells DBN. “However, it is an issue where everyone is aligned because there are a lot of potential savings.”

 “Some plans will do whatever it takes to get patients to be adherent to their therapy or engaged in better behaviors,” Bob Nease, Ph.D., chief scientist and vice president of marketing at Express Scripts, Inc., tells DBN. While the PBM hasn’t launched its own program yet, Nease says it will be following the trend closely. “The use of lotteries is very interesting and it has potential,” he adds.

Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Silverlink, Value Propositions

Less Time in Hospital Correlated to More Readmissions

June 14, 2010 by George Van Antwerp 0 Comments

We all want to get out of the hospital as quickly as possible.  A recent study from JAMA that appeared in the WSJ showed that while days in the hospital dropped from 8.6 days in ’93-’94 to 6.4 days in ’05-’06 the readmission rate (within 30 days) went up from 17.3% to 20.1%.  I’d love to see the economics around this. 

  • Do the hospitals make more money in this case? 
  • Do the plans save more money? 
  • Are patients happier?  [Remember that the majority of them got out sooner.]

“From a societal point of view, dollars spent on health care likely increased.”  Harlan Krumholz, Yale University cardiologist and senior author of the study. 

The study author echos a point that we [Silverlink] often make to our clients which is that hospitals (or payers) need to invest more effort and resources to make sure the transition to outpatient status in seamless.  Do they understand what the doctor’s instructions were?  Do they have someone caring for them?  Did they pick up their medications?

Another key lesson learned here is that it’s important to measure what matters and that what’s measured gets improved.

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

Some of my notes from RESULTS2010

May 28, 2010 by George Van Antwerp 0 Comments

This week was our [Silverlink Communication’s] annual client event – RESULTS2010 (click here to see the final agenda). I’ve talked about this before as one of the best events.  It was great! Educational. Fun. Good networking.  

Here’s a few of my notes along with a summary of the twitter feed (using hashtag #results2010). Unfortunately, the two of us twittering were also fairly involved so there are some gaps in coverage. And, my notes are sporadic due to the same issue.

Overall themes:

  • Communications are critical to driving behavior change.
  • We have to address cost and quality.
  • Reform creates opportunity.
  • Systemic problems require systemic solutions.
  • Measure, measure, measure.
  • Automated calls – while not the whole solution – work in study after study.
  • People are different.
  • There is a gap in physician – patient interactions. 

Notes:

  • Reform basics – guarantee issue, requirements for coverage, income related subsidy.
  • Independent payment advisory board has an aggressive goal – get Medicare spending to equal GDP growth + 1% each year.
  • ½ of the $1 trillion needed to pay for health reform comes from Medicare savings / reform…the rest from taxes.
  • Everyone’s fear is that MCOs become “regulated utilities” that just process claims…unlikely.
  • Need to address underuse, misuse, overuse, and limited coverage.
  • Need to measure quality and cost at the person level.
  • CMS pilots around shared savings are working – outcomes improved.
  • Medicare Part D only got one complaint per thousand for therapeutic interchange programs / drug switching.
  • The decision around defining MLR (medical loss ratio) and what fits in there is critical.
  • Healthcare is like anything else…it’s not great and needs to change, but don’t touch mine cause it works ok. [frog in the pot]
  • How do we make each healthcare decision an informed decision.
  • Decision aids.
  • Pull, push, or pay – 3 ways to drive awareness.
  • Moving from information about your care to information being care.
  • The incentive rebound effect…what happens when you take away an incentive.
  • Social interaction affects our behavior.
  • Solving for how to change consumer behavior cost effectively and in a sustainable manner is a good challenge to work on.
  • How do we move people from desires to action? From “I’d like to exercise” to actually doing it.
  • The fact that some European programs take 3-5 years to see an impact makes me wonder what that means for our US investment strategy given the member churn across plans.
  • Great examples of ethnographic interviews
  • Good McKinsey data on people’s perceptions – Annual Retail Healthcare Consumer Survey.
  • Inform / Enable / Influence / Incentivize / Enforce
  • One way of categorizing – willingness to change versus barriers to change (rational, emotional, psychological).
  • Attitudinal segmentation – cool…but how to scale?
  • Provider staffs attitudes are important.
  • Design – delivery – measurement
  • Readiness to coach
  • A culture of health
  • Have to mix up your tools (incentives, channels)
  • “Communication Cures”
  • The chief experience officer is a new role in plans and PBMs.
  • The only experience you have with health insurance is via communications. Make it count.
  • Loyalty is a result of cumulative experiences.
  • People have to trust you so they listen to your message
  • Communication maturity model
  • Price is what you pay; value is what you get. (Warren Buffett quote…he wasn’t there)
  • Shifting paradigms:
    • Consumption to sustainability
    • Possessions to purpose
    • Retirement to employment
    • Trading up to trading off
    • Perceived value to real value
  • Simple…less is more
    • 1/3 of people feel their lives are out of control.
  • Inflamation causes 80% of diseases (really)?
  • If only 10% of outcomes are driven by costs, why do we spend 100% of our time trying to fix that problem. [tail wagging the dog] [It’s the same point on adherence.]
  • There are 45M sick days per year from 5 conditions – hypertension, heart disease, diabetes, depression, and asthma.
  • Have to look at clinical efficacy and elasticity of demand.
  • Commitment, concern, and cost.
  • Five components – plan design, program, community, communication, and provider engagement.
  • Need a multi-faceted approach to create a culture of health.
  • MDs much more likely to talk about pros than cons.
  • There would be 25% less invasive procedures if patients fully understood the risks.
  • Foundation of Informed Decision Making
  • Huge gaps in patient view versus physician views around breast cancer.
  • Preference-sensitive care
  • Dartmouth Atlas
  • Genomics tells you the probability of being on a disease curve, but not where you are in the potential severity.
  • Only 60-70% of women get at least one mammogram their entire life.
  • Statin study – barriers to adherence:
    • 37% didn’t know to stay on the Rx
    • 27% side effects
    • 15% convenience
    • 15% MD instructions
    • 11% cost
  • In healthcare, we’re all taught to speak a language that no one else understands.
  • It takes a village.
  • Challenge – Use communications to cure cancer.
  • Collaboration. Innovation. Evaluation.
  • Adherence is a great example of where everyone’s interests are aligned.
  • There is no magic bullet for adherence.
  • You need a multi-factorial approach to address adherence…Physicians are rather ineffective at addressing adherence.
  • Evidence-based plan design works to impact adherence (although I think another speaker said no).
  • You have to think about operant conditioning. (Look at dog training manuals and kid training manuals – very similar)
  • Think about all the failure points in the process.
  • What is the relative value to the patient.
  • Reward system has to reward at the failure points not just at the end of the process.
  • Using a point system successfully increased the use of a select (on-site) pharmacy by 57% at one employer.
  • 75% of PBM profits are from dispensing generics…that’s why Wal-Mart was able to be a threat to the industry.
  • Drugs only work in 20-80% of people.
  • There are people with a gene that doesn’t break down caffeine.
  • 3% of people are ultrafast metabolizers of codeine (which turns to morpheine in the body)…that can be a problem.
  • Epigenetics – turning DNA switches on and off.

“Tweets”

Rebecca from ProjectHEALTH closes #results2010 with a remarkable talk on this crucial program; they work with 5,000 families/year.

Reid Kielo, UnitedHealth: 93% of members validated ethnicity data for HEDIS-related program using automated telephony #results2010

25% of Medco pt take a drug with pharmacogenetic considerations. Robert Epstein, CMO Medco #results2010

Bruce Fried: the “California model” of physician groups facilitate efficiencies that improve delivery; an oppty for M’care #results2010

Bruce Fried on Medicare: 5 star ratings have strategic econ. importance, med. mgt. and cust serv. key #results2010

Fred Karutz: members who leave health plans have MLRs 2 standard deviations below the population. #results2010

Fred Karutz: Market reform survival – retain the young and healthy #results2010

Poly-pharmacy has negative impact on adherence. #cvscaremark
#results2010

1 in 3 boys and 2 in 5 girls born today will develop diabetes in their life. SCARY! #results2010

20% of all HC costs associated with diabetes. #results2010. What are you doing to manage that?

Messages to prevent discontinuation of medication therapy far more effective than messages after discontinuation. CVS #results2010

25-30% of people who start on a statin don’t ever refill. #CVSCaremark
#results2010

Maintenace of optimal conditions for respiratory patients increased 23.4% with evidence-based plan design. Julie Slezak, CVS. #results2010

Value-based benefits help control for cost sensitivity for medications; every 10% increase in cost = 2% – 6% reduction on use. #results2010

Pharmacists who inform patients at the point of dispensing are highly influental in improving adherence. William Shrank #results2010

The game of telephone tag in HC is broken. Pt – MD communications. #results2010

37% of Pts were nonadherent because they didn’t know they were supposed to keep filling Rx. #results2010

Last mile: 12% of Americans are truly health-literate; they can sufficiently understand health information and take action. #results2010

Only 12% of people can take and use info shared with them. #healthliteracy
#results2010
#DrJanBerger.

We need to improve the last mile in healthcare… clear, effective conmunication. Jan Berger #results2010

#McClellan used paying drug or device manu based on outcomes as example of “accountable care”. #results2010

72% of those with BMI>30 believe their health is good to excellent; as do 67% of those w/ chronic condition. #McKinsey
#results2010

Are incentive systems more likely to reward those that would have taken health actions anyways (i.e., waste)? #McKinsey
#results2010

Only 36% of boomers rate their health as good to excellent. #results2010

27% of people believe foods / beverages can be used in place of prescriptions. #NaturalMarketingInstitute
#results2010

Why do we spend so much time on impacting health outcomes thru the system when that only explains 10%. #Dr.JackMahoney #results2010

Using auto calls vs letters led to 12% less surgeries & 16% lower PMPM costs in study for back pain. #Wennberg
#HealthDialog
#results2010

MDs are much more likely to discuss pros with patients than cons. #Wennberg
#HealthDialog
#results2010

Should physicians be rewarded as much for not doing surgery? How do economics influence care decisions? #results2010

Physicians were 3x as concerned with aesthetics than breast cancer patients in DECISIONS study. #results2010

Fully-informed patients are more risk-averse; 25% fewer of informed pts in Ontario choose angioplasty. #results2010

Patients trust physicians over any other source (media, social connections) but only receive 50% of key knowledge. #results2010

Informing Patients, Improving Care. 90% of adults 45 or older initiate discussions about medication for high BP or cholesterol. #results2010

What is #results2010? #Silverlink client event.

#results2010 – #Aetna Medicare hypertension program leads to 18% moved from out of control to in control using auto calls (#Silverlink) …

About 2 of 3 medicare pts have hypertension. #results2010

John Mahoney describes how he connects payors, providers, and care via research. #results2010

As information becomes commoditized in healthcare, sustainability enters the vernacular. #results2010

Segmentation innovations of today will be tomorrow’s commodities. Measurement and learning must be “last mile” IDC insights #results2010

Plans are strategically investing in bus. intel to reach wide population for wellness, not just the low-hanging fruit. #results2010

The single most significant future market success factor is measurable results. Janice Young, IDC Insights. #results2010

Knowing our attendees’ preferences could have fueled segmented, precise invitations to #results2010. Dennis Callahan from Nielsen Media.

Drivers of those sereking alternative therapies: stress, lack of sleep and energy, anxiety, inflammation. #results2010

Only 2% of people don’t believe it’s important to lead a healthy lifestyle. Their behavior could’ve fooled me. #results2010

Are purity and simplicity the new consumption? Steve French of Natural Marketing Institute explores. #results2010

Gen Y is the most stressed out generation. #results2010

Less is more. 54% say having fewer material possessions is more satisfying. Natural Mktg Institute #results2010

Loyalty is a result of a cumulative set of experiences. Individual intervention ROI is sometimes difficult. #results2010

Sundiatu Dixon-Fyle of McKinsey; understand how beliefs shape an individual’s ability to change behavior. #results2010

Don Kemper: each of 300M HC decisions made each year need to be informed. #silverlink
#results2010

Medicare Part D: 40% lower cost than projected, seniors covered through tiered coverage powered by communication. #silverlink
#results2010

Mark McClellan: Brookings is engaging private insurers to pool data to understand quality of care. #silverlink
#results2010

Mark McClellan at RESULTS2010; bend the curves, provide quality care efficiently. HC reform >> insurance reform. #silverlink
#results2010

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Social Media, Value Propositions

Automated Call Nudge – WSJ

May 19, 2010 by George Van Antwerp 0 Comments

Yesterday’s WSJ had an article about some research done at Stanford about comparing automated calls and human interventions.  The goal was to see what motivated people to exercise more.  As you can see in the chart below, at 6-months automated calls produced better results while at 12-months they were below the human interventions.  But, an automated solution is obviously much more cost efficient and scalable.  The one big question I have is how to make the automated calls even more interactive.  There are lots of things we do at Silverlink to use automation to drive behavior.

While many are skeptical, the reality is that automated calls are the best channel in healthcare based on the cost per success ratio.  [Do you know any other channel that can get you a 70% “open” rate?]  You can deliver PHI.  You can track interventions for audit purposes.  You can have real-time access to data.  You can create rules based solutions that dynamically change based on interactions. 

And, this is not the first study Stanford has done on this.  Here’s links to two older studies they did:

Books / Articles, exercise, Healthcare, Marketing / Communications, Research, Silverlink, Technology, Value Propositions

Don’t Believe The Hype – Copay Waivers

May 11, 2010 by George Van Antwerp 0 Comments

Don’t believe the hype – its a sequel
As an equal, can I get this through to you 

I talk about it all the time as most people do…non-adherence to prescription drugs is a real issue.  People don’t fill their initial script.  People who do fill their first script drop off after the first several fills.  By 12-18 months after a patient starts therapy, less than 50% of them are still taking their medications.  Here’s a few key articles on this: 

Common barriers to adherence are under the patient’s control, so that attention to them is a necessary and important step in improving adherence. In responses to a questionnaire, typical reasons cited by patients for not taking their medications included forgetfulness (30 percent), other priorities (16 percent), decision to omit doses (11 percent), lack of information (9 percent), and emotional factors (7 percent); 27 percent of the respondents did not provide a reason for poor adherence to a regimen.  Physicians contribute to patients’ poor adherence by prescribing complex regimens, failing to explain the benefits and side effects of a medication adequately, not giving consideration to the patient’s lifestyle or the cost of the medications, and having poor therapeutic relationships with their patients.  (NEJM article) 

Depending on what study you look at cost is certainly an issue, but it typically isn’t the primary issue.  I typically see cost as being a factor in 5-15% of the cases.  I think if you look at how Merck weighs cost in their Adherence Estimator that it is only a small factor.  A lot of this plays out in VBID (Value Based Insurance Design) which while not purely about copay waivers that certainly is an element of most solutions.  

A few friends of mine formed their own company (CareScientific) and had a paper published in AMCP recently.  From that article: 

  

VBID is receiving attention as a tool to increase medication adherence and lower medical costs. However, applying a “plausibility calculation” method to data generated from a recent VBID study involving reduction of drug copayments, this evaluation found that health plan sponsors are highly unlikely to experience net savings by implementing VBID programs, even under generous assumptions, for 2 reasons. First, the price elasticities of medications are too low to generate meaningful increases in medication adherence when copayments are lowered. Second, the potential reductions in the avoidable hospitalization and ER utilization rates across a commercially insured population with varying risk levels are generally not large enough to offset the additional plan costs of lowering copayments to increase medication adherence. 

I would also suggest looking at some of their tools that they’ve developed. 

So, getting back to how I’m tying in my reference to Public Enemy (rap musicians)… 

When I look at the upside for pharmaceutical manufacturers to grow the pie (get more Rxs through adherence), I often wonder why one of the default solutions is to fund copay waivers.  That happens by employers, health plans, and even the manufacturers.  There are many less expensive ways to get that lift by addressing things like reminders and tailoring information to individuals based on their personalized barriers. 

There are lots of high cost solutions that will make an impact.  The question is how to triage those resources to focus them on the right people.  It’s important to identify adherence risks (pro-active intervention) and adherence gaps (retrospective) and intervene with the patient.  

Here are a few of my other posts on this: 

 

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

The Facebook and iPod Generation

May 5, 2010 by George Van Antwerp 1 Comment

When I think of the current generation that is coming into the workforce, I think of people who:

  • Grew up with social media all around and are less concerned about privacy
  • Grew up with the ubiquity of technology having an iPod always on and being in constant communication with their mobile phone
  • Grew up with the US in a constant state of war – 9/11, Iraq, Afghanistan
  • Grew up with the idea of constant stimulus – portable video games, TVs in the car
  • Grew up with periods of market instability – technology bubble, 9/11, housing bubble
  • Grew up with a likelihood of living at home after college [and think that’s ok]
  • Grew up with more global awareness via CNN and the Internet
  • Grew up with allergies and general paranoia – no more leaving home as a kid and coming back when the sun set or eating peanut butter at school


I think the more typical perception of many of them is an overly privileged generation who can’t focus on one thing, expect everything (money, position, title, responsibility) regardless of whether they deserve it, don’t follow basic protocols (like a thank you after an interview), have been coddled their whole life, and have no respect for what others have done.  But I think every generation thinks that of the next generation.

I guess the official definitions are: (see good presentation)

  • Traditionalists – born before 1946
  • Baby Boomers – born btwn 1946 and 1964
  • Generation X – born between 1965 and 1981
  • Millennials – born 1982 to 2000

The Millennials are also called Generation Y, GenNext, the Google Generation, the Echo Boom, or the Tech Generation and are 76M strong. With immigration they are likely to surpass the Baby Boom generation in the 2010 census. [Note – Comments derived from reading an exerpt of The M Factor by Lynne Lancaster and David Stillman in the May 2010 Delta Sky Magazine.]


Their book – The M Factor – is focused on this generation. They talk about the fact that this generation is talking about and searching for “meaning” in their work. They’ve been raised by working parents that struggled with life balance and want more out of work for their kids. They see how work has become so engrained in our lives with Blackberries and other tools.

More than 90% of US Millenials said having opportunities to give back thru their company was somewhat to very important when considering joining an organization.

51% of young workers surveyed as part of the Kelly Global Workforce Index were prepared to accept a lower wage or lesser role if their work contributes to something “more important or meaningful”.

The question that a lot of this drives at is how do you leverage the passion and tech savvy Millenials as part of your workforce. They are going to drive changes. They are going to be innovators. And, they’re not going anywhere. Here’s a good blog on Generation Y.

It reminds me of some mock interviews I did a few years ago at my business school. I was stunned by some of the accomplishments of these people. They had founded companies and businesses. They had volunteered in the community. They were well read and had passion for things that I didn’t care about at their age. I was glad to have made it thru school with my peers. But, on the flipside, I talked with my friends who are the Dean of the School and run the Career Center to point out that not one of those people wrote me a thank you or sent me an e-mail. None of them ever asked me to help them find a job leveraging my network.

The article talks about this Millenial generation growing up at a time when the divorce rate had dropped and parents spent more time with their kids and transformed from authority figures to mentors and friends of their kids. This whole concept of “helicopter parents” has been explored in other areas and still amazes me. [Are you a helicopter parent test.] For example, 11% of US Millenials said they would feel comfortable involving their parents in salary negotiations. [If I had the option legally and a parent showed up with their kid for a salary negotiation, I would rescind the offer. If they can’t do that by themselves, how can I trust them to drive my business in pressure situations?]

In healthcare, the best example I always use for a company focusing on this generation or the “Young Invincibles” is Tonik Health which is a Wellpoint brand. I’m always surprised how few people know them. Take a look at their website (below) – the colors, the words, and the positioning is all so different than how most of us think about our health insurer. Here’s a good blog entry on the “millennial patient“.

Why is this relevant to my healthcare communications blog – because segmentation is so key to effective messaging. You have to understand this generation and how to engage them and drive them to take care of their health. Traditional language, modes, techniques, and messages may not work. The article (from the book) talks about their focus on feedback and scoring. They are used to constant [positive] stroking and having a score to evaluate success. They grew up being rewarded for everything. How does that manifest itself in a wellness system that tracks their good deeds (exercise, diet, preventative actions), provides them with rewards, frames their effort as contributing to the greater good, and integrates technology (e.g., connect devices)?

Only 3% of the people they surveyed said that Millenials handled negative feedback well. They haven’t been allowed to fail. This makes me think about one of my favorite quotes from IDEO – Fail Often To Succeed Sooner. You have to understand how to try, fail, learn, and try again to make improvements.

Here’s some recent research we’d done at Silverlink on the “young invincibles” and “Why I Have Health Insurance”:

Blogroll, Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, Research, Silverlink, Social Media, Value Propositions

The Best Healthcare Conference

April 28, 2010 by George Van Antwerp 1 Comment

In today’s budget conscious economy, people are constantly evaluating where to spend their time and money from a conference perspective.  Some conferences are good networking events.  Some of requirements to work in an industry.  Some are educational.  Some give you new ideas on how to run your business.  Some are in great fun locations with fun events.  Very few fit all of those.

I think our Silverlink Communications client event called RESULTS2010 does all of those.  [Hint – the conference is called RESULTS since that’s what we focus on with our customers.]  It takes on all the key issues we see in the market.  It brings in industry experts and clients to talk about what they are doing to address these issues.  Those problems are framed out by our industry experts that have line experience with these roles.  [Our leadership team comes from places such as Express Scripts, CVS Caremark, Gorman, and HCSC and our team includes people from McKesson, Humana, United Healthcare, IMS, DigitasHealth, Medco, and WebMD.  I challenge anyone to find a more knowledgeable vendor team.]  It gives people a chance to network and talk to their peers.  And, there’s some fun mixed in there.

This year’s event is focused on THE HEALTH CONSUMER.  I’m pretty sure it’s the only conference focused on communicating with consumers in healthcare.  The objective is to provide clients with ideas about how to educate, support, and motivate consumers to take actions which support health outcomes. 

Honestly, it was the original event that convinced me to come to Silverlink.  I was a consultant at my first event working with the company.  I met 75 users who were passionate about the company and had great first hand experience using the technology to make a difference in their companies.  I was able to ask them about the competition and understand why they choose Silverlink for their member communication partner.

So, what does this year’s event have in store:

  1. An amazing list of external speakers including Mark McClellan, David Wennberg, Don Kemper, Jack Mahoney, and Janice Young.
  2. A long list of client case studies – 14 so far.
  3. Specific tracks to cover our different client groups and allow for smaller discussion versus formal presentations – Pharmacy, Population Health, Medicare, and Managed Care.
  4. Industy experts on key topics such as consumer engagement, use of data in healthcare, consumer data, behavior change models and incentives, pharmacy economics, pharmacogenomics, medicare market dynamics, and the evolving retail healthcare model.
  5. Adherence experts such as Dr. Will Shrank from Harvard and Valerie Fleishman who led the NEHI adherence study that is widely quoted.
  6. Several fun events including golf, morning runs, and a few special sports related surprises.

There are several more speakers who you would know and I’m very excited to have come and speak…BUT, I want to leave something inside the package for you to want to rip it open and learn more.

How much does it cost?  Nothing (as long as you’re a Silverlink client).

Where is it?  Boston (a great city).

How do I learn more?  Well…if you work for a large managed care company, a population health company, or a pharmacy / PBM, you may already be a client.  We have over 80 clients today.  So, if you’re not on our invite list, think you might be a client, and want to learn more, let me know.  I’m at gvanantwerp at silverlink dot com.  [spelling it out avoids spam]

This year’s event is in late May so I hope to see many of you there!

Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions

Ingrid Lindberg, Chief Experience Officer, Cigna

April 15, 2010 by George Van Antwerp 3 Comments

This was definitely my favorite and most interesting presentation and discussion from the World Health Care Congress in DC.  Ingrid presented and subsequently spent some time talking with me.  She has what I would consider one of the coolest jobs – transforming a large company to be consumer centric and radically changing the way they think, speak, and act. 

From her presentation, here were a few notes:

  • There are 337 languages spoken in the US today. (health literacy issue?)
  • Only 23% of people understand what their health insurance policy means.
  • Most patients appear to be unaware of their lack of understanding in physician instructions and are inappropriately confident.
  • 35% of consumers spend less than 30 minutes reading their health benefit information.
  • Only 7% of people trust their insurer.
  • Trust translates to loyalty and satisfaction.
  • It’s a mix of quantitative and qualitative research.
  • They spent time monitoring sites like – www.pissedconsumer.com.  (do you?)
  • Their senior staff has to spend time listening to member calls each week.
  • They spent lots of time on ethographic research and identified 6 personas that they use for defining products – Busy Mom, Skeptic, CareGiver, Controller, Athlete, and Bargain Shopper.
  • They identified the #1 dissatisfier was language.  Plans talk to them in a language they don’t understand.  (For example, consumers think of providers as the insurer not a physician.)
  • Consumers didn’t want to be called members since it’s not a health club.  They didn’t want anyone other than their physician to call them patient.  They’ve elected to go with “customer”.
  • She talked a lot about how they’ve changed their EOB (explanation of benefits) and their plan overview to address things like what’s not covered.  She talked about how customers think of the EOB as the “this is not a bill form”.
  • They identified 10,000 separate letters that could go out to a customer.  They’ve re-written 9,000 of them. 
  • She talked about changing their call centers to 24/7 and the fact that they’ve now taken their 1M call in what used to be considered “after hours”.
  • She talked about re-designing their IVR to offer you a self-service option (press 1) or a talk to agent option.
  • She talked about their website and YouTube channel – www.ItsTimeToFeelBetter.com.
  • She talked about their understanding level being around 70% while the industry average is around 15% [of communications sent out].
  • This was in a 15 minute presentation and summarized only 2 years of work. 
  • She also shared some metrics that they use and improvements such as a 8 point improvement in one year of “values me as a customer”. 

And, they’ve shared some of this information in their press kit.  There is also an IBM white paper about some of the technology they’ve implemented.

I think the following slide from her deck sums it up well.

Then I sat down with Ingrid to talk with her.  I had a thousand questions which I limited to about 10.  This is a topic I love and is why I love what I do – work with companies to help them develop consumer communication strategies and implement those strategies to improve the consumer experience and drive better health outcomes. 

  1. How long did it take?  This is about a 3-5 year effort which is complicated by the fact that people in these types of roles typically only last about 28 months.
  2. Did you do it all internally?  No.  They worked with Peppers & Rogers on a Touchpoint Map and used an IBM tool called Moment of Truth.  They also worked with IBM on a new desktop solution.  BUT, she was quick to talk about the fact that those were enablers while the majority of work had to be done by internal change agents since this is a cultural change.  She said that now almost 80% of Cigna people are using their recommended language and are aware of the changes made by her group.
  3. Why haven’t others followed?  It’s hard work. 
  4. How do you deal with consumer preferences?  This is one of my favorite topics to debate.  Should you offer consumers options on how you communicate even if you know that they might not pick one that is the most effective.  For example, I might say to send me an e-mail, but they get lost, they can’t contain PHI, etc.  She said that you have to ask but you have to navigate the path.  She seemed to agree with me that there are some communications where you want to ask (e.g., order status at mail) and others where you want the right to contact them (e.g., drug-drug interaction).  She talked about the fact that it’s all in the framing (e.g., if we have a message for you that could affect your safety, is it okay if we ignore your do not call request?).
  5. Are you changing Cigna’s physician communications also?  Yes.  The changes have become the “language of Cigna”.  Physicians are people, and they are also trying to educate physicians on what they’ve learned about how to communicate with customers.  She mentioned that the most difficult groups to change were the people that were knee deep in this healthcare language – internal people and consultants. 
  6. Based on my discussion with Andy Webber, I asked her if she thought that today’s fragmented environment would allow for a coordinated consumer experience.  She agreed that it’s difficult and that the consumer sees everything as their benefit.  They don’t see the piecemeal parts.  She mentioned that one of their clients had held a “vendor fair” to kickoff the plan year where she presented their learnings and all the vendors were told to use them immediately.  [Maybe that’s part of the solution.]

We then bounced around on a couple of interesting topics:

  • We talked about the fact that lots of companies are hiring non-healthcare people to help them better understand the consumer.  These include consultants, database people, marketing people, and innovators.  My personal opinion is that you need people that have worked in or around healthcare AND outside healthcare.  They also need to have consulting and line management experience.
  • She talked about their war room (she used another term) where they had a current state and future state (of patient experience) and showed all the 10,000 current communications as a waterfall. 
  • We talked a little about some of the things we’d done at Express Scripts when I was there including changing the way we referred to members at the call center to patients and the impact that had. 
  • I shared with her that our biggest difficulty was making web changes at Express Scripts which I thought would be the easiest to do.  She shared that changes on the web were one area where they were lagging and is difficult. 
  • She talked about trying to get innovation from customers by understanding what they want and giving it to them.
Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, Research, Silverlink, Value Propositions

Why Are Copay Waivers So Popular?

April 4, 2010 by George Van Antwerp 0 Comments

It seems like whenever I talk to companies about adherence one of first things they want to discuss is copay relief.  It’s a solution I’ve used before so it’s certainly rationale.  But, let’s not forget that cost is not the primary reason for non-adherence.  Forgetfulness and lack of health literacy are often big drivers of non-adherence with medications.  This is easily validated when comparing lift in medication possession ratio (or more tactically refill rate) by looking at copay waiver type program (value-based design) versus communication programs.

Given that copay waivers often require $10+ per month and other programs can be conducted for much less, I question the ROI.  I’d love to see a head-to-head test.  Try education and refill reminders versus copay waivers to see which yielded a greater MPR improvement.

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

Voice Personality Is A Powerful Lever To Motivate Health Behavior

March 29, 2010 by George Van Antwerp 0 Comments

This article appeared in HealthLeaders (3/3/10) by two of my co-workers based on some very interesting work they’ve been doing.  

It’s not what you say, but how you say it that matters. The “how” includes a number of specific voice attributes, such as inflection, rate of speech, and intonation—all of which contribute to an overall perceived “voice personality.” 

Voice is a powerful lever in the ability to effectively communicate your message to ultimately motivate behavior. Would you be more apt to trust the voice of James Earl Jones or the voice of your local car dealer? How do you perceive these voices overall? Which voice personality most effectively delivers a message? The answers, of course, depend on the listener, what is being communicated, and the behavior you’re trying to motivate. 

In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging. 

Specifically, this research analyzes voice selection for interactive automated calls, an effective outreach channel widely used in healthcare to reach and motivate individuals. 

Subjectivity in Voice Selection
If you put a small group of people in a room and ask them to describe the voice they hear, the answers will be wildly different: “This voice sounds too perky.” “That one sounds robotic.” “This voice sounds friendly and cheerful.” Reaching a final conclusion about which voice is “best” often is a highly subjective process. 

While we don’t consciously listen to an individual’s voice attributes, we do subconsciously assess the voice’s characteristics and create inferences about the speaker. Over the telephone or on the radio, when voice is the focus, we paint a picture of how someone looks, what kind of person they are, their age, gender, and generally whether or not you trust them. 

We’re sometimes surprised in the end at how different the person is when we meet him or her face-to-face. By itself, voice impacts our perceptions, which affect how well we understand a particular message. 

In healthcare, it is a common belief that people prefer a female voice when receiving messages about their health. Perhaps this is because female voices are perceived as more nurturing and caring; and women are often the caregivers in the home. 

But is a female voice equally effective when communicating to all people, of every age, in every region, and for every type of health related behavior? For instance, is a female voice as effective for people of poor health status hearing a message about an important health screening? What about seniors hearing a reminder to take their cholesterol-lowering medications? 

Voice Research
To answer these questions, we created a framework to map specific voice attributes with voice personality. We conducted an attitudinal study to learn how people of different age, gender, and region perceive and respond to different voices. We surveyed 3,000 people across the country, in a statistically representative sample of the commercially insured U.S. population. 

Participants heard the same short informational wellness message spoken by several different voices representing a variety of ages, gender, and unique voice characteristics. Survey responders were asked to provide their opinions on the following: 

  • Is the voice perceived negatively or positively overall?
  • Which attributes do people generally use to describe a particular voice? (e.g., rate, volume, and age)
  • Is the voice perceived as introverted, extroverted, formal, or conversational?
  • Is the voice perceived as coming from someone who is more caring and sincere, or someone who is trying to sell something?
  • Do people believe and trust the voice?

The survey results provide a powerful depiction of how different voices are perceived by different segments of a population. 

What’s in a Voice?
High trust and care/sincerity ratings are important factors when trying to motivate healthcare behaviors. Medication adherence, for example, is associated with the quality of relationship between the patient and the physician. When people trust the voice they hear, and feel that the person speaking to them is sincere, they are more likely to change their behavior. 

There are many interesting attitudinal findings from our study including: 

  • Both men and women across all age groups preferred a male voice to a female voice overall.
  • Voices described as fast paced, young, highly extroverted, perky, and animated rated poorly in the trustworthy and caring categories.
  • Voices described as moderately paced, middle-aged, and well-spoken/educated, were rated most trustworthy and caring.
  • Seniors (those 65+ years old) aren’t as sensitive to voice age as other groups and don’t perceive older voices as necessarily older sounding. By contrast, younger groups perceive “older” voices more negatively.
  • Seniors aren’t as sensitive to the rate of speech as younger populations; therefore, slowing the pace may not be as impactful as was once thought for older populations.
  • Younger people (18- to 34-year-olds) are significantly more sensitive to voice age and rate of speech, which means very careful selection of voices for young audiences is important to drive behavior.,/li>
  • Young people showed stronger opinions overall between men and women when rating the voice gender they prefer. In other age groups, there is general agreement on voice gender preferences. Gender selection is therefore a more important factor for the 18-to-34-year-old age group.

The use of voice to motivate health decisions
The results of this study provide us insight into how people of varying gender, age, region, and health status perceive the voices they hear. Our goal is to validate how specific voices can be used as a lever to change behavior. 

Voice, like other communications levers, such as messages and timing, can be selected based on the demographics, purpose, tone, and intent of communication, as well as how voice supports brand identity. By validating attitudinal voice responses against behavioral activity, voice can ultimately become a measurable behavioral best practice in healthcare communications. 

While the bulk of our experience supports the conventional wisdom that a woman’s voice is more effective for healthcare communications, our voice research suggests that there are opportunities to use a male voice to measurably move health behavior. A recent outreach program to educate individuals about the importance of colorectal cancer screenings supports our attitudinal research. 

The outreach asked if the individual had received a screening during the past two years, and if they planned to schedule a consultation with their doctor. The same message was delivered by a male and a female voice. All population segments, including men, women, Caucasians, Hispanics, and Asians, answered the survey at a higher rate when a male voice was used versus when a female voice was used. 

Conclusion
By applying science and measurement, we can determine the voice qualities that are the most impactful for a specific health behavior and for a group of people. There are measurable patterns in overall voice preference. Communications programs aimed at driving individual behavior should include voice analysis. 

By measuring and understanding perceived voice personality, our research sheds light on an objective way to effectively apply voice in healthcare communications to ultimately impacts behavior change. 

Jack Newsom, ScD, is vice president of analytics at Silverlink Communications, and Ryan Robbins is voice production manager at Silverlink Communications.

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

Addressing Hospital Readmission Rates

March 18, 2010 by George Van Antwerp 0 Comments

High hospital readmission rates are a real source of concern for health plans, from both a quality and cost perspective. With 20% of Medicare patients being readmitted within 30 days of discharge, health plans and their partners have a significant opportunity to reduce readmission rates across all populations. Even just a half-point drop in readmissions for a Medicare plan with 1 million members can yield $10 to $15 million in annual medical cost savings.

In a new podcast, Dr. Jan Berger, Silverlink’s Chief Medical Officer, discusses how health plans can address this costly, growing issue affecting our healthcare system. Dr. Berger offers best practices for reducing readmissions such as:
• Expanding outreach to entire discharged population
• Reaching out within 24-72 hours of discharge
• Coordinating communications among members, physicians and care managers
• Identifying members at risk for readmissions

Download this podcast and visit our new Post Hospital Discharge Microsite to access other valuable resources on this important healthcare topic.

Books / Articles, Business Tools, Managed Care, Marketing / Communications, Methodology, Research, Silverlink, Technology, Value Propositions

DBN On Mandatory Mail

March 5, 2010 by George Van Antwerp 0 Comments

I’ve talked a few times about mandatory mail on the blog and after talking with Drug Benefit News (DBN), a few of my comments appeared in today’s publication.  One of the hypotheses in the article is that mandatory mail is growing (which doesn’t surprise me in this tough economy), and Ken Malley from Medco is quoted several times in there talking about their growth in the program.  He says they have 11M lives in the program which I believe would be more than anyone else.  I also think the Medco program with RiteAid which is described is probably something that clients would like a lot and similar to the Maintenance Choice product that CVS Caremark is offering. 

My comments in the article are mostly about the importance of communications which can ease the transition to mail.  The article also quotes Claire Marie Burchill from Cigna about communications and branding.  They called mandatory mail the “pharmacy of choice” which is not unusual.  When I was at Express Scripts, my team changed it to “Exclusive Home Delivery” and Medco calls it “Retail Refill Allowance”.  [This is the whole concept of framing which is core to communications.]  

The fact is that once members start using mail pharmacy, the overwhelming majority of them like it, “but the challenge is more the inertia of getting them started,” Van Antwerp says. “They need a good boarding experience at mail around first fill, and then it becomes more automatic.” Depending on the payer, mail-order customer retention rates vary from 75% to 95%. 

He adds that if more plans start implementing mandatory programs, “initially you’re going to get some disruption, because people push back against change.” However, once patients realize that they can receive 24/7 support and save money, “most people will be pretty happy,” Van Antwerp says. 

 

All of this plays into the other benefits of mail order – faster generic substitution, adherence, convenience, and savings.  The other key is aligning pricing and plan design to drive mail order which remains a challenge across the industry but is critical.  

The one thing we didn’t get into in the DBN article was the science of communications and how important it is to understand consumers and what motivates them.  I think this is the future of pharmacy.  A good segmentation and targeting strategy allows you to personalize communications and deliver the right message at the right time to the right person using the right channel with the right message to motivate them.  It’s not that easy to do, but it can be done.

Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Silverlink, Technology, Value Propositions

Why Integrated Communications Are Better?

February 9, 2010 by George Van Antwerp 0 Comments

This morning is a perfect example of why integrated communications are better.  What do I mean by this?  I mean where a communication campaign is designed using rules to coordinate events across multiple channels.  Still too mumbo-jumbo…Where companies can interact with consumers across channels (e-mail, voice, print, web, call center) and create a seamless experience.

Here’s an example…

This morning, my kid’s school is closed due to snow.  [Although the snow has passed and they’ve already plowed the side streets.]  When I checked the Internet at 5:15, it wasn’t closed.  At 5:40, I got the call that it was closed.  BUT, the call comes on my home line, our home business line, and both our mobile phones.  Somehow it didn’t wake the kids, but it could have.

I don’t really care about the over-communication in this example, but in a professional setting, this would seem like overkill and potentially a waste of money.  In an integrated communications example, it might work like this:

  • An update was put on the Internet and everyone was sent an e-mail
  • At 5:50, the system would identify anyone who had either not opened their e-mail or had not visited the website (assuming they had cookies on their PC for tracking website visitors)
  • At 5:50, the system would call the primary number to play the recorded message by the principal
  • If there was no answer by a live person or the entire message was not listened to, the system would move on to additional numbers

This is always one of the big discussions we [Silverlink Communications] get in with clients in healthcare.  What are the rules for escalation of communications?  How do I track data in an integrated data set?  What is the right timing between communications?

This is critical.  Sending people a letter and a call or a letter or a call (for example) is pretty easy.  Determining the next action based on their final disposition in the initial outreach is not.

Of course, the other question this begs is how many companies actually track return mail.  I know a lot of companies don’t.  If it keeps getting returned, they’re not processing this return mail and taking the bad addresses out of their member database.

BPM / Process, Business Tools, Consumerism, Healthcare, Marketing / Communications, Silverlink, Technology

The Value of a Stamp

February 3, 2010 by George Van Antwerp 0 Comments

A seemingly random thing we observed years ago when we were doing some direct marketing was that we got a better response when we used a stamp placed at a slight angle.  We believed that stamps seemed to make the letters less “mass mailing”, but we also found that having the stamp not perfectly placed helped.  It looked like people had manually applied them.

It seems silly, but I bring it up to make the point that small things matter and in communications, you should be focused on the outcomes and ROI not simply on the cost.  I see so many times when people get so obsessed with saving pennies that they ignore the fact that a slightly higher cost service/solution/product has a better value.

I’ve observed that in things I buy also.  I might pay 2x what a normal pair of shoes cost, but my shoes last 3x as long as the cheaper shoes (so in the end they cost less).  This is true with furniture.  My question is why don’t people always apply that same logic when making other decisions.

I always try to help clients think about the result they are looking for and the cost per success not the cost per transaction.  For example:

Situation A:

  • 1,000 interventions
  • $0.60 per intervention
  • 4% success

Situation B:

  • 1,000 interventions
  • $0.75 per intervention
  • 7% success

Which would you buy?  The $0.60 service or the $0.75 service.  At first glance, you would gravitate toward the less expensive service, but if you don’t do the math, you’re making the wrong decision.

In Situation B, you have 70 successes at a cost of $750 (or $10.71 per success).  In Situation A, you have 40 successes at a cost of $600 (or $15.00 per success).

General Business, Silverlink, Value Propositions

Will Paying You To Be Adherent Work?

February 3, 2010 by George Van Antwerp 0 Comments

United Healthcare is launching a new program (Refill and Save) that is a different spin on the value-based designs we’ve typically seen. In a lot of value-based healthcare programs, companies lower copayments (or waive copayments) for patients in certain conditions to drive up adherence. This has been shown to work and improve results by about 10% which is great. [Although less than some of the adherence programs we’ve done at Silverlink.]

In this case, United is paying patients $20 for every refill they fill for certain medications starting with asthma and depression. I’m very interested to see the results. There continues to be no silver bullet for adherence which is a problem which drives $290B in cost per year and results in 100,000 deaths.

“Patients with chronic diseases such as asthma and depression who take their medicines regularly and who comply with prescribed treatments are likely to stay healthier. They not only feel better, they can potentially avoid costly medical problems that could result from delaying appropriate therapy,” said Tim Heady, CEO of UnitedHealth Pharmaceutical Solutions

Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy, Silverlink, Value Propositions

Interview with Cyndy Nayer from the Center for Health Value Innovation

January 22, 2010 by George Van Antwerp 1 Comment

I had a chance yesterday to sit down and talk with Cyndy Nayer (President, CEO, and co-founder) from the Center For Health Value Innovation. For some of you, this is a new buzzword for others it has been around a while. I remember back in the early 2000s when stories of Pitney Bowes kept popping up and then working with a few of our clients (like Marriott) when I was at Express Scripts on what were being called “value-based designs”. [I even had an offer to go to ActiveHealth (now part of Aetna) and work on their Value Based offerings several years ago.]

And, it’s a small world. Several people from my past are involved: (1) Peter Hayes was a client at Express Scripts and (2) Roy Lamphier played soccer with me in high school.

What is the Center For Health Value Innovation?

The center is an “information exchange” for value based design which as she points out is much more than just a prescription benefit and not simply giving people free drugs to make them more compliant. [If only it were that easy!]

What do you mean by Information Exchange?

A place where people can share stories, trends, info, and research. They see their job as getting information out there and providing support around modeling, analysis, and identifying gaps. [And, I know they do a lot of education as you can see Cyndy at many conferences.] She talked about educating the marketplace on an “actionable format” for implementing value-based design.

Can you describe Value Based Design?

Value Based Design is a suite of insurance design, incentives, and disincentives that support prevention and wellness, chronic care management, and care delivery. It is focused on linking stakeholders across the care continuum and developing structures like outcomes-based contracting where all stakeholders benefit from better health outcomes.

She mentioned that in an upcoming edition of the Journal of Benefits and Compensation that there will be a paper that builds on some adherence concepts to discuss the 5 Cs of Value Based Design: [Noting that the first 3 come from some work from Merck.]

  • Commitment
  • Concern
  • Cost
  • Communication
  • Community

We talked about the need for communications to be multi-directional and include the patient, the physician, the pharmacy, and other caregivers. We talked about community needing to expand on that to include family, the employer, and other entities. [As we all know, health care is local and value based design is no different.]

We spent a little time here talking about community, and the need for this to happen at a community level. [Much like e-prescribing and other things have found out that localized momentum is important.] One question in my mind is who is the catalyst – the hospitals, the physicians, the local managed care companies, employers, grocery stores, wellness companies, pharmacies.

We talked about the fact that this isn’t the same as Accountable Care Organizations, but like that concept, this has to be developed as part of the fabric of the community not imposed on the community.

Being from Detroit, I asked if this was a model for them to help develop around. That is an area of focus and there has been some work done in the Battle Creek, Michigan area.

Why are employers so interested in Value Based Design?

Originally, employers were interested since it was something new, but the recession forced them to look at this more seriously. But, this is a long-term process and something which they benefit from. Better health lowers absenteeism, and businesses need health communities and healthy workers for growth.

Why don’t companies implement Value Based Design programs?

Companies don’t implement them because they’re not prepared for the amount of work needed to get started and it’s not a cheap fix. [If you want to save money, just drop the benefits…not that anyone really advocates that.] We talked about that lots of people react to the urban legends of just giving out free drugs [which isn’t Value Based Design] which would be easy. Companies need to realize there is work to be done to communicate this, design it, and manage the implementation across the community. BUT, once it’s installed, it’s completely sustainable.

Is there a certification (i.e., URAC) for value-based design?

She told me that nothing exists today and that it would be hard to do. Today, there isn’t alignment in the marketplace around incentives and a standard model. They spend a lot of time working with different groups to drive education and training to link health and productivity measurement with value and functional performance.

What’s next for 2010?

In 2010, they will be bringing much more information forward on how to support and extend the work done in the 1st book (Leveraging Health…which Dr. Jan Berger, Silverlink’s Chief Medical Officer co-authored with the Center) and the decision matrix that they recently published. They will continue to serve more as a guide helping interested parties in private, invitation only events to design solutions and then bring those solutions to market.

How does someone learn more about Value Based Design?

The simple answer is to go to the Center For Health Value Innovation website. They have a whole library of information there.

Blogroll, Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Value Propositions

Latest Data Shows Low % Of Seniors Online

January 21, 2010 by George Van Antwerp 0 Comments

Everyone always wants to move to electronic communications (e-mail, portal) in healthcare (along with other industries) based on cost and data availability.  Unfortunately, seniors aren’t online as much as we think.  Yes, there are exceptions.  We all have stories about our grandparents being online or some blogger whose 80 years old.

But, the latest data from Pew shows that they aren’t online.  Their not using high speed connections.  And, when they do go online, they’re dipping their toes in the water not jumping in the deep end to use all the cool tools. 

This is certainly reinforcing of the data we observe at Silverlink when we interact with Seniors.  They are used to the phone.  They like to talk on the phone.  They know how to navigate and interact with automated telephony (especially intelligent telephony not annoying IVR trees).  And, since we can provide similar data to the web and e-mail about how Seniors interact with the communications, it has been a growing area for healthcare companies.

Healthcare, Marketing / Communications, Research, Silverlink, Technology

Because People Are Different

December 22, 2009 by George Van Antwerp 0 Comments

I’ll borrow our tagline from Silverlink Communications – Because People Are Different – to follow-up on my post on direct mail from yesterday.  The first commentor makes a good point.  Certainly e-mail doesn’t work for everyone.  Nor does the phone (although it is generally ubiquitous today). 

The reality is that different segments require different modes of communication.  The question is how to figure that out. 

  • Do you ask people for their preferences…realizing that many times people don’t know what they want or need?
  • Do you look at historical behavior to predict what will work best for people like them…realizing that healthcare is intensely personal and while predictive may not be indicative…and people’s healthcare behaviors change over time?
  • Do you pursue a cluster approach – i.e., send multiple modes simultaneously…realizing that this isn’t very cost effective?
  • Do you pursue a strategy of sequencing – i.e., call then e-mail then letter – and which pattern works best…and what spacing between modes works best?  (This will vary by message, objective, and audience.)

And, the question that I surprisingly don’t hear many people ask is why is there so much direct mail when we as a culture are generally more interested in being environmentally aware than ever (although we still have a long way to go).  Why kill a tree when other modes are more effective, less expensive, and offer better consumer insights?

General Thoughts, Healthcare, Marketing / Communications, Silverlink, Value Propositions

Why Does Direct Mail Exist In Healthcare

December 21, 2009 by George Van Antwerp 2 Comments

Given all the progress we’ve made in the past 15 years around communications, I wonder why direct mail is still a primary component of communications. Obviously, there are some times when compliance requires a written notification, but considering you can’t tell if someone opened the mail and most companies don’t process return mail, you really have no visibility or ability to audit.

Written communications are also so static unlike a website or an automated call where a response can alter the next step in the communication.

Additionally, there is a time lag on written communications that you don’t have with e-mail or with an automated call.

I’ll break it out more in the table below, but in the end, direct mail costs the most yet gives you the least data, the worst customer experience, and is the least time sensitive. Seems like a problem to me.

Channel

Automated Call

Direct Mail

E-mail
Cost

Low – Medium

High

Low
Ability to Personalize

High

Medium

High
Dynamic Content

Yes

No

No
Know if received by consumer

Yes

No

Yes
Know how long consumer interacted

Yes

No

No
Time from event to consumer

Minutes

Days

Minutes
Response Rate

High

Low

Low

 Now, don’t get me wrong, there is a place for direct mail.

  • People who don’t respond to automated calls or e-mail.
  • People who request more information.
  • Communications which require detailed information to make a decision.

But, why is it that so many companies begin their communications to consumers with direct mail. Is it that people are simply stuck in a rut of what they’re used to and can’t embrace decade old technology? Or is it that people don’t believe the facts in front of them?

Healthcare, Marketing / Communications, Silverlink, Technology
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