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Medicare and Medicaid Social Media Use For Healthcare

As people look at ways to engage the Medicare and Medicaid populations, I continue to talk about the facts from the Pew research that shows how these demographics use technology.  I was glad to see some research from PWC that also reinforced this.  As you can see in the three charts below, the Medicare population uses technology similar to the average respondent while the Medicaid population uses social media for healthcare more. 

Using Social Media For Underwriting

As healthcare moves towards an individual market where prior conditions can’t be excluded, will health plans be able to use social media data in underwriting? It seems logical. If I can understand your behaviors, I can asses your risk for life insurance, and I can predict some healthcare costs.

  • Do you talk about going to the gym?
  • Do you talk about drinking and smoking?
  • Do you share pictures of food and is it healthy?
  • Are you checking in at places like McDonalds or places like the park?
  • Do you have an active social network?
  • Are you going to the dentist and getting flu shots?

As companies like salesforce.com integrate social media through things like Radian6, can this type of tagging and data use be far behind?

The other question is whether is should get used?

Smoking is an easy target for lowering healthcare costs

These statistics from the CDC really paint the picture…

– Smoking is estimated to cost businesses over $170 billion a year.
– Every smoker on the payroll is costing the company more than $3,500 annually in increased health insurance premiums, increased absenteeism and lost productivity.
– Smokers take, on average, 6.5 more sick leave days a year than non-smokers.
– Smokers cost 35-50% more to insure, a figure which is increasing rapidly as healthcare costs spiral.
– On average, up to 40 minutes of the working day is spent on smoking breaks, which equates to 21 working days of lost productivity per smoker per year.

This is certainly why you see companies trying to avoid hiring smokers. For those that show pictures of them smoking on Facebook or in other social media channels, this might be a risk (although I’m not sure if it’s legal to use that).

Using the Local Pharmacist to Moderate the P2P Discussion

P2P or Peer-to-Peer healthcare is a common discussion topic these days. Patients want to go online and learn from others with their condition on sites like Inspire.com or PatientsLikeMe.com. The government has been one of the early adopters.

“The social media sites we have created show that the government can interact in a meaningful way with the public. We don’t just push information out; we strive to make the content relevant so people can act on it, share it with family or friends and ultimately change their behavior.” Amy Burnett, CDC (Tapping Into The Power By Getting Personal, Robin Robinson, PharmaVOICE, May 2011)

The question is how can traditional companies – pharmaceutical manufacturers, disease management companies, providers, managed care companies, pharmacies, and PBMs – interact in these discussions. On the one hand, they have a broad depth of experience and data to share. On the other hand, they can’t just jump in and drive their agenda. They have to add value to the conversation, demonstrate that they care, and add value.

Much like the idea that you can purchase things online and return them to the physical store, I think these virtual discussions need to eventually be tied to a physical experience for many patients. One group that I think could play significantly in this is local pharmacists. Imagine that a chain or an association created a social media team. That team could monitor and interact with patients especially in key conditions such as some of the specialty drug areas. As relevant, this could be linked back to a local store where a pharmacist could spend time consulting with the patient. I think this would be a great way to drive the retail specialty business and increase consumer brand awareness.

“The potential use of social media as a bellwether for identifying trends, informational gaps, support tools, even improved communications between providers, allied health professionals, and others could pave the way for a more collaborative approach to population mapping and patient care.” Michael Parks, Vox Media (Social Media: Paving The Way, Robin Robinson, PharmaVOICE, May 2011)

The CDC has even created a toolkit for people to use.

What’s Your Digital Strategy?

Do you have a digital strategy?  Even if you don’t call it out that way, you certainly have digital as part of your overall member and physician strategy these days. 

Hopefully, you start with a few basics like:

  • What do I want to accomplish?
  • How do I measure success?
  • Who am I targeting?
  • What does my target group do online and what tools do they use (and for what)?
  • What is my competition doing?  (and what do companies outside my vertical that I want to emulate do)

Once you know those things, you can start looking at different areas of focus.  The key ones that jump to mind for me are:

  • Search engine optimization
  • Brand monitoring (e.g., Radian6)
  • Content creation (blogging, Twitter, Facebook, Google+, LinkedIn)
  • Moderation and involvement with social networking (e.g., PatientsLikeMe, DiabetesMine)
  • Tele-monitoring / telemedicine
  • Electronic prescribing / EMR / PHR
  • Digital couponing / incentives
  • Gamification
  • Mobile applications
  • SMS
  • QR codes
  • Augmented reality

But, I’m sure there are others…suggestions on what I’m missing?

Reprint: Getting Aligned For Consumer Engagement

(This just appeared in the publication by Frost  & Sullivan and McKesson called “Mastering the Art and Science of Patient Adherence“.  It was written by me so I’m sharing it here also for those of you that don’t get that publication.)

According to the 15th Annual NBGH/Towers Watson Health Survey, employees’ poor health habits are the number one issue for maintaining affordable benefits. Since studies have shown that 50-to-70 percent of healthcare costs are attributed to consumer choices and adherence is one of those issues, the topic of how to engage consumers isn’t going away.

The challenge is getting the healthcare industry to use analytics and technology tools when engaging the consumer in a way that works for each individual and builds on their proven success in other industries. Healthcare has an enormous amount of consumer data ranging from demographics to claims and behavior data. Consequently, there is great opportunity to use this data to engage consumers in their health to improve clinical outcomes. While on the one hand, it’s like motivating consumers to buy a good, the reality is that healthcare is both personal and local which complicates the standard segmentation models.

This is a dynamic time where people are experimenting with different strategies for engagement. For instance, in medication adherence, people are trying everything from teaming those who have chronic conditions with community pharmacists to make sure they are taking their medications correctly to technology that monitors when the pill actually enters your body. But, there are still fundamental gaps in the process which can be addressed using interactive technology to complement the pharmacist interventions.

Consumer engagement in healthcare is increasingly moving to new channels with 59 percent of adults in the U.S. looking for health information online and 9 percent using mobile health applications according to Pew Research Center. Additionally, there is more and more participation in social media or peer-to-peer healthcare applications. Modes like SMS, which companies are starting to leverage in programs like Text4Baby or the diabetes reminder program recently launched by Aetna, are gaining popularity. Companies like Walgreens have also begun exploring the use of SMS and Quick Response (QR) codes for medication refills.

At the end of the day, consumers want preference-based marketing where they can elect how to best engage them, but that doesn’t mean that’s the most likely channel to get them to take action.They want you to learn from their past responses to improve your future outreach, but they are also skeptic about how their data is used. You have to put yourself in their shoes to create the optimal consumer experience. You have to deliver the right message to the right consumer at the right time using the right sequence and combination of channels.This is not easy.

So, if you’re going to optimize your resources and build the best consumer experience, you need an approach which is dynamic and personalizes each experience. For example, we found that creating the right sequence and timing around direct mail and automated calls improved results by as much as 100 percent in a pharmacy program. Or, in another case, at Silverlink Communications, we found that using a male voice in an automated call to Latinos got an 89 percent better engagement rate around colonoscopies. We also know that using a peer pressure message does not work in motivating seniors to take action in both a retail-to-mail program and a cancer screening program, but does work for those younger than 55-years-old?

You have to make simple messaging relevant to them—why should I get a vaccination, why is medication adherence important, how can you address my barriers? Only an ongoing test and learn approach to consumer insights will suffice, and those that figure this out will become critical in the ongoing fight for mindshare and trust. But, this isn’t a stand-alone opportunity. We have to partner with providers to improve engagement, adherence, and ultimately outcomes in different forms. We have to offer them a platform for engagement that is built upon consumer insights and provides a unique consumer experience to them based on their disease, their demographic attributes, and their plan design. All of these factor into their behavior and are important in “nudging” them towards healthcare engagement and ultimately, better health.

Retail Pharmacy Mobile Applications

I’ve talked before about some of the mobile PBM efforts, but what about the retail pharmacies. You should expect that the chains will have different mobile strategies than the grocery stores or the big box retailers. And, it will be interesting to see how the independents might collaborate on a shared platform.

Here’s a few things already out there:
Walmart new shopping application and Walmart’s page on mobile
CVS retail application
Walgreens has a mobile pharmacy app
Target also has a mobile pharmacy application

So what should or could pharmacies offer consumers in terms of mobile applications:
– A refill application is a minimum
– Education or drug information is another basic
– There are certainly some geographic options such as a store locator or clinic locator
– There are options for location based check-in using Foursquare
– Scheduling MTM consultations or vaccinations are a reasonable option
– What about promoting saving thru 90-day retail or generics?
– As retail pharmacies are in the specialty business, there could be opportunities to promote this channel and offer support.
– Telemonitoring is another option (e.g., FaceTime)
– Use of QR code is another part as is augmenting the shopping experience with augmented reality
– Of course, couponing will be part of the solution, but what I’d like is someone who would download my shopping receipts (from multiple companies) and provide me with relevant savings.
– Should it include Rx coupons? Unlike the PBMs, retailers want traffic and if coupons increase adherence then why not.
– There are other options like photos and integration with social networks and tools.

I think one of the key “killer apps” is secure rules based messaging. Imagine using data to identify when you need a vaccination or identifying a potential drug-food issue or having age based triggers. These could be sent directly to the consumer in a secure environment. Of course, we’re only at about 10% adoption and the key question is whether these are the key consumer that everyone wants to attract. Are they the high utilizers? Do they buy other goods?

More to come here. This is a rapidly evolving space.

Did You Know PhRMA Has A YouTube Channel?

I just ran across this, and I figured I would share it.  PhRMA is the Pharmaceuticals Research and Manufacturers of America.  They represent they pharma and biotech companies.

Here’s a few of the videos from the site.  One on Part D and one on adherence.

Tiny Tower Retail Pharmacy Missed Branding Opportunity

Tiny Tower is a simple yet addictive game you can play on your iPhone or iPad.  My kids figured out the other day that you could re-name the floors.  For example, one of the floors is a pharmacy.

So, instead of saying “pharmacy” this could say Walgreens or CVS or Express Scripts.  What a missed opportunity.  I’ve talked about this before, but I think the pharmacy industry in general has missed integrating themselves into Hollywood and gaming.  When’s the last movie or TV show you saw where the primary actor was a pharmacist or worked at a PBM or even worked at a health insurance company (and was shown in a positive light)?

Here’s an easy branding opportunity.  It also seems like an easy revenue source for the Tiny Tower founders.  Why not have companies pay them to brand these?  Why not have people playing the game earn points to buy up from McDonalds to Red Robin?

Hospital Social Media Stats

Here’s some interesting stats from Ed Bennett that were shared in PharmaVOICE (Oct 2011) based on 1,188 hospitals that are using social media.

  • 548 YouTube channels
  • 1,018 Facebook pages
  • 788 Twitter accounts
  • 458 LinkedIn accounts
  • 913 Foursquare
  • 137 Blogs
  • 3,952 hospital social networking sites

My one pet peeve is the “emergency room” locations that publish their wait time via Twitter.  If it’s really an emergency, shouldn’t I be going in to get care not focusing on wait times?  And, aren’t the wait times variable based on how urgent my need?

Infographic: Word Of Mouth Advertising

As healthcare moves toward a more retail model, word of mouth advertising becomes more important.  This is already true in terms of physician’s influence on prescription use or in some cases distribution location.  It’s also important from a Medicare perspective.  But, this will continue to increase in importance in the future with health reform.

I also believe that clients will require satisfaction scores as part of their SLAs (service level agreements) in many cases in the future and/or tie bonus dollars to this.  Will you be prepared?  Do you understand your customers’ satisfaction with you?  Do you know how to impact it?

Words Matter: Doodling – We Should Foster It

As someone who was trained as an architect, I understand the value of sketches in the design process and have always “doodled” as I try to conceptualize what people are describing with words.  With that in mind, I really enjoyed this TED video and think it’s a good message for all of us in the communications field.

Flu Shots: Stock It And They Will Come?

This is the hot topic. Everyone wants you to get a flu shot because it’s good for your health and a profit making opportunity.

  • The CDC recommends flu shots for everyone over 6 months of age.
  • Pharmacies have big expectations about volume but “unfortunately” (from the perspective of nudging people to act) the disease does not seem to be too prevalent yet.

According to the CDC (and thanks to Larry Marsh’s team at Barclays Capital for sending out in their Flu Clues report):

We highlight that 0.8% of patient visits to physicians were due to flu-like illness, which is down 20bps from last week’s data. We note that this is well below the peak of 8.0% in early 2010. The 0.8% rate is below the national baseline average of 2.5%. Next we note that 6.0% of all reported deaths were due to pneumonia and the flu, 10 bps below last week, and below the epidemic threshold of 6.4% for week 37.

Traditionally, only about 40% of US adults will get a flu shot meaning there’s lots of opportunity for growth in vaccinations.  Tim Martin from the WSJ has talked about this in a few recent articles – Flu Shots Are A tough Sell This Year and People Have Big Plans For Flu Shots.  In the second article, he quotes a recent survey showing almost 2/3rds of adults plan to get the shot this year.  BUT WHY?  (other than the fact that those who respond to survey’s around flu shots may be more likely to take action)

You can also look at the Google flu trends data (again thanks to Larry Marsh and team for pointing this out) which shows online searches down for flu topics:

Like last year, the number of locations for getting a flu shot has expanded exponentially driven predominantly by pharmacies (which BTW is a good thing for them in demonstrating additional value).  You’re even seeing some creative programs building on last year’s programs. One new one I’ve seen is Walgreens use of Foursquare for donating flu shots.

Of course, if we can’t convince healthcare workers to get flu shots then it’s going to be really hard to convince the average consumer.

I would expect MA plans to work with their PDP provider or pharmacy partner to drive members to get flu shots. Since flu shots are a STAR measure, it’s important for plans to reach out and get consumers to get a flu shot.

But why should I get a flu shot if my likelihood of getting the flu is down?  That is the question.

That’s why I’m skeptical about some of the “generic” marketing efforts.  I think everyone knows that they “should” get a flu shot and now finding a location for one is easy.  BUT, we need to make it relevant to them especially those of us in healthcare.  Ideally, their pharmacist and physician are talking to them about it, but if not, how do “we” (as healthcare companies) engage them.

We have to make the “pitch” relevant to them. For families, make them understand the importance of keeping the family healthy and their kids in school. For pregnant moms, help them understand that it’s important and why.  For people who work, stress the importance of not missing work. For people with chronic conditions, focus on their additional risk.  For the elderly, explain the risks to them.

A recent Walgreens study quantified some of the costs of the flu:

A new Walgreens survey examining the effects of influenza on people’s everyday lives and the economy, suggests that last flu season resulted in 100 million lost works days, along with nearly $7 billion in lost wages and 32 million missed school days, among many other findings released today. These findings, the first of a two-part Walgreens Flu Impact Report series, underscore the ramifications the flu and ill-timed illness can have beyond people’s health – from missed work and lost income to parenting challenges.

According to the Centers for Disease Control and Prevention (CDC), on average 13 percent of the U.S. population gets the flu every year, with active flu seasons seeing closer to 20 percent, or more than 62 million Americans.

Videos from Kim Feil, Walgreens CMO

I was looking for something else and stumbled upon a few videos in YouTube by Kim Feil who is the Chief Marketing Officer of Walgreens.

Great Video! Placebo Effect Summarized In Video

A great summary of lots of the placebo research.  A must watch.  (remember if you get this e-mailed to you that you might have to come to the website to see it.)

Press Hits, Presentations, Writing YTD

I wanted to put together a quick summary of brand awareness so far in 2011.  It’s been a banner year already exceeding 2010 press hits (21).

  1. Drug Benefit News article in January around predictions for the industry
  2. Whitepaper on the future of the PBM/pharmacy industry
  3. Mention of my whitepaper in Adam Fein’s blog
  4. Barclays PBM Expert Call on 2/8/11
  5. Drug Benefit News article on Lipitor in February
  6. Managed Care Magazine on Lipitor
  7. Drug Benefit News article on coalition in February
  8. Drug Benefit News article on Walgreens PBM sale in March
  9. AIS Webinar on Copay Cards
  10. Drug Benefit News on Copay Cards
  11. Pharmacy Times on Mail Order
  12. Silverlink eBook we put out on healthcare communications
  13. AJPB July/August 2011 From the Editor
  14. Health Plan Weekly (8/1/11) on OptumRx moving away from Medco
  15. Pharmacy Technology Podcast in July
  16. Ten different appearances in the PCMA SmartBrief
  17. Five references on RxRoundtable.org
  18. A blog citation about extreme couponing
  19. Some discussion of my AIS webinar by David Williams
  20. A guest post on KevinMD about paying physicians for adherence
  21. Grand Rounds
  22. Drug Channels News Roundup
  23. A mention in DigiPharm
  24. HealthLeaders on Medco sale to Express Scripts
  25. HR Online about limited networks
  26. Drug Channels review of the Express Scripts Drug Trend Report

And, I have 5 things that I’ve actively provided comment and content to including my upcoming presentation at the Care Continuum Alliance on engaging the hard to engage with one of our clients – Aetna.

Storytelling Is A Part of P2P Healthcare

P2P (or peer-to-peer) is a popular topic in healthcare today.  It builds on both the social components of behavioral modification along with the social networking trends.

About one-third of Americans who go online to research their health currently use social networks to find fellow patients and discuss their conditions, and 36 percent of social network users evaluate and leverage other consumers’ knowledge before making health care decisions. Social networks hold considerable potential value for health care organizations because they can be used to reach stakeholders, aggregate information and leverage collaboration.  (from Deloitte study)

One of the biggest researchers out there in this space is Susannah Fox from the Pew Research Center.

Peer-to-peer healthcare acknowledges that patients and caregivers know things — about themselves, about each other, about treatments — and they want to share what they know to help other people. Technology helps to surface and organize that knowledge to make it useful for as many people as possible.  (from recent presentation from NIH – “Medicine: Mind the Gap”)

With that in mind, I found this study from a few months ago about storytelling very interesting.  Imagine the power of capturing stories in some form – DVD, YouTube, written – and sharing them with newly diagnosed patients across an expanded social network.  Imagine helping patients plug into a social network (ala – PatientsLikeMe).

Conclusion:  The storytelling intervention produced substantial and significant improvements in blood pressure for patients with baseline uncontrolled hypertension.

What has really surprised me is that I haven’t seen the large institutional healthcare organizations promoting the use of the social networks.  Maybe I’ve missed it, but I would think they would partner up with a few of these to encourage consumers to use them.  I understand on the one hand that that is “handing off” a patient to a different company, but rather than trying to build their own social networking application, I think they’re better served to leverage what exists.

A Few Stats On Seniors And Technology

This is from a WSJ article earlier this year, but I thought it made a few key points about seniors and technology (which is relevant for your Medicare strategy).

Friends, Klout, Networks, and Biological Limitations

Companies like Klout are looking for ways of calculating people’s reach using social media.  The question of course is always the tradeoff of quantity versus quality.

For example, I quit Facebook when I found it to be more distracting than productive.  Yesterday, I cut over 100 people out of my LinkedIn network because it had been years since I had connected and interacted with them and didn’t feel any connection with them.  I also have a requirement that I won’t connect with anyone unless I’ve talked and/or met with them IRL (in real life).  It’s amazing how much of a screening mechanism that is.

But, these efforts run counter to driving up a good Klout score which looks at Twitter, Facebook, LinkedIn, and FourSquare (which I’ve never tried).

It leads you to the great question of “how many friends can you have” and the definition of friend versus business contact.  On the first point, there is research that says the human mind can only manage 150 friends which seems to make sense.  In the traditional sense of friendship, I doubt there are a 150 people who I frequently interact with socially.  But, in the broader sense of having a friendly relationship with a large group of people both socially and professionally, I think social media definitely allows you to expand beyond the 150.

But, if technology limited us to our biological limitations that wouldn’t be any fun.  I find tools like blogging and tweeting as good outlets to share information with like-minded people some of whom I know well, some who I know, and some who I’ll never know.  That’s ok.

A Few YouTube Videos On ADHD

(Note: If you get this e-mailed to you, the videos may not show up without visiting the site.)

Here are a few videos on this topic:

What I Learned In PharmaVOICE

I’ve been reading the magazine PharmaVOICE for the past year or so. I really enjoy it. I occasionally pull a few articles out.

I was reading the March 2011 version on the plane and found a ton of interesting information. I thought I would share some of the nuggets from it:

  • In 2010, 112M people (48% of US adults) were e-pharma consumers (individuals who went online to find pharma information). (Manhattan Research)
  • Fewer than 20% of consumers who go online for pharma information mistrust pharma websites (branded and unbranded).

“We found the degree to which consumers are open to online content from manufacturers surprising, considering the common perception that consumers are generally critical of pharma generated information.” (Manhattan Research Healthcare Marketing Analyst Maureen Malloy)

  • Top Prescribing-Driving Sites (Manhattan Research):
    • Levitra
    • Chantix
    • Cialis
    • Nexium
    • Yaz
    • Lyrica
    • NuvaRing
    • Symbicort
    • Viagra
    • Lunesta
  • Talk about how research is now “peer reviewed” via social media – original article.
  • Talk about the Sanofi-Aventis blog – Discuss Diabetes – which enables two-way conversations with patients in public.
  • Talk about how Merck is helping patients engage with consumers using online videos and checklists.
  • Talk about a text messaging service focused at teens and young adults for adherence – www.ireminder.com.
  • An interesting article by Ogilvy about 8 Health Engagement Zones and 7 things to keep in mind about public and individual communications:
    • Technology is not a panacea…it has to be adopted and incorporated into everyday behavior.
    • Information must be communicated and interpreted effectively to change behavior.
    • To cut through the “clutter”, information will increasingly be communicated via story-telling and visualization.
    • Technology will allow us to create the right message with the right tone in the right place at the right time. [or already does allow for this with the Silverlink Platform]
    • Health messaging will become personalized. [already happening]
    • Highly targeted, persistent, positive messaging will be needed to help overcome fear and embarrassment.
    • Although health is a serious matter, we don’t always have to take ourselves seriously when it comes to health communications. (e.g., gaming)
  • In the year ending Oct. 2010, $4.4B was spent on DTC advertising around pharmaceuticals.
    • Pharma 3.0 success will be “based not on how many drug units are sold, but on how well pharma’s market offerings improve health outcomes, putting patients and payers at the center of the model”.
    • Pharma investments in condition support tools – smartphone apps, websites, devices, and social media – was up 78%.
  • In a recent Harris poll, only 11% of respondents perceived the pharmaceutical industry as generally honest and trustworthy.
  • According to SDI, there’s been a shift in spending from 2007-2009:
    • 30% decrease in print
    • 32% increase in online activities targeting physicians
    • 29% decrease in magazine DTC advertising
    • 300% increase in internet advertising
  • Learned about a physician “hotlink” (my name) by AstraZeneca where they can connect with the AZ medical affairs team by a feature on their iPhone – formulary status, adverse event reporting, request samples, …
  • Similarly, learned about an “Ask Pfizer” button in Sermo.
  • According to the Manhattan Research’s ePharma Consumer v10.0 study – almost 3/4th of the people visiting pharma websites take a product related action afterwards. (That’s amazing!)

“When pharma is thought of as a health-services industry, the possibilities for growth in revenue, engagement, personalization, and freedom from pipeline dependency are almost endless.” (Paul Simms, eyeforpharma)

  • A list of manufacturers and what percentage of their portfolio is at risk in the next 3 years for patent expiration:
    • #1 Pfizer with $53.6B and 68% of their portfolio
    • #2 Lilly with $20.8B and 66% of their portfolio

“The industry has to address the consumer population across multiple channels with information that is timely, easy to understand, accurate, and actionable.” (Deborah Schnell, Health Advice Networks)

  • There was an article discussing a great question about whether “brand equity” exists after patent expiration.
  • There was talk about the shifting “customer” of pharma from the physician to the consumer and the formulary committee.
  • There were some statistics from a Tufts study on REMS where 75% of people thought the program needed a major overhaul.

I shared a lot here to make a point…this is a monthly magazine packed with interesting content. If you’re in this space, you should be reading it.

CatalystRx Mobile Is “Health Entertainment”

I talked about this months ago after I saw Catalyst speak at a conference.  The mobile application is now fully deployed, and you can watch a video about it.  They describe it as health entertainment.

Here’s an example of their refill reminder:

(Note: In the spirit of disclosure, I do own some individual shares of Catalyst stock.)

Pew: 13% of Online Users Use Twitter

Pew just released some new data on who uses Twitter.  It shows that the biggest users are Hispanics and African Americans and the fastest growing age group is 25-44.  Here’s two charts from the report:

 

Pharmacy Kickoff At #RESULTS2011

I’m currently presenting at our client event (see twitter hashtag #results2011 for real-time comments). My presentation is an extension of my white paper on the future of the PBM / pharmacy industry along with a blend of data from our annual client survey and Silverlink Communications best practices with a focus on our work around medication adherence. It also builds on my thoughts from NCPDP that I shared late last year.

Here are a few of the points I touch on:

  • Avoiding being commoditized by adding value
  • Keys to success with a focus on:
    • Evidence-based approaches
    • Consumer engagement
    • Patient experience
    • Cross-channel coordination
  • Adherence and other priorities
  • How to use SMS to drive self-service
  • An approach to condition management in hypertension and diabetes
  • Focus on the “un-engaged” but don’t forget about the engaged consumers
  • Case studies and research around adherence
  • Timing and sequencing of direct mail, automated calls, and e-mail
  • Measuring “trust”

Here’s a teaser of some of the slides I’m presenting:

10 Things To Know About Engaging Patients

I just finished reading this publication by the Institute for Health Technology Transformation. Lots of quick nuggets of information summarized here. Let me share a few:

  • 88% of American adults with Internet acces research health information online; 60% say that the information they found influenced a decision (Pew)
  • Top sites (Alexa rankings) are NIH, WebMD, and medicinenet
  • 94% of patients say they at least sometimes forget important things they were told by their MD (Markle Foundation)
  • Only 3% of people have been harmed or know someone that’s been harmed by health information they found online (Pew)

They go on to provide some good usage statistics by age group; data around caregivers; data around who’s trusted and PHRs; and research from AARP and with Dr. Hibbard that shows the impact of engagement on outcomes.

PBM Mobile Applications – CVS, Humana, Medco, Express, Catalyst, Prescription Solutions

This week, Medco released their mobile application that they’ve been working with Verizon on.  Not a big secret in my mind since I’ve been hearing about it since last Fall.  I’ve talked about CVS Caremark’s application (CVS mobile), Humana’s application, and CatalystRx’s application.  So, this made me wonder why I hadn’t heard about one from Express Scripts.  It seems unlikely that they wouldn’t have one.

There doesn’t seem to have been a lot of fanfare, but they launched one in March.  Here’s a quick summary of it:

The new Express Rx mobile app works across multiple platforms, and is now available for a free download at both the Apple iPhone App Store and at the Android Market (simply search ‘Express Rx’).  In addition, members using a Blackberry or other smartphone device with web browsing capability can access our mobile optimized website at http://m.esrx.com.

With our new mobile app and mobile optimized website, Express Scripts members will be able to securely access the following functions:

  • Start Home Delivery – transfer available maintenance medications to the Express Scripts Pharmacy
  • Order Refills – select and schedule prescriptions to be refilled from the Express Scripts Pharmacy
  • Check Order Status – check to see if an Express Scripts Pharmacy order has shipped, the ship date and by what method
  • Find a Pharmacy – locate a nearby retail pharmacy using the GPS technology built into a smartphone
  • Drug Information – access Drug Digest database to look up drug information, common uses and possible side effects

The app consists of three features: My Rx Choices, which delivers on-demand, personalized out-of-pocket costs, interactions and other information for any prescription drug; My Medicine Cabinet, which allows patients to view the medications they’re on, including prescription and over-the-counter drugs, and set reminders for themselves; and Prescription ID Card, which allows convenient access to a member’s prescription drug card.

Of course, Walgreens also has a mobile application as does Walmart.  Neither of them are PBMs, but they are both critical players in the pharmacy space.
Next on my list to check out is Prescription Solutions.  They also have a mobile application which does:
  • Refill mail service pharmacy prescriptions
  • View your prescription history
  • Set up text message medication reminders
  • Check the status of and track orders
  • Locate a pharmacy by ZIP Code
  • Search your formulary by generic or brand name drug, status, or class
As one might expect, mobile web or mobile apps are quickly becoming the norm.  The key to look at is what is the functionality.  Is it simply putting their websites on a phone or are they developing other technologies that take advantage of the mobile environment (e.g., location based services or enhanced reality).  I’ll share some thoughts on those in another post.

Social Media A Fad? Infographic

I love infographics so I’m sharing this.  I personally don’t know anything that thinks social media is a fad.  I think there is lots of debate about its proper use in different types of businesses especially in patient care, but I think it’s proven it’s here to stay in some form.

Interview With Dr. Victor Strecher (Founder of HealthMedia) From #WHCC11

While I didn’t get to meet Victor at the World Healthcare Congress in DC, I got a chance to do a phone interview with him last week. For those of you that don’t know who he is, here’s a quick bio:

Victor J. Strecher, PhD, MPH
Professor, Health Behavior & Health Education; Director, Health Media Research Laboratory; Director, Cancer Prevention and Control, University of Michigan School of Public Health;
Chairman & Founder, HealthMedia, Inc.
Dr. Victor J. Strecher graduated in 1983 with an M.P.H. and Ph.D. in Health Behavior & Health Education from the University of Michigan. After positions as Assistant and Associate Professor in the School of Public Health at the University of North Carolina, Dr. Strecher moved back to the University of Michigan, where he became Professor of Health Behavior & Health Education and Director of Cancer Prevention and Control in the University of Michigan’s Comprehensive Cancer Center.

Dr. Strecher also founded the University of Michigan’s Center for Health Communications Research (CHCR): a multidisciplinary team of behavioral scientists, physicians, computer engineers, instructional designers, graphic artists, and students from a wide variety of disciplines. For over a decade, Dr. Strecher’s center has conducted research studies and demonstration projects of computer-tailoring and interactive multimedia programs.

In 1998, Dr. Strecher founded HealthMedia, Inc.– a company designed to create interactive health communications solutions for medical care, employer, pharmaceutical, and government settings. The intention of HealthMedia, Inc. is to bring the highest quality science, operational capabilities and creativity to the marketplace.

My key takeaways from the conversation were:

  1. We have to focus on intrinsic motivators in healthcare.
  2. A little help at the right time is a lot better than a lot of help at the wrong time.
  3. Selecting physicians based on organic chemistry scores without weighing empathy may be a issue.
  4. You have to listen to the patient, assess their needs, and provide them with tailored information.
  5. Social media has to embrace “collaborative filtering”.
  6. Most behavior change companies are hitchhikers while some like PBMs are tollbooths. It’s better to be a tollbooth.
  7. Choice has to expand over time.

Intrigued? You should be. Dr. Strecher was a fascinating person to talk with (see some of his insights). We only spent 30 minutes together, but I could easily imagine sitting with him in at my alma mater (University of Michigan) and talking for hours about healthcare communications and how this can impact the country and our outcomes.

We started off by talking about the shift in focus to the consumer over the past decade and how even while this has happened we (healthcare companies) have been guilty of seeing the patient from our perspective not from their perspective. This took us down the path of talking about motivation and what gets people to take action. We focused on the fact that health (in and of itself) isn’t a big motivator, but being healthy to see your kids or grandkids certainly is. We talked about how financial rewards aren’t the right (or only answer) and how there is a need to really understand and articulate intrinsic motives (see write-up on Drive by Daniel Pink).

We talked about his company HealthMedia (owned by Johnson & Johnson) and what they do to collect information on motivation. We talked about the use of stories (a topic that keeps coming up) and providing the right amount of help at the right time. He talked about how HealthMedia monitors consumers, provides them with coaching, and continuously evaluates their goals. He also talked about how they use online technology and mobile technology to get the right connection at the right time.

This led us into a discussion about how important behavior is in health outcomes. He mentioned that 70% of cancers are related to behavior – scary. But, at the same time, we don’t chose candidates for medical school based on their abilities to engage patients or show empathy. We choose them based on their organic chemistry scores. (As a physician, he could say that while I’d probably get tomatoes thrown at me for that comment.)

At this point, I really wanted to understand what HealthMedia has learned to get people off the couch and engaged. It all sounded a little too theoretical to me. He talked about their core process:

  1. Listen to the issues. Assess the patient using branching technology and feedback to them.
  2. Try to figure out what they need using a software algorithm.
  3. Tailor information to them based on what you’ve learned (e.g., if they are concerned about gaining weight when quiting smoking, help them with that). And, I thought a key point here was to help them prioritize their actions rather than giving them a laundry list of things to do.

But, one of the keys in getting them to engage is to work through their intermediaries – employers and payers. For example, while you might encourage consumers to take an HRA for a financial reward, you may need a “health champion” at the employer site to really motivate people at a personal level. Or in another example, he talked about how Kaiser uses Epic and how HealthMedia integrates there. This creates an opportunity for “information therapy” which can be given to the consumer as a follow-up action from their encounter.

We went on to talk about social media which is one of those big topics in healthcare today. Obviously, there is lots of research that talks about the “peer pressure” effect on weight and smoking and other topics. (He mentioned the book Connected here.) But, how to you build trust (see recent post on this) and route consumers to the relevant information. He brought up a concept which was new to me called “collaborative filtering”. My interpretation of this is essentially having an expert monitor and guide consumers to relevant information within the social media realm. You want to find relevance in the data which means it has to be from “friends” who have experience with the topic.

I was asking him about the challenge of building trust given how many companies are out there and the amount of information which consumers are bombarded with. This is when he created the great visual of most companies as being hitchhikers in the behavior change world while others like PBMs are tollbooths. The tollbooths create a pause in the process which is triggered around an event. This event is an opportunity to get the consumer engaged. Of course, in general, these “golden moments” (my phrase) aren’t taken advantage of as much as they could be.

But, if they were, consumers would understand what they want and how a particular behavior maps to those desires. This would lead to improvements in adherence and other outcomes.

We wrapped up by talking about preference-based marketing and the impact of choice. He had some great points here which is an area of interest for me since there’s not much research. He pointed out that choice is instrumental since it appeals to autonomy. BUT, not everyone wants autonomy. Too much choice can be overwhelming. In summary, he suggested that less choice is best early on when the consumer is overwhelmed (e.g., newly diagnosed), but as they become more of an engaged patient over time, more choice is better.

Why I Quit Facebook

For someone who is so active in social media (blogging, tweeting), I think people are surprised that I quit my Facebook account (technically deactivated). Maybe, like Twitter, I’ll take a break and return later.  [Unfortunately, I’m sure there are several people out there who think I de-friended them and won’t realize I just quit.]

But, why quit? Isn’t it a great tool for communicating?

I did find it interesting, and there is more and more information out there…BUT

  1. It changed how I interacted with people.
  2. It sucks up valuable time (and I didn’t even get into Farmville and the other games).
  3. I’m an introvert so I’m not sure I care to share that much.

Ultimately, I felt like my relationships online where different than reality. I would categorize them as follows:

  1. People who I should talk to offline (e.g., family) but where it became easier to talk via Facebook.
  2. Professional friends that I all of a sudden knew more about them then I normally would or needed to.
  3. Acquaintances who I all of a sudden kept in touch with on a semi-regular basis.
  4. Old friends that I would never talk to without Facebook and where I now was in a constant high school reunion.

It essentially became technology enabled voyeurism. Which might be interesting for a few times but gets old.  Even staying involved with Facebook on an occasional basis uses up time. I would think about saying that I didn’t have 30 minutes to work out when I know I spent 15 minutes online.  Maybe I’m being a little “fuddy-duddy”, but at the end of the day, I have

  1. Friends who I want to talk to live (although rarely have the time).
  2. Professional friends and acquaintances for which LinkedIn gives me everything I need.
  3. High school reunions every 5 years which is plenty.

Facebook essentially reverses the trend of having a smaller and smaller circle of friends as you get older.  You create a body of friends from every era of your life and keep them with you over time.  It’s certainly interesting, but unnecessary in my perspective.

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