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Healthcare Gamification

If you believe all the hype about digital health, you might think gamification was a natural solution.  Of course, if you’ve never heard of gamification, let me provide a basic definition from Wikipedia.

Gamification is the use of game thinking and game mechanics in non-game contexts to engage users in solving problems.

Here’s several articles for more information:

  1. Four Factors Driving Gamification in Healthcare
  2. From FitBit to Fitocracy
  3. The Wellness Game
  4. Gamification: Drugmakers And Health Campaigners Turn To Games To Promote Health

I think this quote from the Perficient white paper on this topic is a good one.

Gabe Zichermann, the author of Game-Based Marketing, speaks of balancing the fun and frivolity of gamification with the task of making life easier for cancer patients. He says, “I don’t presume to think that we can make having cancer into a purely fun experience. But, we have data to show that when we give cancer patients gamified experiences to help them manage their drug
prescriptions and manage chemotherapy, they improve their emotional state and also their adherence to their protocol.”

You can also look at a post by Jane Sarasohn-Kahn (one of my favorite bloggers) on this topic where she highlights several trends from a recent paper on gamification in healthcare.

Now, why should you care?

  1. Gamification should improve engagement which is critical to changing behavior.
  2. Gamification creates opportunities to make healthcare fun which can be difficult.
  3. People are different and respond to different “incentives”.  Competition and leader boards are concepts that excite lots of people to take action.

The forecasts for the gamification market are huge.  They show a nice hockey stick which gets every investor excited.


Of course, the important question is who uses games.  Is it just teenage boys?  It’s not.  Here’s a good report which shows you breakdown by age, gender, and many other stats.


Another quick article about gamification is from TEDMED.  The video is below, but it reminds me of some of my personal perspectives.  The sites also lists out several vendors and solutions in the obesity gamification space.

While one “easy” opportunity in my mind is to use gamification to address the rising number of kids with chronic diseases and to help address childhood obesity, there are many other opportunities like adherence.  A few examples of games out there include:

Companies like Ayogo, Mango Health, and Akili are ones that I’ve heard about, but I know there are a lot more out there.

One example I think of from watching my kids play games is from Webkinz which was a blend of real stuffed animals with online digital personas.  The animals could get sick if you didn’t nurture them and visit them.  It made me think of how an avatar could get fatter or slower based on their pedometer or eating habits.

Dossia: Not Just a Personal Health Record Anymore


I had a chance to see a product demo of Dossia the other day.  I was really impressed which I don’t easily say.  I was expecting to hear a pitch on Personal Health Records (PHRs) and why they were different.  Instead, I got to see a robust patient engagement portal which did some really interesting things. (see image above from the Health 2.0 demo they gave)

From their website, here’s the “about” description which lists some very influential players…

Dossia is an organization dedicated to improving health and healthcare in America by empowering individuals to make good health decisions and become more discerning healthcare consumers. Backed by some of the largest, most respected brands in the world – Applied Materials, AT&T, BP, Cardinal Health, Intel, Pitney Bowes, Vanguard Health Systems, NantWorks and Walmart – Dossia’s founding member companies have united under the common vision of changing healthcare.

Having these companies involved over the past 6 years has been really important for them to accomplish what they’ve done.  As someone that’s worked on a lot of the same population health challenges, they’ve accomplished things that not even Google Health could do.

So what were the features and functions that really impressed me:

  1. They’ve built integration to health plans, PBMs, pharmacies, lab companies, and even EMR companies.  This creates a data rich longitudinal view of the patient for the patient.  (I like the expression on their website where they say “Dossia is the connective tissue that powers healthy change.”)
  2. They’ve incorporated health content which by itself isn’t impressive, but the content is tailored to the individual based on their medical data.  Not hard, but not something that many people do well.
  3. They’ve built out a series of partnerships and integrations with over 50 apps where you can navigate that turn them on as widgets within the portal.  This is very similar to some of the cool things that CarePass is doing.
  4. They’ve built the system out using open APIs (application programming interfaces) which allows other companies to easily integrate with them.
  5. And, probably one of the cooler things from my consumer engagement lens was their ability to do WYSIWYG rules creation to trigger outbound communications based on clinical data.  The idea of a rules engine isn’t difficult, but the ease of their solution with the integrated data makes it very powerful.

And, they’ve expanded their reporting.  They’ve pulled in ways to manage those family members for which you’re a caregiver.  They’re doing lots of interesting things.  They are definitely worth talking to if you haven’t seen them in a few years.

Listing of Medication Adherence Solutions

It’s been a few years since I’ve worked on medication adherence solutions.  It seems to have become a big focus again in the industry both with the Medicare Star Ratings program and with all the emphasis on waste.

As I started thinking about adherence, I thought it would be good to create a list of solutions and vendors.  I couldn’t find one anywhere on the web.  So, here’s my initial list of almost 100 companies.

I’ll make this a dynamic list so please comment or send me suggestions to add.

Here’s some old posts on adherence that I think are still relevant here:

I’ve divided the list of solutions and vendors into the following:


  • Adherence Solutions LLC – develop programs to create alliances between different players, sell Dose-Alert which is a smart pill bottle cap, and provide a mobile tool
  • AdhereTech – smart pill bottles
  • Automated Security Alert – medication dispensers to complement their medical alert system
  • Biodose – electronic tray for monitoring time and day of use
  • CleverCap – smart cap for pill bottle
  • Didit – manual tracking device that attaches to a pill bottle
  • DoseCue – smart pill bottle
  • eCap – electronic compliance monitor
  • ePill – medication reminder devices
  • eTect – biocompatible tag on the pill with connectivity and a mobile solution focused on clinical trial adherence
  • iRemember – smart pill bottle cap with voice reminder and smart phone synching
  • MedCenter – monthly organizer and reminder system
  • Med-E-Lert – automated pill dispenser
  • MedMinder – automated pill dispenser
  • MedVantx – medication sampling at the physician’s office
  • Proteus – smart pill technology
  • Quand Medical – uses Near Field Communications and mobile to do medication management and reminders
  • SMRxT – smart pill bottle
  • TalkingRx – audio device attached to pill bottle
  • uBox – smart pillbox
  • Vitality GlowCap – smart pill bottle with communication programs

Mobile / Digital

  • 2Comply – patient portal with web coaching
  • ActualMeds – online medication management for consumers, caregivers, and providers
  • AI Cure Technologies – digital health solution
  • AssistMed – web and mobile based adherence solutions
  • Ayogo – social games and apps to improve engagement and adherence
  • CareSpeak – mobile solution
  • Care4Today – two-way messaging platform, app, and website
  • CellepathicRx – mobile solution
  • CloudMetRx – cloud based solution to help caregivers with medication management
  • Dosecast – mobile medication management and pill reminder
  • GenieMD – mobile medication management and reminders as part of broader solution
  • iPharmacy – mobile pill identifier, medication guide, and reminder app
  • Mango Health – mobile medication management with gamification and incentives
  • Medacheck – mobile reminder system that incorporates caregivers
  • MedCoach – mobile medication management and pill reminder
  • MedHelper – medication compliance and tracking app
  • mHealthCoach – reminder based solution creating a digital support system
  • Mscripts – mobile solution
  • MyMeds – mobile and web medication management and pill reminder solution
  • MyMedSchedule – mobile Rx management tool with reminder service
  • Nightingale – mobile solutions for reminders, engaging your physician, and notifying your caregivers
  • PillBoxie – mobile medication management and reminder app
  • PillManager – mobile medication management and pill reminder
  • PillMonitor – mobile medication reminders and logs
  • PillPhone – mobile phone solution with biometric authentication
  • Prescribe Wellness – automated, digital interventions
  • RightScript – platform to manage prescriptions through mobile reminders that connect patients, caretakers, practitioners, and health plans
  • RxCase Minder – mobile medication management
  • RxNetwork – mobile medication management and reminders with rewards
  • Quintiles – building digitally, connected communities
  • Virtusa – multi-dimensional interventions across the patient’s journey


  • Adheris – adherence suite and advanced analytics (just acquired Catalina Health) [note: they are owned by inVentiv Health who I work for]
  • Avanter – an adherence program for pharmacies in Argentina
  • Capzule – pill reminders as part of PHR
  • Dr. First – embedded tools into EHR
  • HealthPrize – platform with gamification, incentives, education, and communications
  • LDM Group – suite of compliance products
  • McKesson – sampling, coaching, coupons, and messaging
  • MediSafe – mobile medication management app and adherence platform
  • MedPal Health Solutions – platform for medication adherence solutions
  • MedSimple – medication management, pill reminders, coupons, and PAP programs
  • mHealthCoach – care collaboration platform using machine learning to personalize communications
  • Tavie – virtual nurse for improving adherence focused on several conditions


  • Ateb – multi-channel communication programs for pharmacies
  • Atlantis Healthcare – custom adherence solutions
  • Eliza – multi-channel communication programs
  • Intelecare – multi-channel adherence communications
  • MemoText – messaging platform
  • Patient Empowerment Program – medication adherence program for pharmacies
  • Pleio – adherence solutions for the first 100-days (when most people stop taking medications)
  • Silverlink – multi-channel communication programs [note: this is the company that I used to work for and still use]
  • Varolii (now Nuance) – multi-channel communication programs
  • Voxiva – web and text messaging solution
  • West – multi-channel communication programs

Big Data

Tools / Enablers

  • 5th Finger – assessment and personalization tools
  • GNS Healthcare – using data and predictive models to identify targets and fuel intervention programs
  • HumanCare Systems – creating patient and caregiver support solutions
  • Insignia (PAM) – measure of patient activation for segmentation and scoring
  • MedMonk – help pharmacists obtain funding for patients who can’t afford their out-of-pocket pharmaceutical expenses
  • MedSked – low tech, high impact labeling solution
  • Merck Adherence Estimator – screening tool available as a widget or online at Merck Engage
  • NaviNet – communications network to enable adherence
  • NCPA – toolkit and ROI calculator for pharmacies
  • ScriptYourFuture – tools and text reminders
  • Walgreens API – an application programming interface for developers to use to connect their adherence solutions to Walgreens

Medicare focused

  • Dovetail – pharmacist led programs including MTM, in-home visits, and telephonic coaching (focused on Star Ratings)
  • Mirixa – incorporated into the MTM program
  • Outcomes – data and tools as part of their MTM solution
  • Pharm MD – Medicare STARS program

Condition specific

  • GeckoCap – adherence offering for kids with asthma
  • MyRefillRx – mobile adherence app focused on high blood pressure



  • 90Ten Healthcare – providing adherence programs in 23 countries
  • TrialCard – voucher and co-pay programs for consumers to stop Rx abandonment
  • Triplefin – customized programs for pharma brand managers
  • Adherence Engagement Platform – a Pfizer program of adherence materials and tools (I couldn’t find it online only in hard copy)
  • RS Associate – a company working with manufacturers in India
  • – MTM, pre-edit messaging at the POS, and print-on-demand messaging at the pharmacy

International (recommendations send to me without English sites)

What other companies am I missing?  Send them to me directly or add them in the comments section here.  Thanks.

The Prescribing Apps ERA – Will Clinicians Be Ready? #mHealth

Dr. Kraft (@daniel_kraft) recently spoke at FutureMed and talked about the prescribing apps era.  I’ve talked about this concept many times, and I agree that we are rapidly moving in that direction.  And, there’s lots of buzz about whether apps will change behavior and how soon we’ll see “clinical trials” or published data to prove this.

From this site, you can get a recap, but here are the key points that he made:

1) Mobile Phones (quantified self) are becoming constant monitoring devices that create feedback loops which help individuals lead a healthy lifestyle.  Examples include; monitoring glucose levels, blood pressure levels, stress levels, temperature, calories burned, heart rate, arrythmias. Gathering all this information can potentially help the patient make lifestyle changes to avoid a complication, decrease progression of a particular disease, and have quality information regarding his physical emotional state for their physician to tailor his treatment in a more efficient manner.

2) The App prescription ERA:  Just as we prescribe medications prescribing apps to patients will be the future. The reason why this is important is that apps created for particular cases can help the patients understand their disease better and empower them to take better control.

3) Gamification: using games in order to change lifestyle, habits, have been mentioned before. A very interesting concept was that created in the Hope Labs of Stanford. The labs created a game in which children would receive points after there therapeutic regiment, once points were optioned they could shoot and attack the tumor. Helping with the compliance rate of the treatments

4) Lab on a chip and point of care testing

5) Artificial Intelligence like Watson and its application in medicine.

6) Procedure Simulation: Several procedures done by medical professionals follow (not 100%) a see one, do one teach one scenario.  Probably very few people agree with this concept and that is why simulation has great potential. In this case residents, fellows in training can see one, simulate many and then when comfortable do one.

7) Social Networks and Augmented Reality

At the same time, a recent ePocrates study hammered home the point that while this is taking off physicians don’t have a mechanism for which ones to recommend and why.

According to the Epocrates survey, more than 40 percent of physicians are recommending apps to their patients. In terms of the apps being recommended, 72 percent are for patient education, 57 percent are lifestyle change tools, 37 percent are for drug information, 37 percent are for chronic disease management, 24 percent are for medical adherence and 11 percent are to connect the patient to an electronic health record portal.

Physicians also have several different sources for identifying which apps to recommend to their patients. According to the survey, 41 percent get advice from a friend or colleague, while 38 percent use an app store, another 38 percent use an Internet search engine, 23 percent learn of an app from another patient or patients, and 21 percent use the app themselves.

That said, the survey also notes that more than half of the physicians contacted said they don’t know which apps are “good to share.”

As I’ve discussed before, this is somewhat of the Wild West.  Patients are buying and downloading apps based on what they learn about.  They’d love for physicians, nurses, pharmacists, and other trusted sources to help them.  But, those clinicians are often not technology savvy (or at least many of the ones who are actively practicing).  There are exceptions to the norm and those are the ones in the news and speaking at conferences.

IMHO…consumers want to know the following:

  1. Which apps make sense for me based on my condition?
  2. Will that app be relevant as I move from newly diagnosed to maintenance?
  3. Should I pay for an app or stick with the free version?
  4. Is my data secure?
  5. Will this app allow me to share data with my caregiver or case manager?
  6. Will this app have an open API for integration with my other apps or devices?
  7. Is it intuitive to use?
  8. Will this company be around or will I be able to port my data to another app if the company goes away?
  9. Is the information clinically sound?
  10. Is the content consumer friendly?
  11. Is it easy to use?
  12. Is there an escalation path if I need help with clinical information?
  13. Will my employer or health plan pay for it for me?
  14. Is my data secure?

And, employers and payers also have lots of questions (on top of many of the ones above):

  1. Is this tool effective in changing behavior?
  2. Should I promote any apps to my members?
  3. Should I pay for the apps?
  4. How should I integrate them into my care system?
  5. Do my staff need to have them, use them, and be able to discuss them with the patient?  (Do they do that today with their member portal?)


FitBit Review Summary – Device, Apps, And Suggestions

In the spirit of the Quantified Self movement and in order to better understand how mHealth tools like FitBit can drive behavior change, I’ve been using a FitBit One for about 6 weeks now. I’ve posted some notes along the way, but I thought I’d do a wrap up post here. Here’s the old posts.

Those were focused mostly on the device itself. Now I’ve had some time to play with the mobile app. Let me provide some comments there.  And, with the data showing a jump in buyers this year, I expect this will be a hot topic at the Consumer Electronics Show this week.

  • The user interface is simple to use. (see a few screenshots below)

  • I feel like it works in terms of helping me learn about my food habits. (Which I guess shouldn’t be surprising since research shows that having a food diary works and another recent study showed that a tool worked better than a paper diary.) For example, I learned several things:
    1. I drink way too little water.
    2. I eat almost 65% of my calories by the end of lunch.
    3. Some foods that I thought were okay have too many calories.
  • In general, the tracking for my steps makes me motivated to try to walk further on days that I’m not doing good.
  • The ease of use and simple device has helped me change behavior.  For example, when I went to go to dinner tonight, I quickly looked up my total calories and saw that I had 600 calories left.  Here’s what I ate for dinner.  (It works!)


But, on the flipside, I think there are some simple improvement options:

  1. I eat a fairly similar breakfast everyday which is either cereal with 2% milk and orange juice or chocolate milk (if after a workout). [In case you don’t know, chocolate milk is great for your recovery.] Rather than have to enter each item, FitBit could analyze your behavior and recommend a “breakfast bundle”. (and yes, I know I could create it myself)
  2. Some days, I don’t enter everything I eat. When I get my end of week report, it shows me all the calories burned versus the calories taken in. That shows a huge deficit which isn’t true. I think they should do two things:
    1. Add some type of daily validation when you fall below some typical caloric intake. (Did you enter all your food yesterday, it seemed low?)
    2. Then create some average daily intake to allow you to have a semi-relevant weekly summary.
  3. The same can be true for days that you forget to carry your device or even allowing for notes on days (i.e., was sick in bed). This would provide a more accurate long-term record for analysis.
  4. The food search engine seems to offer some improvement opportunities. For example, one day I ate a Dunkin Donuts donut, but it had most types but not the one I ate. I don’t understand that since there’s only about 15 donuts. But, perhaps it’s a search engine or Natural Language Processing (NLP) issue. (I guess it could be user error, but in this case, I don’t think so.)
  5. Finally, as I think about mHealth in general, I think it would be really important to see how these devices and this data is integrated with a care management system.  I should be able to “opt-in” my case manager to get these reports and/or the data.

The other opportunity that I think exists is better promotion of some things you don’t learn without searching the FitBit site:

  • They’re connected with lots of other apps.  Which ones should I use?  Can’t it see which other ones I have on my phone and point this out?  How would they help me?
  • There’s a premium version with interesting analysis.  Why don’t they push these to me?

I also think that they would want an upsell path as they rollout new things like the new Flex wristband revealed at CES.

And, with the discussions around whether physicians will “prescribe” apps, it’s going to be important for them to be part of these discussions although this survey from Philips showed that patients continue to increasingly rely on these apps and Dr. Google.


Finally, before I close, all of this makes me think about an interesting dialogue recently on Twitter about Quantified Self.

Interview With BodyMedia CEO at mHealth Summit #mhs12

BodyMedia 1

Last week at the mHealth Summit in DC, I had a chance to sit down and visit with Christine Robins who is the CEO of BodyMedia. (see bio below)  One of the most exciting things (mentioned at the end) is their new disposable solution coming out.

Christine Robins is currently the Chief Executive Officer of BodyMedia, Inc., a pioneering market leader in wearable body monitors. BodyMedia’s devices are unparalleled in the marketplace, and equip professionals and consumers with rich information to manage a range of health conditions impacted by lifestyle choices.

Prior to joining BodyMedia, Christine was the CEO of Philips Oral Healthcare where she led the global Sonicare® brand to significant sales and share growth. Christine also has extensive experience in a wide range of marketing and finance capacities gained during her 17 years at S.C. Johnson, where she ran notable brands such as Raid® insecticides, Glade® air fresheners, and Aveeno® skin care. With this background rooted in global multi-national companies and an entrepreneurial zeal essential to lead a high technology upstart, Chris is passionate about developing turnaround strategies, building teams, and driving innovation.

A noted speaker, Christine has delivered presentations at universities such as Harvard, Stanford and Duke, as well as keynotes at industry shows such as the Consumer Electronics Show, Health 2.0 and CTIA. She holds a degree in Marketing and Finance from the University of Wisconsin-Madison and an MBA from Marquette University.

If you’re not familiar with BodyMedia, it’s definitely a company to know from a Quantified Self perspective. They have been around since 1999 providing solutions and have 150 global studies about the effectiveness of their devices in weight loss (see one chart below). The devices that they use continue to get smaller and smaller with time and are registered with the FDA as Class II medical devices.

clinical charts_2012_updated

Their devices track 5,000 data points per minute using 4 different sensors. Here are a few screen shots from the mobile apps that they have.

bodymedia iOS 3

And, as you can see, they map well to the chart below which shows what data consumers and physicians want to track with weight, calories, physical activity, and sleep patterns.

Quantified Self 2

For food tracking, they work with MyFitnessPal which provides them with data on products you eat. I think a good example can be seen in this screen shot from the Android app.

bodymedia 4

But, honestly, a lot of what I was really intrigued by was a new offering they’re rolling out called the “PATCH” which will be a 7-day, disposable body monitoring system that does everything the full blown system does. I don’t know the price point yet, but this is really exciting as a way to pull new people into the market and to use as a strategy for setting a baseline with a patient to understand their data. It could then lead to recommendations around disease management.

Another thing that Christine talked about was they’re approach to partnering with places like the Biggest Loser and other to allow for a customized content approach to your messaging from the system. She also showed me how the device will project where you will end up at the end of the day based on your past history.

They also have a module for a coach or weight loss professional to help manage and view data across all the people they’re working with.

(And, I just grabbed this image from their website since it points out the 3 key things to weight loss.)

iBlueButton Interview At The mHealth Summit #mhs12

I had a chance to sit down and do several interviews at the mHealth Summit earlier this week in DC. I’m slow to get my interviews posted, but they were all very interesting.

One of the best was with Dr. Bettina Experton (see bio below) of Humetrix. I will admit that reading about iBlueButton doesn’t do it justice. I was confused as to what they were trying to do and why it won an award. And, while explanatory after the fact, I found the graphic below intimidating as a consumer before talking with her.

[For those of you that don’t know what BlueButton is, you should go research it here.]

Dr. Experton explained to me how broad the BlueButton initiative now is. I only knew that CMS was using it, but apparently, there are now 200 plans also using it including Aetna, United Healthcare, and Humana. What Humetrix focused on for this offering was the mobile empowerment of BlueButton allowing the patient to have control of their information in the iOS platform (i.e., your Apple products – iPhone, iPad). They provide a tool for downloading and encrypting the data – prescription, medical claims, lab, and procedures.


Of course, if you’ve ever seen what this data looks like in the raw form, this wouldn’t seem very helpful. Most of us wouldn’t know what to do with this. But, as Dr. Experton showed me, they’ve rendered the data in a great GUI (graphic user interface) that really brings it to life in a readable and understandable format. For example, they translate the NDC code (used for prescriptions) into the drug name with the chemical name and the dosage. The GUI is very iPod like in terms of simplicity and ease of use.

iBlueButton 2

The iBlueButton app even will pull in patient self-reported data from a PHR (personal health record) and show it in a different color and different section so the provider can understand the sources. Of course, this was another point of confusion for me before we talked which was how would a physician get this and what would they do with it. She showed me a demonstration of the patient opting to share their data and records with the provider in real-time. Of course, this assumes the provider’s office and/or the physician is actually using a device in the presence of the patient, but we know that is changing quickly these days. (See article on survey about MD use of iPad / iPhone.) So, with their tool, I can now store and share my data. The challenge still is integrating this data into the physician’s EMR (electronic medical record), but the iBlueButton app on the provider’s device can do this. It can also print it for those physicians who still want to see the printout in their paper file.

Another thing that you see in the second set of screen shots above is that you can start to report on whether you’re using the prescriptions still that it shows you on. Assuming patients engage, this would be a great tool for medication reconciliation and adherence discussions.

I’m not the Meaningful Use expert, but Dr. Experton pointed out to me that all of this is important since meaningful use requires viewing, downloading, and transmitting capabilities. They provide all of these.

I definitely plan to download iBlueButton and my data, and I hope to use this as a tool to reinforce why any claims provider should be offering you BlueButton access to your data. This is definitely a company to watch.

Bettina Experton, M.D., M.P.H.
President & CEO

Dr. Experton is the founder, President and CEO of Humetrix which she has led over the last 15 years on the HIT innovation path starting with the development of health risk appraisals, chronic care management software, and since the early 2000s with the development of novel mobile device-based solutions which have been deployed worldwide. A physician with over 20 years of healthcare informatics experience, Dr. Experton is the author of multiple information technology patents. At Humetrix, Dr. Experton also conducted groundbreaking health services research on the frail elderly which led to major federal legislation in the area of Medicare and managed care, and has been a national healthcare policy advisor in the US, China, and France. As a healthcare IT advisor to the French Ministry of Health, she made important contributions to the design of the newly launched French government sponsored single web-based individual health record with smart card access made available to French citizens and their physicians. Dr. Experton is an Adjunct Professor of Medicine at the University of California at San Diego, School of Medicine and a permanent member of the Faculty of the School of Medicine in Paris, after graduating Summa Cum Laude where she completed her training in Internal Medicine. In California, Dr. Experton received a Master’s degree in Public Health with a major in epidemiology from Loma Linda University School of Public Health, completed a Pediatrics internship at University of California Davis Medical Center and a Public Health residency with the State of California Department of Health Services.

Healthcare Transparency, Out-Of-Network Claims, and Technology Solutions

Another big focus area these days is around the creation of transparency solutions to enable consumers to make better cost decisions about their healthcare.  While several companies have sprung up to work directly with consumers, the large payers have begun to rollout their own solutions.   And, as you can see from the Towers Watson and National Business Group on Health 2012 Survey, this issue of transparency was the 3rd biggest focus area for 2013. 

If you havent’ heard much about the topic, here’s several articles about the challenge of price discrepancies and surprise bills to consumers:

Here’s what UHG and Aetna are doing:

A few of the companies to look at are:

Companies like GoodRx are creating solutions in this area. 

You also might enjoy this infographic from Change Healthcare.


If you don’t believe this is a big issue in terms of price differentials, take a look at this data from the Healthcare Blue Book.  This shows a huge swing in prices which depending on your plan design can directly impact your out-of-pocket spend. 

Test or treatment Low Fair High
Brain MRI $ 504 $ 560 $ 2,520
Chest X-ray 40 44 255
Colonoscopy 800 1,110 3,160
Complete blood count 15 23 105
Hip replacement 19,500 21,148 43,875
Hysterectomy 8,000 8,546 16,480
Knee replacement 17,800 19,791 42,750
Knee arthroscopy 3,000 3,675 7,350
Laminectomy (spine surgery) 8,150 11,744 25,760
Laparoscopic gallbladder removal 5,000 6,459 12,480
Tubal ligation 2,865 3,183 5,729
Transurethral prostate removal 4,000 4,409 8,875
Ultrasound, fetal 120 169 480
Vasectomy 700 1,003 2,100

Amazing iPhone Application For The Blind

When I saw this presentation at World Health Care Congress in DC earlier this year, it was definitely the most amazing presentation there.  We all talk about all the new applications being developed.  There is one that looks at your tongue to tell if you’re sick.  There’s one that will take an audio file of your cough and compare it to other coughs.  Lots of amazing applications.

This one by LookTel can really make the difference for blind people. 

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

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.

How the application changes your experience? Flipboard and Twitter

I’ve found Twitter to be a great way to get news.  You follow a core group of people who talk about topics that you care about and can quickly sort through mainstream and other news and events. 

But, I was shocked to see the difference in experience moving from using Twitter in a standard format to using it within Flipboard.  Flipboard takes the links and activates them.  It pulls in images, and it makes it into a book.  See the two images here from my new iPad2.

CatalystRx Engaging Patients With Avatars

Last week, I got to see one of the more interesting presentations I’ve seen in a while. CatalystRx presented on some of the work they are doing with a mobile application to be released later this year. The application uses an avatar (well technically an “embodied conversational agent“) to engage with the consumer. I’m not sure how well that will work with a senior population, but the technology (shown in a video demo) was very cool.

The application is based on lots of research (and designed by the people who made Happy Feet). For example, they talked about:

      • The importance of finding the right balance between too cartoonish and too human. They referenced some Disney research about size of the eyes versus the size of the head which creates a positive memory trigger due to similarities to baby’s faces.
      • Creating a “trusted advisor” for the patient (using David Shore’s book – Trust Crisis in Healthcare).
      • The importance of the face and how it shows emotion (both human and avatar).
      • How small talk engaged the consumer and builds trust even when it’s an avatar telling first person stories.

Some of the research comes from Chris Creed and Russell Beale’s work.

Recent research has suggested that affective embodied agents that can effectively express simulated emotion have the potential to build and maintain long-term relationships with users. We present our experiences in this space and detail the wide array of design and evaluation issues we had to take into consideration when building an affective embodied agent that assists users with improving poor dietary habits. An overview of our experimental progress is also provided.

The application helps patients to:

  • Make decisions
  • Identify pharmacies
  • See prescription history
  • Get reminded about refills
  • Get information about generics and formulary compliance
  • Receive personalized interventions

Obviously, mobile solutions as a way to engage patients using a secure environment for delivering PHI is a holy grail (for those that download and stay engaged). This was an interesting and promising variation on some of the solutions out there. I look forward to learning more and seeing it once it’s fully available.

Some Social Media Videos

More and more, I am getting in conversations with clients about emerging media and how that plays into their healthcare communications strategy.  Whether that is simpler things like PURLs, SMS, and mobile applications or more complex decisions around Twitter, Facebook, YouTube, blogging, and social media. 

Here are a few things from YouTube that I thought were good on the general market.

Do You Know The Tone Of Your E-mail?

This one intrigues me.  We know that it’s much easier to convey emotions face-to-face…BUT we continue to evolve to more electronic communications and less face-to-face interactions.  So, does that lead to more mis-understandings.  I’m sure it does.  One study says e-mails are mis-understood 50% of the time. 

Haven’t you ever read an e-mail several times trying to figure out what the writer was trying to say and making certain assumptions.  We all read into messages.

The application is ToneCheck which integrates right into Outlook.  I haven’t tried it yet, but I’m intrigued by the demo.

The Connected Consumer – Razorfish

This was also an interesting look at online consumers and their influence versus brands.

A Single View of the Member

Do you dream of being treated as one consistent individual across a company?  Wouldn’t it be nice if they knew every communication they sent to you – letters, calls, e-mails – and knew every communication touch you had with them – webpages visited, faxes, inbound calls, e-mails?  Unless someone can tell me different, this is still a dream world at most companies and maybe more than a dream at most healthcare companies.  (It’s even more complicated if you start thinking about all the touches by the health players – hospitals, clinics, MDs, disease management companies – and integrating them.)

All that data could help paint a much better picture of each individual if blended with outcomes data.  Who responded to what?  When did they respond?  What did they do?  How did it vary by condition?  How did it vary by gender?  By age?  What can you use to predict response rates? (I.e., the key here is having data transparency, easy to access data, and the ability to mine and analyze the information.)

There are so many variables that it can be overwhelming.  That’s why I found the discussion around Campaign Management 2020 by Elana Anderson and then commentary by James Taylor interesting.

“we can dream of technology that supports fully automated marketing processes and black box decisioning, tools that simplify marketing complexity and support collaborative, viral, and community marketing” (Elana’s blog entry)

This really gets at the heart of some of the fun projects we are working on these days at Silverlink Communications with our clients where we are bringing Decision Sciences to healthcare and helping clients optimize their engagement programs, retail-to-mail, brand-to-generic, HEDIS, and coordination-of-benefits (among dozens of other solutions).  Helping clients layout a strategy, define a process, develop a test plan, execute a program, and then partner with them to improve results is what makes my job so exciting.

As we go into the new year, I hope all of you are having fun at your jobs or quickly find a new job if your unemployed.

What’s Your “Age”?

We were talking about this the other night at a New Years Party. There are now several ways of assessing your “real age”. Of course, you have the actual calendar showing days, months, and years that have passed since your birthday, but is that a fair assessment of how your body is really aging.


Without getting philosophical, I think these are some fun tools that assess your age that give you some directional indication. [Hint…It’s always better to be younger!]

1 – Your RealAge is a test that looks at 125 different factors to assess how you are aging. It takes into account diet, exercise, relationship, stress, and lots of other facts. It is an interesting test. (I was 3 years below my calendar age.)

2 – Your Wii Age is an assessment on the Nintendo Wii that looks at your flexibility and a few other factors based on how you respond to a test you can do each day. (I have taken it several times, but at best, I got to 14 years below my calendar age.)

3 – Your BrainAge is a game that provides exercise for your brain. It is made for the Nintendo DS. (I have never played this.)

4 – Your LifeTime Fitness Age is based on free assessment they provide members. I just did it the other day where they looked at my heartrate on the treadmill, a strength test, a flexibility test, and looked at my weight and body fat. (Happily, I was 6 years below my calendar age.)

Viral Marketing in Health: Humana Steps Up

I talked about Humana‘s innovation group a few days ago. They have done it again with two new games. One is on and the other is a Facebook application.

The Freewheelin Cycle Challenge is an online bicycle-racing videogame that matches you and a quirky virtual opponent. To make it to the finish line first, players energize their bicyclist and pick up speed by capturing nutritious snacks, such as nuts and oranges. They lose energy, however, by rolling over holiday junk food, including candy canes, cookies and other sugary snacks.

“The Battle of the Bulge” is an application that will be available at beginning Dec. 24. To participate, users go to “The Battle of the Bulge” Facebook page and answer a few questions about their lifestyle, including exercise and eating habits. Based on the responses, users are assigned a virtual waistline, affectionately called a “bellytar.” The goal of the game is to maintain an ideal weight.

But it won’t be easy. Other “friends of flab” can “fling fat” your way, making your bellytar’s pants literally bulge at the seams. In a worst-case scenario, you could be headed toward an online heart attack. To shape up, simply answer questions about exercise correctly and watch your bellytar shrink before your very eyes. Then answer questions about nutrition correctly to fling some fat of your own.

I find these to both be great examples of viral marketing which Seth Godin does a good job of explaining on his blog. Obviously, there is a long-term objective here which is driving healthy behaviors and positioning Humana as a leading edge company. They also hope to learn about human behavior and understand how tools like these can affect healthcare.

Health 2.0: The Companies

This is the third of three posts that I intended on the Health 2.0 conference which just ended in San Diego. This one is really just a laundry list of some of the companies that participated.

For sponsors, I was able to grab their logos:


For other companies, here is a quick list of some of the ones that participated that I don’t think I already mentioned:

Health 2.0: My Notes

I am just flying back from the Health 2.0 conference out in San Diego. I feel like there is a ton of information that I want to share so kudos to Matthew and Indu for the great job. (And, if you make it to the end of this post, you must really like the topic.)

I decided the best way to do this is in three posts: (1) Notes; (2) Companies; and (3) Observations. [Some people were doing live blogging which I just couldn’t do and keep focused.]

Here are a few of the other blog postings about the event:

So, let me begin here with my notes from the conference which began Monday with some informal sessions (user driven) and a deep-dive on a new vendor American Well. [I missed this event since it was so packed that it was standing room only in the hallway, and I was 5 minutes late getting off a conference call. That being said, they were in there for 3 hours so there must be something pretty interesting.] Tuesday was pretty much packed from breakfast (7:00) until I got back from dinner (11:00).

Matthew Holt:

  • Talked about his Health 2.0 picture of search, social networks, and tools. And, at the end of the conference, he showed a preliminary sketch of the model for the fall Health 2.0 conference where each of these are blown out into smaller segments.
  • Talked about the challenge of wrapping context around transitions. [In a side conversation, I thought someone else made a great point of saying that one of the biggest challenges will be how to drive change.]
  • Talked about the four stages of Health 2.0. I was soaking it in versus scribbling notes madly so all I got were phase 1 (user-generated content) and phase 2 (users as providers). But, I believe the later phases do (or should) show these models integrating into the establishment.

Susannah Fox (Pew Internet & American Life Project):
[Who by the way was a very good speaker and refreshingly gave a 30-minute presentation w/o any slides.]

  • Talked about an early 2000/2001 quote from the AMA on not trusting the Internet and a push to the physician. [That seems to have softened a bit over the years.]
  • Said that 40% of adults in America have a high school education or less which gets right to the issue of health literacy.
  • Talked about validity of online data. Researchers want to see date and source, but patients don’t look for that.
  • Talked about an article in a cancer magazine about misinformation which said the most highly correlated factor was a discussion around alternative medicine. Those sites often had misinformation on them.
  • She set the tone for the day by using the concept of a seven word expression to summarize your talk. Her’s was “Go Online. Use Common Sense. Be Skeptical.”
  • Pointed out that only 3% of e-patients report bad outcomes based on online data. [I think this whole discussion around what patients want in terms of research versus experiential data from their peers is very interesting.]
  • Talked about the white space between a “physican is omnipotent model” (my words) versus a “patient self-diagnosis world”. That is where we have to find a solution.
    • [A person from Europe who I talked with said that not only is their model different but the fact that they hold the physician on a pedestal makes some of these things impractical there.]
  • Talked about a new term for me – “participatory medicine”.
  • Said that Pew had classified people into three groups not on the concept of do you own a mobile device (for example) but on how you use it (e.g., do you feel like the device interrupts your life when it buzzes you, do you require help in setting up your devices).
    • 1/3 of Americans are “elite tech users” who own lots of devices
  • There is still minority distrust of some of these online tools. Some of this is generational.
    • The memory of the syphilis experiment is failing.
    • There is limited discussion of faith in these discussion areas which is important.
    • The older generation typically has less technical skills.
  • Her next seven word expression was “Recruit Docs. Let E-Patients Lead. Go Mobile.”
  • She described African American and Latino users of mobile devices as leveraging it as a Swiss Army knife versus a spoon. [I hope I use it more as a spork…which I assume is evolutionary over the spoon.] They use it more than TV or computers.

Patient Videos:

  • One of the most engaging segments was a series of video clips from patients.
    • The founder of (I’m Too Young For This) spoke about being diagnosed with cancer at an early age and how he overcame the physical challenges and has become a go to destination for people about cancer.
    • The founder of Heron Sanctuary in Second Life talked about how she has limited mobility in real-life and her ability to create a world in second life where she can help people and gave examples of how people are using this virtual reality tool.
    • A young woman with RSD talked about how she has used ReliefInsite to manage her disease and pain. She also had the same issue of being “too young” to have RSD and the challenges of finding a physician to help her and believe her.

The format for most of the day was to have 3-4 founders or executives from companies get up and talk for 4 minutes on their company. Then a panel of people would comment and questions would get asked. On the one hand, it was a compelling, fast-based approach that kept your attention. [No nodding off at this conference.] On the other hand, it was heavy on marketing and light on really drilling down on the problem. [Although I am not sure that was the purpose or even achievable without making this a multi-day conference.]

So…here were a few of my quick notes on some of the companies. I will post another one trying to look at some screen shots and other observations. If you didn’t get mentioned here, it’s likely because I was simply watching or distracted. Hopefully, I catch everyone on the Health 2.0 Company post.

  • WEGO Health – allows consumers to rank content…i.e., directed search…gave example of search for some health topic that returned 98,000 links on Google, but only 50 here…option to score after consumer uses the link
    • Seems interesting. How often is it updated? How do you build awareness? Can it be part of a broader search engine? Seems like a likely acquisition to be another option like images or desktop from a search criteria within Google.
  • HealthCentral – biggest brand you don’t know (or something to that effect)…have 40+ sites around specific disease states…6M unique visits per month…new VC money…100 “expert patients” found to create initial communities…ability to create inspirational cartoons that summarize your story…good GUI
    • I really liked some of the features they demonstrated (in 5 minutes). They talked about creating micro-communities (e.g., spouses of people with a disease).
    • The idea of “recruiting” 100 “expert patients” to build an active community was one of the best I saw.

In preparation for discussion on patient-MD solutions, someone shared that only 2-3% of MDs allow appointments to be booked online. There was discussion that patients don’t really look to the Internet to find a physician or hospital. They look at what’s in-network and they ask their friends. There was an example given for Yelp which is used to rank restaurants, but allows people to review the physician. [A comment I heard later was when will we see a site ranking the sites that rank physicians.]

  • Carol (company name) – talked about mall concept in that people shop for something like a physical or allergy test not necessarily a specific type of MD…provide cash prices and insured prices
    • Seemed interesting. I will have to think more about how I search.
  • – I talked about this company on the blog a few weeks ago…still like the graphics…saw a few other features that I hadn’t noticed such as customizing the search criteria and using slider bars so that you get weighted recommendations

I thought there was a good discussion on why would an MD participate in a ranking site.

  • Help them sub-specialize (i.e., I want to treat knee pain not neck pain).
  • Allow them to attract the right type of patient that matches their style and focus.
  • Ego…allowing them to manage comments.

IDEO, the famous industrial design, company facilitated a lunch workshop and talked at the conference. For simplicity, I will blend both notes here. (see old post about IDEO book)

  • Talked about user-centric design which is key. At lunch asked us to come up with a solution to address the problems of diabetes patients. Showed us four interviews with diabetics. But the stress was not on solving what we thought was their problem, but trying to actually listen to what they say and do in order to find something. Key point.
  • Talked about empathic research showing that we don’t say what we think, do what we should logically do an online car loan, or even do what we think we do.
  • Talked about a book called Thoughtless Acts.
  • Gave examples of project with Bank of America that showed how most people round up their credit card payments so they started a “Keep the Change” campaign which allowed them to attract 2M new members.
  • Walked through an example of creating the Humalog pen for Eli Lilly.
  • Talked about creating a new bike design.
  • All of them were common in the framework they use and their focus on the person/user/patient/member.
  • Lunch was an interesting workshop where you listened to the videos, identified issues, brainstormed solutions, picked a solution to “pitch”, and then shared your idea with your neighbor. At our table…
    • Saw problem largely as educational / informational
      • Don’t know what to expect
      • Don’t know where to get information
      • Don’t understand lifecycle and treatment plan options
      • Don’t know what to do with the pump
    • Talked about everything from portal to device solutions
    • Settled on an iPump concept that would blend an iPod with an insulin pump and foster a community around it to develop cases (e.g., a belt that it fit into as part of a formal dress), videos to download to it on education, connectivity to trigger auto-refills, etc.

Then we had several discussions by physicians that were blending the old model of house calls with technology. Seems very cool (for those that can afford it). Although one example was relevant, it missed the masses. One showed a trader who was too busy to leave the trading floor, but he had a sore throat so the physician came to his office, took a culture, and gave him an antibiotic.

  • One great point that they made was the benefit of seeing the patient’s environment (i.e., home) in helping them manage a disease.
  • I loved the fact that they would send me an e-mail with my notes from the visit rather than trying to scribble things down while they are talking.
    • Of course, this begs the question of literacy and teaching physicians how to communicate in simple, non-medical language.
  • Another great point was the issue of technology as a good unidirectional solution. For example, if the physician wants to know whether something works, an e-mail is very efficient if it does. Leaving a voicemail so that you play tag back and forth only to realize the patient is feeling better is a waste of time.
  • Jay Parkinson referred to himself as the “Geek Squad” for healthcare (think Best Buy computer technicians). Great analogy. He also showed this seemingly very intuitive and easy to use EMR called Myca which I believe he has built.
  • Somebody tied this back to the physician ranking discussion by asking how this new flexibility of business model would be captured and tracked on those sites (e.g., does MD respond to e-mail).
  • I can remember if I jotted this down or one of them said it but I have “More Time. Save Money. Less Costs.” I think this was in response to a question I e-mailed in about how these new models were affecting the compensation and lifestyle of the physicians.

Phreesia talked about their tablet solution (i.e., electronic clipboard) for the physician’s office. They had an interesting statistic that 49M Americans move each year so address data is constantly changing. (Not to mention plan coverage, drug use, etc.) They are getting 200-300 new MDs a month to sign-up for this.

I don’t see myself using it, but this is an interesting option. Organized Wisdom talked about their product LiveWisdom which allows users to leverage a live person (I assume MD or RPh or RN.) via chat to address questions they might otherwise contact their MD about. They pay $1.99 per minute.

  • As they admitted, they are limited in scope and often have to refer the patient to an MD. They seemed to me limiting, but creating an opportunity to partner with American Well who helps you find an MD, sees if they have time to talk, and launches an interactive video session and chat session with the MD right then for a pre-agreed upon rate.

There were two patients there that were involved in lots of feedback sessions. The first was a woman who has lost 144 pounds (w/o going on The Biggest Loser) and has become an online advocate and support mechanism for lots of people using DailyStrength. The second was Amy Tenderich who is a very active diabetic and blogs at DiabetesMine.

Amy’s story was great. Her blog is very engaging and as Matthew said it is “thought by many to be the #1 blog for patients“. I had a chance to talk with her and her husband and heard a lot about how it started and the response. It is a great story, and she is very knowledgeable and was willing to really push the patient-centric agenda at the conference.

Someone made the point about linking patient costs to compliance with their care plan which I have blogged about before. I completely agree that the patient should be rewarded for using self-service options (web vs. live agent) and for staying compliant.

ReliefInsite talked about their solution and shared that 1 in 6 Americans suffer from chronic pain. No matter what the CEO said, he couldn’t do better than the opening patient video which used their solution. (Which he said was a surprise to him.)…seemed like a good, interactive tools with nice reporting.

Emmi Solutions showed their online educational tool which had videos built in a conversational tone and used animation to help people understand procedures and their disease. Seemed great. Said that informed patients are less likely to sue.

MedEncentive is one that I will have to spend more time looking at. It plays to the incentive question and rewarding patients and MDs. They talked about a 10:1 ROI and said the medically literate patients have less hospital visits.

[Completely off topic, but from the conference, I heard someone talking about CouchSurfing which is apparently a “network” where you allow people (that you don’t know) to come sleep on your couch. I thought that died with hitchhiking in the 60s.]

A consultant from Mercer commented that some large employers with physicians on staff are more effective [at health and cost management] than small health plans. Not sure if that was a complement to employers or an insult to health plans.

BenefitFocus which automates the set-up of your benefits (imagine no more paperwork to enroll) had a great video showing the future with personal consultants (via hologram), biometric signature, and other cool things. [I have heard good things about them for years although they never returned my phone calls several years ago even with name dropping one of their biggest investors.]

Virgin Healthmiles was there and talked about their pedometer which is tracked online. They also have an employer kiosk for tracking weight and body fat. Offline, he also told me that they are rolling out connections which will be on the treadmills and other machines at participating gyms. I am a big fan of what they are doing. I believe he said they recommend 7,000 steps a day per person (and think he told me that 2500 is a mile).

Stan Nowak (my boss) presented the Silverlink story talking about using technology to engage patients, the importance of capturing data, extreme personalization, and showed recent success improving compliance by 3x by rapidly doing a series of pilots.

  • I am not sure I have figured out our seven word description but here’s a few attempts:
    • Patients Are Different. Personalization Matters. Be Proactive.
    • Preference Based Communications Engage Patients & Drive ROI.
    • Segment. Learn. Interact. Empower. Use Communications Appropriately.

iMetrikus talked about their solution which connects over 50 biometric devices today into backend healthcare systems. They charge $3 PMPM which caused me to raise an eyebrow. It is a great solution and integration is a nightmare, but that seems like a lot of money. But, I am all about ROI. If I can get better return on this than on another project and it exceeds my cost of capital, why wouldn’t I do it.

iConecto didn’t present but had a booth and introduced a section. But, I love the concept of using play (e.g., Wii) to drive health.

To be fair, I will even include my notes about Eliza Corporation (our competition). Their CEO and our CEO did a podcast with Matthew the weekend before which you can listen to here. The messaging is fairly similar (although I have a strong bias about why us). She talked about tailoring [of messaging] being the new black. She talked about using clinical and demographic data to drive programs. They are a good company, and it was well done. [I was even flattered that several of their employees said that they read my blog.] Both companies commented on how they feel old (~7 years) compared to a lot of the companies presenting here (~2 years).

  • One thing that I find strange is for two companies that pretty evenly split the healthcare marketplace for Strategic HealthComm is that we are located within 10 miles of each other near Boston.

At one point, there was a discussion around ROI especially on new technologies and how to get that first big project. One of the panelists said that a 1:1 ROI over two years would be sufficient. [Not true for any company that I have worked at or consulted to.]

The final panel discussion and closing statements had a lot of good content:

  • Discussion of the patient as a provider and what that could mean.
  • Discussion of importance of sharing information across solutions.
  • The concept of citizen (European) versus patient.
  • From the Wired magazine participant, discussion around fidelity versus flexibility:
    • Disk versus MP3
    • HDTV versus Tivo
    • Microsoft versus Google
  • Importance of moving upstream in care
    • Disease management
    • Wellness
    • Prevention
    • Diet
  • As part of upstream discussion, talked about involving the food companies and used the analogy of inviting the oil companies to a green conference. [I wondered where the MCOs were, the hospital networks, and the politicians.]
  • The author of the book “Demanding Medical Excellence” (who I believe is part of the Health 2.0 staff talked about “random acts of doctoring” and the issue of solving healthcare for the few or the masses.
  • Indu talked about building a new system versus extending and improving the existing system. [A great question]
  • I think it was Matthew that brought up the issue of designing for credibility.

Wow! If you made it through this thesis, good for you. I hope it’s helpful. It is certainly easier than me trying to find my notes two months from now or sending a bunch of e-mails to people on sections they might find interesting.

Forrester on PHRs

In mid-November, Forrester put out a report titled “PHRs: From Evolution to Revolution” by Liz Boehm, their healthcare lead. It’s not my lead area so I didn’t spend the money to buy the report, but here is the executive summary.

Health plans, driven by employer demand and expectations of improved member satisfaction and reduced medical costs, are investing in payer-based personal health records. But consumers have not raced to adopt them. Health plan customer experience professionals are on the hook to not only drive adoption but also engineer low-cost, interactive health support programs that will help members make better choices and save costs. To maximize their chance of success, health plan customer experience professionals need to focus on four critical areas: data management, behavior change, interface best practices, and patient and provider recruitment. This focus will help drive near-term success and position plans to weather the coming changes in the personal health record (PHR) market.

What I found interesting was the list of companies that they interviewed (and who they didn’t talk to).

Setting Healthcare Goals

I have always been a big believer in using New Years as an excuse to think about my goals – what did I accomplish last year, what do I hope to accomplish in 2008, and what are my 5 and 10-year goals. With the exception of a few years, I have done this for most of the past decade. It is a an interesting tale of how my priorities have evolved from very career oriented in the early years after business school to much more balanced now. My goals will now typically include a few career objectives, some family objectives, a financial planning objective, and a few personal objectives (e.g., run a 1:40 half-marathon).

When I got ready to write this entry, I decided to try and find a story / study that I had heard referenced numerous times about an ivy league class where they tracked the success of people that wrote down their goals versus those that didn’t. Unfortunately, all I found was that it was a myth. I still believe it is a helpful process, and I think telling some of them to others so that they encourage you is also important.

A good term to use in setting goals (work or personal) is S.M.A.R.T. which stands for Specific, Measurable, Attainable, Realistic, and Timely. Just Google “SMART goals” and you will find numerous links. It is often a good idea to have a specific objective or event and/or to reward yourself. (e.g., I want to lower my BMI by X points prior to my annual visit to the doctor and will upgrade the cabin on my next cruise if I achieve this.) And, don’t forget to set a baseline metric for where you are today so you know how much you have improved.

So what goals should you have a health consumer…here are a few ideas:

  • Know your metrics (BMI, HDL/LDL)
  • Understand your family history and probability of diseases
  • Lose weight or improve your physical fitness
  • Take any preventative measures needed based on age or gender or other attributes
  • Take advantage of any wellness programs offered (wellness goal article)
  • Learn about the food you take into my body
  • Eliminate any unhealthy activities (e.g., smoking)

And, what goals would we want our healthcare companies to have for the new year:

  • Understand me as an individual and how I want to be communicated with
  • Improve your customer service so it is proactive and I only have to tell you once who I am
  • Make your communications understandable to me not only to a medical professional
  • Help me manage my data
  • Give me tools to make decisions don’t just shift risk and responsibility to me
  • Help me with prevention and wellness and other long-term activities

With that in mind, it should be interesting to see if Revolution Health gets some traction with their new offering – Resolutions 2.0. From what I have read and seen, it looks like they have created an online tool for setting and tracking goals and combined that with two things – social interaction to build encouragement and expert insight to provide hints and advice. It will be interesting to see the adoption and use. It would be great if they could track it versus a control group to see the improvement in achievement of goals.

“The beginning of a new year always brings with it a fresh start and the best of intentions to change one’s life for the better,” said Steve Case, chairman and CEO of Revolution Health. “We all make New Year’s resolutions but going it alone can often make those good intentions a grind. By adding the power of friend-to-friend support along with expert information, is offering a simple, fun and free way for people to achieve goals they never have before.”

The expert “groups” they have created include the following which although broader in scope than I expected seem to have something for all of us:

  1. Improve My Relationship/Marriage
  2. Keep My Family Active
  3. Take Charge of Your Life
  4. Become A Complaint Free Person
  5. Eat Right and Stay Slim
  6. Walk More to Lose Weight
  7. Sleep At Least 7 Hours A Night
  8. Have a Smoke Free Day
  9. Lose Up to 20 lbs By Spring
  10. De-stress

PHR – Key for Improving Senior Care???

In the AHIP (America’s Health Insurance Plans) magazine Coverage (Sept+Oct 2007), there is an article on using Personal Health Records to improve healthcare for seniors. I am reading it as I type my commentary here, but I start with some skepticism.

  • Apparently CMS (Centers for Medicare & Medicaid Services) commissioned a 18-month pilot to help design a user-friendly PHR for Medicare beneficiaries.
  • The article gives a good, simple definition of PHR as being “designed for use by individual consumers and contain a core set of medical information that includes physician office visits, medications, lab results, and general health information.”
  • It talks about advance PHRs having a care alert which is a signal to consumers that they are due for a treatment of test. [I have talked with a few PHR vendors about this. I can’t agree more. It is great to have the data, but the systems need a proactive communication mechanism to push timely content to consumers so that they take action. (shameless plug…what a great opportunity for someone like Silverlink to offer an automated call program that takes automated triggers from the PHR and launches a pre-defined, personalized call to the consumer)]
  • It offers an interesting statistic that I haven’t seen before – 100M people (of the 249M insured) have at least one chronic disease.
  • CMS previously rolled out a bare-bones PHR at which had 2M of the 42M Medicare beneficiaries register. [Of course, registration means nothing. How many actively log-in, update information, and use the information?]
  • Plans participating in the pilot include HIP of NY, Arkansas BCBS, BCBSLA, Humana, Kaiser Permanente, UPMC Health Plan, Aetna, and Medcore Health Plan.

“Health information technology will improve health outcomes and contain costs and help provide meaningful dialogue between members and providers so tests are not conducted unnecessarily.” (Laura Landry, Director of IT, BCBS Louisiana)

  • It talks about AHIP and the BCBSA (Blue Cross Blue Shield Association) collaborating to make PHRs transferable across plans which is vital for success.
  • Apparently, the groups have also collaborated to define a model PHR which would include physician encounters, names of clinicians and facilities, medications, lab results, family history, immunizations, health risk factors, advance directives, allergies, alerts, and physician directed plans of care.
  • The article also highlights another issue which is true for many solutions which is density of utilization by provider. For example, if the physician is expected to use a tool but only 5% of their patient base uses it, it will be hard to get them to change their workflow. If 90% of their patients use the same tool or a tool that provides a common interface to the physician, then they will be more likely to interact using the technology.
  • A representative from Humana says that seniors are using the data to enhance their dialogue with physicians. [I think this is a key point. I spearheaded the rollout of a “physician kit” at Express Scripts which was a set of forms that the patient could download to take to the physician’s office to discuss generics, mail order, and their condition. The key was that us communicating with either party was only so effective. We had to drive the two parties most involved in care to talk together with the facts in front of them.]
    • The article later talks about several of the demonstration projects that offer printouts for discussion or putting in the patient’s chart.
  • Humana members can also give access to family members and providers through their user names and eventually direct access.
  • Kaiser’s PHR allows the member to see when a lab was done, the results, and send questions to the physician directly through the tool.
  • It talks about one of the PHRs which automatically hides certain information from the provider but can be unhidden by the patient.
  • I thought the article was going to skip the subject of whether this population would adopt this technology, but towards the end it points out that according the US Census Bureau only 35% of people over age 65 have computers and only 29% have access to the Internet. [Of course, this will change as the Baby Boomers move into this phase of their life.]

senior-w-computer.jpgThe other critical component in my mind is that these things have to be automatically populated. The patient can contribute family history, allergies, and OTC utilization, but why should I have to type in my physician visits or prescriptions. That should all come directly into a system. There is a lot to prove here. The concepts are sound and rationale, but it’s a complex system with limited historical adoption of consistent technologies. People won’t stand for having to rebuild a new PHR every year as vendors and companies cycle through trying to settle on a few core products.

Teaching Kids About Health

Having kids makes you think about things differently. I was playing an online game with my kids this weekend when I started thinking about how it could be used to influence them. The game is called Webkinz. It is an interesting business model where kids buy stuffed animals which have a code. They go to the Webkinz website and use the code to register their “pet”. They then can work and play games to earn money. They have to feed and care for their pet to keep it happy. They pick the food.

My first take was how to use the tool to teach kids about good food (e.g., veggies and fruit) versus junk food. I didn’t study it intently, but I believe the “pets” are filled up better off the good food in the game. It also has little advertisements like the following:


But, why not also use the game to teach the kids about exercise. If you don’t take the kid for a walk, it gains weight. Or, it already has a physician that you can visit, but why not improve that to give the kids preventative actions that they need to take for their pet. Since many people learn through action and experience, this could be a technique to start improving the next generation’s understanding of healthcare and wellness.

Mashing Two of My Posts

I was thinking about Google’s SMS service earlier today (see post on this).  Separately, I was thinking about my post on remembering health information (e.g., drugs, strength, previous lab values).

So I went to one of the Google Health Blogs to suggest the idea.  Unfortunately, the e-mail they list bounces back and you can’t leave comments…strange.  Why not combine the two comments from my earlier blogs was my suggestion?  Obviously, it only appeals to a piece of the population, but I would love to be able to text message my PHR (Personal Health Record) with “Rx name, strength” or “PCP name, phone” or “HCL scores and dates”.  [Look at myPHR, iHealthRecord, ActiveHealth, Microsoft, or Google for PHR solutions.]

It is always so difficult to remember that information, but if I could get it texted to me in a few seconds, it would be great.  I have to believe there is some unique code in my Blackberry that could serve as a unique identifier for security purposes.  Just a thought…

BTW – If you try to find Google blogs on health, you find out there are dozens of Google blogs:

“There’s all this hubub about what Google and Microsoft are doing,” Aetna CEO Ron Williams (pictured) said this afternoon on a visit to Health Blog HQ. “We’re perplexed by the fact that their vaporware gets all this attention and we get very little.” (comment on the WSJ Health Blog)

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Would You Use a Pharmacy Kiosk?

Another question from a few years ago that I thought I would throw out here [while I wait for my connecting flight in Charlotte]. Would you use a pharmacy kiosk to drop off your prescription and pick up your prescription as long as you had access to a pharmacist via video conference?

This was an idea that I worked on for about a year. The concept was the following:

  1. Develop a kiosk that had the following functionality:
    • A scanner for you to scan in your paper prescription, insurance card, and identification;
    • A video conference connection for you to talk to a pharmacist who was located remotely using a phone receiver for privacy;
    • A credit card swipe for payment; and
    • Stock the top 200 drugs which could be picked and labeled via robotics and dispensed real-time after your claim was adjudicated and copay collected.
  2. The technology was going to be a blend of what Duane Reade had piloted in NY and what RedBox had created in the DVD space.

redbox_kiosk_1_300.jpg + dr-kiosk.jpg

These kiosks could then be used by the different constituents in the following way:

  • Retail pharmacies to serve as an afterhours pharmacist for certain drugs
  • PBMs as a way to serve employers by putting a kiosk on-site for employees to get acute drugs or short-fills for movement to mail order
  • FDA as a secure way of managing behind-the-counter drugs such as Sudafed where dispensing could be tracked electronically across pharmacies
  • Grocery stores or other retailers as a low-cost customer service play of offering their customers access to drugs without having to invest in inventory and physical assets

I had lots of debate with pharmacists about this.  The pushback of course was whether I was trying to replace or dis-intermediate them.  That was not the objective but rather trying to find a way to allow them to focus on truly providing counseling to patients who needed it while allowing patients filling maintenance drugs or simple acute drugs to get them delivered at the lowest cost.

Given the pharmacist shortage, this seemed like a logical solution to me.  Who knows.  There might be an adoption of this.  It is probably like automated grocery store lines.  I remember seeing them about 10 years ago at a few places and just within the past 2 years they have taken off everywhere.


The one company that had a similar concept, raised funding, and seems to be getting a little progress is Instymeds.  They have focused on using the technology for rural hospitals where pharmacist staffing and afterhours pharmacy access is difficult.  When I spoke with their CEO, they had raised over $10M, had very patient VCs that were willing to wait out the changes needed in the regulatory environment, and had millions from previous successes in the entrepreneurial space.  I wish them luck.

Here is my older entry on some basics around kiosks in healthcare.

Mashup Idea – Twitter + Telemedicine + Second Opinion

I spoke a little on Mashups the other day in my Geekipedia entry, and I was thinking about it yesterday while I ran.

Here are the concepts that could come together:

  • Realtime blogging through Twitter
  • Telemedicine especially around remote monitoring and access to experts
  • The need for quality assurance in healthcare for complex or even routine procedures
  • Transparency and the need to expose more to the patient
  • Voice to text
  • Intelligent data mining and algorithms

The specific example that came to my mind was when a complex surgery is being done by a surgical team with little experience and where the procedure takes hours.  The team could talk through the process and a voice to text program could document all of what they said.  The text could then run through an algorithm looking for key words or phrases.  Depending on what was being said, it could be sent to a team for QA or to provide a second opinion real-time.  Additionally, it could be sent to the family to keep them up-to-date on progress.

There would need to be a lot to build this out, but I could see a lot of advantages to it.  Just a thought.

Scary or Interesting Technology

After my post the other night about analyzing your writing, I had a chance to talk with a technology company about how they digest and use text from things like letters, e-mails, and call recordings.  It was fascinating.  They were describing to me a system they developed for the military which is now available commercially.

They can take all these communications and use them as part of a segmentation or targeting model that is based on patient behavior.  How great (and scary) would that be?  (Big Brother is always watching.)  Imagine that you have a model that tries to identify how to best incent a person to improve their health.  If you could input any e-mails or letters they have sent into your company and input any call recordings using speech to text, you would have all types of indicators about personality and interests along with communication modes, time of day that they respond to information, etc.


Obviously, a patient-centric healthcare model means really understanding things about people.  To do that, we have to get multi-dimensional and think differently.  Rather than simply focusing on moving people to mail order from retail, shouldn’t you focus on attracting the people that are most likely to stay with it and not move right back?  If you are going to offer an incentive for taking a Health Risk Assessment, don’t you want to offer it only to the people that will act on the results?

Compliance with prescriptions or testing is a great example.  There are certain people that are more inclined to stay compliant.  But, it is also important to understand what message will motivate them to stay compliant – not dying, seeing their kids get married, saving money, not missing work, etc.

And, because we are in healthcare, there are some legal constraints about when you can make different offers within the same or similar populations.

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