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What Driving Teaches Us About Wellness

July 15, 2008 by George Van Antwerp 0 Comments

We all understand the challenges in getting people to take their healthcare seriously which manifests itself most prominently in a obese society which leads to numerous other conditions – heart disease, diabetes, high blood pressure.

I was reading an article earlier today about driving slower to maximize your fuel usage and thought what a great example of how people don’t do what’s best for them. You can reduce your fuel needs by driving slower, but most of us are too hurried to do that. We don’t follow practical, fact-based suggestions. It’s just like the challenges of eating well. It is much easier to go to the fast-food restaurant than to plan your lunch, buy healthy foods, pack a lunch and bring it to work.

Another good link is between using a phone when driving and wellness. Again, we know that people being distracted by their conversations (voice and text) while driving can lead to accidents. Certainly, headsets and voice technology should reduce those distractions (although the data doesn’t support that). For example, when I am driving, I simply press the button on my Bluetooth headset, speak the person’s name, and then the phone calls them. Much less distracting for my eyes on the road…but I am still talking to someone and multi-tasking. So, again, why don’t we do what’s best for us and stay off the phone? It’s generally not efficient…we are pressed for time…we have become a country of multi-taskers. A similar reason to why lots of people don’t exercise…too busy.

“There are limits to how much we can multi-task, and that combination of cellphone and driving exceeds the limits,” says David Strayer, a University of Utah psychologist who has found that by many measures, drivers yakking on cellphones are more dangerous behind the wheel than those who are drunk, whether the conversation is carried on by handset or headset.

Consumerism, Healthcare, Research, Technology

McKinsey On Automated Calling Technology

July 15, 2008 by George Van Antwerp 0 Comments

McKinsey and Company published a report called “Using IT To Boost Call Center Performance” in the Spring of 2006 which had a few relevant comments for those of you looking at how to leverage automated communications in the healthcare space. Here are the two primary quotes that I took away:

Customers are getting used to automated transactions – in fact, some prefer them. Our research suggests that more than 60 percent of customers favor an automated option for many types of simple interactions (for example, balance inquiries or payments); the rest said they didn’t mind being presented with an automated option as long as they could connect with a live agent if they wanted one.

Investments in new VR (voice recognition) and IVR (interactive voice recognition) technologies can help automate an additional 5 to 30 percent of incoming calls while maintaining or even enhancing customer satisfaction and revenue.

I always love finding those 3rd party verifications of the value propositions that we see at clients.

Healthcare, Research, Technology, Value Propositions

IDC – Healthcare Communications

July 14, 2008 by George Van Antwerp 0 Comments

Janice Young at IDC just put out a new report titled “Too Much Information? The Irony of the Coming Information Glut and New Technologies that Help Target Communications” which focuses on several fast-follower announcements about what we have been doing at Silverlink Communications. Here are a couple of quotes from the report.

The final mile of the current healthcare information blitz is not just getting at or to the information, though in the very fragmented, silo’d U.S. healthcare system, that is hard enough. But the real solution provides targeted and event-triggered information based on consumer interactions or events, rather than relying on the consumers to search and seek.

These two announcements join Silverlink’s earlier announcement in March 2008 of their new Adaptive HealthComm Science Platform. The Silverlink platform integrates decision support and analytics to create personalized customer communications. Unique to the Silverlink solution are behavior analytics to communications success and affect on customer behavior and outcomes.

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

Beating The Patient Over The Head

July 14, 2008 by George Van Antwerp 1 Comment

Something that I don’t normally do, but I am going to edit this after the fact to stress what the story really is supposed to be about since someone told me the original text might be offensive to a competitor that I respect.  The point is whether being pushy is worth it in some cases.

The other day a patient asked one of our people about a mail order order pharmacy where they had gotten a call every other day for the past 12 days about refilling their medication. Each message was slightly different – your supply of medication is about to run out, you need to refill your medication, your prescription has run out, etc.  The patient didn’t like the call program.

I found this an interesting debate…how pushy is good if you drive a desired outcome?  Also, we all obviously know that vendors and consultants don’t always make the decision so if a client tells you to do this even if it makes no sense, what do you do?

I think it makes for a good debate and had it with several clinical people:

  • At what cost is a better refill rate okay…especially since this doesn’t mean that they are compliant? Are you willing to drop your patient satisfaction by several points?  (We often used to give clients a report that showed savings per disrupted member or per drop in satisfaction at my prior employer.)
  • If the company is just driving up refills and can they do that without creating more waste?  This was a constant debate at mail.  One trick here is whether you base it on refill dates or days supply.
  • With this frequency of calls is there a chance that you actually get people that would have refilled to just wait for the calls to come and say yes?
  • If people take the call because they know you will keep calling them, is this actually better acceptance of calls or just being an “obnoxious salesperson”?
  • Are you calling people that have refilled at retail due to data latency issues?
  • Do you drive people back to retail?
  • Have you dulled them to future calls by upsetting them on this program?

Now, on a more clinical program, my opinion here might be different. If you could successfully get an overweight individual to diet by constantly reminding them. This might be okay. It’s an interesting debate.

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

Genetic Art

June 27, 2008 by George Van Antwerp 0 Comments

I was reading about this company DNA 11 the other day, and I found it a pretty cool concept. They take your DNA and make it into art focusing on the 1% that is unique. According to the article in American Way magazine, prices ranged from $390 to $1,200 with 25 color options or the ability to request a custom color (to match your sofa perhaps).

They can do pets, fingerprints, and lip prints.

Consumerism, Healthcare, Innovation, Marketing / Communications, Technology

More On Silverlink’s Think Different Event

June 5, 2008 by George Van Antwerp 1 Comment

I am now up in Minneapolis at our 4th Think Different event on how to engage the healthcare consumer.  I talked about the first few speakers the other day, and I finally had a chance to hear the other speakers present.  This week, I had the chance to listen to  James Taylor (of Smart (enough) Systems fame not music) and Fred Jubitz (American Express).  Here are a couple of my takeaways.

[Again, if you are coming to the upcoming events, this might be a little bit of a spoiler.]

A few notes from James’ presentation:

  • He gave a great example of a program they did at Fair Isaac where they compared the standard, baseline program with one that was highly personalized.  What was the improvement – 2,000%!!
  • He gave a good real-life example of the need for channel coordination talking about buying tickets for the Chunnel and how he got different prices on the web and phone which were also different from the prices his father in England got using the same channels.
  • The Chunnel example reminded me of something that someone told me the other day.  They were using the Dell self-service example and pointed out that Dell now uses real-time chat right before you buy.  They have found that this increases the average sale by 15%.
  • The Chunnel example also made me think about how web technology allows us to do a lot of customization by visit, but most companies don’t do this.  At the simplest level, I remember a competitor of Firepond (previous employer) where if I visited their website from work it looked one way and from home looked different.
  • James talked about ATM customization as an easy example.  How much money do you normally take out.  Only showing you services that you have access to.  Some of this is starting to happen, but not much.
  • He also talked about rules creation and how that varies.  I think it is always interesting to trace the evolution of rules and policies within a company.  Are they there because of regulatory issues?  Is it because someone coded the legacy systems that way?  Is it based on a personal interpretation?  Or are they dynamic and regularly reviewed?  One of the worse examples that I have ever seen was a large healthcare company that believed that HIPAA required them to re-code everything as it moved from development to production.  (A very costly error in interpretation.)
  • He also talked about the evolution of interactions:
    • Automate decisions
    • Apply rules
    • Segment customers
    • Predict risk and value
    • Optimize
  • James hammered home the point of never stopping to try to optimize since as the environment and your customer base change the optimal solution might change.

Fred who ran the gold and green cards at AMEX talked about:

  • American Express really wanted to be a lifestyle enabler not a payments company.
  • He talked about the Centurian Card (black AMEX card) which apparently is able to charge $5,000 initiation fee plus a $2,500 annual fee.  (Surprising that people still pay it, but I have heard examples of people buying a plane with their black card so I guess that level of service requires something.)
  • He gave examples of how companies think about cards and showed a lot of affinity cards which made me think about groups and how people like to affiliate with others (e.g., by diseases).
  • He talked about the importance of several things:
    • Know your audience
    • Key metrics
    • Segmentation
    • Personalize
    • Continuous improvement
  • He showed the standard framework for segmentation looking at size of wallet (i.e., how much you charge / spend per year) versus their share of wallet (i.e., how much of that is with AMEX).  Each box on the grid then had a strategy – invest, retain, focus, divest, etc.
  • He showed a lot about how the financial services companies can personalize the web experience, but he pointed out that this took months to develop as they built up your profile.
  • I think a key point he made relative to healthcare is that a lot of a new member’s behavior was determined in the initial months which led to how they used their card.  He gave an example of his blackberry.  The first couple features he learned are all he uses.
    • What are you doing in the initial months to “train” your members or be trained by your healthplan to use the website and leverage other ancillary services (e.g., gym membership) that they might offer?
  • He stressed evolving your segments but not starting over each year or you will lose some of the lessons you have developed.
  • Finally, as you always want to stress, he said to keep it simple.

Additionally, you can see some of Matthew Holt’s comments about the event at The Health Care Blog (here and here) and Les Masterson’s comments in The Health Plan Insider.

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

GINA – A Good First Step For Personalized Medicine

June 5, 2008 by George Van Antwerp 1 Comment

Whether you are a patient or a health care company, I think you should be happy about this. GINA is the Genetic Information Nondiscrimination Act of 2008 which was signed into law on May 21st. It is a good step in encouraging individuals to participate in genetic testing without worrying about that information being used against them by an employer or health plan/insurer. It also bans companies from requiring genetic testing.

Based on an e-mail I got from Fulbright (a law firm where a friend practices), they offered the following definitions:

A. Genetic Information = includes the individual’s genetic tests, the genetic tests of family members of the individual, and the individual’s family medical history. Any information related to the individual’s or any family member’s participation in clinical research offering genetic services is included as is the genetic information of any fetus and embryo of an individual or family member of an individual who is pregnant. The sex or age of the individual is not considered genetic information, however.

B. Genetic Test = any analysis of DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes.

The use of genetic information (i.e., genomics) is a key step in creating personalized medicine. We know people are different and their bodies react differently to different drugs and different treatments. Some (much) of that can be attributed to their genetic make-up and likely to environmental factors.

The future holds a lot of promise once we can delivered personalized therapy that is specific to an individual. But, no one is going to get these tests if they distrust or worry about how the information is used. I have talked about this issue before when looking at companies like 23andme.

Consumerism, Healthcare, Technology, Value Propositions
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Wisdom Of The Crowd – Socializing Wellness

June 5, 2008 by George Van Antwerp 1 Comment

You probably caught the articles last year about how obesity seemed to spread throughout social networks. Now, in an article in the Washington Post (5/27/08), they talk about another example of research showing that smoking is similarly affected by social networks. Theoretically, this research could have significant implications for using social media (i.e., Facebook, MySpace, SecondLife). I can easily imagine blogs out there following people’s efforts to lose weight or quit smoking. I can see a Facebook “badge” or “sticker” congratulating someone for not smoking.

In a study published last week in the New England Journal of Medicine, the team [Nicholas A. Christakis, a medical sociologist at the Harvard Medical School, and James H. Fowler, a political scientist at the University of California at San Diego] found that a person’s decision to kick the habit is strongly affected by whether other people in their social network quit — even people they do not know. And, surprisingly, entire networks of smokers appear to quit virtually simultaneously.

Some of the observations that they found which seem interesting included the way non-smoking spread throughout a interrelated but not always directly related group. I don’t find that too surprising. If everyone quits and it is no longer “cool” or accepted you are marginalized and likely to feel pressure to quit. This was a concern that they noted which might lead to other negative health outcomes for the group that doesn’t change.

In a small group of my friends, I have seen one person’s efforts to lose weight (which included drinking less) impact the broader group. Others lost weight. Less beer is consumed when we get together. And, there is more discussion about the gym and running and other activities. For those who aren’t interested in those topics, they miss out on part of that dynamic.

  • A person whose spouse quit was 67 percent more likely to kick the habit.
  • If a friend gave it up, a person was 36 percent more likely to do so.
  • If a sibling quit, the chances increased by 25 percent.
  • A co-worker had an influence — 34 percent — only if the smoker worked at a small firm.

“It could be your co-worker’s spouse’s friend or your brother’s spouse’s co-worker or a friend of a friend of a friend. The point is, your behavior depends on people you don’t even know,” Christakis said. “Your actions are partially affected by the actions of people who are beyond your social horizon” — but in the broader network.

“People quit in droves — whole groups of people quit together at roughly the same time,” Christakis said. “You can see it ripple through a network. It’s sort of like an ant colony or a flock of birds. A single bird doesn’t decide to turn to the right or the left; the whole flock has mind of its own.”

From a employer, health plan, or even individual perspective, the question is how do we capitalize on this? How can we create wellness programs that leverage this “viral marketing” approach to drive behavior across the “colony or flock” to quickly and efficiently drive change. Certainly, this is where I see an opportunity for some of the Health 2.0 type of companies to play a role in creating communities and enhancing dialogues on key topics to enable this process faster and make the reach broader.

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

The Doctor Will See You…IF You Promised Not To Critique Them

June 3, 2008 by George Van Antwerp 1 Comment

It takes a lot for me to get offended, but I find this offensive.  The WSJ Blog mentioned it this morning, and when I clicked through the links, it seems like a total disconnect with the technology world.

Medical Justice Inc. has put together a contract physicians can ask their patients to sign. In it, patients promise not to post anything about their experience, good or bad, without your prior approval. The organization calls it a “vaccine against libel.” (AMA article)

This seems ridiculous to me.  Don’t we all have reputations that we work and go to school to create and protect.  Doesn’t every business have a brand equity that they work to protect.  This is nothing new.  So trying to create a fascist environment where public comment about your services is not allowed is ridiculous.

What’s next?  Hotels that won’t let you stay there unless you don’t rate them.  eBay not allowing feedback on buyers and sellers.  Architects not letting you visit their buildings unless you promise to like them and not comment about them.

This is a new economy which is driven by consumers.  Healthcare is going to be part of that like it or not.  Patients should have choice and should have transparent access to how physicians and other providers perform.  I am not against establishing some standards in terms of how the experience is evaluated, but censoring speech seems like the WRONG way to accomplish this.

Why don’t they focus on helping the physician create a positive experience, be responsive to criticism, and get patients that like them to post their comments.  We all realize that one or two people can be negative about a person or company, but that can be outweighed by a hundred positive reviews.

Consumerism, Healthcare, Marketing / Communications, Technology

Pavlovian Response To Sound

June 2, 2008 by George Van Antwerp 0 Comments

We recently got a new dog (a Tibetan Terrier), and we decided to start training the dog using the clicker method.  I kiddingly commented that it would be great to have something like this to train people.  Apparently there already is such a method, and it can be used as a teaching method for autistic children (for example) along with sports training.

Basically, clicker training is an audio reinforcement for positive behavior…think whistle with dolphins.  TAG Teach is a website where you can learn more.

What I found interesting is how to link this in with sonic branding and the Pavlovian response concept.  Could I create an audio sound that drove behavior?  For example, I have my dry cleaning dropped off and picked up at my house.  They use an automated call to remind me to set it out.  All I have to do is pick up the phone and hear the voice.  Once that happens, I know what to do and hang up on the call.

TAG stands for Teaching with Acoustical Guidance and uses a sound marker to indicate correct performance.

The TAG refers to the distinctive sound made to mark or “TAG” a moment in time. This sound becomes an acoustical binary message, a sort of “snapshot” that is quickly processed by the brain.

A TAG means “yes.” Absence of a TAG means “try again.”

The student no longer has to perform a time-consuming language analysis while attempting complicated movements. The immediacy and clarity of the feedback allows the student to form a mental picture of the movement or position.

TAG points are the individual pieces of a desired response action or position. Students receive a TAG (the click sound) when the points are correctly performed.

The set up for a golf swing may have TAG points for grip, body position, foot placement, and club placement. The swing component may have TAG points for hand, arm, and club position at the top and end of the swing, TAG points for leg position, arm position, and weight transfer during the swing. With a beginning golfer a limited set of key TAG points are defined and executed individually. With an experienced golfer a diagnosis is performed and TAG points are identified based on technique errors requiring correction.

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

Hall of Shame – Customer Service

May 31, 2008 by George Van Antwerp 0 Comments

On the positive side, there were no healthcare companies that “won” this “competition”.  Winning being that you were rated as having poor customer service the highest percentage of times.  (On the flipside, very few were included.)  [full rankings here]

“We’ve seen a fall in customer service as we’ve gone into a recession,” said Richard D. Hanks, the president of Mindshare Technologies, a customer-service consulting company. “As the cost cutting occurs . . . they start to cut the wrong things.” (Article)

Not surprisingly, the people surveyed said that being knowledgeable, available, and friendly were very important.  As we all know, the key attribute is knowledge and with the complexity of benefits, multiple systems that healthcare reps need to access, and turnover, this is a challenge. 

It’s no wonder that everyone is trying to move people to self-service.  In a related article, some of the benefits of self-service were clearly articulated:

“What better customer service is there than self-service?” ask the marketers. “It’s fast!” “It’s accurate!” “It’s convenient!” “It’s confidential!” (No more bystanders overhearing that triple-cheese, extra-mayo order.)

 

  • People buy more. Customers spend 39% more per order at fast-food kiosks and are twice as likely to upsize than if a person takes their orders. (Machines are programmed to ask every time, and no one can overhear.) Customers also buy more at deli kiosks in supermarkets.

 

  • More people buy. Good Web self-service allows for far more customers to be adequately served.

 

  • People remain loyal. “You mean I’m going to have to upload all my data into a new bank? And learn a new system? No way.”

 

  • People give the company high marks for customer service. Yes, funny but true. It’s hard to complain about a food order that you placed yourself, a transaction that you scripted or the way you pumped your own gas. When customer service is self-service, you have only yourself to blame.
Marketing / Communications, Research, Technology, Value Propositions

Guest Post: Health Researchers Obtain Grants for Video Game Study

May 30, 2008 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

American Cancer Society on YouTube

May 29, 2008 by George Van Antwerp 0 Comments

I think it’s interesting to see how the American Cancer Society is using YouTube to create a call to action both around the election, the uninsured, and other issues.

Consumerism, Healthcare, Marketing / Communications, Technology

Our First Think Different Event

May 29, 2008 by George Van Antwerp 2 Comments

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

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

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

From Kinney Zalesne:

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

From Liz Boehm:

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

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

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

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

Skin Cancer Widget

May 28, 2008 by George Van Antwerp 0 Comments

I get a lot of solicitations to talk about products on the blog. I also get a lot of general e-mails. The ones I generally respond to are people giving me a heads up about an article, press release, technology, or something else that I just wouldn’t have known about. That doesn’t mean I will do anything about it, but if I have time and find it interesting, I will usually click through the link. And, if it still catches my attention then I will write about it.

This one is fairly self-explanatory, but I found it interesting. VisualDxHealth has built a widget for you to self-diagnose your skin cancer. Which, according to the statistics they sent me, is valuable since 1 in 6 Americans will develop skin cancer and the survival rate is high when found and treated early.

The Recognizing Skin Cancer widget interactively provides information about the different types of skin cancer and includes a visual identification quiz that tests the user’s knowledge about recognizing the signs of these conditions.

Unfortunately, I can’t add widgets and other code to my blog or I would have lots of these types of cool things on the site.

Consumerism, Healthcare, Technology

Wii Fit: Using Technology To Teach Wellness

May 28, 2008 by George Van Antwerp 0 Comments

I talked about the Wii a few months ago when we first got one. At the time, I didn’t know that Wii Fit was coming.

This past weekend we happily bought it, and I enjoyed it. It tells you your BMI. You can do yoga. You can do aerobic exercise (running, hula hoop, step aerobics). You can do agility exercises (downhill skiing, tight rope walking). I was a little skeptical, but I have been fascinated by the Wii so far.

And, I loved the fact that my 6 year old could get into it. She loved that once you put in your height, and it calculates your weight that it changes your Mii (avatar) to reflect your likely dimensions. She spent lots of time on the yoga moves that I probably never could have gotten her to do in a traditional forum.

This creative use of technology gives me a lot of hope for how we can teach our youth, drive rehab programs, and impact people.

Now what I am looking for is when will we see a competition to lose the most weight only using the Wii for training.

Healthcare, Innovation, Technology
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Missing The First Step

May 28, 2008 by George Van Antwerp 1 Comment

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

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

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

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

Additional Blog Site

May 27, 2008 by George Van Antwerp 0 Comments

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

Consumerism, Healthcare, PBM / Pharmacy, Research, Technology

Book Review: Health Care Reform Now!

May 27, 2008 by George Van Antwerp 3 Comments

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

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

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

Some of the facts he shares:

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

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

Some of my favorite quotes:

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

Comments:

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

My summary after reading the book was:

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

Go read the book. Help make a change.

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

May 22, 2008 by George Van Antwerp 0 Comments

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

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

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

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

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

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

Incentives and Communications

May 13, 2008 by George Van Antwerp 0 Comments

Everybody looking at the healthcare system understands that incentives and alignment of goals is a critical component for successful change.

  • Providers need to be motivated to focus on wellness and prevention.
  • Individuals need to be motivated to care about the cost of care and to act in a healthy manner.
  • Pharmacists need to be motivated to take the extra action of moving patients to lower cost agents, resolving administrative edits, and counseling patients.
  • Hospitals need to be motivated to focus on Six Sigma type process initiatives.
  • Health Plans need to be motivated to invest in long-term care initiatives that prevent people from getting sick.
  • PBMs need to be motivated to drive optimal prescription use even if that includes more over-the-counter (OTC) drugs.
  • Employers need to be motivated to offer benefit plans to cover their employees which are simple to understand and align employees with healthy outcomes.
  • Pharmaceutical manufacturers need to be motivated to drive adherence across clinical conditions and to bring new drugs to market that represent significant improvements in therapy (better outcomes, less side effects, easier deliver methods).

With that in mind, I am glad that Silverlink Communications announced this morning that we are partnering with IncentOne to incorporate incentives into our communication programs.  Going forward, incentives will offer us another lever to improve outcomes in our programs that we conduct for clients.

“If applied appropriately in healthcare, incentives are an influential lever to motivate healthcare behaviors, arguably the most powerful force for changing the economics of healthcare,” said Stan Nowak, CEO and co-founder of Silverlink. “We’re excited to be partnering with IncentOne to design highly flexible, personalized and incentive-driven outreach that enables health plans to better connect with and engage their members to drive healthcare behaviors and reward them at the same time.”

“This is a truly integrated technology partnership that seamlessly connects healthcare consumer participation to incentives,” said Michael Dermer, CEO at IncentOne. “Silverlink and IncentOne together can deliver complementary solutions that drive participation and ultimately cost savings in healthcare. The combination of our expertise in finding the right incentives and Silverlink’s personalized communications to drive consumer behavior delivers the ability to implement more effective programs.”

Matthew Holt (author of The Healthcare Blog) did a podcast with both the CEOs yesterday that you can listen to to learn more.

You can also look at a study by Hewitt Associates of large employers which covers several related topics:

  • 2/3rds plan to offer incentives to motivate sustained health care behavior change.
  • 67% will utilize health care data and measurements to drive their organization’s health care strategy.
  • 74% of employees think their employer should help them understand how to use their health plan better.
  • 12% of employees think employers should help them become healthier.
  • Employee decisions on healthcare were influenced by cost:
    • Nearly one-third (30 percent) said they did not go to the doctor when they were sick because of cost.
    • 27 percent didn’t fill a prescription given by a doctor.
    • Almost one in five (19 percent) stopped taking medications before their prescription ran out, and of those, 18 percent did so due to finances.

Certainly, there are numerous examples of incentives being used to drive behavior.  Moving patients to evaluate mail order pharmacy has been a solution where coupons have been used over th years.  Driving therapeutic conversions have used incentives in the form of copay waivers.  Getting patients to complete health risk assessments (HRAs) and other tools have given incentives.

The interesting component will be the personalization of incentives.  While I may enjoy a $10 gift card to the dog store, my wife may enjoy a $10 gift card to the spa.  Flexibility of incentives and alignment of incentives with what drives behavior will be important.

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

Does Social Media Help With Retention?

May 8, 2008 by George Van Antwerp 2 Comments

Lois Kelly posted an interesting entry on her Foghound blog about the Catholic Church beginning to use Social Media.  This is an obvious reaction to the statistics she quotes about retention of active membership.

As she asks, the true question is whether tools themselves can impact this or whether the message has to change also.

On the other hand, it also makes me wonder what we are waiting for in healthcare relative to social media.  If a conservative organization like the Catholic Church can embrace it, why aren’t we jumping into it more aggressively.

Marketing / Communications, Technology

Robot Animals

May 6, 2008 by George Van Antwerp 0 Comments

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

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

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

Books / Articles, Research, Technology

Reminder: It’s Time For Your Patient To Come In For A Visit

May 6, 2008 by George Van Antwerp 0 Comments

Aetna announced that it is launching electronic alerts to 320,000 physicians. They will be called Care Considerations.

My understanding is that they will use the ActiveHealth engine to compare claims data to treatment guidelines to identify gaps in care. They will then send the physician a message through the NaviMedix platform and through fax, e-mail, or the phone.

This will be an interesting program to follow:

  • Will physicians take action off the alerts? How?
  • Since the NaviMedix system will allow two-way interaction, what will they say about the alerts?
  • Will this impact health outcomes?
  • Are these preventative alerts or are they catching things late in the lifecycle of a disease?
  • What will patient’s reactions be to their physician reaching out to them? I would be a little hesitant.

I am a little surprised that the program doesn’t include outreach to the patient also. I would be skeptical of a request to schedule an appointment without some understanding of why I should do it. Otherwise, it would look like an obvious attempt to drive revenue. It reminds me of something a physician said to me once. He said that they can control revenue in many cases. For a patient with mild pain, they can send them home and suggest they take Advil and call them if the pain continues. Or, they can write them a prescription, send them for a test, and schedule a follow-up visit in a few days.

This gets to the issue of Defensive Medicine which I talked about a few days ago.

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

Virtual Consultations

May 6, 2008 by George Van Antwerp 0 Comments

When I talk with people about using American Well or some other type of service, I continually get two very good questions which point to a next generation offering (I think).

  • How can they get my vitals – temperature, blood pressure, etc.?
  • Can they write a prescription?

For the first question, there is a logical future state where we have home devices for these things that are wirelessly connected to our PC and data can be captured and pulled back to the consulting professional (i.e., doctor, nurse, pharmacist).

For the second question, I think it is more complicated. A prescriber can write a prescription today without seeing you. But, they traditionally have data available from looking up your nose or feeling your throat or listening to your cough. There is a fine line to walk between self-diagnosis and prescribing off limited information. This is especially true when the physician is only seeing the patient for the first time and has no history.

Consumerism, Healthcare, Technology, Value Propositions

Drug Testing At 12…At Home

May 2, 2008 by George Van Antwerp 4 Comments

My local area paper – West NewsMagazine – has an article in the April 30th edition about Teens and Drugs.  I will save my comments for the end here, but I found it an interesting read.

  • The company they talk about is TestMyTeen.com.  They distribute one free kit to the parents through school and they charge $18.99 for additional kits that test for the 10 most commonly used drugs.
  • It says that drug testing gives teens a socially acceptable excuse to say no.
  • The article has several people talking about testing before you have a problem as a source of prevention.
  • According to the Drug Test Resource of St. Louis which also offers a home drug test kit for $49:
    • 54% of all high school students will use an illegal drug by the time they are a senior
    • 82% of those that use a drug try cocaine
    • 2 of those that use a drug try heroine
  • They say that the average age for first drug use is 12.
  • The article talks about making it routine and providing rewards for a positive test.

“We should be telling our children that we love them and trust them, but we don’t trust the environment they’re going to be in.  In the end, I’d rather they think we don’t trust them than to bury them.”  Shelley Kinker, co-founder of Drug Test Resource of St. Louis

“The problem is, you’re not dealing with the issues that caused them to use in the first place and drug testing them might just drive them to use something else, like more alcohol or a substance you’re not testing for.”  Tish Fontana, a professional counselor

WOW!!  I am not sure where to start.  I certainly worry about my kids and peer pressure.  Some days, I feel like I want to have software to record their every keystroke on the computer; give them a GPS tracking watch so I know where they are; and eventually have a way of recording the speed and location of the car at all times.

BUT, I ultimately think it’s our duty as parents to teach our kids how to make decisions and enable them to become productive adults.  Let me go point by point here:

  • Testing for the most common drugs.  Great, but doesn’t that just encourage creativity to get around the system…look at steroid use?  Isn’t drinking a bigger issue with teenagers?  Isn’t abuse of prescription drugs a real issue?
  • I can’t see kids (that wouldn’t already say no) using the excuse of being tested to stop peer pressure.  And if they do, what are they going to do when they go to college?
  • I really can’t see testing my kids at 12 without any reason to suspect they were using.  I agree that trust is earned, but don’t we start with the assumption of innocence in this country.
  • The age and prevalence of use statistics are scary.  I wonder what the frequency of use is.
  • Rewarding your kid for not using drugs.  How about punishing them for using drugs?  Or rewarding them for stopping using drugs.

I care, but I think this is pretty extreme.

Books / Articles, Healthcare, Technology

Social Media in HC Presentation

April 30, 2008 by George Van Antwerp 0 Comments

When I was posting the uninsured presentation, I stumbled upon this.  It is a good summary of some of the things going on in the industry today.

Consumerism, Healthcare, Marketing / Communications, Technology

Healthcare Retention

April 30, 2008 by George Van Antwerp 2 Comments

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

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

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

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

Lots more to come on this topic.

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

Doctors Won’t Trust PHRs

April 29, 2008 by George Van Antwerp 1 Comment

One step forward and two steps backwards is my reaction to this comment…if it’s true.

Steve Leiber — who runs Healthcare Information and Management Systems Society, the trade group for health IT — told the WSJ Health Blog that physicians won’t trust PHRs.  As John Sharp mentions on the eHealth Blog, this points to the need for PHR certification especially around data sources (i.e., payor claims data, patient self-reported).

Wow.  I just assumed that was part of any legitimate PHR.  I have asked the question of several vendors and always thought I got the answer that you could tell where the data came from.  I would certainly think some data in an emergency situation is better than none especially if you have some understanding of the source and date of the information.

If PHRs just become a tool for patients with no use in the medical community, they are doomed for extinction or will simply be marginalized.  We need solutions that bring us together.

Consumerism, Healthcare, Managed Care, Technology, Value Propositions, Weblogs

What A Difference A Few Years Makes

April 29, 2008 by George Van Antwerp 0 Comments

Before a whole week passes, I need to capture my interview with Gene Drabinski from Trizetto. Gene is the President of Cost and Quality of Care. This was a fun interview where we just kicked back at the end of day two at the World Healthcare Congress and talked.

I haven’t spent much time around the Trizetto people recently and still thought of them as Facets which was the software that I remember from my payor days at Ernst & Young LLP.

Of course, I had done some homework prior to the meeting and began by asking some questions about being acquired by Apax who is taking them private. We talked about the advantages of being private versus public. The big one being the ability to plan long-term and make investments rather than try to make each quarter’s number.

He was then kind enough to walk me through some of the history of Trizetto. If you go to their news page off their website, I had realized before I talked to them that I was outdated in my frame of reference. They are talking about social networking and consumerism and decisioning not about claims processing and efficiencies.

We talked a lot about the CareKey application which they acquired. CareKey (now CareAdvance) is a PHR (personal health record) which sits on top of a member database. He described several key features of the application:

  • Good metadata (i.e., data about data)
  • Ability to reach out and capture new data systemically
  • Custom rules environment
  • Able to be integrated with workflow and used in disease management, case management, and utilization management

CareAdvance Enterprise – Enterprise software that allows health plans to automate utilization, case, disease and population management, and to extend a personal health record and personal health management tools to their members. The system includes two modules: Personal CareAdvance and Clinical CareAdvance, which integrate with the health plan’s core information systems, aggregating the member’s personal claims and diagnosis history, current prescriptions, and laboratory data into a single data repository.

We talked about transfering the information from one PHR to another. He clarified that the transaction data was transferable but not the context. We then spoke about their vision for Integrated Healthcare Management as an out-of-the-box solution to make the patient “be the best I can be”. From what he said, the physician is the final constituent that they need to get integrated.

“Integrated Healthcare Management is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer,” said TriZetto Chairman and CEO, Jeff Margolis.

From Gene’s session at the conference, he facilitated a panel that included Vicky Gregg who is the President and CEO of BlueCross BlueShield of TN. One of her slides which captures the Trizetto IHM vision is here:

My takeaways were (a) Gene’s would be an enjoyable person to work with and (b) Trizetto is doing a bunch of interesting stuff and focused on how to use technology to transform the industry.

It’s also worth reading through Jeff Margolis’ document called The Health Plan of Tomorrow.

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