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Would You Pay $100 A Month For A Diabetes Application?

An article in MobiHealthNews caught my attention this morning when it talked about 2 payers agreeing to pay $100 a month for Welldoc’s diabetes application. This is fascinating to me since (a) I’m always interested in how people price and value services and (b) I’d love to bundle something like this into our diabetes offering. 

This of course begs the key question which is what is the value of the application.  We’re all familiar with the fact that diabetes drives significant costs within our healthcare system.  Here’s a quick summary from the ADA.

The national cost of diabetes in the U.S. in 2007 exceeds $174 billion. This estimate includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity. People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of diabetes. Approximately $1 in $10 health care dollars is attributed to diabetes. Indirect costs include increased factors such as absenteeism, reduced productivity, and lost productive capacity due to early mortality.

Of course, diabetics also spend a lot of money on out-of-pocket costs themselves.  $6,000 from one study mentioned here.

But, I think the key question here is what assumptions make this a good investment.  Let’s me walk through my thought process.

  • At $100 per month, you pay $1,200 per year per member.
  • BUT, members won’t actively stay engaged with the application all year long so you have to assume some percentage of engaged members.  (A key question is whether you pay only for actively engaged members or all members enrolled in the program.)  And, how long does a patient have to use the application to achieve the results?
    • If 20% are engaged, the cost per engaged member would actually be $6,000 ($1,200 divided by 20%). 
    • If 60% are engaged, the cost per engaged member would be $2,000.
  • The next question is how you estimate the value of the application.  Based on their study, they saw a 1.9 point drop in A1c which is a good one-year drop and a good outcome metric to focus on (see article).  So the question becomes…what is the value of a 1.9 point drop in A1c?  This is a question I was looking for earlier.
    • This pharmacist based study talks about a 0.8% reduction in A1c leading to $1,200 in total savings.
    • This CVS study showed a $3,756 annual savings for an adherent diabetic versus non-adherent.  (But, adherence wasn’t shown in the Welldoc study.)
    • The President from Welldoc quotes a savings of $3,500-$4,000 per point drop in A1c, but I couldn’t find the study to support that.  (I e-mailed their PR people about this.)
    • And, a few weeks ago at a mHealth conference, I heard someone say the value was $7,000 per point reduction in A1c.

As you can see from this tweet, I was looking for this study yesterday and mentioned DiabetesMine to see if Amy might know, but she didn’t.

 

So, my conclusion is that this is worth it if:

  1. The value is closer to the $3,500 point.
  2. You pay based on actual engagement or utilization…or you only give it to people who actually use it versus the overall population. 
  3. The application improves adherence.

I hope to figure this out since this was the first FDA approved device and looks very promising.

Shifting Spend In Pharmaceutical Spending

Pharmaceutical manufacturers are dealing with massive shifts in their industry – less blockbuster drugs, more generics, emergence of different global markets, a greater payor emphasis on outcomes and adherence, less interaction with sales reps, more use of biologics, and the emerging biosimilar opportunity.

All of that is causing a massive shift in where they invest.  In some cases, you’re seeing manufacturers invest in devices (e.g., Sanofi diabetes device) or into education and content at a disease (not drug) level or even in mHealth (e.g., Boehringer and Healthrageous). 

With that in mind, I found this Booz & Company survey interesting in highlighting how their shift in spending is changing.

Are You Turning Data Into Knowlege?

I’ve used this framework for years, but I wanted to post it here as I think about outcomes reporting. (image source)

This is key as you move to add value around data and use the knowledge and wisdom to create informed actions.

 

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

CellScope – Another Smartphone Bolt-On

Turning your smartphone into a diagnostic device seems to be a large focus right now.  I just saw another one called CellScope.  They allow you to take a picture of your inner ear or your  skin and submit those for review. 

 

From a recent article:

Khosla Ventures also recently invested $1 million in CellScope, an alum from Rock Health’s first class of startups in 2011. The company is developing smartphone peripheral devices designed for consumers to use for at-home diagnosis.

Think of it as a “modern-day digital first aid kit.”

CellScope’s first offering will be a smartphone-enabled otoscope that will enable physicians to remotely diagnose ear infections in children. Parents will be able to use the peripheral, which attaches to a smartphone camera lens, to send an image of their child’s inner ear that physicians can use to make a diagnosis and then write a prescription if need be. CellScope says ear infections in children make up 30 million doctor visits annually in the US alone. The consumer device would help parents miss less work and potentially cut down on late night emergency room visits, according to the startup.

The startup traces its origins to bioengineering Professor Dan Fletcher’s lab at UC Berkeley, where CellScope founders Erik Douglas and Amy Sheng were developing cellphone-microscopy for remote diagnosis in developing countries. CellScope expects to launch future products focused on throat and skin exams, including non-clinical apps for consumer skincare.

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. 

Good Mobile Health Quote From Intel

I saw this quote in my morning mHealth e-mail and wanted to share it.

“To change behavior, mobile health applications need to go beyond self- tracking, providing tips or access to an online community. Such applications need to address disconnects between long-term intentions and moment-to-moment choices. The most effective tools will creatively instantiate well-evidenced behavior-change principles with data mining, social networking, location awareness, and other capabilities of mobile technologies.”

– Margaret Morris PhD, Senior Researcher, Intel

Curing Cancer Starts With Prevention

“We have forgotten that curing cancer starts with prevention of cancer in the first place.” Dr. David Agus, author of The End of Illness

Dr. Agus is a prominent cancer researcher who’s views on cancer are apparently radical (although seem logical to me). In an article about him in Fortune (2/27/12), it talks about how use of statins lowered cancer rates by 40% (although why isn’t known). It also talks about how inflammation is linked to diseases like heart attacks, Alzheimer’s, and diabetes and how taking a baby aspirin might curb inflammation.

He’s gone on to be part of the founding team at Navigenics and then subsequently Applied Proteomics.

Navigenics, Inc. develops and commercializes genetics-based products and services to improve individual health and wellness. Navigenics educates and empowers individuals and their physicians by providing clinically actionable, personalized genetic insights about disease risk and medication response to catalyze behavior change and inform clinical decision-making. The company was founded by leading scientists and clinicians, and continues to advance genomic knowledge and adoption of molecular medicine through studies with leading academic centers. Navigenics’ services are available through employer wellness programs and health plans, as well as through physicians and medical centers.

Proteomics, the study of proteins expressed by the body, has the greatest potential for biomarker discovery. Protein expression profiles, determined from easy-to-collect body fluids (e.g., blood, urine, saliva, etc.), represent a snapshot of the current health status of an individual, a sum of the influence of genetics and environment. However, assaying such markers is not without its challenges, and proteomics has failed in the past due to immature technologies and a lack of process control. Lack of control adds noise and variability that block effective biomarker discovery and validation.

Applied Proteomics, Inc. was founded in May 2007 by Dr. Danny Hills (Applied Minds, Inc.) and Dr. David Agus (USC-Keck School of Medicine) to make proteomics-based biomarker discovery practical and productive. Using their combined expertise in oncology, proteomics, systems control, and computation, the company has developed the leading protein biomarker discovery platform. API’s systems control and computational expertise as well as recent technological innovations (e.g., improved instrumentation, faster computing, and extensive genome annotations) make proteomics-based biomarker discovery possible as a replicable, industrial application. API has demonstrated that its approach leads to superior data (better signal, less noise), which leads to better results (more protein features and biomarkers observed). Better results will lead to improved diagnostics and a more efficient and effective healthcare system.

The article talks about several negative reactions to his philosophies, but I must agree that a simple approach to prevention seems much easier to live with then complicated treatment plans on the backend.

At the same time, I was talking with an oncologist the other day about the fact that you’re seeing more and more long-term cancer survivors and what their needs are from the healthcare system. This is changing the needs of the system, but it also is complicating the data that physician’s see. If you base your perception of success on survival, the data is skewed based on earlier screening. (see Reuters article)

Bad Pitch

I was just reading an email pitch that I received from a healthcare social networking vendor talking about their system for engaging patients and physicians.

Maybe, it’s just me but that seems to imply some understanding of how to engage people and use social media. First, they didn’t use my name in the email. It just said “Hi ,”. Then, at no point in the pitch did they say anything about why they reached out to me. And finally, they then asked me to tweet specific pre-formatted tweets that they had created. If I wanted that, I would follow them and do a RT.

And to top it off, they don’t offer a way to follow-up to learn more. It was just shameless self-promotion. #Fail

Why Blending Rx and Dx Data Matters

Yesterday at the PBMI conference, I was listening to a presentation on the blending of pharmacy and medical data. This has been the Holy Grail for a while although companies have struggled to do it well and successfully use it to affect change. That being said, I think it’s one of the biggest focus area for differentiation in the market today. From a large PBM perspective, you can look at the Guided Health efforts at Prime Therapeutics. From a payer software perspective, you can look at Active Health.

Some of the examples from yesterday were interesting data points that you’d never see without digging into both sets of data. For example:

  • 84% of patients using PPIs chronically had no clinical diagnosis to support that
  • 67% of patients taking CNS stimulants had no clinical diagnosis to support that
  • 31% of patients taking atypical antipsychotics had no glucose monitoring
  • 60% of patients taking a psychotropic drug didn’t have a clinical diagnosis
  • Of course, the challenge is not only to identify them but to engage the patient and the provider in the best course of treatment looking at cost, outcomes, and patient experience.

    Rock Health Report on Digital Health

    I saw this out on Slideshare, and I thought I would share it here.

    NYT Article On ACOs Replacing Health Insurers

    I think it’s a bold (maybe foolish) prediction that is made in the NY Times article saying that ACOs (Accountable Care Organizations) will be the end of health insurers.  We don’t even know that ACOs will work yet.  You can even see some debate on this topic in this blog post on Why ACOs Won’t Work.

    But, I’m not an ACO expert so let me focus on what I found interesting in the NYT article.  It points out a few things:

    1. The focus on preventative care
    2. The fact that some managed care organizations are changing (and others will too)
    3. The fact that “ACOs” (in whatever form they take) will need a platform

    This is what I find interesting.

    I think the concept of an ACO (or Patient Centered Medical Home) where care becomes localized and there is greater focus on prevention and wellness not just sick-care is great.  We should all want that to happen in some form.

    But, in all cases, this changes the data needs and role of the physician.  They need to be empowered with new information and tools.  How do they manage their panel of diabetics?  Will some database track them and monitor their screenings and blood sugar?

    When the field of medicine is constantly changing with new drugs and new studies, how will physicians have the best practices pulled into their practice?  They won’t want to wait the 16 years it takes for things to work their way through the system.  They’ll actually want to embrace the best solutions and see more comparative effectiveness information.

    I see a huge opportunity here for someone to create an ACO “platform” that embeds business rules, tele-monitoring, consumer engagement, and reporting into a way to create the “i-physician” (informed physician) of the future.

    Uping The RxAnte: An Adherence Predictive Model

    Those of you that have heard me speak know that I look at this topic of predicting adherence both from an area of fascination along with the eye of a skeptic.  While I love the concept of predicting someone’s adherence and therefore determining how to best support them from an intervention approach, I also believe that the general predictors are pretty straightforward:

    1. Number of medications
    2. Plan design (i.e., cost)
    3. Gender
    4. Health literacy and engagement (see PAM score research)

    And, this is a hot topic (see post on FICO adherence score).  You can see my prior posts on some different studies, on the Merck Estimator, and some notes from the NEHI event on this topic.  It generated a good dialogue on Kevin MD’s blog when I talked about paying MD for adherence.

    I had a chance to talk with Josh Benner the CEO of RxAnte the other day.  It sounds very interesting, and they have an impressive team assembled.  In general, they’re focused on:

    • Predictive modeling
    • Decision rules
    • Monitoring and managing claims to track adherence
    • Evaluating effectiveness of interventions
    • And creating a learning system

    There are definitely some correlations to the work we do at Silverlink Communications around adherence.  We’re helping clients determine a communication strategy that might include call center agents, direct mail, automated calls, e-mail, SMS, mobile, or web solutions.  We’re looking at segmentation and prioritization.  We’re looking at past behavior and messaging.  The goal is how to best spend resources to drive health outcomes from primary adherence to sustaining adherence.  This is a challenge, and we all need to build upon the work that each other is doing to improve in this area.  We have a huge problem globally with adherence.

    United HealthGroup At CES – Two Videos

    This is Dr. Crounse from Microsoft talking about worldwide healthcare and using technology.

    This is Dr. Reed Tuckson from United Healthcare talking about creating cost effective healthcare leveraging technology.

    Using the Local Pharmacist to Moderate the P2P Discussion

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

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

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

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

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

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

    A Computer For The Baby?

    I found an article in USA Today about computers for toddlers very interesting. (Image is The Vinci from this article.)

    While I think anyone with kids has noticed their affinity to towards the Apple products (iTouch, iPhone, iPad), this article questions the wisdom of getting babies computers to play with. There are a few key questions here:

    • Is it necessary?
    • Does it accelerate their learning?
    • Will it negatively impact them?

    According to the article, 10% of kids below 1 and 39% of kids age 2-4 have used a mobile device. I guess the question I would have is whether this is simply for watching a video or for some actual educational purpose. The article quotes an expert saying that there is no evidence that educational toys are building brainier babies and the companies are simply preying on us parents that want to give our kids a headstart. Is it true?

    I think technology has a role in our kid’s lives, but you have to think about it like TV and other things. Use it in moderation. Kids still need to learn by experiencing things. Kids still need to build with Legos. They need to get out and play. They need to read books. They need to draw and create things.

    This is just a good reminder about the Kaiser study on the amount of screen time our kids have today.

    The article also reminds you that the American Academy of Pediatrics recommends no screen time for kids under 2 and no more than 2 hours a day after that.

    Cost and Outcomes Drive Better Use of Data

    Overall, I would describe healthcare companies as trying to figure out how to drive the best outcomes at the lowest cost while maintaining a positive consumer experience.  This isn’t easy.  One area of opportunity that companies increasingly look at is how to use data to become smarter. 

    • Can I build a predictive model of response curves?  Who’s likely to respond?  Who’s likely to take action?
    • Can I develop a segmentation model that works?  How will I customize my communications after the segmentation?
    • Can I rank and prioritize my outreaches?  Should I do that based on risk or based on potential value? 

    Ultimately, I think this is driving companies to be a lot smarter and to look at how they use both medical and pharmacy data.  For example, I’ll point to both CVS Caremark and Prime Therapeutics in press releases from earlier this year. 

    “The ActiveHealth CareEngine offers evidence-based information that can be used to improve the health care of our members and enables us to take our programs to the next level by seamlessly incorporating medical data,” stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. “This agreement will enhance our existing programs to identify issues related to gaps in care, potential drug-to-drug interactions and duplicative care — information that is important to bring to the attention of the member’s physician.”  (article that this is sourced from)

    Smart use of medical and pharmacy data is one of the most powerful tools we have to improve outcomes and increase value for our members and clients,” said David Lassen, PharmD, Chief Clinical Officer at Prime. “Through ongoing partnership with health plan clients, Prime is uniquely positioned to view the entire spectrum of patient care, and we can leverage that information to help manage cost and to improve outcomes. We are very excited to collaborate with Corticon on the development of this clinical platform.” (press release)

    The next step will be to integrate PRO (patient reported outcomes) from sources like connected devices and PHR (personal health records) that might show blood pressure, workouts, calories, or other data points that could help companies determine when to intervene and how to add value to drive an outcome.

    Additionally, another key is continued work in the outcomes-based contracting world and bonus areas such as Star Ratings where the financial value is tied in the short-term to outcomes.  This creates a burning platform for smarter use of data and use of a broader set of data to understand and impact care.

    What’s Your Digital Strategy?

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

    Hopefully, you start with a few basics like:

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

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

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

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

    Text4Baby Learnings About Flu Shots And More

    Here’s a slide presentation from the Text4Baby team that they presented yesterday.  This has been one of the biggest SMS programs in the country and has gotten a lot of press.  They did a survey of people about their plans to get flu shots and also share some other data and plans.

    The Dynamic Video Book: Aetna Example (Specialty Opportunity)

    

    About a year ago, I picked up a “book” at an Aetna booth at a conference. I’d shown the technology to a few clients, but I’d never had a physical example. I thought I would share it here. When you open it up, it has a video embedded into the book. The video has several different options for messaging that you can view by pressing the buttons.


    The cool aspect of the book is that it can be linked up to a computer so the videos can be updated over time. It’s produced by a company called Americhip who calls it “Video in Print”.

    I’m sure it’s more expensive than a typical direct mail piece, but it can be used and updated over time. My thought is that this is a great tool for specialty pharmacy. These are high cost patients. Imagine a book with the following videos that came with their first script:

    1. Understanding your disease
    2. What to expect from your medicine
    3. How to access support
    4. Refilling your medication
    5. The importance of adherence

    The content of these videos could change over time as their condition evolves, as they change medications, or even based on different lab values.

    Reprint: Getting Aligned For Consumer Engagement

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

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

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

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

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

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

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

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

    Sustained Patient Engagement Around Hypertension: Silverlink and Aetna

    At Silverlink, we had a great opportunity to work with one of our clients and publicize it. This morning, Aetna released a joint press release with us about our hypertension program.

    As companies continue to look at new ways to use technology to engage patients around chronic diseases, solutions like this offer companies a unique way to blend multiple channels into an overall consumer experience that improves engagement and outcomes.

    From the press release:

    The program also achieved high levels of engagement, with nearly 60 percent of participants continuing to actively monitor their blood pressure by using a free blood pressure monitor and submitting readings on a monthly basis. The frequency of participants’ cholesterol (low-density lipoprotein (LDL) cholesterol) screening also improved 5 percent.

    “By helping our Medicare members manage their high blood pressure, we are hoping to help prevent heart disease, strokes and even deaths,” says Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Our nurse case managers work closely with our members and do a tremendous job providing them with the information, tools and support they need to help them control and improve various chronic conditions, including hypertension. The results of our program with Silverlink demonstrate that an automated program can further support and engage members in managing their own health conditions.”

    Retail Pharmacy Mobile Applications

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

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

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

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

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

    The Augmented Reality Prescription Bottle

    I was watching a YouTube video on Starbucks’ augmented reality cup which got me thinking. Why not do the same with the prescription bottle?

    What a great way to engage the tech savvy consumer.

    Perhaps you could provide a plain language summary of information about the medication. You could give a list of side effects. Or show how to take the medication.

    Perhaps it could have an embedded survey that you complete weekly.

    And, it seems like an easy opportunity for someone to offer an augmented reality applications for all medications. Hold up the phone to a pill and get information on it. (maybe a little harder)

    I think there is a lot more here as companies like Lamar continue to evolve.

    Why Don’t Physicians Use More Information Therapy

    My PCP is very good about giving me information to read every time I visit him.  (Never mind that it sits in a pile on my desk.)  But, I believe this is under-utilized in today’s information rich society.

    I was reading an article this morning from PharmaVOICE about physicians not using certain medications or treatments because they didn’t have the time to spend with patients explaining them.  Therefore, they default to the “easier” solution which requires less explaining.  Is this prevalent?  I don’t know.

    The article talked about a survey from Sermo and Aetna Health which revealed that almost 2/3rds of the 1,000 MDs surveyed felt that “the current health care environment is detrimental to the delivery of care”.  And, less than 1/5th felt that “they could make clinical decisions based on the what was best for the patient, rather than on what the payers are willing to cover”.  Pretty scary and sad.

    Imagine if the physician was using an electronic interface during the encounter.  They could pre-create several information packets around certain diseases, drugs, and/or treatments.  When the patient was diagnosed and a treatment plan agreed to, they could e-mail the package to the patient.  It might include written information, links to websites, YouTube videos, or other assets.  I would imagine this could be very powerful and address the common gaps that exist between what the physician says and the patient hears.

    [The article was “Is the Business of Health Care Getting in the Way of Providing Good Health Care? by Ken Ribotsky in PharmaVOICE from October 2011.]

    What Will Happen With Generic Lipitor (atorvastatin)?

    Well, it finally looks like generic Lipitor will be on the market soon.  I think November 30th is still the date.

    Of course, now the question is what will this mean to you (the consumer)?  Since atorvastatin will be distributed by only one manufacturer for the first six months after the patent expires, there will not be a significant price drop.  Therefore, I know at least one (and have heard two) PBMs will be blocking the generic drug during that time.  Consumers will be able to get Lipitor at a generic copay.

    I’ve offered my opinion on scenarios like this before.  I think it’s confusing to the consumer.  It’s great for Pfizer and generally everyone wins since it’s the same out-of-pocket costs to the consumer and lower cost to the plan sponsor (employer) than the exclusive generic (due to rebates), BUT I think it sends a confusing message.  “You can and should use generics except for in some cases where the brand drug is cheaper.”  I’m not sure how this plays out in states where generic substitution is required by law.

    Of course, your other option is to go use the Lipitor $4 coupon.  If I were the Pfizer brand manager for Lipitor, I would offer a $50 payment for a 1-year supply of Lipitor and lock people in for the year.  [A seperate discussion needs to be had about how cash and coupon claims which don’t necessarily get adjudicated affect adherence measures for bonus payments like Star Ratings…and yes, I know that coupons aren’t supposed to be used for Medicare members, but I don’t think that’s monitored well.]

    So, you might go to get your generic Lipitor and leave with the brand at your generic copay.  On the other hand, I wouldn’t be surprised to see some PBM negotiate well enough to get a better price on the generic than Lipitor (net of rebate).  [Of course, these are the types of scenarios that cause friction in the supply chain.  Which drug can the retailer buy better?  Does the client get the rebates shared with them or not?]

    I know this is what some companies like GoodRx are looking at with their application which compares drug prices across retailers.  It shows you if there’s a coupon available (see broader article on them).  It suggests savings like splitting the pill.  (No mail or 90-day promotion yet that I saw.)  Of course, this is from a cash paying customer perspective.  But, with atorvastatin, you may want to compare your plan design with the cash price with coupons.  You’ll want to know if it’s part of the $4 generics program or if you get a better price with the CVS or Walgreens discount card programs.

    Here’s two examples from GoodRx.  One is for Lipitor which shows some variation (and has no generic today).  The other is for Prozac which has been available as a generic for a while.

    Monitoring Your Health Thru Existing Devices – Convergence

    Not a big surprise, but a company [and probably many more] is focused on applications that leverage the smart phone for remote monitoring.  They are looking at respiration, pulse, heart rhythm, and blood oxygen level.

    This reminds me of the Ford announcement about monitoring air quality for allergies and considering a diabetes app within the car.

    This idea of convergence isn’t new.  I think we’ve all seen how our smart phones now replace our cameras in many cases.

    The one that I keep wondering about is when monitoring will happen through the toilet.  You could monitor your kids for drugs or alcohol.  Your urine could tell you about a urinary track infection or the color can tell you about dehydration.  Your feces color or smell could also provide health information.  This has been a topic on Dr. Oz before (but I couldn’t get the video to play and embed here).

    Maybe the “smart toilet” will be the next big thing in preventative health.

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