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Behavioral Economics – Affirmative Choice – Organ Donations

June 3, 2010 by George Van Antwerp 1 Comment

You can call the framework whatever you want but forcing people to chose an option works. I think Organ Donations are a great thing and the data is out there to show what states should do to encourage this. In Colorado, 64% of driver’s license and State ID applicants signed up as donors. In Michigan and NY, less than 13% did. The 8 states who have rates in exceess of 50% all do the same thing…the employees at the motor vehicles department ask the people and force them to say yes or no.

Apparently there are some people pushing for “presumed consent” which would require that people opt-out. This is apparently done in several European nations, and while I don’t have an issue with it personally, I’m sure it won’t happen here.

This framework reminds me of the Select Home Delivery option which Express Scripts designed a few years ago, and I believe is the best product idea to come out of the Consumerology concept.

From Donate Life America:
* Top 5 states for participation – Colorado (64%), Iowa (63%), Montana (62%), Washington (57%), and Wyoming (55%)
* Bottom 5 states – New York (11%), Michigan (13%), Arizona (17%), California (25%), and Kentucky (26%)

Books / Articles, Consumerism, Healthcare, Marketing / Communications, Value Propositions

Text4Baby (or Bebe)

June 3, 2010 by George Van Antwerp 0 Comments

This seems to be one of the more successful texting programs in the healthcare space.  This public-private partnership with sponsors like J&J and Pfizer is leveraging texting technology to try to address the US infant mortality rate (with is 30th worldwide).

With 25% of people not having a landline and more and more people (especially younger generations) depending upon the mobile phone, this makes a lot of sense.  In general, the sick population for the healthcare companies are not the younger generations, but this is typically different for pregnancy.  What I didn’t know until reading an article about this is that Hispanics and African Americans are 2.5x as likely at Whites to put off prenatal care until the 3rd trimester or skip it altogether. 

So what do you do?  Text BABY (or BEBE) to 511411 and punch in your due date.

Who writes the content?  The National Healthy Mothers, Healthy Babies Coalition.

Is there a charge?  No.

What is the content?  You get up to 3 texts a week until the baby’s first birthday.  They talk about seeing their doctor.  Keeping their appointments.  Get immunizations.  Put babies on their backs to sleep. 

What do they hope to learn?  Will users have different outcomes?  Will they go to more appointments?  Will they stop smoking?  Will the incidents of low birth weight and pre-maturity decline?

Consumerism, Healthcare, Innovation, Marketing / Communications, Social Media, Technology, Value Propositions

Some of my notes from RESULTS2010

May 28, 2010 by George Van Antwerp 0 Comments

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

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

Overall themes:

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

Notes:

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

“Tweets”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What is #results2010? #Silverlink client event.

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

About 2 of 3 medicare pts have hypertension. #results2010

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

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

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

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

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

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

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

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

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

Gen Y is the most stressed out generation. #results2010

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

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

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

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

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

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

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

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

Who Is Dr. Obvious?

May 25, 2010 by George Van Antwerp 0 Comments

As someone pointed out to me today, there is now a character called Dr. Obvious which is featured on the Medco site – www.medcopharmacy.com.  He’s also on Twitter and Facebook.  So, who is he?  What’s the twist here? What’s the Institute for the Incredibly Obvious?

You might get some idea by watching the video on Facebook or some of the videos on YouTube.

Here’s one on automated refills (which is the push for most pharmacies – retail and mail).

 


Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media, Value Propositions

Reframing Death – A Good Example

May 22, 2010 by George Van Antwerp 0 Comments

Anyone who works in communications knows that framing is a critical concept to grasp.

Here’s a simple statistic presented two ways:

  • An astonishing 40% of people were offended by the action
  • A majority of people had no issues with the actions taken

Another great example I like is using graphics to frame things.  Here’s a picture of how much a simple drink compares to in terms of donuts.

So, I was intrigued a few weeks ago when I was at my cousin’s funeral (Fr. Tom McDevitt) by how well the priest did at framing his passing.  (You can listen to the entire podcast of the funeral here…I’d start around 16:25 if interested.)  There were several times that I wanted to pull out my BlackBerry and tweet a few things (but I thought that might be inappropriate).  The priest (or actually priests) did a great job of turning his life into lessons for all the people there and framing this out as a celebration (which it certainly felt like with 80 priests and 3 bishops there…I counted).  He talked about how he found the good in everything.  He talked about how he continued to learn.  He talked about how he kept doing things even if he didn’t feel good trusting that he would die when it was appropriate.  He talked about dealing with forgiveness and not holding grudges…it only punishes the person with the grudge.

This has always been the way my family views funerals.  It’s a time to reconnect and remember people especially in today’s day and age where families are so busy and so far flung.  But, at the same time, death is a challenge for most of us.  We miss the people that we loved and knew.  Fr. Tom had been one of the cousins that I’d stayed in touch with over the years, and he had married my wife and I and baptized one of our kids.  But, you still learn a lot about a person at their funeral.  I was amazed at all the things he did and people he touched.

It seems to surprise people, but I’ve know a lot of people that have died over the years:

  • In high school, one classmate killed himself, one friend killed himself, my friend’s brother killed himself, and my friend’s mom tried to kill him (due to her chemical imbalance).  Additionally, another guy I knew got killed in a fight…And, a kid got paralyzed in a lacrosse game and eventually died dramatically affecting my friend who collided with him.
  • When I was 30, two co-workers of mine died of brain aneurisms (who were about the same age).
  • I come from a large family and have seen 12 aunts and uncles die.  But, only one grandparent since 3 of them were dead before I was born.
  • A few years ago, a person I worked with killed themselves.
  • Another time a co-worker’s dad got shot on a hunting trip.
  • Last year at my daughter’s school, one kid died of cancer, another kid drown, and an older brother of a kid got hit by a car and died.
  • And, to top it off, I worked at a cemetary for 2 years when I was younger.

My point is that I have seen death and consider it a very normal part of life.  One of the quotes from Fr. Tom’s was “It’s a great day to live.  It’s a great day to die.”  Do you live your life that way?  Understanding and finding the value in what you do and enjoying life is important.  While I appreciate the challenge of communicating difficult information and dealing with death, I think we all have a need to think more about how to frame things and understand them.

Healthcare, Marketing / Communications, Value Propositions

Automated Call Nudge – WSJ

May 19, 2010 by George Van Antwerp 0 Comments

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

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

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

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

Who’s Your Date To The Genetic Testing Prom?

May 18, 2010 by George Van Antwerp 1 Comment

Genetic testing (aka pharmacogenomics, personalized medicine) is certainly a hot topic these days.  There is lots of research around how to use the testing to manage drug spend by appropriately matching drugs with genetics at the individual member level. 

I find it interesting to see who’s going to the “prom” with whom here.  Another interesting perspective is how physicians feel about these (see survey).

  1. Medco acquired DNA Direct.
  2. CVS Caremark hired Per Lofberg from Generation Health and invested in the company.
  3. P&G invested in Navigenics.
  4. Walgreens was going down the path with Pathway Genomics before the FDA intervened.

So…what is Express Scripts doing?  I’ve heard some talk at a conference about their strategy which involves a broader focus on integrating data from multiple sources including genetic testing to help drive clinical decisions.  It seems like they’re either late to the party or smart in staying away.  The question is whether this is a nice to have, a differentiator, or something that consultants will start requiring the PBM to provide.  From their 2009 Outcomes conference:

[Genomics and personalized medicine]  The potential for improved outcomes and cost savings are attractive but still unproven.

Healthcare, Innovation, Managed Care, PBM / Pharmacy, Research, Technology, Value Propositions

Don’t Believe The Hype – Copay Waivers

May 11, 2010 by George Van Antwerp 0 Comments

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

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

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

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

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

  

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

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

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

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

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

Here are a few of my other posts on this: 

 

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

The Facebook and iPod Generation

May 5, 2010 by George Van Antwerp 1 Comment

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

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


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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

Thoughts On Express Scripts 2010 Drug Trend Report

May 1, 2010 by George Van Antwerp 0 Comments

As one of my favorite annual projects during my time at Express Scripts, I love the drug trend report. It has been a historical benchmarking tool for the industry and become a normal deliverable for many of the PBMs. Here are my initial thoughts after reading this year’s document which looks at 2009 data.

Individuals often are not rational.

  • As driven by their Consumerology initiative over the past few years, Express Scripts has shifted the dialogue around the B2C components of the PBM industry to one of behavior change versus simply plan design. This report continues to reinforce that messaging.
  • Waste has been an ongoing drum beat since my days there. This continues to be the message with a shift to include non-adherence to channel mix and drug mix.
  • They talk about the Healthy People 2010 initiative and that key to closing “the last mile” in achieving our objectives is the ability to influence behavior.
  • One of my favorite charts is below showing the waste by class. Not surprising, plan sponsors should focus on heart disease, depression, high cholesterol, and ulcer disease. [Diabetes is not in the top four but is one of the typical areas of focus.]
  • Key Performance Indicators (KPIs):
    • Overall drug trend – 6.4%
    • Specialty drug trend – 19.5%
    • Traditional (non-specialty) drug trend – 4.8%
    • $800.23 PMPY average drug spend
  • The top five classes are:
  • Specialty drug spend is up to $111.10 (processed under the prescription benefit) with a belief that this is only 50% of the total spend which includes specialty drugs processed under the medical benefit.
  • The top specialty classes include inflammatory conditions, MS, and cancer which represent 67% of total specialty spend.
  • I was surprised to see the member contribution to the drug costs had gone down while the actual dollars had stayed flat.
  • I was also surprised that they found adherence (as measured using Medication Possession Ratio) stayed flat from 2008-2009. I think most of the information available had implied thru survey data that it was going down with the recession.
  • I’m having some difficulty reconciling the MPR analysis below with the waste argument. If 80% MPR is ideal and most classes are above 80% MPR, I’m not sure I see the crisis in the data.
  • One of the key charts that I always copied and hung on my wall is the one below. It shows the classes by rank, the utilization, the average cost, and now the estimated behavioral waste (generics and mail).
  • You should certainly go into the document and look at the class level detail. They’ve included a utilization chart by gender by age which I really like. The sections also give some insight into future pipeline. I think I’ll pull diabetes out into a separate post.
  • It’s interesting that they identify only three segments for non-adherent patients with specialty medications versus more on the traditional side:
    • Active Decliner
    • Refill Procrastinator
    • Sporadic Forgetter
  • They project that utilization will continue to go up at about 3% per year and that trend will be mitigated with new generics coming to market.
  • Another interesting analysis is where the waste is by state:
  • They have some information on their Consumerology approach, but I’ve talked about that before.
  • I liked their simple plan design primer:
  • Towards the end, they talk about some of the changes they’ve made over the past few years to their programs to reflect their consumerism approach:
    • Step Therapy Choice
    • Formulary Rapid Response
    • Call4Generics
    • Select Home Delivery (which is gem of their new programs in my assessment)
    • First Generic Fill Free
    • Select Curascript
  • A simple graphic that points to the importance of understanding the consumer and developing programs to effectively drive behavior is below. [This is very similar to all the work we do at Silverlink with clients to help them drive health outcomes and behavior.]

I like it. Very humanized versus purely statistical document. Good job Emily, Steve, Yakov, Andy, Bob, Brian, and Chris. (That’s the core group that I know well.)

Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

The Best Healthcare Conference

April 28, 2010 by George Van Antwerp 1 Comment

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

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

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

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

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

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

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

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

Where is it?  Boston (a great city).

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

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

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

Ingrid Lindberg, Chief Experience Officer, Cigna

April 15, 2010 by George Van Antwerp 3 Comments

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

From her presentation, here were a few notes:

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

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

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

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

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

We then bounced around on a couple of interesting topics:

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

Voice Personality Is A Powerful Lever To Motivate Health Behavior

March 29, 2010 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

There are many interesting attitudinal findings from our study including: 

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

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

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

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

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

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

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

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

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

Are You Pouring On The Pounds?

March 26, 2010 by George Van Antwerp 0 Comments

Now here’s an example of an ad campaign from NY that my change the way you think about soda.

And, from a recent article in Fast Company:

  • Drinking one can of soda per day can add as much as 10 pounds to your weight in a single year
  • People do not eat less food when the drink more calories…these are just more calories.
  • For every glass of sugared beverage consumed per day, the likelihood of a child become obese increases by 60%

“Snickers is a nutritional wonderland compared to a Coke.”

As someone who has evolved from a 12-pack of Mountain Dew per day in college to 7 Diet Cokes per day until a few years ago to 1-2 Cokes per day now, this may finally push me over the edge.  [Although I did go to zero per day for a year, and my weight didn’t change at all.]

Books / Articles, Healthcare, Marketing / Communications, Research, Value Propositions

Gender Bias Of Statins

March 22, 2010 by George Van Antwerp 0 Comments

Statins are cholesterol lowering drugs (i.e., Lipitor, Crestor, Zocor). Millions of people take them and they account for about 10% of drug spend.

There is now some discussion of whether they work equally in men and women. I guess genomics would make you believe that it’s unlikely, but I’ve never heard anything about this discussion before the recent article in Time Magazine.

I don’t have the time to read all the research in depth and there appears to still be some debate so let me simply pull a few interesting things from the story:

* There is little evidence that statins prevent heart disease in women.
* There is evidence that women are more likely to experience the serious side effects of statins than men are. Those include memory loss, muscle pain, and diabetes.
* The data suggests that statins can reduce heart-related deaths but not deaths overall.
* For females to prevent one event (e.g., heart attack), 36 women would have to take Crestor for five years (from Jupiter study).

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

Google Health And SureScripts

March 21, 2010 by George Van Antwerp 0 Comments

I’m just catching up with this announcement from a few weeks ago. Google Health has added Surescripts to their partner list. This is interesting to me on a few fronts.

1 – Can this solve the portability issue? Today, if you change employers, your prescription history gets reset. If your employer changes health plans or PBMs, your prescription history gets reset. While this isn’t always a major issue, that history is important both for a DUR (i.e., drug-drug interaction) perspective but also from a research perspective (e.g., Medication Possession Ratio).

2 – Google is going to message users about potential DUR issues. That is a big value proposition of the PBMs. Given the other threats to their business model ($4 generics, direct-to-consumer mail order, claims administrators, legislation, pharmacy to employer contracting), is this another issue?

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

Addressing Hospital Readmission Rates

March 18, 2010 by George Van Antwerp 0 Comments

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

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

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

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

Why Do We Need Healthcare Reform?

March 13, 2010 by George Van Antwerp 0 Comments

This was made a few months ago, but I think it does a good job of addressing some of the core issues.

Healthcare, Managed Care, Politics, Value Propositions

DBN On Mandatory Mail

March 5, 2010 by George Van Antwerp 0 Comments

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

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

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

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

 

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

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

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

CVS Caremark, Behavioral Economics, Social Media, and Adherence

March 3, 2010 by George Van Antwerp 0 Comments

Yesterday, CVS Caremark announced an expansion on their research partnership with Harvard to include three people focused on behavioral economics and social media.  The focus of both these efforts is around prescription compliance (an almost $300B problem).

The work is going to be focused on three areas:

  • Providing Appropriate Incentives: Research how appropriate financial incentives – in the form of lower copays and immediate up-front rewards – motivate consumer decisions to help improve health care behavior.
  • Developing education tools: Determine how education materials and programs targeting consumers can be applied to persuade positive behavior that will affect meaningful change for patients.
  • Tailoring Communications: Studying how specific messages resonate with individuals to promote improved health outcomes, adherence and personal care.
Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Social Media, Value Propositions

Why Don’t All PBM Clients Save With Mail Order?

March 2, 2010 by George Van Antwerp 8 Comments

This is one of those questions that eludes many people so let me try to explain it here.  It’s one of the major constraints for PBMs in terms of driving mail order volume.  Most (all) PBMs select patients to target for retail to mail programs based on a win-win-win criteria.

  • Does the patient save money?
  • Does the plan sponsor save money?
  • Does the PBM make money (net of costs of acquisition)?

In most cases, the patient will save money since the default plan designs incent mail use.  Typically plans are set up to be roughly 2x the retail copay meaning that you get a 90-day supply for twice the cost of a 30-day retail supply.  The only time that this sometimes doesn’t work is on generics where the mail order price could be more than the retail price.  Which shouldn’t happen if you have a MAC (maximum allowable cost) list being used at both retail and mail.

BUT, the problem for clients is that over time as copays have gone up it’s possible that the copay savings they give to the patient as an incentive to choose mail could outweigh the savings they get from the PBM.  For example:

  • Let’s assume it’s a brand drug.
  • Let’s assume that the average cost for a 30-day supply is $100 (and therefore $300 for a 90-day mail order supply).
  • Let’s assume that the average discount at retail is 18% and the average mail order discount is 23%.  (i.e., the client pays $82 for a 30-day supply at retail and $231 for a 90-day supply at mail)
  • Let’s assume that the copays are $30 at retail for the brand drug and $60 at mail.  (i.e., the client is passing on $30 of their savings to the patient)
  • Therefore, in this case, the client is saving (pre-copay) $15 by moving a drug to mail order.  (5% incremental discount times the $300 drug cost)
  • The client saves $15, BUT they pass on a $30 copay savings to the consumer meaning that they pay an extra $15 for each of these brand scripts moved to mail.  PROBLEM!

So, the question is what to do here.  Well, first most PBMs or consultants should be recommending mail order copays that are 2.5x or more the retail copay.  AND, they should be recommending differences in the copay multiplier based on the tier and the actual discounts received to make sure that the plan sponsor is not upside down.

At this point, you should be saying “well this seems so easy”, BUT it’s not.  Plan sponsors don’t want to reduce the copay savings for consumers because it’s viewed as a takeaway or viewed as not being competitive.  They are stuck with this 33% savings framework that worked when copays were $10-15.  It’s a real issue which every account team within the PBMs should be focused on.

Now, on the final point…the PBM making money.  I’ve already talked about this many times.  The PBM makes money on generic medications at mail.  This margin underwrites all the other business which is often a loss leader.  [Or at least this was the model a few years ago as some people remind me.]

Healthcare, PBM / Pharmacy, Value Propositions

More Adherent If You Use Mail

February 28, 2010 by George Van Antwerp 0 Comments

This was obviously a great study for the PBMs although it was a Kaiser research project.  The study showed that 84.7% of patients that used mail at least 2/3rds of the time stuck with their physician’s regimen versus 76.9% who picked up the medication at a Kaiser retail location. 

“While everyone knew that mail- service pharmacy made prescriptions more affordable, this new empirical evidence shows that it can also improve outcomes for patients with chronic conditions.  This should be an ‘eye-opener’ for any policymaker who wants to address the chronic care crisis in America,” said PCMA President and CEO Mark Merritt. 

There was nothing new about the fact that people with a financial incentive and who lived farther away from their retail pharmacy were more likely to use mail order. 

The question I would have is whether there is inherent selection bias.  Are people who use mail better planners and therefore simply more likely to be adherent? 

The other question I would have is around Kaiser as the example.  The members have to use Kaiser retail pharmacies, and I’ve heard that they aren’t always in easy to access locations like a CVS or Walgreens store and that there can be significant wait times.

Healthcare, PBM / Pharmacy, Research, Value Propositions

50,000 Adults Die Each Year Of Vaccine Preventable Diseases

February 28, 2010 by George Van Antwerp 0 Comments

Diseases easily preventable by adult vaccines kill more Americans each year than car wrecks, breast cancer, or AIDS.

I found this article from WebMD to be both interesting and surprising.  According to the article, the diseases are flu, Hepatitis B, pneumococca, meningitis, shingles, human papillomavirus, tetanus, and whooping cough.

According to the CDC survey:

  • Pneumococcal vaccine is used by 25% of Americans at high risk of severe illness and by 60% of Americans aged 65 and older.
  • Hepatitis B vaccinations were completed by 32% of high-risk U.S. adults under age 50 and for 34% of non-high-risk adults under age 50.
  • HPV vaccinations have been given to only 10.5% of American women 19-26 — and only 6% got all three shots.
  • Tetanus shots are current for only 60% of U.S. adults under age 65 and only 52% for older adults.
  • Flu shots are taken by fewer than two-thirds of adults at high risk of severe flu complications.
  • Shingles vaccines are taken by only 7% of U.S. adults 60 and older. 

    • So, that begs the question of whether consumers should be responsible for costs if they don’t take preventative measures.  I’m sure there are lots of reasons why they shouldn’t be, but let’s assume that the cost of vaccines were covered AND that their healthplan communicated to them the need to go get vaccinated.  In that case, if someone doesn’t get vaccinated, becomes sick, and causes thousands of dollars in cost to be incurred (which all of us pay for), is that ok?

    I have no problem bearing costs for people who are uninsured and support universal coverage.  I have no issue paying more if I can’t control my weight or chose to make bad decisions.  I see healthcare as covering things that I can’t prevent – accidents, genomics, etc.

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

    Should Drugs Be Free?

    February 18, 2010 by George Van Antwerp 0 Comments

    You hear this argument a lot especially within the context of value based design.  There are two reasons that people consider dropping drug copays to $0 for a commercial population – (1) they believe it will increase adherence and (2) they believe it will incent people to move to generics or to mail order.

    First, I am fundamentally against providing prescription medications for free.  People have no vested interest in things that are free.  And, I strongly believe that people need a vested interest in their healthcare.  A temporary $0 copay or a rebate is okay, but I prefer a clear and simple message like “all generics are $4”.  (Not even Wal-Mart can say that…most $4 generic programs are only for 300 or so drugs.)

    Tonight, I want to drill down specifically on using this to incent people to move to a generic drug.  I don’t believe this is a cost effective solution.  Here’s my quick model which says that a company with a 60% generic fill rate would have to increase their generic fill rate by 8 percentage points to breakeven.  I would argue that it is too big of  jump to happen (at least within one-year).

    Why?  Because the 60% of people that are currently paying a copay which reduces the net cost to the client stop contributing.

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

    Prime Therapeutics Drug Trend Report 2009

    February 5, 2010 by George Van Antwerp 1 Comment

    It’s been a while since I did all my analysis on the drug trend reports last year. It’s almost time for some of them to start coming out again. Prime Therapeutics typically publishes their document at the end of the season (see press release). (see my review of their 2006 trend report)

    In general, I liked the report. It was an easy read and something that I think anyone could pick up and understand.

    General Notes:

    • Prime is owned by 11 Blues plans and partners with 5 additional plans.
      • $8.3B in drug spend under management.
      • 27% annual membership growth
      • 94% member satisfaction
    • Prime’s drug trend (PMPM cost) decreased by 0.5% in 2008. (Specialty trend was only 0.9%.) This is their 6th year of single-digit trend which is great. [I really want to dig in and know why – population, drug mix, plan design.]
    • Their generic fill rate was 63.7% (in December 2008). [This seems low…CVS Caremark’s for the same period was 66.3%.]
      • Some of this is plan design, but I think their average age is lower than other PBMs which would drive a lower GFR with higher acute drug use…which is more likely to be generic. [I’m speculating on age, but they share that their average age is 33 which seems low.]
    • 1.1% of their total Rxs were specialty drugs.
      • Neither here nor there, but they are the first company I’ve seen to show ingredient costs per day for specialty. (It was $75 vs. $2.50 for traditional drugs.) Most show costs as a 30-day supply.
    • Their average costs per Rx were $61.87.
      • Brand = $132.65
      • Generic = $19.20
    • Their Rxs PMPY remained flat at 11.5 which still seems low to me. [They state that the average number of retail Rxs per capita was 12.6…does that mean it’s actually higher once you add in the mail Rxs and adjust for days supply?]
    • Their average member cost share was 26.4%.
      • 27.2% for brands
      • 40.1% for generics
      • 5.0% for specialty
    • For Medicare, the utilization is much higher at 47.9 claims PMPY.
    • Their average age was 33.3 (commercial) and 72.7 (Medicare).
    • The GFR for their Medicare business went up 8.7 percentage points to 71.3% which is a huge jump.
    • I like how they break traditional drugs into two buckets – Spectrum (not my favorite name) and Focus. This allows them to show different strategies on these two (vs. specialty).
      • Focus are drugs for high blood pressure, high cholesterol, diabetes, respiratory disorders, and depression.
    • They say they have a GFR of 34.9% in specialty. [This seems incredible. I didn’t realize there was that much generic opportunity but maybe I’m outdated here.]
    • They show a chart on page 30 around generic fill rate which seemed strange to me. It shows the best in class sometimes exceeding what they consider the theoretical maximum. I think I understand why, but I’d have to challenge whoever came up with the theoretical maximum if I already have clients exceeding it.
    • They have a Generics Plus drug list which I imagine is a lot like the High Performance Formulary which we had at Express Scripts and was part of my GenericsWork solution that I launched when I was there.
    • They are the first PBM that I’ve seen recommend a $5 generic copay to try and avoid prescriptions being processed for cash and losing those claims for DUR purposes. I think this is great.
    • I was surprised to find out they have a generic drug alert program. [A program telling me the drug that I’m on is now available as a generic.] They might be the only PBM I know with this. From a consumer perspective, I think this is great. From a business perspective, I know that almost all of these people will get switched by their pharmacy to the generic without doing anything so the value of that mailing is pretty limited.
    • I was surprised to see them quote the Harris Interactive study from March 2005 on barriers for refilling medications. I like to see their data to compare.
    • They have a section on value-based plan designs and provide three types of pharmacy solutions – drug-based, behavior-based, or risk-based. Sticking with their focus on risky patients, they recommend a risk-based model. I like this concept although I’m more of a behavior based advocate myself. They other question I have is can you offer lower copays for people at risk without having any type of “equity” issue with the other employees within the same plan?
    • They have an Adherence Report which conceptually I like although it only goes out every 6 months. There is research out there that says intervening after a 14-day gap-in-care (i.e., lack of adherence) is important to get people back to therapy.
    • One of my favorite images that they’ve been using for a few years is the one below. It shows using a predictive model to focus on at-risk members and allows you to especially focus on those that are at risk based on medical data, but have no Rx claims. (Something they can do with the ownership by the Blues and access to medical data.) [They say these people are zero percent adherent which is a term I’ve never heard anyone use before.]

    Key Research Points:

    • For high risk patients (survived a heart attack or show signs of heart disease), one heart attack can be prevented for every 16-23 members who regularly take cholesterol lowering medication.
      • 3.2% membership is high risk and not on a cholesterol medication.
      • Patients who receive a targeted outreach are 3x more likely to begin therapy
    • Every one percent increase in GFR (generic fill rate) has the potential to reduce pharmacy expenses by 1-2%. [Walgreens also used 2% in their drug trend last year which is higher than what I’d seen before.]
    • They talk about increasing generic usage as likely to increase member’s adherence. [I think Dr. Will Shrank has shown in some of his research that those that start on generics are more likely to be adherent.]
    • I’d love more detail on the case study on page 9 so maybe I’ll have to read the references…BUT what it says is significant:
      • By getting 5,000 high risk members with high blood pressure to be compliant with a statin for 1 year, they saved $2.1M in potential medical costs.
        • Avoided – 44 heart attacks, 5 strokes, 20 heart failure hospitalizations, and 8 kidney failure hospitalizations requiring dialysis
    • There are currently 183 medications in development to treat diabetes and related conditions.
    • Patients with type 2 diabetes are 2.5x more likely to be hospitalized if they do not adhere to their medication therapy.
    • Those who report being non-adherent to their cardiovascular medications have a greater than two times the likelihood of having a heart attack, stroke, or other cardiovascular event.
    • For every heart attack avoided thru proper use of high blood pressure or cholesterol medication, a plan sponsor could save approximately $30,000.
    • Drugs for MS (multiple sclerosis) patients have a monthly cost of $2,200 (wholesale). 1 in 5 members with an out-of-pocket cost > than $250 declined to fill and they were 7x more likely to decline than members with costs of <$100.

    Potentially Conflicting Statements: (you have to read these things closely to find this stuff)

    • On pg. 21, they recommend a $10 copay for generics, but on pg 32, they say adherence is best when your generic copay is less than $10. Maybe two different questions, but seems inconsistent.
    • On pg 32, at one point they say that every $10 difference in Tier 2 copayments leads to a 2.3% higher GFR and in another point, they say a 2-3%. [I might be missing something here since the two are worded slightly different.]
    • On pg 35, they say that step therapy encourages members to use a generic alternative before a “second line, usually more costly brand medication.” I think this is meant to imply that it’s usually a brand drug versus it’s usually more costly. But, then on pg 46, they say before a “more costly medication”. It’s possible to have a generic as step one (or an OTC) than a more expensive generic as a step two, but I don’t think that’s very common. [For you clinicians, think H2 before generic PPI before brand PPI from a few years ago.]
    Books / Articles, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

    The Value of a Stamp

    February 3, 2010 by George Van Antwerp 0 Comments

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

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

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

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

    Situation A:

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

    Situation B:

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

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

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

    General Business, Silverlink, Value Propositions

    Will Paying You To Be Adherent Work?

    February 3, 2010 by George Van Antwerp 0 Comments

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

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

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

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

    Splitting Up CVS Caremark – Stupid – Just Learn How To Compete

    January 26, 2010 by George Van Antwerp 5 Comments

    The fact that the NCPA [see their press release on this] and others in the pharmacy community have chosen to push for the FTC to investigate the CVS Caremark merger and continue to encourage this is ridiculous.  CVS has owned a PBM (Pharmacare) for years.  Walgreens has its own PBM.  Longs had a PBM (RxAmerica).  Kroger’s has a PBM.  Unless I’ve missed it, I don’t remember hearing about them not being able to own a PBM or seen complaints about their ownership.  [And, like Adam Fein – I didn’t know this retrospective breakup was even an option.]

    So, I perceive this whole FTC issue as a backhanded strategy to gain a competitive advantage over a competitor that’s beating them in the market.  [Just imagine the distraction of having to split the companies up or the hassle of having to put in a bunch of additional limitations.]  We know that independent pharmacies have continued to lose marketshare for years to retail chains and mail order.  It’s no different than any other market where scale matters (e.g., hardware stores).  If small pharmacies can compete, they should figure out how to make money and demonstrate value that people will pay for and stop focusing on crying wolf about a successful competitor.  [More on what I would do another time.]

    I’ve been a big believer of retail and PBM integration for years.  At Express Scripts, we only thought there were a few companies that could buy us – Walgreens, Wal-Mart, or United.  At this point, I don’t see that happening, but I see lots of efficiency in leveraging plan design, retail face-to-face counseling, pharmacy automation at mail, and other coordinated solutions.

    Another issue that is raised [in complaining about the CVS Caremark integration] are patient complaints.  These are certainly possible, but isn’t that a BBB issue or someone else’s issue.  Unfortunately, I bet you can’t find a pharmacy or a PBM without some patient complaints.  People take their healthcare personally and hate change.  BUT, I can’t imagine that I would go to the government and point out that some clients of my competitor aren’t happy.  [And the fact that politicians believe the hype and try to push stupid legislation like HR 4489 makes a mockery of our government.]  I’ve talked about transparency before so I won’t harp on this here, but how many companies (in our capitalist society) are required to provide data about margins and forced into a certain business model. 

    Another issue you hear is about CVS Caremark “steering” people to preferred pharmacies (CVS, mail, specialty).  First off, this is not a PBM decision.  Limited retail networks have been an option for ever.  Clients chose what plan designs to implement.  The PBM’s job is to implement these plans and manage them effectively.  PBMs and consultants (e.g., Hewitt, Mercer) often model out the options for the clients so they learn how to save money.  And, in many cases given the pace of cost increases, if these options didn’t exist, then employers would drop benefits quicker.

    Finally, the data doesn’t lie.  Members are generally very happy with the PBMs and mail order (or as much as they are with any “managed care” type company).  PBMs save clients money (and make money doing it).  PBMs provide clients with data.  Clients have lots of options for “transparent” companies and there’s been no big movement of marketshare to them.  PBMs drive adherence.  Mail order patients are more adherent.  Specialty mail order pharmacies drive successful outcomes.  The point is that the model works…stop trying to fight the model and come up with a better mousetrap. 

    [Enough ranting for the evening.]

    Blogroll, Books / Articles, Healthcare, PBM / Pharmacy, Politics, Value Propositions

    Pharmacy Counseling – Mail vs. Retail Privacy

    January 26, 2010 by George Van Antwerp 0 Comments

    One of the other things that caught my eye in the USA Today article about the changing role of pharmacists were the comments about counseling.  I’m not sure if I see that as any change.  Isn’t that what most pharmacists go to school for?  They want to help patients.  They don’t go to school to count pills. 

    A few years ago when I worked on my idea of a kiosk to dispense medications that was the big discussion I had with several pharmacy leaders.  I wanted to free up the counter time for counseling and let the kiosk hold the refills and acute medications which didn’t require as much pharmacist time. 

    Today, when you go to most pharmacies, you talk with the pharmacy technicians which in some states don’t even have to be certified and can essentially be someone with only a high school education.  Not that there is anything wrong with not going to college, but I bet that most of us have high expectations for the person standing on the other side of the counter.

    So, I think everyone would love the pharmacist role to evolve.  BUT, I think the other question this begs is whether this is a private setting to have that discussion.  Now, there are a few pharmacies that have created a quiet area for counseling, but let’s face it, the majority of the time, you’re standing at the counter with another patient right over your shoulder (or back at the yellow line 24″ behind you).  How many of us really want to talk about the rash that developed as a side effect or the new diagnosis that we got from our physician or the fact that we can’t afford the medication in front of our neighbor or some miscellaneous person that might be judging us?

    So, I’m always amazed when people talk about mail order as this anonymous 800# for counseling.  Isn’t it more convenient to be able to call your pharmacy from your own home (or another private setting) at anytime of day or night and ask questions?  Isn’t it more private?

    Since less than 20% of people can even tell you the name of their pharmacist (and probably an equally low percentage of patients are known by name by the pharmacist), does this face-to-face relationship really matter?

    I won’t deny that the Ashville Project worked and that the cases where the pharmacist is engaged with the patient in a long-term, trusted care relationship that it makes a difference.  I only question whether that model exists, is scalable, is cost-effective, and can be staffed.  (Don’t forget that just a few years ago they were forecasting massive staffing shortages around pharmacists…I don’t think that’s been solved.)

    Healthcare, PBM / Pharmacy, Value Propositions

    Interview with Cyndy Nayer from the Center for Health Value Innovation

    January 22, 2010 by George Van Antwerp 1 Comment

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

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

    What is the Center For Health Value Innovation?

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

    What do you mean by Information Exchange?

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

    Can you describe Value Based Design?

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

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

    • Commitment
    • Concern
    • Cost
    • Communication
    • Community

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

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

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

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

    Why are employers so interested in Value Based Design?

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

    Why don’t companies implement Value Based Design programs?

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

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

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

    What’s next for 2010?

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

    How does someone learn more about Value Based Design?

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

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