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New Deloitte Post

I had the chance to share two new posts through other channels.  For those of you that have followed me here, I wanted to share those with you.

I just posted a new blog about The Specialty Pharmacy Elephant on The Center for Health Solutions blog by Deloitte –

I also used LinkedIn to share a post about The Pharmacy Marketplace in 2016.

PHM Is The New Black Post At CCA Blog With Diabetes Examples

This is a partial copy (teaser) of a guest blog I did on the Care Continuum Alliance blog earlier this week.


With all the talk about Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), the adoption curve for the Care Continuum Alliance (CCA) model for Population Health Management (PHM) should move beyond the innovators in 2013 and begin to “Cross the Chasm.” I believe there are several preconditions that would set the stage for this to occur, for instance:

  1. Technology advances leading to the “Big Data” focus;
  2. The changing paradigm from fee-for-service to outcomes-based care;
  3. The realization of the role of the consumer led by the e-Patient movement, the idea of the Quantified Self, and the focus of large healthcare enterprises on being consumer centric; and
  4. The budget crisis that is driving employers and other payers to embrace PHM, wellness, and other initiatives that impact cost and productivity.

Of course, most companies are still in the infancy of designing systems to address this coordinated care model, which does not view the patient as a claim, but longitudinally aggregates demographical, psychosocial and claims data.  Additionally, training staff using Motivational Interviewing and integrating external staff into the virtual care team in partnership with the provider will continue to evolve as do our care delivery models.

To read more especially the diabetes examples that I shared, please click over to their blog.  Thanks.


17 Healthcare Blogs You Should Read

This is just a list of my favorites.  Feel free to add your own recommendations.  I broke them into 3 categories.

(BTW – I’m sure I missed a few of you so I’m sorry.)

1. Key Foundational Blogs To Follow

2. One’s I Read Frequently

3. Good Blogs That I Use For Certain Topics

I’ll also give a shout out to a new blog that has started that I have high hopes for based on their initial content –

New Year Blog Survey

Happy New Year!

For those of you that are regular readers, I’d love to get your thoughts on the following:

  1. Do you like me including infographics in the blog?
  2. Do you like the mix of content from mHealth to PBM to population health management?
  3. Do you like the mix of short posts sharing articles and other information or would you prefer less posts that were more detailed analysis of a subject?
  4. What would generate more discussion / comments on the blog?

Thanks for your time.  You can comment here, e-mail me at gvanantwerp at mac dot com, or respond anonymously to the survey embedded here.

Press Hits in 2010 (and before)

2010 was a good year.  21 press hits.  (Thanks to a great press team at Silverlink that supports my ideas.)

This built on some success with the press in 2008 (2) and 2009 (15).

Just out of interest, I went to pull some older press hits from pre-Silverlink:

AND, I finally found a link to my first healthcare publication in the International Journal of Radiation Oncology Biology Physics on using activity based costing to compare different treatment options.

Finally – New Blog Name

I mentioned a few weeks ago my need to get a new name since the people that had Trademarked “Patient Centric Healthcare” asked me to stop using it for the blog.  I looked at a bunch of names.  Finally, I’m going with “Enabling Healthy Decisions SM”.  I think that summarizes what I’m interested in – healthcare communications, healthcare analytics, healthcare marketing, healthcare technology.  I generally am most interested in those subjects when they relate to leading consumers to make better decisions about their health.

The Innovator’s Prescription – Christensen Book

I haven’t had the chance to read the book yet, but for those of you interested, I thought I would point you to the review from a few months ago on The Health Care Blog.

The book is mistitled. It should have been titled “The Innovator’s Diagnosis”. The book does a fantastic job at diagnosis (Dx) of problems in the U.S. health care system. It presents many new, innovative analytical frameworks and lenses through which to view the U.S. health system.

However, it’s weak on prescription (Rx): many of the proposed solutions are speculative, ungrounded, and/or defy political reality.

Getting Kids Active

In today’s computer world, this is as much a challenge for some kids as it is for us adults to find the time. But, it’s important to start the practice early. I liked Dr. Dolgoff’s blog entry on this. It’s pretty straightforward but a good reminder for all of us.

Step One: Let your children see you enjoying exercise.

Step Two: When your child is old enough (around age 3), allow them to participate in very small amounts. You don’t want to overwhelm them.

Step Three: Don’t say no!

Step Four: Step it up!

Step Five: Keep it up!

Using Twitter For Health Care

Last week, I talked with a reporter about using Twitter for health care.  It can add a new dimension to communications, but I am not sold on it replacing current communications.

Some of my jumbled thoughts on this:

  • I like the one to many concept of Twitter with the opt-in concept (preference-based marketing), but it doesn’t personalize to the individual the way the information is delivered.
  • It definitely provides a stream of consciousness which is interesting.  I see a lot of application for a reality show type of health tools…like Biggest Loser via Twitter.
  • I like the idea of posting a question to a broad audience for quick response – Does anyone have research showing the impact of statins on asthma patients?
  • I don’t see this helping with patient to provider communications.  Do I really want my blood sugar posted to Twitter and sent to my physician from my smart device?  Do I (the physician) really want to see all that real-time data?  No.  What about HIPAA…from what I know Twitter is not meant to contain confidential information.  There are plenty of rules engines which can be used to capture data; look for things outside the norm; and then send an alert.
  • A lot of healthcare information has caveats and requires more than 140 characters to get across the message.  Most clinical things couldn’t be send this way.
  • As with most inbound things (i.e., I have to register or search it out), Twitter feeds get those that know what they are interested in and are active in their health management.  It still doesn’t help to drive action from those that aren’t engaged in their healthcare.
  • I can certainly see it as an alert to information, but since one tip to productivity is to batch things, do I really want them broken out during the day in a bunch of Twitter feeds.  I would rather get a daily synopsis from a website (which might be created by Twitter feeds).

Some things I found when looking on the web about this topic:

Here is a presentation on Twitter (they even have one of my old posts in there…which was a pleasant surprise to me) around healthcare.

So, my general perspective is that there is some value in pushing basic information out, reality show type of healthcare (Twitter surgery), capturing feedback, and developing community, but it’s not a tool for the corporate to individual communications that I typically deal with.

BioGenerics, Text Analysis, and Transparency

Here are a couple of blog posts from other blogs worth reading:

  • David Williams on the “Folly of BioGenerics” which talks about why they won’t be just like generic drugs.
  • James Taylor on Text Analysis which if ever figured out would be very helpful in taking inbound e-mails, letters, and call center notes and using them for customer relationship management.
  • Gilles Frydman on “Opaque Inc.” and how difficult it is to understand the US healthcare system.

Ix for Rx Management

Josh Seidman from the Center for Information Therapy today announced on their blog that the center is going to begin focusing on “Ix for Rx Management” that will look at adherence along with other critical issues.  As I talk about all the time, finding the right way to deliver information to people in a way that they can accept it and act upon it is critical.  Given that we use more and more medications, this is a critical area where the center’s leadership can help build awareness of the problems.

“Although awareness certainly is an important precursor, it may be the easiest step in the pathway that takes the average consumer along the road to information consumption, then knowledge accumulation, and ultimately leading to behavior change. We know there’s a large body of research that tells us that, in order to be successful, our Ix initiatives need to “meet people where they are.” More specifically, we need to target the information to the individual’s particular moment in care and tailor it to their particular needs and circumstances.”

Cigna And Social Media

I usually hold Humana out as an innovator in the area of established health care companies using social media and other tools to drive awareness.  I was pleasantly surprised to find out more about Cigna’s activities on Facebook, MySpace, and Twitter along with their deployment of games (like Humana) from the World Healthcare Blog.


7 e-Patient Conclusions

Thanks to e-patient Dave’s reminder on the e-Patient blog

Here are 7 conclusions from the white paper that came out last year on this topic. Very important in diffusing some of the myths around the role of social networking in healthcare and the use of the Internet for information.

1. e-patients have become valuable contributors, and providers should recognize them as such.
“When clinicians acknowledge and support their patients’ role in self-management … they exhibit fewer symptoms, demonstrate better outcomes, and require less professional care.”

2. The art of empowering patients is trickier than we thought.
“We now know that empowering patients requires a change in their level of engagement, and in the absence of such changes, clinician-provided [information] has few, if any, positive effects.”

3. We have underestimated patients’ ability to provide useful online resources.
Fabulous story of the “best of the best” web sites for mental health, as determined by a doctor in that field, without knowing who runs them. Of the sixteen sites, it turned out that 10 were produced by patients, 5 by professionals, and 1 by a bunch of artists and researchers at Xerox PARC!

4. We have overestimated the hazards of imperfect online health information.
This one’s an eye-opener: in four years of looking for “death by googling,” even with a fifty-euro bounty for each reported death(!), researchers found only one possible case.

* “[But] the Institute of Medicine estimates the number of hospital deaths due to medical errors at 44,000 to 98,000 annually” … [and other researchers suggest more than twice as many]
* We can only conclude, tentatively, that adopting the traditional passive patient role … may be considerably more dangerous than attempting to learn about one’s medical condition on the Internet.” (emphasis added)

5. Whenever possible, healthcare should take place on the patient’s turf. (Don’t create a new platform they have to visit – take yourself wherever they’re already meeting online.)

6. Clinicians can no longer go it alone.

* Another eye-popper: “Over the past century, medical information has increased exponentially … but the capacity of the human brain has not. As Donald Lindberge, director of the National Library of Medicine, explains ‘If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
* In contrast, when you or I have a desperate medical condition, we have all the time in the world to go deep and do every bit of research we can get our hands on. Think about that. What you expect of your doctor may shift – same for your interest in “participatory medicine.”

7. The most effective way to improve healthcare is to make it more collaborative.
“We cannot simply replace the old physician-centered model with a new patient-centered model… We must develop a new collaborative model that draws on the strengths of both systems. In the chapters that follow, we offer more suggestions on how we might accomplish this.”

Presentation Zen

Have you read the book – Presentation Zen? If not, you can visit the blog to start to understand what Garr Reynolds talks about in his book. In general, one of the key points that I always try to relay to people is that slides are not your leave behind. Don’t put too much content on them. Don’t talk to them. Think about how to engage your audience in your story.

Take a look at a few of the slides he shares here. How does his presentation compare to your last presentations?

Physician as Coach: Patient as Player

I really like this analogy.  Dr. Field talks about it in his blog.

It is easy for me to understand the role of my physician as providing me with the details about my disease.  They can tell me what to do.  They can motivate me to do it.  BUT, ultimately, it depends upon me as the patient to actually deal with the condition and improve it.

A Single View of the Member

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

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

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

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

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

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

Mean Or Nice: Which Is More Contageous?

I found this blog entry on Dr. Gupta’s blog very interesting. It talks about the fact that being mean is more likely to stick with someone and effect them than being nice. Isn’t that frustrating? Wouldn’t we all like to believe that we could make things better by being nice when all it takes is a few rude people to change that.

That’s because, it seems being inconsiderate and rude to people has a much bigger impact than being nice. A recent study, conducted at the University of Chicago Booth School of Business, found feeling slighted can have a bigger impact on how a person treats another, than being the recipient of someone’s generosity.

Working with college students who were tasked with exchanging money in an orchestrated test of taking and sharing, researchers found the young people were willing to share at beginning of the study. But when they felt they were being taken advantage of, or that their fellow students were cheating them, they became more aggressive and greedier, rather than stepping back and appreciating what they were given.

Psychologists say this is not unusual. The meaner deed has the greater impact. Give something to someone and they may appreciate it. Take it away and they’ll fight you or at least object strongly.

As the doctor says “All this anger and hostility not only leads to unhappy people, but can cause anxiety, which raises our blood pressure, and puts stress on our hearts.”

Viral Marketing in Health: Humana Steps Up

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

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

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

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

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

Uproar Over “Reference-Based” Medicare Pricing – Please

Here is an overview of the issue on the WSJ Health Blog.

First off, I am not sure I would call it reference based pricing when the rest of the world calls it mandatory generics.  In many states, this is even a requirement where the pharmacy has to fill a multi-source brand (MSB) with the generic equivalent of the drug.

[In English, what this means is that once a brand drug has lost it’s patent and the drug is available as a generic then the generic (which is typically much lower cost) has to be dispensed.]

So, the issue is that apparently Medicare plans don’t always point out that if members choose the higher cost brand product (Prozac versus fluoxetine) that they will pay more..and often a lot more.  Brand manufacturers raise their prices on the brands after they lose patent since they know there are people out there who really want to purple pill and not the generic white pill (for example).

I don’t know if Medicare plans allow it, but I know a lot of clients who allowed members to get the brand name drug at their copay (not at the drug cost) if the physician wrote the prescription for DAW (dispense as written).  The problem is the physician might simply do this at the member’s request even if they don’t need it.  From everything I have ever seen, it should be less than 1% of members who really need the brand versus the A-B equivalent generic.  (Look here for the FDA information on generics.)

I don’t disagree that for the 1% that have an allergic reaction to the inactive ingredients (e.g., blue dye #17) that there should be an exception process BUT we can’t build for the exception and manage costs.  Too many people will choose the easy path and drive costs up significantly.

Humana is “Crumpling It Up”

I have given it away in the title, but would you have looked at the webpage below and imagined this was from Humana.

crumpleitupYou can go to their website CrumpleItUp to learn a little more about what they are doing with bikes called freewheelin and what they are doing around games and health.

They have a fascinating group there in Louisville that works on innovative ideas.  A lot of them don’t drive the core business of health insurance but they are related to improving the health of the general public or looking at interesting ways to use technology.

They have recently added a blog about this that you can see here.  Additionally, I had a chance to meet with Grant Harrison from this group at the WHCC and also hear him speak as part of a panel on innovation.  I was very impressed with him and a few of the other people in the group.

As John talked about over at Chilmark Research, it is refreshing to see someone focusing on this type of innovation.  When I talked about innovation with a reporter recently, I suggested that Humana would be one of the first groups that they should interview.

5 Myths of Health Care

Charlie Baker, the CEO of Harvard Pilgrim, has a post on his blog about the Five Myths of Healthcare. It’s worth a read as is his blog.

1) America has the best healthcare in the world.

2) Somebody else is paying for your health insurance.

3) We would save a lot if we could cut the administrative waste of private insurance.

4) Health care reform is going to cost a bundle.

5) Americans aren’t ready for an overhaul of the health care system.

MD Rating Sites

(Getting a few things out here and off my desk)

This is a question I often wonder about.  I was glad to see that e-patients put a report online.  I haven’t read it yet, but I think it is something that many of you would want to know.

I think that the main issue Given hit upon in the report (but I’m not sure she recognizes as the primary challenge of doctor rating sites) is the numbers issue. With over 700,000 physicians in the U.S., a ratings database of 10,000 or even 20,000 is pitifully and woefully small.

Preaching To The Choir

On the Maritz healthcare blog, the author talks about segmenting the population to drive wellness behaviors.  I couldn’t agree more.  That’s what we always talk about.  Understand what motivates different people is critical.  Bob Nease talked about this the other day on the Express Scripts blog.  You have to help people feel confident and provide them with a motivating and personal message that compels them to take action.

The challenge is aggregating data and learning from prior interactions to understand how people respond, when they respond, what mode they respond to, and what motivates them.  (among other things)

That is why communications is both a science and an art.

Do I Pay The Mortgage Or Chemo Bill?

15% of Freddie Mac’s deliquencies this year were due to illness.  I am sure this is a combination of medical bills and lack of ability to work, but this is a real issue.  As one of the comments on the WSJ Blog about this said, it’s the “perfect storm”.

Obama and his team have a real challenge (or opportunity) to figure out how to help us out of this market that we are in.

Changing Behavior – Examples

On the Express Scripts Consumerology Blog, I noticed a new entry this morning from Bob Nease (Chief Scientist) about changing behavior.  It points to two things – motivation and self-efficacy.  (What’s in it for me and do I believe I can be successful.)

There is an interesting study from the University of Michigan that he discusses, and he also provides some detail on one of their web pilots.  What the web study showed is that a simpler message led to more “click throughs”.  This is very similar to what we see in the voice channel of communications.

If I call you and tell you there is an opportunity to save money with your health benefit, you are likely to go to the next step or transfer to hear more.  On the other hand, if I tell you a lot in the message, I might get a much lower click-through (or continuation or transfer) rate.

Since ultimately, I care about conversion in the claims data (i.e., did the patient really change behavior) these metrics are nice proxies but don’t mean much.  I care about did the patient and their physician actually act on the recommendation or the opportunity to save money.  I posted that as a comment on the blog so hopefully Bob can add that detail.

We have clearly seen this in some of our programs where we would rather qualify them on the phone and then transfer them leading to a higher close rate than simply drive up transfers.

Customer Experience Matters

I found this new blog (Customer Experience Matters) and thought I would share it.  It is written by Bruce Temkin who works for Forrester Research.

To get you started, here are a few posts I think you would enjoy:

Retail Healthcare Blog

Just a quick note on a new blog someone sent me on the Retail Healthcare Market.

Don’t You Want To Live

Apparently, the Walgreen‘s CEO told the WSJ that not only is this a tough year, but they are taking a tough love approach with their patients.  In their blog earlier today, they said that Jeffrey Rein said “Walgreen pharmacists try to persuade patients to take their pills by asking them whether they want to be alive to see their children grow up.”

As they talk about, there have been several studies showing that patients are skipping pills and doing other things to stretch their prescriptions.  But based on what I saw in the Lehman Brothers research yesterday about Walgreens, I wouldn’t have thought things were that desparate.  They reported August same-store stales of 3% which is low compared to their historical results but still positive in this economy.

Interestingly, the report commented that they were increasing promotional activity which would negatively impact front end margins while CVS had recently said that it’s promotional spending (as a percentage of sales) was lower.

[In full disclosure, I do not own any of these stocks as individual stocks.  They may be held in mutual funds that I own.]

Prescription Price Elasticity Explained

If interested, Emily Cox who runs the research group at Express Scripts recently put up a post on some research on this topic on their blog.  This is a relevant target based on the discussions around compliance and value based insurance design.

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