Enabling Healthy Decisions

What a vicious cycle. As patients get sicker, they get prescribed more and more medications which just leads to lower adherence which increases their total healthcare costs and the likelihood that their health will get worse.

A study released at the end of December by Medco Health Solutions highlighted some key issues:

• 1 in 4 seniors take between 10 and 19 pills A DAY. [WOW]
• 51% take at least 5 different prescriptions a day. [Not to mention vitamins, supplements, and other over-the-counter medications.]
• 57% of those polled (1,000 people over 65) admit they forget to take their medication, BUT 63% of those with 5 or more medications said they forget.
• 1/3^rd of seniors using 5 or more prescriptions do not feel knowledgeable about the drugs their prescribed or their potential side effects.
• 35% of the senior weren’t sure they could list all the medications they use.
• The top concerns of those with 5 or more Rxs:
  • 40% – ability to afford their drugs
  • 23% – side effects
  • 17% – interactions
• 49% of those polled that were in a Medicare Part D plan wanted to know how to delay or avoid falling into the donut hole.

“It’s usually the patients who are in worse health who are taking large numbers of prescription drugs. For these people, especially, taking their medications properly and regularly is critical,” said Dr. Woody Eisenberg, vice president and chief medical officer of Medco Retiree Solutions. “The problem is that the more medications prescribed, the harder it is for older people to manage them well and know essential information that can help prevent medication-related harm.”

As part of Medicare Part D, coverage for prescription drugs varies based on the total amount of money by participant. Participants have one amount of coverage until their costs (plan plus participant) reached $2,250 (2006 #s). Then, they don’t receive any coverage (i.e., pay full price) until their out-of-pocket costs reach $3,600. This gap is lovingly referred to as the donut hole.

Numerous studies have shown that adherence suffers when patients have to pay the full cost of their medications during this time period.

I haven’t seen a lot of programs focused on educating consumers about this (i.e., you’re about to reach the donut hole…here are some actions you can take). Consumers can save money (or delay hitting the donut hole) by using generic medications and mail order (among other strategies). There are also PAP (patient assistance programs) or other things that they can look into. [More info from the U.S. Centers for Medicare and Medicaid Services on this.]

In a survey by Medco Health Solutions, they found that 49% of the seniors polled that were enrolled in a Medicare Part D plan were worried about how to avoid the donut hole.

• 60% of them had done something to avoid reaching the donut hole
  • 76% using generic medications
  • 39% asking for free samples
  • 27% using mail order

In the Medco survey, seniors estimated that using mail order saved them $540 a year and 19% estimated they saved at least $1,000 annually. [They provide information at http://www.medcomedicare.com.]

Of course, I think that we should be doing lots to help the Haitians with their crisis, but the immediate thing that came to my mind the other day when the medical evaluations were paused was – Health Tourism.  If it costs 1/2 to 1/3 as much to care for people outside the US, wouldn’t our money be better spend funding care for Haitians in other countries rather than bringing them here. 

I realize it’s not quite that straightforward, BUT I think there is something here.  If we know how much in terms of tax dollars and donations are going to cover the costs incurred by our hospitals and physicians, why not find a way to funnel that towards other locations.

There is an article in today’s USA Today about wounded veterans that got me thinking about where this falls on the healthcare reform priorities. As I’ve stated before, I completely agree that the US system needs reform. The question is whether to go “big bang” or focus on change in key areas. I continue to argue that focus on fixing one problem at a time is best. I would initially focus on the uninsured. This article made me realize that another area of focus should be on providing comprehensive coverage for those that serve our country.

While most of us enjoy our freedom, there are a select few which are willing to sacrifice their lives to protect us. We should never forget that. They should be cared for.

In a study by the MarketingProfs, they look at use of social media by industry which is interesting. The full report is something you have to pay for, but they give you a presentation you can download for free and allow us bloggers to use some of the charts.

1. The first one shows users of videos for viral marketing. I was surprised to see healthcare at 18.5%, but this makes sense. There are lots of videos which can be educational.

1. The next one shows social media use by company type. I certainly have seen a lot of companies putting LinkedIn and Facebook pages up. Additionally, a lot of companies are using Twitter for PR and other information. Since I don’t use MySpace that doesn’t surprise me that it’s so low.

1. The last one isn’t shown by industry, but I think it’s interesting. I’d love to know if healthcare is more conservative than other industries. I would imagine they would be. [The other thing to know here is the mix by size.]

Reading a brief summary of this book caught my attention. The Checklist Manifesto hits on one of those sensitive areas in healthcare…can technology make physicians better? YES.

“Medicine today is so complex that even the sharpest doctors can no longer keep everything they need to know in their heads.” (Atul Gawande)

• Only about ½ of heart attack patients get the best care within the recommended window.
• It takes an average of 17 years for a new treatment to reach even ½ of the patients who would benefit.
• Using a “safe-surgery checklist” reduced the number of complications and deaths by 1/3. (The New England Journal of Medicine)

(Or at least that’s a good sensationalist title)

In a study in the American Journal of Epidemiology, it suggests that people who grew up in the Rock ‘n Roll generation are holding on to their hearing longer than their parents. (Will this continue for the iPod generation?)

The odds of having hearing impairments were 13% lower in men (and 6% in women) for every five-year increase in year of birth. (Based on study of 5,300 people born between 1902 and 1962.)

As the blurb in the USA Today mentions, there are other factors – ear protection, less noisy jobs, better treatment for conditions that led to hearing loss.

In a letter to the editor, a consumer was suggesting that one answer for BTC (behind-the-counter) medications such as cold medications would be to require the pharmacist to determine who should get them. Certainly, we need to figure out a way for these medications not to be used to create methamphetamine (meth), but this won’t work (IMHO). On the flip side, requiring a prescription for patients to get these doesn’t make a lot of sense either. It would drive up physician visits and overall healthcare costs.

Why?

• Pharmacists are already very busy (at most pharmacies).
• The margin on these medications probably doesn’t justify applying high cost labor to them. Today, a pharmacy technician that makes significantly less does and can handle “filling” these. [Of course, if this argument worked, pharmacies would stop filling $4 generics and free antibiotics.]
• What’s the proper diagnosis for a cold and how would you screen people?
• If criminals wanted the drugs, wouldn’t they just get sick and come in to get them?

From the Corporate Research Group blog:

One thing is clear, voters do not want the trillion-dollar health care bill that is being forced on the American people.  This bill is not being debated openly and fairly. It will raise taxes, hurt Medicare, destroy jobs, and run our nation deeper into debt….I will work in the Senate with Democrats and Republicans to reform health care in an open and honest way. No more closed-door meetings or back room deals by an out of touch party leadership. No more hiding costs, concealing taxes, collaborating with special interests, and leaving more trillions in debt for our children to pay.

[BTW – On a personal note…It’s always fun to be onsite for big elections.  I was in Boston for this although I’d put it as my 3rd most interesting election.  I was in Brazil in 1989 for their 1st election in 30 years and I was in Prague for the vote to split Czechoslovakia into two countries.  Those were both a little more exciting…although not as relevant to my day-to-day life.]

In one of the most stunning studies ever, the researchers show that people (not all just most) are happier on days that they don’t work. But, let’s drill in since I actually found the study interesting and began to wonder about implications that might have on when healthcare companies should communicate with people.

The study in the Journal of Social and Clinical Psychology showed that people are happier on weekends (when most aren’t working) due to “more connection with other people and more self-direction” (co-author Richard Ryan). (see article in USA Today)

One other aspect of the research was that people were happier when they were competent even if the task was difficult.

So, this brings up lots of questions:

• Since we know that happy call center agents can influence customers, how do you increase their feelings of competency, autonomy, and connectedness?
• Are you better off communicating with members/patients on the weekends when they are happier?
• Who are the people that are happier at work than home?
• Since the general stereotype is that men are less competent with household chores and raising kids, did gender matter? (The article said that age, education, salary, marital status, and # of hours didn’t matter.)