Healthcare.gov is not the same as health reform aka Obamacare aka PPACA

It’s time to begin to focus on how to improve Healthcare.gov.

It seems like the government made all the classic rookie mistakes around implementation. They went for the Big Bang. They worked on it for years only to release it at the last second. They brought in tons of vendors and no one really coordinated them. They over paid for the project and didn’t tie anything to performance. They minimized the testing and complexity.

I think they’re going to make the same mistake again unfortunately. Fixing it may be harder then starting some of it over. Not the integration but the workflow. Bringing in the A-team and not delaying the penalties won’t be quick. And the new people should be smarter and slow things down so they don’t get thrown under the second bus.

But, this failure shouldn’t doom health reform. They are two different things. Sometimes I think the politicians living in their Disneyland of Washington forget more than they know.

The reality is that we have a huge, unsustainable healthcare issue in the US. We should be ashamed to have all the people without coverage that we do. While health reform won’t fix everything, it’s a stepping stone and a lot of the CMS work around innovation, ACOs, and Medicare STARS is critically to payment reform and the shift from FFS to value-based healthcare. There is still a ton of work to be done. We haven’t addressed health literacy. We haven’t addressed quality. The overall experience is still disconnected and generally poor.

The politicians need to focus on making our country better not playing games (on both sides).

And, while I disagree with the tactic, the Republican play to focus on the budget was important. We can’t bankrupt this country for our kids. While the government villianizes the Private Equity industry that leverages up companies and takes on debt risks that’s exactly what the government is doing now.

BTW – one of the interesting benefits of the healthcare.gov debacle is that it’s a ton of free advertising for the site. Everyone is talking about it for free and pulling consumer awareness up. (I doubt that was a strategy.)

Aetna’s Metabolic Syndrome Innovation Program

I’ve been closely following Aetna’s innovation for the past few years (see post on CarePass and Healthagen).  I had the chance last week to speak with Adam Scott who is the Managing Director of the Aetna Innovation Labs.

Here’s Adam’s bio:

Adam Scott is a Managing Director within Aetna’s Innovation Labs, a group developing novel clinical, platform, and engagement solutions for the next generation of healthcare.  Mr. Scott specializes in clinical innovation, with a focus on oncology, genetics, and metabolic syndrome, as well as “big data” analysis.  His work is aimed at conceptualizing and developing products and services that better predict illness, enable evidence-based care and lengthen healthy lives.  Prior to joining Aetna, Mr. Scott’s 15-year healthcare career has included management roles in consulting, hospital administration, and most recently health information technology.  Mr. Scott holds a bachelor’s degree from Washington University in St. Louis and a Masters in Business Administration from Northwestern University’s Kellogg School of Management.  Mr. Scott resides with his family in Needham, MA, where he actively serves as a director on community boards.

This is one of my favorite topics – Metabolic Syndrome (although yes…I still hate the term).

Definition of Metabolic Syndrome from the NIH:

Metabolic (met-ah-BOL-ik) syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetesand stroke.

The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

The Aetna Innovation Labs are focused on bringing concepts to scale and staying 2-3 years ahead of the market.  They are looking to rapidly pilot ideas with a focus on collecting evidence.  In general, Adam described their work as focused on clinical, platform, and engagement ideas.  They are trying to collaborate with cutting edge companies that they think they can help to scale quickly.  It’s pretty exciting!

As stated in their press release about this new effort:

“During the course of the last year, Aetna Innovation Labs has successfully piloted an analysis of Metabolic Syndrome and the creation of predictive models for Metabolic Syndrome. This prior work showed significantly increased risk of both diabetes and heart disease for those living with Metabolic Syndrome,” said Michael Palmer, vice president of Innovation at Aetna. “With this new pilot program with Newtopia, we are aiming to help members address Metabolic Syndrome through specific actions, before more serious chronic conditions arise, like diabetes and heart disease.”

Aetna selected Newtopia for this effort for their unique approach toward achieving a healthy weight with an integrative and personalized focus on nutrition, exercise, and behavioral well-being. Newtopia’s program begins with a “genetic reveal,” leveraging a saliva-based genetic test to stratify participants with respect to three genes associated with obesity, appetite, and behavior. Based on the results of this test and an online assessment, Newtopia matches each participant to a plan and coach trained to focus on the member’s specific genetic, personality and motivation profile. Through online coaching sessions, Newtopia will help members achieve results related to maintaining a healthy weight and Metabolic Syndrome risk-reduction, which will be measured by changes from a pre- and post-program biometric screening.

“Newtopia’s mission is to inspire individuals to make the lifestyle choices that can help them build healthy lives,” said Jeffrey Ruby, Founder and CEO of Newtopia.

If you’ve been following the story, this builds upon their project with GNS to develop a predictive algorithm to identify people at risk for Metabolic Syndrome.  As you may or may not know, there are 5 first factors for Metabolic Syndrome (text from NIH):

The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

  • A large waistline. This also is called abdominal obesity or “having an apple shape.” Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.

  • A high triglyceride level (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.

  • A low HDL cholesterol level (or you’re on medicine to treat low HDL cholesterol). HDL sometimes is called “good” cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.

  • High blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

  • High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

So, what exactly are they doing now.  That was the focus of my discussion with Adam.

  1. They are running data through the GNS predictive model.
  2. They are inviting people to participate in the program.  (initially focusing on 500 Aetna employees for the pilot)
  3. The employees that choose to participate then get a 3 SNP (snip) test done focused on the genes that are associated with body fat, appetite, and eating behavior.  (Maybe they should get a few of us bloggers into the pilot – hint.)  This is done through Newtopia, and the program is GINA compliant since the genetic data is never received by Aetna or the employer.
  4. The genetic analysis puts the consumer into one of eight categories.
  5. Based on the category, the consumer is matched with a personal coach who is going to help them with a care plan, an exercise plan, and a nutrition plan.  The coaching also includes a lifestyle assessment to identify the best ways to engage them and is supported by mobile and web technology.
    newtopia
  6. The Newtopia coaches are then using the Pebble technology to track activity and upload that into a portal and into their system.

We then talked about several of the other activities that are important for this to be successful:

  • Use of Motivational Interviewing or other evidence-based approaches for engagement.  In this case, Newtopia is providing the coaching using a proprietary approach based on the genetic data.
  • Providing offline support.  In this case, Aetna has partnered with Duke to provide the Metabolic Health in Small Bytes program which he described as a virtual coaching program.

Metabolic Health in Small Bytes uses a virtual classroom technology, where participants can interact with each other and the instructor. All of the program instructors have completed a program outlined by lead program developer Ruth Wolever, PhD from Duke Diet and Fitness Center and Duke Integrative Medicine. Using mindfulness techniques from the program, participants learn practices they can use to combat the root causes of obesity. The program’s goal is to help participants better understand their emotional state, enhance their knowledge of how to improve exercise and nutrition, and access internal motivation to do so. (source)

We also talked about employer feedback and willingness to adopt solutions like this.  From my conversations, I think employers are hesitant to go down this path.  Metabolic Syndrome affects about 23.7% of the population.  That is a large group of consumers to engage, and pending final ROI analysis will likely scare some employers off.

Adam told me that they’ve talked with 30 of their large clients, consultants, and mid-market clients.  While we didn’t get into specifics, we talked about all the reasons they should do this:

  • People with Metabolic Syndrome are 1.6x more expensive
  • People with Metabolic Syndrome are 5x more likely to get diabetes
  • Absenteeism
  • Presenteeism

This ties well with my argument that wellness programs aren’t just about ROI.

Obviously, one of the next steps will be figuring out how this integrates into their other existing programs to address the overall consumer experience so that it’s not just another cool (but disconnected) program.  And, of course, to demonstrate the effectiveness of the program to get clients and consumers to participate.

Two quotes I’ll leave you with on why this is difficult (but yet exciting to try to solve):

“The harsh reality is that scientists know as much about curing obesity as they do about curing the common cold: not much. But at least they admit their limitations in treating the cold. Many doctors seem to think the cure for obesity exists, but obese patients just don’t comply. Doctors often have less respect for obese patients, believing if they would just diet and exercise they’d be slim and healthy.” (source)

Thirty percent of those in the “overweight” class believed they were actually normal size, while 70% of those classified as obese felt they were simply overweight. Among the heaviest group, the morbidly obese, almost 60% pegged themselves as obese, while another 39% considered themselves merely overweight. (source)

10 Healthcare Projects I’d Like To Solve

I always tend to see the glass half full so when I see a problem then I often want to rush in and try to fix it. With that said, here are 10 things that I’ve thought about that I’d like to fix or see as big opportunities:

1. The healthcare experience. While this is the third leg of the Triple Aim, it often seems like the one that is so hard for healthcare companies to get. The system is so fragmented that the patient often is forgotten.

2. Device integration. While devices are better and integration is possible, there is still a huge lift to integrate my data into the typical clinical workflow. This is only going to get much worse with ubiquitous use of sensors and will be the limiting factor in the growth of the Quantified Self movement. (See my post on FitBit)

3. Intelligent phones. This is something that people carry everywhere. They often live life through the phone sometimes missing out on reality. The phone has tons of data as I’ve described before. We have to figure out how to tap into this in a less disruptive way.

4. Consumer preferences. I’m a big believer in preference-based marketing. But the question is how do I disclose my preferences, to whom, and are my preferences really the best way to get me to engage. What would be ideal is if we could find a way to scale down fMRI technology and allow us to disclose this information to key companies so they could get us to take actions that were in our best interest. (see old post on Buyology)

5. Benefits selection. I’ve picked the wrong benefits a few times. This drives me crazy. As I mentioned the other day, the technology to help with this exists and all the data which sits in EMRs and PHRs should allow us to fix this problem.

6. The role of retail pharmacy. This is one of my favorite topics. With more retail pharmacies than McDonalds and a huge problem of access, pharmacies could be the key turning point in influencing change in this country.

7. Caregiver empowerment. Anyone who cares for an adult and/or child knows how hard it is to be a caregiver and take care of their own needs. This becomes even harder with the people being geographically apart. With all the sensors and remote technology out there, I see this being a hot space in the next decade.

8. The smart house. As an architect, I’ve always dreamed of helping create the intelligent house where it knows what food you have. It manages your heat and light. It tracks your movements and could call for help if you fall. I see this being an opportunity to empower seniors to live at home longer.

9. Helping the disenfranchised. For years, we’ve all seen data showing that income can affect health. The question is how will we fix this. Coverage for all is certainly a critical step but that won’t fix it. We have a huge health literacy issue also. Ultimately, public health needs a program like we had to get people to wear seat belts. We need yo own our fate and change it before we end up like the humans in the movie Wall-e.

10. A Hispanic healthcare company in the US. With 16% of the US that speak Spanish, I’m shocked that I haven’t seen someone come out with a health and wellness company that is Hispanic centric in terms of the approach to improving care, engaging consumers, and providing support.

So, what would you like to solve?

The Healthcare Mark-up Game – Driving Up Healthcare Costs

The idea of healthcare costs and the need for healthcare transparency has become a front page issue. With the shift to consumer driven healthcare and high deductible plans, the average consumer is increasingly aware of what things cost. And companies like Change Healthcare provide tools to help consumers navigate this maze.

But, what I don’t hear many people discuss is the issue of middlemen and how this adds cost to the system. I’ve worked for several middlemen so I think I understand the model well. Of course, these companies make good (and true) arguments which is that they lower costs due to scale based efficiencies. But, healthcare is big business so everyone has to get paid somehow. Some of the “non-profits” make the most money.

Let’s look at prescription drugs:
– This begins with the manufacturer who adds the marketing and sales costs to the actual ingredient and packaging and shipping costs.
– The drug is then shipped to a wholesaler who stocks the drugs and ships them to pharmacies.
– The drugs are then sold by the pharmacy to the consumer and the pharmacy bills the payer.
– Assuming the payer isn’t the actual employer, the payer will then bill the employer.

So who all gets paid in this process:
– The manufacturer of the drug
– The advertising companies (they name the drug, they create the packaging, they create the ads)
– The marketing companies (they set up the websites, they create the mobile apps)
– The law firms (trademarks, patents)
– The sales companies (they hire and manage the pharma reps)
– The data company (the manage the Rx data to help target the reps)
– The shipping companies (transportation)
– The wholesaler
– The pharmacy
– The marketing and communication companies (refill programs, on the bag messaging)
– The technology companies (switch company, adjudication company)
– The recruiters (hiring, staffing)
– The PBM (contracting, rebating, customer service)
– The payer (adjudication, customer service, risk management)
– The broker (commission)

Still wonder why healthcare is expensive?

I wish I had an easy answer. A lot of these services are needed and it would cost more if the employers all had to do this themselves. There would be no scale. There would be no efficiencies.

This is certainly one argument for the efficiencies of a single payer system but I don’t think that’s very efficient IMHO.

Why Wall Street Would Love An Rx Report Card By Company

I think this is true for both Wall Street along with prospective employees. I think both would love to have a report card on the prevalence of prescription drug use within a company?

– Is there an abnormally high use of anti-depressants?

– Is there an abnormally high use of sleep medications?

– Is there an abnormally high use of anti-virals associated with STDs?

All of these might indicate cultural problems which would be early indicators of turnover or other issues.

On the flipside, there might be other health data points that provide additional data.

– What is the average step count for the population?

– What percentage of the population play sports?

– How many people have metabolic syndrome?

– How many hours do people sleep?

– Are there treadmill desks and other tools to support good health?

– What percentage of people eat lunch by themselves or at their desk or in a meeting?

– What percentage of people call the EAP line?

What other health data points would you want?

The 15 Year Old Technology Missing From Healthcare.gov

I talked about my experience trying to use the site day one. I honestly hoped it was an anomaly but it doesn’t seem to be.

But, as I think about Healthcare.gov and the general benefits selection process, I see two huge gaps.

Back in 1999, I was working with a company called Firepond. The had what was called a product configurator. At the time, I was at E&Y and Empire BCBS and several other Blues hired them to build a tool for brokers. The tool sat behind a really slick web interface which allowed the broker to ask a consumer less than 10 questions. They would move a sliding bar across the screen and it would dynamically rank their plan options to tell them what was the best option for them to buy. It seems like that wold be great for Medicare.gov and Healthcare.gov.

What we were missing then which Big Data might actually help us solve now is individual claims data. This is what drives me crazy when you have to pick your benefits at work. Why can’t I upload my benefits information and have a tool actually tell me what to buy? If I had my claims history plus a predictive model, I could make smarter decisions about how to select my benefits.

7 Steps To Manage Specialty Drugs – From Prime Therapeutics

Prime Therapeutics is a PBM owned by the Blues.  Several years ago, they insourced their specialty pharmacy operations from Walgreens.  This has been part of their transformation which was a result of new leadership under Eric Elliott who used to run Cigna’s PBM.  

As a PBM that’s owned by the Blues, I’ve talked about them before as an interesting cross of a standalone PBM (ala Express Scripts) and an integrated PBM (ala Humana Rightsource).  

As everyone in the industry knows, the shift in pharmacy has moved from innovator drugs in the traditional space to innovation in the specialty or biopharmaceutical space.  This includes both branded products and biosimilars.  This is critical path for employers, payers, and PBMs.  

A traditional strategy of promoting generic drugs and mail order or preferred pharmacies just doesn’t cut it anymore.  Although specialty drugs are still only used by about 1% of the population, they are the fastest growing area in healthcare.  According to Prime Therapeutics Drug Trend Report, their clients saw a 19% increase in specialty spending last year.  And, specialty drugs now account for over 30% of all the drug spend.  

If you look at the drug pipeline, this is going to continue to explode.  I just met with a series of specialty pharmacies to discuss their offerings and strategies.  There are several drugs coming that claim to “cure” some of these specialty conditions are at least meaningfully impact the patient outcomes in ways that weren’t even envisioned years ago.  And, I think we all know that’s not going to come cheap!

So, tomorrow (10/10/13), Prime is releasing a new report – “Specialty: Today & Tomorrow” which highlights Prime’s specialty drug trend over the past year and recommends strategies that high-performing plans use to manage the steady rise in these costs.  [My comments in brackets.]

1.        Bridge the benefit divide: use combined pharmacy and medical benefit data to see the full scope of specialty spending and seek solutions.  [Critical.  IMO – No one is doing this well yet, but this is something that everyone’s trying to figure out.]

2.        Focus on the biggest issues: use combined data to target the most urgent issues and focus on the areas that can provide the greatest return on investment.  [I’d expand this to be an integrated set of data – medical, pharmacy, lab, patient reported, EMR, etc.  This has to then be integrated with tools for depression screening and others to make sure the patient is supported.]

3.        Narrow the specialty network: use cost-effective distribution channels and limit the number of distributors to secure lower prices. [Fairly obvious.  I think many people are doing this.  I would expand on this to include looking at site of distribution for savings.]

4.        Embrace a management mindset: make sure the right specialty drugs are used properly by those who will benefit the most. [Agree.  I’ve talked about this before.  Some of these drugs still have huge adherence issues which limits their effectiveness leading to massive cost issues.  This is why some people are using only 14-day fills.]

5.        Promote preferred drug use: build plans that encourage desired behaviors. [I think we’re finally at a point where we’ll see specialty formularies, more rebating, and with bio-similars there may be more utilization management programs.]

6.        Protect members from high costs: limit members’ out-of-pocket costs and use available tools to reduce the burden on highly vulnerable members. [Critical.  The specialty pharmacy has to help the member limit their financial exposure.]

7.        Pick the right partner: select a trusted advisor with comprehensive capabilities and deep connections to help anticipate and address specialty drug challenges.  [Agree.  An aligned philosophy and strategy to work with these critical patients is fundamental.  This small group of patients drives most healthcare costs.] 

A copy of the specialty report is now available on Prime’s website and short videos about each of the seven steps can be found on Prime’s You Tube channel. This new report is the first specialty-focused report published by Prime. It follows Prime’s 2013 Drug Trend Insights infographic released in May. Visit the Industry Insights of Prime’s website for more drug trend information. 

Retail Pharmacies As The Distribution Point For Information

It’s always exciting to be “right” in a prediction.  When I spoke at the CBI conference a few weeks ago, one of the key points I made was that today’s healthcare consumer is overwhelmed with information.  They get conflicting data.  They don’t have enough time with their physicians.  They are increasingly responsible for decisions and even with transparency, they don’t always know what to do.  With that in mind, one of my suggestions was that retail pharmacies had a great opportunity to step in and be this information management source for consumers.  (aka – The retailers can serve as the physical resource for the retailing of healthcare.)

With that in mind, I find the announcements by Walgreens and CVS very interesting.

From the CVS press release:

“Humana’s partnership with CVS/pharmacy reflects our proven and ongoing commitment to educate individuals and their families at the places they go when they have questions about their health,” said Roy A. Beveridge, MD, Humana’s Chief Medical Officer. “We’re working to ensure people develop a better understanding of how their health coverage can help them make better, and healthier, decisions.”

“Providing information about new health insurance coverage opportunities is in keeping with our purpose of helping people on their path to better health,” said Helena Foulkes, Executive Vice President and Chief Health Care Strategy and Marketing Officer for CVS Caremark. “We are pleased to combine our innovative suite of services and our new and existing relationships with organizations such as Humana to help patients understand and have access to information about insurance options in their community.

From the Walgreen’s press release:

Walgreens store personnel are directing individual customers who inquire to the GoHealth Marketplace, a resource where they can shop and compare health insurance plans, enroll and find other important tools and information. Consumers can access the GoHealth Marketplace online from www.walgreens.com/healthcarereform or via phone at 855-487-6969. Walgreens also is providing informational brochures and other materials in stores.

“As an accessible, community health care provider serving more than 6 million people each day, Walgreens can help connect those customers who may be considering new health insurance options with resources and information,” said Brad Fluegel, Walgreens senior vice president and chief strategy officer. “Our goal is to help ensure people fully understand the marketplace, and working with GoHealth, to provide personalized consultation from experts who can help them make informed decisions.”

In both cases, they may have addressed one of my questions about this strategy from my presentation which was how would they monetize this.  I think it’s the right role, but I wasn’t sure how it would lead to revenue other than general revenue related to store traffic.  I assume both of these have some “commission” or “referral fee” for traffic generated.

Interesting Survey Results About Obamacare

Given all the buzz about healthcare exchanges (much of it echoing what I talked about last week), I thought this was an interesting study from Coupa Software.

From the press release they sent me…

The results highlight just how divided the healthcare community is over the new law:

93% believe there will be negative outcomes from the new law, including:

  • Quality of insurance policies will suffer (53%)
  • Quality of healthcare will suffer (51%)
  • Americans will die earlier (19%)

74 percent felt there would be also be positive benefits for patients, including:

  • More Americans will have some level of coverage (57%) 
  • Increased preventative care services (36%)
  • Lower hospital bills for patients (21%)

78% identified spending inefficiencies in their workplace, including wasteful spending

66% believe Obamacare will eliminate some of those inefficiencies

    • More Americans will have some level of coverage (57%)
    • Increased preventative care services (36%)
    • Lower hospital bills for patients (21%)

Here’s a look at the raw data: https://www.instant.ly/report/52386bb2e4b0c02bc208a937

Healthcare.gov Registration Process – My Experience…Not Good

I was up and ready to try the new healthcare exchanges at HealthCare.gov this morning.  While it started well with a nice GUI (graphic user interface), it went downhill from there.

Once I got in, it was busy so I had to hold.  

Then, when I tried to create a username and followed the directions, it wouldn’t accept my username.  

And, finally, when I got through it all, it wouldn’t accept who I was to let me proceed.  

If everyone else has a similar experience, this is either going to be a miserable failure or the call centers are going to be lit up with phone calls and huge waits.  I guess to answer the question that the CEO of BCBS of NC poised the other day…this won’t reflect badly on the plans because I can’t even get far enough into the process to see what plans participate.  

The one positive (other than the design) was that the terms and conditions were ridiculously simple!

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The Connected Pharmacy of 2020

At the conference last week, I was talking about the opportunity for retail pharmacy to play a broader role as the patient’s medical home.  As part of that discussion, I tried to create a vision of a digitally connected location.  Here’s my summary of that…

Imagine that the pill bottle you use is now a smart object (expanding on the RxVitality concept).  It now knows when you are running low on pills.  Since it’s connected to your WiFi signal and to your smart phone, as soon as you’re low, it does the following:

  • Send a new refill request to the pharmacy (or to your physician if you’re out of refills)
  • Puts a reminder in your phone for you to pick up the prescription (action item list, calendar) and updates that once it gets confirmation on time from the pharmacy

As you’re driving by the pharmacy, your smart phone reminds you to pick up the Rx as it knows where you are based on GPS.

When you enter the pharmacy, it has a system to capture information from your devices or phone about your sleeping habits, what you’ve been eating, and your exercise.  All of this information is important for them to actively manage your health.  Additionally, as you enter the pharmacy, they use a technology like FaceDeals to recognize you and do several things:

  • Alert the pharmacy that you’re in the store so they can pull your prescription
  • Pull up your CRM (customer relationship management) profile so they pharmacist and tech can great you by name and link back to other information (i.e., Hi George.  Are you here to pick up your prescription?  By the way, how did those crutches work out?)
  • Offer you a coupon on some new OTCs or medical supplies based on your chronic disease(s)

While you’re shopping (at a grocery or big box pharmacy), you’re linking your smart phone to the smart cart which is helping you navigate the store.  As it confirms your identify via fingerprint or facial recognition, it opens up a link to your medical data.  This allows the cart to help you navigate the store and scans everything you put into the cart to look for drug-food interactions (e.g., grapefruit juice).  It also helps to steer you to better food options (eat this not that) based on your diagnoses (i.e., for a diabetic, I would suggest this other cereal).  All of this is happening on your screen to protect your privacy.

By the time you get to the pharmacy, you stand in front of the register which has a scale embedded in the floor so they can instantly know your weight and compare that to your last measurement.  Since they are now tied into your medical data, the Point of Sale technology also gets relevant alerts that they can talk with you about (e.g., Did you know that your health coverage has changed?  Did you know that you have access to a health coach to discuss your condition?).

As you leave, all of the data they collected is integrated and pushed out to both your personal health record (PHR) along with the electronic medical record (EHR) that your physician uses.  Any new risks identified are also shared with your caregiver or others in your social circle that you’ve identified and opted-in to receive information.  This social connectivity helps to create the village necessary to drive change.

Scary or fascinating?  I prefer to think about this as a fascinating way of leveraging technology and data to make my experience better and improve my outcomes, but I know not everyone will feel that way.

I Thought I Got To Keep My Doctor In Health Reform

We all remember when President Obama pointed out that you wouldn’t have to change your doctor with health reform.  That’s probably true in the most expensive plans, but you can’t always eat your cake and keep it too.

We know healthcare prices vary from semi-rational to outrageous.  It would be hard to get any concessions if every physician had to be in the network.  So, like we’ve seen in pharmacy with some initial screaming but general acceptance, plans are going to reduce the size of their networks in return for some price concessions.

Should this be a surprise?  No…unless you actually believe politicians.

Will this lead to a different set of issues around monitoring out of network use?  Yes.  This is something plans historically don’t do very well.

What Will Really Happen October 1st For Health Reform?

10/1/13…That is the date that the healthcare exchanges will go-live (or at least are supposed to go live).  As of a week ago, the testing hadn’t even begun.  Will they actually get through all the testing and go-live in time?  It will be a huge failure if they don’t.

On the flipside, if they go live but the experience is horrible and pricing is wrong, will that reflect poorly on the exchanges or on the health insurance companies?  I know several of the large health insurance companies who are ready (or as ready as they can be) are worried about that.  

There are other issues to be sure:

  1. Do people even know that the exchanges exist?  (A recent survey said only 27% of young people did.)
  2. If people know, will they come to buy insurance?  Will they understand the exchanges and that they can get a subsidy?
  3. Will exchanges end up with only the sick or will there be a mix of healthy and sick?  (This will eventually be an issue, but plans will have to underwrite for 2015 exchange pricing before they really understand this.)

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Sorry…Put A Few Posts On The Wrong Blog

To those that get my blog posts e-mailed to them, sorry about any confusion.  I used to maintain a family history blog, and had a few requests to update it.  I posted a few things to the wrong site this morning.  

Retail Pharmacy As The Digital Medical Home

I’m excited to deliver my presentation on the topic about the retail pharmacy as the digital medical home tomorrow at the intersection of three CBI conferences – Point of Care Summit, Retail Strategy Summit, and Strategic Distribution Planning for Specialty Products.  As always, I’m sharing my slides below via SlideShare, and I’ll set up some tweets to give you the cliff note version.

The key here IMHO is that retailers are best positioned to take advantage of this, but the key points are:

  1. Why retail pharmacy?
    • Retail pharmacies have trust from consumers.
    • Easily accessible.
    • Pharmacy is the most used benefit.
  2. What’s the challenge?
    • Successfully engaging the consumer.
    • Integration with the provider so there are process oriented care gaps.
    • Data.
  3. What needs to happen?
    • Focus on the golden moments for engagement.
    • Systemic model for engagement – e.g., Prochaska.
    • Tools and skills to motivate the consumer – e.g., Motivational Interviewing, Incentives.

Is Wellness Really Just About ROI?

Al Lewis and Tom Emerick posted a great article on the HBR blog about the Danger of Wellness Programs.  It reminds me a lot of what my old boss published after she left Healthways, but as the old expression goes – don’t throw the baby out with the bathwater.

I’ve talked about this before in my post on why CVS asking for their employees weight was a good thing, but let me elaborate more.  While the HBR article makes some great points about ROI, the reality is that companies don’t just jump into wellness for the ROI.  It’s about creating a better workforce.  What Al Lewis and his partner ignore are other realities like:

In general, only 12% of people are fully health literate.  Most people are unengaged with their healthcare and overwhelmed with work and life.  That’s why programs like biometrics and health risk assessments are important.  They try to create teaching moments for us to pay attention to our health and realize our risks.

Interview With Authors of Anxious Kids, Anxious Parents

After getting a press release about their new book, I did an e-mail interview with the authors of the book “Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous & Independent Children”.    

A quick bio on the authors Reid Wilson, PhD and Lynn Lyons, LICSW is below:

  • Reid Wilson, Ph.D. is the Clinical Associate Professor of Psychiatry at the University of North Carolina School of Medicine. He is author of Don’t Panic: Taking Control of Anxiety Attacks and the coauthor of Stop Obsessing! How to Overcome Your Obsessions and Compulsions.
  • Lynn Lyons, LICSW, is a licensed clinical social worker and psychotherapist in private practice and a sought-after speaker and consultant. She specializes in the treatment of anxiety disorders in adults and children, including generalized anxiety, phobias, social anxiety, obsessive compulsive disorder, and performance anxiety.

I didn’t get a chance to read the book, but from the teaser I received, I had a few questions which they answered for me.

What percentage of children have a diagnosable anxiety disorder today?  

 

Research estimates that one in five children and adolescents have a diagnosable anxiety disorder. This does not mean that all of these children receive treatment, but that they have symptoms of anxiety that meet the criteria for an anxiety disorder. 

How has the prevalence of anxiety increased over the years?  

 

Although we don’t have exact data on the increase of anxiety disorders in children, we do know that research and understanding of anxiety in children has increased dramatically over the last two decades. More children are diagnosed based on a much greater knowledge and awareness of anxiety disorders such as Obsessive Compulsive Disorder and Post Traumatic Stress Disorder. Anecdotally, adults report greater stress levels, and we know that parental stress, anxiety and depression impacts childhood anxiety. Anxiety is the leading reason that a parent seeks out mental health treatment for a child, and most clinicians who work with anxious children are very busy these days!  

Is there a test to know when someone is clinically anxious or just feels anxious?  (i.e., when should parents seek help?)

First, it’s important to remember that anxiety is normal. It happens to all of us and is very helpful when dealing with danger. The warning system and fight-or-flight reaction is an important part of survival, so should be respected and appreciated. There is no “test” for an anxiety disorder. We look at the symptoms and functioning of a child to determine the diagnosis. Anxiety becomes a disorder when the child spends significant time managing the anxiety, or remains highly distressed due to their fear, or significantly limits their participation in normal life activities. For example, a family might expend a lot of energy making sure that a child doesn’t “freak out,” so the distress might be minimal, but only because everyone is working so hard to avoid any triggers. Or a child may be unable to manage daily events, such as going to school or friends’ houses, sleeping alone, or participating in new activities. Anxious children can also be very rigid, demanding that adults follow anxiety’s rules. When a child cannot handle changes in routine without great distress, and when a family feels that anxiety is in charge of the family’s functioning, then help is needed.   

How does childhood anxiety show up in a kid’s behavior?

 

Avoidance is anxiety’s calling card. When a child consistently avoids, or becomes overly upset when avoidance isn’t possible, then anxiety is often the culprit. Other signs are when they become rigid about how things need to be done, when they have difficulty with new experiences or with uncertainty about how events are going to turn out, or when they begin skipping “fun” events because of fear or worry. Sometimes children are very good at expressing their fear, worries, or nervousness; again, this can be normal. If their worry prevents them from moving forward, and they tend to cry, throw a tantrum, or ask for excessive reassurance, then anxiety is probably in charge. 

How does someone treat childhood anxiety – counseling, medication, other?

One great thing about being in the anxiety business is that it is a very treatable problem. Once you know how it functions, it’s not all that mysterious. Therapy is highly effective when it focuses on teaching children and parents how anxiety operates and then gives them concrete skills to handle anxiety’s predictable tricks. We work with parents and children together to make sure that patterns of avoidance and overprotection are interrupted, and we give kids concrete strategies to deal with anxiety when it shows up. Therapy should be active and experiential, meaning that families should have homework assignments that give them the experience of moving into uncertainty and then handling it. 

Medication can help, but, if given the opportunity, we’d rather work with a family on learning new strategies first. Most kids and parents benefit greatly from psycho-education and skills. Even when medication is used, we don’t recommend it as the only course of treatment for children and teens. 

What are the other impacts of childhood anxiety as someone grows older?

 

Anxiety in childhood is a very strong predictor of both anxiety and depression in later life. The more episodes of anxiety a teen has, the less likely they are to complete college. Most adults with anxiety report that they began having symptoms as a child, so we know that anxiety just doesn’t go away in children if left untreated; it actually gets stronger and leads to other diagnoses and problems. As you can imagine, if avoidance is your best coping strategy, you miss out on many experiences in life. Anxiety impacts relationships, career, and the ability to live independently. Risk of substance abuse is also increased as anxious teens and young adults self-medicate their symptoms. 

What will the book teach parents and/or kids that will help them improve their level of anxiety?

 

Our book focuses on the importance of teaching children and teens how to handle uncertainty and discomfort. We normalize anxiety as a part of growing and developing, and we give parents concrete ways to support moving toward anxiety, rather than avoiding it. We help parents to understand that keeping their anxious child safe and comfortable actually makes anxiety stronger. We offer them a step-by-step plan to deal with anxiety when it (inevitably) shows up. Research tells us that anxious parents tend to have anxious kids. Our goal is to interrupt the transmission of anxiety from one generation to the next by helping parents react differently to their children’s worry and their own. And, actually, the skills we teach are preventative: handling uncertainty, being a problem solver, and knowing how to talk back to worry and move forward into life’s challenges are skills that all children should learn. 

Personal Example Of How Zip Code Affects Health

The Robert Woods Johnson Foundation has been talking about this issue for a while.  Yesterday, they released some great pictures of this within a few cities.

It got me thinking about how where you live influences your health.  Here’s a very personal example from the three houses I’ve lived in as an adult.

  • At my first house, all of my neighbors ran so I eventually started running with them leading up to me running three marathons.  
  • At my second house, all of my neighbors played poker 1-2 times per month which was a great social activity (although not so great on the calorie count those nights).
  • At our new home in Charlotte, I haven’t found a running club or a poker group or even a golf group, but I’ve been invited to play tennis with a group of guys that play “recreational” tennis weekly.  

Each of these are directly influencing several things – activity, diet, sleep, and social interactions.  

I’ll have to hold off judgement on the tennis group since it hasn’t started yet.  I had to ask my kids to start helping me since the last time I played an adult in tennis was in 9th grade with my dad.  I’ve played with my kids for a few years, but they generally play with their opposite hand to prevent beating me too badly.  (which either says something about me or them in terms of play)

World Suicide Prevention Day 2013

Today, September 10th is World Suicide Prevention Day.  For many people, this may just seem like another day that gets used to recognize a cause.  To others, this is a day to acknowledge some of the scary statistics around suicide including:

  • There is one suicide every 40 seconds worldwide.
  • For every “successful” suicide, there are 20 failed attempts.
  • Therefore, there is one attempted suicide every 2-3 seconds.

These are 2011 statistics which were projected to increase 50% by 2020.  

I think a lot of people mistakenly think of suicide as a teenage issue, but it’s not.  Many of you have probably seen articles in the US about suicides in the military which happen almost daily.  The suicide rate among middle-aged Americans has risen dramatically also.  A few years ago with several high profile suicides in the LGBT community there was a big focus on this with the It Gets Better Project.  

If you haven’t been touched by suicide in your life, you’re lucky.  I unfortunately can think of several people I know:

  • My friend from high school who killed himself.
  • My friend from grade school who’s brother killed himself.
  • A kid in my high school, that killed himself.
  • A friend’s ex-husband who just killed himself a few months ago.
  • A former co-worker who killed himself.

People who have attempted suicide usually aren’t very willing to talk about it based on the risk of being stigmatized, but this TED video is by one survivor speaking out.  

 

The key is for people to recognize the signs (when possible) and engage people.  The Cleveland Clinic and WebMD give some good information on the topic.  Here’s a list from the Cleveland Clinic site:

  • Excessive sadness or moodiness — Long-lasting sadness and mood swings can be symptoms of depression, a major risk factor for suicide.

  • Sudden calmness — Suddenly becoming calm after a period of depression or moodiness can be a sign that the person has made a decision to end his or her life.

  • Withdrawal — Choosing to be alone and avoiding friends or social activities also are possible symptoms of depression. This includes the loss of interest or pleasure in activities the person previously enjoyed.

  • Changes in personality and/or appearance — A person who is considering suicide might exhibit a change in attitude or behavior, such as speaking or moving with unusual speed or slowness. In addition, the person might suddenly become less concerned about his or her personal appearance.

  • Dangerous or self-harmful behavior — Potentially dangerous behavior, such as reckless driving, engaging in unsafe sex, and increased use of drugs and/or alcohol might indicate that the person no longer values his or her life.

  • Recent trauma or life crisis — A major life crisis might trigger a suicide attempt. Crises include the death of a loved one or pet, divorce or break-up of a relationship, diagnosis of a major illness, loss of a job, or serious financial problems.

  • Making preparations — Often, a person considering suicide will begin to put his or her personal business in order. This might include visiting friends and family members, giving away personal possessions, making a will, and cleaning up his or her room or home. Some people will write a note before committing suicide.

  • Threatening suicide — Not everyone who is considering suicide will say so, and not everyone who threatens suicide will follow through with it. However, every threat of suicide should be taken seriously.

The Mayo Clinic gives this list of things to do:

  • Encourage the person to seek treatment. Someone who is suicidal or has severe depression may not have the energy or motivation to find help. If your friend or loved one doesn’t want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or other trusted person. You can help by offering support and advice — but remember that it’s not your job to become a substitute for a mental health provider.

  • Offer to help the person take steps to get assistance and support. For example, you can research treatment options, make phone calls and review insurance benefit information, or even offer to go with the person to an appointment.

  • Encourage the person to communicate with you. Someone who’s suicidal may be tempted to bottle up feelings because he or she feels ashamed, guilty or embarrassed. Be supportive and understanding, and express your opinions without placing blame. Listen attentively and avoid interrupting.

  • Be respectful and acknowledge the person’s feelings. Don’t try to talk the person out of his or her feelings or express shock. Remember, even though someone who’s suicidal isn’t thinking logically, the emotions are real. Not respecting how the person feels can shut down communication.

  • Don’t be patronizing or judgmental. For example, don’t tell someone, “things could be worse” or “you have everything to live for.” Instead, ask questions such as, “What’s causing you to feel so bad?” “What would make you feel better?” or “How can I help?”

  • Never promise to keep someone’s suicidal feelings a secret. Be understanding, but explain that you may not be able to keep such a promise if you think the person’s life is in danger. At that point, you have to get help.

  • Offer reassurance that things will get better. When someone is suicidal, it seems as if nothing will make things better. Reassure the person that these feelings are temporary, and that with appropriate treatment, he or she will feel better about life again.

  • Encourage the person to avoid alcohol and drug use. Using drugs or alcohol may seem to ease the painful feelings, but ultimately it makes things worse — it can lead to reckless behavior or feeling more depressed. If the person can’t quit on his or her own, offer to help find treatment.

  • Remove potentially dangerous items from the person’s home, if possible. If you can, make sure the person doesn’t have items around that could be used to commit suicide — such as knives, razors, guns or drugs. If the person takes a medication that could be used for overdose, encourage him or her to have someone safeguard it and give it as prescribed.

Get SMAC’d (Social, Mobile, Analytics, and Cloud) and BYOD

I was reading the mHealth Trends and Strategies 2013 by netcentric strategies, and I thought I would share a few things from the report.  Of course, I like the acronym SMAC which I re-used in the title and in a recent presentation.  

  • Mobile phone use for health information reached 75M in 2012.
  • Tablet activity for healthcare reached 29M in 2012.
  • 50% of people will download mHealth applications (prediction).

“mHealth is not a separate industry, but rather it’s the future of a healthcare industry that’s evolving to care for patients differently, putting them first to deliver services better, faster, and less expensively.”  quote from David Levy, MD, Global Healthcare Leader at PwC

  • Only 27% of MD actively encourage patients to manage their own health through mHealth applications.  (problem)
  • 13% of MDs actively discourage mHealth participation.

There is a whole section on remote patient monitoring with some good points about the system and the financial case. There is another section on preventative technology talking about adherence and compliance.  It makes a key point which I believe is that technology will be welcomed by the 7M long-distance caregivers.  

And, if you haven’t heard the term yet – BYOD.  This stands for Bring Your Own Device which is about letting the user chose the device / interface that works for them but being flexible in terms of normalizing the data and using it within the workflow that you develop.  

It’s a good, quick read.  

The New Grade – A, B, C, D, Fat

We all know childhood obesity is a big issue and many parents don’t realize it.  But, I didn’t realize that for a few years now some schools have been changing the traditional report card to include new letters – BMI.

This is hot topic that I’ve highlighted in a few posts about boy scouts and obesity and in the new categorization of obesity as a disease.  We’ve also seen a huge rise in companies focused on biometrics like BMI.

So, is this movement at schools good or bad?

Here’s a few points to consider:

  • We learn early in life so helping kids to understand the importance of health early is important.
  • Most parents don’t know their kids are overweight and are often overweight themselves.
  • PCPs are encouraged to track BMI on an annual basis and report on it (but most don’t).

On the flipside:

  • Some people would argue that BMI’s not a good measure of health.
  • It doesn’t do much good to just tell people they’re overweight if you’re not going to provide a solution to help them manage their weight.
  • Schools already offer less physical activity and often may not have great food choices.

One other thing I think people overlook is that they assume just because their kids are active or play sports that they can eat whatever they want or that they’re actually getting enough exercise.

OMG – Prescription Coupons Could Cost Consumers More

Talk about an article that seems a few years late to the party…

Anyways, I was reading a link from the PCMA today about an article on philly.com about copay cards.  It stresses several points:

  • The cards are typically only for 90-days.
  • The cards get people started on brand drugs not generics.
  • People are less likely to switch to generics after they use the brand.
  • This costs people more money over time.

I’ve talked about copay cards many times and presented on this topic at the PCMA conference a few years ago.

Let me give some quick thoughts here.

  1. The cards may typically be for only 90-days, but most people that drop off therapy or titrate to other strengths do so in the first 90-days so perhaps this is saving some money.
  2. Of course, it’s for brand drugs not generics.  That’s the business model we’ve created in this country where generics are priced at pennies so there is no marketing to support those products.  It’s the PBMs and pharmacies that do the marketing for generics since they are the ones making money here.
  3. I think it’s a fair generalization that people are less likely to switch, but this is the problem.  If the drugs are the same (per the FDA), why is this an issue?  Is it an educational issue.  Or, is there really a difference?
  4. I’m not sure the consumer cost is the issue.  That’s marketing 101.  Don’t most consumers understand this issue that sales and coupons drive you to build loyalty often to higher priced products.  I think the debate here needs to stay on the payer who pays 70-80% of the drug costs.  They are the ones who really have an issue here since they don’t control the decision made in the market.

This one doesn’t seem to be going away, but I’m not seeing any net new information.

A New Approach To Care: Health Incentives In The Affordable Care Act (Guest Post)

Preventative Care is a key aspect of the Affordable Care Act that stands to benefit millions of Americans, in ways that you might not expect.

The term describes an array of services, programs, and incentives that are funded by the government in order to make people healthier. Contrary to what you might think, however, the funds are not limited to impacting care on the individual level.

Rather, the reforms will include everything from building public health centers to creating bike lanes and walking paths. Not to mention, free immunizations for individuals and families.

It’s important for consumers to understand what these changes could mean for them, in every respect. With this thought in mind, let’s explore the ways in which individuals, families, and communities will be impacted by these new reforms.

Individual and Family Health

Individuals and families will benefit tremendously from a host of preventative services that will be offered free of charge by insurance providers, regardless of pre-existing conditions.

Offered services will include: Breast cancer screenings, wellness checkups, domestic violence screenings, contraception, and breast-feeding supplies. Immunizations, counseling services, and depression screenings will also be made available as a result of the new legislation.

For many Americas, this change will mean first time access to potentially life-saving services that work in turn to promote further wellness among individuals, families, local and regional communities.

Public Health and Prevention

Without funding, reforms are simply laws on the books that don’t have any real-world import.

In 2010, The Prevention and Public Health Fund was created in order to ensure that care actually gets to the people who need it, through the development of programs that mobilize entire communities toward the goal of better health.

The fund’s initial budget has been compromised since 2010, but local governments have already received an estimated $290 million to put towards the development of healthy eating programs that are aimed at some of our nation’s deadliest health issues, such as child obesity and diabetes. Funding has also been put to work through infrastructure development to create sidewalks and bike paths, in an effort to encourage daily exercise.

Although the Prevention and Public Health Fund has met some opposition from congressional republicans, the potential for positive impact is clear.

Smoker’s Penalty: Two Sides Of The Same Coin

The Affordable Care Act takes a bold stance on smoking.

The Smoker’s Penalty, as it’s come to be known, has to do specifically with plans offered in the state health insurance marketplaces, which will open for business this October.

Under the ACA, insurance providers are allowed to charge smokers up to 50% more for their coverage than non-smokers, due to the associated health risks.

However a recent, highly publicized computer error has delayed this possibility. This is due to the fact that the computational system in place cannot differentiate between price inputs for smokers of differing ages. The glitch may take up to a year to fix.

Although this may seem like good news to smokers, no one knows how insurance companies will respond to the penalty issue come October.

Some view the smoker’s penalty as discriminatory, while others see the benefit in a hard-nosed incentive to get people to quit.

The good news is that the ACA will provide access to quitting services and products at no charge to consumers, and you can’t be denied coverage for having been a smoker.

All of these incentives, controversial or otherwise, are clear indicators of a much needed change in government thinking. Healthcare reform is doing more to help Americans avoid potential problems altogether. Let’s hope this is just the beginning.

Michael Cahill is the Editor of the Vista Health Solutions Blog. He writes about the health care system, health insurance industry and the Affordable Care Act. Follow him on Twitter @VistaHealth and @VistaHealthMike 

94% of Cancer Doctors Say Patients Affected by Drug Shortages

This seems like the type of headline you’d expect to see in a 3rd world country not the US.  But, we’ve been talking about drug shortages for years, and while it may be better in a few areas, cancer isn’t one of them.

I was recently reminded of this in an AJMC article which was discussed at ASCO and had this data point about 94% of oncologists and hematologists from a University of Pennsylvania study.  

Looking back a few years, I think IMS did one of the best studies on this topic.  Here’s a few of the items they highlight from the study (with links to their charts).

It can be a little mind-boggling.

  • Is it an issue of planning and forecasting demand?
  • Is it an economic issue of not enough profit in these drugs?
  • Is it an issue of quality where these get shut down due to manufacturing issues?
  • Is it a structural issue of too few suppliers?
  • Is it a raw materials issue?

Diet Soda Versus Regular Soda – Ongoing Confusion

I view this as one more example of how the average consumer gets confused by all the information out there.

images

Should I focus on calories?

Should I focus on the ingredients?

Should I just drink water?  (of course)

Now, “new” research shows that the artificial sweeteners in the Diet drink can actually fool your body making it worse for you over time.  This isn’t completely new if you look at this blog from a few years ago.

But, we often wonder about why consumers don’t take responsibility for their actions and then get upset when more aggressive measures have to be taken.  (See the recent Penn State uproar.)

Consumers don’t know who or what to trust.

Should I drink alcohol?  Is it good for me in moderation?

How much exercise is needed?  New research shows that it can’t all be done at once.

Extreme Weather Isn’t Good For Our Health

After moving to Charlotte, it’s been raining and flooding here all summer.  It reminds me of 1993 when I moved to St. Louis, and they had their 100-year flood.

100yearflood-basic-1

All I ever hear from everyone is that this isn’t normal weather for Charlotte.  It begs the question of whether any weather is normal.  [I’ll avoid going down the global warming path here.]

So, I found it interesting that there was a recent article says that this will essentially be part of a new normal which will be more weather extremes.  Drought.  Flooding.  Hurricanes.  Extreme Heat.

So, what does this have to do with health?  A lot.

When these extreme weather scenarios come up, people are less likely to leave the house.  Kids don’t go outside and play.  And, as you can see on the CDC website, they’re focused on analyzing these trends to understand the impact.  On the NC HHS site, here’s what it says about this weather change.

“Some of the health impacts of climate change may include illness, injuries or deaths due to heat, air pollution, extreme weather, and water-borne pathogens.”

Weather has an impact.  Just look at SAD (Seasonal Affective Disorder).

Or, just think about childhood obesity.  Our kids are supposed to get 60 minutes of activity a day.  While we assume that happens with sports, it doesn’t always as I blogged about before.  With many of them over-scheduled to begin with and schools dropping recess, weather may be the last straw.  As recent research shows, a structured recess program is important for academic success.

Some days, I think our kids work harder then us parents.  Let’s look at a kid playing a serious sport.

  • 7:50-2:55 school for 5 days a week
  • 1-2 hours of homework per day
  • 2 hours of sports practice 5 days a week
  • Homework on the weekend
  • Games / tournaments on the weekend

Now, add a second sport which many kids do.  Or a part-time job as they get older.  (I know I’m getting off on a tangent, but it’s been so long since I’ve had time to blog…I need to get back into a pattern.)

Only 15% Of Workers Leave The Office Every Day

Have you noticed that you eat lunch more at your desk every day?  I certainly have.

With 7 hours of meetings (at least) every day plus 300+ emails every day, we’re busy.  I’d argue that most companies these days are busier than they were historically.  At the same time, everyone is focused on wellness and healthier choices.  When sleep, diet, exercise, and stress are all related to health, it’s hard to separate those from the workplace.

That being said, I wasn’t too surprised by this recent poll I saw which highlights this.

Exercise at work

How Bank Of America Messed Up My Account At Citibank

8/8 – UPDATED POST WITH NEW INFORMATION FROM BANK OF AMERICA AND CITIBANK…LEADING TO A CHANGE IN “VILLIAN” HERE.  REGARDLESS, THE KEY LESSONS HERE ARE THAT CONSUMERS NEED ADVOCATES AND YOU HAVE TO PUSH HARD TO GET ANY RESOLUTION WHEN YOU GET STUCK BETWEEN TWO BIG COMPANIES.  (like my issue with CVS and Express Scripts which was never resolved)

To say I’m frustrated would be an understatement. This scenario seems like something from a movie in which the evil bank blatantly abuses their power over the financial system to push people into economic hardship.

images

I write about this here for two reasons:

  1. Maybe this will bring it to someone’s attention that will help and
  2. All we generally hear about is the bad customer service in healthcare which pales in comparison to this.

Here’s the scenario:

  • On 6/3/13, we paid off our Bank of America mortgage when we sold our house in St. Louis.
  • On 6/17/13, BofA sent us a payoff check for our overpayment of our escrow.
  • On 7/5/13, that money was deposited into our Citibank account.
  • On 7/18/13, BofA confirmed that the check cleared.
  • On 7/23/13, Citibank removed the funds from our account and stated that BofA had rejected the check.
  • After several calls, Citibank could not explain the reason for the funds being removed other than to say the check wasn’t paid by the institution. Here’s some of the reasons that they’ve made up to try to tell me why:
    • First they told me that we both didn’t sign the check. That was wrong.
    • Then they told me that it was made out to a business. Which it wasn’t.
    • Then they told me that BofA rejected it. Which they didn’t.
    • Then they told me that it was because I used an ATM. Which I didn’t.
    • Then they told me to go into the branch office where I made the deposit. I used the same lock-box that I’ve used for years. There are no branches in St. Louis or Charlotte.
  • On 7/30/13, we had a 3-way call with Citibank and BofA to confirm the check was paid.
  • On 8/1/13, BofA faxed proof of payment to Citibank.
  • As of 8/5/13 after more calls with the 3rd supervisor at Citibank, they still couldn’t prove that the check was paid or find the BofA proof even after they had selected the location for the proof to be faxed.
  • I then got all fired up:
    • Followed the @AskCiti Twitter account and asked them to direct message me contact information for someone who could help me…with no response.
    • E-mailed the CEO of Citibank with no response.
    • E-mailed 3 members of the Committee on Financial Services with no response.
    • E-mailed the Ombudsman at the CFPB with no response.
    • E-mailed 3 members of the Citibank Board of Directors with no response.
    • E-mailed the WSJ reporter who wrote the article about Citibank’s use of Twitter for customer service.
    • E-mailed 6 other members of the Citibank executive team with no response yet.
    • Wrote my original blog post here throwing Citibank under the bus
    • Tweeted again to @AskCiti for help linking to the blog post

FINALLY, there was some action on 8/6:

  • The 3rd supervisor at Citibank called me back several times to see if he could help.
  • The @AskCiti people direct messaged me and called me several times.
  • The Executive response team at Citibank stepped in to help.  They even called the Bank of America CEO’s office to get them involved.
  • I’ve now had a direct person in both offices to call several times a day to try to get resolution.

In a surprise turn of events, it was Bank of America that screwed this up.  While they swore on 5 different calls that they paid the check, in the end, they showed it as cleared, but they never actually sent the money to Citibank causing the issues.  There’s some customer service issues to blame on both sides, but fortunately, the Citibank team could listen to the recorded three way call where B of A swore that they paid Citibank getting me all riled up.  I’m not sure how this happens or why me, but this has been a frustrating experience.  After 11 years with Citibank and different accounts with B of A for years, you want more.

In the end, they’ve been helpful, but I shouldn’t have to go so far to get resolution.  (Of course, B of A still hasn’t paid Citibank although they have provisionally credited my account the money…not that I’m willing to spend it yet.)

Frustrated…Yes.

Do you ever feel like no one can help you with your issue in a company? It’s not like I have hours of free time to play games with the bank. Why can’t big companies ever actually resolve something themselves?

Walgreens and Express Scripts Collaborate To Compete With CVS Caremark

The recent press from Walgreens and Express Scripts is interesting on several fronts:

  1. We worked for years even when I was there to try to figure out a win-win around 90-day with Walgreens.  It wasn’t easy.
  2. Walgreens and Express Scripts have a “colorful” past regarding working together.
  3. This is definitely in the best interest of the patient which we don’t always see everyday in healthcare.
  4. This is a definite recognition of the success of the Maintenance Choice program by CVS Caremark.

Here’s some language from the Walgreens’ press release.

Under the new option, plan sponsors that choose to include Walgreens as part of the Smart90 program for their pharmacy benefit will provide their members who have chronic conditions such as high cholesterol, high blood pressure and diabetes, the choice to receive 90-day supplies of maintenance medications through home delivery from Express Scripts or directly at a Walgreens retail pharmacy for the same copayment. Pending adoption by benefit plan sponsors, plan members could access Smart90 Walgreens as early as January 2014.

“Working together with Express Scripts, Smart90 Walgreens will offer more pharmacy locations and better member access coverage than any single retail chain 90-day maintenance medication solution in the nation,” said Kermit Crawford, President of Walgreens Pharmacy, Health and Wellness. “Through Smart90 Walgreens, our more than 8,000 Walgreens retail pharmacies will provide plan sponsors with cost savings and will offer their members safe, easy and convenient access to important in-person pharmacist consultations and a wide-range of health and wellness services that can further improve medication adherence and lower overall healthcare costs.”

“Members will be able to continue to receive the safety, convenience, cost savings and care offered from Express Scripts home delivery pharmacies,” said Glen Stettin, M.D., senior vice president of research and new solutions at Express Scripts. “Our data are clear: 90-day prescriptions delivered to a member’s home improve medication adherence and health outcomes, lower the cost of care and add convenience when compared to 30-day prescriptions. Over the past few years, our Smart90 program has driven more 90-day prescriptions for participating clients, and we’re pleased to now offer this additional option.”

Why Use RunKeeper?

I’ve been a longtime user of Garmin for my running.  They provide easy to use GPS watches that provide you with all the details and history you want.  I also now have my FitBit as another tracking device when I run.

So, while several people encouraged me to try RunKeeper, I was hesitant.  How many trackers for the same activity do I need?  But, I started carrying my iPhone for music while I ran so I decided to give it a try.

I like it.

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So, the question is why?

  1. It talks to you.  While looking at my Garmin is pretty easy, the RunKeeper app speaks into my headphones while I’m running to tell me when I’ve completed a half-mile, what my total time is, what my average mile pace is, and what my last split was.  I can certainly calculate all that and see it on my Garmin, but this is very easy.
  2. It gives you reinforcement and now some badges (through Foursquare which I don’t use).  But, I do like the reinforcement – i.e., that was your longest run, that was your fastest run.  Simple but positive.
  3. It has a nice GUI (graphical user interface) or app.  It tracks my data.  It’s easy to read.

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So, if you’re like I was, I’d recommend trying it.

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