Walgreens Clinic Rebranding Is More Than A Name Change

July 30, 2013 by George Van Antwerp 2 Comments

As I talked about in my post about Walgreens and innovation, Walgreens has renamed their TakeCare Clinics to Healthcare Clinics at some locations.  This is more than just a meaningless name change.  This is the beginning of a business model change.  This is the shift from acute care to ongoing chronic disease management.  This is a big move that changes their place in the healthcare value chain.

It’s part of the overall strategy that has pulled them into the ACO space.

It will be interesting to see if CVS Caremark and their MinuteClinics follow them.  CVS Caremark already announced a different strategy in terms of providing advocates.  If I were them, I would jump fully into the remote monitoring / mHealth space and provide chronic disease management from a remote basis.  I think this would be different and innovative.

Walgreens Healthcare Clinics

Books / Articles, Care Management, Healthcare, Innovation, Leadership, mHealth, PBM / Pharmacy, Value Propositions
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Who Do Consumers Expect To Help Them Navigate The Exchanges?

July 29, 2013 by George Van Antwerp 1 Comment

As part of Health Reform, we’re going to have millions of people who are new to healthcare and will need a lot of help in figuring out what to do.  With that, the government is creating thousands of navigators to help.

The question is who will these “navigators”, “assisters”, and “counselors” be.  Some will work for the government.  Some will work for non-profits, but I was surprised to see CVS Caremark jump into this space.  It makes a ton of sense.  Certainly, many of these people are going to pharmacies for OTCs or paying cash for some medications, and we certainly saw opportunities in the early Medicare Part D days where there were opportunities for the retail pharmacies to help consumers.

Their survey says 74% of people are familiar with the ACA (i.e., Health Reform).  While that might be true, the Kaiser Family Foundation research shows that only 12% of the uninsured know something (or more) about health exchanges.  That means there is a huge effort needed in a very short time frame.

KFF Health Reform

Healthcare

Treadmills Improve Medical Work

July 27, 2013 by George Van Antwerp 0 Comments

This is an interesting article talking about how accuracy improved while walking on a treadmill versus sitting or standing.  I think this is another great reason to sit less (in case the fact that sitting kills you wasn’t enough).  

Fidler and Levine’s 2008 paper documented that reviewers who walked while reading cross-sectional CT scans had a 99% rate of detecting lesions with significant clinical importance, compared to 88.9% for reviewers who sat.

The challenge of course is how to incorporate these treadmills into the workplace without causing any type of risk or having people misuse them.  I can see meeting rooms with a group of treadmills for walking meetings.  I’ve seen companies with several treadmill desks that people can use for conference calls or periods of time when they are focused on a task that can be conducted on a treadmill desk.

This will require some education about what activities can be done.  What speed to use the treadmills at without losing accuracy or getting all sweaty.  Perhaps with increased focus on wellness this will takeoff in more companies.  

Healthcare
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53% Of Employers Plan To Use Disincentives

July 22, 2013 by George Van Antwerp 0 Comments

I found this really interesting in an article in Employee Benefits News (Employers take closer look at financial disincentives by Gililan Roberts – July 2013).  This stat is from an Aon Hewitt survey which showed that while only 5% of employers use disincentives today there are 53% which plan to begin doing so in the next 3-5 years.

This shouldn’t be a big incentives as I think most people now know that loss aversion is much more powerful than a general incentives (i.e., I’d rather not lose money, but I’m less motivated to get money.)  [See also an older study on financial incentives and weight loss.]

For example, in a recent program that I’m involved with, we’re seeing slower uptake then I’d like with $1,000 in incentives on the line.  My suggestion the other day was to send an e-mail to everyone saying “Thanks For Your $1,000 Donation To Our Corporate Budget”.  Somehow, I suspect a lot of people might open that e-mail and take action after realizing that they’re just giving $1,000 to the company by not taking any action.

There is often lots of discussion about using a carrot or a stick for incentives.  My favorite image is the frozen carrot as in there has to be some perceived incentives (positive reinforcement) but if no action is taken then there needs to be a downside (disincentive).

With the huge jump in wellness programs, incentives are going to be a popular topic.  Additionally, with Health Reform allowing for 30% of healthcare premiums to be tied to behaviors and outcomes, you’re going to see a lot of companies taking actions.

What was a surprise to me in this article was the strategy to use disincentives in the 3rd year of a program.  The article spoke several times about people getting used to the positive incentive and taking it for granted so that there was a need to nudge them to do more.

That reminds me of conversations I’ve had with employers talking about behavior change and incentives.  My suggestion was to look at a 3-year plan moving from:

  • Year One: Provide an incentive for taking an action (e.g., completing an HRA)
  • Year Two: Provide an incentive based on participation (e.g., talking to a disease management nurse or logging your steps)
  • Year Three: Provide an incentive tied to outcomes or behavior change (e.g., stopped smoking, averaged 10,000 steps a day, dropped BMI below 30)

It seems like I need to make Year Four into changing from incentive to penalty for not changing behavior or not doing something that’s recognized as critical to improving health, outcomes, and ultimately cost containment.

The other point that they brought up in the article is the transition from the employee to the spouse which could be another Year Four option.  The article quotes the VP of Product from HCSC saying that spouses often cost more than the employee to insure.

Cyndy Nayer, a value-based wellness consultant, is quoted in the story several times.  She says that “employers can get a 6%-10% and maybe even 18%-20% increase in engagement with incentives”.  For those of us focused on engagement, those are big numbers.

Healthcare

Did You Know? Chronic Kidney Disease (#CKD) From The National Kidney Foundation

July 19, 2013 by George Van Antwerp 0 Comments

I was reading a document from the National Kidney Foundation (NKF) the other day.  Some of the facts jumped out at me.  I thought I’d share them.

  • 83,000 people are on the waiting list for a kidney transplant
  • 1 person dies every 2 hours while waiting for a kidney transplant
  • 26M Americans (1 in 9 adults) have chronic kidney disease (CKD) and most don’t know it
  • 367,000 people depend on dialysis for survival

It also reinforced some things that many people may know:

  • Once kidneys fail, patients need a transplant of dialysis to survive
  • People with diabetes, high blood pressure, or a family history of these conditions are at risk for CKD
  • African Americans, Hispanics, Asians, Native Americans, and the elderly are at increased risk

You can also find more information about CKD from the CDC.

There was an article this week in the NY Times about this silent killer.  Here’s a paragraph from there.

Only 1 percent of participants with no lifestyle-related risk factors developed protein in their urine, an early indicator of kidney damage, while 13 percent of those with three unhealthy factors developed the condition, known medically as proteinuria. Obesity alone doubled a person’s risk of developing kidney disease; an unhealthy diet raised the risk even when weight and other lifestyle factors were taken into account.

Books / Articles, Care Management, Healthcare, Research
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Obese Scouts (And Leaders) Told To Stay Away

July 18, 2013 by George Van Antwerp 0 Comments

Did you catch the story the other day that kids and adults that had a BMI of over 40 were told they couldn’t come to the annual Boy Scout Jamboree? And those that had a BMI of between 32 and 39.9 had to submit documentation that they could attend.

What do you think about that?

If you look at the adult US statistics, this would represent about 30%+ of the population. (United HealthGroup report: “United States of Diabetes“)

This is one story where I’m sure there’s a lot that we’d want to know. In Time, they talk about the fact that they published the restrictions two years ago. This would have allowed people time to improve their BMI. But, jumping from 40 to 31 might be too big of a jump in two years for some people to do in a healthy way.

If I were developing this type of program for a company, I’d expect to answer these questions:

  • What did you do to support the scouts and leaders in losing weight? Did you give them a coach? A registered dietician?
  • Did you create a culture of health? What types of foods are at boy scout meetings?
  • Is there a reasonable alternative for the obese scouts to get a similar experience if clinically appropriate?

Obviously, this isn’t a work environment so the rules are different. On the one hand, congrats to them for being brave enough to take this topic on and try to encourage scouts and leaders to have a healthy weight. On the other hand, they need to make sure they do this in a way that doesn’t shame these people and need to make sure they support their weight loss.

But, don’t be fooled. The world is going to continue to move this way. Obesity is too big of a driver of healthcare costs and other presenteeism and absenteeism impacts.

Just look at Japan…(source)

Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.

Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.

To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.

Books / Articles, exercise, Healthcare, Press, Words Matter
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CarePass, Another Aetna Innovation – What’s Your Healthy?

July 10, 2013 by George Van Antwerp 5 Comments

Have you seen the new “What’s Your Healthy?” campaign?  Here’s a few shots.

BTW – My healthy is keeping up with my kids in sports and moving down a belt notch.

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As many of you know, I consider Walgreens and Aetna to be two of the most innovative healthcare companies today (out of the big, established players).  [And, full disclosure, I own stock in both.]  I’ve talked about Walgreens (see Walgreens post on innovation) several times along with Aetna (see Healthagen post).

That being said, the new campaign along with the press caught my attention.  I was glad that I was able to get some time with Martha Wofford who is the VP and head of CarePass.

“We want to make it easier for everyone to engage in their health and hopefully shift from thinking about health care to taking care of their health,” said Martha L. Wofford, vice president and head of CarePass from Aetna. “CarePass helps consumers connect different pieces of health data to create a fuller, more personalized picture of their health.”

I spent some time talking with Martha and team about their initiative.  Here’s some highlights that stuck out to me.

  • There use of goals was really easy and intuitive.  If you log-in to the CarePass site and get started, you have 3 options or you can create your own (see below).  We spent some time talking about the importance of making these relevant to the individual not focusing on “healthcare goals” like adherence or lowering you blood sugar.  Most of us don’t think that way.  As they described them, they picked “motivation centric goals”.
    Aetna Carepass goals
  • I was also really interested in how they picked which apps to recommend.  There are so many out there, and many of you know that I’ve been fascinated by the concept of curating apps or prescribing apps to people.  They had a nice, simple process:
    • Which apps are most popular?
    • Does the app have “breadth”?  (i.e., national applicability)
    • They also spent more time pre-screening apps which collect PHI to understand them before listing them on the site.
    • They’re using the consumers goals to recommend apps to them.
  • The other big question I had is why do this.  It certain helps build the Aetna brand over time, but there’s not direct path to revenue (that I see).  They described their efforts as “supporting the healthcare journey” through connected data.  Ultimately, it’s about making Aetna a preferred consumer brand which may be very relevant in the individual market and exchange world in the not too distant future.
  • I like the idea of companies being “app agnostic” as I call it.  Walgreens is doing this.  Aetna is doing this.  I plan on doing this in my day job.  This allows the consumer to pick the app that works for them and as long as the data is normalized (or can be normalized) and the app provides some type of open API (application programming interface) it’s much easier to integrate with.
  • We talked a little about what’s next.  Metabolic syndrome is something they brought up.  This is something that Aetna’s been talking about in several forums for a while now.  They launched a new offering earlier this year.  (I still hate the term metabolic syndrome from a consumer perspective, but it seems to be sticking in the healthcare community.)
  • We also talked about new goals to come around smoking cessation, medication, and stress.
  • Another discussion I have with lots of people is how this data gets used.  (see a good article about what’s next for QuantifiedSelf)  I personally really want to see my data pushed to the care management team to monitor and send me information.  (Eat this not that type of suggestions)  Martha talked about how the data belongs to the member and they have to choose to push it to the coach.  She also talked about how they’re integrating with their PHR (Personal Health Record) first and then looking at others.  (see old interview with ActiveHealth)

In summary, CarePass is a nice additional to your #QuantifiedSelf toolkit.  As you can see from the screenshots below, the GUI (graphic user interface) is simple.  It’s well designed.  Integration with your apps is easy.  It provides you with goals and motivation.  They help you navigate the app world.  And, it helps you bring together data from multiple sources.  Once it can pull in all my Rx, medical and lab data along with my HRA data and my device data, it will be really cool!  But, I know that I’m a minority in that effort.  I’m really intrigued by the lifestyle questions they ask and wonder how those will ultimately personalize my experience.

Carepass lifestyle questions Carepass dashboard

So, what apps do they share?  Here’s a screenshot, but you really should log-in and try the site and see the full list.  It’s simple and worth the effort.

Carepass apps

As an added bonus, I’m adding a presentation I gave with Aetna at the Care Continuum Alliance two years ago.  I was searching for my past interviews with Aetna people and found this online so I added it to SlideShare and put it here.

Books / Articles, Care Management, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, mHealth, Press, Research, Technology, Value Propositions
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Prescribing An App vs. An Rx – Why Are People Surprised?

July 7, 2013 by George Van Antwerp 1 Comment

A staggering 90 percent of chronic patients in the US would accept a mobile app prescription from their physician, as opposed to only 66 percent willing to accept a prescription of medication, according to a recent survey from health communications firm Digitas Health.  (source)

Is this surprising to anyone?

I don’t think it should be…and here’s why:

  1. In general, most apps don’t cost anything while prescriptions generally do.
  2. I don’t know of any apps with side effects.
  3. It’s unlikely that your app will have a negative interaction with another app (like a drug-drug interaction).  It may give you conflicting information, but that’s about it.
  4. You don’t have to wait to get your app.  You can probably download it while you’re at the physician’s office.  A prescription can take time to get either waiting in line, waiting for it to get filled, or sending it in through the mail.
  5. You don’t have to refill your app.  You may have to update it every once in a while, but it tells you when and all you have to do is press a button.

Of course, most (all) apps won’t have the same likelihood as Rxs in improving your health.  Of course, Rxs only work if people take them…which they don’t.

Still surprised?

Books / Articles, Healthcare, mHealth, Research, Technology, Value Propositions

More CDHPs Are Coming – Is That A Good Thing?

July 3, 2013 by George Van Antwerp 0 Comments

I think we all see it coming.  It’s a tidal wave of responsibility being pushed from the employer to us the individual.  On paper, this seems like a great thing since 75%+ of healthcare costs are driven by personal behaviors.  On the other hand, this means we actually have to understand the healthcare system and how to make decisions.

Here’s the abstract from a recent Health Affairs article:

Consumer-directed health plans (CDHPs) are designed to make employees more cost- and health-conscious by exposing them more directly to the costs of their care, which should lower demand for care and, in turn, control premium growth. These features have made consumer-directed plans increasingly attractive to employers. We explored effects of consumer-directed health plans on health care and preventive care use, using data from two large employers—one that adopted a CDHP in 2007 and another with no CDHP. Our study had mixed results relative to expectations. After four years under the CDHP, there were 0.26 fewer physician office visits per enrollee per year and 0.85 fewer prescriptions filled, but there were 0.018 more emergency department visits. Also, the likelihood of receiving recommended cancer screenings was lower under the CDHP after one year and, even after recovering somewhat, still lower than baseline at the study’s conclusion. If CDHPs succeed in getting people to make more cost-sensitive decisions, plan sponsors will have to design plans to incentivize primary care and prevention and educate members about what the plan covers.

You can see some of the growth stats and concerns also in an American Medical News article.  But, as someone who’s live through it, there are a series of issues (all of which are addressable).

  1. Shifting first dollar payment to the individual also shifts a huge burden of time to the individual.  Which bills do I pay?  Which receipts do I send to the HSA?  Which to the HRA?  How much should I put in each account?  What’s the status of my payments?
  2. This only works if I understand my tradeoffs.  What should I be doing differently?  How could I have spent less money?
  3. It can create the wrong incentives.  My regular transactions like pharmacy seem to cost me a huge amount of money every month while my procedures seem very inexpensive.

My point here is that healthcare is like a balloon.  When you step on one area, it doesn’t eliminate the costs.  It simply shifts the costs.  Until we understand the macro-economic impacts of our short-term decisions, it’s unlikely that we’ll really change our path.  I see a huge shift happening and when the tidal wave pulls back it’s going to leave us with a huge Medicare bill in the future as people have put off preventative care only to have more issues in a decade.

Books / Articles, Care Management, Healthcare, Managed Care

Should You Care That Obesity Is Now A Disease?

June 20, 2013 by George Van Antwerp 2 Comments

The AMA has opened an interesting discussion in the past few days with their decision to recognize obesity as a disease.  On the one hand, we all know obesity is a problem that’s impacting our overall health and productivity across the world.  On the flip side, will this actually change anything?

Key discussion points:

  • What is a disease?
  • Is BMI a good metric to use?  If not, what should be used to measure obesity – waist?
  • How do you treat it?

Here’s a few quotes from some articles:

“Right now, physicians will treat high blood pressure, diabetes, give patients medications and say, ‘Oh you also need to lose weight,’” Khaitan told FoxNews.com. “I think (this) gives the physicians a little more credibility in pushing patients to address obesity and become healthier. It’s recognized as a disease…not just something that (because) you have poor lifestyle habits, this is your problem.”  (Fox News)

Obesity is not just a health risk but a disease. Estimates of the genetic contribution to weight gain in susceptible families range from 25—40% with a greater heritability for abdominal fat distribution of 50%1>2.  Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the disease category.  (British Medical Bulletin 1997)

“The American Medical Association’s recognition that obesity is a disease carries a lot of clout,” says Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. “The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity.”  (USA Today)

Telling all obese people that they have a disease could end up reducing their sense of control over their ability to change their diet and exercise patterns. As experience with addictions has shown, giving people the sense that they suffer from a disease that is out of their control can become self-defeating. So the disease label should be used sparingly: just as not all drinking is alcoholism, not all overeating is pathological. (Time)

Here’s a few facts from the Obesity Action Coalition:

  • In the United States, it is estimated that 93 million Americans are affected by obesity.
  • Individuals affected by obesity are at a higher risk for impaired mobility and experience a negative social stigma commonly associated with obesity.
  • Socioeconomic status plays a significant role in obesity. Low-income minority populations tend to experience obesity at higher rate and are more likely to be overweight.
  • In 2001, the states with the top five percentages for obesity were Mississippi, West Virginia, Michigan, Kentucky and Indiana.
  • Almost 112,000 annual deaths are attributable to obesity.
  • In the United States, 40 percent of adults do not participate in any leisure-time physical activity.

Here’s also a few things you might not realize about obesity from Yale:

  • Finding 1: Obesity can raise some cancer risks
  • Finding 2: Obesity is tied to heart attacks in younger adults
  • Finding 3: Obesity can ruin your day
  • Finding 4: Obesity speeds up girls’ puberty
  • Finding 5: Obesity is a cause of diabetes in kids
  • Finding 6: Obesity in middle age increases risk for dementia

Let me give my hypotheses on why this might matter:

  1. In theory, this is supposed to increase the likelihood that physician’s talk about obesity with their patients.  This would be great, but I think most research shows physician’s aren’t prepared or comfortable with this discussion.  Will the fact that it’s a disease make this easier?  Maybe.
  2. This may be a boon for the obesity Rx market (assuming any of them work and have minimal side effects).  Physician’s may be much more likely to write an Rx for a disease than a lifestyle issue.
  3. This may help get obesity Rxs and bariatric surgery to be covered by health insurance.  The downside of this is that more people may not actually change behavior (diet, exercise, sleep) but instead look for a “quick” fix through drugs and surgery.

In my mind, there is a best case scenario here:

  • Calling it a disease drives awareness among the healthcare community.
  • This increases investment in resources to treat obesity.
  • Treatment is viewed more like mental health to include drugs and behavioral therapy.
  • Physician’s get trained on the disease.
  • Pharma details physicians on the disease and creates CME programs.
  • Patients start to take this more seriously.
  • Plans cover obesity – insurers, employers, CMS.
  • Obesity becomes a broad program including diet, exercise, coaching, Rx, and bariatric surgery following a progressive approach to treatment tied to your starting point.
  • Companies link incentives to managing weight.
  • New metrics are designed that are better than obesity.

Of course, one of the more recent articles which was depressing on this topic was that exercising regularly may not overcome the impact of sitting the rest of the day.  That makes it very hard to increase caloric burn while having a job that requires lots of desk, computer, and meeting time.

Costs Of Obesity In America

Books / Articles, exercise, Healthcare, Methodology, PBM / Pharmacy, Research, Value Propositions

Presentation – 2nd Annual Bio/Pharma Retail Summit – Discount

June 12, 2013 by George Van Antwerp 0 Comments

I’m excited to be presenting in the Fall with Adam Fein and lots of other great speakers at the 2nd Bio/Pharma Retail Strategy Summit to be held September 18-19 in Philadelphia, PA.  

I get to talk about one of my favorite topics which is how health reform is driving change in the industry and enabling new opportunities for the pharmacy / pharmacist.  

You get to listen to me for 90-minutes so I’m hoping to find some great examples, data, and insights to get you thinking hard about your business and the white space here.  I hope to see some of you there.  If interested, I’m passing on a discount code they offered to me as faculty.

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Healthcare
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Why The Cigna PBM Deal With Catamaran Is Relevant?

June 12, 2013 by George Van Antwerp 1 Comment

Not a big shock to anyone, but Cigna announced yesterday that they were signing a 10-year deal with Catamaran (formerly SXC) to outsource the operations of their pharmacy (PBM) business.  (see WSJ article or the story on Adam Fein’s blog)

This PBM industry has been full of change over the past 5 years as I’ve discussed many times.  So, the question is why is this deal relevant or just another yawner.

Let me give a few reasons:

  1. This is the 3rd big managed care company (Aetna, Wellpoint, Cigna) to decide to create this type of long term relationship with one of the big PBMs.  They each picked a different one.  (Aetna/CVS, Wellpoint/Express, Cigna/Catamaran)  United brought their business in-house from Medco, and Humana has continued to expand their pharmacy business.  
  2. Eric Elliott (former head of Cigna’s PBM and now head of Prime Therapeutics PBM) and Dan Haron (current head of Cigna’s PBM) are both very smart executives who I believe saw lots of value in the integrated PBM story.

So, if I read between the lines here, I come to a few quick thoughts:

  1. Are they all structuring long term deals that get them through this reform period and minimize risk, but give them the chance to bring this back in house after this settles down?  
  2. Could this symbolize a further repositioning and commoditizing of the PBM industry that all of these companies want to retain marketing, engagement, strategy, and formulary but outsource call center, operations, contracting, network management, and other tasks?  Would this further accelerate a “race to the bottom” on price that I’ve talked about before?
  3. Does this have implications to specialty pharmacy?  Will that become split into two different businesses – operations versus clinical care?  (more on that later)
  4. I don’t know the bidding here, but scale used to matter a lot.  If CVS and Express Scripts didn’t aggressively bid for this contract, that might imply a point of diminishing returns in terms of scale.  (which I clearly believe exists)
  5. Under what circumstances does the integrated model work (i.e., what does Humana, United, and Kaiser see differently) or will all the payers look to outsource certain tasks to the big PBMs?

The interesting times in the industry continue.  It’s a head scratcher of what comes next!

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Pharmacy Non-Adherence Infographic

June 11, 2013 by George Van Antwerp 2 Comments

While I’ve moved most of the infographics I find to my Pinterest account, I wanted to capture and share this one from Stephen Wilkin’s blog since it hits so many of the points that I try to make with people.

patient-non-compliance-infographic3

Care Management, Healthcare, Infographic, Marketing / Communications, Methodology, PBM / Pharmacy, Research
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The Role Of Healthcare Technology Curator

June 11, 2013 by George Van Antwerp 0 Comments

When I worked as an IT consultant, you had two clear choices – an enterprise system (e.g., SAP) or a best-of-breed (BOB) strategy.  People liked the simplicity of an enterprise system, but you may have sub-optimized reporting or some flexibility in your solution.  On the other hand, the BOB strategy required more maintenance, effort, and coordination to pull it off in a coordinated fashion.

In today’s healthcare world, I look at and meet with a ton of technology companies.  The struggle is how to keep up with all the change in the industry and be nimble enough to engage the new start-up, but flexible enough to evolve with the market without impacting the consumer experience.

Maybe it draws on my training as an architect, but I was describing my technology vision as one of a general contractor.  The buyer (client) wants a BOB solution.  They want everything optimized – data, reporting, workflow, content, mobile, clinical algorithms, etc.  At the same time, they often underestimate what it takes to manage all of these vendors, integrate the data on the backend, and create an integrated consumer experience across multiple vendors and technology platforms.

That’s where I see some real value add as a “technology curator”.  I see one of my roles in helping manage an evolving ecosystem of healthcare companies and working with a flexible technology platform that can quickly plug and play with different solutions.  This also allows me to have pre-built integrations with certain solutions, but I can also offer consumers the ability to choose their device (for example) and with the right API set up just be device agnostic in my solution.

Over time, this offers clients a lot of flexibility.  The get the BOB approach within an enterprise system environment.  They don’t have to keep issuing RFPs and evaluating vendors (since we’re doing that).  They don’t have to stitch together multiple data sets to create the integrated, longitudinal view of the consumer (since we’re doing that).  They don’t have to pretend that they’re offering a cohesive consumer experience (since we’re doing that).  And, most importantly, they are flexible over time to jump from solution to solution within the architecture without disrupting everyone since it’s behind the “presentation layer” that the consumer experiences.

Care Management, General Thoughts, Healthcare, Innovation, Marketing / Communications, Methodology, Technology, Value Propositions

MTM is like Population Health Management

June 7, 2013 by George Van Antwerp 0 Comments

I saw this quote of the day in Drug Benefit News, and it made me think about all the discussions I’ve been having around population health management and the need for a longitudinal patient record and integrated member experience.

Medication therapy management (MTM) at its core is viewing “the member in its entirety and not as individual activities…and looking at all of those things around medications for that patient. You can have the best programs in the world but if the patient is not engaged, they are a waste of time and energy, and that’s why an integrated activity like MTM has the opportunity to be so significantly effective.”

– Jan Berger, M.D., chief medical officer at Silverlink Communications, Inc.

 

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared.

Healthcare

The #QuantifiedSelf and “Walking Interview”

June 6, 2013 by George Van Antwerp 0 Comments

If you haven’t heard, “sitting is the new smoking” in terms of health status.  And, unfortunately, you can’t just get up and exercise for an hour and then go sit all day.  That brief spurt of exercise doesn’t change the fact that we sit for 9+ hours a day.

If you think about our shift in work from a very manual work environment to a service and technology work environment, we’ve made activity during the day harder and harder to achieve.  Between e-mail and meetings, most of us are stagnant to accomplish our work.

That got me thinking about the #QuantifiedSelf movement and all of the activity trackers (e.g., FitBit, BodyMedia).  We know companies definitely look online to see people’s social media activity as part of the interview process.  Will they begin to ask about their activity data as a proxy for health?

On the flipside, perhaps the person interviewing should really be asking to see their potential boss’ activity data.  I’d be as interested in knowing what happens during the day.  It would provide a lot of insight into what happens in terms of meetings, face-t0-face activity, and be a good proxy for the real work experience.

Of course, the other option would be to introduce “walking interviews”.  People talk about walking meetings.  I’ve even done a running meeting going for a jog with a potential partner to discuss how we work together.  (It was the only time we could find to meet at a conference.)

Walking interviews would tell you a lot about someone’s health.  You could go up some stairs.  You could walk a few miles in an hour.

Since we know that health, happiness, and wealth are all correlated, this type of insight for the interviewer and interviewee seems very valuable.

JustStandInfoGraphicV3

Books / Articles, Business Tools, exercise, Healthcare, Infographic, Social Media
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Could Generic Prescriptions Be The Greatest Placebo Ever?

May 22, 2013 by George Van Antwerp 1 Comment

Those of you who know me know that I’ve been a huge advocate for generic prescriptions since the early part of my PBM/pharmacy career in 2001. It wasn’t long ago that I talked about unresponsible reporting when slamming generics and scaring the population. But, we all enjoy a good conspiracy theory which is about the only thing that makes sense reading the new Fortune article – Dirty Medicine – about Ranbaxy. Both articles are written by the same author, but this one scares me a lot more than the other one. This article reads like a fiction book but appears to be true.  It should scare you also and put a spotlight on the FDA.

Here are a few things from the article.

On May 13, Ranbaxy pleaded guilty to seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn’t meet specifications, and making intentionally false statements to the government. Ranbaxy agreed to pay $500 million in fines, forfeitures, and penalties — the most ever levied against a generic-drug company.

The company manipulated almost every aspect of its manufacturing process to quickly produce impressive-looking data that would bolster its bottom line. “This was not something that was concealed,” Thakur says. It was “common knowledge among senior managers of the company, heads of research and development, people responsible for formulation to the clinical people.”

It made clear that Ranbaxy had lied to regulators and falsified data in every country examined in the report. “More than 200 products in more than 40 countries” have “elements of data that were fabricated to support business needs,” the PowerPoint reported. “Business needs,” the report showed, was a euphemism for ways in which Ranbaxy could minimize cost, maximize profit, and dupe regulators into approving substandard drugs.

But, we know that generics have worked. People have gotten better so one has to assume this isn’t a massive fraud especially when 50% of generics have traditionally been made by the brand manufacturers themselves who would never risk their companies to do what Ranbaxy did. So, it made me wonder about the Placebo Effect. Did some drugs work simply because of that?  Is there anything else that would make sense for why this wasn’t discovered more quickly?

I’ve talked a lot about the Placebo Effect. There’s now even an app to make you feel better using the Placebo Effect.

I’m shocked that the PBMs, pharmacies, manufacturers, associations, wholesalers, and others aren’t out talking about this.  I would want to let the public know that this isn’t a systemic problem, but is one contained to one instance and that quality will be maintained…but maybe no one cares?

Books / Articles, Healthcare, Marketing / Communications, PBM / Pharmacy, Value Propositions
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Relocation vs. Travel – Presenteeism and Health Implications

May 22, 2013 by George Van Antwerp 0 Comments

Surprisingly, I’ve been happily living in the St. Louis area for almost 20 years. I moved here after going to the University of Michigan for graduate school at Washington University, and I never thought I’d stay. My girlfriend (now wife) moved a year later, and we’ve loved it ever since. We’ve built two houses, had two kids, and made a lot of friends.

I’ve had chances to move many times to Kansas City, San Francisco, Boston, Columbia (SC), Florida, Minneapolis, New York, New Jersey, and several other cities. All of them I have turned down. So, one of the big questions I get asked now days is why are you moving out of St. Louis since you’ve commuted for so long and “enjoyed” it. That’s a tough one, but as someone who cares about my health, let me position this from a health perspective for all of you.

Ultimately, we’re moving for one reason which is to spend more time with my family. Of those 20 years, I estimate that I’ve spent at least 9 of them where I traveled 50-90% of the business days. You can do the math, but if I assume 15 days per month on the road over 9 years, that’s about 1,620 days that I’ve been gone or 4.4 years. That’s a lot of time to miss with your wife and kids.

But, I also see several health reasons for this:

  • Most people I know (including myself) sleep better at home and have a more regular routine. No early morning flights. No late night flights. No uncomfortable beds. No loud neighbors. No temptation to work until all hours of the night. And, as I’ve talked about many times, lack of sleep is a major contributor to productivity, decision making, and health.
  • You eat better at home and don’t have to eat out every meal which can affect your calorie intake and therefore your weight.
  • Long commutes have both mental and physical health implications (none of them good) as you can see in this article and infographic on LifeHacker along with this other article on ABC.
  • Being at home and spending time with your family can also affect them (as we know health is social). Here’s one example about eating with your kids that I often quote.

Of course, commuting has some productivity gains (if done right) from a work perspective:

  • You can work long days without worrying about other things that you should do when you’re home. (Why do you think consultants are so productive?)
  • You can find some nice quiet time on planes to work. (Although this has gone down over time with more crowded flights, more connecting flights, and smaller seats.)

You have to trade this off with productivity lost on travel days (e.g., I wake up every Monday at 4:30, leave for the airport at 5:30, land in Charlotte at 10:15, and get to my office around 11:30 with best case 90 minutes of work done).

But, moving definitely impacts your presenteeism as I’m learning (at least for a few months). After 20 years in one city, there’s a lot to do to move. You have to find new service providers (doctors, dentists, handyman, vet, hair), new schools, new sports teams, new stores, etc.

But, for those of you that aren’t convinced since you think travel is glamorous, let me share just a few stories with you.

  • On one of my toughest travel days, I had breakfast with a CIO in Boston at 6:30 am; caught a flight to Minneapolis to give a presentation over lunch; then caught a flight to have a dinner meeting in San Francisco. Long day.
  • In some weeks, I used to spend over 20 hours a week in a plane (not including airport time). Talk about sitting disease.
  • Just yesterday, when I tried to squeeze in one last trip before I moved, I got up at 3:30 to catch a 6:00 flight. I flew to Florida took a few calls, had a meeting, and then came back to the airport to catch an 8:oo PM flight home. That flight was delayed until 2:05 AM meaning that if I hadn’t just gone to get a hotel room (without any clothes or toiletries) that I would have gotten home 24 hours after I left the house.

Of course, the frequent flyer miles and hotel points are great. We’ve taken many a trip with it. I’ve given my parents free flights. Heck, we’ve even given our dog walkers free flights.

The key is to evaluate several factors which are what I’ve looked at:

  • Will you be traveling from which ever city you live in? Don’t move your family just to be traveling out of a new city.
  • Do you like the new city and would you consider living there long-term? For example, I know I probably would never like true city living in NY.
  • What is important to your family and is it present in the new city? This is a complicated one to find the right mix of services and education.
  • Can you afford to live in the new location without a major impact on your quality of life (or will your job account for this)?

Anyways, this has been one reason why I haven’t been blogging as much lately. The move is all consuming especially with lots of things going on at work. I have 4 more days in St. Louis before moving so we’re excited and nervous.

General Thoughts, Healthcare, Value Propositions

Personalized and Relevant Messages are Key to Successful Patient Engagement

May 18, 2013 by George Van Antwerp 0 Comments

Guest Post From The President of TeleVox Software

It shouldn’t come as a surprise to anyone that we live in a society yearning for instant gratification. We expect to get information in the blink of an eye, the answers we need within minutes and material goods delivered prior to the date that was promised. But what may surprise you is that even through the desire to have this information so quickly, the importance of providing a personalized message remains one of consumers’ biggest wishes. For instance, studies show that tailoring the message to the needs of patients as well as personalizing the messages are key to successful high-tech patient engagement. In fact, according to a recent TeleVox Healthy World Report, Technology Beyond the Exam Room: How Digital Media Is Helping Doctors Deliver the Highest Level of Care, 50 percent of patients expect information to be personalized to their specific needs. In the age of instant feedback and heightened technology, it is interesting to know that patients still desire a personalized approach in terms of their healthcare.

The days of simply setting forth wellness plans based solely on numbers and stereotypes are past us. Patients are looking for communications that are relevant to their lives, and it is their expectation that healthcare professionals will take time to engage in this level of personalization. Know Your Health also found that 53 percent of patients expect communications to be relevant to them as individuals. Relevant patient engagement can include personalized interactions, individualized treatment plans, and follow up. Patients thrive on a feeling of importance, ranging from a doctor knowing their name and medical history when they walk in to a follow-up call or email after the appointment to continue that personal connection.

Think about this: According to the same report, 21 percent of the population will refuse information if it is not tailored specifically to them. And, further, 13 percent of patients surveyed report they will ignore information sent their way if it doesn’t have their name on it. Why would providers want to miss out on connecting with an important part of the population by simply not including their name on any communication to the patient?  Including this step can ensure patient engagement is successful and save valuable resources, as the information conveyed will have a better chance of being received by patients.

Finally, taking time to connect with patients outside of their yearly exams or scheduled check-ups is another important link in ensuring that patients make positive decisions that ensure a healthy future. 68 percent of the population would like to receive educational tips that will help them live a better life via email throughout the year. Many Americans are concerned with the direction of the overall health and well-being of the country, but still aren’t taking steps to get where they need to be. However, healthcare providers can take steps to tailor messages that are relevant and personalized to patients to ensure successful high-tech patient engagement, and ultimately a healthier America.

Scott Zimmerman is a regularly-published thought leader on engaging patients via ongoing communication between office visits. He is the President of TeleVox Software, Inc, a high-tech Engagement Communications company that provides automated voice, email, SMS and web solutions that activate positive patient behaviors by applying technology to deliver a human touch. Scott spearheads TeleVox’s Healthy World initiative, a program that leverages ethnographic research to uncover, understand and interpret both patient and provider points of view with the end goal of creating a healthy world–one person at a time. Zimmerman possesses 20 years of proven performance in the healthcare industry, with domain knowledge in the surgical, interventional and pharmaceutical arenas. Prior to joining TeleVox, Scott served for nine years at GE Healthcare in a variety of cross-functional and global leadership roles in sales, services, quality, marketing, pricing, finance and product development. Scott is a graduate of the John M. Olin School of Business at Washington University in St. Louis.

Healthcare
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No Fat Customers Please – #BoycottAbercrombie

May 14, 2013 by George Van Antwerp 0 Comments

My kids have worn Abercrombie and Fitch clothes for the past few years even thought I find the advertising suggestive and the store environment not particularly inviting for the average adult (loud music, small aisles, very young staff). Even with that, I was shocked to see some of the recent news about their attitude towards their customers in response to why they don’t stock XL and XXL clothing sizes. With today’s focus on customer experience and competitive retail environment, this seems like not only a bad business model, but one that is shallow and unhealthy.

“In every school there are the cool and popular kids, and then there are the not-so-cool kids. Candidly, we go after the cool kids. We go after the attractive all-American kid with a great attitude and a lot of friends. A lot of people don’t belong [in our clothes], and they can’t belong. Are we exclusionary? Absolutely. Those companies that are in trouble are trying to target everybody: young, old, fat, skinny. But then you become totally vanilla. You don’t alienate anybody, but you don’t excite anybody, either.” (source article)

But, a bad business model and a shallow minded CEO isn’t a reason to boycott a company. And, after growing up in a family where we boycotted many companies due to business practices, I never saw myself as someone who would support this “hippie” approach. That being said, I think that Abercrombie’s attitude is a real issue for the health of our kids for 3 reasons.

  1. We have a major obesity issue in the US. (from CDC)
    1. Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.
    2. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.
    3. In 2010, more than one third of children and adolescents were overweight or obese.
    4. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.
    5. Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.
  2. We have a bullying issue in the US. (source)
    1. Over 3.2 million students are victims of bullying each year.
    2. 1 in 4 teachers see nothing wrong with bullying and will only intervene 4 percent of the time.
    3. Approximately 160,000 teens skip school every day because of bullying.
    4. 1 in 7 students in grades K-12 is either a bully or a victim of bullying.
    5. 56 percent of students have personally witnessed some type of bullying at school.
    6. Over two-thirds of students believe that schools respond poorly to bullying, with a high percentage of students believing that adult help is infrequent and ineffective.
    7. 71 percent of students report incidents of bullying as a problem at their school.
    8. 90 percent of 4th through 8th graders report being victims of bullying.
    9. 1 out 10 students drop out of school because of repeated bullying.
    10. Harassment and bullying have been linked to 75 percent of school-shooting incidents.
    11. Physical bullying increases in elementary school, peaks in middle school and declines in high school.  Verbal abuse, on the other hand, remains constant.
  3. We have a suicide issue in the US. (CDC fact sheet)
    1. Among young adults ages 15 to 24 years old, there are approximately 100-200 attempts for every completed suicide.
    2. In a 2011 nationally-representative sample of youth in grades 9-12:
      1. 15.8% of students reported that they had seriously considered attempting suicide during the 12 months preceding the survey;12.8% of students reported that they made a plan about how they would attempt suicide during the 12 months preceding the survey;
      2. 7.8% of students reported that they had attempted suicide one or more times during the 12 months preceding the survey; and
      3. 2.4% of students reported that they had made a suicide attempt that resulted in an injury, poisoning, or an overdose that required medical attention.

 

As adults, I believe we have a responsibility to break the cycle of bullying and set an example. This isn’t time to create a fraternity culture in adulthood. We have systemic issues to address in serious ways. I know we won’t be shopping at Abercrombie again, and I think my kids have lost their interest in wearing the clothes.

Books / Articles, Consumerism, General Thoughts

Why Do People Think Adherence Is So Easy?

May 6, 2013 by George Van Antwerp 5 Comments

I think we all know that medication adherence is a big deal. The most common number quoted is the $290B waste number from NEHI. There are numerous studies that confirm the value of non-adherence even one that just came out.

The amount of money spent on trying to improve adherence is huge! Pharma has worked on. Retail pharmacies have worked on it. Providers have worked on it. Insurance companies have worked on it. Employers have worked on it… And all of these have happened across the world.

At the same time, you see people get so excited about things don’t make any sense to me.

Let me take an easy example. A few months ago, a company called MediSafe put out a press release around moving medication adherence on statins up to 84.25%. Nothing against the company, but I read the press release and reached out to them to say “this is great, but it’s only 2 months of data…most people drop therapy after the first few months so who care…call me back when you get some good 12 month data.”

But, a lot of people got all excited and there was numerous press about this – see list of articles about them.

Now, tonight, I see another technology getting similar excitement. Fast Company talks about the AdhereTech technology which integrates a cellular phone with a pill bottle. And, it costs $60 a month. In my experience, companies wouldn’t even spend $2 a month to promote adherence so $60 is just impractical. The argument is that this is good for high cost specialty drugs that are oral solids not injectables. But, this isn’t a new idea. Glowcaps already built this model with a very slick interface and workflow.

And, I don’t know about you, but I think this would be obnoxious. And, I love data and am part of the QuantifiedSelf movement. I’m not sure I understand the consumer research here. I would have to believe all of the following to buy into this model.

  • Non-adherence people are primarily not adherent due to no reminders to take their medication on a daily basis.
  • People with chronic conditions that require high cost specialty drugs are going to change behavior because some bottle sends them a text message.
  • Manufacturers or some other healthcare company is willing to pay $60 a month for this service.
  • There won’t be message fatigue after a few months (weeks) of messaging.
  • Pharmacies would be have to be willing to change their workflow to use these bottles.

Yes. Will this work for some people…sure. But, if it helps 10% of people, then my cost is really $600 per success.

Should we be working on better solutions to address adherence…of course.

But, let’s stop trying to figure out some gimmick to fix adherence. Let’s look at root cause.

For example:

  • People don’t know why they’ve been given a medication.
  • People don’t understand their disease.
  • People can’t afford their medication.
  • People don’t know what to expect in terms of side effects.
  • People don’t see value in improving adherence.
  • People don’t know they have to refill their medications.
  • People aren’t health literate.

We have a lot of problems.

Books / Articles, Healthcare, Managed Care, Marketing / Communications, Methodology, mHealth, PBM / Pharmacy, Research, Value Propositions
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Presidential Physical Fitness Award – Reasonable? Role Models?

May 6, 2013 by George Van Antwerp 0 Comments

I must admit that I don’t remember taking the presidential fitness test as a kid. With that being said, I was surprised to learn from my daughter that in her class of club soccer, volleyball, and baseball players she was the only kid to meet the highest level (greater than the 85th percentile across several measures). She made it today by running her mile in 7:37.

So, what does this require? It made me curious. Here’s what you have to do:

benchmarks_presidential_large

Could you do that?  These seem pretty difficult to me.  I could probably do the mile in 6:06, but I doubt I could do 53 pull-ups.  And, I doubt I could sit and reach 7 inches beyond my toes.  (Looking at the 17 year old male standards.)

On the other hand, we certainly need our kids to be more fit.  We have a big childhood obesity issue.

Childhood Obesity

But, it also made me think about Michelle Obama’s efforts in this space.

Lets Move

I think these programs are good starts, but lets not forget that obesity is a social issue and kids learn from those around them.  Let me ask the uncomfortable questions about those who our kids look up to.

  • How many overweight coaches do you know?
  • How about overweight teachers?
  • How about policemen and firefighters?
  • How about clergy?

These are all key role models…not to mention us parents who are often overweight.

I guess my suggestion here to the President would be to think about how to use our massive government payrolls as a foundation for change. Let’s think about the Presidential Fitness Challenge and create a broader wellness solution to change the visual role models for our kids and figure out how to help companies invest in this.

For example, we know that sleeping is correlated to weight and health.  I was talking to my brother-in-law who is a police officer when he told me that they are expected to get 8 hours of sleep a night.  Imagine if companies set this expectation for their employees (sleep impact on work).  

“Sitting Disease” may make a great late night comedy story line, but it’s a reality of our information economy that has to be addressed.

sitting-disease-how-sitting-too-long-can-affect-your-health_5123e1818a55e

Books / Articles, Business Tools, exercise, General Thoughts, Healthcare, Infographic, Innovation, Leadership, Marketing / Communications, Methodology, Value Propositions

How Walgreens Became One Of The More Innovative Healthcare Companies

April 28, 2013 by George Van Antwerp 3 Comments

While we are generally a society focused on innovation from start-ups (and now all the incubators like Rock Health), there are a few big companies that are able to innovate while growing.  That’s not always easy and companies often need some catalyst to make this happen.  Right now, there are four established healthcare companies that I’m watching closely to track their innovation – Kaiser, United/Optum, Aetna, and Walgreens.  (Walgreens has made the Fast Company innovation list 3 of the past 4 years.)

I think Walgreens is really interesting, and they did have a great catalyst to force them to really dig deep to think about how do we survive in a big PBM world.  It seems like the answer has been to become a healthcare company not just a pharmacy (as they say “at the corner of Happy and Healthy”) while simultaneously continuing to grow in the specialty pharmacy and store area.

Let’s look at some of the changes they’ve made over the past 5 years.  Looking back, I would have described them as an organic growth company with a “not-invented-here” attitude.  Now, I think they have leapfrogged the marketplace to become a model for innovation.

  1. They sold their PBM.
  2. They re-designed their stores.
  3. They got the pharmacist out talking to people.
  4. They got more involved with medication therapy management.
  5. They increased their focus on immunizations increasing the pharmacists role.
  6. They formed an innovation team.
  7. They invested heavily in digital and drove out several mobile solutions including innovations like using the QR code and scanning technology to order refills.
  8. They’ve reached out to partner with companies like Johns Hopkins and the Joslin Diabetes Centers.
  9. They increased their focus on publications out of their research group to showcase what they could do.
  10. They started looking at the role the pharmacy could play and the medications played in readmissions.
  11. They partnered with Boots to become a much more global company.
  12. They offered daily testing for key numbers people should know like A1c and blood pressure even at stores without a clinic.
  13. They created an incentive program and opened it up to link to devices like FitBit.
  14. They partnered with The Biggest Loser.
  15. They increased their focus on the employer including getting into the on-site clinic space.
  16. They created 3 Accountable Care Organizations.
  17. They partnered with Novartis to get into the clinical trials space.
  18. They developed APIs to open their system up to developers and other health IT companies.
  19. They formed a big collaboration with AmerisourceBergen which if you read the quote from Greg Wasson isn’t just about supply chain.

    “Today’s announcement marks another step forward in establishing an unprecedented and efficient global pharmacy-led, health and wellbeing network, and achieving our vision of becoming the first choice in health and daily living for everyone in America and beyond,” said Gregory Wasson, President and Chief Executive Officer of Walgreens. “We are excited to be expanding our existing relationship with AmerisourceBergen to a 10-year strategic long-term contract, representing another transformational step in the pharmaceutical supply chain. We believe this relationship will create a wide range of opportunities and innovations in the rapidly changing U.S. and global health care environment that we expect will benefit all of our stakeholders.”

  20. They jumped into the retail clinic space and have continued to grow that footprint physically and around the services they offer with the latest jump being to really address the access issue and help with chronic conditions not just acute problems.

“With this service expansion, Take Care Clinics now provide the most comprehensive service offering within the retail clinic industry, and can play an even more valuable role in helping patients get, stay and live well,” said Dr. Jeffrey Kang, senior vice president of health and wellness services and solutions, Walgreens. “Through greater access to services and a broader focus on disease prevention and chronic condition management, our clinics can connect and work with physicians and other providers to better help support the increasing demands on our health care system today.” (from Press Release)

This is something for the whole pharmacy (PBM, pharma, retail, mail, specialty) industry to watch and model as I talked about in my PBMI presentation (which I’m giving again tomorrow in Chicago).  It reminds me of some of the discussions by pharma leaders about the need to go “beyond the pill”.

 

Books / Articles, Care Management, Consumerism, exercise, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, mHealth, PBM / Pharmacy, Press, Technology, Value Propositions
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How Aetna’s Pivoting With Healthagen – #whcc13

April 9, 2013 by George Van Antwerp 0 Comments

Do you know the term “pivot“? It’s all the rage now in terms of describing how companies continue to evolve their models with this rapidly changing business environment.

Of course, Aetna is one of the big healthcare players in the US. They’re not going to abandon a model that’s been working for well over 100 years. But, thanks to some great leadership from people like Mark Bertolini, CEO of Aetna, they’ve created a new business unit called Healthagen (building on the company they bought known mostly for iTriage). The screen shot says it all.

I got the privilege to sit down with Dr. Charles Saunders who runs Healthagen at the World Healthcare Congress in DC (#whcc13).

Charles E. Saunders, M.D., is responsible for leading the strategic diversification of Healthagen’s products, services and global opportunities. He focuses on identifying new growth opportunities and developing market strategies that can help Healthagen and Aetna profitably manage quality and cost for its customers.

Prior to joining Healthagen, Dr. Saunders served as executive in residence at Warburg Pincus, one of the world’s largest and oldest private equity firms. He has held a number of other significant leadership positions during his career, including CEO of Broadlane, Inc., President of EDS Healthcare Global Industry Solutions; Chief Medical Officer of Healtheon / WebMD; Principal of A.T. Kearney; and Executive Director of San Francisco General Hospital Managed Care Programs.

Dr. Saunders received a B.S. in biological sciences from the University of Southern California and an M.D. from Johns Hopkins University. He is board certified in Internal Medicine and Emergency Medicine and has served on the faculty of several universities, including the University of California, San Francisco; Vanderbilt University; and University of Colorado.

I also got to hear him speak right before I talked to him. (As a side note, he is a great presenter which is something that I really respect in a world of people who present too many slides, use notes, talk to the screen, and can lose you quickly.)

He hit on several key themes in his presentation that we then discussed further face-to-face:

  1. Social Caregiver Model
  2. Game Theory
  3. Digital / Mobile

One of my first questions was to really understand Healthagen and what it was set up to do. (As you can see from the screen shot below, they’re doing lots of things in this group.)

He boiled it down nicely to three things:

  1. Physician (provider) enablement
  2. Patient engagement
  3. Population Health Management IT

Our next discussion was really around why and how to create and innovate within a large company like Aetna. He reiterated what I believed that Mark Bertolini championed this new vision along with several of the other senior leaders. But, I think the key was that they recognized that issue of trying to do that internally and were willing to form a group to be different. To minimize bureaucracy for this group. And, to leverage their capital and assets to support this group. Not many big companies do this well. My impression is that Aetna is and will continue to be successful here. (Full disclosure – I own a minor number of Aetna shares and have believed this since I bought them about a year ago.)

Of course, in today’s market, there’s an explosion of innovation with questions on the short-term and long-term ROI of many initiatives and start-ups. With that in mind, Dr. Saunders pointed out that they don’t want to own everything. They want to create a plug and play platform of enablement. iTriage is a great example of this where they brought in a mobile technology with 2M downloads in 2011 and now have over 9.5M downloads of the tool (on top of massive increases in functionality and integration). You can download it here – https://itunes.apple.com/app/itriage-health-doctor-symptoms/id304696939?mt=8.

Certainly, one concern others have historically had in this space was how to own solutions and sell them to their peers (competitors). Dr. Saunders talked about their ability to do this with ActiveHealth and a perception that the industry is over that issue as long as Aetna can continue to demonstrate that they are good stewards of the data and are keeping the appropriate firewalls in place.

We wrapped up the conversation talking about the social caregiver and game theory. I think both are important in our mHealth / digital world. With the sandwhich generation, this is increasingly important. That is where Aetna is focusing…enablement of the caregiver for infants and seniors leveraging a social approach. This reminds me of their recent announcement of a pilot with PatientsLikeMe. We also talked about game theory and the role of that in healthcare which is a common theme from my discussion with Keas this morning and a theme from the overall conference.

It should be interesting to watch Dr. Saunders and his team and how Aetna continues to pivot.

Consumerism, Events, Healthcare, Leadership, Managed Care, Marketing / Communications, Methodology, mHealth, Press, Technology, Value Propositions
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Key Topics At #WHCC13 In DC

April 9, 2013 by George Van Antwerp 0 Comments

I’m at the World Healthcare Congress (WHCC13) in Washington DC this week.  This has always been one of the top 5 events for me to try to come to every year (admitting that there are a few like TED that I haven’t attended due to budget yet).

It’s interesting  how trends start to flow within a conference and how the trends change year to year.  This year, the key themes that I continue to hear are (in no order):

  • Engagement is critical.  Between MD and Patient.  Between social network / influencers and member.  Between employee and employer.
  • We have to get past the barriers to health enablement (i.e., legacy IT systems) and make change happen.
  • Game theory can help improve engagement.
  • Mobile tools are important.
  • Data integration has to happen and employers are doing it themselves.
  • Biometrics are critical path.
  • We can’t solve healthcare if we don’t solve health.  The community.  Our food choices.  Work / life balance.  (I would add sleep and stress.)
  • Rapid innovation.
  • Reform isn’t going to be easy on the employer or the employee.

But, since Twitter is my new note taker…here’s a few sets of tweets for you.

#whcc13 tweets whcc13 tweets3 whcc13 tweets2 whcc13 tweets1

Events, Healthcare, Managed Care, Marketing / Communications, mHealth, Press
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#WHCC13 Interview: Content + Community + Competition = Keas

April 9, 2013 by George Van Antwerp 0 Comments

I had the opportunity to sit down this morning with Josh Stevens who is the CEO of Keas.

“Keas is the most engaging wellness program in the workplace. Keas promotes healthy behavior and teamwork with interactive media that delivers relevant, individualized content to hundreds of thousands of employees. Keas has a proven track record of supporting corporate HR in increasing retention, productivity, teamwork, collaboration, and competitiveness. By rewarding people for achieving simple exercise and nutrition goals, employee health is improved and overall healthcare costs are decreased.”

He is a passionate believer in using fun and social to drive change in healthcare with a focus initially on wellness and then moving upstream to other challenges like disease management.

As CEO of Keas, the market leader in corporate wellness, Stevens is responsible for leading the development and market adoption of the company’s breakthrough wellness platform and applications.

Stevens has over 20 years of experience in product, sales, marketing, and is a recognized leader in driving high-value product experiences that deliver customer delight and investor’s valuation growth.

Prior to Keas, Stevens was Vice President of e-commerce at YouSendIt, Senior Vice President of strategy and business development at TicketsNow, and General Manager of e-commerce at AOL. Prior to his GM role at AOL, Stevens held a variety of leadership positions in business development, product marketing, product management, and corporate strategy.

Some of you may have seen Keas over the years. They were founded by Adam Bosworth who was responsible for Google Health at one point. They’ve gone through a few evolutions, but it seems like they’ve hit on a working model leveraging several principles that we discussed:

  1. Being intellectually nimble
  2. Developing holistic and integrated solutions
  3. Using content, community, and competition to drive engagement
  4. Building social networks around health
  5. Integrating into the consumer’s experience to be seamless (e.g., single sign on)
  6. Recognizing that change is dependent upon corporate culture changing also
  7. BYOD (bring your own device) meaning that they can integrate with anyone with an open API
  8. Realizing that while some people (like me) might want to focus on data in a Quantified Self manner, we’re only 15% of the population

While Josh isn’t a healthcare native, that seems like a good thing. I’ve seen a lot of people try to come into healthcare from the outside. Most of them fail because they get overwhelmed by the regulation or frustrated by the challenges or stick too much to what they personally think should work. In the hour we spent together, I didn’t get that sense.

I’m looking forward to learning more about Keas and trying out the tools myself. One of the most fascinating points was that they get people to engage 15 times per month. I told him that that was a ridiculous number in healthcare. We went on to talk about his hiring a team from the gaming industry and that they were used to being tied to repeat visits not simply getting people to download the tool.

IMHO – if you could get 50% of people to engage twice a month with a tool (and sustain that engagement rate), you would be a hero.

As I’ve talked about in my posts about CVS and as I tweeted earlier today from the conference, companies need to engage the worker at the workplace to transform healthcare. Josh gets that key point.

“Today’s employees spend most of their daily lives at work and companies can have a huge impact on improving overall health by creating a culture of wellness at work. That culture starts with Keas’ fun, engaging platform, which helps employees become healthier, more productive and more engaged at work, and in life.” (press release)

Healthcare, Innovation, mHealth, Press, Social Media, Technology, Value Propositions
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Why CVS Caremark Asking For Your Weight Is Good For You

March 30, 2013 by George Van Antwerp 0 Comments

I continue to annoyed by all the fear-mongering in the industry around what CVS Caremark is “doing to their employees”.  What about focusing on how they are helping their employees to get better?  (If interested, you should read some of the information they have on their blog.)

Our “Plan for Health” combines an evolving, best-practice approach to health coverage with preventive care and wellness programs. Our colleagues will be more accountable for taking control of their health and associated costs. The first step is getting to know your numbers by getting a health screening and completing an online wellness review each year. If colleagues complete both by the May 1, 2013 deadline, they will avoid paying an additional $600 for the 2013-2014 plan year. (from the CVS Caremark blog)

I was hopeful to hear someone come out strongly and speak about it yesterday on CBS, but instead the CEO of Mercer just talked about “soft” programs that depend upon consumers being proactive around their health.  I would rather hear about the value of screenings and how it helps employees.  In talking with one friend of mine at a biometrics company, he told me that in one case almost 40% of the people that they identified with diabetes (or pre-diabetes) and hypertension (or pre-hypertension) didn’t know they had the disease (or were at high risk).  That to me is a valuable insight to the individual especially when coupled with a program to help them learn and manage their disease (or risk).

For example, companies for years have been using Health Risk Assessments (HRAs) to try to baseline employee health and use that to accomplish several things:

  1. Help the employee to understand their risks
  2. Identify people who should be in coaching programs to improve their health
  3. Learn about their population and how to improve their health benefits

Use of biometrics is the right evolution from the HRA.  People have tried HRAs for years with some success.  Companies pay as much as $600 for people to take this online survey that has no necessary link to reality.  Most HRAs aren’t linked to lab values.  Most HRAs aren’t linked to claims data.  Most HRAs don’t necessarily trigger enrollment in health programs.  They are supposed to activate the employee to be proactive which doesn’t work for many sick consumers especially those in the “pre-disease” phase.  (Here’s a good study that does show some increased activation.)

As I mentioned the other day, this use of biometrics and link between incentives and participation (and ultimately outcomes) is normal and will ultimately improve the link between the workplace and the employee around health.

Let’s take a broader look at insurance to help set some context:

  • For life insurance, you have to disclose certain data and depending on the policy level you have to do other things like get a physical and have blood work drawn.  That effects your costs and their underwriting.  
  • For car insurance, if you get in accidents, your costs go up.  In some case, you can have a monitoring device put on your car to lower your costs.  (like getting blood work done)
  • For home owners insurance, your costs go up if you live in a flood zone or a earthquake zone.  It also goes up if you have lots of claims.

Whether we want to admit it or not, we do determine a lot of our healthcare costs based on decisions we’ve made or had made for us since we were kids.  Some of these are conscious and some are subconscious.  And, obesity which is a large driver of many of these chronic conditions and has an impact on your likelihood of having cancer.  So, a company asking for your BMI and other data to help understand your risks for healthcare costs (of which they typically pick up 80%) doesn’t seem unusual.

Certainly, some are environmental such as those that live in “food deserts” like Detroit.  In other cases, workplace stress can affect our health.  We’re just starting to get smarter about “sitting disease” and it’s impact on our health.  Or, we may take medications that affect our blood pressure (for example).  It’s certainly important to understand these in context of your lab values and discuss a holistic strategy for improving your health with your physician and any care management resources which are provided to you (nurse, social worker, nutritionist, pharmacist).

This idea of learning more about employees in terms of biometrics, food, sleep, stress, social interaction, and many other data points is going to be more and more of a focus.  Companies want to learn how their employees do things.  They want to understand their health.  They want to improve their health.  They want to invest in their workforce to improve productivity, innovation, and ultimately job satisfaction.

While the glass half-empty people won’t see this and there are some companies that don’t always act this way, I generally believe that companies are trying to act in a way to increase their top line and most intelligent executives understand the correlation between health and wealth and the link between employee satisfaction and growth.

Ultimately, healthcare costs are estimated to put a $240,000 burden on us after we retire (even with Medicare) so if someone wants to help me become healthier and thereby save me money which improves my ability to retire and enjoy life I’m happy for them to do.

Books / Articles, Care Management, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Value Propositions
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Life Through #QuantifiedSelf Glasses

March 25, 2013 by George Van Antwerp 1 Comment

No…this is not about how Google Glass can impact healthcare although I do believe it can and will (something many are talking about). 

This is about how the QuantifiedSelf movement can change your view of the world.  Ever since I’ve been using the FitBit (see my review) and focusing on getting 10,000 plus steps per day, I’ve noticed a change in how I view the world. 

Here’s some examples:

  1. We got 12″ of snow yesterday.  I was immediately thinking about how great of exercise it would be to shovel the snow.  I was excited to go out several times and shovel.
  2. When I was flying today, I was thinking “hopefully we’ll get dropped off at a far gate so I can get in some extra steps.”
  3. I’ve been excited to clean the house and get in the steps from cleaning.
  4. I look forward to grocery shopping.
  5. I park farther away in the parking lot.
  6. I’m sometimes intentionally less productive at home to get a few extra sets of stairs in for the day.
  7. When I’m cutting brownies, I’m calculating out how many brownies are supposed to be in the recipe and making sure I cut them to the right size.
  8. When I eat something, I think about how many steps I’ll have to walk (or run) to burn off that food. 
  9. When I pick meals at a restaurant, I’m always looking for their nutritional menu or going online before ordering.

It’s a totally different way of thinking about life when you look through these “quantified self glasses” to see the world through a “health lense” about calories, exercise, sleep, stress, and other dimensions.

Healthcare, Methodology, mHealth, Technology
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How The CVS Program Will Change The Employer – Employee Contract

March 22, 2013 by George Van Antwerp 1 Comment

Have you heard that CVS Caremark is requiring employees to go get biometrics and going to take action on it? OMG!

I’m not sure I understand why people are all upset. Let’s look at the facts:

And, by the way, have we forgotten how much healthcare costs have gone up over time and who pays that bill. It’s either the employer or the government. Both of those things impact our pay as individuals either in terms of lower raises to cover healthcare costs, shifting healthcare costs to us, or taxes. It’s not sustainable so the person who pays the bill has to step in since we’re not. (Which is also why I support the NY ban on soda.)

Now, let’s look at our healthcare system where in the current fee-for-service model, there isn’t an incentive for physicians to address this.

For now, people should be happy. They’re only being required to do the biometrics. The penalty isn’t linked to whether they’re fat or have high blood pressure or smoke or have high cholesterol or have diabetes. A recent study by Towers Watson shows that while 16% of employers do this type of outcome based incentive program today (2013) that this is going to jump to 47% in 2014. So, this will be the norm.

And, guess what…sticks often work better than carrots in some cases.

And, healthcare costs are making us uncompetitive globally as a country.

  • The cost of healthcare is greater than the cost of steel in a car.
  • The cost of healthcare is greater than the cost of coffee in a Starbuck’s cup of coffee.

And, health reform is allowing (even enabling) this to happen. It says that you can treat people differently and create up to a 50% differential in costs associated with their health. (Not a legal definition so read the fine print.)

But, what I think all of us (consumers and employers) will need to realize is that moving to this (which I agree with) will change the employer and employee relationship in several ways.

  1. You can’t put these programs in place without something to help me manage my obesity, cholesterol, and/or other chronic condition. This will drive wellness and disease management programs to be more engaging and successful.
  2. This will put pressure on employers to create a culture of health since we spend so much time at work and work contributes to our health conditions.
    1. Need more time to be active. Less sitting. Treadmill desks. Standing meetings. Nap time. Walking breaks. Use of devices to track steps. Incentives. Gym discounts. Healthy food discounts.
    2. Need less stress.
    3. Need more sleep.
    4. Better food choices at work.
  3. This will drive a lot of the new tools and run counter to some trends about limiting dependent coverage since you can’t address obesity without engaging the entire family and the social network.
  4. This will also create a whole exception process by which people who gain weight due to certain drugs have to be excluded. People who can’t exercise may have to be excluded. People may have to see short-term goals (i.e., dropping BMI from 35 to 32). Physicians will have to be engaged.
  5. Coaching will have to expand to include dieticians, social workers, and others to help people beyond the historical nurse centric coaching model.

If none of this motivates you, then just think about the “gift” we’re giving our kids and maybe that will be a wake-up call why someone has to do something here. (As I shared the other day, I struggle with my weight so don’t think I’m some super skinny, high metabolism person who thinks this is easy.)

Books / Articles, Business Tools, Care Management, exercise, Healthcare, Leadership, Managed Care, Marketing / Communications, Research, Value Propositions
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Two Surveys On #mHealth #healthapps

March 20, 2013 by George Van Antwerp 0 Comments

The data from these two surveys just passed my desk so I thought I would post them.

Mobile survey
mHealth survey MCOL

Healthcare, mHealth, Technology, Value Propositions
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