Tag Archives: Customer Experience

Healthcare Companies Sitting On Lots Of Cash…What Will They Do With It?

In the September 8-15 edition of Time Magazine, they have a whole article about data and numbers.  One of the pages is on which companies have the most cash.  Apple is number one and the one you always hear about.  As we’ve all seen, there are lots of rumors about Apple, Google, and Amazon and what they’re doing that is health related. 

At the same time, I was intrigued to see all the health related companies on the list:

  • Medtronic – $13.7B
  • Abbott Labs – $8.1B
  • Merck – $27.3B
  • Pfizer – $48.8B
  • Johnson & Johnson – $29.2B
  • Abbvie – $9.9B
  • Eli Lilly – $12.7B
  • Amgen – $23.1B
  • Bristol-Myers Squibb – $8.3B

You have several other non-healthcare companies which are doing things in healthcare that are also on the list:

  • Walmart – $8.7B
  • GE – $14B
  • Procter & Gamble – $8.5B
  • Qualcomm – $31.6B

If you look at the Rock Health recent report, you can imagine how these companies could leverage all this money to really change healthcare.  They could fund companies.  They could buy companies.  They could invest in orphan drugs.  They could create new technology standards.  They could educate consumers.  They could push technologies like the Internet of Things. 

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Book: My Healthcare Is Killing Me

“A hospital bed is a parked taxi with the meter running.”  Groucho Marx

While I was flying last week, I had the chance to read My Healthcare Is Killing Me.  I could probably think of a few other titles for the book like:

  • Don’t let healthcare bankrupt you
  • Navigating the healthcare billing maze
  • Negotiating to better health
  • The $20 disenfranchisement fee

Those should give you a hint about the topic of the book.  It’s written by Chris Parks, Katrina Welty, and Robert Hendrick who are all part of the founding team at Change Healthcare.  If you’re not familiar with Change Healthcare, you should look at them and others in the transparency space.  (You can look at Jane Sarasohn-Kahn’s series on cost transparency for more information.)

Here’s a few of my notes from the book:

  • Hospitals and doctors view their patient’s bills as Days Sales Outstanding (which is why you can negotiate for prompt payment).
  • 22% of people have been contacted by a collection service for a medical bill
  • 60% of consumers that asked for discount on a medical bill were successful
  • The bill is NOT what the provider will (or expects) to get paid…It is the most that they will get paid
  • The chance of getting the right diagnosis and treatment on the first visit is 50% (scary)

The book has an interesting analogy from Patsy Kelly comparing healthcare to a restaurant:

“In healthcare, the patient does not order the service or have the primary responsibility for payment.  Additionally, the person who pays for the service does not order it or consume it, and the person who orders it does not pay for it or consume it.”

Another quote from Unity Stoakes was:

“We must arm ourselves with knowledge, wisdom and information.  Demand transparency in pricing by researching alternatives.  Negotiate!  Take control of your own healthcare now.  The more you know, the more power you have.”

The authors do a good job of simplifying down some of the complexities of the healthcare payment system.  Some things have changed with health reform, but the fundamentals are the same.  For someone taking on a large, complex condition which is likely to result in lots of costs, its worth reading.  For someone trying to change healthcare and understand the fundamentals, it’s also a great quick read which you can then follow-up on to see how this became the foundation for Change Healthcare. 

 

A Frustrating Pharmacy Experience Highlights Service Challenges #Fail

We all talk about the challenge of consumer engagement in healthcare.  If we can’t get consumers to engage, we’ll never get them to change behavior or be preventative.

But, as the recent Times article highlights, sometimes engagement still leads to failure which can be very frustrating.  As I think about my recent experience within the pharmacy system, I’m reminded of a comment that I re-tweeted yesterday.

In this case, I have connections which I suppose I could escalate this to, but it seems wrong that the only way to resolve my customer service issue is to call in personal favors from Express Scripts and CVS.

 

 

But, maybe that’s what I’ll have to do.  At this point, the only way I seem to be able to get my medication is to pay cash which seems like a total system failure.  (Thankfully, I can use the GoodRx app to figure out which pharmacies have the lowest cash price for me.)

So, here’s the scenario…

  • On 12/31/12, I requested a refill for my 90-day retail script that was getting filled at my local CVS store.  
  • I got busy and couldn’t go to pick it up until 1/2/13.
  • Obviously, my plan design changed on 1/1/13, and I was no longer eligible for 90-day retail scripts at CVS.
  • I asked the pharmacist to run it as a 30-day script.  They tried numerous times, but for whatever reason, they couldn’t get the 30-day script to go through.
  • I asked them to transfer the script to my local Schnucks (grocery store) pharmacy.
  • I filled the January 30-day script and a February 30-day script.
  • When I came back for my March refill, they were getting a RTS (refill-too-soon) reject from the PBM – Express Scripts.
  • The local pharmacist and I both jumped on our phones and talked to the pharmacy help desk and customer service at Express Scripts and got the same answer…”You should have another 59 days supply based on the 90-day Rx you picked up at CVS on 12/31/12.”
  • I tried explaining to the customer service rep that I never picked it up.  They said that I’d have to solve that with CVS since they show it in the Express Scripts system…which by the way had me very upset that it became my issue to resolve a problem between the pharmacy and the PBM.  The rep went on to explain to me that they don’t talk to retail pharmacies to resolve issues like this.  (This became one of very few times when I was shouting and upset on a customer service call.)
  • My local pharmacist called the CVS store that said they show the original claim, but it shows that they didn’t fill it.  They agreed to try to reverse it again.
  • One complicating factor here which I think is making this worse is that the 2012 plan was with Medco which has since been bought by Express Scripts.  As a new client to Express Scripts, I would assume Medco sent them an open refill file probably on 12/31/12 or 1/1/13.  A reversal after that day might never come over to Express Scripts.
  • So, I posted the above tweet out of frustration over a week ago.  Express Scripts’ social media team quickly followed-up and assigned someone to work the case…BUT, it’s still not fixed.
  • I talked to Express Scripts yesterday, and it was still something they were trying to resolve with CVS.
  • I talked with CVS who confirms that they never filled the script and show it never paid by Express Scripts.  They blame it on an issue with their software vendor that somehow the reversal was caught in the system.  They said it could get resolved in the next 48 hours.

Who knows when this will resolve itself, but everyone seems to be able to blame someone else here.  Never mind that the patient (me) can’t get their medication.  As someone who tries to look at this from the average consumer’s perspective, this is a nightmare and total customer experience failure.  I understand the system.  I understand plan design.  I know the pharmacists.  I know the teams at Express Scripts and CVS.  Even with all that, I’m stuck having to go outside the system, pay cash for my prescription, and hope that my paper claim will get processed and hit my deductible in my plan design.

fail-stamp

 

100 Questions To Ask To Understand The Patient Experience

Someone asked me yesterday if I could come up with 100 questions on one topic that I would want answered. I started by thinking about Rx adherence, but I evolved it to a broader topic (patient experience) to get to 100 questions. This is my list of 100 questions I would want to evaluate to understand the patient experience with a disease and what factors are relevant to segmentation and differentiation.

This exercise also led me to this equation as a strategic framework (not a mathematical algorithm…yet).

Patient Data (Demographics):

  1. What is their age?
  2. What is their gender?
  3. What is their income?
  4. What is their highest level of education?
  5. What is their race / culture?
  6. Are they married?
  7. Do they have kids?
  8. Do they work in healthcare?
  9. Where do they live?
  10. Are they in a rural, urban, or suburban setting?
  11. Have they ever had a medication before?
  12. What has their prior adherence been on other medications?
  13. Does the patient go to multiple pharmacies?
  14. Do they have multiple MDs?
  15. What type of insurance do they have – commercial, individual, Medicare, Medicaid?
  16. Do they have a family history with the disease?
  17. Have they ever done a genetic test to know they were at risk for the disease?
  18. Do they have friends with the disease?
  19. Are they a caregiver for others?
  20. What is their health literacy?
  21. Have they enrolled for the website for their payer?
  22. Have they downloaded any mobile apps?
  23. How often do they exercise?

    Patient Beliefs:

  24. What is their Patient Activation Measure (PAM) score?
  25. What stage of change are they in? (TTM)
  26. Are they a fatalist?
  27. Are they actively part of any social groups (e.g., church)?
  28. Do they have motivation to change?
  29. Have they successfully changed behaviors before?
  30. Do they perceive the change as achievable?

    Diagnosis Attributes:

  31. What type of disease is it?
  32. Is it a mental health disease?
  33. Is there a social stigma associated with the diagnosis (e.g., obesity)?
  34. Is it a “social” disease (i.e., lots of active communities to create P2P support)?
  35. How long since they were first diagnosed?
  36. Is the disease progressive?
  37. Is this a rare disease?
  38. Is this a curable disease?
  39. Will this disease kill them?
  40. Does there a mechanism for feedback on the drug – blood pressure cuff, blood sugar monitor, scale?
  41. What are the total costs of the disease – Rx, lab, MD visits, behavior change?

    Treatment (Prescription) Attributes:

  42. Does the patient’s treatment plan include behavior change – diet, exercise, smoking?
  43. Did the physician provide them with any information (i.e., Ix or information therapy)?
  44. Did the physician direct them to any resources (e.g., prescribe apps)?
  45. Did the physician write a prescription?
  46. Did the physician give them samples?
  47. Is this a new prescription or a refill?
  48. Are they on other medications?
  49. How many other medications are they on?
  50. Was it prescribed by a PCP or a specialist?
  51. Was it prescribed in the hospital or on an outpatient basis?
  52. Was it an eRx or a paper Rx?
  53. Is this a first-line of therapy or a second-line?
  54. Is the medication contra-indicated with another other medications they are on? (DUR)
  55. What is their copay?
  56. Is there a copay card?
  57. Where there any utilization management requirements (PA, ST)?
  58. Is it a brand or a generic?
  59. What is the form of administration – pill, injection?
  60. What is the size of the pill?
  61. Does the medication require specific times to be taken?
  62. Is the medication once-a-day?
  63. Is there a delay between starting therapy and feeling better?
  64. Is there an adherence program that surrounds the drug?
  65. Does the adherence program integrate with the physician?
  66. Did the physician tell them the name of the drug or just write the Rx?
  67. Did the physician explain any side effects of the drug?
  68. Does the drug have any side effects?
  69. Is the drug being used off-label?
  70. Is there a REMS program for the Rx?
  71. Is this a clinical trial?

    Care Team Attributes:

  72. How long have they gone to this physician?
  73. Is this a single practitioner or part of a group practice?
  74. Is the physician group owned by a hospital?
  75. Is the physician group an ACO or PCMH?
  76. How old is the physician?
  77. What gender is the physician?
  78. How long was their visit to the MD when they were diagnosed?
  79. What type of pharmacy was it filled at?
  80. Do they have a relationship with the pharmacist?
  81. Are they in a disease management program?
  82. Are they in a care management program?
  83. Do they have a caregiver to support them?
  84. Was the caregiver at the MD visit when they were diagnosed?
  85. Have they articulated their life goals to the team?
  86. Do they have an advance directive?

    Technology Attributes:

  87. Does the patient use healthcare websites?
  88. Does the patient use healthcare mobile apps?
  89. Is there a mobile app to support this disease?
  90. Is there a mobile app to support this drug?
  91. Is there a mobile app to support their behavior change?
  92. Does the patient have and use a PHR?
  93. Does the physician use an EMR?
  94. Did the patient’s “self-diagnosis” with Dr. Google match the physician’s diagnosis?
  95. Is there anything unique about the pill bottle to support engagement?
  96. Are the patient’s programs about the disease multi-channel?
  97. Are the patient’s preferences used to evolve how they are communicated with?
  98. Are the patient’s communications tailored to them based on their data?
  99. Do they use SMS?
  100. Do they have a smartphone?

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