Enabling Healthy Decisions

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?