Most Medicated Generation

Well, we have finally broke the 50% mark of people using maintenance (or chronic) medications. It shouldn’t be a big surprise. Sit around the table with your friends and ask who takes a medication (without asking what for). Why do so many people take medications:

• We are in worse health…think obesity.
• There are better medications.
• Doctors are more willing to prescribe.
• Patients know more about using medications through DTC (direct-to-consumer) advertising.

This is all according to a Medco report that was just published looking at a sample of 2.5M customers of all ages from 2001 – 2007. A few of the facts:

• 2/3 of women 20 and older take maintenance medications.
• ¼ of children and teenagers take maintenance medications
• 52% of adult men take maintenance medications
• ¾ people 65 or older take maintenance medications
• Among seniors, 28% of women and 22% of men take 5 or more maintenance medications

“Honestly, a lot of it is related to obesity. We’ve become a couch potato culture (and) it’s a lot easier to pop a pill” than to exercise regularly or diet. (Dr. Robert Epstein, Chief Medical Officer at Medco)

Dr. Epstein makes the point that in some cases we have turned diseases that were once a death sentence into chronic conditions - AIDS, some cancers, hemophilia and sickle-cell disease. I was just talking about this yesterday with a nurse about an adherence program where I said we needed to look at some specialty drugs because they are being used chronically.

The biggest jump was in the 20-44 year old age group where utilization grew 20% mainly for depression, diabetes, asthma, ADD, and seizures.

Medco estimates about 1.2 million American children now are taking pills for Type 2 diabetes, sleeping troubles and gastrointestinal problems such as heartburn. (This should be troubling to everyone in terms of the long-term implications to our health care system.)

The Brand Only PBM

A few years ago, I would have argued that PBMs could one day simply cover generic drugs and not cover brand drugs.  With most therapy classes (excluding specialty) having multiple generic options, this seemed possible.  Already, some companies have generic fill rates which are above 70% (meaning that 70% of all prescriptions filled are filled with a generic).

But, now I am wondering the opposite.  If retailers drop generic drugs to $4 and make them available in 90-day supplies for $10 (see Wal-Mart), do you need to PBM in the middle managing those claims?

There are of course several questions to be answered:

• What percentage of the total generics filled in the market are available at these prices?
• What happens with new generics that typically have a higher price for the first 6-months?
• Do these claims still get processed so that they show up in the PBM claims database to be used for drug-drug interactions?

And, Wal-Mart upped the ante here including over-the-counter drugs which typically aren’t covered by insurance.  We aren’t there yet, but it poses an interesting question about the future breadth of coverage and what the implications could be.  Today, most PBMs don’t make money on the brand drugs other than perhaps an administrative fee paid by the pharmaceutical manufacturer for those drugs that are on formulary.  (Something in the range of $1-$5 per claim depending on the cost of the drug and the contract.)

It would turn the market upside down also since a lot of the intervention programs today are in place to drive use of generics as first-line therapy so if they weren’t part of the benefit then the programs wouldn’t have as much value.

Just a thought.  BTW - I have asked the Wal-Mart people to answer the last question above for me since I am interested in whether this is a real issue today or whether most of these claims get paid out using the U&C (usual and customary) field and logic in the POS (point-of-sale) system (i.e., they process as paid claims not cash claims).

Pharmacy Satisfaction Did You Knows

PharmacySatisfaction.com puts out a weekly factoid. They are very interesting and make some great points. I have talked about it before, but here is an updated list with the new factoids from 2008.

• Independent drug stores continue to score highest in customer satisfaction, followed by food stores, clinics, and chain and mass merchandise pharmacies, in that order.
• The number one concern across all pharmacy users is that their prescriptions are filled accurately.
• Independent pharmacy customers are the most satisfied with the services their stores provide.
• The most useful feature those Web sites offer to them, the survey found, is the ability to order refills online.
• Nearly three in 10 order their refills online.
• An average of 69.4% of customers own or use a computer.
• Customers average three visits each month to their pharmacy.
• Only about 1-in-5 pharmacy customers, overall, say that they use a loyalty card that provides points, discounts or other savings.
• While the majority of loyalty card users are satisfied with the expected cost savings by using their card and with the ease of enrolling and understanding the benefits of their card, fewer than 1-in-4 card users are highly satisfied.
• The drug store industry remains largely up for grabs, with nearly half of pharmacy customers saying they use more than one pharmacy to fill prescriptions.
• Pharmacy use varies considerably by population. Chain pharmacies are most commonly used among residents of areas with more than 100,000 people. Independent pharmacies are most commonly used among rural respondents (areas with less than 100,000 people). Use of independent and mass merchant pharmacies decreases as population increases. Chain, food store, mail/online, and clinic pharmacy use tend to increase with population.
• However, as pharmacy customers age, they are much less likely to use chains and considerably more likely to use mail/online and clinic pharmacies.
• Seven-out-of-ten pharmacy customers indicate that they “definitely would” or “probably would” use their local pharmacy if they could receive the same amount of medication at the same price as their mail-order pharmacy.
• The heaviest users of prescriptions are survey respondents in their 60s, averaging 5.4 new scripts and 29.2 refills per year.
• The most preferred method for filling those prescriptions among respondents is to take them to the pharmacy and wait for them to be filled.
• Indeed, physically handing a paper script to the pharmacist or tech in the store—or picking up a script phoned in by the doctor—remains the overwhelming choice among consumers. Most shun the use of drive-through windows.
• How long patients have to wait for their scripts to be filled is a key component of customer satisfaction.
• Fully 93 percent of those surveyed expressed satisfaction with the ability of pharmacies to dispense their new prescriptions in the time promised.
• Pharmacy customers’ most commonly preferred method of refilling prescriptions (assuming prices and amounts of medication are the same) is calling an automated telephone system and picking up prescriptions at the store.
• Independent customers are the most likely to receive prescription refills in less than 15 minutes, followed by food store, chain and mass merchant customers.
• The average survey respondent is spending a considerable sum each month on drugs at their pharmacy—$82 on average (versus $57 a month on food and groceries at their pharmacy).
• Customers who paid full retail price for their medications, paid an average of $81 for their most recent prescription.
• Customers who paid the store discounted amount for their medications, paid an average of $75 for their most recent prescription.
• Customers who paid a fixed-percent co-pay for their medications, paid an average of $56 for their most recent prescription.
• Customers who paid a fixed-dollar co-pay for their medications, paid an average of $36 for their most recent prescription.
• On average, respondents spend $82 a month at their pharmacy on prescription drugs, $57 on food/groceries, $18 on non-prescription (OTC) drugs and $14 on personal care/cosmetics.
• An average of 85.9% of computer owners/users use the computer to improve their health by looking for information about diseases.
• Much has been written about the value of closer pharmacist-patient relationships, but Americans seem to feel far more connected to their physicians, dentists and nurses than to their pharmacists. That’s clearly not all pharmacy’s fault; the same survey respondents agreed that they were usually given the opportunity to speak with their pharmacist when filling their last prescription. What’s more, pharmacists ranked a close second to doctors as sources of information about medications.
• Only 16 percent of respondents describe their relationship with their pharmacist as “We are on a first-name basis and have known each other for a very long time.”
• Walgreens’ “Dial-a-Pharmacist” initiative, launched in February 2006, allows non-English speaking patients to connect with pharmacists speaking 14 different languages.
• Doctors (94%) are the most commonly referenced source of information on medications, followed by pharmacists (83%), nurses (57%), pharmacy brochures (50%) and the Internet (42%).
• Doctors (77%) are the most trusted source of information on medications, followed by pharmacists (64%), nurses (43%) and pharmacy brochures (20%).
• Independent pharmacy customers have the most trust in pharmacists, while mail/online customers have the least. Compared to last year, customers of all types of pharmacies place more trust in their pharmacist as a source of information.
• More than one-third of pharmacy customers failed to fill all their prescriptions last year, and only 35 percent of all respondents said they were fully compliant on the medications they did take. Nevertheless, refill reminders from the pharmacy remain relatively rare, most patients profess.

2008 Factoids

• In general, older patients tend to be more compliant than their younger counterparts.
• The biggest reason for not taking all medications as directed was simply, “I forgot.”
• Nearly 2-out-of-3 (65%) indicate that they missed a dose or took less medication than prescribed in the past year.
• The most commonly cited reason for not filling all prescriptions is not needing (42%), followed by too costly (27%), changed by doctor (20%), side effects (17%) and insurance did not cover (16%).
• Among the medical conditions displayed, those treated for HIV/AIDS and high blood pressure are the most likely to have filled all of their prescriptions in the past year. Those treated for RLS are the least likely to have filled all their prescriptions in the past year.
• For competing pharmacy providers, satisfaction is a key measurement. Customers who say they are “highly satisfied” with their pharmacy are much more likely to return than those who are simply “satisfied.”
• Pharmacy customers who are “highly satisfied” with their pharmacy overall are considerably more likely to have positive return intentions, compared to customers who are simply “satisfied” (97% definitely intending to return versus 65%). Survey results have also shown significant revenue differences between highly and poorly rated pharmacies, health plans, and PBMs.
• Compared to last year, pharmacy customers place more importance on four of the six overall areas of pharmacy services—most notably professional services — followed by pricing and insurance, and overall convenience.
• 31% of customers consider it “very important” that Pharmacists give advice on OTC/herbal products.
• 38% of customers consider it “very important” that Pharmacists give advice on health conditions.
• 57% of customers consider it “very important” that Pharmacists are friendly and courteous.
• 65% of customers consider it “very important” that they are able to speak to a Pharmacists give clear instructions about Rxs.
• 65% of customers consider it “very important” that they are able to speak to a Pharmacists about their concerns/questions.
• 66% of customers consider it “very important” that their pharmacy protects the privacy of their health info.
• The most common ailment that drives customers into your stores is high blood pressure, which afflicts nearly 50 percent of the respondents surveyed by WilsonRx. High cholesterol, allergies, ailments of the esophagus, arthritis and diabetes also are extremely common among patients.
• When asked about their satisfaction levels, respondents who received birth control prescriptions were happiest with the medical treatment they’re getting, followed by those thyroid disorders, epilepsy/seizures and type I diabetes.
• Among the pharmacy services customers say are most important to them is: Help untangling complicated insurance issues, and money-saving alternatives like generic drugs.
• Consumers are generally satisfied with many of the services, medicines and health-oriented advice they find at their local pharmacy, but they’re also keenly aware of the high costs of pharmaceuticals and quick to shift outlets if they feel their needs aren’t being met.
• Those who are covered by prescription plans—including nearly 39 million Medicare patients enrolled in some kind of coverage—often feel overwhelmed by the complexities and co-pay issues they encounter at the pharmacy counter.
• Know your customer — whomever, wherever they are. Being able to identify different customer types is an important first step in anticipating customer needs and managing the expectations of each person.

Are You Doing Enough To Drive Generics?

From the Express Scripts Outcomes event a few weeks ago, here is an estimate of all the money left on the table by not increasing your generic fill rate in certain key categories.  Are you doing enough?

• Utilization management programs - step therapy, prior authorization, quantity level limits?
• Formulary coverage?
• Plan design incentives?
• Pharmacy incentives?
• eRx messaging?
• Web tools?
• Patient communications?
• Patient incentives?
• Driving people to mail?

Here is a graph from CVS/Caremark’s trend report from last year that shows correlation between certain programs and generic fill rate.

Incentives and Communications

Everybody looking at the healthcare system understands that incentives and alignment of goals is a critical component for successful change.

• Providers need to be motivated to focus on wellness and prevention.
• Individuals need to be motivated to care about the cost of care and to act in a healthy manner.
• Pharmacists need to be motivated to take the extra action of moving patients to lower cost agents, resolving administrative edits, and counseling patients.
• Hospitals need to be motivated to focus on Six Sigma type process initiatives.
• Health Plans need to be motivated to invest in long-term care initiatives that prevent people from getting sick.
• PBMs need to be motivated to drive optimal prescription use even if that includes more over-the-counter (OTC) drugs.
• Employers need to be motivated to offer benefit plans to cover their employees which are simple to understand and align employees with healthy outcomes.
• Pharmaceutical manufacturers need to be motivated to drive adherence across clinical conditions and to bring new drugs to market that represent significant improvements in therapy (better outcomes, less side effects, easier deliver methods).

With that in mind, I am glad that Silverlink Communications announced this morning that we are partnering with IncentOne to incorporate incentives into our communication programs.  Going forward, incentives will offer us another lever to improve outcomes in our programs that we conduct for clients.

“If applied appropriately in healthcare, incentives are an influential lever to motivate healthcare behaviors, arguably the most powerful force for changing the economics of healthcare,” said Stan Nowak, CEO and co-founder of Silverlink. “We’re excited to be partnering with IncentOne to design highly flexible, personalized and incentive-driven outreach that enables health plans to better connect with and engage their members to drive healthcare behaviors and reward them at the same time.”

“This is a truly integrated technology partnership that seamlessly connects healthcare consumer participation to incentives,” said Michael Dermer, CEO at IncentOne. “Silverlink and IncentOne together can deliver complementary solutions that drive participation and ultimately cost savings in healthcare. The combination of our expertise in finding the right incentives and Silverlink’s personalized communications to drive consumer behavior delivers the ability to implement more effective programs.”

Matthew Holt (author of The Healthcare Blog) did a podcast with both the CEOs yesterday that you can listen to to learn more.

You can also look at a study by Hewitt Associates of large employers which covers several related topics:

• 2/3rds plan to offer incentives to motivate sustained health care behavior change.
• 67% will utilize health care data and measurements to drive their organization’s health care strategy.
• 74% of employees think their employer should help them understand how to use their health plan better.
• 12% of employees think employers should help them become healthier.
• Employee decisions on healthcare were influenced by cost:
  • Nearly one-third (30 percent) said they did not go to the doctor when they were sick because of cost.
  • 27 percent didn’t fill a prescription given by a doctor.
  • Almost one in five (19 percent) stopped taking medications before their prescription ran out, and of those, 18 percent did so due to finances.

Certainly, there are numerous examples of incentives being used to drive behavior.  Moving patients to evaluate mail order pharmacy has been a solution where coupons have been used over th years.  Driving therapeutic conversions have used incentives in the form of copay waivers.  Getting patients to complete health risk assessments (HRAs) and other tools have given incentives.

The interesting component will be the personalization of incentives.  While I may enjoy a $10 gift card to the dog store, my wife may enjoy a $10 gift card to the spa.  Flexibility of incentives and alignment of incentives with what drives behavior will be important.

Addressing Medicine Adherence

There are numerous studies on this, but they all point to the same issue…compliance.

The National Council on Patient Information and Education (NCPIE) released a report last year that I just came across titled “Enhancing Prescription Medicine Adherence: A National Action Plan“. With only 50% of patients using medication as prescribed, the systemic costs are enormous - $177B annually according to their estimates.

“Besides an estimated $47 billion each year for drug-related hospitalizations, not taking medicines as prescribed has been associated with as many as 40 percent of admissions to nursing homes and with an additional $2,000 a year per patient in medical costs for visits to physician’s offices.”

• Between 40% and 75% of older people don’t take their medications at the right time or in the right amount.
• As few as 30% of adolescents take their asthma treatments as prescribed.

Look at this in light of the recent study that showed about a quarter of people share drugs.  Another huge problem.

Their 10-step national action plan includes:

• Elevate patient adherence as a critical health care issue
• Agree on a common adherence terminology that will unify all stakeholders
• Create a public / private partnership to mount a unified national education campaign to make patient adherence a national health priority
• Establish a multidisciplinary approach to compliance education and management
• Immediately implement professional training and increase the funding for professional education on patient medication adherence
• Address the barriers to patient adherence for patients with low health literacy
• Create the means to share information about best practices in adherence education and management
• Develop a curriculum on medication adherence for use in medical schools and allied health care institutions
• Seek regulatory changes to remove roadblocks for adherence assistance programs
• Increase the federal budget and stimulate rigorous research on medication adherence

I am a little surprised that they didn’t talk about technology.  Integrated electronic medical records, personal health records, etc.  Since at least 1/4 of people don’t even fill their initial script, I don’t see how we can address adherence without beginning there and providing full lifecycle data to physicians about the status of scripts and refills.  I think there is also a huge role for collecting data about why people fill or don’t fill.

Poor Health Plan Satisfaction Due To Poor Communications

JD Power just finished their second annual National Health Insurance Plan Study which looks at member satisfaction.

“The study finds that the majority of health plan members rate their insurer lowest for the communications and information that are provided to help them understand their plan. Only 45 percent of members reported they fully understand how to use their health insurance coverage and member services. Enhancing member understanding with critical plan details—such as prescription coverage, co-pays, how to locate physicians and how to appeal coverage denials—can lead to higher satisfaction ratings for insurers.”

They evaluated 17 regions and publish reports like the following:

Information and communications is the third largest driver of health plan satisfaction at 17%. The only two things above it are coverage and benefits (#1) and choice of physicians, hospitals, and pharmacies (#2). So, it makes a great case for why communications is something to invest in and focus on. It drives satisfaction which drives retention. Additionally, it is something through which you can create sustainable differentiation. Benefit design and network size are pretty easy to copy.

Health: A Luxury

With rising food costs and constantly increasing costs for health insurance, could health become a luxury? It’s an interesting (and sad question).

Let’s take a pessimistic view of the situation for someone living in poverty:

• Fast food is probably cheaper than many health foods.
• The working poor likely have less time to exercise and no money to belong to a gym.
• The working poor may have more than one job to make ends meet and/or may work in an environment which is hazardous to their health.
• Financial stress could impact sleep which impacts obesity.
• Access to quality health providers may be limited based on location and/or access to transportation.

I saw an article in the Philadelphia Inquirer about this, and it made me think. Talk about a long-term crisis. This is a great rallying call for why reform is necessary.

Does Social Media Help With Retention?

Lois Kelly posted an interesting entry on her Foghound blog about the Catholic Church beginning to use Social Media.  This is an obvious reaction to the statistics she quotes about retention of active membership.

As she asks, the true question is whether tools themselves can impact this or whether the message has to change also.

On the other hand, it also makes me wonder what we are waiting for in healthcare relative to social media.  If a conservative organization like the Catholic Church can embrace it, why aren’t we jumping into it more aggressively.

Five Ways To Recognize the Best Doctors

An average visit to the MD lasts less than 20 minutes and when you ask questions, you are interrupted in 18 seconds (see article).

Is this a fulfilling experience? I think they forgot to add the time you wait to get in the office and the lost opportunity cost for many of us (i.e., what else I could do with that time)?

“On the one hand, there are claims that doctors or drug companies are evil and dishonest. On the other hand, news reports describe triumphs of modern medicine in curing disease and improving quality and quantity of life,” says Dr. Brown in his new book, Navigating the Medical Maze: A Practical Guide. “How can so many seemingly intelligent, caring people reach such different conclusions? The solution is teaching people how to sort through conflicting advice so they can arrive at the best choices for themselves and for their families.”

I haven’t read the book yet, but I have a copy of it. I have a few things in front of it, but I did get this article from Dr. Brown that I thought I would post here.

Five Ways to Recognize the Best Doctors
By Steven Brown, M.D., PhD.

Doctors are just like any other group of people. Some are good, some are bad, and some are mediocre. How can you be sure you are getting one of the good ones? Rate your doctor in these five areas and see how he stacks up.

1. Thoroughness
The best doctors want to get your whole story. The first time she sees you, she (or her staff) should get your whole medical history, not just the details of the problem that brought you in that day. Since the parts of our bodies are all connected, problems in one part often relate to another part, even if the connection is not obvious to the layperson.

2. Communication
Does the doctor take time to listen to your story? Does he take time to explain the problem and answer your questions? Do you have to sit in front of the door to keep him from leaving? Doctors today are under considerable pressure. Costs of practice are rising, and payments from insurance companies are falling. Since doctors are paid based on how many patients they see, the only way to maintain their income is to see more patients in less time. If the doctor takes the time you need, that shows that he has decided to make less money in order to take better care of you. That is the kind of doctor you want.

3. Knowledge
Does your doctor know what she is talking about? When you ask why she is recommending one treatment over another, does her answer reflect knowledge of the medical literature? Is she threatened by questions, or does she welcome them? By the way, it is a good sign, not a bad one, if the doctor tells you she needs to look something up. That shows that she is humble enough and careful enough to check for the latest facts.

4. Self-sacrifice
If you need a doctor who does a lot at the hospital, such as a heart doctor, a lung doctor, or a surgeon, make friends with a nurse or secretary at the hospital. Ask them what doctors answer their pages quickly. Some doctors call back in less than a minute. Others take two hours to call back despite multiple pages. A doctor who cares about his patients will call back right away. He wants to know what is wrong, and he wants to do something about it. His patients are more important to him than his other activities. This exemplifies self-sacrifice. We all want a doctor who makes us a priority. If the doctor is in a specialty that does not go to the hospital, look for other evidence of self-sacrifice. Your friends may be able to tell you stories about a particular doctor who went the extra mile to help them.

5. Character
The single factor that ties these areas together is the doctor’s character. Anything you see that suggests poor character is a reason to go elsewhere. Has the doctor had any serious issues with your State’s Medical Board? You can find out by going to their web site. Does she treat her staff badly? Does he treat you and others with respect? If a doctor does not have good character, at some point it will affect his decisions. As vulnerable as we are to our doctors, we cannot afford that risk.

Anything that shows good character, for example doing well in the areas above, is a reason to overlook minor annoyances, such as an unpleasant receptionist. Having a doctor with good character is also more important than bedside manner. Some doctors may not seem particularly warm or friendly, but they exhibit the attributes we have discussed.

Fortunately, there are not a lot of truly bad doctors out there, but there are a lot who are mediocre. If your doctor does not show these traits, try to find one who does. If your doctor does show these traits, rest assured – he’s a keeper.

Dr. Brown is the author of Navigating the Medical Maze: A Practical Guide. He is a cardiologist in private practice, and is also a Clinical Associate Professor of Internal Medicine at Texas Tech University. He is a contributor to Chest, Circulation, and other health journals. For more information, please visit www.drstevenbrown.org.

College Grads On Work Hours

As you can tell, I have been slow on the posts lately…too much work. Today (for example), I have a breakfast meeting in Boston, an afternoon meeting in Minneapolis, and then fly to Phoenix for a morning meeting on Wednesday. Crazy day.

But, all this made the USA Today Snapshot in Section B catch my eye. It was an Accenture College Senior survey about how many hours they expect to work in their first job (post graduation). What would you guess? I would have said 50-60 hours especially when you’re in your initial job and proving yourself.

I at least find this surprising. What are the 5% doing that work less than 30 hours per week? And the 41% that think they are working between 31-40 hours per week. These are college graduates most of which I would think are taking salaried jobs.

Robot Animals

In the spirit of research, I found this an interesting article. It talks about using robotic squirrels to infiltrate the squirrel population and learn about their communication techniques, social queues, and survival instincts.

“Animals and humans are all affected by behaviors, body postures and signals from each other that we may not be aware of.” Sarah Partan, Asst. Professor in Animal Behavior at Hampshire College

Obviously, I don’t think we are going to build robots that mimic humans and get responses, but it is often hard to fully understand the situation response that you get especially since so much of an individual response if framed by past experiences. But, that being said, my one takeaway (other than general interest) was the need for thinking holistically about multiple channels (e.g., web and chat) or sonic branding (i.e., the voice delivering the message).

Shared Savings With The Patient

Shared savings is always an interesting idea. It is often something that companies look at in a business to business relationship. What about health plan or employer with the patient? Is this an avenue to drive smarter decisions?

The whole theory behind consumer directed health care is making the consumer more responsible and aware of cost. [Although I will continue to argue that the original premise years ago was about driving quality of care not simply cost effectiveness.] But, clarity around the total long-term cost of a healthcare decision is not always readily apparent. In a best case scenario, I may understand the cost of a provider compared to another provider, but do I understand their comparable outcomes and those implications on longer terms costs…NO.

Pay-for-performance is something being tried (not for the first time) in healthcare. But, I don’t hear anyone talking about incentivizing the patients. If they go to the clinic instead of the Emergency Room, why not give them 25% of the savings generated. If they use self-service (i.e., the Internet) versus calling a live agent, why not give them points towards a healthy reward? There are a few innovative models being tried, but it is certainly not the focus. The focus is on making them pay the first X thousand dollars out of pocket with limited information. Transparency and access to data in a real-time setting is critical. I should be able to text message Google and say compare price of Dr. Smith versus Dr. Adams or Hospital A versus Hospital B and provide me with their comparable outcomes for my disease.

Perhaps the bigger question is whether or not incentives can be a key element in any structural re-design of healthcare. We know that providers clearly aren’t aligned to provide preventative care in most cases. If they treat you and educate you to not get sick, you don’t come into the office and you don’t need surgery. It’s great for the health plan, but it reduces provider (i.e., MDs and hospitals) revenue and drug company revenue. I am sure I am not the only one who sees that that is a problem.

Reminder: It’s Time For Your Patient To Come In For A Visit

Aetna announced that it is launching electronic alerts to 320,000 physicians. They will be called Care Considerations.

My understanding is that they will use the ActiveHealth engine to compare claims data to treatment guidelines to identify gaps in care. They will then send the physician a message through the NaviMedix platform and through fax, e-mail, or the phone.

This will be an interesting program to follow:

• Will physicians take action off the alerts? How?
• Since the NaviMedix system will allow two-way interaction, what will they say about the alerts?
• Will this impact health outcomes?
• Are these preventative alerts or are they catching things late in the lifecycle of a disease?
• What will patient’s reactions be to their physician reaching out to them? I would be a little hesitant.

I am a little surprised that the program doesn’t include outreach to the patient also. I would be skeptical of a request to schedule an appointment without some understanding of why I should do it. Otherwise, it would look like an obvious attempt to drive revenue. It reminds me of something a physician said to me once. He said that they can control revenue in many cases. For a patient with mild pain, they can send them home and suggest they take Advil and call them if the pain continues. Or, they can write them a prescription, send them for a test, and schedule a follow-up visit in a few days.

This gets to the issue of Defensive Medicine which I talked about a few days ago.

Health Reform and Tax Reform

Maybe it’s a stretch, but I think that conceptually there is a parallel here. If we had to all of a sudden pay all of our taxes in one big check at the end of the year, I think people would be a lot more focused on taxes. How much they are? How they are calculated? But, we pay each paycheck (or at least most of us), and the impact is muted.

Even if employers simply transferred the dollars to us and we bought individual insurance through our employer to get the group discount, we would still be writing the monthly checks and be much more sensitive to the costs and what we get for our money. Today, those of us still lucky enough to have group health insurance often don’t realize the true cost of an office visit, a surgery, a medication, or any of the other things we use.

Home Delivery Versus Mail

Do you care what it’s called? Some people really dislike Mail Order Pharmacy and go with Home Delivery. I made that change when I was responsible for the product at Express Scripts.

It becomes a little bit more meaningful when you talk about Mandatory Mail which is a benefit design where you are required to fill your maintenance medications at a specific mail order pharmacy after you have titrated to (i.e., found) the right strength for your chronic medications.

Should it be Exclusive Home Delivery? How about Retail Refill Allowance? Or Mail Preferred? Do they make a difference? Do you feel better about being forced to use one particular pharmacy?

On the other hand, if they are giving you money (i.e., a lower copay), to do something that saves your employer money and is equally as safe and more convenient, should you care?

Virtual Consultations

When I talk with people about using American Well or some other type of service, I continually get two very good questions which point to a next generation offering (I think).

• How can the