I will give credit to the Health Care Reform Now blog for leading me to this article in The Indianapolis Star, but I think it is a sad reality.

“More and more of the middle class is finding out that even if they have jobs and insurance, they can be wiped out by medical events that are not even catastrophic,” says Dr. Christopher Stack, a retired orthopedist and co-founder of Hoosiers for a Commonsense Health Plan, the state’s chapter of Physicians for a National Health Program. “You can run up a high five-figure bill real easily.”

A Harvard study published in 2005 estimated that about half of all bankruptcies filed in the U.S. have their origins in medical costs, a ratio that jibes with Silver’s and other bankruptcy veterans’ observations here in Indianapolis. While the rest of the world’s industrialized nations provide health coverage to all or nearly all of their populations, the U.S. mass-produces the distinctly American phenomenon of medical bankruptcies.

I am not a big fan of the donut hole in Medicare, but perhaps we need a donut hole type concept for health insurance where people have a maximum out-of-pocket in any one year.  Although I am sure that would beg the question of what was optional versus required surgeries and treatments.  It just seems a shame that we can bankruptcy hard working people with insurance over their medical bills.

My most popular post ever is “What is a PBM?” which made me think that this is probably a relevant post for the average healthcare consumer.  And, given the historical push to mail combined with the current economy, you can expect mail order pharmacy (or home delivery pharmacy) along with 90-day retail pharmacy to be a hotter topic.

At Silverlink Communications, we work with a lot of companies on their retail-to-mail (RTM) communications strategy and execution.  One of the first things I point out to all of them is that over 50% of people don’t usually know what mail order pharmacy is.  So, you have to address awareness at the same time as recruiting new patients.

So, for all of you that receive a letter or call talking to you about moving your prescription to mail order, let me answer a few of your basic questions:

• Mail order pharmacies are also called home delivery pharmacies since they deliver your medications through the mail and directly to your home (or other address provided).
• The mail order pharmacy is typically owned by either your managed care company (aka health insurer) or by a pharmacy benefit management company that your insurer contracts with directly to provide this service.
• There is typically only one mail order pharmacy that you can use (i.e., is considered “in-network”).
• The service is typically the fulfillment of 90-day prescriptions of medications which you will take on a long term basis (aka maintenance medications).  This is not true for controlled substances which typically only allow a 30-day prescription and for some specialty and injectable drugs.
• You often have a financial incentive to choose mail order where you will get a 90-day supply for less than it would cost you to buy three 30-day prescriptions at your local pharmacy.  This discount is due to the buying power of the mail pharmacy, the automation which reduces the costs of dispensing the drugs, and the lower distribution costs (i.e., no need to move the drug to all 5,000 retail locations).
• The drugs are the same drugs you buy at your local pharmacy.
• You have the same access to a pharmacist but it is over the phone not face to face (which I personally prefer and think is more confidential).
• You can do your refills over the IVR (interactive voice response) line and over the Internet along with traditional means of live agents and using snail mail.
• These mail order pharmacies use robotics and other highly sophisticated solutions to dispense the drugs accurately and quickly.
• Many of the mail order pharmacies that we work with offer services around calling your physician to get new prescriptions and also use our automated outbound calls to provide you with order status (WISMO calls - what is the status of my order) and refill reminders.
• You shouldn’t typically start a new drug at mail order.  You want to wait until you have had two fills locally to make sure you are titrated to the right strength (i.e., your MD might switch your dosage initially so you don’t want to buy too much supply of a drug you might not use).

This is a study from a few years ago from Harris Interactive and BCG that I found on the BioPlus website.  If I am interpreting it right, it would imply that those that are most involved in their healthcare are most likely to be non-compliant.  It doesn’t seem logical, but perhaps those are the people that want to play doctor and are most likely to think they know better.

I was with a friend and was talking about how many calories you burn per hour. The instructor at the aerobic kickboxing class I have gone to on and off for years always says that I could burn up to 800 calories per hour in the class. When I am on the treadmill, I always try to get it up close to 1,000 calories per hour. I have never been good about tracking calories in, but I always think about how much more I need to work out if I have been eating poorly.

So, if you’re looking for an estimators, here is a calculator and here is a great laundry list of activities from cooking to hiking and biking to broomball or calories burned per hour. I pulled a few common ones from their list here:

In pharmacy, there is a rarely used benefit structure called Therapeutic MAC (Maximum Allowable Cost).  What this does is say that in any class of drugs (e.g., cholesterol lowering drugs) there is a maximum amount of money that will be paid by the plan.  But the individual can get any drug.

That can be controversial since a patient could end up being required to take a more expensive drug by their physician costing them a lot of money.  (Although most pharmacy plans allow for a clinical prior authorization in cases like this where they might pay less.)

My thought is why not do the same thing at least for physician visits.  If my health plan simply published statistics that said they will pay $100 for any visit to a physician’s office.  I could then go to any physician and that physician would know they were going to get $100 for my visit plus whatever they charge me.  It would eliminate a whole process of constantly managing the network and focus patients on the price that their physician charged.

I am sure there is something that I am oversimplifying, but it seems logical.

We know adherence is a serious issue that drives healthcare costs.  And, as I have talked about a little here and a lot with many of our pharmacy clients, it’s not a simple issue.  People aren’t adherent for a variety of reasons - cost, side effects, health literacy, or simply just forgetting (among others).

There are lots of tools out there to help you organize your medications and manage them.  Whose job is it to help you - yours, your physicians, your managed care company, your pharmacy, your pharmacy benefit manager?  Obviously, you (the patient) have the primary responsibility.  After that, your pharmacy is best positioned to help you with this.  But, the managed care company stands to benefit the most by preventing serious medical conditions associated with non-compliance.

So, I was a little surprised to see a new company come up that offers to send you calls, e-mails, or text messages to remind you to take your medications.  And, you can even talk to a pharmacist.

Let’s break this down:

• Whatever pharmacy you use (mail, retail, specialty) will offer you consultation with a pharmacist for free.
• I believe most pharmacy benefit management (PBM) companies offer automated e-mail reminders that you set up yourself off their website for free.

I don’t know why I as a consumer would pay for this.  And, it seems pretty high for a managed care charge.  If I went to a client of ours and told them I would send messages to patients for $100 PMPY (per member per year), I think they would choke on that price tag.

So, will it work??  Who knows?  I have been surprised by business models before.

I am a big believer in the fact that the experience matters for healthcare.  From my architecture days, this means physical space, sequence of events, bedside manner of the staff, clarity of communications, and processing of the claim (at the simplest level).  Everything that the patient experiences as associated with an event drives their satisfaction.

So, I was pleasantly surprised taking my daughter to the dentist a few weeks ago.  We had gone to a “kid’s dentist” before which was an hour away that I thought did a good job (although the kids hated going).  But, this one was over the top.

When you walk in, the entire room is covered with art (e.g., there is a giant Spiderman climbing on the ceiling).  There are video game stations in the corner.  There is a large flatscreen TV playing a slide show of pictures of the kids coming to visit that day.

And, it doesn’t stop there.  Each room is decorated.  The staff talks to the kids (more than the parent).  Every tool and process is explained to the kids in simple terms.  They sometimes give out balloons.

Just something to think about when you try to look at things from an outside-in perspective.  How is the patient experiencing your service?

I was reading about this company DNA 11 the other day, and I found it a pretty cool concept. They take your DNA and make it into art focusing on the 1% that is unique. According to the article in American Way magazine, prices ranged from $390 to $1,200 with 25 color options or the ability to request a custom color (to match your sofa perhaps).

They can do pets, fingerprints, and lip prints.

I always enjoy coming across new blogs with interesting articles. Here are a few that I found yesterday and added to my blogroll:

The Health As Human Capital Blog (sponsored by a company described as “dedicated to providing better information for better decision-making in health care and business”)

The Doctor Comes To You Blog about the onsite healthcare industry

Medication Non-Adherence Blog by Alex Sicre who comments on my blog often

I think it was earlier this year when LinkedIn rolled out a new feature called questions which allows you to pose questions to LinkedIn users and get answers. I continue to like this tool, and it has been interesting to watch it evolve from a “startup” (when I joined there were less than 2M members) to a tool that well over 10M people use and has gotten lots of press.

I finally decided to pose a question:

Do you have any good (or bad) examples of healthcare communications? I am looking for how your healthplan, disease management company, pharmacy, or PBM communicates with you. What worked or isn’t working? This could include letters, websites, phone calls, social media, etc. Examples might include communications around moving you to a 90-day prescription, moving you to a generic drug, improving your awareness of a disease, addressing compliance and adherence, reducing your out-of-pocket costs, etc.

I received four answers:

Answer One: I had some great success marketing to Medicare members by conducting health and fitness seminars as well as bring in experts to discuss retirement and other topics of interest. Initially, I’d obtain a 3% response through postcards and an additional 1.0% through phone calls. Conducting a series of seminars in one area can also bring in additional attendees (0.5%), through word-of-mouth buzz.

I found seminars to work well because the attendees were getting something of true value for their time (information and a social event with their peers) and I had a captive audience to market. A win, win situation.

Answer Two: My experiences with Blue Cross have been pretty good, there’s the health mag they send out with information articles, etc. I’ve never been able to access the website services though, something to do with the number that CS can never work out though I’ve tried on several occasions. I love my primary doctor and feel she and her partner give excellent care and plenty of information to their patients. They’re the only ones who’ve ever given me a reading list and web printouts! It was just a general question I had, not a condition I suffer from.

In addition to other tasks, I handle the health documents for the children enrolled with us and find that often the doctors have done a very poor job in informing the parents of what to watch for, what a result means, etc. Their offfice staff often do a shoddy job of filling out the forms correctly. Last month I recieved paperwork for a child, the physical form stated passed 20/20 for vision, it was accompanied by a referral from the doctor for a full eye exam as the child had failed the eye test miserably! I once received a normal hearing result for a child we knew was deaf as a door nail. When trying to get an insurance company to cover a needed service or therapy for such is incredibly difficult with that kind of paperwork.

Thanks for the opportunity to raise awareness!

Answer Three:
Aetna sent me a letter suggesting several plan options that may be cheaper than the one I currently have. That was a positive. I wish that I could compare the plans side by side on the website. It is difficult to remember the details of each one as you look at them individually.

Answer Four: As a health promotion practitioner, we are at a time when the national consciousness of health has never been higher. The most important thing we can do at a workplace is create individuals and systems that are health literate. We spend enormous amounts of money in our wrongly terms “health care” system. What we actually have is a “sick care” system, and what is truly missing are incentives and action by companies to recognize the billions of dollars we could save and then return to economy by protecting our workforce with sound health promotion. Our children are contracting early onset adult diabetes and we commonly refer to our bleak situation of the obesity epidemic. Our “health care” system, and thus the traditional “disease management” is from a biomedical chronic disease model.

It is time to work at reducing costs related to health care and absenteeism from a proactive rather than reactive approach. Many companies and organizations provide services that have yielded significant economic returns from building well companies.

According to the the NIH, most people are unhappy with our current system, and unable to continue to straddle the costs of ever increasing health care. We can avoid chronic disease by acknowledging new paradigms of business operations that include well companies. For information, contact www.positivepurposeinc.com