Envisioning 2.0

Yesterday, the Wall Street Journal published a very interesting article focusing on the practice of care-management. According to the Journal: “[A] growing number of employers and health insurers are turning to services that essentially audit an employee’s health care and look for ways to both improve outcomes and save money.

But critics contend that some of these programs intrude into the private relationship between patients and their doctors, and that they add yet another layer of bureaucracy, while saving money mostly by denying or switching specific drugs and procedures.”

A few key ways that care managers work with patients is by offering them second opinions on their care and switching or nixing treatments that don’t conform with evidence-based medicine.

From a health policy perspective, care management makes sense as it can help to alleviate practice variation: the sometimes stark differences in how physicians treat patients in across the country or in the same hospital.

However, care management can also spurn resentment. Despite our (apparent) march toward consumer-driven healthcare, the physician-patient relationship is still sacred. Decisions that are made in the physician’s office are very sensitive and I can understand why people become upset when a third party is injected into the process.

This is another in a great series of articles the Journal has been writing focusing on the mechanics of the healthcare system. I highly recommend this one.

John Bell, who writes the blog Digital Influence Mapping Project, has an interesting post about a subject near and dear to my heart: health literacy.  He outlined an idea  for helping consumers understand health information better.  I’ve reproduced some of the points he made in his post below:

“There is a terrific opportunity to provide health literacy programs to help all consumers get smarter about the healthcare options available to them. . . .

This new health literacy program is the perfect initiative for a brand-conscious, consumer-committed pharmaceutical company. Each of the pharmas struggle between ambitions to make their corporate brand meaningful to consumers and their need to build product brands and sales. . . .

The U.S. Government has an initiative afoot under HHS’s Health Resources and Services Administration. They will have an event at the end of October which is apprently Health Literacy Month. NIH has it’s own effort, as well. We should not leave this up to the government. A smart pharma could make this their signature CSR (corporate social responsibility) effort.”

For more about his idea, please click here.

 

A new poll released today by Harris Interactive indicates that when it comes to healthcare, most Americans want the candidates to focus on ensuring that everyone has access to insurance.

They also feel that the US does a good job of making sure that the very poor and the very rich can access care.  However, they believe that the middle class is being left behind.  According to the Wall Street Journal: “Across party lines, there is widely held belief that the U.S. health-care system works better for the very poor and the wealthy than it does for the middle class.”

What’s great about this presidential election cycle is that the candidates are focusing heavily on this issue.  Some would like to use the tax code to encourage people to purchase health insurance.  Others think that mandating that every American purchase insurance is the way to go.  However, as we enter this debate about how to increase access, we should be looking toward the states for information and knowledge about what works – and does not. There’s a lot of innovation happening at the local level that can inform our decisions about what the health system of tomorrow will look like.

 

Yesterday, the Wall Street Journal Health Blog cited a “closely watched” survey focusing on the predictable annual rise in health insurance premiums.  Digging past the headlines, Jacob Goldstein noted that “high deductible [health] insurance plans tied to special savings accounts continue to lag behind expectations, despite being praised high and low as a tool to slow the rise in . . . costs.”

You can learn a lot about why a product or service is not gaining ground by reading comments left on blogs, online bulletin boards and other sources.  Many of those commenting on the Health Blog’s story cited poor administration and mass confusion as reasons high-deductible plans have not taken off.  Some relevant comments are below.

Without Information I Can’t Make Good Decisions

“I have tried the consumer approach to health insurance. It is very difficult to obtain pricing or exact information from insurance companies or providers. How can you be an active shopper of health care if your ill and no one will provide the information to create an informed decision? You will not be having success connecting the consumer or provider until one can truly negotiate and understand the pricing.”
-Paul Brunner

Incompetence Ruined My Experience 

“My last job was with a Fortune 100 company. Their HSA administrator was completely incompetent. I had claims denied several times that clearly fell within the guidelines (contacts and eye exam, for example) while they were giving me excuses as to why they didn’t. Reimbursement checks were “lost in the mail”. In the end, it just seemed like a scam to take my money and my time. I did lodge a formal complaint with our HR department who told they had similar complaints and not many people sign up for a second year.”
-AMC in Florida

High Deductibles, Poor Service Keep People From Coming Back

“If someone actually needs the funds for health care, they offer few advantages except for a lower premium cost because the coverage starts after a high deductible. Duh. For a medical practice as a business, they are nightmares. Patients usually do not know how much is in their accounts and how providers are paid. We rarely have a clue as to how much we will be paid and how much the patient will owe. We need to bill the third party, wait until they adjudicate the claim and then try to collect from (often disappointed) patients.”
-Eric Einstein

 

In an unprecedented move, Robert Goldberg, co-author of the blog Drug Wonks has broken a JAMA embargo on news about a group of editorials and studies that will be published in this week’s edition.  They focus on the cardiovascular risks of Actos and Avandia.  According to Goldberg:

“We are publishing, ahead of an embargo, an editorial and a release on two separate articles being issued by JAMA on Sept 11. . . . The one by Nissen claims that Actos reduces risk of heart problems but has no impact on overall death from heart disease. This claim is made from a dataset that is observational, does not control for [severity] of heart problems and does not have MI or heart safety as a primary endpoint. The one by Furberg — a meta-analysis of only 4 clinical trials (a meta-analysis that must set some sort of record for being the smallest ever accepted for publication) claims that Avandia long term has a high risk of MI among long term users yet has no long term impact on total incidence of death from heart problems.”

Goldberg and his colleagues are known for their staunch defense of pharmaceutical companies, so this blog post – if it had appeared after the publication of the JAMA data – would not be very surprising.  However,  what’s notable is that he broke the embargo, in an attempt to “contain whatever damage Nissen, Furberg and JAMA intended with the anticipated publicity.”

I have been following the Avandia debate closely and this latest wrinkle is very interesting.  In this instance, Goldberg blasts Nissen and Furberg because they did not present their data in a public forum – i.e., during the FDA’s recent advisory committee hearing on the safety of Avandia.

I think that Furberg and Nissen did not present the data because they understand public relations.  If the data had been shown during the advisory board hearing, it may not have received much media coverage.  After digesting reams of data and viewing countless statistical presentations, how will journalists know what is important?  Furberg and Nissen, no PR neophytes, understand that the best way to drum up attention is to carve out a platform and scream at the top of your lungs.

Goldberg also understands PR and knows that by attacking Nissen and Furberg preemptively, he is certain to be quoted by at least some mainstream media outlets reporting on the data.

We’ll see how the communications battle between the two camps plays out.  At the very least it should be an interesting case study on how to wage a PR battle.

Image Credit: Roy Grinnell

This post also appears on my blog HealthCareVox.

Over the past year, I’ve been reading Richard Meyer’s blog, World of DTC Marketing, with great interest. Meyer serves as Senior Global eMarkeing Manager for Medtronic and worked at Eli Lilly and Company for many years. He is well-qualified to discuss direct to consumer (DTC) advertising and other drug marketing tactics. For quite a while Meyer has been encouraging his colleagues to reduce their reliance on DTC advertising. Last month, he wrote a wonderful post focusing on why many pharmaceutical marketers have been slow to embrace social media communications tactics. He said:

“DTC marketers are great at coming up with a myriad of excuses why they can’t do things because the FDA regulates the DTC industry. The truth is that there are many ways to connect with customers using Web 2.0 that will keep even the most conservative legal and regulatory people happy. We’re all paid to take risks and part of that risk taking is working with internal resources to make them understand that the battlefield has changed.

Over and over again when I recommend tactics in my consulting work I hear the phrase ‘I’ll never get this passed regulatory or legal.’ [Your] job is to protect your brand, and company, from making mistakes and getting letters from the FDA. The FDA, however, does not fully understand the Web and has not issued any in depth guidelines for DTC advertising on the Internet. I am sure that eventually they will get around to issuing guidelines for DTC advertising on the Internet but for now marketers should be leading the way into these uncharted waters.”

I couldn’t agree more with Meyer. This is why I’m pleased to announce that my firm, Envision Solutions, has partnered with the brand monitoring company TNS Media Intelligence/Cymfony and the law firm Seyfarth Shaw, LLP to help drug companies overcome the legal and regulatory obstacles associated with social media communications and monitoring. We have developed the pharmaceutical industry’s first white paper that provides strategies to help it embrace social media without violating DTC promotional regulations.

I encourage drug industry executives and others interested in conducting successful pharmaceutical social media communications to download this free white paper (registration required). We will also discuss this paper during a special Webinar scheduled to take place on September 11 at 1:00 p.m. Click here to learn more.