Copay cards - follow the money

Co-pay cards are an often used tactic to encourage patients to try a new branded medication that is prescribed by their physician, eliminating the concern for an expensive co-payment that can come with a Tier 3 drug. In CRM terms, they are used as a conversion tactic, and can even be the gateway to an adherence program.

Here is another perspective on co-pay cards:

In a very interesting article and interview in MMM, the Pharmaceutical Care Management Association is cited in an estimation of how much additional cost must be reimbursed because of the use of copay cards: $32 billion over the next ten years. In addition, the PCMA clarifies who is paying for those costs: employers, unions, and state employee plans. As well as taxpayers.

In other words, someone has to pay the insurance companies the money they expected in their copayments. Some is borne by the phramaceutical manufacturers, but some is also paid for by those who contractwith the insurers, like employers et al. The details of this analysis are not crystal clear, but it most likley is based on the missed savings that would come from generic usage. In any regard, this is a thought provoking total.

Want to read more about the perspective of the PCMA?: Browse their website, or a research report (by Visante) about their planned drug cost savings over the next 10 years.

Statistical modeling for medication adherence

Patients not adhering to their medication regimens has been shown in multiple studies to yield sub-optimal health outcomes as well as decreased sales opportunities for pharmaceutical companies. Various CRM efforts over the years have tried to address this. Now a new tool may be avaialable.

There was a fascinating article in the NY Times Health Blog recently about Fair Isaac (FICO)creating a logistic regression style "medication adherence score" much like their credit score, that predicts likelihood to adhere based on demographic, financial, and transactional variables. For example: Are sixty-something
middle class Midwestern grandparents with low net worth particularly non-adherent?

If a score comes up as such, would a pharmaceutical company target them with a an extra adherence mailer, kit, or a premium adherence pill bottle? Or call center support? Since these are expensive resources, targeting using a validated model score seems attractive.

Of course, these resources could be offered to anyone, but could be promoted selectively.

I think likely the modeling score was validated on historical data. It will be fascinating to see how accuracy is tracked moving forward. Also, whether pharmaceutical firms or communications agencies will adopt it.

Measurement's role in the journey to health

A trio from the CementBloc, yours truly included, described the journey to wellness in a recent article on Mediapost.

In particular, consider the role that measurement plays as patients are taking medication to get healthy. Illness is often accompanied by one or more physiological metrics that are out of the normal range. As a patient is undergoing treatment, a primary way to measure return to health is by tracking those metrics as they return to the normal range. A patient can work with his or her physician to adjust the therapy based on how these health-related metrics change over time.

Metrics on wellness can be thought of individually or collectively, and technology plays an ever-increasing role in both cases. Individually, patients have more means than ever to quickly and automatically see how their health is improving. Just a few examples are the Wii Fit with built-in scale, the Bayer Contour USB glucose meter, and the Nike training and heart rate monitors. Pharmaceutical relationship-marketing programs come with pill reminders and online pain management diaries. These diaries have evolved from paper-based journals to secure Web pages, and now reside as apps on personal digital assistants (PDAs) and mobile phones.

Collectively, healthcare companies and device manufacturers want to measure overall utilization of wellness, conversion, and adherence tools placed in the marketplace. Web analytics data can signify which patient resources are most being utilized, and which features should be improved.

It is fascinating to think of what role media can play on this journey. Imagine if one's weight loss is not progressing as rapidly as needed, or pain relief is not coming quickly enough. Could one's PDA tracker or personal monitor someday become a venue for product placement for better nutrition products, exercise equipment, or even medication? As our country debates individual Web site data privacy issues, this may be a new angle to consider.

Automated speech processing: commercial state of the art

I have always been fascinated by progress in the area of automated speech processing, since my days as a Master's student at the University of Cambridge in Computer Speech and Language Processing and I spent time with Professor Steve Young at the Cambridge University Machine Intelligence Laboratory.

Thus it was with great interest and pleasure that I read this review of the state of the art of commercial speech processing systems within Scientific American earlier this month. Like many high tech fields, there have been mergers and convergence in the suppliers, to the leader Nuance Communications. Extensive pre-training is no longer required. General listening is now possible in structured sub-languages and categories. Plus, the commercial applications have become widespread, especially related to phone interfaces.

Why is this relevant for healthcare relationship marketing. Possible applications include:

* Acquisition and registration into programs via mobile smartphones, for either patients or professionals.

* Automated dictation transcription processing of the highly structured clinical reports that physicians issue after seeing patients.

* speech to text social network inputs as a convenience, or for the visually impaired.

* processing call center transcripts for marketing intelligence.

* insert your brainstorm here.

Iphone for family vaccine tracking

See the enclosed Novartis video on the Apple website for an application of Iphone to Vaxtrack. This is a long-term tracker and scheduler of children's vaccines for parents. Indeed, Apple provides the usability for a medical situation that parents struggle to keep up on, but are anxious about. Also impressive are the I.T. professionals at Novartis describe the iphone as enterprise ready, for patients, and for their internal applications.

One question: how will the data be transferred years in the future when the more advanced versions of iphones and Apple gizmos come around? What about compatibility of data with other manufacturer PDAs? Is there hope of a data standard? Hopefully, this will be as easy as transferring songs.

Adherence Hardware

As reported in MMM, there is a very interesting development by a startup firm called Vitality, which is an adherence designed pill bottle called Glowcaps. We have seen a demostration and it is quite an interesting device, which has a cellular connection that can communicate adherence status, and in a closed loop system can lead to SMS,emails, or call reminders. Also and intersting business model: funded by PBMs like Express Scripts who have a vested interest in keeping patients adherent, from a financial and a health outcomes perspective. Pharmaceutical companies piloting this sdevice are also asked to pay performance of sales lifts, though no specific companies are disclosed in the article.

In principle, this has benefits of reducing the false positives of typical adherence "reminder" programs. An alert is sent out only when the bottle is not opened for over a day, or two days, as set. More importantly, there has been a documented adherence lift.

Read more, and ask what else the future brings, with wireless, mobile, and microelectronics, we may be seeing more of this adherence hardware in the future.

Managing Healthcare Email Cadences

An interesting point of view article just came across Mediapost on Managing Email cadences by Greatchen Scheiman of Ogilvy One.

The article covered off on basic frequency and portfolio ideas, asking sensible questions from the *sender's* perspective like "do you have new information to discuss," and "how often is the market changing." The example cited are sporting events like baseball: in-season, daily updates on games make sense -- out of season, less frequent news is far better.

However, thinking about Email cadences for healthcare is really more about what the *recipient* is going through in their decision making journey, whether this recipient is a patient, caregiver, or a health professional.
Time-based events are inherent in medicine:

* decisions to visit doctors, scheduling appointments with doctors, patient visits, and follow-ups, referrals to specialists
* time of health progression, like pregnancy, or pediatric growth
* seasonality of conditions like allergies, and arthritis pain
* treatment and medication protocols, as in oncology, psychiatry, or neurology
* refill schedules
* adherence drop-off patterns


Therefore, plan your healthcare email cadence so that your messages are in fact preparing your stakeholders for the important decisions they need to make.

Furthermore, let's not forget other Email best practices like subject line testing, creative testing, clear calls to action, and Opt-out management.
Proper planning can help you make the most of this channel.

Coming down to the wire - finishing it off

June, 2010 is an interesting confluence of several factors all dealing with "coming to the finish line." The kids finishing school, the little league heading toward the playoffs, my book deadline imminent. Even the just completed Belmont Stakes horse race has its finish line. Plus I'm involved with multiple relationship marketing projects due to rollout within a month. These are all examples of homestretch, approaching a deadline.

When this happens, it is always a mix of emotions:

* desperation to get the project finished

* intensive, often late night work, to meet the delivery time.

* a thrill that the moment of truth is arriving.

Just as with patient conversion in CRM, do not presume that once the Rx is given that it will actually be filled (payer issues must be managed), and even if filled, that the drug will be taken (instructions and support are needed for adherence). The optimal patient experience must include the finish line.

Yet one thing is very important, at the finish line, not to let up on quality, not to forget the details. Otherwise, the competition may come back and pass you as you aim to cross the finish line. My son reminded me that come from behind victories happens in every horse race. Indeed the lead horse must stay vigilant.

How does your organization prepare for the big conclusion at a deadline?

How do you strike the proper balance between eagerness to complete, while still maintaining high quality?

Patient Clinical Outcomes Data on Social Media? Misguided

Perhaps I am a purist, but as a member of the healthcare analytics community I have been following with much concern the growth of social media where patients enter conditions, treatments, and outcomes, for retrieval as statistical summaries by others.

A recent NY Times article May 28th called out two social media websites that encourage consumers to describe their medical conditions and what treatments they have been using, namely Cure Together and Patients Like Me.

Having perused and joined these websites, there are certainly positive aspects. One is encouraging patients to track their progress toward achieving health goals, such as weight loss. Another is a venue for desperate patients with serious conditions to quickly link to others who are suffering similarly, and learning about potential treatments.

However, the major point of concern is how data on self-reported patient conditions, treatments and outcomes is being aggregated, summarized, packaged, and even sold as psuedo-outcomes results, or pseudo market research data.


Has healthcare social media research gone from the messaging and linguistic interpretation, as described in
Medical Marketing and Media in May 2009, to more quantitative clinical outcomes analyses?

For those viewing such statistics, Caveat Emptor. There are many sources of biases and unknowns here.

What clinical trials, outcomes research studies, and formal market research surveys accomplish, among other things, is provide clinicians, patients, and healthcare companies with statistically reliable data on treatments and outcomes by applying the scientific method, so that results can be properly interpreted. There are screening criteria for inclusion, test vs. control methodologies, and careful interpretation of results. Pharmaceutical data providers like IMS also hire statisticians to ensure their prescription and claims data are accurately projected.

By contrast, self-reported treatments and outcomes on consumer social media have none of that. Anyone can enter any condition, or any treatment, presuming the right terms are used and laypeople are self-reporting their outcomes using their own interpretations. It is the self-reporting bias taken to the Nth degree.

The websites sited above issue data tables regularly, package them, even create pseudo E-books for sale, and are aiming to re-sell as "research" for health organizations. These may be curiosities, or signposts, but are unlikely to be interpreted as any serious efficacy results.

It will be fascinating to watch the ramifications of this from the medical community, or even patient health advocacy groups.