Aetna announced the results of a six year study of healthcare claims and utilization for members of its CDHP. Some of the key findings included:

- sustained savings over a five year period, employers saved anywhere between $7-$21 million per 10,000 members over the five year period,
- members of the plans sought increased levels of chronic and preventive care,
- higher utilization of generic drugs, and
- higher utilization on-line tools and information.

These seem to be promising results given the struggle that health plans have experienced in reigning in healthcare costs. It will be interesting to see the strategies that Aetna and other health plans may employ to compress the length of time that it may take for employers to benefit from such savings.

No matter what your role in today’s healthcare system, it is not difficult to feel boxed in. Health insurance providers frequently dictate where a patient can seek care and which treatments are open to that patient and his or her doctor. Due to the reimbursement model, physicians are being forced to operate from a reactionary model, rather than a consultative one, often preventing patients from taking responsibility for their health. Pharmaceutical companies are being reigned in by a growing array of limitations, regulations and litigations. These reductions in choice can lead to reductions in engagement. Many parts of the system are operating on autopilot. Active decisions, purposeful change and collaborative engagement are hard to come by – and even harder to sustain.

However, one change is undeniable and has already been set in motion. Consumers are gaining more of a voice in their coverage. Workplace innovations like Consumer Driven Health Plans (CDHPs) and Flexible Spending Accounts (FSAs) are expanding consumer options and enabling customization like never before. The cost versus care debate is renewing the focus on ideas such as the medical home, retail health clinics, preventative health and patient rights.

Ironically, while choice for consumers is the wave of the future, the recent past has left many consumers unprepared for this development. As passive recipients of doctors’ orders and fillers out of insurance provider paperwork, individuals have little practice in deciphering or seeking out what information they need. They are inexperienced in screening doctors, selecting hospitals and setting health goals. As an inevitable shift towards consumerism appears, healthcare providers will have to foster discernment and educate consumers. Naturally, as choice grows among healthcare seekers, providers will not only be required to educate consumers; they will also need to attract and keep them – to earn positions as providers of choice in their fields. In an open market, health insurance providers, physicians, pharmaceutical manufacturers and other industry members will need to distinguish themselves and provide stand-out customer service in order to retain a competitive edge.

A recent New York Times article discusses the impact economic woes continue to have on individuals increasingly cutting back on prescriptions that they need.

According to IMS , the number of prescriptions dispensed in the first eight months of 2008 was lower than last year, the first downturn in over a decade.

The ramifications could be disastrous to a health system already facing monumental challenges in trying to stem rising costs and keep people healthy. Think about it this way:, if too many chronic condition patients stop taking medicines like cholesterol-lowering statins or anti-hypertensives for too long the result could be catastrophic leading to expensive emergency conditions, such as a strokes or heart- attacks. Catastrophic situations only serve to increase a rapidly escalating healthcare cost base.

Of course, there is a school of thought that America is over-medicated to begin with and that perhaps the prescription cuts are beneficial. In some cases, I might agree with this philosophy, but it seems like a foregone conclusion that individuals with serious conditions such as diabetes, high cholesterol, hypertension, and obesity either stretching out their medicines or not taking them altogether, will result in a truly bad and expensive outcome for that person.

There also was an interesting fact in this article regarding the spend on pharmaceutical products in total in the U.S. Pharmaceuticals only constitutes about 10% of the total healthcare spend in the country. From a financial perspective, I would say that medicines still appear be a more cost-effective way of mitigating higher medical costs, such as hospitals and physicians fees. So the challenge for our healthcare system is finding methods to reinforce that message and help consumers to make the right decisions about using their medicines as a method of preventing more serious acute health issues.

Note to health plans: if you are offering health and productivity incentives for members to use health tools and services … make sure to pay them out or it could really impact your members’ feelings of goodwill and loyalty.

My health plan recently launched a health and wellness program with a great amount of enthusiasm and fanfare. To go along with what looks like some wonderful health services, the plan was also offering some intriguing and exciting wellness incentives and rewards for participating, staying engaged throughout the year and providing feedback on their program.

Sounds great doesn’t it? The first order of business was to take a Health Risk Assessment and earn a $100 gift card. Given that I am very focused on proactive healthcare and preventative maintenance (because of what I do for a living), I immediately called the 800 number and energetically informed them that I wanted to enroll in the new Health & Productivity program. This is what I heard, “I am sorry, but you are not eligible for this program. In fact you aren’t in our database as even being a member of our plan.”

I ask, “How could that be? I have my member card with my member ID and I just received a packet with all of the wellness program information.” I was then told that they would have to escalate this for further investigation … that investigation took 14 days. Ten calls later and many chats with “managers” of my health plan it was indeed confirmed that I was a member and eligible for the health and wellness program, however, there was one day left for me to take the Health Risk Assessment and receive my $100 gift card promotion.

I immediately took the Health Risk Assessment and awaited my gift card in the mail, dreaming of the things that I could do with that gift card – a nice 90 minute stress relieving massage … aahh. I waited and waited for weeks and then months. Finally, I called my health plan again and inquired about the status of my gift card only to be told that even though I had completed the HRA, the information was not received until the morning after the promotion ended and therefore I didn’t qualify for the gift card.

The long and short outcome of this story: I will never participate in my health plan’s wellness program again Instead I will stay healthy my own way, and if I have a choice to change health plans, you can bet that I am going to do it in a heartbeat.

A challenge that pharmaceutical companies continue to have in adherence programs that they bring to the market is driving initial participation and ongoing engagement in their programs without “inducing” the patient. Traditionally, adherence programs have been run through a combination of interventions that include the use of alternative coupons and vouchers, samples, patient starter kits, and loyalty programs. These programs have not been extremely successful as adherence continues to be a challenge. Part of the reason, I believe is that not enough patients are motivated by a co-pay deduction or a seven-day free trial of a drug to actually take action. In addition, adherence programs are front-loaded with communication when a patient initially opts-in, but then the communication all but disappears (I know this because I am enrolled in several adherence programs).

Similar to today’s wellness programs, pharma companies have to begin understanding the catalysts that will truly motivate patients to participate and engage in adhering to their medication. They need to find methods that tap into the intrinsic motivators that engage patients.

Companies should consider a more integrated adherence program that incorporates more of a loyalty premise that enable patients by offering a choice of rewards for staying adherent – ideas such as offering patients points for persistency. While there may be some discussion around getting close to the line of an inducement, the idea is that providing patients with points that they can then redeem for health related rewards offers what we call at Maritz “purposeful choice.” It essentially allows the patient to choose from rewards that are personally meaningful and may further engage them in maintaining adherence to their medication regime. Rewards could include items such as debit cards to be used on prescription refills or may include merchandise that helps them better manage their life around the disease they have.

Or better yet, why don’t health plans, who are actively initiating wellness programs, consider working with pharma or adopting these programs under their larger wellness strategy?

In previous posts, I’ve mentioned briefly about Maritz’ “whole-brained” approach to implementing successful wellness programs. Just to reiterate, what I mean by “whole-brained” is essentially rewiring the brain to activate new behaviors and sustain them long term. At Maritz, we apply the focus, repetition and positive reinforcement model to ensure the wellness program’s success. More specifically:

Focus: the act of paying attention, which creates chemical and physical changes in the brain.

Repetition: repeated, purposeful and focused attention, which leads to long-lasting personal evolution or change.

Positive reinforcement: people receive positive feedback; it creates a synapse in the brain, encouraging the behavior to continue.

When companies take a whole-brained approach to health and wellness incentives and answer the five integral questions – what do you want me to do, why is it important, how do I do it, what’s in it for me, and how am I doing – successful health and productivity programs becomes a continuous cycle resulting in optimum member participation and, more importantly, healthier members.

I recently read an interesting post on Fierce Healthcare regarding why people hate pharmaceutical companies so much. The gist of the article is that consumers hate pharma companies because their mishandling of current safety issues around Vioxx, Vytorin and Avandia – to name a few – has shattered public trust. The post also references an Adweek article that says consumers love to hate pharma because they don’t want to be sick enough to need drugs. In addition, negative attention aimed at pharma’s marketing practices has further eroded trust in the industry.

Despite all the criticism, I continue to believe that pharma plays a vital role in our health system and as a former pharma employee, I see the good things that pharma companies do everyday to extend and enhance the health and wellness of our society.

Undeniably, as industry continues to mishandle situations, public distrust and negative perception of the pharma industry will thrive. That said, I am amazed at the fierce level of anger and disgust that seems to exist about pharma companies. You know it’s bad when companies that were long held as gold standards in ethics and integrity are now being equated to used car salesmen, as evidenced in this Pharma Marketing Blog post

While the industry needs to do a better job of improving public trust and reassuring the public when news begins to leak around safety and efficacy issue, I believe that an argument can be made that the benefits derived from the products and services that pharma companies bring to the public far outweigh the periodic issues that occur when a drug is found to have risks that were not previously identified.

Where would we be without companies that have invested hundreds of millions of dollars in developing drugs that continue to extend and enhance human life, continue to help mitigate the risks of chronic diseases and in some instances find cures for diseases once thought incurable? Think about this … a child suffering from Hodgkin’s disease 20 years ago may not have lived, but with pharma’s continuing efforts to bring new products to market, that child today has an opportunity to live a long and healthy life. Also, pharma provides many subsidies to the uninsured population through patient assistance programs and samples of drugs that many physicians give to their patients who can’t afford medicine.

Furthermore, our healthcare system is reaching a crisis mode with escalating healthcare costs and an ever increasing unhealthy population. With the growing focus on preventative medicine and proactive wellness initiatives in reducing healthcare costs, pharma will continue to play an important role in preventing illness from occurring, managing those already sick and curing diseases that we could never fathom curable a decade ago.

Did anyone read the alarming article in the Wall Street Journal last week regarding the toll that the economy is having on consumers’ health care spending? Essentially the article highlighted some trends that the market is seeing in consumers’ reducing their spend on key health services such as: prescription adherence, wellness and preventive screenings and delaying care for minor health issues that carry large catastrophic risk. The article found some very alarming key findings associated with the economic downturn:
• 22% of consumers have cut back on seeing their physicians;
• 11% have scaled back on prescription drugs;
• OB/GYN visits, the sole source of preventive care for many women has dropped 6% versus the same period from last year;
Specific health services being hit are in joint replacement, mammograms and other preventive services. What concerns me is that while consumers are tightening their belt with short-term medical needs what they may be creating is higher risk factors that could then lead to much more expensive outcomes. As more people delay or decide to forego preventive screenings and wellness activities it could lead to minor medical problems becoming major medical problems that result in costly hospital bills and potentially even greater chronic conditions.

Some may argue that the economy is forcing patients to be more responsible consumers of health services. But can that really be the case when the disturbing anectodal evidence suggests that consumers are having to choose between paying for food, gas and things for their children versus spending money on a diabetes blood test that could save their life.

My question is this: if health plans and drug companies are really serious about maintaining the momentum for preventive wellness initiatives why are they not doing a more proactive job of keeping people engaged in being well especially with the economy forcing people to make life-or-death choices? Why are preventive screenings not fully covered? And why are people with chronic diseases having to choose to defer costly tests that could prevent even costlier hospitalization. Health plans and employers must see that this undermines the investment they have made thus far in trying to engage consumers into thinking, acting and doing things that lead to more proactive health.

During this economic crisis, I think it is more important than ever for health plans and employers to ensure that they are using incentives, rewards and communications to actively maintain engagement in preventive wellness programs. The incentives can range from $0 co-pay for prescription drugs to premium deductions and gift cards that offset the costs associated with medical bills. Furthermore, health plans and employers need to continue to communicate the benefits of consumers staying engaged in health focused activities, why it makes sense in both the short and long term. Right now, it appears that consumers see health services and preventive services as an “easy to cut” item in their budget. While this may provide short-term relief, the long-term consequences could have a significant impact on consumers’ wallets and their health.

There has been quite a bit of debate about the subject of consumerism in healthcare and what it means in the healthcare market. By all indications, it appears as though certain characteristics of consumerism are taking hold in the healthcare market. Countless surveys, including Deloitte & Touche’s Consumerism Survey indicate that consumers want and are ready to take on more decision-making responsibility for their healthcare decisions and how they buy services. So what does that mean to the healthcare market? How prepared are healthcare providers to deal with consumerism? Do healthcare providers understand what consumerism and the characteristics of a consumer-centric marketplace mean for their business?

I recently attended an interesting webinar hosted by Deloitte & Touche Consulting regarding consumerism in our health system. While many believe that consumerism is slowly making its way into the health system, D&T concludes that traditional characteristics of consumerism already exist in our healthcare market.

The healthcare market is unique in that not all of the knowledge or decision making actually resides with the consumer. Employers usually choose a health insurer for employees, health insurers determine what physicians and drugs will be covered and physicians determine the best treatment strategy for a patient. Very little data exists that provides information around cost, quality and value – attributes that consumers typically use when purchasing goods and services. Yet there is a movement occurring as employers continue to encourage employees into Consumer Directed Health Plans (CDHPs). The thinking is that if consumers share more of the out of pocket costs while also having more control of healthcare dollar spend that they will become more responsible consumers of health services. And while that may be logical, the question remains as to whether consumers have access to enough data, information and health/disease knowledge to make good decisions on how they consume health services. The question remains…will consumers make appropriate decisions about how they consume health services or will there be a risk that additional out-of-pocket costs will create a disincentive for consumers, who may then “hold” off on seeing a doctor until it is absolutely necessary, potentially leading to catastrophic events? This in effect may undermine the entire objective of making individuals better consumers of health services.

What do you think? Is true consumerism really present in the healthcare system?