Driving In Traffic

I just read a Reuters article by Ben Herschler on the potential influence of the Gates Foundation on the pharma industry. A quick quotation to get you started:

“The billions of dollars thrown at global health problems by the Bill & Melinda Gates Foundation are changing the game in drug discovery, posing big challenges to the world’s top drugmakers, according to a report on Tuesday.

Pharmaceutical information group IMS Health Inc. said the emergence of megabuck philanthropy was both a threat and a collaboration opportunity for manufacturers.

“Pharma companies need to develop an explicit strategy to deal with this phenomenon,” IMS said in its annual Intelligence.360 report on factors shaping the industry.”

Now my day job is in healthcare and I’ve done a lot of work with the pharma industry over my career. I have helped with clinical research, written patient education materials and consulted on launch strategies and professional education efforts on new treatments.

Yes– major philanthropic associations can do a lot to bolster the research efforts of pharma. Additionally, pharma gets good karma points for partnering with good causes. Nonetheless, one must always remember that in economics and business, nothing is ever free. Afterall, today’s new era of empowered philanthropy, generous giving rarely means “without strings.”

Just looking forward: How will pharma handle the philanthropist’s demands for affordable prices on these new treatments that they have helped to bring to market? Afterall, right now most new treatments are priced based mostly on what the market will bear and competitor prices, rather than any real analytical plan to recoup costs plus a reasonable profit.

Or will philanthropic organizations require a “return on investment” when partnering. If so, what would this look like?

Not to leave out the megabuck philanthropies, I also have questions for them. What happens when an ethical question comes up about the research on a treatment? How will you ensure that your altruistic and philanthropic missions are not compromised by a greedy and immoral few? All it takes is one poorly designed study, one failure to disclose financial relationships, or one questionable and tragic death to occur in one of those studies to ruin all the good work being done.

We need only look back as far as 1933 and the Tuskegee Syphilis Study to see how unethical research can ruin the trust of individuals who need care. Growing up and working in the south, I have seen the unfortunate legacy of this experiment. I have personally heard many African Americans voice suspicions and be doubtful of treatment offered to them. Some people going so far as to avoid doctors and hospitals at all costs and dying because they refused to seek treatment. I can only imagine what would happen if something similar happened in AIDS/HIV ravaged areas. It could completely undo all the work being done and send us tumbling toward the loss of multiple generations of people who really deserve better.

Today I heard that Georgia Congressman, Charles Norwood returned to Georgia today to enter hospice care for metastatic lung cancer.

For those of you who do not know, Congressman Norwood has been quite proactive in healthcare policy. He has been quite vocal about medical malpractice reform and was one of the driving forced behind the passage of the  “Patient Bill of Rights.”

Now I can’t say that I agreed with everything he put forth.  However, meeting him when I took a graduate school trip to DC to learn about health policy, made me respect him for what he was trying to do.  It was clear upon that short little meeting that Congressman Norwood really had the patient in mind and his intent was to make policy that would benefit those without power or voice.

It makes me sad that he reaches this point in his life and has had to step down from public service.  With that said, I wanted to take a moment to publically thank him for his efforts. I was going to email, but I’m sure the staffers are covered up and won’t be able to respond.  I know it sounds trite, but sincerely–my thoughts and prayer are with him and his family.

Thanks Congressman Norwood for caring enough to work hard for healthcare and many other issues.

“Revolutions are not made; they come.”

— Wendell Phillips, 1811-1884, Harvard Lawyer

It is interesting that the Wikipedia biography for Mr. Phillips says that he was a great advocate of the virtues of plain talk. And after the last two days, I think he’s right.

Are more bad days coming?

Coming back from the holidays, I fully expected my first days back to have to help out with all the traditional stuff that gets piled up in a growing psychiatric practice when it is closed for several days. Appointment requests, medication refill questions, medical record stuff, etc. However, I was under no illusion that my main role (as the insurance expert in an office filled with doctors, nurses and therapists who want to have nothing to do with anything remotely related to such things) would be to be the bad guy that had to remind people that they were going to have to meet their yearly deductible once again, therefore the payment for the days services would be considerably more than their December appointments.

What I did not expect was the considerable numbers of patients who have had SIGNIFICANT changes in their coverage (as in going from a moderate copay —as outpatient mental health benefits are never equivalent to medical benefits— with small or no deductibles to large deductibles plus a healthy percentage of the contracted rate).

Whoa! Screaming, wailing and gnashing of teeth. Not to mention accusations that I’m just plain out wrong. If it wasn’t that, then it was emploring questions seeking an explanation— “Why is it like this when they take so much out of my pay anyway?” Boy— its hard to offer comfort to people when they ask that!

In an effort to find some simple explanations that John and Jane Q. Public could grasp and understand (lets not hope for agreement— my goal was to just give them something to chew on), I did a little digging in hopes of finding some words of comfort from people who understand this phenomenon well.

Its not gold, but I think its worth something.

When I opened my e-mail this morning, I found a press release from VIMO. While I’ve been getting stuff from them a for a little while now and given their focus on the consumer/patient I thought the report they were releasing on healthcare spending accounts might be helpful.

While I had and will continue to have to struggle not to offer the information as a platitute aimed to passify (although, not a bad outcome when you are dealing with the 15th person for the day), I think the report makes some very salient points.

Private health insurance spending is also a cash flow that should rightly be viewed as a significant national asset….Private health insurance premiums are not–at the moment, at least– packaged into securites that are tradable in a fincancial market. The poing of this exercise, however, is simply to drive home the magnitude of private health insurance preimums as a source of wealth.

OK– this is a completely new way of looking at that section of your paycheck for most people. —- But that and $2.00 gets me a small coffee at the local cafe.

The main point is that employers are having to look at new ways to structure their health insurance because they are not able to bear the brunt of the costs and they understand that their employees cannot either. Subsequently, this shift in plans is the first step in creating a system that can take advantage of triple tax savings that were created with the implementation of the Medicare Modernization act. This is summed up well by the report by saying:

The moral of this story has two fundamental points.

1. Health insurance is a large and growing part of compensation and therfore;

2. Anything that affects the value of health insurance benefits offered to employees will have an especially large impact on compensation since the wage and salary components of compensation are relatively stagnant.

Yeah— I know, it is still a hard sell. The people I worked with today, still aren’t really buying it. However, I am always amazed at how a little education and an effort to understand does soothe the soul. The news may not be good, but trying to connect and understand the problem does a lot.

On the flip side, I don’t really think that the people I talked to today realized that they had come of age, so to speak. Today, they made the great leap from passive patients to consumers, from whom action is now required. No doubt when they realize that, another wave of irritation and anger will emerge.

Right now, they surely don’t the changes they are seeing, but perhaps they will develop a tolerance once they have the “simple speak” knowledge and tools that take a lesson from our Mr. Phillips and give consumers a better handle the demands of these changing times.. Lets hope those get here quick or else I’ll have many more bad days ahead.

Beginning January 1, 2007, the handful of members of the International Federation of Pharmaceutical Manufacturers and Associations will need to comply with the latest effort to self-regulate pharmaceutical marketing practices. See the IFPMA Code here. 

When reading the document, I was transported back to reading the PhRMA’s Code on interacting with healthcare professionals and the OIG’s Pharmaceutical Compliance Program “guidance”.  So — really there is nothing new here

—In a nutshell, you can pay or reward people or organizations for prescribing medications.  Additionally, when marketing medications, a company must stick to the scientific facts and avoid discussions of off-label uses. 

I appreciate the IFPMA’s efforts to globalize this movement of ‘compliance’ in hopes keeping those greedy pharmaceutical marketing professionals (not everyone falls into this category) from inappropriately promising efficacy they cannot deliver and to keep them from finding similar devil prescribers who are just looking to line their pockets versus really focusing on providing quality care.

I also had to laugh when I read what would happen if the guidelines were breached.

If a member company is found to be in breach of the code, the IFPMA will “publicly announce the company’s name and obtain the company’s written agreement to end the objectionable practice(s) concerned,” the organisation’s director commented in a statement.

Yea… that should work. 

Really, all snarkiness asside, given the small number of IFPMA members (who by their membership have agreed to comply), I feel this effort lacks any real potential of doing anything to further reform or keep dishonorable companies from keeping on with their business as usual.

According to an article published today by Reuters the General Accountability Office published a report that the FDA needs to improve their monitoring of direct-to-consumer drug advertising. Specifically, the FDA should issue warning letters more quickly when misleading advertisements appear.

The GAO findings are based on an examination of 19 letters issued in 2004 and 2005 which took, on average, 8 months to send out. The GAO asserts that by the time the companies received the letters, most had already discontinued the ads. Additionally, the GAO found that even after the letters were received, some companies continued to break the rules on the same medications.

The GAO report found that the pharmaceutical industry spent 4.2 Billion dollars on DTC ads in 2005. This is almost double the amount spent in 1997. Breakdown of other spending includes 7.2 Billion dollars promoting directly to doctors and 31.4 Billion dollars spent on R&D.

Logic would seem to suggest that if spending on DTC advertising continues to grow exponentially, monitoring will become even more difficult. There will simply be too much volume to keep up with given the current resources of the FDA. In fact, the FDA has tried to proffer this as an explanation for the lapses. According to the article, the GAO is standing firm that the FDA could do more.

What does this mean for the patient? It means that the patient is going to have to be more diligent in researching various treatments that are advertised to them. They may not be the panacea that they are made out to be on TV or in print ad. Additionally, physicians, nurses and healthcare providers are going to have to take time to explain why a certain treatment is preferred. Additionally, providers are also going to have to spend time managing expectations, especially if efficacy information is prettied up and side-effect facts are under emphasized.

Tags: DTC, FDA drug advertising, direct to consumer, General Accounting Office

In graduate school I was introduced to the public health journal, Health Affairs. Since then I have often dropped by their site to quell my late-night health policy cravings. Recently I discovered that they have started a blog. This is wonderful news to me!!! Now I can just add them to my feeds and enjoy the wonderful little samples from the comfort of my sofa.

Chris Fleming has written two good pieces on Consumer-Directed Healthcare.

• Protecting the Chronically Ill in the World of Consumer-Driven Insurance
• Consumer-Directed Plans Can Save Money, But Quality Effects Uncertain

The only downside to the new blog is that you apparently must subscribe to the online or print journal to leave comment or trackback. Not really proper blog manners, but perhaps like many they are still learning.
tags: Health Affairs, Consumer-Directed Insurance, Consumer-Directed Healthcare, chronic illness

The 15th Edition of Health Wonk Review is up at Insureblog.

Bring a good bottle of wine and drop by for some “tasty vittles!”

Thanks for the hospitality, Henry.

In keeping with the theme here: A “Bridge Out” sign means that there has been a failure and that we have to find a new way of getting where we want to go. The rise of consumer-driven health plans indicates that the era of managed care failed to control the increased cost and demand for care and that many things about the way we receive healthcare in the US.

This week Wellpoint, one of the nation’s biggest healthcare insurance providers, has gone on record stating that in 2007 they will the first insurer to have consumer-driven health plans in all states and for all types of people (from major employers to small groups to individual plans).

“Our customers who choose these consumer-driven products will have new opportunities to lead healthier lives because of this first-of-its-kind national offering,” Wellpoint CEO, Larry Glassock

The press release also goes on to share:

“we’re empowering consumers through unique and robust online tools and incentives that encourage and reward them for choosing to live healthier lifestyles… Consumers who choose Lumenos will be eligible for extensive preventive care and personal health coaching, as well as smoking cessation and weight management programs. In addition, most consumers will receive financial rewards for completing various wellness programs.”

WOW! That sounds great, right?!?!?! Well, I always read these things and think about what my parents and my in-laws know about healthcare/ health policy and what they would think.

So for those of you who are not familiar with this new type of health plan, their implementation will produce significant changes in how care is reimbursed. Consumer-driven health plans are designed to shift some of the financial decision-making and responsibility to the individuals who consume healthcare services. Health savings accounts and high deductibles are key components to this new type of health plan. The thought behind all of this is to allow patients to determine how best to spend their healthcare dollars.

If you buy into traditional economic theory as applicable to the healthcare industry, this is not a bad way of trying to control skyrocketing costs. Since the price of services has a direct impact on demand for services, in theory , this type of plan has the potential to reduce duplication of services and unnecessary utilization of higher levels (more expensive) of care. In very simple terms, if patients are required to share some of the financial responsiblity of their care, then they are more likely to choose the cheapest, most effective care.

There are at least two very big ‘rubs’ to this plan. First, in order to to be able to make appropriate choices, consumers will need to know the cost of the care. While it seems easy enough, a physician or facilities’ billing rate for a service is significantly different than a contracted rate. And a contracted rate or allowable charge is significantly differerent than the acutal amount paid for services by an insurer or other third party payer. So healthcare consumers will need to understand all of these to be able to make the appropriate choices. Also healthcare providers will need to set up a system to be able to accurately inform the consumer the costs for a service. While this seems easy enough, it becomes increasingly complex when one understands that every, single, solitary insurance plan is different in regards to deductible, copay, contracted rate and reimbursement rate.

Second, in order to be able to chose the cheapest, effective treatment, healthcare consumers will have to know and understand their treatment options. This means that they will need to better understand the science behind their illnesses as well as the science behind the possible treatments. This would be a whole lot easier if we went back to the old world model of having healthcare providers that were able to develop rapport and a trusting patient-provider relationship. In the past, providers were given the time and opportunity to really partner with individuals, understand the complexities of care and develop a truly individualzed treatment that best fit the patient/consumer’s need. However, in the days of the 15 minute visit, this becomes increasingly difficult to do.

President Bush’s recent executive order pushing for many things including transparency of pricing information is an attempt to address the issue of understanding the financial aspects.

However, how do we make sure individuals have the information they need to be able to get the best treatment value? In reality, physicians and healthcare providers, because of their ability to understand and evaluate individual cases and circumstances, are the best resources for helping individuals make these decisions. However, they will likely need to develop new ways of doing this that are cost and time efficient. If healthcare providers do not develop these new ways, consumers/patients will be left to fend for themselves.

If consumers do not adequately educate themselves or access resources/advocates that will assist them, then this plan too is doomed. Costs will not be contained, health will not be preserved and access to appropriate, effective care will continue to be compromised.

Technorati tags: health policy, consumer-driven healthcare, Wellpoint, health economics, healthcare

The times… they are a changing!  Drum roll please…..

The Centers For Disease Control have recently launched the web home for the National Center for Health Marketing and what do you know… the Director, Jay Bernhardt has his own blog.  (Thanks to Nedra at Spare Change for letting me know about the launch of the blog.)

One of the wonderful things about government websites is that they do an excellent job of defining purposes, functions, processes and best practices.  Just listen to this for a definition of Health Marketing:

Health Marketing involves creating, communicating, and delivering health information and interventions using customer-centered and science-based strategies to protect and promote the health of diverse populations (CDC, 2005).

or this:

Health Marketing is a multidisciplinary area of public health practice.  This innovative approach draws from traditional marketing theories and principles and adds science-based strategies to prevention, health promotion and health protection.  Drawing from fields such as marketing, communication, and public health promotion, health marketing provides a framework of theories, strategies and techniques that can be used to guide work in public health research, interventions, and communication campaigns.

I know it is not rocket science to come up with a definiton of what health marketing is all about.  However I do appreciate the efforts required for the NCHM leaders, expert advisors, and legal wonks to reach a consensus on the official defintion that will provide an opportunity for good policy and practice to emerge.  Their efforts also give a starting point for discussion. Agreeing, disagreeing , castigating  and/or lauding  are important processes in refining the area and becoming better at improving the health of individuals through education.

Now, I’m not suggesting that we all have a big sip of the NCHM kool-aid and march forward.  In fact, the NCHM admits that health marketing is "a new area of practice that is still being defined."

At this point, I think the emergence of this new area of governmental focus points to the fact that health marketing is growing discipline with special considerations that separate it from traditional marketing practice.  I also think that the launch of this new site and blog indicates that there is great potential in health marketing to help individuals become healthier and more active participants in their own healthcare.

Tags: health marketing, healthcare marketing, health promotion, National Center for Health Marketing, Jay Bernhardt

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On July 24, 2006, Senator Harkin (D-IA) introduced legislation that would amend the Public Health Act and the Rehabilitation Act of 1973 to set standards for medical diagnostic equipment and to establish a program for promoting good health, disease prevention, and wellness and for the prevention of secondary conditions for individuals with disabilities, and for other purposes.programs.

In my work with individuals with psychiatric disabilities, this kind of attention and support to their wellness is very much needed. Many of these people lack access to preventative medical care. They also typically have very unhealthy lifestyles that increase the rates of chronic health problems such as obesity, hypertension, hyperlipidemia, cardiovascular disease, and diabetes. Also places that care for individuals with psychiatric disabilities lack the funds to purchase equipment, supplies and space to conduct those programs that they need most– like smoking cessation, nutrition education, and exercise equipment and facilities.

This legislation sets up a competitive grant process for public agencies and nonprofit organizations to access funds that can be used to:

• develop programs or activities for smoking cessation, weight control, nutrition, or fitness that focus on the unique challenges faced by individuals with disabilities regarding these issues;
• establish preventive health screening programs for individuals with disabilities to reduce the incidence of secondary conditions; and
• create athletic, exercise, or sports programs that provide individuals with disabilities (including children with disabilities) an opportunity to increase their physical activity in a dedicated or adaptive recreational environment

In my work writing materials (Solutions for Wellness and Nutrition for Americans) to educate individuals with psychiatric disabilities about changing their lifestyle through nutrition and activity so that they can be healthier, I know of the difficulty of accessing funds to actually have classes on this topic. If passed, this legislation could help to set up pilot programs to promote wellness in this population. I personally think that this could be a wonderful start in helping individuals with psychiatric disabilities to become more active participants in their own care.

To date there are no co-sponsors of this legislation. However after posting this, I will be writing my Senator. If you feel so inclined, I hope that you would write yours too. Click here to find your’s.

Tags: US Senate, Tom Harkin, S 3719, psychiatric disabilities, public health act, rehabilitation act of 1973, health promotion, wellness promotion, legislation, health legislation