All posts by Anne Woodbury

Money, mobile devices and courageous communicators critical to the success of digital health

The Consumer Electronics Show(CES 2014) kicks off today and includes an entire track dedicated to Digital Health. In fact, this year’s event will dedicate its largest footprint ever to health and wellness.  Industry expert John Korry recently categorized emerging medical technologies at CES 2014 as follows:

  1. Real time monitoring of chronic diseasemHealth Photo
  2. Aging-in-place
  3. Wearable technology for fitness

Yet, many of these “new” technology solutions have been available for a number of years. I’ve been on the digital health bandwagon since the turn of the century when I first learned about a Veteran’s Administration pilot using what is now the Bosch Healthcare Telehealth Solutions device to coordinate the care of veterans living with chronic disease. Fast forward twelve years, and the partnership has grown to provide care coordination and telehealth services to over 60,000 veterans. Why is this type of technology not more commonplace?

Follow the money. And mobile devices.

The reality is that these technologies have failed to penetrate the market due to lack of reimbursement – both for the start-up investment costs to purchase the devices and for ongoing clinical support.

As an example, I looked into purchasing the Philips Personal Medication Dispenser for my mother who is on Medicare. The machine distributes the exact dose she needs at the exact time she needs it, but costs more than $800 and was not covered by insurance. Additionally, I would need to pay out of pocket for a home health aide to help her fill the machine as she cannot not operate it on her own, adding an additional hefty expense. The machine and service is certainly cheaper than assisted living rent (which would be the next step if she can’t manage her own medications), but it’s still a hard pill to swallow (pun intended) for those who are forced to pay out of pocket.

It’s also cheaper than hospitalization, which might result if she does not take her medication as directed. Thirty to 50 percent of patients don’t adhere to their medication regimens, leading to approximately $100 billion in preventable costs annually (the costs for those hospital stays that insurers do cover could buy 125 million personal medication dispensers, for those of you playing at home).

In the end, I didn’t purchase the personal medication dispenser, but I did opt for a holiday gift of Philips’ Lifeline with AutoAlert. It is still a heavy investment of more than $500 annually, but it is worth the 24-7-365 monitoring service that helps my mother remain at home and gives us the peace of mind that help is always available. Plus, there was no start-up cost and we can pay monthly for the service.

Despite the fact that most of these new solutions are not covered by the largest public insurers in the U.S., digital health services and apps are gaining popularity because of people like me—those of us who are paying out-of-pocket to improve their health and wellness—and by private payers and other accountable-care payment models that are willing to pilot and evaluate new technologies. (PwC’s video and mHealth commissioned reports provide more detailed information about the trends).

Where does that leave the digital health technologies in terms of access to the biggest sectors of the insured: Medicare, Medicaid and subsidized individual coverage? Government pilots like the Medicare Health Support Program did not meet cost-saving expectations—the start-up and program costs were just too high. But now that almost every American is already paying out-of-pocket for their smart phone, which can serve as a highly interactive digital health device, has one of the biggest barriers to digital health adoption—the up-front technology investment—evaporated?  Smart phones may not solve every problem, but they do hold promise to break through the reimbursement barrier.

What can digital health companies do to hasten adoption?

For digital health to truly penetrate, companies need to work together to:

  • market to the end-customer who has growing influence and is choosing more often to use their discretionary income on health-related medical technology;
  • develop a sound strategy for unlocking the private and public insurance systems to support reimbursement for the accompanying clinical services; and
  • educate clinical partners about solutions that improve patient care and provide revenue streams.

The strategies themselves may seem simple yet are terribly difficult to implement. However, a company’s leadership usually can control 99 percent of the difficulty by demanding alignment and coordination among diverse teams such as regulatory affairs, clinical research, managed markets, marketing and communications. Communicators can take the lead in helping facilitate this internal alignment. Here are three specific ways to accomplish these strategies:

  1. Make the economic case: Traditionally, health care innovation is driven by the need to provide clinical studies designed only to prove efficacy and safety. However, the “holy grail” should be clinical studies that show efficacy AND impact on cost. Cost-savings is ideal but cost neutral and cost-containment may also do the trick in our current health care environment. Some companies choose to do economic modeling, but of real value is a study designed specifically to consider cost implications. Both the clinical and economic case should be planned for when considering medical technology or medical intervention. There will continue to be pilot projects that result in lackluster outcomes, but those who understand the current system of health care know this more about the broken systems in which pilots are tested, rather than the technology itself. The role of the communicator is to put the results in the proper context.
  2. Feed patient demand: Even in the face of what some call a “government takeover of health care” we still see a dramatic rise in active consumerism that can help fuel innovation in and the adoption of digital health technologies. Patient voices can help in reimbursement discussions but also influence patient satisfaction scores which are becoming more important when choosing a provider, a hospital or an insurance company. Access to mobile health technologies and the patient’s experience could influence a consumer rating for the provider and service and become a significant differentiator in marketing efforts. Patient demand will certainly grow if companies collect and share engaging patient stories through every available traditional and social media channel. Of course consumers want the same technologies used in finance, travel, energy and almost every other industry to be used in health care. Consumers are sharing opinions online, voting with downloads and backing it up with their checkbooks. And, in a free-market society, consumers usually win.
  3. Work with medical and consumer groups: The power of third-party advocates cannot be overstated. Sustaining good relationships with these groups over time has enormous benefit. A few examples:
    • Anything said by a third party about a service or product is at least 10 times more valuable than if said by a company representative. This goes for product review boards and regulatory bodies as well.
    • Advocates help shape the opinion of policymakers and other influencers, and their opinions are sought by the media. They give speeches in front of large crowds—usually to people that include your target audience. You want them to proactively bring your product up as a positive example.
    • If you have good relationships with key third parties, they can serve as allies on media stories and regulatory issues.
    • Frequent discussions with third parties can broaden your strategic understanding of stakeholder needs, and help you spot trends and foresee potential problems.

Let’s get to work.

It’s 2014 and it’s time for a fresh start. We’re going to see a lot of innovative, promising health technologies this week at CES, and communications professionals can help get them to market successfully. Gather the right people together in your company and answer the following three questions:

  1. What are we doing to make the economic case about the value of our solution?
  2. What are we doing to find and promote our patient stories?
  3. What are we doing to cultivate relationships with clinical and consumer advocacy groups?

We’d love to hear what you come up with. Share your comments here or @hcpolicymatters.

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The Freshman Healthbook Presents: Interviews with “Ones to Watch”: A conversation with United States Congressman Alan Grayson

The Freshman Healthbook Presents: Interviews with “Ones to Watch”

A conversation with United States Congressman Alan Grayson

 grayson_high_res-660x993

As part of the Health Care Policy Matters site launch earlier this year, TogoRun introduced a new resource called the Freshman Healthbook – a convenient reference tool on the new policymakers in Congress who will have a significant impact on the evolution of health care in the U.S.

In addition to serving as a guide to the new Congress, the Healthbook identifies several freshmen as the “ones to watch” when it comes to health care policymaking.

One of our “ones to watch,” Congressman Alan Grayson represents Florida’s 9th congressional district. As part of our ongoing series, Interviews with Ones to Watch, The HC Policy Matters team recently caught up with this freshman Congressman to talk about his health care priorities and the Affordable Care Act (ACA).

What are your health care priorities?

My health care priority is health, for the greatest number of people.

What part of the Affordable Care Act do you believe will have the largest impact on the United States health care industry?

I believe that the part of the ACA that will have the largest impact on the United States health care industry is the affordability credits. The affordability credits are projected to make health care coverage affordable for 15 million new “customers,” and they will become an integral part of affordability for millions of others who already have coverage. Another part of the ACA that will have a very large impact on the U.S. health care industries are the minimum coverage standards, such as (to choose one of many) the bar against denying coverage or care because of pre-existing conditions.

How will your previous leadership with the Alliance for Aging Research influence your views on policies affecting aging Americans?

From my work with the Alliance for Aging Research, I have learned not to view medicine as static. Technological evolution and revolution can dramatically improve health and longevity, and reduce health care costs.  One crucial responsibility of government is to accelerate those changes, i.e., to bring the future closer.

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The Freshman Healthbook Presents: Interviews with “Ones to Watch”: A conversation with United States Congressman Raul Ruiz, M.D.

The Freshman Healthbook Presents: Interviews with “Ones to Watch”

A conversation with United States Congressman Raul Ruiz, M.D.

Raul_Ruiz,_official_portrait,_113th_congress

As part of the HC Policy Matters site launch earlier this year, TogoRun introduced a new resource called the Freshman Healthbook – a convenient reference tool on the new policymakers in Congress who will have a significant impact on the evolution of health care in the U.S.

In addition to serving as a guide to Congress’ new health care policymakers, the Healthbook identifies several freshmen as the “ones to watch” when it comes to health care policymaking.

As one of our “ones to watch,” Congressman Raul Ruiz, MD, is not only a Harvard-trained physician, he is also the founder and director of the Coachella Valley Healthcare Initiative. The HC Policy Matters team recently caught up with this freshman Congressman to talk about his health care priorities and the Affordable Care Act.

What are your health care priorities?

As an emergency room doctor, health care is a very important issue to me. My priorities are increasing access to affordable, high quality health care for people in the 36th Congressional District and across the country, protecting Medicare for our seniors, improving veterans’ health care, expanding access to prevention and wellness education and addressing the physician shortage.

What part of the Affordable Care Act will have the largest impact on the health care industry?

The insurance components of the Affordable Care Act will have the largest impact on the health care industry. Millions of people will now be able to obtain health insurance and thus increase utilization of health care services throughout the country.

What policies would you support to address the demand for more medical professionals in the United States?

I support creating more residency graduate education programs and developing pipelines programs to get more doctors in to our health care system, especially in underserved areas.

 These pipeline programs take students who have a passion to serve, especially in their underserved communities, and create incentives for them to obtain a medical education and return home as physician leaders and community advocates. These programs are more important that ever today. As we expand the pool of people who are insured and the demand for doctors goes up, we must increase the number of quality doctors who also care about community wellness.

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New Sunshine Rules Bring Clarity and Challenges

doctor pocket

On February 1, the Department of Health and Human Services (HHS) issued the long-awaited final provisions of the Sunshine Law, or, more formally, the “National Physician Payment Transparency Program: Open Payment.” A copy of the full report is available at https://www.federalregister.gov/public-inspection.

The Basics

The intent of the law, which is part of the dictates of the Patient Protection and Affordable Care Act, is to increase transparency regarding financial relationships between drug, biologic and device manufacturers and health providers. HHS will post that data to a public website. While the provisions of this act are U.S. specific, many European countries are considering such legislation.

Nearly all financial transactions must be reported, including:

  • Compensation
  • Food
  • Entertainment or gifts
  • Travel
  • Consulting fees or honoraria
  • Funding for research or education
  • Stocks or stock options
  • Ownership or investment

Shedding light on the implications for health care communications and marketing

The release of these provisions will bring clarity and reduce confusion for health care communicators. To provide a perspective to health care communicators, TogoRun asked Mark Senak, SVP and Partner at sister firm, Fleishman Hillard, and an authority on regulatory communications, to provide his perspective. Mark is also the owner of the popular health care website, “Eye on FDA.”

According to Mark, the Sunshine Law has the following implications for health care communicators:

Corporate Image:  At least 12 pharmaceutical companies have initiated voluntary disclosure of payments with various approaches – from simple postings to couching this information in the context of “responsibility programs.” ProPublica, an independent, non-profit newsroom that produces investigative journalism in the public interest, has posted this information in a database so that anyone can search physician payments by geography and physician. Amounts posted are from a few thousand dollars to many million. This database is far from complete.

According to Mark, companies do need to consider how their approach to reporting will affect their corporate reputations. Are they ahead of the pack, or not? And has their approach to increased transparency affected their own corporate image? How does what they are reporting compare to their competitors? Companies should prepare their messages and statements now, if they haven’t already done so, and reflect on how to position their approach within the context of their overall brand positioning. They should also have systems in place for responding quickly to emerging issues.

Physician Spokespersons:  Another issue, according to Mark, is that once mandatory reporting begins, there may be physicians and institutions that will be reluctant to work with industry or not want to work with the industry at all. Of course, this could have significant negative impact on health care overall by thwarting collaborative research. From a communications standpoint, it also may impact a company’s ability to support the sharing of relevant and sometimes breakthrough information by leading key opinion leaders. That said, it does level the playing field by giving everyone the opportunity to see who is working with which company and for what end.

Also, physicians may turn to industry for clarification, so companies should prepare clear explanations of the reporting requirements for both external and internal stakeholders. Health care communicators should also have a clear understanding of the conflict of interest policies for all potential advisors/partners.

And, finally, communicators should understand what role they will play in processing and reporting payment information to be compliant.

Be vigilant: Once HHS posts this information, companies need to monitor what is being posted. There is no guarantee that everything will be correct, and companies need communications protocols for dealing with this.

The Sunshine Challenge

For healthcare and marketing professionals, these rules are intended to bring clarity and reduce confusion on disclosure requirements. However, many are concerned that the new requirements will prove to be burdensome, costly and political. We believe that the industry’s ability to spur innovation and advance science is contingent on healthy – and transparent – relationships between industry and physicians. Drug development is helped, not hampered by sharing data, information, opinions and perspectives. The challenge will be to ensure that the new law does not chill information exchange or collaborative research and that patients are the ones who will benefit in the end. A watchful eye is needed as the law goes into action.

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TogoRun releases version 2.0 of The Freshman Healthbook

Just in time for President Obama’s second-term inauguration on Monday, we have released Version 2.0 of The Freshman Healthbook , which includes some of the recently announced committee assignments of the newest members of Congress.  We mined the Senate and House announcements to determine which Freshman received assignments on the committees with the most jurisdiction over healthcare issues.

Below is a list of the most influential committees on health care issues in the House and Senate with their assignment status and the names of the Freshman members. A few committees are still awaiting final assignments and will be updated in the Healthbook when they are made available.

Senate:

  • Senate Committee on Health, Education, Labor, and Pensions (HELP)
    • Assignment status: Subcommittees still unassigned
    • Freshman members:
      • Sen. Tammy Baldwin (D-WI)
      • Sen. Elizabeth Warren (D-MA)
      • Sen. Chris Murphy (D-CT)
  • Senate Committee on Finance
    • Assignment status: Complete
    • No freshman on this committee
  • Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
    • Assignment status: Complete
    • No freshman on this committee
  • Senate Special Committee on Aging
    • Assignment status: Complete
    • Freshman members:
      • Sen. Jeff Flake (R-AZ)
      • Sen. Joe Donnelly (D-IN)
      • Sen. Elizabeth Warren (D-MA)
      • Sen. Tim Scott (R-SC)
      • Sen. Ted Cruz (R-TX)
      • Sen. Tammy Baldwin (D-WI)

House:

  • House Committee on Energy and Commerce
    • Assignment status: Committee to be assigned on January 22
  • House Committee on Ways and Means
    • Assignment status: Committee still unassigned
  • House  Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
    • Assignment status: Complete
    • No freshman on this committee

Check out The Freshman Healthbook v.2.0 and follow us on @HCPolicyMatters to keep up with the latest.

 

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