by Jason Brandt (@jasondmg3)

What if there were a coordinated healthcare system in which teams of caregivers focused on sharing information and insights about their mutual patients and preventing health issues before they became critical?

Is it a utopian dream or perhaps the mission statement of an advocacy group? No – it’s the original vision developed two decades ago by the founder of CareMore, a Cerritos, California-based company that serves more than 50,000 Medicare Advantage patients throughout the Southwest. The company’s 26 “care centers” are vastly different from a traditional medical practice, and may offer lessons for achieving greater patient compliance.

CareMore’s model is based on the application of an old systems-management principle first developed at Bell Labs in the 1930s and refined by the management guru W. Edwards Deming in the 1950s: You can fix a problem at step one for $1, or fix it at step 10 for $30.

Most U.S. healthcare is repair-centric, not prevention-centric – big health events occur in the lives of patients, and the system is geared to try and fix them. But what would happen if we prevented the big events in the first place?

This “upstream” intervention approach – as opposed to treating “downstream” outcomes – means CareMore’s overall member costs are 18 percent below the industry average.

What does it look like? Consider these examples:

• A woman with a history of congestive heart failure notices she’s put on three pounds in 24 hours – a sign of possible fluid in her lungs. CareMore noticed too, because her scale wirelessly communicated with the clinic.
• A diabetic who cut his foot and was referred to CareMore had a nurse practitioner clean and dress his wound – and then check on it every two days until they were certain the risk of infection had passed. Had the patient not been able to drive or catch a bus, CareMore would have sent a car.

If that sounds like a luxury take on traditional healthcare, it’s actually just the opposite. CareMore found that, among elderly patients, as many as one-third fail to show up for their doctor appointments because they lack the network of friends and family – or even basic fiscal resources – to make the trip. So this massive area of fundamental noncompliance – getting to a doctor before a small problem turned into a big one – was often replaced with just calling 911 when they got sick.

Against that backdrop, providing transportation for these patients was very cost effective.

The problem of noncompliance isn’t limited to missed appointments. Patients leave prescriptions unfilled, medicines untaken, exercise-and-diet regimens unfollowed, and symptoms unnoticed and unreported.

CareMore’s largest innovation may be in deciding that noncompliance is their issue, not the patients’. And the numbers show that it works: their hospitalization rate is 24 percent below average; hospital stays 38 percent shorter; and amputation rate among diabetics 60 percent lower than average.

Others are watching: In August, CareMore was acquired by WellPoint, which serves 70 million people nationwide directly or through subsidiaries, and has plans to expand the CareMore model.

Of course, it’s easy to draw a distinction between broad-based preventative care and pharma, and the CareMore example may not translate perfectly to the world of pharma marketing and patient communication if for no other reason than pharma is not in a primary-caregiver role. But there is now significant evidence that making compliance our issue rather than the patient’s pays long-term benefits, both in terms of cost and patient outcomes.

(Photo by Win McNamee/Getty Images North America)

By Kimberly Reyes (@CommDuCoeur)

On March 23, 2010, President Obama signed his controversial Healthcare Reform Bill into law, with the objective of making healthcare more affordable and expanding coverage to the 32 million Americans that are currently uninsured, including self-employed individuals and low-income families.

Groups such as Physicians for Reform and Physicians for a National Health Program reflect the general endorsement from healthcare practitioners nationwide, but strictly from a bird’s-eye perspective.  Overall, “treating someone without insurance is the most expensive way to provide care. Rather than having the cost and risk of their care pooled with others, the cost falls directly on the patient, who cannot afford it, and is taken on by hospitals and clinics struggling to stay open,” notes practicing internist “PalMD,” author of The White Coat Underground.  However, as the effects of healthcare reform begin to take shape, so are concerns that doctors are being stretched thin by the influx of new patients.

Believe or not, Pharma is projected to play a significant role in alleviating the burden imposed on HCPs.  Pharmacists are a critical component of our nation’s healthcare system, working in tandem with doctors to provide comprehensive patient care.  According to a 2008 position paper released by the American College of Clinical Pharmacy in support of healthcare reform, “Pharmacists have extensive clinical knowledge and expertise in the use of medications, and are one of the most accessible of all health care professionals.”  Furthermore, their guidance on medication compliance and healthy living could potentially keep patients from flooding emergency rooms.

Drugmakers are expected to assist this effort with the proper educational tools for both physicians and patients on medication information and health management.  Millions of new patients walking through hospital doors creates a demand for increased health literacy, and a crucial opportunity for Big Pharma to reclaim its battered image.

Pixels & Pills has previously covered the HITECH Act, which provides incentives for hospitals and HCPs to adopt the widespread use of electronic medical records.  This will become an important venue in helping facilitate the cooperation and coordination between doctors and pharmacists as they are united by healthcare reform and the changing patient landscape.  As a result of the HITECH Act, treating physicians have adopted mobile technologies and are turning to the Internet as a vital resource in their practice.  It is imperative that Pharmaceutical companies make information on their drugs available and accessible to the doctors who look to technology to alleviate the strain from increased patient demands.

Beyond these points, the implications of Obama’s historic bill are undoubtedly widespread throughout the healthcare community.  What are some other ways that Pharma can contribute to healthcare reform?

By Jim Mittler, PhD, Medical Director (@jim_mittler)

We all know that the social media revolution is happening and it cannot be stopped—this is according to the exponential growth of social media over the past several years. It has fundamentally changed the way in which information is disseminated and the way people communicate throughout the world today. While I believe change is a good thing, what we do with social media to improve public health communications remains to be seen. Sure, the Centers for Disease Control (CDC), whose mission is to protect the health of United States citizens, is participating quite well in social media. They have Facebook, Twitter, and YouTube pages, create widgets to add to Web sites, and actively blog; all of which serve to promote general health and release information on emerging health threats, like the swine flu. But how much of this information is really reaching patients and making an impact?

According to a recent report from Manhattan Research, patients and caregivers are harnessing the Web for health-related information like never before. Use of Web-based health resources has grown to nearly 160 million people in the United States in 2009. In fact, the number of people using the Web as their main source for health information has surpassed the number who get health information from their doctor. This is troubling in some ways because much of the information on the Web, and particularly the interactive discussions occurring in the social media realm, is unregulated. Clearly, the government puts out credible information, as do pharmaceutical companies because of FDA regulation. General health Web sites (eg, WebMD) or disease-specific advocacy groups (eg, the National Multiple Sclerosis Society) produce great patient-oriented information about medical conditions and they host blogs, messages boards, and chat rooms that build a network of support among affected patients and caregivers. While social media is great for finding information and providing support to users, the open exchange of information through unmoderated message boards, chat rooms, and Twitter can increase the potential for dissemination of noncredible and possibly erroneous health information, which could be harmful to patients. Even more troubling are the “snake oil salesmen” who pose as experts and offer “medicinal” products that are untested and unregulated and, therefore, are not safe. Despite these pros and cons of social media for health information, we must accept it and harness its power to improve public health and support patients in the best way possible.

The Web and social media offer convenient channels for obtaining health information, but who is using these resources?

According to recent survey data from the National Telecommunications and Information Administration (NTIA), users of the Web are more likely to be younger, more educated, have a higher economic status, and are White or Asian vs those who reported no Internet use. This is referred to as the “digital divide” – the gap between those who can access and have the skills to effectively use information technology and those who cannot. This concept is not new. Despite the efforts of many organizations who seek to close the digital divide, it still exists according to NTIA 2009 data.

Coincidentally, there is another divide in the United States that mirrors the digital divide. Healthcare disparities are the differences or gaps in the care experienced by one population compared to another population. The 2009 National Healthcare Disparities Report (NHDR) shows that some Americans received worse healthcare than others – specifically, minorities (ie, African Americans and Hispanics) and the poor had worse access and use of healthcare, and when they did, it was of lower quality.

Can social media help close the healthcare disparity in the United States?

Several interesting observations of those who use the Web and social media suggest that it has the potential to narrow healthcare disparities. The good news is that the digital divide may be closing more quickly as people shift away from home computers and laptops to access the Web by using Web-enabled mobile devices (smart phones) more frequently. Interestingly, uptake of mobile devices to access the Web has been swift among African Americans. According to a 2009 Pew Internet report, African Americans are the most active users of the mobile Internet and their use is growing the fastest. Daily access to the Web via a mobile device by African Americans has increased 141% between 2007 and 2009. This suggests that minority populations who are most affected by health disparities are becoming increasingly connected to the Web and, therefore, have a wealth of health-related information at their fingertips.

If social media has the power to disseminate health information and support patients, it is important to know how those affected by health disparities are utilizing social media. An interesting report on the type of social media used for health-related information provides some insight on the implications for health communication. Using data from the Health Information Nation Trends Study, Chou et al found that all users most often turned to social networking sites more often than online support groups or blogs; however, significantly more nonwhite Americans used social networking sites than white Americans (45% vs 31%, respectively [P<.001]). These data suggest a unique opportunity to target minority populations with health information via social networking sites.

Where revolution meets reform.

The recently enacted Health Care Reform Act will expand access to health insurance coverage and reduce the costs associated with healthcare. Essentially, it will bring healthcare to more Americans and have an impact on health disparities in the United States. Parallel to this act, the American Recovery and Reinvestment Act of 2009 (ARRA) includes billions of dollars in Medicare and Medicaid incentive payments to providers and hospitals who adopt health information technology into their practices. The health information technology sections of ARRA (termed HITECH) are designed to improve healthcare quality, safety, efficiency, and reduce health disparities; engage patients and families; improve care coordination; ensure adequate privacy and security protections for personal health information; and improve public health.

The components of health information infrastructure are complex. However, one major component is the creation of electronic health records (EHRs). Ensuring meaningful and timely access to EHRs will be important to engage patients to take responsibility for their own healthcare. This can be achieved through a secure patient portal, which can be a standalone Web site or integrated into the Web site of the healthcare provider. A patient portal is more than a link to a patient’s medical record. It can also take on multiple functionalities that are akin to a social networking site. Patient portals allow interactive communication with a physician. Patients can ask questions about their disease or treatment and provide comments to their physician by self reporting disease symptoms or side effects of therapy. Patients can schedule “social events” (ie, office appointments) through the portal. Healthcare providers can also post individualized educational materials to a patient’s splash page and suggest links where patients can find credible information on preventative health measures, diseases, and/or medications.

Patient portals represent a new form of health-related social media that can enhance the direct interaction between patients and healthcare providers and dissemination of valuable health information. Minorities who are affected by the health disparities in the United States are rapidly adopting Web-enabled mobile devices and tend to preferentially use social networking as a means to gather health-related information.

As patient portals become commonplace in the future, we may see healthcare disparities diminish thanks to power of social media.

Jim Davidson, Chair, Public Policy Group, Polsinelli Shughart PC gives us a legal perspective on healthcare reform’s Impact on the DTC climate.

Howard Dean talks to Pixels & Pills about the issues between doctors and DTC and how Pharma needs to harness the power of the Net.

Next week, 600 of the world’s leading pharmaceutical executives and marketing professionals will gather in our nation’s capital for the 10^th Annual DTC National Conference.  From April 7^th to April 9^th, the industry’s thought leaders plan on discussing significant factors shaping the direct-to-consumer pharma marketing landscape, positioned around this year’s themes of the economic crisis, healthcare reform, mastering the “media mix,” and creative innovation.

In addition to attending the DTC National Advertising Awards dinner and The Top 25 DTC Marketers luncheon, participants will gain insight through relevant case studies, the latest market research, forums led by the best in the biz, and networking opportunities.  This year’s highlights include an exclusive Medical Device Marketing workshop for Gold Pass holders, a panel and meet-and-greet with Governor Howard Dean, former chair of the Democratic National Committee, and speakers from Pfizer, Novo Nordisk, and DDMAC.

Pixels and Pills remains devoted to sharing insight and breaking ground in pharmaceutical marketing, and we consider the exciting changes and challenges facing the direct-to-consumer field a critical part of the dialogue.  DTC advertising is a vehicle through which patients are informed about potential health risks and encouraged to explore their treatment options.  In addition to empowering the patient, DTC delivers them to the doors of many physicians, fostering strong cooperative relationships based on transparency and trust.

Some major events have occurred in the past year that will heavily impact the DTC industry.  In response to the economic recession, top drugmakers redirected their advertising efforts away from traditional channels and into more cost-efficient alternatives.  The debate over healthcare reform is putting pharma under the magnifying glass, with lawmakers reconsidering the rules and regulations presiding over the industry’s advertising efforts.  Marketing professionals are recognizing the power of the Internet and social media, but still need to address the concerns of budget, regulations, and how DTC fits into their strategies.  Despite the Plavix gurney and the Pristiq wind-up doll, 2009 brought some pretty forgettable commercials to the small screen, putting pressure on ad execs to step up their game.

All these issues–and more–will be addressed at this year’s DTC National Conference, and Pixels & Pills will be there bringing exclusive behind-the-scenes action to you live with video interviews of key speakers and major industry personalities.  Meet the contributors as we talk to the movers and shakers of the DTC world, and keep visiting our website for up-to-the-minute news and video from the three-day event.

2010 is the year everything changes in Healthcare.  We’re looking for pharma industry experts and executives to interview via phone or at the DTC event in Washington DC next week.  Will you be at the 10^th Annual DTC National Conference?  Let us know by e-mailing us at info@pixelsandpills.com – we’d love to talk to you!

By Russ Ward (@russcward)

We all agree that going mobile is easier. Some of us even argue that going mobile is better. But is going mobile safer? When it comes to electronic health records (EHR), that’s where the naysayers focus and where even the proponents find shaky ground.

We’re not just talking about useful information. Your health records are some of the most important documentation you have. They could save your life. They are also potentially damning.

Without them, you could get drugs you’re allergic to, receive the wrong diagnosis, lose track of important markers of your condition.

But with them, you can lose approval for insurance.

And with them stolen, someone else can get treatment and send you the bill.

There is, clearly, a huge danger in your health records falling into the wrong hands. It would be disingenuous to refuse to acknowledge the truth that mobile health records are a proposition with inherent risk. However, they are not just a proposition – they are a growing reality.

This is because there are a variety of benefits to electronic health records – and not just the refrain of “easier!”

• They can reduce the potential for human error. No papers to slip out of manila folders; no charts mis-alphabetized; no boxes of records accidentally sent to the storage facility. (See one doctor’s reasons.)
• They can make it more likely that doctors will report adverse events, according to a survey sponsored by Pfizer.
• Your information is available faster and in a more organized way, making the best care possible quicker.

How can we get the benefits while minimizing the risks? Moreover, how can your work minimize those risks?

• Hacking – digital theft – is a worry of many people. Digital encryption and authentication are problems that need more sophisticated solutions every day. Not only are Microsoft HealthVault and Google Health working on these problems, but a host of smaller solution providers (such as Diversinet) are too.
• Physical theft is another major reason why digital records are exposed. Laptops and other devices, by virtue of being mobile, are easily stolen. (Check out these examples.) As a professional: do you have strict procedures for asset management? As a patient: is it made clear to you how the laptops, smartphones, tablets and other electronics that your healthcare professionals use are locked down and tracked? (And as a professional: can you help them come up with new and better ways to do that?)
• Monitoring your credit report comes naturally to most people by now – get the reports every year and make sure there are no errors. Checking out your health records should become just as automatic for patients – and made just as easy to do by providers.

EHR are a fact of life. If your own GP doesn’t have them now, the practice will probably have migrated to digital in six months. For those of us who are not only patients, but also provide solutions in healthcare, the opportunity is there – for us to learn more about them, and then use our dovetailing experiences to improve EHR for everyone.

This new series on Pixels & Pills will focus on the importance of revisiting traditional ways of thinking.

By Sven Larsen (@zemoga)

Dr. Jay Parkinson is at the bleeding edge (pun intended) of an entirely new way of thinking about doctoring.

Except that it isn’t new at all.

Dr. Parkinson has an MD and a master’s of public health. He went into practice in Brooklyn in 2007, but in a startling new way. He had a website, Google Calendar, an iPhone and PayPal. House calls, IM, email and video chats. No insurance, no office, no staff of scrub-clad nurses and receptionists. Since then, his experience has ballooned into an extremely successful business model. And of course: he had 10% overhead costs, not the more usual 70%.

Oprah’s favorite Dr. Oz has this to say about him: “His system gives supremacy to the covenant between doctor and patient, and the bonus is that it’s a better value to you. By cutting out the middlemen who often distort that relationship, Parkinson is putting the doctor-patient relationship back where it should be. It’s slick and it’s smart. You might say it’s like living in the twenty-first century.”

But even more telling, Dr. Parkinson has this to say about his business model: “Is that innovative? Man, I don’t know. It’s paying attention to what’s awesome about Flickr and then doing it.”

He’s exactly right, and this is one of our mantras. We in the pharma industry need to stop being so elitist and thinking we’re so special. This industry is not utterly different from any other industry. No, we’re not making comic books or snack cakes or cardboard boxes. Yes, our work can literally be a matter of life and death. Yes, of course there are rules and regulations.

But find me an industry that doesn’t have regulations. We have got to break with the mindset that the way we’ve been doing it is always for good reason. And sometimes, what we find when we’re able to break with it, is that the way we used to do it was pretty great in a lot of ways.

House calls were wonderful. Sitting in a busy practice for two hours, filling out reams of insurance paperwork and inching away from the germ factories slumped around you? Not so wonderful. Of course Dr. Parkinson’s model worked. He looked at what was great about other technology-enabled situations in his life and applied them to healthcare, in order to make the best of the old ways possible again.

We must move away from tradition – the recent traditions that aren’t working – in order to look back and regain the benefits of the older traditions, amplified via technology, for both patient and provider.

In a recurring series, Patient 2.0 posts look at what goes on outside the marketing company and the exam room. Where are the other links in the healthcare chain and how can digital technology help them?

By Sven Larsen (@zemoga)

We’ve talked about the pharmacy, the outpatient center, even the medicine cabinet, in terms of where the patient has healthcare experiences. What about the acute setting – when the patient is admitted into the hospital itself?

As former med students ourselves and having had numerous conversations with physicians some issues are glaringly obvious. and The biggest problem we see, which could be fixed completely using technology, is a simple one: sleep.

Residents are routinely pressed into 30-hour shifts in hospitals, yet truck drivers aren’t allowed more than 11-hour shifts and pilots aren’t allowed more than 8. Why? Is it somehow worse to think about people dying or being injured by accidents on the road or in the air than from a misdiagnosis or an accidental overdose? It doesn’t make any sense to have patients’ lives in the hands of student doctors – hands that are not only untried, but beyond exhausted. Hazing isn’t allowed in frats anymore, so why is it still allowed in med school? This is madness. It isn’t about tradition. It’s about championing the patient’s health and safety. It literally is a matter of life and death.

This is a field exquisitely attuned to data, always striving to better patient outcomes. The idea of residents (or their patients) benefiting from working nonstop from daybreak Monday to lunch on Tuesday – surely that belongs in the days of leeches and bloodletting, of using whiskey and a stick as anaesthesia.

Hospital staffing and demand can be tracked and predicted with the precision with which it such forecasting is done in any other large facility. Processes and paperwork can be automated and digitized, minimizing the need for paperwork and maximizing the time spent learning and treating patients.

Technology can keep doctors in training healthier, and keep patients in less danger – and we should be working on that. Not only does it keep our patients safe, but it champions the well-being of our future physician customers. They need to get through their training safely and effectively, and we can help.

Live From the E-Pharma Summit (#epharma)

Dave deBronkart, Co-Chairman of the Society of Participatory Medicine provides some unique insight in to the patient’s approach to digital media and healthcare.