What Does Criticism of CVS Caremark’s New Healthcare Program Really Reveal?

CVS Caremark was in the news a couple weeks ago after they launched a new element to their health insurance program. As part of their standard coverage, all employees have been asked to take a health screening or face a $50 per month penalty through their premiums. As part of this screening, employees must disclose some sensitive information, such as weight or BMI, which would be collected and tracked by a third party.

This new policy created a firestorm.  The first objection was that it was mandatory, forcing employees to disclose information they may not be comfortable sharing.  On top of that, by including weight and BMI, some observers saw this as a first step towards a “fat tax”, where employers could raise premiums or deny coverage for poor health.

While I can't speak to how this info might be used in the future (although use of medical data by employers is illegal right now), I am bewildered by the criticism.  That criticism isn't difficult to respond to:

• Understanding your key health metrics is an important part of maintaining, and ultimately improving, your health.  Although there is little hard data around the quantified self movement, there is plenty of anecdotal evidence that having this data leads to better decisions
• Whether you interpret the $600 as a penalty or an incentive to do your health screening, employers should have some tool to encourage employees to collect this data.  Let’s be honest, most people will not do this on their own
• CVS Caremark isn't the only company doing this – according to the National Business Group on Health, 62% of large employers offered biometric screenings in 2011 and 52% of those had incentives to complete them.  And as one of the largest healthcare companies in the US, it’s important for CVS to be a leader and set the tone for other companies to follow

What I’m more fascinated by is the root causes of this fear.  Given the state of our healthcare system, you would think everyone would be open to new, innovative approaches to reducing costs.  Instead, this is a reflection of larger themes in our national dialogue:

• Backlash against any policy that is perceived to reduce individual choice, even when the decision is made with positive intent
• Mistrust of large corporations and government, with a believe they are nefarious and any data they collect will be used negatively
• A media that recognizes these fears and stirs up controversy by highlighting stories that play into them

As a country, are we so stubborn that we’re unwilling to try new approaches, even if it reduces some of our choice for our own benefit?  CVS Caremark is a Fortune 20 public company and I can guarantee if this program doesn't show results (monetarily or health-related), it will get shut down.  But that doesn’t mean we shouldn't try it, even for just one year.  I agree, there are some policies that may go too far (i.e., NYC’s soda ban – while I applaud the intent, it’s too capricious and difficult to enforce), but shutting down innovation under the pretense of individual choice sets a dangerous precedent.

On top of that, whether we want to acknowledge it or not, large corporations and government drive the economy and agenda of this nation, but also help us live better lives.  Without large business, we wouldn't have Walmart, Apple, or Google.  Without government, we wouldn't have roads, public education, or scientific advances.  And, for better or worse, in order for them to continue serving us and improving our collective lives, they need to be smart about their money, which often times means using data to make better decisions.

The controversy seems to have died down for now, but I believe this is only the start of a larger conversation about the employee-employer relationship around healthcare.

Is Taylor Swift A Bad Role Model for Healthy Attitudes?

Taylor’s at it again.  Last weekend she performed her recent breakup song “Never Ever Getting Back Together” at the Grammys and took a swipe at an ex.  This is one in a long line of send-offs inspired by the real-life heartbreak she’s become synonymous with.

Why does this happen to her so often?  I have a cynical theory - that her record label and handlers exaggerate what would typically be normal dating drama, reinforcing her image and making her songs much more personal and powerful.

But let’s say this is real and she always strikes out.  We all have friends who seem to be unlucky in love.  But how much of this is outside their control and how much is a self-fulfilling prophesy?  Taylor may be attracted to the wrong people, but if her history and music is any indication, she could be trapped in a viscous cycle, struggling to break out of it.

While this pattern sells plenty of records, there are a some issues with her message when it comes to a few widely-held health tenets:

Health Tenet #1: Importance of strong long term relationships, both romantic and non-romantic

Issue: Taylor’s music discourages or minimizes the value of these relationships and says it’s OK to be alone

Health Tenet #2: Importance of a sense of control on mental / physical health

Issue: Taylor’s songs often lay the blame of failed relationships on her partner, allowing her to play the victim and brush responsibility away from her

Health Tenet #3: Power of positive thinking and optimism

Issue: There’s an underlying pessimism in her songs and an ongoing narrative that she’ll never be able to find love or happiness

Maybe this is going too far – at the end of the day, Taylor’s just singing fluffy pop music targeted towards confused, hormonal teenagers.  But it does beg a larger question – what is the entertainment industry’s responsibility when it comes to health?  For every success story (e.g., Jennifer Hudson’s weight loss, Robert Downey Jr.’s success in rehab), we’re fed many more stories about celebrity failure and downfall.  These narratives may make us feel better about ourselves, but can reinforce negative attitudes and desensitize us to bad behavior. 

I give credit when the entertainment industry takes a more nuanced view of these issues (e.g., non-exploitive profiles on celebrity challenges and recovery), but this won’t be enough if performers like Taylor continue to be role models and send potentially harmful messages.  

What Is The Impact Of China’s Rapid Growth On Public Health?

I flew into Chicago last Thursday night and was greeted by this gorgeous sight:

It’s not the traditional skyline, but in some ways I find it even more breathtaking.  Beyond its beauty, what struck me most was the incredible planning and work that went into creating this city.  But at what price?

China is facing this exact dilemma, generating record levels of pollution that have engulfed several cities.  This issue was highlighted by several news outlets over the past few weeks, including this great photo essay.  It’s clear that China’s massive growth has had some short term consequences, including apparent environmental impacts.  But when the public is breathing in pollution 25x higher than the safe amount, what are the long term impacts to public health and the economy?

MIT released an interesting study last year examining this question.  The study first laid out common health impacts of this pollution, ranging from hospital admissions, to chronic respiratory issues, to lost productivity.  Applying various scenarios and simulations, the study estimated that China lost $112 billion due to this pollution.  While this is dwarfed by China’s $7 trillion GDP, it’s still a staggering sum that will only be exacerbated as the country continues to grow.  Given the strain the US is currently facing on its own healthcare system, it will be curious how China deals with its issues down the line.

One area it needs to tackle is the disturbing misconceptions and a lack of public information about prevention.  In the photos, you can see people wearing face masks to combat the smog.  This is also a common sight at airports, where I usually laugh because I don’t think a flimsy mask is going to prevent you from getting sick (there’s even some evidence to back me up).  Similarly, the masks in China aren’t going to prevent people from breathing in many of the smaller particulates that can be just as harmful as the ones you can see.  China’s government needs to look beyond just curbing the pollution and think about educating people on how to stay safe or risk an even larger catastrophe.

Why Does San Francisco Eat So Healthy?

I was in San Francisco this past weekend when a friend made an interesting comment.  She’s a picky eater, but throughout the weekend she found that all of her requests were honored.  After the third time she successfully got soy milk for her coffee, she commented that “it’s strange that every restaurant has soy milk.  I guess it’s because everyone eats so healthy here.”

Which begs the question – why does San Francisco eat healthier than the rest of the nation?  It’s a generalization, but this stereotype seems to hold true – there were fresh, nutritious food options everywhere.  This is pure speculation, but I have a few theories:

-          Great agricultural climate: Northern California has a mild, sunny climate that produces a vast array of fruits and vegetables.  Most of this produce comes from the Central Valley, which is one of the most productive agricultural regions in the world.  There is also an abundance of seafood, which reduces pressure to produce red meat.  This abundance of fresh, accessible produce gives locals the ability to take advantage of these healthier resources

-          Liberal culture: The west coast, and especially major cities, has traditionally been more liberal.  That liberalism may translate more into social justice and moral questions about how our food is produced and distributed.  This attitude may have led to less demand for processed, big agra food and more focus on local, sustainable products

-          Immigrant population: This is a little more theoretical, but I wonder how much the influx of Asian immigrants impacted food culture.  Traditional Chinese food (not the stuff from Panda Express) is focused around fresh vegetables, stews and steamed dishes that could take advantage of the area’s agricultural abundance

-          Higher income:  San Francisco and Marin counties have some of the highest per capita income in the US and, as research shows, higher income leads to healthier behavior

I could be completely off here, but I think many of these arguments hold some weight.  But is there a way to apply these principles to other parts of the country?

-          It would be difficult to change the nation’s agricultural landscape, but food access has improved tremendously in the past few decades.  The abundance of fresh, healthy food throughout the country and year-round has been achieved through better technology and new retailers, although with some interesting consequences

-          While the county is certainly not going to become more liberal, a greater awareness and acceptance of issues like climate change may make people question their food choices and seek out healthier, more sustainable options

-          We see ethnic foods becoming more common, which can be healthier, especially compared with meat and potatoes diets of the past

-          Increasing income is unfortunately the most difficult issue to tackle, but if we build up demand for these products using the other three factors, prices for these healthier foods may decrease and allow lower income Americans to enjoy the benefits that so many in San Francisco already do

Are You Going to Keep Your New Year’s Resolutions?

With everyone hyped up about 2013, wanted to quickly visit a study from the University of Scranton on resolutions.  Here’s some quick math and my comments:

• Percent of Americans who usually make New Year’s Resolutions: 45% (This seems pretty low – maybe the other 55% already know they’re going to fail?
• Percent of people with resolutions who maintain them after 6 months: 46% (This seems absurdly high – this means 25% of Americans are still going to the gym or saving money after 6 months?  Either people are setting really attainable goals or there’s something fishy w/ this study)
• Health-related resolutions among the top 10 most popular: 3 (Lose Weight, Staying Fit and Healthy, Quit Smoking – no real surprises here)
• Success rates of people in their twenties vs. people in their fifties: 2x more resolutions attained (Interesting statistic – does this imply people in their twenties are better suited for change, have easier-to-achieve goals, or is it the opposite for people in their fifties?  Certainly says something about which group could be a better target audience for change messaging)

What Can Anthony Bourdain Teach Us About America’s Attitude Towards Healthcare?

If I could trade places with one person for a day, it would probably be Anthony Bourdain.  His shows allow him to travel to far flung regions and showcase culture beyond the landmarks.  Wrapped in beautiful cinematography, he often goes below the surface to uncover engaging people and stories better than any other travel show.  This past rainy weekend was the perfect opportunity to catch up on his recent trip to Paris, which showed a contrast to the US that I haven’t been able to shake.

One of the episode’s recurring themes was the newish trend of brasseries focusing on local, sustainable products, pushing aside traditional French recipes and preparations.  To accommodate this shift, many of these restaurants had prix fixe menus that changed daily, a concept Parisians were tolerant and accepting of.  This is no small task, since it requires diners to enter a restaurant blindly and trust that the chef will deliver something memorable.

A similar concept crossed my mind a few years ago when I visited Europe and was shocked to find art museums handing out iPods to visitors as audio guides.  It struck me that there was an implicit handshake between the museum and its visitors saying that the iPods would be returned unscathed, something that I couldn’t imagine seeing in the US at the time.

We may have iPods in museums now, but I believe we see less of this trust between authority and individuals in the US, substituted for rugged individualism and a need for personal control.  To illustrate using the restaurant industry, look first at the fast casual concept, which has experienced huge growth over the past few years.  Their business model (use Chipotle as an example) is that the customer can create and customize their meal however they want, no questions asked.  Many restaurants also now have open kitchens, allowing the diner to see what goes into their food preparation.  Finally, there’s been a big debate in the food community about substitutions, with many saying that chefs must accommodate a diner’s request even at the fanciest restaurants.  In all these cases, rather than trusting the chef or the kitchen, the diner has seized control back into their own hands.

While you can see this everywhere in the world, I think there’s a bit more of this in the US, the result of capitalism and our unique history of self-sufficiency.  We have been taught through history classes and the media that we need to act as an individual and control as much as possible, not letting others dictate how we should think or, in this case, eat.

I believe this ethos also extends to healthcare.  Recent areas of innovation have been focused on consumer empowerment as we plod towards exchanges and the internet becomes a bigger source of medical information.  Putting aside politics (e.g., the wisdom of the single payer system), is this a good trend?  Put another way, is our fear and mistrust of central authority, combined with the democratization of the digital age, a good thing for the US health system?

Think about the challenges a doctor faces.  After four years of med school, four years of residency, and countless more years practicing, patients now feel “empowered” to undermine, or worse ignore, a diagnosis or treatment.  At a higher level, I see this every day when our customers want us to customize our member engagement campaigns, outreaches that have been tested and tweaked to maximize their effectiveness.  Rather than trusting our approach, our country’s staunch individualism has made evidence and expertise seem like a bad thing.

Since when do we know better than experts?  In order for consumerism to be successful, I think we need to figure out how to marry up expertise and individual decision making so that we make the right decisions.  This starts with a fundamental conversation about our culture and authority – maybe in this case we need to be just a little more French.

“So, What Exactly Do You Do?”

I dread that question.  Insurance is unsexy, much less drug insurance which is obscure and sounds even more boring.  Then throw on top of that my actual role (product strategy and marketing), which is unique for our own company and tough to understand.  So even after I give the condensed version (“I help people get their drugs at the right place and at a low cost”), I still get quizzical looks before the conversation comes to a grinding halt.

Since the shortened version doesn't work, this week’s post is dedicated to the longer version, which also connects back to how the healthcare system needs to change and what small part my company is doing to help.

At a very high level, my group does three core things:

1) Create Network Products: Employers and health plans (“clients” in our terms) come to us because they don’t want to manage drug spend for the people they employ or cover.  Our company provides this service by acting as a middleman between the clients, their members, pharmacies and pharmaceuticals.  We negotiate drug discounts with pharmacies and drug companies that are then passed back to the client and members through other discounts and lower copays. 

My group specifically analyzes and markets the best combination of pharmacies and discounts to save clients the most money, while still giving members access to get their drugs.  For example, a client can choose to let members fill prescriptions at more pharmacies, making it easy for their members to get their drugs.  However, the client saves money by cutting out duplicative pharmacies and only allow members to fill at selected retailers (i.e., clients can save more money by cutting out the CVS or Wagreens that are within 5 miles of one another).

2) Create Incentives: In addition to choosing what type of pharmacy network they want, clients also need to create incentives for their members to use these networks and continue taking their medication.  These incentives are usually either financial or hard stops.  For example, to encourage folks to use the smaller pharmacy network, we can increase the copay for their drugs by $10 if they fill at a non-preferred retailer – some people will pay that penalty, but many will switch over to our network.  If a client is really serious about saving money through these restrictions, they will put fill limits in place, which means a member’s prescription is not covered if they try to fill that Rx outside of their plan.

3) Encourage Usage: While the incentives are the dollars and cents, we also develop consumer marketing materials to take a softer approach.  These come in the form of letters or calls or emails that tell you how you can save money and the importance of staying on your medications.  They are also used in conjunction with the incentives to make sure we avoid as many rejects and unhappy members as possible.

These efforts result in saving the client and member money by passing along the discounts from these restrictions. At the same time, our company makes a very small profit by charging dispensing fees for each drug processed or a small spread between what the pharmacies pay and what the client pays.  Some argue that we’re increasing the cost of drugs, but without taking advantage of our size (we’re the second largest purchaser of generic drugs in the country), we couldn't get these discounts that far outweigh the fees.

So what does my group teach us about the healthcare system as a whole?  First, there’s real value in intelligently limiting healthcare choices.  By changing the pharmacies a person can fill at, we can recognize up to 10% savings across all drug spend – combine that with other programs (e.g., drug formularies, clinical programs) and we’re talking serious money.  On top of that, our customer satisfaction is at an all-time high, meaning people are not up in arms about having fewer choices.

Second, this is a delicate system that requires incredible coordination.  If any one of these systems breaks – fewer clients come to us for drug benefits, pharmacies start playing hardball, members stop taking their drugs – we will not be able to provide the same services and everyone will be worse off.  Prime examples of this are the spat between Walgreens / Express Scripts and the argument for the individual mandate (i.e., if everyone doesn't participate, then we can’t pay for the people who use the most care).

Finally, it’s going to take a lot of smart people to get out of this mess.  I work with some very intelligent people, yet we’re only impacting a very small part of the healthcare problem, and imperfectly at that.  If we’re going to keep our country healthy, we need a lot more brainpower and energy behind big ideas that are going to make real change.

Can Shock and Awe Tactics Work For Healthcare?

One of the highlights of my Chicago summer is the Air and Water Show.  Every year, the city brings out stunt planes and jets to put on a big spectacle along the lake.  Regardless of whether I’m at North Beach or sitting in my apartment, I feel like I’m part of the action if for no other reason than the sound of these planes invading our city.

Listening to the jets in my apartment this year reminded me of the early tactics of the Iraq War.  At the beginning of the conflict, the US flew these same planes overhead and remotely bombed cities to scare Saddam Hussein and force him to surrender.  This “shock and awe” tactic certainly scared me into paying attention to the show this past weekend – could it do the same for patients?

A great example of this already in place are the cigarette pack labels that either warn smokers about the dangers smoking or show graphic images of its effects.  Another example is the annual drug or drunk driving seminars for middle and high school students, complete with a totaled car for dramatic effect.

But could this tactic be put in place for less severe problems and a more sophisticated group?  Let’s say we want to target heart disease.  While we read stories about it every day, people may benefit by seeing, firsthand, the impact of poor nutrition, low exercise, and not taking medications. 

For example, a company could require all employees to view an annual seminar on the topic, where they bring in a motivational speaker directly affected by the disease to talk about its impact on them and show how the disease has ravaged their life.   To get people to attend, the employer could provide insurance credits or a reward through attendance.  The seminar would be sponsored and facilitated either by the employer or their insurance company, who would both realize cost savings through better behavior.  At the end of the day, this type of event could promote better health by exposing realities first hand at a relatively low cost.

The tough part of this analogy, however, is that the tactic didn’t work in Iraq or with cigarettes.  While they both initially opened people’s eyes, these sounds and images became too commonplace, so people made it part of their daily routines and started to ignore them.  That’s why I think the key is limiting this type of marketing and making it as shocking and controversial as possible.  This solution would also need to be part of a larger effort that rewarded behavior rather than just scaring, but it could send a strong message like jet engines in Chicago each summer.

What Can Travelling Through America Teach Us About Healthcare?

Every major company has a dedicated consumer research team that can conduct research on its own or let another company take the lead.  Unfortunately, this approach relies heavily on surveys and focus groups, which are notorious for capturing consumer preferences, but not explaining or predicting actual behavior.  Retrospective studies, especially data driven ones, can see what people are actually doing, but only for a single point in time and may miss nuances or actual causes of this behavior.  Is there a better way?

I've always loved the idea of tagging along with a patient or family to see how they really act in the real world, which is why I’m intrigued by The Odyssey Initiative.  This program will send three teachers across the country to the best schools to document what they do right, culminating with them taking these lessons to open a new school in 2014.  The group will also post videos and best practices online, creating a robust resource for other education leaders.

Let’s be honest: this is pretty ridiculous.  This group will spend a year on the road capturing anecdotal information and then try to connect these observations together to create a successful model.  This goes against the traditional model of collecting as much data as possible at the lowest possible cost (through surveys and focus groups) and drawing conclusions from that.  They think they can walk into a bunch of schools then create the ultimate school?

That’s what I love about this idea, that it’s so contradictory to our notions of consumer research.  This group is taking the hardest possible approach by visiting face-to-face with teachers around the country.  However, I think they will find insights and best practices that may apply to a single classroom or the entire system, but may not have been captured through traditional research.

And why can’t this same approach apply to healthcare?  A travelling team sits in doctors’ offices to understand how to improve the patient experience.  A team could embed themselves with the healthiest and unhealthiest people to understand how they make decisions.   Given all the changes in healthcare coming down the pipeline, a team like this could draw insights radically different from what we know today and create the next big idea because we haven’t taken the time to truly listen.

Are Health and Social Awareness Campaigns Helpful or Harmful?

Today is the Chicago Pride Parade, an annual celebration of the LGBT community where a diverse crowd lines the streets of Boystown to speak up for gay rights.  This culminates a weekend of events and is part of the larger LGBT Pride Month, which celebrates achievements by gay activists and provides awareness and education for the community.

This is just one of what seems like an endless supply of social awareness campaigns aimed at educating the public about an issue, raising money for a cause, or both.  These events can be large in scope (e.g., Breast Cancer Awarenss month and all related events organized by the Susan B. Komen Foundation), have a smaller scope, but impact the social zeitgeist (e.g., yellow Livestrong bracelets, Save the Ta-Tas merchandise), or be extremely localized (e.g., any of the dozens of campaigns found on a college campus each day).  While it’s hard to argue many of these organizations are successfully getting out their message and raising money to support efforts, are these campaigns good for their causes or more harmful?

Increased awareness certainly has many benefits, especially when taking a controversial or taboo issue and removing the stigma – think AIDS and cancer.  Awareness events are snappy and create a sense of urgency, developing a community that feels more comfortable sharing their issue and changing the cultural landscape.  But at the same time, short sound bites about a cause can distort the message.  Two examples are Prostate Cancer Awareness month, which encourages men to get their PSA screening even though there is evidence that the test is flawed and leadsto overtreatment, and Kony 2012, which got the public’s attention despite Joseph Kony being a marginalized political figure. 

Then there are the challenges that fundraising present.  Susan B. Komen is a great example of when monetary decisions compromise the integrity of the organization and lead topublic outrage.  At the same time, just because a non-profit or awareness campaign is fighting a good cause does not mean they are spending their money efficiently or that every dollar raised is going back to advancing the cause.

Am I against awareness campaigns?  No - I think they can be beneficial as long as they are part of a larger education campaign and don’t just rely on emotional pitches to rally support.  I also worry about having so many messages coming from so many different sources that they all lose their meaning and do not engage enough people.  My hope is that people enjoy events like Chicago Pride Parade or other health-related events, but continue to educate themselves about the cause long after the rainbow flags are removed from Broadway.  And, if these messages are becoming watered down or distorted, I hope organizations have the self-awareness and lack of pride to reallocate their resources elsewhere to achieve better results in another way.

What Does An All-Inclusive Resort Teach Us About The Healthcare System?

Several weeks ago, I visited an all-inclusive resort In the Caribbean.  While I should have been relaxing and disconnecting from work, my mind kept drifting back to how this model reflected the challenges of our current healthcare system:

1) Overuse of benefits: Anyone who has been to an all-inclusive resort or cruise knows that there is an endless supply of food.  I found myself grazing on snacks throughout the day and having multiple meals even if I didn't need more food.  Although those meals provided no additional benefit (and probably hurt me – did I really need that last plate of nachos?), I ate and drank because it was there and it was free.  Similarly, people with more generous insurance benefits may use more than their fair share of services, which is costly to the system and does not always mean better outcomes for the patient.

2) Subsidizing high cost consumers: Given that a lot of people were eating a lot of food, how do these resorts stay in business?  Serving low cost products is one answer, but they also benefit from the people who don’t consume as much.  These guests are far less costly, but still pay a similar, flat price, helping to subsidize the other guests.  Insurance companies do the same thing, offsetting older, sicker, more expensive patients by balancing their risk pool with younger, healthier, and cheaper consumers.

3) Misaligned incentives for healthy behavior: The resort also offered excursions like scuba diving and zip lining that sounded like a lot of fun.  These trips could have been the best part of our trip, but we chose not to participate.  Why?  It took extra effort to book the trips (we wanted to make as few decisions as possible), they weren't pushed aggressively by the resort (they were provided by other companies), and they cost extra money. 

The public makes similar calculations when deciding between healthy or less healthy behavior.  For example, cooking healthy (or cooking at all vs. going out to eat) requires planning, time that many people may not have or want to invest.  Health foods are also marketed far less aggressively than fast food and processed meals (especially to kids), meaning consumer awareness of their options may be lower.  Finally, anything “healthy” has a stigma (whether true or not) of being more expensive, which dissuades people from making these better decisions even if it’s better for them in the long run.

Interestingly, all of these issues are addressed in the Affordable Care Act (i.e., eliminates Cadillac plans, requires individual mandate to pay for higher risk individuals, allows for free preventative services).  I’m not advocating for or against healthcare reform, but I do think addressing those problems moves our healthcare system away from being a hedonist escape for a select few towards a more balanced, sustainable model.

How Can Facebook Use Its Resources To Improve Public Health?

This past month, the big news out of Silicon Valley was the Facebook IPO, when they agreed to trade more access to capital for more public responsibility and scrutiny.  While most of this responsibility is financial, it’s hard to ignore the opportunities to improve social welfare.  Given how much data they collect and how many people they influence, it’s fair to ask if they should use that information to benefit health causes.

Facebook has already taken a first step with their organ donor initiative, which gives users the ability to sign up to become a donor and share their decision online.  In the first day, state registries saw nearly 15 times more people enroll than on a typical day and over 33k new members registered in the first week.

While some people may question the effectiveness and ethics of this, I think it’s a good illustration of how massive tech companies such as Facebook and Google can use the core foundation of their products (users and data) to benefit healthcare.  Broader opportunities for Facebook may fall into a few categories:

1) Resource Portal: With a dizzying array of healthcare non-profits, for-profits, government agencies, and homegrown support groups, Facebook could act as a curator for indexing user resources.  While this idea is very Web 1.0, having a personal improvement / health portal could spark greater awareness by promoting these links rather than relying on users to find them using Facebook’s clunky search tool

2) Personal Data Management and Analysis: Given the wealth of user data, Facebook could act as an aggregator of personal health information and predict future outcomes.  Privacy concerns aside, algorithms could analyze changes in behaviors based on posts or user-generated data and provide advice if that person was looking to change health behavior.  Google tried to collect digital health records with Google Health, but it required active management by the user.  By making it passive (i.e., collecting data already entered into the system), Facebook could build a large user base that might gain traction

3) Engagement Support for Healthcare Companies: Facebook is just beginning to realize its potential as an effective outreach tool, but there are some basics that healthcare companies need to understand to be effective.  As a public service, Facebook could offer free courses on the best way to utilize their tools to more effectively engage users

Obviously there are concerns and issues with each of these ideas and a strong business case against pursuing them.  But as their influence and scope grows, and as the healthcare landscape evolves, it will become more critical to harness their product to influence health changes

Do Consumers Lose Out If Healthcare Companies Don’t Speak Plain English?

A recent article in BenefitsPro discusses how the current administration may reverse course on a popular provision in the Affordable Care Act. The requirement forces healthplans to simplify plan language and give examples of coverage options by this fall. I imagine this will resemble credit card offers that have a table highlighting key components (e.g., APR) and put everything into plain English.

However, insurance companies are pushing back, saying that this would be expensive – a trade group puts the cost at $382 million over the first two years. The author contends the White House may buckle under this pressure, hoping to appear business friendly heading into the November elections.

Overall, I disagree with the insurance trade group assessment. There will definitely be an upfront cost, but they don’t talk about the potential benefits from this transparency. For example, this education may allow the customer to choose a more efficient plan that puts limits on coverage or helps them understand those limits better, both of which help healthcare dollars be spent more efficiently and lower costs.

While I think transparency benefits the system by helping consumers make better decisions, my faith was shaken by a Freakonomics podcast that discussed financial literacy education. One of the guests argued against this (there’s a great debate in the middle of the podcast), saying that a little education…

1) …can give consumers overconfidence that leads to more reckless behavior – a healthcare analogy is a patient who visits a doctor armed with online research that complicates the diagnosis and treatment options

2) …shows no evidence of positive behavior change. She says that studies show people like learning about finance, but didn’t necessarily change their habits

3) …isn’t sufficient to address the complex financial products available - healthcare insurance definitely has a similar complexity

This isn’t a perfect comparison and educating people on their plan options, not how to use the plan, are two different processes. Nevertheless, while I support greater transparency and providing greater consumer choice, the outcome of this regulation, if it survives, could be a little more uncertain.

Do Studies Support Legislation To Reduce Childhood Obesity?

I recently ran across a couple interesting articles examining the relationship between junk food and childhood obesity, with implications on legislation. Somewhat surprising findings:

1) A study by the American Journal of Preventative Medicine found that fast food restaurants did not have the intended response to a ban on kid’s meal toys. The study was based in Santa Clarita, CA, the first city to pass this type of ordinance, and found that restaurants responded by eliminating the toys and promoting existing menu options rather than retooling meals to allow toys to remain on the menu. While there are a number of reasons to choose this strategy (e.g., long lead time to revamp menus, extra costs associated with toys), it demonstrates that the legislation failed to deliver more healthy meals. What will be interesting to see is the impact to sales and how much demand they toys accounted for.

2) Another recent study from Penn State took the blame for poor nutrition away from school and placed it on the home. The study showed that while access to junk food at schools rose between fifth and eighth grade, obesity rates among the students in the survey declined. This led the team to conclude that obesity was influenced less by school choices than by other factors. While this finding isn’t groundbreaking, it does bring into question investments being made to reduce junk food at schools and improve nutrition. If access at school has limited impact on obesity rates, would energy and resources be better spent on parent education and access to healthier foods at home?

You could argue these measures were successful because they eliminated a marketing gimmick targeted towards kids and reduced exposure to unhealthy foods. Some restaurants, potentially spurred by this type of legislation, are proactively taking new measures to improve kid’s meals (e.g., McDonalds will be automatically adding apples to Happy Meals starting in March). But these are great case studies on how legislation may not be an effective tool if businesses can work around the rules or the real issues are outside the scope of the law.

How Can Sex Games Lead To Safer Sex?

A recent ad campaign in Sweden managed to shatter a stigma by tapping into the male competitive spirit. To promote safe sex, an ad agency handed out 50k condoms, each with a QR code that installed an app to measure how good you are in bed. After instructing the user to put on the condom, the app measured various factors (e.g., sound, duration, rhythm), then uploaded the data to a central server. Users could then see their own performance and compare with others across the country.

You can call this crude or tacky (especially if you were an unwilling partner), but I think it’s brilliant. This ad agency was able to reach a captive audience by helping users to quantify something every guy wants to brag about, then giving them a semi-voyeuristic view into where they stack. Enabled by technology to collect and share this information, this campaign allowed the agency to attach a relevant message regarding safe sex and address a social issue.

Are there other groups of people or conditions that could benefit from a similar program? Could diabetics monitor how stable their glucose levels are then compare with other users? How about tracking Facebook or general computer usage to highlight behavior traits (e.g., user spends 30 mins per day updating statuses, 45 mins per day viewing friend profiles) and discourage people from spending so much time in front of the monitor?