Wednesday, October 2, 2013
Long lines online for health insurance
by Matthew Arnold, Principal Analyst
So much for the soft launch. The Affordable Care Act’s health insurance exchanges opened yesterday, and demand promptly crashed Healthcare.gov as the site saw more than a million visitors before 7 a.m., according to President Obama, who added that that’s five times more visitors than Medicare.gov has ever seen at one time.
“That gives you a sense of how important this is to millions of people around the country,” said the Navigator-in-Chief in a Rose Garden speech imploring the uninsured to visit the site, where “you can compare insurance plans side by side, the same as you’d shop for a plane ticket on Kayak or a TV on Amazon.”
The president noted that even Apple had to squash some bugs after last week’s iPhone updates, though it seems like HHS wasn’t expecting an Apple Store-on-release-day-style crush of insurance-seekers. Sites for some state-run exchanges went down, too.
Friday, September 27, 2013
Medicaid and the ACA’s opportunity cost for pharmas
by Matthew Arnold, Principal Analyst
The Affordable Care Act’s insurance exchanges open in a few days, and the insurance provisions of the law take effect in a few months. Regardless of the last-minute political shenanigans, this thing is happening.
So how’s it looking for pharmas? Well, the logic behind the industry’s buy-in to healthcare reform was that as an estimated 30 million uninsured Americans come in from the cold, enough of them would get branded drugs and biologics to more than make up for the steep discounts the industry promised to federal programs. Also, it would go a long ways toward solving the nation’s crisis of uninsured (and therefore undertreated and undermedicated) individuals.
But that number – 30 million uninsured, brought into the healthcare system – figured prominently in calculations as industry leaders performed their cost-benefit analyses and elected to buy an almost-$100 billion seat at the negotiation table.
There are many shoes yet to drop here – will the exchanges work? Will any of the healthy Young Invincibles sign up to offset the sick and the not-quite-old-enough-for-Medicare-or-poor-enough-for-Medicaids? Will all of the highest users enlist en masse, sending premiums through the roof? But one thing’s for sure – and here’s where we come back to politics – we’re unlikely to hit that 30 million number anytime soon.
A few of the week’s more memorable reads:
- The FDA finally finalized guidance for regulated mobile medical apps, limiting its purview to those apps that either facilitate a regulated medical device or turn a smartphone or tablet into a regulated medical device – in short, those apps which, if buggy or ill-designed – can hurt you.
- Pfizer is giving video detailing another go in the UK with Pfizerline, a service that lets docs book time with reps for remote details.
- So, how are those Medicare ACOs doing? Early indications aren’t super-positive.
- UNAIDS says “treatment as prevention” – getting HIV drugs into the hands of 10 million people in low-to-middle income countries – has sharply curbed new infections over the past decade, with new infections among children are down 52% since 2001. Now the goal is to get ARV meds to 15 million patients in those countries by 2015.
- The insurance exchanges soft-launch next week, and a number of sizable companies are dropping the low-end, bare-bones “mini-med” plans they offer employees and sending them to the exchanges instead. That will mean greater scale for the exchanges and, for those employees on the low end of the pay scale, low-to-no increase in premiums – but it calls into question the future of employer-based health insurance.
- The Affordable Care Act: Huge and hugely glitchy. But also kittenish. This latest demonstration of the Obama Administration’s digital marketing chops might not bring “Young Invincibles” into the exchanges in droves, thereby preventing an adverse-selection death spiral, but hey, it’s worth a try.
Friday, September 20, 2013
Interesting things we read this week:
Epic, the EHR giant, announced an open API for developers looking to plug personal health data from trackers and monitoring devices into its system. While the breadth of the move is unclear, it’s an intriguing bit of Glasnost from a vendor not known for its openness.
What the heck is Calico, the Google’s death-killing venture headed by former Genentech CEO/current Apple board chair Art Levinson? Well, according to Levinson, the company will act more like an institute, funding basic research into the mechanisms of aging, than a pharma.
Taking on dengue fever with an app, Google Maps and smartphones in Pakistan.
Emerging markets are proving less of an easy-peasy revenue stream than some of the rhetoric out of the industry might have suggested in recent years.
Americans are totally confused and anxious about the ACA. Not news, exactly, but there’s some good insight here into what they’re confused about and why they’re skeptical of it.
Epic opens up
by Matthew Arnold, Principal Analyst
Epic this week posted a microsite announcing – in typically brisk form – that it would open up its system to developers in order to accommodate and render usable the coming flood of data from fitness trackers and personal health monitoring devices. As the EHR giant put it:
Do you make a personal health monitoring device with data to share?
With open.epic, we’re helping incorporate personal tracking data with clinical records to drive better care. Here, developers will find the APIs, sample code, and implementation guides to put that data in the hands of clinicians. Together, we can create the connections to put this data to work
Friday, September 13, 2013
A few interesting things we read this week:
Video games can be used to improve brain function. Good news for mouse potatoes – and for pharmas mulling pill-plus bolt-ons.
Wired profiles health startups, looking at a couple of clusters of hopefuls offering services to employers on the one hand and to group practices and hospitals on the other, and ties their emergence to the changes wrought by the ACA.
Novo Nordisk is looking to talk to women over 50 about vaginal dryness through a social media campaign featuring blogging eminences and dubbed Great Life After Menopause.
Why some hospitals shun the big vendors in favor of a painstaking DIY approach.
What does Apple’s iPhone motion sensor chip mean for wearables? Do they go the way of the market for low-end point-and-shoot cameras after the advent of the original iPhone? So far, they’re playing it pretty nonchalant.
Monday, August 26, 2013
Pharma’s opportunity to improve the patient experience through decision support
By Rory Stanton, Consumer Analyst
One of the topics we’re digging into here at Manhattan Research is decision support. Though the internet is a go-to option for most US consumers for health information, there are many hurdles to accessing the right information to help consumers make decisions about their health. In fact, only 55% of online consumers reported that they can find all the health and medical information that they need on the Internet. The flood of health apps, websites, portals, health communities, and health news sites has created a bit of “information overload”, and patients need decision support tools to help determine what all this information means in the context of improving and managing their own health.
Some of the key things we’re seeing in this space:
- Decision Aids: Because healthcare models are changing and patients have less time in front of a physician, they have less time to discuss options, risks, and whether or not to elect certain treatments. Pharma can help consumers speed up the decision making process in a number of ways. A recent JAMA study demonstrated the influence of decision aids on improving participants’ informed decision making and decisional satisfaction.
For example, take Janssen’s Hep C tool. Janssen breaks down dense content into discreet, digestible components for consumers with which to take action. They’ve also used multiple mediums for content to keep it engaging and enjoyable. There’s a video component for patients to relate to another patient’s story, condition education component (with options to deliberate, factors that affect your choice, explanation of side effects), and an opportunity to participate in the Hep C community with interactive “promise” tiles that are embedded in the background of the home page.
- The use of interactive video in consumer advertising: Pharma can experiment with interactive communication to allow consumers to experience brand content in a very personalized way. Interactive video companies like Interlude and Jelly Vision allow consumers to partake in the ad or content they’re experiencing by allowing viewers to select one of two options at various points in the video ad. In this way, the brand serves up content that is relevant to only the user’s unique needs.
- Web-design that takes the guesswork out website navigation: Consumer traffic to pharmaceutical corporate websites is low because usability is typically low. Product websites are fraught with too many navigational choices on the home page for consumers to be able to digest the information when they need it. Offering too many decisions on what to view next on one page paralyzes patients and stands in the way of their main objective: to get the information they need to make informed decisions. The experience of guiding patients through critical decision points for those who arrive on pharmaceutical corporate websites or product pages will be paramount.
Clarifying the many decisional conflicts experienced by consumers is important for the success of the next crop of drugs from Big Pharma. Keep an eye out for more work in this area next quarter.
Monday, August 19, 2013
EHRs are a heavy lift for physicians
by Matthew Arnold, Principal Analyst
Electronic Health Record vendor Athenahealth’s annual Physician Sentiment Index found, doubtless to their disappointment (but probably to no one’s surprise), that most doctors feel the financial costs of EHR outweigh their benefits to patient health.
The survey of 1,200 ePocrates docs did find that more than two-thirds have a positive view of EHRs, and that they’re getting more comfortable with billing, payers, meaningful use and ACOs. But while more than two-thirds say patient health will benefit from EHRs, 45% said benefits do not outweigh costs – up from 40% last year – and 51% said the financial benefits fail to outweigh the costs.
EHRs, as we found with the Taking the Pulse® U.S. 2013 study, are a disruptive technology, and physicians are now spending several hours tethered to them each working day (2.7 hours, on average – more for those in group practices and hospitals). This shift is impacting everything from how physicians access digital resources to their interactions with patients.
As we put it in our U.S. Physician Market Trends report, “Even as they trade in the mountains of paperwork required to run a solo practice for larger practices, they’re spending more and more of their day in Electronic Health Records to meet the Meaningful Use provisions of the HITECH Act. Next year, they’ll have to master a new set of ICD codes. Their authority over prescribing decisions is increasingly trumped by the formularies of those ACOs, hospitals and managed care organizations.”
So it’s not a shocker that they’re less than thrilled with these changes to their practices, and it’s encouraging that Athenahealth found signs of acclimation to this new world physicians find themselves in.
Friday, August 2, 2013
The telehealth horizon
Manhattan Research analysts Shawn Dimantha and Rory Stanton attended the mHealth + Telehealth World Congress 2013 conference last week in Boston, and Shawn spoke on virtual care models the second day. What follows is the second installment in a two-part conversation Shawn and Rory had reflecting on the conference.
mHealth + Telehealth World Congress Day 2:
Rory Stanton: So we kicked off the day with your panel on clinical and business validation of virtual care models.
Shawn Dimantha: Yeah, it was great to get the consumer/connected health perspective from the other analysts. One of the more interesting points was that awareness of virtual care models like video consults is low, but those who are aware have a high usage. I think one of the challenges is defining what exactly virtual care models are — these models encompass everything from electronic self-tracking to remote patient monitoring to telehealth. We all talked about the drivers of and barriers to adoption of virtual care models.
However, I tried to also focus on the healthcare professional side of the equation, namely physicians and nurses, because they are often the key enablers of these technologies. I talked from recent personal experience, as I was in the midst of battling a cold that I am thankfully now over! As for my own talk, I think Beth Walsh over at Clinical Innovation+Technology gave a great overview in her article on the panel. I had a lot of great feedback from attendees — I intended to humanize and personalize virtual care models with my own story, and to emphasize that behind all the technology are the people and the relationships that tie them together. Technology is only a solution so long as it reflects and complements the underlying systems of care that already exist.
Talking telehealth and mobile health
Manhattan Research analysts Shawn Dimantha and Rory Stanton attended the mHealth + Telehealth World Congress 2013 conference last week in Boston, and Shawn spoke on virtual care models the second day. What follows is the first installment of a two-part conversation Shawn and Rory had reflecting on the conference.
mHealth + Telehealth World Congress Day 1:
Shawn Dimantha: I missed Day 1, because I was under the weather, but I heard that Philip Fasano of Kaiser had a great talk.
Rory Stanton: Phil Fasano, the CIO of Kaiser Permanente, discussed Kaiser’s transformation into a completely paperless organization over the past 6 years through the use of EMRs and carefully coordinated change management efforts. Today, all 9 million members of Kaiser Permanente have an EMR and Kaiser’s 37 hospitals are functionally paperless.