Stonewall | LGBTQ+ Pride Turns 50 — And the World Comes Together

When I was judging the ANA International ECHO Awards last year, many of my judging colleagues saw this data-inspired Destination Pride campaign from PFLAG Canada.

When I came to New York in the 1980s, working as a media relations manager at the Direct Marketing Association, the city was a very different place than it is today.

New York was crawling out of bankruptcy, awash with graffiti, litter and crime, and thousands of people dying from a virus which our president barely would mention. ACT UP  AIDS Coalition to Unleash Power, Gay Men’s Health Crisis, American Foundation for AIDS Research, God’s Love We Deliver, Housing Works  this was the new “industry” that rose up in New York (and elsewhere) to find a way to halt a crisis that was robbing the world of bright, young minds  people from all walks of life.

Straight or gay, we were all running and hiding from a virus … in advertising, in media, in fashion, in the arts, in finance, and so on. It didn’t matter who you were  it could find you, and you’d probably die. My own Stonewall was not a riot in Greenwich Village in 1969, it was joining the fight against AIDS 20 years later, and a fight for those who were afflicted, marginalized, and isolated as pariahs.

Welcome to New York From Thousands of People I Never Got to Know

One of my first experiences upon moving to New York was giving food to and hugging a homeless man outside McDonald’s on Third Avenue. He was covered with lesions of Kaposi’s sarcoma, a manifestation of AIDS. He said, through crying eyes, that I was the first person to have touched him in two years. He was so frail, but his hug was so strong. I know he probably did not live long thereafter. I cry for him, even today, as I recall this happening. I wonder, too, about all the thousands like him, whose contributions we’ve been denied ever to know.

This fight against AIDS must continue today  a cure must be achieved. Thankfully, drug treatments have emerged to help those who have HIV infection, to become undetectable, or to prevent infection altogether, but these therapies are expensive and research toward better treatments, and a cure, must be funded. For those who become HIV+, it may no longer be a death sentence, but I’m certain it’s still no picnic. There are too many population segments living outside affordable, accessible, quality health care.

Pride and the Pursuit of Happiness

Through all this, I came to New York City because it represented a place where all of the world’s individuals could be who they are  no matter who you are and the city fosters such individualism, collectively. Stonewall, having claim to the birth of our modern gay rights’ movement, was part of this allure. Growing up in small-town America, I loved small-town values, but I could barely find myself thriving in the restrictions, expectations, and judgments that served, in my mind, to repress my own freedom-loving path and pursuit of happiness. New York would be my catalyst. In fact, New York even as a global city is, to me, a quintessentially American city where life, liberty and the pursuit of happiness can be very hard, but well worth the reward.

In 1994 on the 25th Anniversary of Stonewall I marched down Fifth Avenue, with people from all over the world who gathered to show our pride.

Twenty-five years on, we are prouder still. In 2019, I’m going to march again in New York  this time on the 50th Anniversary of the Stonewall Riots. I march for me, liberated, yes and for all of those who live still in repression, who are denied equal access under the law, and who are hated, harmed, or ignored, simply because of whom they choose to love. World Pride is a celebration of boundless, limitless love but also a love with responsibility toward ourselves and each other. Love respects. Love is compassionate.

Plan Your Travel Accordingly: Love and Education in a Campaign

When I was judging the ANA International ECHO Awards last year an extremely rewarding experience that I’m hopeful you choose to make happen for yourself this year many of my judging colleagues saw this data-inspired Destination Pride campaign from PFLAG Canada (agency FCB/Six, Toronto):

The Association of National Advertisers just posted this updated commentary about the campaign on its own site and YouTube Channel.

This campaign earned a GOLD ECHO, among many other advertising honors. The campaign shows how technology, data and creativity came together to truly help make the world more safe, tolerant and enjoyable for everyone, providing global destinations with a LGBTQ+ friendliness score. (New York City scores a 72 with room for improvement. How is your city doing?)

I’m hopeful to see more such innovative, provocative, and engaging ECHO entries this year. Great work toward positive business and social outcomes matter.

Stonewall50 | World Pride, march on!

From ACA to Medicare: 5 Answers to Healthcare Marketers’ Legal Questions About Insurance

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

In the spring of 2010, healthcare marketers saw the Patient Protection and Affordable Care Act (ACA), nicknamed ObamaCare, become law. It was the largest expansion of health insurance coverage since the establishment of Medicare and Medicaid in 1965. More than 50 years have passed since healthcare became more accessible, yet it remains a fiercely debated topic among politicians and is now the No. 1 concern among voters, according to a new poll from RealClear Opinion Research.

The tug-of-war between those who view healthcare as a guaranteed right and those who believe the government should have a minimal role is shaping up to be a driving force in the 2020 election. The processes used to “right-size” the government’s role shows we remain deeply conflicted. Court cases in different jurisdictions return victories and defeats to both sides. Voters generally approve Medicaid expansion when it’s on a state ballot, but elect federal representatives with divergent views. Why is this still so complicated?

The U.S., which has the world’s most powerful armed forces, spends 3.6% of its gross domestic product (GDP) on the military. Contrast that with the 18% of GDP spent on healthcare, and you start to get a sense of the scale of the industry and the Rubik’s Cube nature of how its pieces depend on each other. Those who view healthcare as a matter of seeing the doctor when you are sick tend to see the upside in expanding coverage. Those who think of it in economic terms tend to worry about potential disruption to jobs, given that healthcare is the largest source of employment in many towns. And those who view it as a commodity tend to think the marketplace should be left alone to sort it out.

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

  • The ACA (today’s status quo): For Americans who do not receive health insurance through their employer, the ACA removed restrictions on individual policies, such as exclusions for pre-existing conditions, lifetime limitations on benefits, and widely divergent premiums based on your health. Of course, the ACA also set up online exchanges where you could see if you qualify for certain subsidies to help you purchase different levels of gold, silver, or bronze coverage. Some people objected to the “individual mandate” that penalized taxpayers as a means of encouraging them to get coverage. Since its passage, the penalty for the mandate has been reduced to $0.
  • Single-Payer: Single-payer refers to the federal government reimbursing physicians and hospitals for services provided to patients, but doesn’t explicitly tie the reimbursement amounts to those of an existing program, such as Medicare or Medicaid. The uncertainty creates financial uncertainty for providers. Single-payer would, for the most part, eliminate the role of health insurance companies, which advocates believe would save money on administrative “waste” and opponents see as removing choice from the marketplace. Consumers who have “skimpy” health coverage might have more services covered under single payer, while those with richer benefits through commercial insurance might have fewer services covered.
  • Medicare-for-All (multiple flavors): Medicare-for-All is an expansion of an existing federal program accepted by almost all providers. Several proposals generally fall under the “Medicare for All” moniker, making it more complex to sort out. The name gives the impression the covered benefits would be similar to original Medicare parts A&B, but most proposals envision benefits like those available through Medicare Advantage, with benefits for vision, dental, and prescription drugs. Some proposals use traditional Medicare as a starting point for calculating reimbursements, while others use a more ambitious “global payments” approach for hospitals and standard rates for other types of providers. Consumers could purchase supplemental insurance to access services that are not covered. There would be no monthly premiums because tax revenues would cover costs. Medicare, Medicaid, and CHIP would be discontinued in favor of Medicare-for-All.
  • Medicare Buy-in: Medicare Buy-in is a smaller expansion of Medicare than envisioned under Medicare-for-All. This proposal would allow people 50 years old and over to pay a premium for the coverage provided under traditional Medicare or Medicare Advantage. The buy-in premium would be expected to cover 100% of administrative and benefit costs, although the enrollee may qualify for subsidies that bring down monthly premiums. Consumers could also purchase supplemental coverage, preserving a role for commercial insurance companies for that segment, as well as for younger consumers. Reimbursement rates for providers would mimic Medicare payment rates.
  • Universal Coverage: This is a goal rather than a pre-defined approach. As the name implies, Universal Coverage means everyone has access to healthcare, but it does not necessarily mean all services would be covered and it does not specify which of the above methods would be used to achieve it. In some countries, Universal Coverage also means that the government would control pricing, which critics say leads to an overall decline in the quality of care and advocates view as being more socially equitable.

As the debate over healthcare heats up — yet again — it may produce confusion and fear among people who have come to depend on specific programs, even if those programs have well-known flaws. Real change isn’t likely until after the 2020 elections, and the direction of that change will depend on who voters send to D.C. to represent them. In the meantime, be prepared to answer a lot of questions from worried patients.

A Few Thoughts on Healthcare Marketing Amid Neverending Brand Crises

Today’s news cycle operates at breathtaking speed. Headline after headline shoves its way into the spotlight and then is forgotten almost as quickly. So what does it mean for healthcare marketing when every refresh of the web browser seems to include another story related to healthcare?

Today’s news cycle operates at breathtaking speed. Headline after headline shoves its way into the spotlight and then is forgotten almost as quickly. So what does it mean for healthcare marketing when every refresh of the web browser seems to include another story related to healthcare?

Poor healthcare access. Astronomical health insurance premiums. Surprise bills.Medicare for All. Single Payer. Universal coverage. The list of healthcare grievances and proposed solutions goes on and on. The near-constant presence of these stories indicates a level of societal frustration that should worry all of us who work in healthcare.

Pick any one of these stories, and we can explain it. Poor healthcare access? Well, it’s related to a bottleneck in residency programs, a growing shortage of licensed providers and low reimbursements. Unaffordable health insurance premiums? That’s because the cost of covered services is high and demographic trends are driving more consumption. Medicare for All? Don’t you know that would result in hospital closures and massive layoffs? Each well-reasoned explanation becomes another brick in the wall.

healthcare marketing image
Credit: Getty Images by Jeffrey Hamilton

The seemingly unsolvable complexity of healthcare creates an atmosphere in which incremental improvements are unsatisfying, and Hail Mary visions of massive reform start becoming more palatable. That’s a risky spot to be in for an industry that dislikes market uncertainty. Industries that remain tone deaf to societal pressures become targets for disruptors. It’s starting to happen in healthcare around the edges, where the barriers to entry are lower, such as primary care and telehealth. Meanwhile, established players pursue vertical and horizontal mergers to keep patient volume in their delivery systems, which doesn’t address the underlying affordability and access challenges driving public discontentment.

As marketers, it’s important to understand and respond to the changing competitive environment. As communicators, we respond to media inquiries and help people navigate our systems. Let’s also remember that our scope of responsibilities includes raising difficult conversations about external perceptions with internal stakeholders. Without that ongoing engagement and a willingness to try new things, we may reach a point where the “system” is transformed around us through legislative action or competitive disruption.

Solving the Puzzle of a Medicare Age-in Strategy

As Medicare acquisition marketing gets harder, the next frontier will evolve. In this next stage, growth strategies are likely to swap to more of a robust age-in strategy. Getting the age-in year “right” relies not only on a tightly managed communication plan but also the content to support it.

As the Medicare marketing landscape has changed, we have seen the rate of Medicare eligible consumers who switch plans drop, and then plateau. In this next frontier, growth strategies are likely to swap to more of a robust age-in strategy, preparing those coming up on their Medicare eligibility for the process of selecting the best plan for them.

The journey that consumers take during their 64th year as they navigate their choices opens up some exciting possibilities. They’ll be choosing between Medicare Advantage, Original Medicare and other options. And healthcare marketers will be navigating:

• A wide open calendar – the Initial Enrollment period lasts seven months. A plan for communication to your age-in prospect pool as they age-in will be custom to their timeline.

A wide open media frontier – with an audience that engaged in a variety of media channels. In fact, in the U.S., there are more Facebook users from the 65 and above age group than those in the 13- to 17-year-old group.

• The potential for scale with age-in that comes with the influx of boomer population.

As exciting as the opportunity is, being there for the age-in “when” is also complex. But mainly from the perspective of doing so efficiently. Think about it, over the span of a year, consumers will choose their point of entry. Getting this “right” relies on a tightly managed communication plan and the content to support it.

The age-in timeline will need to support:

  • Awareness – Trying reaching out to the audience early, this way you’ll inspire confidence and make it easier to engage. Starting early will ensure you are part of the consideration set.
  • Engagement – Try to connect their planning process to your brand by engaging in a dialogue. And then tailor your approach. You’ll want to have the content available to satisfy the research needs of your audience.
  • Conversion – If you’ve done all of these things well, you’ll be in the position to support the really good stuff – the shopping!

That’s a lot! And determining the right amount of touches is daunting! That’s why we recommend investing in a data environment to help you make sense of the situation.

Your age-in data environment should enable:

  • Clarity – aggregate all relevant prospect and customer-level activities into one analyzable and consistent source.
  • Accurate reporting – drive accurate and timely reporting from your offline and online marketing spend and efforts
  • Deep insights – build a foundation for discovering marketing insights based on real world customer interactions.

A data environment will give you the confidence you need to make decisions and be in control of the situation. Then you’ll be able to set up all of the nifty content you need for success!

Open Enrollment and the Reluctant Health Insurance Shopper

Many industries have seasonal patterns. If you are a marketer, you know the ebbs and flows of your industry and invest in a significant marketing presence during the peak season. In healthcare, the major season is “Open Enrollment.” From now through mid-December, consumers will see a surge in ads for medical groups, hospitals and health plans. Is it worth it?

Many industries have seasonal patterns. If you are a marketer, you know the ebbs and flows of your industry and invest in a significant marketing presence during the peak season. In healthcare, the major season is “Open Enrollment.” From now through mid-December, consumers will see a surge in ads for medical groups, hospitals and health plans. Is it worth it?

It should be. Open enrollment consists of three overlapping windows of opportunity:

  • Consumers who get health insurance through their employer will have an opportunity this fall to renew or change their coverage for 2019. This selection period, depending on your company, may begin in late August and usually wraps up by Thanksgiving.
  • Seniors who have Medicare Advantage or traditional Medicare can change plans during a window of time specified by the federal government. The open enrollment period is October 15 — December 7, 2018, for coverage changes that take effect January 1, 2019.
  • For consumers who purchase coverage through one of the exchanges, open enrollment starts on November 1. Those who use the federal exchange, Healthcare.gov, have a deadline of December 15, while some state exchanges have later deadlines.

That means most adults in the U.S. who have health insurance can evaluate their options and potentially make a switch this fall. So it is the peak enrollment season not only for health plans but also for the hospital networks and medical groups that want to persuade you to have them ‘in network.’

The problem is that that most people do not want to engage in comparison shopping for health insurance. In fact, a higher percentage of people will compare and switch auto insurance coverage than health insurance coverage — even though they spend far more on health insurance annually[i].

About 85% of people will just let their current coverage renew. At many companies, the percentage of roll-overs is much higher. Why? In general, people view open enrollment selections as complicated and likely avoid reconsidering options they may not fully understand. Knowledge of health insurance terminology varies. And people have difficulty evaluating the trade-offs between premium and deductible amounts in the context of their tolerance of financial risk. As a result, the comparison shopping behavior so common in other types of considered purchases is less pronounced when it comes to making healthcare-related purchases.

So is investing in open enrollment marketing worth it? It depends. Your competitors are pouring money into the market this time of year, as are other seasonal advertisers for elections, new automotive models, holiday decor and gift-giving. Rates for traditional and online paid media will climb significantly.

Healthcare requires both upstream marketing as well as direct-to-consumer seasonal marketing to convert prospects. The success of open enrollment depends on the efforts you have undertaken in the months leading up to peak season. If your conversion elements are not in place — effective online targeting, an easy to navigate website, a trained customer service team and a significant ground game — then you may be paying a premium that will make your return on investment metrics look even worse.

Note: [i] In 2014, 39% of auto insurance customers compared coverage and 29% switched carriers as a result, according to J.D. Power. That same year, only 15.8% of commercially insured adults who retained coverage made any sort of switch for all reasons (5% switching products within a carrier; 10% switched carriers; 2.5% dropped coverage), according to ACAView. That year the average annual cost of car insurance paid was $907.38 in 2014 according to Quadrant Information Services. The average annual contributions for health insurance for a single adult totaled $6,025, according to Kaiser Family Foundation

Addressing Unspoken Fear in Healthcare Marketing

There’s a lot of fear in healthcare marketing — the unspoken fears that lurk in the minds of consumers, blocking their ability to absorb your content. Marketers who don’t address these nagging worries in the conversion funnel risk turning off prospects who are otherwise excellent candidates for that service line.

Healthcare Marketing Strategy
Credit: Pixabay by Gerd Altmann

There’s a lot of fear in healthcare marketing. I’m referring to unspoken fears that lurk in the minds of consumers, blocking their ability to absorb your content. Marketers who don’t address these nagging worries in the conversion funnel risk turning off prospects who are otherwise excellent candidates for that service line.

Fear is a funny thing. A little of it keeps you alert and causes you to be more careful. Too much fear and you cognitively shut down. The difference — in the first scenario you believe you can do something to minimize the danger, while in the other scenario you don’t know of a solution and you feel paralyzed.

Imagine marketing a service line for a serious health condition. Your reader may have insurance, but there’s a negative inner dialogue unfolding in his mind: “I will miss work. If I miss too much work, I might lose my job. If I lose my job, I won’t have life or health insurance. If I don’t have insurance or a job, I could bankrupt my family. They would end up with nothing.”

The prospect has catastrophized a possible outcome and now wants to avoid your messaging entirely out of both fear and guilt. And because these internal monologues are unspoken, it’s very difficult to get the kind of feedback that enables you to make improvements. If you have service line campaigns that are not performing, ask yourself if fear might be getting in the way and how you can break down those barriers to conversion.

You can address unspoken fears at several places along the funnel, starting right at the top and adding more detail along the consumer journey:

  • At the top of the funnel, consider adding a truthful, positive indicator into your outbound messaging that contrasts today’s treatment with what was available years ago. Advances in knowledge, techniques, and technology can help a fearful consumer move beyond legacy emotional assumptions and create a narrow window of reconsideration.
  • On your campaign page, proactively address common concerns while also streamlining navigational flow to your call-to-action. A generic FAQ link may be too subtle for consumers with nagging worries. Consider clearly labeled links such as “Time away from work,” “Insurance accepted,” “How outcomes have changed,” “Managing out-of-pocket costs” or similar topic-specific labels. Each item or grouping should conclude with your CTA.
  • System-generated emails triggered by user submissions as well as nurture campaigns should include links to content that normalizes typical concerns and provides reassurance that these can be discussed comfortably at the appointment. Some patient no-shows are caused by nagging worries that cause people to disengage even before an in-person consultation.
  • Consider adding a simple form at check-in that asks about the patient’s concerns and provides pre-populated topics to select. Patients can become surprisingly quiet when the doctor enters the room. If the provider knows what topics are weighing on the patient’s mind, the dialogue can be more meaningful and a foundation of trust developed.

And throughout this process, work with your organization’s best-performing providers as well as financial counselors, patient navigators, social workers and philanthropic foundation for insights that help improve responses to common patient concerns.

The Upstream Healthcare Audience Puzzle

In healthcare marketing, it’s often assumed high-visibility, consumer-facing communications are the primary areas of focus. But the healthcare ecosystem is complex, and there are multiple upstream influencers who determine the total number of consumers eligible to come to your hospital or physician network for treatment.

In healthcare marketing, it’s often assumed high-visibility, consumer-facing communications are the primary areas of focus. After all, the response rates to these campaigns drive the Return on Investment (ROI) metrics shown in quarterly reports. But the healthcare ecosystem is complex and there are multiple upstream healthcare influencers who determine the total number of consumers eligible to come to your hospital or physician network for treatment.

Changes in influencer priorities or relationships can dramatically decrease or increase your pool of commercially insured prospects. So, a strategic approach to marketing requires being mindful of these upstream stakeholders, crafting aligned audience-based messages and conducting focused outreach that keeps your brand as a ‘must have’ in their decision-making.

Where Upstream Healthcare Influencers Come Into Play

For example, let’s say there’s a long-established manufacturer in your market with 500 employees. It’s considered one of the best places to work because of advancement opportunities and good pay, so people stay a long time. Because of that, the workforce’s average age has drifted up into the 40s. Some still use maternity services, but the claims history now includes more high blood pressure related encounters, hip/knee replacements and oncology care.

The cost of claims to the insurer rises to over 85 percent of total premiums paid by employer and employee. Months ahead of open enrollment, the insurer proposes a significant rate increase to the broker the company has relied upon for years. The company’s CFO strenuously objects because the increase would squeeze its margins, forcing it to raise its own prices or cuts costs elsewhere.

The haggling between employer, broker and health plan begins in earnest and trade-offs are explored. These usually involve changing benefit structures, but in some situations, the manufacturer will change insurers completely or move to a narrow network product.

If your doctors and hospitals are ‘high performing’ and remain in-network, this can be a growth opportunity. For everyone else, that workforce and all those dependents just became unpersuadable through consumer advertising — they simply won’t pay out-of-network rates to come to you.

I’ve seen these volume shifts undo the progress made through consumer-directed outreach.

How do your physicians, hospitals — and your marketing — influence this chain of events?

Yes, much of it is based on hard data about per-encounter costs, clinical quality, chronic illness management and readmission rates, but negotiations also have a perceptual side. What’s the awareness and perception of your organization among these influencers?

Here’s where a marketer’s expertise can help:

Existing Patients/Members

Help your organization achieve quality and patient engagement goals by using your knowledge of persuasive techniques to improve shared-decision making efforts. According to Health Affairs, patients who are not engaged in their care incur costs up to 21 percent higher than patients who are very engaged.

Additionally, even small improvements in medication adherence, appropriate use of the Emergency Department, handwashing and post discharge follow-up appointments with Primary Care Physicians can pay off noticeably in quality and cost metrics.

A marketer’s understanding of patient experience mapping, consumer psychology and communications tone can support patient and staff engagement efforts. Touch base with clinical and case management leaders and offer your help.

Employers

In the U.S, half of health insurance coverage comes through employer-sponsored plans. The yearly determination about benefits is a serious discussion that involves human resources/benefits, as well as finance/administration.

Direct Marketing: An Rx for Medication Non-Adherence, Part 2

Last month, I wrote about the fact that regardless of the condition for which a medication is prescribed, after three to four months, only about 40 to 50 percent of the people prescribed long-term medications are still taking them. Controlled testing has shown that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent. So why aren’t these techniques used more often?

healthcare marketing[Editor’s note: In a related matter, healthcare marketers are invited to discuss matters like these on June 15 at the Target Marketing Healthcare Roundtable. This link allows marketers to register.]

Last month, I wrote about the fact that regardless of the condition for which a medication is prescribed, after three to four months, only about 40 to 50 percent of the people prescribed long-term medications are still taking them. Controlled testing has shown that direct marketing techniques can improve patient adherence with medications by 20 to 25 percent. So why aren’t these techniques used more often?

One of the biggest barriers to creating effective patient intervention programs is the speed with which they have to be implemented. Keep in mind that 20 to 30 percent of prescriptions are never filled, and 40 to 50 percent are not taken as prescribed, according to the National Council on Patient Information and Education. (Opens as a PDF) As a result, the closer to the point of prescribing that patient interventions begin, the more successful they will be. If the interventions don’t start until three months after a prescription is written, a significant portion of the patient population is already gone, and the patients who remain are those who are likely to remain persistent, anyway.

There are several reasons why people don’t take their medication as prescribed, but most important among them is the fact that people often do not understand why they are taking a particular medication or how long they’re supposed to take it.

Educating patients about how their medication works in simple language can go a long way to helping them realize how and why to take it. And while there are various stakeholders who can benefit from increased adherence, each has their own particular barriers to creating an effective program.

First, there are the pharmaceutical manufacturers. They’re constrained by the FDA regarding what they can say to the patient, not allowed to stray from the language in their approved labeling. Frequently, this constraint ends up with patients getting communications in language that they can’t understand. Additionally, brand managers may be reluctant to spend money from this year’s promotional budget to affect potential sales increases in future periods when they may have moved on to another assignment.

Pharmacies could potentially benefit from increased adherence; however, their margins on prescription drugs are too low to devote the resources necessary to deploy an effective patient education program. Their efforts are largely limited to refill reminders, which are not effective in increasing persistency. Forgetfulness affects compliance (taking medication as directed), but persistency (continuing to take medication over time) is driven more by the psychological factors I addressed last month.

Healthcare providers are constrained by the amount of time they have to spend with a patient and by the fact that the patients generally forget most of what they’re told during their 10 minutes with the provider before they even leave the office.

Those who have the most to gain are the insurers, the ones who pay the healthcare bills. Apart from the patients, these payers have the highest stakes in the game. Convincing a patient to take cholesterol and blood pressure medications is a lot cheaper that paying for the hospitalization costs associated with a cardiac event. And while the insurer, (for example, Aetna) may know that a patient was diagnosed with a particular condition, it’s the PBM, pharmacy benefits manager, (for example, Express Scripts) who knows if a medication was dispensed and when. These are important data points for creating effective patient interventions, because the sooner you get to the patients, the more patients you can affect. But the PBM can’t account for the 20 to 30 percent of prescriptions that are written and never filled.

The most effective interventions start with incenting patients at the time that their initial prescription is written: specifically, giving them a free initial supply of medication for providing their contact information. That data capture lays the groundwork for early intervention. From there, a data sharing partnership between the payers and the PBMs can provide the information to get the appropriate communications to patients at the right times. This type of partnership is a tall order, but as the New York Times reported in April — citing a study in the Annals of Internal Medicine:

“This lack of adherence, the Annals authors wrote, is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.” (Opens as a PDF)

The various stakeholders need to come together to improve this situation.