The Truth Is Out There –Are You?

by Laurie Gelb, July 28, 2010

Health care surveys still ask “analog questions” in a digital world, limiting the impact of disease management, marketing initiatives and even transactional communiqués like EOBs. Besides evoking “socially acceptable” responses (who wouldn’t want to be healthily skeptical and savvy, unless you wanted to be stubborn and oppositional?), surveys in 2010 often still rest on “service as product” and “product = attribute bundle” paradigms, which apply poorly to medicine.

As interventions move into the social and mobile media, the risk of pouring more money and brand equity into misguided action increases. In fact, adding to “stimulus overload” can hasten patient and caregiver denial, apathy, fatalism, overkill – and it’s ever-easier to tell everyone in their social networks how and why they got to that point.

Health care realities that are often overlooked by forced choice (e.g. A vs. B scenarios, point allocations, rankings) and attribute-based questions include:

• N=1. No two patients have exactly the same personal/family histories and environments. Yet we ask everyone the same questions. Why? We have computers now so we can personalize questionnaires in real time, the same way we say we want to personalize interventions.

• Heuristics – shortcuts – are more necessary to making health choices than any other kind. You may be able to consider all the possible routes to work in the morning, but you can’t consider – ever—all the supplements you could be taking.

• Opportunities to re-evaluate choices like daily dosing, glucose monitoring, diet, exercise are infinite– unlike  the dishwasher that you’re basically stuck with for a few years

• Instability/unpredictability of product “attributes” – we don’t all define “effectiveness” the same way, yet we all know what “four bedrooms” means, and the drug you took with no issues yesterday can land you in ER today.

• Inability to create what everyone knows would be the ideal product (want a vitamin water that melts solid tumors?), unlike, say, the cereal industry (Apple Jacks with 12g sugar/serving)

• No single “health personality.” For me, popping a naproxen is nothing; for my son, it’s agonizing. Yet he’s blasé enough to have visited a chiro, whereas I never will. So if you ask the two of us the same questions about beliefs and recent care, you’ll miss why our choices differ.

• In for a penny, in for a pound. A plumber can unclog the kitchen sink with no effect on the bathroom, whereas treatment focused on one system often adversely affects another. And when weighing the zero-sum game of deductibles, co-pays and OOP limits, it’s easy to feel that there are no good choices.

By replacing traditional questionnaires with decision-centered designs in which no two respondents may see exactly the same questions, we can understand and track what our audiences believe they know and the extent to which these beliefs are associated with their choices. With dynamic surveys, domains, measures and thresholds are not pre-established but are provided to us by respondents (with whom we are conversing, not forcing them to abstract something that is very real). This on-the-ground data enables us to better address knowledge gaps, evolving expectations, epidemiology/behavior, barriers to action and more – often with interactive tools. Moreover, patient, clinician and payor thresholds often differ significantly, creating misaligned incentives. When we understand how these differ, we can realign programs for “win/win/win” scenarios that optimize health outcomes.

Women Rule in Consumer Health Internet use

By Clive Riddle, February 4, 2010

The CDC’s National Center for Health Statistics this week released preliminary results from their National Health Interview Survey, a national household survey regarding consumer use of health information technology with data collected from January through June 2009.

Their report cites a previous study:  The social life of health information [online]. Pew Internet and American Life Project. 2009, which found 74% of adults in the U.S. use the Internet, 61% have used the Internet to search for health or medical information and, 49% of adults have accessed a website that provides information about a specific medical condition or problem.

• The new National Health Interview Survey examined use by adults age 18-64 and found that women’s consumer use of health care internet exceeded men’s in every category:
• 50.8% used the Internet to look up health information during the past 12 months (58.0% of women, 43.4% of men)
• 3.3% used an online chat group to learn about health topics in the past 12 months (4.1% of women, 2.5% of men)
• 4.9% communicated with a health care provider by e-mail in the past 12 months (5.6% of women, 4.2% of men)
• 6.0% requested a refill of a prescription on the Internet during the six month survey period ((6.6% of women, 5.3% of men)
• 2.7% had made an appointment with a health care provider in the past 12 months using the Internet (3.5% of women, 1.8% of men)

Using Social Media to Model H1N1

By Clive Riddle, September 10, 2009

In the September 2009 issue of Predictive Modeling News, Russell A. Jackson reports on the use  of Twitter, Facebook, blogs, search engines and more in modeling the spread of the H1N1 influenza virus, in his article “Social Media, Traditional Data Sources Fuel Swine Flu Models” Both social media updates and comments, and keywords from online searches, can provide data useful for such analytics.

Russell writes “One example of the cutting-edge marriage of predictive modeling and social media is the Social Web Information Monitoring for Health – or ‘SWIM for Health’ -- project operating out of the University of Iowa. Researchers there have embarked on a major study that tracks public perception of the swine flu outbreak and other infectious diseases, utilizing technology from OneRiot that indexes the social web in real time. The project, its participants say, ‘has the potential to enhance disease tracking and forecasting by harnessing the power of the social web.’ By monitoring updates from Twitter and Facebook, recent blog posts, current popular search queries and other web usage activity, public health officials can potentially locate an influenza outbreak or simply indicate an elevated perception of disease risk. Such information might help public health authorities better address public concerns. The first step in the research includes an interactive, real-time map of the United States that monitors swine-flu-related Twitter updates. It’s available at http://compepi.cs.uiowa.edu/swim/.

Who is OneRiot you ask? Jackson tells us “launched in November 2008, OneRiot “finds news, stories and videos people are talking about right now across the social web.” Unlike any other search engine, it ranks a web page’s relevance based on its current popularity with real people. OneRiot is a privately held company headquartered in Boulder, CO, with offices in San Francisco.”

Another initiative Russell cites is a project in which “researchers with the National Institutes of Health’s Models of Infectious Disease Agent Study, or ‘MIDAS,’ recently posted these questions on Facebook: [1} “When did you first learn about the swine flu outbreak?”  2} “Have you searched the internet for additional information on the swine flu outbreak?” {3} “If a vaccine for swine flu became available, would you want to be vaccinated?” …. The researchers will use the Facebook responses to build a dynamic model that simulates how changes in decision-making influence patterns of disease spread. The model will help them and others identify the strategies that improve adherence to interventions and reduce the spread of disease. “

So perhaps not only can you reduce your chance of contract with H1N1 by socializing online instead of in person, but you might help measure and combat its spread at thie same.

H1N1 Flu: Key Info, Web Resources and News Headlines

by Clive Riddle, July 29, 2009

So the health care community has been warned for some time to brace for a surge in swine flu this fall. As August approaches, what’s the latest? The following is a summary compiled of some key information, key web resources, and recent news headline:

- KEY INFORMATION –

CDC provides this summary in their latest situation update: “On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of novel influenza A (H1N1) was underway by raising the worldwide pandemic alert level to Phase 6. This action was a reflection of the spread of the new H1N1 virus, not the severity of illness caused by the virus. At the time, more than 70 countries had reported cases of novel influenza A (H1N1) infection and there were ongoing community level outbreaks of novel H1N1 in multiple parts of the world.  Since the WHO declaration of a pandemic, the new H1N1 virus has continued to spread, with the number of countries reporting cases of novel H1N1 nearly doubling. The Southern Hemisphere’s regular influenza season has begun and countries there are reporting that the new H1N1 virus is spreading and causing illness along with regular seasonal influenza viruses. In the United States, significant novel H1N1 illness has continued into the summer, with localized and in some cases intense outbreaks occurring. The United States continues to report the largest number of novel H1N1 cases of any country worldwide, however, most people who have become ill have recovered without requiring medical treatment.”

According to the CDC Novel H1N1 Flu Situation Update as of July 24, 2009, the U.S. has experienced 43,771 cases involving 302 deaths. The top five states by number of cases are:  

1. Wisconsin 6222 cases; 6 deaths
2. Texas 5151 cases; 27 deaths
3. Illinois 3404 cases; 17 deaths
4. California 3161 cases; 52 deaths
5. Florida 2915 cases;  23 deaths

For the week of July 12 -18 the CDC reported that:

· Widespread influenza activity was reported by seven states (California, Delaware, Georgia, Hawaii, Maine, Maryland, and New Jersey).

· Regional influenza activity was reported by Puerto Rico and 13 states (Arizona, Arkansas, Connecticut, Florida, Nevada, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, Washington, and West Virginia).

· Local influenza activity was reported by the District of Columbia and 13 states (Alaska, Illinois, Massachusetts, Michigan, Minnesota, New Hampshire, New Mexico, Oklahoma, Oregon, Tennessee, Texas, Utah, and Wisconsin).

· Sporadic activity was reported by 17 states (Alabama, Colorado, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, Vermont, and Wyoming).

The World Health Organization’s (WHO) latest update, as of July 24, 2009, states “in most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.... The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be able to revise its estimate of pandemic vaccine supply once it has the new yield information. Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials. These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose. Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.”

- WEB RESOURCES -

Pandemic (H1N1) 2009

World Health Organization

Key Facts About Swine Influenza

Centers for Disease Control and Prevention

Novel H1N1 Flu (Swine Flu) and You

Centers for Disease Control and Prevention

 Novel H1N1 Flu Situation Update

Centers for Disease Control and Prevention

Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts

Centers for Disease Control and Prevention

H1N1 Influenza A (Swine Flu) Alert Center

Medscape

- NEWS HEADLINES -

H1N1 Flu Spreads to Remote Corners of the World

Reuters Health Information, July 28, 2009

Pregnancy Likely to Be Swine Flu Shot Priority

Associated Press via Google, July 28, 2009

H1N1 Flu Shots Ready in Months, Winter a Risk: WHO

Reuters Health Information, July 27, 2009

China Presses Quarantine Against Flu

New York Times, July 27, 2009

Swine flu could hit up to 40% in U.S. this year and next without vaccine

Associated Press via USA TODAY, July 26, 2009

US: 160M doses of swine flu vaccine due in Oct.

AP via GoogleNews, July 23, 2009

First Trials of Swine Flu Vaccine Begin in Australia

Bloomberg News, July 22, 2009

Grants to States and Territories, July 2009

HHS Press Release, July 10, 2009

A Selective List of National Medical Home Web Sites and Resources

By Clive Riddle, May 30, 2009

If you’re involved with, or monitoring patient centered medical homes, this should be of interest. Medical Home News (www.MedicalHomeNews.com) in their June 2009 issue provides the following list of key medical home web sites and resources. You can also sign up for a free periodic Medical Home Bulletin e-newsletter from their web site.

 

The Patient Centered Primary Care Collaborative

www.pcpcc.net

National Center for Medical Home Implementation - American Academy of Pediatrics

http://www.medicalhomeinfo.org

TransforMed - affiliated with the American Academy of Family Physicians (AAFP)

www.transformed.com

The CMS Medicare Medical Home Demonstration

http://www.cms.hhs.gov/demoprojectsevalrpts/md/list.asp - select Medicare Medical Home Demonstration

James F. Coan, CMS MMHD Project Officer - medhomedemo@cms.hhs.gov

Technical Assistance Available to Participants in the Medicare Medical Home Demonstration (MMHD)

www.medhomeinfo.org (to be activated soon)

The National Academy for State Health Policy (NASHP)

http://www.nashp.org/index.cfm - Click on “Medicaid: Supporting the Patient Centered Medical Home in Medicaid and SCHIP”

The Commonwealth Fund

http://www.commonwealthfund.org – Enter “medical home” in the search box for multiple reports, including the Nutting Report (see this month’s Industry News)

The National Partnership for Women and Families

http://www.nationalpartnership.org -- Click on “Medical Home” on the home page

Preconference Readings for the Medical Home Training Program

http://www.medicalhomesummit.com/training_reading.html

Serious Games: Health Plans and Health Games

By Clive Riddle, March 25, 2009

Should you be playing games with your health? (Alright, maybe the correct word is “for” and not “with”, but I wanted your attention.) Nevertheless, a growing body of policy, research, health care, and health insurance organizations think you should.

The Serious Games Initiative founded at the Washington DC based Woodrow Wilson Center for International Scholars, “applies cutting edge games and game technologies to a range of public and private policy, leadership, and management issues.” The Initiative earlier this decade launched Games for Health to coalesce a community of researchers, health care professionals and game developers involved with games designed for health care applications. The organization’s Games for Health Fifth Annual Conference will be held June 11-12, 2009 in Boston.

Humana became a believer in the movement. In September 2007 , Grant Harrison, vice-president of Humana’s Integrated Consumer Experience said “giving healthcare consumers the ability to become more closely connected with the management of their health through video games is a unique way in which to accomplish Humana’s goal of helping members become both mentally and physically health.” The company stated that Humana’s Innovation Center would research and develop “the best ways to connect with consumers using game technology. In collaboration with Serious Games pioneer Digitalmill Inc., Humana is evaluating all aspects of the games for health space.”

In May 2008 they launched HG4H: Humana Games for Health, a web site for their initiative, and began forging partnerships with schools and other organizations to offer various exercise and games for health programs. HG4H has since partnered with various game developers to offer “interactive video games that provide fun physical and mental workouts and motivate healthy lifestyle choices.” HG4H has categorized their offerings into six categories: exergames, persuasive games, casual games, educational games, virtual world games and pervasive games.

Just last month, when announcing new online games added to the HG4H program, Paul Puopolo, Humana’s director of consumer innovation stated “we know that a healthier lifestyle doesn’t have to be boring and these games are a perfect way for consumers to connect health with a technology they already enjoy. With childhood obesity on the rise, games like Lunch Crunch and Bubble Trouble give kids the lessons in health they need but present the message in an entertaining way – through a little friendly competition online. We also know that baby boomers are looking for ways to keep their minds young, so games like Split Words and Entangled Objects help with cognitive functions and attention skills – exercises that so many adults need.”

Lunch Crunch? Bubble Trouble? Split Words? Entangled Objects? These don’t sound like the offerings typically announced in press releases by health plan. Trying to get to the bottom of just what’s going on here, I spoke to Laura Fay, CEO of HAPPYneuron, Inc., a developer partner with Humana. HAPPYneuron is a majority owned subsidiary of Scientific Brain Training (NYSE Euronext: MLSBT) and offers a broad range of personalized brain training workouts in multi-media formats. Scientific Brain Training was founded in 2000, and the company has had a North American presence since 2006.

For Humana, the HAPPYneuron games offered online were “designed to stimulate your attention, language, memory, planning and abstract-thinking skills” with the core targeted audience including seniors for the purpose of deferring the onset of age related brain decline. Laura told me that their Humana applications have now been up two months with public access at www.humanagames.com with five HAPPYneuron click and play games offered.

Laura shared that HAPPYneuron offers direct to consumer individual products from their web site, in addition to partnerships with organizations such as Humana. Their current and prospective partners include health plans, publications, employers, pharmaceutical companies, research organizations, educational institutions, and senior centers.

HAPPYneuron product offering include individual online memberships with “access to more than 3,000 hours of unique game play with its 34 innovative online games... designed and developed by a team of neurologists and cognitive psychologists to work the brain’s five major cognitive functions: memory, attention, language, visual/spatial and executive” and “HAPPYneuron Junior, a series of 24 online games has been developed by a group of neurologists and specifically designed for children 8 through 12 years old.” The company also offers CD/DVDs and books.

Their core offerings involve memory games providing “cognitive training fun with very diverse exercises, each one with numerous options, difficulty levels and data sets.” Laura stated an end result is to deliver a level of peer comparison, with exercise data results that provide feedback on a given exercise compared to the applicable peer group

I asked Laura what ROI can their cognitive training games offer Humana or other health care partners? She answered that “a one-point increase in cognitive activity corresponded with a 33% reduction in the risk of Alzheimer’s” and share the following cost implications (citing the Alzheimer’s Association as her source):

• 10 million Boomers will get Alzheimer’s Disease
• The average lifetime cost of care for someone with Alzheimer’s disease is $174,000
• The annual of caring for someone with Alzheimer's is $18,400 for someone with mild symptoms, $30,100 for moderate symptoms and $36,132 for severe symptoms.
• Medicare costs for beneficiaries with Alzheimer’s disease were $91 billion in 2005. Medicare costs are expected to increase by 75% to $160 billion in 2010 and to $180B by 2015

For developers such as HAPPYneuron, there’s more than fun and games at stake here in the emerging games for health sector. According to the Health eGames Market Report 2008 “iConecto estimates the Health eGaming market at approximately $7 billion during the next 12 months including the markets for brain fitness ($267M), exergaming ($6.4B+) and other Health eGames on the consumer and professional side ($250M+).”

e-Visit Data

By Clive Riddle

Patient online e-visits, introduced at the start of this decade, continue to gain momentum as technologies improve, consumer demand increases, experience from prior pilot studies becomes more widespread and major health plans advance and adopt e-visit initiatives. Here's a collection of some recent data on e-visits, compiled in MCOL's March @How-TO newsletter:

• Trinity Clinic in Whitehouse, Texas, reports e-visits average five minutes, compared with 15 to 20 minutes for comparable office encounters, and averages one to two billable e-visits per month per doctor (1)
• Medfusion, an e-visit vendor, has process half a million e-visits for about 2,500 physicians during the last three years (1)
• McKesson's Relay Health, an e-visit vendor, charges physicians $25 per month per doctor for use of the web visit tools (2). RelayHealth, has 15,000 subscribing physicians (3)
• Manhattan Research survey results found 31% of physicians reported using some type of online communication with their patients in the first quarter of 2007, up from 24% in 2005, and 19% in 2003 (3)
• "National surveys suggest that the majority of online consumers now desire e-mail access to their physician and are willing to pay about $25 for an online consultation. A recent Wall Street Journal Online/Harris Interactive Poll found that 62 percent of patients said the ability to talk to a physician electronically would affect their choice of doctors and a Harris Interactive poll conducted in 2006 found that 74 percent of patients would like to use e-mail to communicate directly with their physicians." (3)
• "A recent Kaiser Permanente study of patients who used the medical group’s secure e-mail system between 2002 and 2005 to access their physicians found that they phoned their physicians nearly 14 percent less than did patients not using the system, while each doctor averaged about two e-mail messages per day." (3)
• "A two-year study of a pediatric rheumatologist’s e-mail and telephone interactions with 121 patient families, published in last October’s Pediatrics, found that the physician received an average of 1.2 e-mails per day, while answering patient questions by e-mail was 57 percent faster than using the telephone." (3)
• "75% of patients polled in the 2007 WSJ/Harris poll reported that their doctor does not currently offer e-Visits or other e-services" (4)
• "Blue Shield of California has estimated that the use of online patient-provider communications tools by its members will save the organization $4 million a year in office visit claims." (4) 

(1) Demand for e-visits grows but uptake still sluggish
Managed Healthcare Executive, November 1, 2007
http://managedhealthcareexecutive.modernmedicine.com/

(2) Physicians diagnose their patients via mouse calls
Akron Beacon Journal, March 10, 2008
http://www.statesman.com/life/content/life/stories/health/03/10/0310housecalls.html

(3) Online physician communication 
Physicians News Digest, March 2008
http://www.physiciansnews.com/cover/308.html 

(4) e-Visits:The Tipping Point - Are We There Yet?
Rhondda Francis, TransforMed, 2008
http://www.transformed.com/e-Visits/e-Visits_Are_We_There_Yet.cfm