Last week I had the privilege of spending two days with diabetes experts in Washington, DC at the American Diabetes Association’s 5^th Disparities Partnership Forum.

The goal of the conference was to provide a forum for discussion around the onset of type 2 diabetes in high-risk populations. One of the many populations discussed was women. Brandy Barnes, the Founder and CEO of DiabetesSisters, and I submitted an abstract to the ADA highlighting the unique needs of women living with diabetes and it was selected as one of two Promising Practices to be presented at the conference.

I was so excited about being able to share the work of MicroMass and DiabetesSisters with an audience of experts who are all genuinely interested in understanding how to positively influence women with diabetes. Creating sustainable behavior change is critical, and I know together our organizations are already making great strides.

Andi Weiss presents at The 5th Disparities Partnership Forum from MicroMass on Vimeo.

The aging workforce (the Boomers) has different values and attitudes than those exhibited by younger workers – you know the “Generation X” and “Generation Y” (Gen X & Y) folks. Much has been written about these differences and their potential effect on many industries, and healthcare is not exempt.

What is of concern is that the healthcare industry is growing, and we are facing a physician shortage. The major contributing factors to this shortage are: an aging population; rising practice expenses; and an increase in the number of physicians who want a more flexible work schedule. In addition, there are an estimated 340,000 physicians who have started retirement at the beginning of 2010.

Adding all the new technological advancements in medicine along with these demographic trends, we can begin to see the importance of successfully recruiting young physicians. In essence, recruiting young physicians will (if it has not already) become paramount to the success of many healthcare entities.

Both Gen X and Y physicians carry many of the known traits of Gen X and Gen Y workers: they are technologically savvy and expect technology to be well utilized in the workplace; they value personal fulfillment; they seek a casual work environment and an attractive work/life balance; they are interactive and prefer immediate feedback; and they seek out creative challenges and opportunities to lead. Best of all they are ambitious; however, they require good rational reasons to go the extra mile.

It is clear that the practice of medicine is in the midst of an evolution, and it appears that Gen X and Y physicians will be perfectly suited for it. In fact, one could argue they are driving it. And of course, the federal health care law is an impetus to some of these changes, as well. It is fortunate for us that Gen X and Gen Y physicians embrace technology and teamwork; they like electronic medical records and smartphone apps; and they like sharing the load with other doctors on the team. This is opportune because we need doctors who can practice medicine as well as improve medical care on the larger scale.

From the human health behavior point of view, it will be interesting to see how we, as healthcare marketers, adapt to this new kind of physician and the new patient-physician dynamic/dialogue that will occur. From my personal point of view, I cannot wait for the new ways in which these new, young physicians will make my healthcare experience better.

The Beatles had the right idea when they wrote the song “Come Together” (never mind that the song was actually a play on a political ad campaign from the 1960s).

If you’re like me, you’ve heard the song hundreds or even thousands of times and never thought too deeply about the lyrics. Let’s face it; they don’t make a lot of sense on their own. Some have speculated that the song references the personalities of different members of the band (i.e. “one holy roller” for George Harrison, the “spiritual” Beatle). Or possibly, it’s just the result of some other illegal, “creative influences.”

As I’ve been researching journal articles and reading blogs and editorials on healthcare reform, I’ve been struck by the fact that so many of the proposed changes to the system are about making healthcare more collaborative. It’s about providers, patients, and other stakeholders coming together. Just take a look at three of the proposed changes—Accountable Care Organizations (ACOs), Insurance Exchanges, and Patient-Centered Medical Homes (PCMHs).

Accountable Care Organizations

ACOs are one of the most anticipated aspects outlined in healthcare reform. The idea is that all sorts of providers, including physicians, specialists, and hospitals will come together to provide care that focuses on quality rather than volume of services. Kind of sounds like an HMO, right? Well, not exactly. One of the major differences between ACOs and HMOs is that ACOs give their patients the option of going to providers outside the ACO network. ACOs would cover a minimum of 5,000 Medicare patients for at least 3 years. The goal of an ACO is for providers to work together to cut unnecessary healthcare costs while still providing quality services. If they are able to meet certain cost and performance measures, they’ll be reimbursed by Medicare according to their cost savings. To keep ACOs from dominating the marketplace, they’ll be subject to anti-trust and anti-fraud review processes. The moral of the story is that it’s advantageous to work as a team to save money and be reimbursed a chunk of the savings.

Insurance Exchanges

What happens to all the people who aren’t insured through their employer or are purchasing their own insurance? Prior to healthcare reform, those individuals would either end up paying higher premiums or choosing to forego insurance entirely. If the individual mandate stands, anywhere from 30-35 million people who were previously uninsured will be required to purchase insurance. With so many people buying insurance on their own, why not bring them together to leverage more affordable premiums? That’s exactly what insurance exchanges are designed to do. Exchanges will prohibit insurance discrimination against individuals with pre-existing conditions and bring together individuals and small businesses (with fewer than 100 employees) to purchase insurance. All exchanges will be required to have four different benefit categories of plans as well as a catastrophic plan. These exchanges will be run by states and are effective starting January 1, 2014. For more information on exchanges, see the Kaiser summary of healthcare reform.

Patient-Centered Medical Homes

In a similar vein to ACOs, PCMHs will bring together providers to enhance patient primary care. The difference between an ACO and a medical home is that ACOs are networks of providers, while a medical home is a team of primary care providers, usually made up of physicians, nurses, and physician assistants, who are assigned to a particular patient. The PCMH team is led by the patient’s personal clinician who works together with their team to coordinate care and promote overall patient health. This approach has been shown to be especially beneficial for patients with chronic conditions, but is also an effective approach for other groups of patients, as well. The Affordable Care Act provides an incentive for PCMHs—they can receive reimbursement for caring for patients with chronic conditions who are covered by Medicaid.

Even though the lyrics of “Come Together” may not make all that much sense, the message certainly applies to the changes we’re seeing in healthcare today. Healthcare is moving in the direction of collaboration and it’s moving quickly. Most of the changes mentioned above are already being implemented or in the final stages of planning. Only time will tell how these changes actually stand up to all the hype, but for now, it looks like the one thing is for sure–patients, providers, and others are coming together, right now, over the health concerns of you and me.

Affordable Care Act. Obamacare. The Donut Hole. Individual mandate. Healthcare reform.

It’s hard to escape it—discussion about the changing US healthcare system is everywhere.

As I was driving into work this earlier this week, I heard a story about the upcoming Supreme Court ruling on the constitutionality of the Affordable Care Act (ACA). You can listen to it here.

Despite the hubbub in the media around the healthcare debate, sifting through all the policy lingo and technical jargon can be overwhelming. The law itself is a lengthy 955 pages–not exactly user-friendly.

For many of us, the topic of healthcare reform is like the mystery meat casserole Great Aunt Marilyn brings to family reunions—you don’t really know what’s in it, you definitely don’t want to ask what’s in it, but you try it anyway because she tells you, “It’s good for you!”

Whether we understand what’s in it or not, the Affordable Care Act will change healthcare as we know it. In fact, it already has. Since it was enacted in 2010, the ACA has expanded health insurance coverage for young adults and individuals with pre-existing conditions, offered prescription drug discounts to seniors, provided free preventive care like mammograms and colonoscopies to the newly insured, and started to shift the healthcare system to a more patient-centered model. (Healthcare.gov, a site managed by the Department of Health and Human Services has outlined the key aspects of the law and a timeline for when they will be rolled out.)

This summer, I’ll be taking a look at ways the Affordable Care Act is changing the healthcare landscape in the US. Each week, I’ll focus on a different topic related to healthcare reform and how it impacts people in different levels of healthcare, from patients to providers to pharmaceutical companies. Check back in for more insights, ideas, and musings about all things healthcare–Great Aunt Marilyn would want you to. Just watch out for the casserole.

It usually goes something like this:

• Patient goes to see doctor for an ailment
• Doctor assesses patient
• Doctor writes patient a prescription
• Patient thanks doctor and leaves, prescription in hand
• Patient decides not to fill the prescription.

From then on, the doctor and patient are operating under conflicting assumptions—a great plot for a 70s sitcom, but bad news for better medical care.

Recent research looked at primary nonadherence, that is, patients failing to fill an initial prescription. Rates of nonadherence were highest in metabolic diseases such as diabetes (31%), hypertension (28.4%) and high cholesterol (28.2%).

If so many people are failing to fill their scripts, but the doctor assumes that they are taking the medication as prescribed, how can treatment progress effectively?

Doctors are only as good as the information they have.

Given the high rate of primary nonadherence, doctors should make the following direct question a standard part of follow up visits, “Did you fill the prescription for Drug X that I gave you?” People are less likely to lie in the face of a direct question.

Obviously that one question won’t solve the communication disconnects that plague doctors and patients, but it’s a start.

So don’t lie to your doctors.  Trust me, they’d rather hear the ugly truth.

For many people living with chronic conditions, new research in medicine is opening up possibilities to advance treatment at an amazing pace. With a better understanding of the cause and contributing factors for many conditions, the idea of a “cure” is not a far-fetched possibility.

This could really change the way certain conditions are viewed. For many physicians (and patients) disease management is often focused on addressing symptoms of the condition – the downstream effects. Think about the flu – the vaccine is pretty good at preventing it, but once you have it there’s not much to be done except minimize the symptoms.

But now, there might be a way to stop the virus before it can spread in the body. Research has uncovered a “master key” of sorts that could act like a universal “off switch” for flu viruses. This approach of looking upstream and focusing on the root cause might lessen the overall burden and perceived severity of many conditions.

Marketing for many drugs has mirrored this treatment approach for years. The focus is almost always trying to affect the prescribing decision of the doctor. When you consider that this decision is the culmination of a lengthy and involved process that includes not only the time spent with a particular patient, but also the doctor’s past experience treating similar patients, the way they were trained in medical school, and even their personal beliefs and prejudices, you see that there is a lot more going on upstream that has potential to shape prescribing behavior.

These factors that guide prescribing decisions are often overlooked in pharmaceutical marketing because the drug doesn’t always have a role.  But if, like in the flu example, you can effect a change early in the process, the downstream results can be favorable.

Recently, the FDA approved Dendreon’s Provenge, a vaccine for prostate cancer. The vaccine is a milestone for immuno-oncology, as well as for personalized medicine. It’s really interesting – each dose of the vaccine is made from a patient’s own cells so every therapy is unique to the individual.

Testing individuals to customize therapy is nothing new. It’s been done for years in oncology and infectious disease, but usually as a guide for selection of existing therapies.

The potential for further advances in personalized medicine is huge, potentially reaching many important therapeutic areas. But one key issue that I can see from this is re-training physicians to think differently about treatment than they do now.

We know that physicians often treat patients in a predictable way, usually based on their own experience, expectations, and assumptions about a condition or medication. Most of the time this is OK, especially when you consider the time constraints in most practices and the prevalence of many chronic conditions. But illness affects everyone differently, and a one-size-fits-all approach may not be ideal.

Perhaps the evolution of personalized medicine will help health care practitioners to think differently about the way they practice. By learning more about the personal characteristics, values and behaviors of patients and not just the condition they have, their approach to treatment could become more individualized. Personalized medicine already has its own advocacy group. Lets encourage more frequent use of patient insights to create a personal medicine movement.

Do you trust your doctor? My mom sure does.

I can’t tell you how many times my mom has driven me nuts by not asking her doctor a question she has been wondering about, saying, “if it was important, he would have mentioned it.”

On the rare occasions when I’ve managed to get her to push for answers, she usually tells the doctor that it’s her daughter who is insisting. I’m fine being her excuse, as long as she gets answers.

But it got me thinking, how does generation dictate how we interact with our doctors?

Turns out, it doesn’t.

I was surprised, since I’ve always chalked up my mom’s relationship with her doctor to her being of “that generation.” (I won’t say which generation, on the off chance that she’s reading this.)

Conventional wisdom says that older people want their doctors to tell them what to do, while younger people want more of a partnership. This conventional wisdom is wrong.

When we took a look at the relationships people want to have with their doctors, we didn’t find the neat generational patterns that we expected.

Instead, we found that the type of relationship you want with your doctor is more a factor of your unique psychology than about whether you first met Ron Howard as Opie Taylor, Richie Cunningham or the Oscar-winning director of A Beautiful Mind.

With reports of unintended acceleration in several models, including hybrids racing at high speeds (but cleanly!) down busy interstates, Toyota and its products are being blamed for not addressing safety concerns adequately. Of course they aren’t the only ones taking the blame – the NHTSA is also under fire for not investigating more thoroughly. Lots of “they didn’t do this” and “they said they fixed it” being thrown around…

Yet hardly anyone is talking about the drivers’ role.

This reminds me a lot of how we often approach our own health. We, as patients and consumers, rely on “they” to do all of the hard work. Only in this case, “they” applies to the pharma manufacturers, the FDA and health care practitioners. When there are problems with specific medicines, or even when our health isn’t as good as it should be, “they” are always around to take the blame.

No one would argue that there aren’t some bad players out there, but it’s time that “we” started to take on more responsibility with healthcare. The information we need is there – pharma companies spend millions every year trying to educate patients and physicians.

Like a car, the recommendations and medications that doctors provide to us are just a tool, a conveyance, to get from a starting point to a goal. We all need to do a better job of how we handle it before things really get out of control.