Collecting ideas and thoughts slightly too big for @digital_pharma

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Posts tagged "insurance"

I wonder if it’s too early to say if there’s a movement happening here. I see signs that remind me of the big shifts that have happened online over the last 15 years, but that doesn’t mean it’s really occurring. So you tell me: Does pharma realize that they are less in the pill business and more in the health business?

Of course, maybe it doesn’t matter. Maybe because so many of the world’s health problems require some sort of prescription medication that it doesn’t matter what business they are in because the sales will always be there.

But maybe it does matter. What pharma presentation doesn’t start with the litany of horrors about the ending of blockbuster drug patents, insurance changes, and slowing sales? Maybe re-framing the issue gives pharma the opportunity to see themselves in a different light and get beyond their less-than-hopeful prognosis for their industry.

So if pharma is in the “getting people healthy” business, they need to see and embrace all the ways people can get healthier, and right now, the fun/sexy/exciting means of doing that involves tech. Specifically, mobile tech.

I don’t need to get into all the reasons why mobile and health care make such a great match (Need a refresher? Here you go: 2012 Tech Outlook for Pharma) so let’s just skip ahead and pretend pharma has embraced mobile tech not just as a means of selling more pills, but as a new part of their complete health package.

This means that apps aren’t just commercials, but have to become powerful tools that help people become healthier. They can’t stop at “Let’s make the patient aware that they might have a diagnosable issue.” Let’s move them down the road to “As part of treating condition X, we have prescribed Brand Y and bundled it with this app to help you make healthier choices.”

By moving to a mobile platform, pharma can start to embrace elements of local check-ins (how many times you went to the gym and how many times you went to that greasy spoon around the corner), gamification (get points for taking your meds and drinking enough water) and social media (let your friends encourage you to take care of your health because they can see when you’re really working at it).

Uh oh. We’ve just moved past the world of the un-branded app into something bigger. Who’s gonna pay for all this?

Getting pharma to embrace the idea that apps are something more than product commercials is seismic, and requires a lot of changes on every level. So, what should pharma be able to do in the very near future?

Because these apps take a prescriptive course, they can’t really be said to be unbranded. Thus, they need to be treated like meds. They need a review process, even if the information they are conveying is pretty close to common sense. For example, when a doctor tells you to drink 8 glasses of water a day, it’s a non-event. If pharma tells you to drink 8 glasses of water a day, that’s prescription from a company and might need some review.

Maybe this shift will start to unearth some long-standing rules of thumb regarding health that might actually be untrue? (e.g., That “8 glasses of water” rule is a completely arbitrary number and doesn’t take into account the size, activity or even the local weather of the patient, right?)

And since these apps are no longer unbranded, and are a form of treatment, shouldn’t pharma be compensated? Oh, I have your attention now, don’t I? People spend more than a hundred dollars for As Seen On TV exercise programs. They should expect to pay for the same information in app form.

That sounds like quite a hurdle until you consider that if the apps are like a treatment from a doctor, the insurance companies are going to have to figure out how to cover them. While there will be whining from the insurance companies, the overall effect is that patients are more likely to improve their lifestyle and be reminded by the app to take their meds. This creates healthier patients, ones who are less likely to need to see a doctor and cheaper to insure.

All of these things lay the groundwork for a change in how most people view medicine: that prescriptions are often more effective when they work in tandem with lifestyle changes (e.g., pre-insulin diabetes treatments are going to be more useful if the patient loses weight and eats better). The burden on health doesn’t lay solely on pharma who makes the pill, or on the doctor who prescribed it, but equally between pharma, doctor and patient.

Merging the silos of pharma and non-pharma can only have a positive impact on the world’s health, as we can’t just take the pill and assume we’re going to be all better.


This also appeared over at, where I am a guest blogger. But that doesn’t mean I don’t want to talk about this in Twitter. Bring it!

Morning! I just got back from two days worth of conversations about an integrated insurance company/provider network (no fair guessing who) and after talking to a dozen people well-placed through the organization and strategy, I had an interesting realization.

For a certain type of product, usually new products, one of the biggest obstacles you have to overcome to get people to buy your product is fear. That’s why infomercials work: after 30 minutes of “seeing” the product, we feel like we have enough familiarity with the product to evaluate it on it’s merits. Cutting edge technology? Fear was the biggest hurdle for the iPad: yes, the fanboys will buy it, but… what about everyone else? Will they understand how this new computing niche can fit in their life and actually displace other technology? Luckily, a legion of fanboys and fangirls were around to show it off and explain how much easier business travel is if you ditch the laptop in favor of the iPad, for example.

There are certain industries in which fear is endemic. The health care system is a great example. Not only are we terrified of the mammogram and colonoscopy, what about surgery? Recovery statistics? Human error in the hospital? Long physical therapy? Needles? There’s very little in health care that doesn’t cause most people’s heart to beat a little faster in fear (ask a nurse what percentage of people raise their blood pressure in fear of having to take a harmless blood pressure exam).

And that’s true on the insurance side. Can you explain why one thing is covered and something else isn’t? Of course you can’t. Insurance companies have servers that do nothing but process the rules to determine what’s covered and what’s not. Can you explain to a teenage what a formulary is? No? What about a medical deductible? That phone book of a set of policies and rights when you enroll makes organic chemistry seem like a cake walk. All fear inducing.

So here’s my pitch to any and all insurance people who might read this: You want a winning strategy? Make sure everything you do, every slip of paper you produce, every phone call or text message you send, every bit of your website, every sign in your office, every communication to every patient and provider does one thing: lower their fear. The fear of misunderstanding. The fear of payment. The fear of limited coverage.

Do that, sail by that star, and everything will fall into place. 

Medicine is scary enough. Your coverage should be the least of anyone’s worries.