Cover My Meds

CoverMyMeds_Logo CoverMyMeds is a company in a brilliant niche. ePA – Electronic Prior Authorizations.

Usually a doctor’s prescription reaches pharmacy, which informs patient when to pick it up. If the drug needs the insurance company’s authorization, it’s up to the Pharmacist to notice that and get authorization process started (includes paperwork, calls, faxes). Patient may not even find out till they arrive to pick up medication.

This messy cycle happens 200 million times a year in US, costing $20-30 Billions dollars annually. Cover My Meds offer APIs and widgets to digitize this workflow with all stakeholders.

For example, on payer side it can enable automated routing to staff queues acc. to rules, auto-determination for some, electronic notifications to prescribers, reporting, etc. For pharmacies it can alert pharmacists about PA need, kick off approval workflow digitally, etc. For patients it means less prescription abandonment.

Most fascinating aspect of Cover My Meds is its business model. It’s free for everyone who uses it. They make money by charging drug companies to pay for the service. Drug companies fund that from the revenue of what otherwise would have been unfilled prescriptions. That is a win-win all around… minimal barrier to adoption.

Cover My Meds started with a $250K seed in 2008. They were acquired by McKesson Corp. for $1.1B last month. A well-deserved unicorn exit in Health IT.

PillPhone

Currently there are a number of hardware-based solutions in the market that aim to help the patient take the right medication at the right time. The conventional options of boxes, organizers, dispensers, watches etc have been there for the longest time. The last few years have seen devices get a bit smarter with phone, internet, cellular connectivity and some built-in decision support (alerts, reminders) . See Philips’ ManageMyPills service, MedMinder, Glowcaps, for example.

Seems like the new crop of ‘medication management services’ are purely software applications using the increasingly-ubiquitous mobile phone as the hardware companion. The space is getting crowded: PillBoxApp, PillBoxer, RememberItNow, ZumeLife, PharmaSurveyor, MedWatcher and Jitterbug. PillPhone joins the lineup with a few mildly notable differences.

Pillphone is made by Vocel, a mobile messaging platform developer. It’s based on ‘The Pill Book‘: consumer guide to the most prescribed drugs in america. The book has been around for decades; now in it’s 14th edition. The app is available on AT&T, Sprint and Verizon networks and the company claims it can work with most handsets and costs around $4/month. The features are pretty standard: visual/audible alerts and reminders, a mobile MAR, visual identification (i.e pill pictures), and side-effects information. Bit surprisingly, they have managed to get an FDA 510(k) clearance, handful of patents and some big investors.

No doubt that mobile computing platforms (not just phones, maybe dedicated health devices in future) are going to play a crucial role in providing medication adherence services of tomorrow. One of the key gaps though, is in integrating such personal MARs data with institutional EHRs. If we continue to be unable to reliably involve patients in the medication reconciliation process, then such mobile applications are just another isolated island of data – incapable of making the overall healthcare system more efficient. See Joint Commission‘s take on this topic here. Lets hope that in future everyone who checks into ER can hand over their detailed medication history on a dumb (or smart) phone to the staff and providers can use that information right away.

Jitterbug Health Services

Jitterbug Wireless is a Mobile Virtual Network Operator (MVNO) founded in 2006. They offer simplified mobile hardware and service targeted towards baby boomers, with the value proposition being the opposite of a feature-rich phone. Few big, buttons and great customer service are it’s selling points for seniors who are looking for hassle-free wireless connectivity. Verizon Wireless is their main underlying network provider.

My interest piqued after I heard David L. Inns (Jitterbug CEO) speak at the Mobile Health 2010 event held in May 2010 at Stanford University. He described a sizable list of Health-related services available to Jitterbug customers. Here is the current list, and pertinent facts (from May 2010 time frame) from the presentation he gave at the event:

  • Check-in Calls: Automated calls to check-in on the user or a loved one. $5/month.
  • Medication Reminders: Automated calls at the right time to remind taking medication. Neat functionality includes a prescription refill reminders (with option to be connected to the pharmacy), personal dashboard that tracks medication adherence, and the ability to share it with others. In partnership with Meridian Health. $10/month.
  • LiveNurse: Unlimited 24-access to a registered nurse for health advice and information. Free on rate plan $29 and up, $4 month otherwise. 12,000 reported users in 6 months post-release and about 4000 calls handled per month. One-fifth of the callers end up seeking medical attention within 24 hours.
  • Daily Health Tips: Daily guidance and tips on living a heart-healthy lifestyle. Free. In partnership with the American Heart Association’s Go Red For Women Movement. Reported 4,000 users.
  • Wellness Calls: 5-minute per week motivational calls with tips and techniques related to topics like sleeplessness, stress, loneliness etc. Attracted 1,000 users in one month. Free with plans above $29. Content by Brian Alman who runs TruSage.
  • 5 Star Emergency Response: Personal emergency response service. Based on the offering by startup MobiWatch that they acquired late 2009. Supposed to be launching around Fall 2010.
  • D-Coach: A little-known, yet-to-be-launched diabetes management service in partnership with WellDoc. Incidentally, WellDoc’s Diabetes service recently got FDA clearance in August 2010.

None of these service concepts are unique per se, each has been attempted by other wireless (and non-wireless) companies. But two things make them highly viable within Jitterbug. First is their niche target market. It’s no secret that majority of healthcare costs are due to individuals age 65 and up. And that is Jitterbug’s target user too. A personal mobile device may provide the elusive ‘last-mile‘ access to such individuals. Second is the personalized, high-touch nature of Jitterbug’s service. Jitterbug users are already used to connecting with a human operator with one button-click and use them for pretty much everything – find a contact, dial the number, get weather info, etc.. Adding health-related services to that framework makes undeniable sense.

It’s not hard to imagine other services waiting to materialize- outpatient appointment scheduling and reminders, preventive services (flu shots, etc.) assistance, personal health record information access, to name a few. I bet we’ll see more wireless network operators move into the healthcare services vertical. For now, advantage Jitterbug.

PictureRx

As I’ve written before, medication adherence is an undeniably critical problem for the healthcare system. Most startups in this area have taken the approach of finding novel ways to remind or monitor the patient about medication, with the assumption that the problem is forgetfulness. Instead, PictureRx offers something that tries to solve a much more fundamental cause of poor adherence- lack of understanding your medications.

I heard Sunil Kripalani (PictureRx founder) speak at a Kaiser Permanente Garfield Center event earlier this month. Some of the data he presented was quite eye-opening. More than a third of Americans have basic or below basic health literacy levels (see National Assessment of Adult Literacy 2006 here) and some of the written drug information formats today haven’t been revised in decades (like rx bottle lables, package inserts, etc.).

PictureRx offers a visual aggregation of all medication relevant information for the patient. What does the pill look like, when to take it, how to take it, why should you take it… are all laid out in a simple format.

Verbal instructions at doctors office are often forgotten. And labels on pill bottles dispensed at retail pharmacies tend to be confusing, especially for the population demographic that takes the majority of prescribed medications- seniors. Patients who clearly understand when, how or why they take a medication are less likely to have events like missing a dose, wrong dose or running out.

Medication management is one of the spaces where an incremental improvement of  single-digit percent can mean huge improvement in outcomes and cost savings for the healthcare system overall. Simplified instructions, with clear emphasis on the important aspects of medication regimen can be a much more fundamental change agent than sophisticated reminders.

MedWatcher

Drug safety surveillance (more formally, pharmacovigilence) is a serious and complex issue. Once a drug is FDA-approved and on the market, it needs to be constantly monitored for long/short-term side effects. That process is currently rigid: once observed conclusively, these effects are reported by providers to relevant authorities and disseminated back to all medical community (after some lag time) through literature or subscribed updates.

MedWatcher is a mobile application trying to streamline this process, and increase public (patient) participation in pharmacovigilence. FYI- it’s not out yet (some sources projected Aug 2010 release, but I couldn’t find it in iTunes), so all that is known is intended functionality.

The application will serve two major purposes. First, users can receive drug-related alerts through it, based on FDA MedWatch and less-formal sources (news, media etc.). FDA MedWatch may be a treasure-trove of information, but it’s not easy to use. You can subscribe to an RSS feed, get email or text messages about all drug-related warnings. With tens of thousands of drugs on the market, that is like drinking from a fire hose.

If you are a patient worried about your cholesterol-lowering Zocor or a cardiologist who wants to stay informed about statins in general, there needs to be a way to subscribe to only what you care about. I’m hoping that MedWatcher leverages a comprehensive drug-database like FDB, Medi-Span, Red Book etc. to lets users do exactly that.

The second major functionality is for users (both patients and provider) to submit side-effects through a lean process. They mention that serious side-effects will ‘automatically’ be submitted to FDA (rest probably become discussion topics on MedWatcher itself). The current FDA MedWatch online reporting process is cumbersome and a bit disconnected (who remembers to submit voluntary information after they have seen/experienced a side-effect?).  Having a user-friendly mobile application form would solve some of that.

I think the direct patient engagement is very promising in this niche space. The concept may run the risk of becoming yelp for drugs, but even yelp reviews hold useful information once you figure out how to get rid of the noise. By opening direct communication channel with patients, it has the potential to provide the same disintermediation that TrialX provides for clinical trials.