Monthly Archives May 2014

Mid-level Practitioner Role to Expand with Obamacare. Do You Have What it takes to Target Them?

Despite the current government shutdown which has caused grumbling across the nation, US citizens have been able to experience history in the making; the opening of the health insurance exchanges of the Affordable Care Act (“Obamacare”). This groundbreaking portion of this legislation means that many who have been going without health care services will now be able to get treated. The exact number is still being fiercely debated, however, it is estimated that by 2014, we will be adding at least 14M people to the insurance rolls and 24M over the next decade.

Regardless of the exact number a historic number of patients will be added to our current system. Not to mention, a portion of them will likely have chronic conditions which have gone untreated for years. This will vastly increase the need for primary care providers. While the ACA has provisions for increasing the number of primary care physicians the ACA alone will not close the gap. Therefore, funding is also provided for education and development of 600 nurse practitioners and nurse-midwives by 2015. Even beyond this, much of the patient load will eventually fall on these mid-level practitioners. Evidence of the value of mid-level practitioners by industry is already being seen. Especially in certain disease states such as chronic diseases and even oncology (where nurse practitioners often lead the chemotherapy and supportive therapy), there has been considerable effort to create effective and appropriate outreach to these clinicians. Furthermore, the movement of the industry toward “patient-centered care” puts nurse practitioners and midwives front and center.

This takes us to the issue of targeting and segmenting. There are approximately 200,000 practicing nurse practitioners and physician assistants in the US. That does not count the midwives or clinical nurse specialists who also have clear leadership for disease management in certain medical areas. As with physicians, it is way more effective to determine who are the high-value mid-level practitioners and specifically reach them with targeted messaging and engagement opportunities. Forward thinking life science companies are developing strategies to reach out to this important audience. Looking at one of the customary methods for targeting clinicians, we spoke to a leading provider of prescription data for mid-level practitioners. For the entire group nurse practitioners and physician assistants, we were confidently told that only 1,000,000 prescriptions per year have been captured. Consider this fact: in a recent survey Snowfish, LLC conducted from 425 mid-level practitioners the average mid-level practitioner was writing 50 prescriptions per week. Therefore, this sample alone (representing less than 0.2% of the NP/PA universe) is writing more than 1,000,000 prescriptions a year – more than the data providers are capturing for the entire universe. It is clear that a significant prescription volume of mid-level practitioners is not being captured by data providers.

The reason is quite clear; often prescriptions written by mid-level practitioners are not written under the provider’s name but the physician with whom they work. It is almost comical to think that some of these physicians have prescription volumes attributed to them. Literally they would have to spend their entire day and night only writing prescriptions. This is also applicable to other forms of targeting data such as claims and longitudinal data. There is no reason to give up hope. There are proven methods for targeting, segmenting, and profiling mid-level practitioners which incorporate a multi-faceted data strategy. Snowfish, LLC has developed and approach that takes into account the various considerations which make a certain clinician of high importance and is based on years of knowledge and experience working with this group. Snowfish, LLC has developed a unique way to target the mid-level practitioner that is only growing in importance.

As we embark on this momentous change in our health care system, we are aware that our industry is seeing the role of the mid-level practitioner increase in magnitude. With the right approaches, companies can target them with the same pin-point accuracy that is achieved with physicians. To learn more or request our white paper on the NP/PA world please click here.


Melissa Hammond, MSN is Managing Director at Snowfish, LLC and leads their mid-level practitioner strategy services. Please go to for more information.

Posted by Melissa Hammond  |  Comments Off on Mid-level Practitioner Role to Expand with Obamacare. Do You Have What it takes to Target Them?  |  in Management Consulting

19th Annual Wharton Healthcare Business Conference: Key Insights from CEOs and Senior Healthcare Leadership

At the suggestion of a colleague, I recently attended the 19th Annual Wharton Healthcare Business Conference titled “Reshaping Healthcare: Emerging Trends Changing the Face of Our Industry.”  It was a full day in which five CEOs from major healthcare companies along with senior leadership from dozens of others discussed issues such as US healthcare reform, emerging markets, aging, diabetes/obesity, and personalized medicine.   It was a unique opportunity to hear from and participate with individuals representing a broad spectrum of the industry.  Payers, medical device, pharmaceutical, and medical institutions were all in attendance.

A great deal of the discussion dealt with the dynamic state of healthcare and the how effective use of collaboration, innovation and technology is critical to get and keep us on the right track.  While I currently focus on the business side I got my start in the clinical world and always have the individual patient in mind.  That is why it was particularly intriguing to hear CEOs of health plans and patient care delivery companies and top executives of pharma companies express the power of patient wellness to reinforce the bottom line.

It is clear that healthcare reform and the introduction of Accountable Care Organizations (ACOs) are doing a lot to drive this strategy. Unlike the fee for service structure, there is a major incentive among the various industry sectors to keep people healthy as the focus shifts from quantity of care to quality of care.  Additionally, the rules applying to the payers resulting in explosion of their membership and making it more likely that the member will remain with them for the long term is also driving some radical, but welcome change.  This being said, I have outlined the top 5 points regarding these and other related issues that were emphasized by the Conference faculty:

  • Companies are re-defining their core competencies.  Payers have shifted the focus from sick care to the whole patient, i.e., wellness and prevention.  Companies such as Humana and United Healthcare are spending considerable resources to help patients improve adherence with lifestyle modification and medication adherence.
  • Pharmaceutical companies are focusing beyond just pharmacotherapeutics to include diagnostics and disease management.  As stated by one pharmaceutical executive in the context of diabetes management, the industry’s role in management requires going “beyond the pill”.  This involves taking an active role in advocating lifestyle changes.  He
    referred to diabetes clinical trials in which all patients are prescribed lifestyle modifications regardless of treatment arm. Improvement in glucose control is usually demonstrated in the placebo arm as well. The industry is focusing on answering the question of how to gain the benefits of lifestyle modification and further accentuate that benefit through the addition of drug therapy.
  • These initiatives are not expected to be cheap and that is OK.  It was echoed by many of the experts that driving disease prevention, management and adherence is not an inexpensive endeavor but it is the right thing for the industry to do.  This was underscored during a session focused on the strategic impacts of an aging population.  The introduction of penicillin has resulted in a significant extension of the lifespan as the risk of certain death from infectious diseases has gone down exponentially.  However, individuals are living longer with chronic diseases and frailty.  While there was definitely concern as to how society will pay for care of this quickly growing population, the clear message was that the goal of effective disease management in the aging should not be designed to be cheaper, but more effective.
  • Personalized medicine poses significant opportunity but many questions still remain.  There was much discussion of the role that personalized medicine will play in the evolution of the healthcare system.  Personalized medicine is designed to address the goal of a more efficient process to determining therapy.  Still, these approaches will at least initially, create new demands for the system.  There are concerns regarding what to do with the information gained from genotyping and phenotyping.  Will it drive meaningful treatment?
  • Industry change will require appropriate leveraging of technology and data.  The majority of the discussion focused on the use of technology and patient data to facilitate wellness by driving adherence to medications and lifestyle modifications.  We learned of innovations ranging from web-based and mobile technologies to specially-designed pill bottles which send a signal thus stimulating a call or email to the individual reminding them to take their medication.

Essentially, the Conference reiterated that while these times may be quite trying for our industry, there is significant opportunity for all sectors if we think innovatively and collaboratively.  We can also explore areas that were not historically in our individual “sandboxes” in order to maintain an active position in this healthcare revolution.


Melissa Hammond, MSN, GNP is Managing Director at Snowfish, LLC a strategic consulting firm which works exclusively in the life sciences industry.  For more information, please check out

Posted by Dave Fishman  |  Comments Off on 19th Annual Wharton Healthcare Business Conference: Key Insights from CEOs and Senior Healthcare Leadership  |  in Management Consulting