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Outcomes Conference 2011 Recap

Good Intentions, Bad Behavior and a Better Tomorrow

Steve Miller, MD, MBA
Chief Medical Officer, Express Scripts
PRESENTATION 28 MB (30:24) (audio file)
Q&A 25 MB (27:37) (audio file)

Every year, suboptimal behavior costs the United States healthcare system $403 billion – all money spent with no additional health benefit obtained.

This pharmacy-related waste breaks out as follows:

  • Channel: $88.3
  • Mix: $56.7
  • Adherence: $258.3

Eliminating this waste and achieving optimal outcomes are only possible with an advanced understanding of human behavior.

Express Scripts commissioned Harris Interactive, a nationally recognized and respected research company, to conduct a study of pharmacy-related behaviors. This landmark study reveals the difference between what people want to do (intent) and what they actually do (behavior). We call this the "intent-behavior gap."

Research shows most people want the same things plan sponsors want:

82% of people taking brand-name drugs would rather be taking generics.1
70% of people getting maintenance medications in retail would rather be in home delivery.1
40% of people go to more expensive retail stores would switch to lower-cost retail stores.2

Don't let behavior fool you. The disparity is not between what plan sponsors and consumers want. It's between what consumers want and what they do. To drive out waste, we need to activate consumers' good intentions to close the intent-behavior gap.


Kit Sundararaman, PhD
Consumerology® Solutions Group, Express Scripts
PRESENTATION 10 MB (10:00) (audio file)
Q&A 25 MB (27:37) (audio file)

It is possible to eliminate 33% of pharmacy-related waste by closing the intent-behavior gap – and save the nation $134 billion annually – with proven solutions that help patients do what they already want to do.

At the Express Scripts Research & New Solutions Lab, we focus on applying the behavioral sciences to make it easy for consumers to activate good intentions.

Select Solutions is the result of our unique ability to provide breakthrough programs using the behavioral sciences. It's a family of choice-based products that engage members and leverage human behavior in a radically new way to drive substantial savings.

One or more of these consumer-friendly programs may be the right answer for your organization.


Bob Nease, PhD
Chief Scientist, Express Scripts
PRESENTATION 27 MB (28:42) (audio file)
Q&A 6 MB (5:58) (audio file)

Findings from the Harris study reframe conventional thinking: the problem is not a lack of information or incentives … it's that consumers aren't acting on their good intentions. We've been barking up the wrong tree!

With the right tools, it's possible to stage a sustained campaign over time that will lead to better health and value. Start now to:

  • Maximize home delivery
  • Maximize use of generics and low-cost brands
  • Maximize use of lower cost retail pharmacies
  • Manage specialty use on medical side
  • Maximize therapy adherence in key classes

Brian Seiz, PharmD
Clinical Services, Express Scripts
PRESENTATION 35 MB (37:06) (audio file)

Failure to take medications as prescribed costs the U.S. approximately $308 billion every year. These costs appear in the form of physician office visits, emergency room visits and hospitalizations that would not have been necessary had patients been adherent.

A problem of this magnitude cannot be solved with a one-size-fits-all approach. Through multiple test-and-learn efforts over the years, our strategy has evolved. We studied the effects of messaging and framing, copayment adjustments, channel selection, memory-aid devices and more. Our current multi-faceted approach to intervention encompasses our in-depth understanding of patient perception about adherence and predictive modeling.

1 Harris Interactive on behalf of Express Scripts from January 14 to 19, 2011, among 2,099 U.S. adults aged 18 and over currently taking at least one prescription drug regularly for a health condition that has lasted (or is expected to last) at least 12 months.
2 Express Scripts Research, 2011.

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