A blog covering the health/care ecosystem and people.

Forget about the 80/20 Rule. Welcome to the 41/12 Metric: 12% of U.S. adults account for 41% of healthcare spending in America, calculated by RAND Corporation in their new report, Multiple Chronic Conditions in the United States. RAND’s report quantifies the growing chronic care landscape in America that will be a burdensome legacy for younger Americans in terms of financial and social costs. First, a definition: RAND defines a chronic condition as a physical or mental health issue that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment. Older adults are more likely to

Former Surgeon General Dr. Regina Benjamin was the first person who quoted to me, “Health isn’t in the doctor’s office. It’s where people live, work, play and pray,” imparting that transformational mantra to me in her 2011 interview with the Los Angeles Times. I wrote about that lightbulb moment here in Health Populi. Dr. Benjamin was the 18th Surgeon General, appointed by President Obama in 2009. As “America’s Doctor,” she served a four-year term, her mission focused on health disparities, prevention, rual health, and children’s health. Today, Dr. Benjamin wears many hats: she’s the Times Picayune/NOLA.com professor of medicine at

As the annual meeting of the American Telemedicine Association convenes this week in Orlando, there’s a lot of telehealth news to curate. The topline of it all: virtual healthcare is mainstreaming, with more providers, payors, and patients aligning in support of virtual health care delivery. Three-quarters of providers have some form of basic telemedicine or telehealth in place. One-third of healthcare providers use some flavor of virtual care technology in their workflow, according to research from KPMG and HIMSS Analytics summarized in the first graphic. KPMG sees virtual care options — remote patient monitoring, enhanced portals, and web interactions for patient-provider

We make our health across many dimensions: via nutrition, safe physical/built environments, financial wellness, education, and the environment among them. In this last category, the environment, new research finds that climate change has a significant impact on health. The report, Mental Health and Our Changing Climate: Impacts, Implications, and Guidance, was sponsored by the American Psychological Association in conjunction with Climate for Health and ecoAmerica. “Climate change-induced severe weather and other natural disasters have the most immediate effects on mental health in the form of the trauma and shock due to personal injuries, loss of a loved one, damage to

It’s generally thought that healthy people are more health-engaged than people diagnosed with medical issues. But that’s old health school thinking: most health consumers managing chronic conditions say they’ve become more engaged with healthcare over the past two years, according to CDW’s 2017 Patient Engagement Perspectives Study. In 2017, 70% of patients told CDW they’d become more engaged with healthcare, up from 57% in 2016. That’s a 20% growth in the proportion of patients engaging in healthare in just one year. Growing signs of patient engagement are in people driven to access online patient portals for their personal healthcare records: People

Geography is destiny, Napoleon is thought to have first said. More recently, the brilliant physician Dr. Abraham Verghese has spoken about “geography as destiny” in his speeches, such as “Two Souls Intertwined,” The Tanner Lecture he delivered at the University of Utah in 2012. Geography is destiny for all of us when it comes to our health and well-being, once again proven by Gallup-Healthways in The State of American Well-Being 2016 Community Well-Being Rankings. The darkest blue circles in the U.S. map indicate the metro areas in the highest-quintile of well-being. The index of well-being is based on five metrics, of consumer self-ranking

We are all Amazon Prime primed as consumers now. So it should not surprise healthcare providers, plans and suppliers that consumers expect just-in-time convenience for their healthcare, Accenture has found. Mind the gap: 8 in 10 U.S. patients would welcome some aspect of virtual healthcare, but only 1 in 5 providers is meeting that need. The consumer demand for virtual care is palpable for: Tracking biometrics, among 77% of consumers (say, for measuring blood pressure or blood glucose for people managing diabetes) Following up appointments, for 76% of people after seeing a doctor or being discharged from hospital Receiving reminders

Health citizens in America will need to be even more mindful, critical, and engaged healthcare consumers in 2017 based on several factors shaping the market; among these driving forces, the election of Donald Trump for U.S. president, the uncertain future of the Affordable Care Act and health insurance, emerging technologies, and peoples’ growing demand for convenience and self-service in daily life. The patient is increasingly the payor in healthcare. Bearing more first-dollar costs through high-deductible health plans and growing out-of-pocket spending for prescription drugs and other patient-facing goods and services, we’re seeking greater transparency regarding availability, cost and quality of

The American Psychological Association, which conducts the annual Stress in America survey, has found rising levels of stress during #Election2016. 1 in 2 U.S. adults says the U.S. presidential election is a source of stress, with Democrats and Republicans equally likely to feel this way. So the APA is offering tips on how we can deal with the health impacts of election season stress. These include: Take a digital break and limiting your media consumption, reading or listening to “just enough to stay informed.” Instead, go for a walk and do things you enjoy. Avoid getting into and limit discussions about the

Managing stress, weight, mental health, sleep, and heart function are among the top-most desired reasons already-connected health consumers are interested in further connecting their health, according to The 2016 HealthMine Digital Health Report. The most popular tools people use to digitally manage their health deal with fitness and exercise (among 50% of connected health consumers), food and nutrition (for 46%), and weight loss (for 39%). 3 in 4 people who use digital health tools say they have improved their health by connecting to these tools. 57% of digital health users also say going health-digital has lowered their healthcare costs. The survey

Large employers are taking more control over health care costs and quality by pressuring changes to how care is actually delivered, based on the results from the 2017 Health Plan Design Survey sponsored by the National Business Group on Health (NBGH). Health care cost increases will average 5% in 2017 based on planned design changes, according to the top-line of the study. The major cost drivers, illustrated in the wordle, will be specialty pharmacy (discussed in yesterday’s Health Populi), high cost patient claims, specific conditions (such as musculoskeletal/back pain), medical inflation, and inpatient care. To temper these medical trend increases,

The bad news: mortality rates haven’t improved much and obesity rates rose in one-third of communities. The good news: public health gains can be made in resource-poor communities with the right health policies, based on research from The Commonwealth Fund, Rising to the Challenge, the Fund’s Scorecard on local health system performance for 2016. The top-line of this benchmark report is that health care in the U.S. has, overall, improved more than it’s declined. Among the big levers driving health care improvement in the past year have been the further expansion of health citizens covered with insurance through the Affordable

“Work is the second most common source of stress, just behind financial worries,” introduces The Business of Healthy Employees report from Virgin Pulse, the company’s 2016 survey of workplace health priorities published this week. Virgin Pulse collaborated with Workforce magazine, polling 908 employers and 1,818 employees about employer-sponsored health care, workers’ health habits, and wellness benefit trends. Workplace wellness programs are becoming more holistic, integrating a traditional physical wellness focus with mental, social, emotional and financial dimensions for 3 in 4 employers. Wearable technology is playing a growing role in the benefit package and companies’ cultures of health, as well

The top health-related activities among U.S. adults include routinely taking vitamins and supplements, and prescription medicines, according to Frost & Sullivan’s report, Are We Engaged Yet? Their response to the titular question lies in in the subtitle: “US consumers appear confused or ambivalent about what it means to be proactive or engaged in their health.” 1 in 2 U.S. adults says they’re “somewhat engaged” in their healthcare, according to Reenita Das’s write-up on the study in Forbes magazine. She notes that: Consumers with higher incomes have more confidence in their access to health care services and quality of care Budget-constrained consumer

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

Most people in the U.S. acknowledge that their richest country in the world has a broken healthcare system, especially when it comes to costs. A handful of think tanks and lawmakers offer fixes for American healthcare. Now there’s a new problem-solver in healthcare town, Health:Further, and they aim to move U.S. health forward by building bridges between stakeholders in the U.S. health ecosystem. My longtime colleague and friend, Andre Blackman of Pulse+Signal, has joined the organization as “Producer.” Here, we’ll learn more from my (JSK) interview with Andre (AB) about the organization, their mission, and plans to go beyond “disruption”

It’s Christmastime, so I’m thinking about connections. “Connectivity” can be social (offline and online), which is indeed a health factor (see Christakis and Fowler on being Connected). But the kind of connectivity to which I’m referring is broadband, WiFi, the kind most often associated with data plans, cable to the home, and free WiFi at your favorite coffee or fast food joint. That kind of connectivity is also a social determinant of health, and is increasingly becoming so for all people. Yet as peoples’ need for internet connectivity is fast growing, especially for health, home broadband connectivity has reached a

Shocking statistics were published in this week’s Proceedings of the National Academy of Sciences showing rising death rates for middle-age men. The major causes: suicide, drug and alcohol poisoning, and liver diseases. The line chart illustrates the death rates per 100,000 population of U.S. whites (“USW”), the top line on the graph, compared with 45-54 year old men in France, Germany, the United Kingdom, Canada, Australia, and Sweden — along with U.S. Hispanic males (“USH”) — for whom death rates have fallen since 1990. The authors note that the increase in midlife mortality is only partly understood. Increased availability of

Noncommunicable diseases (NCDs) are the #1 cause of death in the world. NCDs are the yin to the yang of infectious diseases. Mortality from infectious disease has fallen as national economies have developed, while NCDs such as heart disease, respiratory disease, cancer, diabetes, and other NCDs are a growing burden. Health Affairs devotes its September 2015 issue to The Growing Burden of Noncommunicable Diseases, featuring research focusing both on global trends and U.S.-specific challenges. In their look into the relationships between NCDs, unhealthy lifestyles and country wealth, Thomas Bollyky et. al. note that NCDs aren’t only the “diseases of affluence,”

Workplace well-being programs are going beyond physical wellness, incorporating personal stress management and financial management. Nearly one-half of employers offer these programs in 2015. Another one-third will offer stress management in the next one to three years, and another one-fourth will offer financial management to workers, according to Virgin Pulse’s 2015 survey of workplace health priorities, The Busness of Healthy Employees. The survey was published June 1st 2015, kicking off Employee Wellbeing Month, which uses the Twitter hashtag #EWM15. It takes a village to bolster population health and wellness, so Virgin Pulse is collaborating with several partners in this effort

People with anxiety, depression, interpersonal challenges, and substance abuse go to work every day. Together, these factors erode the mental health and wellbeing of workers, and this negatively impacts companies’ productivity, workplace morale, and profitability. Employers are increasingly taking notice of their role in promoting mental health on-the-job, a trend captured in the report Promoting Mental Well-being: Addressing Worker Stress and Psychosocial Risks, an international survey of employers published in May 2015 by Buck Consultants, part of Xerox. The survey polled 439 employers in 31 countries, and the report focuses on the results in four of those nations: Brazil, Singapore, the

There’s a trifecta of books written by three brilliant doctors that, together, provide a roadmap for the 21st century continuum of health care: The Patient Will See You Now by Eric Topol, MD; The Digital Doctor from Robert Wachter, MD; and, Being Mortal, by Atul Gawande. Each book’s take provides a lens, through the eyes of a hands-on healthcare provider, on healthcare delivery today (the good, the warts and all) and solutions based on their unique points-of-view. This triple-review will move, purposefully, from the digitally, technology optimistic “Gutenberg moment” for democratizing medicine per Dr. Topol, to the end-game importance of

If you’re meeting with a physician in the next week or two, put on your empathy hat: chances are, they are feeling burned-out. Overall 46% of physicians report they were burned out in 2014, up from just under 40% last year. Medscape’s Physician Lifestyle Report 2015 finds that at least one-half of physicians are burned-out who work in critical care, emergency medicine, family medicine, internal medicine, general surgery, and infectious disease (including HIV). And, at least 37% of physicians are burned-out working in all other specialties, shown in the first chart. Medscape gauges doctors’ self-assessments of burnout with a lens

‘Tis the season for annual health trendcasting, which is part of my own business model. Here’s a curated list of some of my favorite trend reports for health care in the new year, with my Hot Points in the conclusion, below, summarizing the most salient trends among them. TechCrunch’s Top 5 Healthcare Predictions for 2015: In this succinct forecast, Walmart grows its presence as a health plan, startups get more pharm-funding, hospitals channel peer-to-peer lending, Latinos emerge as a “most-desired” health care segment, and Amazon disrupts the medical supply chain. Experian 2015 Data Breach Forecast: Healthcare security breaches will be

The supply side of telehealth has been readying itself for nearly a decade. The demand side appears to be aligning in 2014 for adoption to grow and sustain (some) solid business models. On the demand side, Towers Watson’s 2014 survey of large employers forecasts growth among companies that will offer telemedicine in 2015. Towers found that 37% of employers planned to offer telemedicine to workers as a lower-cost site of care; 34% more employers were considering telemedicine in 2016 or 2017.  The health benefits adviser calculates that employers could save over $6 billion if industry replaces virtual health consultations with

“Telehealth isn’t about seeing a provider by video: it’s about decision making,” Dr. Adam Darkins, leader of the U.S. Department of Veterans Affairs National Telehealth Programs, told the audience in his keynote address at the Government Health IT Conference in Washington, DC, on June 17, 2014. Dr. Darkins, trained as a neurosurgeon, realized earlier in his career “time and again,” he said, that he should have seen his patients more frequently in-between face-to-face visits. “A good decision downstream can make a lot of difference to someone’s longevity,” Dr. Darkins recognized. He’s worked with a team at the VA to build

4 in 5 U.S. patients – 81% of them – want an equal say in health care decisions with their care provider, according to a 2013 Institute of Medicine study. At the same time, patients choose to take “drug holidays,” opting out of taking three or more doses of medicines in a row, or adopt “trail mix” approaches to taking prescriptions, casually and inappropriately mixing Rx drugs. Welcome to your world, pharma industry: where people say they want control, but somehow don’t exercise it in the way you — drug companies — define as “compliance” or “adherence.” Customer experience in

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

Employers who provide health insurance are getting much more aggressive in 2013 and beyond in terms of increasing employees’ responsibilities for staying well and taking our meds, shopping for services based on cost and value, and paying doctors based on their success with patients’ health outcomes and quality of care. Furthermore, nearly one-half expect that technologies like telemedicine, mobile health apps, and health kiosks in the back of grocery stores and pharmacies are expected to change the way people regularly receive health care. What’s behind this? Increasing health care costs, to be sure, explains the 18th annual survey from the National

  One in two doctors is burned out. Physicians are seeing more patients in a day and spend less time with each of them. This leads to job burnout, and greater probability for medical errors and eventual liability challenges, along with feeling pushed toward early retirement. In a study published in August 2012 in the Archives of Internal Medicine, Mayo Clinic researchers learned that physicians are more burned out than workers in any other profession. And those at greatest risk of “being on a hamster wheel,” as Dr. Jeff Cain, president-elect of the American Academy of Family Physicians describes the scenario, are primary

The antidepressant market is worth $20 billion in the U.S. Antidepressants were the third most common prescription drug taken by Americans of all ages in 2005-2008 and the most frequently used by people age 18-44 (according to the National Center for Health Statistics). About one in 10 Americans age 12 and over takes an antidepressant medication. But there is little evidence that pharmacotherapy should be used as a first line of treatment for mild to moderate depression. Why are anti-depressants the first line of treatment for mild to moderate depression in the U.S.? The answer lies in the fact that

Therapy is now a click away, whether on a computer, a smartphone or a tablet. Drs. Freud, Ellis and Beck, heads-up: the Internet is the new couch of psychiatry. That is, at least for people with mild to moderate depression and those with anxiety, as I report in my latest paper for the California HealthCare Foundation, The Online Couch: Mental Health Care on the Web. Many factors are aligning that make therapy online an effective extension of face-to-face therapy for the right patients at the right time in the U.S.: An undersupply of psychologists, psychiatrists, and other therapists, especially in rural and