A blog covering the health/care ecosystem and people.

    CVS Health’s acquisition of Aetna was approved this week by U.S. Federal regulators after months of scrutinizing the antitrust-size-market control implications of the deal. I wrote this post on the deal as an inflection point in American healthcare on 3rd December 2017 when CVS and Aetna announced their marriage intentions. This post updates my initial thoughts on the deal, given the morphing US healthcare market on both the traditional health services front and fast-evolving retail health environment. The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal

The impact of health and wellness is on most consumers’ minds, Nielsen’s consumer research has found. Sarah Schmansky, Nielsen’s strategy leader for health, wellness and “fresh,” moderated a panel at the GMDC Health-Beauty-Wellness Conference in Orlando today that brainstormed how consumers are shopping for health. Underneath that “how” is more than the next-best-me-too-product for allergy or acne. It’s about efficacy of the product at the core, but bundled with social responsibility and sustainability, informative packaging, transparency of ingredients, and education that empowers the individual. “Self-care is the driver of growth,” Sarah began the discussion. But these needs under the self-care umbrella

All sectors who are stakeholders in the healthcare ecosystem aren’t created equal, Accenture explains in their report, Healthcare’s future winners and losers. Observing the influx of new flavors of entrants like Amazon and Google, start-ups like Iora Health, Oscar and FetchMD, begs the question: how will legacy healthcare system players fare? Who will survive, and what will be the success factors that bolster long-term viability? To answer that question, Accenture points to three market trends that set “new rules” in healthcare: Blurred lines, which are the grey areas and adjacencies between technology, service, finance, and retail The middle of nowhere,

The Search for Value is the prevailing journey to a Holy Grail in healthcare these days. On that, most stakeholders working on the ground, globally. can agree. But whose value is it, anyway? Three reports published in the past few weeks give us some useful perspective on that question, woven together in today’s Health Populi blog. Let’s start with the Philips Future Health Index, which assesses value to 16 national health systems through three lenses: access, satisfaction, and efficiency. The results are shown in the map. “Value-based healthcare is contextual, geared towards providing the right care in the right place, at

Hospital and healthcare providers are getting real about improving patient and health consumer experience, the latest Kaufman Hall research finds. The company’s 2018 State of Consumerism in Healthcare report is out, subtitled, “Activity in Search of Strategy.” Kaufman Hall has developed a Healthcare Consumerism Index for healthcare providers based on four pillars: access to care, consumer experience, pricing, and a strong foundation of consumer insights. Based on their assessment of providers on these components, Kaufman Hall found identified four tiers of performance: The top-performing group, Tier 1, includes only 8% of providers. These are the early adopters who allocate resources

Less can lead to more for so many things: eating smaller portions, lowering sugar consumption, and driving less in favor of walking or cycling come to mind. When it comes to healthcare utilization, doing less can also result in equal or even better outcomes. Groundbreaking research presented at this week’s ASCO meeting found that some women diagnosed with certain forms of cancer do not benefit from undergoing chemotherapy. The American Society of Clinical Oncology (ASCO) is one of the largest medical meetings annually, and at this huge meeting these research results for the TAILORx trial were huge news with big

The rolls of the uninsured are growing in America, the latest Gallup-Sharecare Poll indicates. The U.S. uninsurance rate rose to 12.2% by the fourth quarter of 2017, up 1.3 percentage points from the year before. 2017 reversed advancements in health insurance coverage increases since the advent of the Affordable Care Act, and for the first time since 2014 no states’ uninsured rates fell. The 17 states with declines in insurance rates were Arizona, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa, Missouri, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Among these, the greatest

In the U.S., trust in the healthcare industry declined by 9 percentage points in just one year, declining from 62% of people trusting — that’s roughly two-thirds of Americans — down to 53% — closer to one-half of the population. I covered the launch of the 2018 Edelman Trust Barometer across all industries here in Health Populi in January 2018, when this year’s annual report was presented at the World Economic Forum in Davos as it is each year. The Edelman team shared this detailed data on the healthcare sector with me this week, for which I am grateful. Check

Chronic diseases are what kill most people in the world. In the U.S., the chronic disease burden takes a massive toll on both public health and mortality, accounting for 7 in 10 deaths in America each year. That personal health toll comes at a high price and proportion of national health expenditures. A new alliance between Livongo and Cambia Health seeks to address that challenge, beginning with diabetes and scaling to other chronic conditions. Livongo has proven out the Livongo for Diabetes program, which has demonstrated positive outcomes in terms of patient satisfaction and cost-savings. The plan with Cambia is

In 2018, spending on branded prescription drugs will fall in wealthy countries, while spending on specialty drugs will increase, resulting in flat medicines spending. In the U.S., net spending on medicines will fall in 2018 and remain flat at about $800 per person, according to forecasts in 2018 and Beyond: Outlook and Turning Points, from the IQVIA Institute for Human Data Science. “Concerns about existing medicine costs have captured significant attention,” the introduction warns, setting the stage for slowing growth. Key factors for slow growth include payor concerns about budgets and the consideration of value when deciding on access for new

Over four in 10 U.S. workers were enrolled in a high-deductible health plan in the first 9 months of 2017, according to the latest research published by the National Center for Health Statistics, part of the Centers for Disease Control in the U.S. Department of Health and Human Services. The report details Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2017. About 28 million people were uninsured in the U.S. in 2017, about the same proportion as in 2016 — but nearly 20 million fewer than in 2010, as the line chart illustrates. The

In 2020, national health expenditures (NHE) in the United States will exceed $4 trillion to cover 334.5 million Americans. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40 of health spending per person. I sat in on a press call today with researchers from the Office of the Actuary working in the Centers for Medicare and Medicaid Services (CMS) to review the annual forecast of the NHE, published in Health Affairs in a statistically-dense eleven page article titled, National Health Expenditure Projections, 2017-2026: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth. What are those “fundamentals” pushing up healthcare spending?

Health care ranks highest among working Americans as the top critical issue facing the country, well above terrorism, the role of the Federal government, unemployment and jobs, education, immigration and taxes. Over half of American workers also rate the country’s healthcare system as “poor” or “fair,” based on the results of the EBRI/Greenwald & Associates Health and Workplace Benefits Survey. Workers dissatisfaction with U.S. healthcare is based largely on cost: one-half of workers experienced an increase in health care costs in the past year. Furthermore, only 22% are satisfied with the cost of their health insurance plan, 18% are satisfied

Connecting Life’s Dots, the organization Living in Digital Times partners with CES to deliver conference content during the show. At CES 2018, LIDT is connecting a lot of dots to help make health streamline into daily living. Robin Raskin, founder, kicked off LIDT’s press conference setting the context for how technology is changing lifestyles. Her Holy Grail is to help make tech fun for everybody, inclusive for everybody, and loved by everybody, she enthused. LIDT has been a presence at CES for many years, conceiving the contest the Last Gadget Standing, hosting  tech-fashion shows with robots, and supporting a young innovators

Nurses working in the U.S. are number one when it comes to ethics and honesty, the Gallup Poll found for the sixteenth year in a row. After nurses, military officers, grade school teachers, medical doctors and pharmacists rank second through fifth in ethical-line behind top-rated nursing. It’s important to note that consumers have ranked pharmacists and doctors in second and third place in this annual survey for many years. This year, both professions fall below the military and teachers. Nurses have been #1 in this study every year since Gallup launched the survey in 1999, except for 2001 when firefighters topped

In 2016, most consultations between patients and Kaiser-Permanente Health Plan were virtual — that is, between consumers and clinicians who were not in the same room when the exam or conversation took place. Virtual healthcare may be the new black for healthcare providers. Mercy Health System in St. Louis launched a virtual hospital in 2016, covered here in the Health Populi post, “Love, Mercy, and Virtual Healthcare.” Intermountain Healthcare announced plans to build a virtual hospital in 2018. And, earlier this month, UPMC’s CEO, Jeffrey Romoff, made healthcare headlines saying, “UPMC desires to be the Amazon of healthcare.” UPMC, aka University of Pittsburgh

  A response to Amazon’s potential moves in healthcare and pharmacy…strategic positioning for the post-Trump healthcare landscape…vertical integration to better manage healthcare utilization and costs…these, and other rationale have been offered by industry analysts and observers of the discussions between CVS and Aetna, for the former to acquire the latter. “A pharmacy chain buying a health insurance company?” many have asked me over the past few days. These inquiring minds include people who work both inside and outside of health/care. I ask back: in 2017 and in the future, “What is a pharmacy? What is a health plan?” See the

U.S. consumers’ most-valued brands include Apple, Google, Amazon, Netflix, Pinterest, Android, Spotify, PIXAR, Disney and Samsung, according to  the 2017 Brand Relevance Index from Prophet. The top 50 are shown in the first chart. On the second chart, I’ve circled in red the brands that have reach into healthcare, health, fitness, and wellness. Arguably, I could have circled every brand in the top 50 because in one way or another, depending on the individual, people find health “everywhere” that’s relevant to them based on their own definitions and value-systems. This is Prophet’s third year conducting this study, and I was

Last week, President Trump once again used the “M” word (“murder”) in a sentence accusing the pharmaceutical industry of too-high priced products for U.S. health citizens. The sentence included the phrase, “Drug companies are getting away with murder.” That week, USA Today published an article on a new FDA-approved specialty drug therapy that could add up to over a $1 mm price tag. There is much to report in the world of pharmaceutical innovation, pricing, and patient Rx coverage this month. The CVS Health – Epic announcement ranks high in Health Populi’s vision for the evolving health/care ecosystem, bringing together two

“Wellness is a way to cope with the demands and rigors of new modern lifestyles,” according to Ogilvy in their latest report, The Wellness Movement Pioneers: New Global Research Findings. The report makes the case that the mass public are project-managing life adopting mental health, nutrition, physical activity and sleep to boost personal wellness. There is a big business model underneath this, which has inspired Ogilvy to start up the company’s Health & Wellness Practice. Think of this report as the group’s own business case to address the $3.7 trillion global wellness economy, illustrated by the first image. The report

On July 23, 1967, I was a little girl wearing a pretty dress, attending my cousin’s wedding at a swanky hotel in mid-town Detroit. Driving home with my parents and sisters after the wedding, the radio news channel warned us of the blazing fires that were burning in a part of the city not far from where we were on a highway leading out to the suburbs. Fifty years and five days later, I am addressing the subject of health equity at a speech over breakfast at the American Hospital Association 25th Annual Health Leadership Summit today. In my talk,

  6 in 10 people diagnosed with a chronic condition do not feel they’re doing everything they can to manage their condition. At the same time, 67% of healthcare providers believe patients aren’t certain about their target health metrics. Three-quarters of physicians are only somewhat confident their patients are truly informed about their present state of health. Most people and their doctors are on the same page recognizing that patients lack confidence in managing their condition, but how to remedy this recognized challenge? The survey and report, Strengthening Chronic Care, offers some practical advice. This research was conducted by West

Patient satisfaction should be baked into healthcare provider service goals, according to Prioritizing the Patient Experience from West Corporation, the communications company. West is in the business of improving communications systems, and has a vested interest in expanding comms in health. This research polled patients and providers to assess how each healthcare stakeholder perceives various patient satisfaction issues, which when done well are grounded in sound communications strategy and technologies. Patient satisfaction is directly linked to the bottom lines of healthcare organizations, West contends, due to two key drivers: Evolving payment models are increasingly tying patient satisfaction to reimbursements; and,

U.S. consumers consider Consumer Electronics to be the most innovative industry they know. But people believe that Health & Wellness should be the most innovative sector in the economy. Welcome to the 2017 Klick Health Consumer Survey, which focuses on health innovation in the context of peoples’ hopes for technology to improve health and healthcare. 1 in 2 people say that technology has had a positive impact on their health and wellness, skewing slightly more toward younger people (although 45% of people 55 years of age and older agree that tech positively contributes to health. 41% of consumers say they’ve

A person enrolled in a high-deductible health insurance plan is more likely to be cost-conscious than someone with traditional health insurance. Cost-consciousness behaviors including checking whether a plan covers care, asking for generic drugs versus a brand name pharmaceutical, and using online cost-tracking tools provided by health plans, according to the report, Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey from EBRI, the Employee Benefit Research Institute. A high deductible is correlated with more engaged health plan members, EBRI believes based on the data. One example: more than one-half of people enrolled

“What doctor?” asks the title of a PwC report on the emergence of artificial intelligence (AI) and robotics in healthcare. AI and robot technology are penetrating all aspects of the macroeconomy, and they’ve begun to re-shape the health economy, as well. Underneath PwC’s titular question are two lenses: the role of the AI/robot doctor vis-a-vis the role of the human doctor. PwC identifies eight areas that AI and robotics will impact in healthcare, shown in the first diagram: Decision making Diagnosis Early detection End of life care Keeping well Research Training, and Treatment. For keeping well, AI and robotics can

The economics of kidney disease in America is a hefty burden: about 26 million people in the U.S. have some aspect of chronic kidney disease and are at-risk of kidney failure. The number of people diagnosed with kidney disease doubled during each of the last two decades, according to the American Society of Nephrology. The annual cost of treating end-stage renal disease (ESRD) is over $32 billion, consuming 28% of Medicare expenditures…and increasing. Now consider the personal costs of dialysis in America: about $500 for a single hemodialysis treatment in a center, roughly $72,000 a year for one patient. There

A family in Orange County, California, paid a brother’s 1982 hospital bill by selling 50 pieces of their newly-deceased mother’s jewelry. “It’s what she wanted,” the surviving son told a reporter from The Orange County Register. The cache of jewelry fetched enough to pay the $10,000 bill. Patients in the U.S. cobble together various strategies to pay for healthcare, as the first chart drawn from a Kaiser Family Foundation report on medical debt attests. As health care consumers, people cut back on household spending like vacations and household goods. Two-thirds of insured patients use up all or most of their savings

People want to live healthier lives, and consumer good companies are responding to these demands to keep and gain market share and profit margins. Consumer product firms reformulated over 180,000 consumer products in 2016 for in response to consumers’ health and wellness wishes, based on data collected by Deloitte for The Consumer Goods Forum project (CGF) and published in The CGF Health & Wellness Progress Report. The CGF is an industry network of some 400 consumer goods, retail, and service companies supporting the global adoption of standards and practices. This Report focused on the CGF members’ progress toward health and wellness

U.S. consumers love technology, retail, and consumer products; automotive company reputations are improving, even with Volkswagen’s emission scandal potentially tarnishing the industry segment. The only corporate sector whose reputation fell in 2016 was the pharmaceutical industry’s, according to the Harris Poll’s 2017 Reputation Quotient report. The line chart illustrates the decline of pharma’s reputation, which puts it on par with its consumer perceptions in 2010 — just before Medicare Part D was legislated and implemented, which improved pharma’s image among American health citizens (especially older patients who tend to be more frequent consumers of prescription drugs). Pharma’s reputation quotient is back

3 in 4 Americans’ health care costs have risen in the past few years. Two-thirds of Americans want to lower their costs, but don’t know how to do that. A survey from Amino released this week, conducted by Ipsos, has found that one in five people could not afford to pay an unexpected medical bill without taking on debt, and another 18% of Americans could only afford up to $100 if presented with an unexpected medical bill. This medical debt side effect more likely impacts women versus men, the less affluent, the unmarried, and those with no college degree. While

Telehealth has come of age at HIMSS in 2017. No longer is the concept relegated to footnote or edge-booth status on the conference floor. Instead, telehealth, broadly defined, is now a mainstream concept embraced by healthcare providers, payors and, increasingly, consumers. I spent time brainstorming telehealth with one of the pioneers of modern telehealth in the U.S., Dr. Roy Schoenberg, who co-founded American Well with his brother Ido Schoenberg, in 2007. As such, the company is among the most mature telehealth entities operating in America, delivering live video health visits to millions of health consumers through the American Well telehealth

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

Healthcare consumers are in a “state of denial,” according to research conducted for Alegeus, the consumer health benefits company. Overall, 3 in 4 consumers feel fear when it comes to their healthcare finances: most people worry about being hit with unexpected healthcare costs they can’t afford, and nearly half fear they won’t be able to afford their family’s healthcare needs. The wordle illustrates consumers’ mixed feelings about healthcare: while people feel frustrated, overwhelmed, powerless, confused and skeptical about healthcare in America, there are some emerging adjectives hinting at growing consumer health muscle-building: optimistic, hopeful, supported, engaged, accountable. Still, denial and

It’s human nature to take what we have for granted. But it wasn’t all that long ago that millions of Americans were uninsured. Since the advent of the Affordable Care Act (ACA), American voters’ feelings about the plan were split roughly 50/50, with slightly more U.S. voters, at the margin, disliking Obamacare than liking it. “Don’t it always seem to go that you don’t know what you’ve got ’til it’s gone,” Joni Mitchell sang in her iconic song, “Big Yellow Taxi.” In the lyrics, Mitchell was  referring back in 1970 to land development and eroding public green space. “You paved

In President Donald Trump’s preliminary thoughts about health care in America, the landscape would feature a mix of tax credits, health savings accounts, high-risk pool, state Medicaid block grants, and regulatory control shifting from the Federal government to the states, according to PwC’s forecast for the new year, Top health industry issues of 2017. PwC frames the 2017 top healthcare issues under the overall strategic imperative of value, with three categories: Adapting for value Innovating for value Building for value. The ten top issues that will shape U.S. healthcare for the next year, PwC expects, will be: An uncertain fate for the

Based on a TIME magazine interview conducted today with President-Elect Donald Trump, the pharmaceutical and life science industries may expect to find coal in their Christmas stocking, and tougher pricing constraints in 2017. “I’m going to bring down drug prices,” Mr. Trump said, quoted on the TIME website naming him Person of the Year. “I don’t like what’s happened with drug prices.” As CNN put it, “Trump put the entire drug industry on notice on Wednesday in an interview with Time.” In fact, Donald Trump’s campaign website talked about drug importation as one potential tactic consumers could potentially use to

The global market for spending on medicines will high $1.5 trillion by 2021, according to the latest forecast from QuintilesIMS. Drug spending grew about 9% in the past two years, and is expected to moderate to 4 to 7 percent annually over the next five years. That dramatic 9% growth was heavily driven by new (expensive) specialty drugs to treat Hepatitis C (e.g., Harvoni and Sovaldi) and cancer therapies that hit the market in the past couple of years. There will be a “healthy level” of new innovative meds coming out of the drug pipeline in the next several years

“See me, feel me, touch me, heal me,” is the lyrical refrain from The Who’s Tommy. These eight words summarize what Deloitte has learned from the firm’s latest look into healthcare consumers, published in the report, Health plans: What matters most to the health care consumer. U.S. consumers’ demands for health care are for: Personalization from doctors, hospitals, and other care providers — the most important priority; Economically rational coverage and care choices; Convenience-drive access and care experience; and, Digitally connected care. Personalization is Job 1: “Consumers want to be heard, understood, and given clear directions through a personalized health care

“The patient is the best sensor,” asserted Jamie Heywood, founder of Patients Like Me, during the perennial meeting sponsored by PwC, the 180° Health Forum. This event featured several panels of PwC’s curated group of so-called “provocateurs” in healthcare, and I was grateful to be one of nine selected for the event. Heywood joined Dr. Leanna Wen, Baltimore City Health Commissioner, and me in a panel called, “Strange Bedfellows or Soul Mates? The New Dating Game in Health.” The theme of our collective brainstorm was how collaborations across the ecosystem could help make health and healthcare better. The drawing is

People feel like get-no-respect Rodney Dangerfield when they deal with health insurance, government agencies, or pharma companies. Consumers feel much more love from personal care and beauty companies, grocery and fitness, according to a brand equity study by a team from C Space, published in Harvard Businss Review. As consumer-directed health care (high deductibles, first-dollar payments out-of-pocket) continues to grow, bridging consumer trust and values will be a critical factor for building consumer market share in the expanding retail health landscape. Nine of the top 10 companies C Space identified with the greatest “customer quotient” are adjacent in some way to health:

Existing healthcare industry players – the stakeholders of hospitals, physicians, pharma/life sciences, medical device manufacturers, and health plans – are operating in a whirlwind of change. While there are many uncertainties in this period of transition, there’s one operational certainty: learn to do more with less payment. That’s due to the growing pursuit of payors paying for value, not on the basis of volume or what’s “done” to a patient in care delivery. At the same time, another force re-shaping healthcare is interest and focus on wellness and health management. Combined with the growing health economic value proposition, wellness and

It takes a couple to bend the health care cost curve when you’re senior in America, according to the EBRI‘s latest study into Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households. In previous research, The Employee Benefit Research Institute (EBRI) has calculated that health care expenses are the second-largest share of household expenses after home-related costs for older Americans. Health care costs consume about one-third of spending for people 60 years and older according to Credit Suisse. But for singles, health care costs are significantly larger than for couples, EBRI’s analysis found. The average per-person out-of-pocket spending for

In the past week, the Pharmaceutical Research and Manufacturers of America (PhRMA), the advocacy organization for the branded prescription drug industry, published Medicines: Costs in Context,” the group’s lens on the value of prescription drugs in the larger healthcare economy. Their view: that prescription drug costs comprise a relatively low share of health care spending in America, and a high-value one at that. PhRMA contends that 10% of the health care dollar was allocated to prescription drugs in 2015, the same proportion as in 1960. “Even with new treatments for hepatitis C, high cholesterol and cancer, spending on retail prescription

As consumers gain more financial skin in the game of paying for health care, we look for more retail-like experiences that reflect the Burger King approach to consuming: having it our way. For health are, that means access, convenience, transparency and fair costs, respect for our time, and a clear value proposition for services rendered. That doesn’t happen so much in the legacy health care system — in hospitals and doctors’ offices. It has already begun to happen in retail health settings and, especially, in the changing nature of pharmacies. Retail Health 2027, a special supplement to Drug Store News

Retail clinics are a growing source of primary care for more U.S. health consumers, discussed in a review of retail clinics published by Drug Store News in July 2016. There will be more than 2,800 retail clinics by 2018, according to Accenture’s tea leaves. Two key drivers will bolster retail clinics’ relevance and quality in local health delivery systems: Retail clinics’ ability to forge relationships with legacy health care providers (physicians, hospitals); and, Clinics’ adoption and effective use of information technology that enables data sharing (e.g., to the healthcare provider’s electronic health records system) and data liquidity (that is, securely moving

When consumers consider the many stakeholder organizations in healthcare, a majority trust pharmacists first, then doctors and dentists. Hospital and health insurance execs, and members of Congress? Hardly, according to a survey from Meyocks, a marketing consultancy. Meyocks conducted the survey via email among 1,170 US adults, 18 years of age and older. This survey correspondends well with the most recent Gallup Poll on most ethical professions, conducted in December 2015. In that study, pharmacists, nurses and doctors come out on top, with advertisers (“Mad Men”), car salespeople, and members of Congress at the bottom, as shown in the second

Technology alone won’t improve health care in America, especially in people with chronic health problems don’t want to use it. Furthermore, too many clinicians who have invested in digital health technologies (namely, electronic health records systems), aren’t fully taking advantage of what they have. This and other health care realities are explored in Better Together: Patient Expectations and the Accountability Gap, based on a consumer survey conducted by Nielsen Strategic Health Perspectives for the Council of Accountable Physician Practices, an affiliate of the American Medical Group Foundation. The survey polled 30,007 consumers in March 2016, and combined physician data culled from Nielsen’s

The growth of health care costs in the U.S. is expected to be a relatively moderate 6.5% in 2017, the same percentage increase as between 2015 and 2016, according to Medical Cost Trend: Behind the Numbers 2017, an annual forecast from PwC. As the line chart illustrates, the rate of increase of health care costs has been declining since 2007, when costs were in double-digit growth mode. Since 2014, health care cost growth has hovered around the mid-six percent’s, considered “low growth” in the PwC report. What’s driving overall cost increases is price, not use of services: in fact, health care