Health Populi http://healthpopuli.com Fri, 05 Feb 2016 12:47:25 +0000 en-US hourly 1 Improving the Patient Experience in Legacy Health Systems – My Start-Up Health Interview http://healthpopuli.com/2016/02/05/improving-the-patient-experience-in-legacy-health-systems-my-start-up-health-interview/ http://healthpopuli.com/2016/02/05/improving-the-patient-experience-in-legacy-health-systems-my-start-up-health-interview/#respond Fri, 05 Feb 2016 12:44:42 +0000 http://healthpopuli.com/?p=14020 The so-called legacy healthcare system are the incumbents in American health care — hospitals, physician practices, pharma, health plans, and other organizations that have long-served and been reimbursed by traditional volume-based payment. Patients, now morphing in to health consumers, look to these stakeholders to provide new levels of service, accessibility, convenience, transparency and value — […]

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Startup Health QuoteThe so-called legacy healthcare system are the incumbents in American health care — hospitals, physician practices, pharma, health plans, and other organizations that have long-served and been reimbursed by traditional volume-based payment. Patients, now morphing in to health consumers, look to these stakeholders to provide new levels of service, accessibility, convenience, transparency and value — the likes of which people find in their daily life in other market sectors. Those consumer demands are pressuring the health system as we know it in many new ways, which I discussed with Unity Stoakes, Co-Founder of Startup Health, at the Health 2.0 Conference in October 2015.

Here’s the video…which covers a lot of ground, from health engagement to Amazon, Uber, PokitDoc, Walmart, and The Fortune at the Bottom of the Pyramid.

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Building Health Bridges — Health:Further Goes Beyond the Disruptive http://healthpopuli.com/2016/02/04/14001/ http://healthpopuli.com/2016/02/04/14001/#respond Thu, 04 Feb 2016 13:45:17 +0000 http://healthpopuli.com/?p=14001 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 […]

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Andre of Health FurtherMost 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” to re-making American healthcare.

JSK: You’ve recently become the Producer for Health:Further. Can you give us an overview of what it’s about?

AB: Absolutely! So Health:Further began as an event in Nashville, TN, to bring together key stakeholders in healthcare to highlight the forward movement of the industry through innovation. After a sold out success of over 600+ attendees and dynamic speakers, the team at Jumpstart Foundry – the healthcare innovation fund behind Health:Further – decided to take it up a notch. This year we have evolved Health:Further to become a series of events (3 smaller Quarterly events and 1 large event in the summer) as well as a learning platform for healthcare innovation. We’re giving an opportunity to those who want better guidance on the trends in healthcare that impact their work, to get plugged in directly with experts and innovators.

HF logoJSK: You mention the importance of creating inclusive environments for legacy healthcare organizations which have largely been left out of digital health developments. Why do you feel that is an important concept to embrace for health innovation?

AB: Here’s the thing: there are a number of leaders and forward-thinking healthcare organizations who want to get up to speed on what matters for the future of their business. Oftentimes however, they may not know exactly where to start, what to focus on and who they can specifically learn from in order to be successful. That is what we’ve created through Health:Further – a safe, inclusive environment for these groups to get involved with meaningful innovation. The reason this is important is simple: we need as many smart people as possible to get an understanding of how they can create something better in healthcare. The organizations that have been around for decades serving their populations are deeply rooted in our country’s history and community-based health systems- making sure that they can easily connect with innovations that can help them improve their processes and empower patients is a vital aspect of our mission.

JSK: What stakeholder groups do you plan to reach with the Health:Further platform?

AB: Through Health:Further we are looking at connecting with healthcare executives, entrepreneurs interested in or already innovating around healthcare, as well as investors wanting to get deeper insight into what’s coming around the corner. These are the people who are making important decisions for the future and we’ve realized that they want to know four key things: what important trends in healthcare do we need to know; how is this going to impact our business; who is doing it well; and, how do we get involved. We want to make sure those stakeholders and those questions get connected and answered with our platform.

JSK: As someone who has always kept an eye on the next important innovations and concepts in public health/healthcare through your Pulse + Signal work, what should we expect in the next 5 years?

AB: There are three fundamental dynamics going on that will help shape the future for smarter, more effective health innovation. First, the aspect of co-creation and design thinking going hand in hand is powerful. Years ago when the aspect of co-creation was first introduced, it was more of a marketing angle. Working alongside customers to create a product in a process that ensured success — making it well-received by users — was brilliant. I remember a Chevy campaign that solidified the concept in my head during my PR days. Mix that together with how we’re learning about design thinking efficiency being baked into healthcare and the interaction of patients to be part of the process will become a game changer. The recent insights from a Texas hospital sheds great light on this.

Secondly, consider the aspect of consumer technology not only continuing to mainstream but also being accessible to a growing population – regardless of socioeconomic status. We’re seeing programs like Dr. Lisa Gualtieri’s RecyleHealth initiative for recycling used digital activity trackers gaining steam. The program is not only being used for research but also for improving the digital literacy of consumers who otherwise aren’t exposed to the digital health landscape. It’s not just about people using the technology but how and why they are using it that will solidify its usefulness. This is an important step in expanding the impact of the innovations we are seeing coming in the future and one that we’re excited to dig deeper with upcoming Health:Further activities.

Lastly, I believe that policies are finally leaning toward creating an environment where innovation in healthcare can be rolled into smart business models for health systems across the country. Reimbursement has historically been a speed bump in how much these new concepts can get adopted by healthcare providers in order to reach the population. Now that we’re seeing some progress, underpinned by value-based payment — especially around issues like telehealth. I feel the stage is being set for more great things to come.

JSK: Beyond the March 1st event focusing on telehealth, what “further” events can we expect from Health:Further later this year?

AB: We created the Health:Further Quarterly (HFQ) events as a half-day deep dive into a specific subject that is having a profound effect on healthcare’s evolution. The March 1st 2016 event will explore how telehealth is enabling access and creating new business models in the industry. We’re excited to be bringing notable telehealth experts like Dr. Pramod Gaur and innovative Doctor on Demand to demo their platform and speak on the evolution of care delivery. We’re excited to be thinking about additional topics to highlight during our next two HFQ events — they will be taking place on May 10th and November 1st of this year. Since HFQ is all about taking a specific aspect of healthcare innovation, we’re looking at a number of themes: aging in place, the role of the patient, interoperability, consumer health hardware & privacy.

In addition to the Quarterly events, we are excited to be hosting our second annual Health:Further meeting towards the end of August. Health Populi readers interested in getting notified of our events and opportunities to speak and showcase their companies can contact me anytime or sign up for our email list on the Health:Further homepage.

Follow Health:Further on Twitter (@HealthFurther) as well as on Facebook for more curated resources and information on taking healthcare to new and better heights.

Health Populi’s Hot Points:  There is a growing proliferation of healthcare tech incubators and start-up programs around the world, and throughout the U.S. in metropolitan cities and mid-size towns. Health:Further is a new-new thing in this space, a hybrid of innovation inspiration, smart market content, and networking opportunities. The focus on business models will help the organization indeed take Health, Further.

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Welcome to the Era of Personal Health IT – a #HIMSS16 Preview http://healthpopuli.com/2016/02/03/welcome-to-the-era-of-personal-health-it-a-himss16-preview/ http://healthpopuli.com/2016/02/03/welcome-to-the-era-of-personal-health-it-a-himss16-preview/#respond Wed, 03 Feb 2016 13:25:04 +0000 http://healthpopuli.com/?p=13992 People – patients, caregivers, health consumers all – have begun to use the digital tools they use in daily life for booking taxis, managing money, seeking information — for their health. This is the growing adoption of Personal Health IT (PHIT), and it’s a growing aspect of the annual HIMSS Conference that the planet’s health […]

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thought-leadership-janePeople – patients, caregivers, health consumers all – have begun to use the digital tools they use in daily life for booking taxis, managing money, seeking information — for their health. This is the growing adoption of Personal Health IT (PHIT), and it’s a growing aspect of the annual HIMSS Conference that the planet’s health IT folk will attend from 29th February until 4th March in Las Vegas.

I talk about the phenomenon of PHIT and #HIMSS16 in The State of Health IT to Engage the New Health Consumer, a summary of the driving forces of the trend and opportunities to learn more about PHIT at HIMSS, on the ground.

And if you are indeed on the ground in Vegas at HIMSS, please attend Jan Oldenburg’s and my session, Having It All: Telehealth Solutions that Enhance Existing Doctor/Patient Relationships. We’re going broad and deep on the definition of “telehealth,” from evidence-based examples of email between patients and doctors through to mental health Skype-type visits (HIPAA-secure) and telehealth from the grocery store and retail pharmacy kiosk. (That’s Session 130 on Wednesday 2nd March, 1130 am, in the Sands Expo Convention Center, Marcello 4404).

For more about the growing role of health consumers becoming info-mated, see these posts on Health Populi, and two on the HIMSS website:

In Health Populi

Homo informaticus – the global digital consumer

The Health Information Economy – Better with Patients

More Consumers Expect a Connected Health Experience

People In Consumer-Directed Health Plans Are Getting – Surprise! – More Consumer-Directed

On the HIMSS website…

The New Healthcare Consumer – Homo Informaticus Meets Health

Using Personal Health IT (PHIT) to Transform Healthcare

Health Populi’s Hot Points:  There can be no effective consumer-driven health care without consumers driving themselves in the health/care ecosystem. To be effective health consumers, people need to be literate in ways well beyond understanding a prescription label. It means being health plan literate, knowing how to use the Internet to seek and understand health information about conditions and procedures, and efficiently handling the administrative tasks of schedule appointments and the planning for the financial implications of your own health care services. That’s a lot of personal workflow, and digital tools can help support people in their morphing into health consumers.

Too many of these digital tools aren’t yet ready for prime time adoption by mainstream people who aren’t yet quantifying themselves on an ongoing basis. My upcoming paper from the California HealthCare Foundation, Digitizing the Safety Net: Health Tech Opportunities for the Underserved gets to the root of the challenges for health-digitizing “the rest of us.” That paper will be published online next week…and I’ll link it here when it’s available for download. The key learning: let’s scale what works, which might be simple stuff — but when scaled, it will be a beautiful thing, empowering people for self-care, better outcomes, health confidence, and in aggregate, healthier communities.

The ultimate outcome: using the right Personal Health IT can effectively drive personal health — but also public health at scale.

 

 

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My Body, My Self – With My Physician, Say Patients http://healthpopuli.com/2016/02/02/my-body-my-self-with-my-physician-say-patients/ http://healthpopuli.com/2016/02/02/my-body-my-self-with-my-physician-say-patients/#respond Tue, 02 Feb 2016 15:05:12 +0000 http://healthpopuli.com/?p=13979 9 in 10 people in the U.S. believe working with their health clinician as a partner will help them better manage their overall health, according to a survey conducted for The Society for Participatory Medicine. Consumers’ majority call-out for shared decision-making with health care professionals also extends to their self-tracking health data — for example, […]

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9 in 10 people in the U.S. believe working with their health clinician as a partner will help them better manage their overall health, according to a survey conducted for The Society for Participatory Medicine.

Consumers’ majority call-out for shared decision-making with health care professionals also extends to their self-tracking health data — for example, via activity trackers, digital glucometers for blood sugar, technologies for blood pressure, and food logging apps. 84% of people said that sharing their personal self-tracking health data with clinicians between visits would also help people manage health.

That clinician’s involvement is very important to health consumers for adopting and using a digital tracking device: 81% of people would be more likely to use the device if their health care professional recommended it.

Additional survey results are illustrated on the infographic, shown here.

“Increasingly, patients are actively monitoring their own health data to better self-manage their health and collaborate with their health care professionals,” Dr. Danny Sands, Co-Founder and Chair of the Society said in the organization’s press release on the study.

ORC International polled 2,012 U.S. adults, 18 and over, in December 2015.

Health Populi’s Hot Points:  In the post-Recession economy, people have been more inspired by do-it-yourself personal work flows in daily life, from trading stocks and managing finances to arranging airline travel, hotel rooms, and just-in-time car services (read: Lyft and Uber).

So the health consumer’s healthcareDIY muscles are growing, too, enabled especially through the mass adoption of mobile platforms (particularly smartphones), and a growing supply-side of digital health tools.

CDC EHR adoption sharing with patients January 2016The most prevalent digital health tools available in 2016 is the electronic health record, now available in most physician offices. Some 74% of office-based physicians had a certified EHR system in 2014, according to the CDC update published in January 2016 on the adoption of EHRs.

As the chart illustrates, just over one-third of physicians were electronically sharing patient health information with ambulatory providers and hospitals. Those physicians with EHRs were more like to share patient health information with external providers than physicians who did not have an EHR system. There is significant geographic variation in health data sharing by physicians, with the greatest likelihood nationally occurring in Oregon, Washington, North Dakota, and Massachusetts.

That’s as far as clinicians sharing EHR-stored patient data with other clinicians.

As for clinicians sharing with patients? Now that patients recognize the value of sharing their own patient-generated data with their personal physicians and other clinicians, we’re at the inflection curve of change as patient connect the dots between their personal DIY health/care strategies and their interactions with health care professionals.

A crucial linkage to moving this forward will be the development of digital health tools that seamlessly and enchantingly fit into both patients and health care providers’ work flows (personal for patients, professional/clinical for doctors and nurses). There’s no greater higher calling or need for user-centered design than in patient-centered health.

Note: I sit on the Board of Directors for the Society for Participatory Medicine.  Follow the Society on Twitter @S4PM.

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It’s Good to Be Hawaiian When It Comes to Health – the 2015 States of Well-Being http://healthpopuli.com/2016/01/29/13969/ http://healthpopuli.com/2016/01/29/13969/#respond Fri, 29 Jan 2016 13:13:09 +0000 http://healthpopuli.com/?p=13969 Where you live in the U.S. is a risk factor for your health. Hawaii, Alaska, Montana, Colorado and Wyoming rank highest on the State of American Well-Being 2015 State Well-Being Rankings, the Gallup-Healthways Well-Being Index. Well-Being is based on an index of five components that people self-assess: purpose, social, financial, community, and physical. See the […]

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Gallup-Healthways State Rankings 2015 Hawaii then AlaskaWhere you live in the U.S. is a risk factor for your health. Hawaii, Alaska, Montana, Colorado and Wyoming rank highest on the State of American Well-Being 2015 State Well-Being Rankings, the Gallup-Healthways Well-Being Index.

Well-Being is based on an index of five components that people self-assess: purpose, social, financial, community, and physical. See the map: the darker blue the state, the healthier the population perceives itself to be. Note more light blue to the northeast and south, and dark blue in the mountain states, Alaska and Hawaii.

Some states have stayed in the top-tier of wellness since 2012: Hawaii (#1 in 2015), Colorado, Montana, South Dakota, Minnesota, Utah, Nebraska, Iowa, Alaska, and Vermont. Except for Vermont, none of these states lie in the northeastern U.S., and none are situated in the south.

It is the south that tends to have people identifying with the lowest levels of well-being; the states that have tended to lie low in well-being for several years include West Virginia, Kentucky, and Mississippi  In 2015, three Midwestern states joined southern states in poorest well-being: Indiana, Missouri and Ohio.

The Well-Being Index found last year that where you live is also associated with your likelihood of faring well after a heart attack. It turns out the states where people have lower BMI are also those with better cardiovascular outcomes.

Health Populi’s Hot Points: Your zip code is more important than your genetic code, as the Robert Wood Johnson Foundation has asserted. So, then, does it follow that geography is destiny when it comes to our health status?

The answer lies in the social determinants of health, the aspects of daily living which bolster or diminish human health outside of the healthcare system. These include financial wellness, food, safe streets and living environments, education — in my economics education, all considered inputs into human capital. Improve access to and quality of early childhood education, young peoples’ nutrition, and a safe community, and you’ve got the groundwork for better health outcomes and economic development. My economist gurus Gary Becker and Jeffrey Sachs have often written about this, among many other scholars making the case.

Some examples of health care dealing head-on with #SDOH are…

And increasingly, health insurance plan sponsors — especially employers — are focusing on well-being’s role in worker productivity and workplace engagement.

For more real-time learnings about the social determinants of health, follow the #SDOH hasthtag on Twitter.

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Health Consumers Happy With Doctor Visits, But Want More Technology Options http://healthpopuli.com/2016/01/27/health-consumers-happy-with-doctor-visits-but-want-more-technology-options/ http://healthpopuli.com/2016/01/27/health-consumers-happy-with-doctor-visits-but-want-more-technology-options/#respond Wed, 27 Jan 2016 13:52:49 +0000 http://healthpopuli.com/?p=13958 9 in 10 adults in the U.S. have visited a doctor’s office in the past year, and over half of these patients have been very satisfied with the visit; 35% have been “somewhat” satisfied. Being a highly-satisfied patient depends on how old you are: if you’re 70 or older, two-thirds of people are the most […]

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Satisfaction with doctor visits by generation cohort Harris Poll Jan 16

9 in 10 adults in the U.S. have visited a doctor’s office in the past year, and over half of these patients have been very satisfied with the visit; 35% have been “somewhat” satisfied.

Being a highly-satisfied patient depends on how old you are: if you’re 70 or older, two-thirds of people are the most satisfied. Millennial or Gen X? Less than half.

What underlies patient satisfaction across generations is the fact that younger people tend to compare their health care experience to other retail experiences, like visiting a bank, staying at a hotel, or shopping in a department store.

These insights come from the Harris Poll conducted in September 2015, and discussed in its press release, Satisfaction with Doctor Visits on the Rise.

The rankings of consumers’ retail experiences compared with health care experiences rank as follows, in terms of the percent of consumers satisfied (NET = “very satisfied” + “somewhat satisfied”):

  1. Last visit to a restaurant = 91%
  2. Last online purchase = 89%
  3. Last visit to department store = 88%
  4. Most recent visit to health care provider = 88%
  5. Last visit to a bank = 87%
  6. Last stay at a hotel = 78%
  7. Last car purchase = 76%
  8. Last interaction with health insurance company = 63%
  9. Last visit to mobile phone store = 59%

A variety of factors bolster consumer satisfaction with visits to health care providers. These experience factors include doctor’s overall knowledge, training and expertise, attested by 83% of patients. In second place, must lower, is the doctor’s ability to access your overall medical history, with 65% of consumers. Time spent with the doctor is cited by 58% of patients, followed by ease of making an appointment (49%), efficient and simple billing process (45%), ability to communicate with the doctor outside of the appointment by phone or email (44%), time spent in the waiting room (43%), convenient location (40%), minimized paperwork (32%), and appearance and atmosphere of the doctor’s office (31%).

Not surprisingly, the value placed on each of these traits varies by generation: Millennials seek greater conveniences like easier billing processes, appearance of the office, and time spent in the waiting room. Matures (70 and over) more likely seek doctor’s ability to access the medical history, time spent with the doctor, and the doctor’s overall knowledge and expertise.

Physicians visits to consumers techs by net demanded Harris Poll Jan 16

At least one-half of all health care consumers are looking for technologies that help them with administrative and financial aspects of the doctor’s visit. These include online cost estimators which give the patient an idea of the cost for services ahead of time (valued by 62% of people); online medical record access (for 59%), proactive communications from the doctor to schedule preventive care, via email or text (59%); online appointment scheduling (52%); email access with the doctor (51%); and online billing and payments (50%). Again, these tech-demands vary by generation, with majorities of people under 50 looking for all the tools to be available. For the Matures, over 70, the most desired tech tools are access to online medical records and proactive communications from the doctor for preventive reminders.

Consumers are now interested in new options for healthcare services in shopping environments, and Harris polled various services offered in retail health settings. The most likely services consumer would use were getting flu shots, visiting with cold or flu symptoms, caring for a cut or puncture wound, examining a rash, all noted by at least 50% of consumers. By generation, Matures would most likely go retail for flu shots, and Millennials for every service offered in retail.

Health Populi’s Hot Points:  The so-called consumer-directed health plan era (CDHP) ushered in health insurance programs where plan members were exposed to more financial skin-in-the-game in the form of greater out-of-pocket costs and premium share. The latest iteration of CDHPs are high-deductible health plans, most often coupled with health savings accounts. The theory underneath this plan design was that, in the past, third-party payment shielded consumers from behaving as “consumers” — that is, shopping for the “best” health care in their community in terms of value (price and quality). However, in the early phase of CDHP adoption, people have been prone to self-ration care — delaying recommended tests, needed physician visits, postponing medication refills, splitting pills when not instructed by prescribers, and avoiding dental visits.

But in 2016, we see plan members beginning to mature as health consumers, shopping around especially for new retail health formats that share characteristics with other retail experiences, both offline (say in slick coffee shops, helpful department stores, and value-priced Big Box self-serve settings) and online (need I utter the one word: “Amazon?”).  [As an aside, here’s a great smart take on Amazon being the new single largest search engine for all-things-shopping].

The Harris Poll’s finding that, across generations, retail clinics and shopping venues are now seen as a viable alternative settings to the traditional physician visit makes this point. Under value-based health care payment for providers, more of them should welcome collaborations in these convenient, lower-cost settings, ensuring quality and privacy/security of peoples’ personal health information.

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The Health Information Economy – Better With Patients http://healthpopuli.com/2016/01/25/the-health-information-economy-better-with-patients/ http://healthpopuli.com/2016/01/25/the-health-information-economy-better-with-patients/#respond Mon, 25 Jan 2016 13:34:00 +0000 http://healthpopuli.com/?p=13945 “Consumers expect to have their data available and shareable.” Two essays in two issues in the past two weeks of The New England Journal of Medicine point to the importance of patients – people, caregivers, consumers, all — in the morphing “health information economy,” a phrase used in the title of one of the published […]

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Reasons for Pursuing Patient Controlled Data Mandl Kohane NEJM Jan 16“Consumers expect to have their data available and shareable.”

Two essays in two issues in the past two weeks of The New England Journal of Medicine point to the importance of patients – people, caregivers, consumers, all — in the morphing “health information economy,” a phrase used in the title of one of the published pieces.

In Time for a Patient-Driven Health Information Economy, Dr. Ken Mandl and Dr. Isaac Kohane, who are both affiliated with the Department of Biomedical Informatics at Harvard, discuss peoples’ growing interest in engaging with their personal health information, noting frustrating barriers to doing so: HIPAA, which can be seen as a lever for engagement but too often serves as an excuse to block patients’ information access; health providers’ concerns about security breaches and data leakage; and, a fragmented technology infrastructure that limits “data liquidity,” the ability for the totality of an individual’s personal health information to move out of their data silos into one convenient, understandable format for the patient. “Where is the easy button?” people wonder, the kind they have from banks, investment companies and airlines? [The authors point to the Blue Button initiative at the VA which has been very useful, but has not gained significant market traction beyond the VA].

But there’s a convergence of factors that can reset the on-ramp and provide traction for people to get their health information, Mandl and Kohane explain. The proliferation of smartphones and apps, the internet cloud, and the growth of value-based payment for health care are driving forces for the new scenario of a patient-driven health economy on the supply side. On a wonkier (hugely important) front, data standards like FHIR and SMART are being deployed within traditionally closed electronic health records systems to enable data liquidity.

On the demand side, people – patients, caregivers – are pressing up to the providers from the grassroots, needing this information so they can take on their mantle as new health consumers. And a growing cadre of switched-on providers are adopting an Open Notes approach to sharing information with patients.

Shared Decision-Making — Finding the Sweet Spot from Dr. Terri Fried of the Yale School of Medicine complements Mandl’s and Kohane’s vision of the patient-driven health information economy. Fried discusses the importance of physicians’ listening to patients’ concerns and values in the process of the clinician-patient shared decision-making process. Too often, clinicians’ approach to weighing therapeutic treatment decisions — say, in dealing with guidelines for treating cancer or heart disease — do not account for patients’ preferences. Yet, she notes, eliciting patient priorities about their own lives can yield quite different choices between therapeutic options. “Clinicians’ recommendations can cause them [patients] to make choices contrary to what they would otherwise prefer,” Fried recognizes.

mhealth-israelhealth-it-for-next-generation-care-deliveryorna-berry-phd-corporate-vp-innovation-coes-and-rd-centers-june-2015-3-638Health Populi’s Hot Points:  The new health consumer is of the genus homo informaticus, whom I’ve called out since learning about from EY’s look into the multi-channel consumer in 2014. EMC;s new latest thought leadership on Information Generation looks into the always-on phenomenon across many vertical markets, including healthcare, as they phrase it, “at the speed of now.”

89% of health providers say technology has changed patient expectations, EMC’s survey found. Most patients want faster access to healthcare services, 47% want personalized experiences, 45% seek 24/7 access and connectivity, and 42% would like access on more devices: here comes homo informaticus to health care, on mobile phones and tablets.

That these two essays on patient-centered information appeared on January 14th and January 21st, 2016, respectively, in the nation’s most prestigious peer-reviewed medical journal – NEJM – attests to the growing embrace of patients by physician leaders like Drs. Mandl, Kohane and Fried. While the private sector is innovating innumerable patient-facing technologies in the forms of portals, personal health records, and mobile apps (which we’ll see next month at #HIMSS16 in Las Vegas), the public sector — regulators and the health IT policy framers — must quickly move to promote and support the transition to true patient-and-person centered health information.

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Getting Beyond Consumer Self-Rationing in High-Deductible Health Plans http://healthpopuli.com/2016/01/21/13932/ http://healthpopuli.com/2016/01/21/13932/#comments Thu, 21 Jan 2016 06:12:13 +0000 http://healthpopuli.com/?p=13932 The rising cost of health care for Americans continues to contribute to self-rationing care in the forms of not filling prescriptions, postponing necessary services and tests, and avoiding needed visits to doctors. Furthermore, health care costs are threatening the livelihood of most American families, according to the Pioneer Institute. “What Will U.S. Households Pay for Health […]

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EBRI cost conscious decision making by type of plan Dec 15

The rising cost of health care for Americans continues to contribute to self-rationing care in the forms of not filling prescriptions, postponing necessary services and tests, and avoiding needed visits to doctors. Furthermore, health care costs are threatening the livelihood of most American families, according to the Pioneer Institute.

“What Will U.S. Households Pay for Health Care in the Future?” asks the title of a study by the Institute, noting that health care costs for an American family of average income could increase annually to $13,213 by 2025 — and as high as $18,251. Pioneer calculates that this forecasted spend will consume as much as 27% of household income.

[The Department of Commerce calculates that Americans spent $1 in $5 of household income on health care in 2015].

Adding to the discussion of concerns about health care consumers with more “skin in the game,” JAMA Internal Medicine published a letter the week of January 19, 2016, on cost-sharing obligations, high-deductibles, and shopping for health care. Researchers from Harvard and USC surveyed a nationa sample of U.S. adults via GfK’s Knowledge Panel, analyzing HDHP enrollees for attitudes on price shopping, out-of-pocket costs, and health care demand. Increaing a deductible (that is, increasing skin in the game) did not inevitably lead to consumers’ price shopping for health care. “If increasing price shopping is viewed as an important policy goal,” the team wrote, “there is a need for greater availability of price information and innovative approaches to enrollee engagement with this information.”

A third report, from EBRI (the Employee Benefit Research Institute), looked further into the hearts and minds of HDHP enrollees. Findings from the 2015 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, published in December 2015, found evidence that HDHP members did exhibit more cost- conscious behaviors compared with traditional plan members such as checking whether the plan would cover care, asking for generic drugs versus brand name Rx’s, talking with doctors about treatment options and costs, and using online cost-tracking tools provided by health plans.

Telehealth-visit-costs-vs-other-urgent-care-options1Health Populi’s Hot Points: Impacts of HDHPs are borne by a large and growing cohort of consumers, including both those who sign up for health insurance at work and shoppers on Federal and State-run health insurance marketplaces. According to an April 2014 Department of Health and Human Services (HHS) report, 65% of health plan enrollees chose silver plans; in these plans, 30% of health care costs were covered by the consumer, and the average deductible in these plans was $2,907 per person.

What consumers have begun to figure out is that cheaper, high quality care is increasingly available outside of hospitals, doctors offices, and emergency rooms in the form of telehealth and digital health channels. The second chart shows that a telehealth visit with, for example, American Well is half the cost of a visit to a primary care doctor, one-third the price of an urgent care visit, and about $700 cheaper than an ER admission.

EBRI interest in having telemed visit 12-16So it is unsurprising that EBRI’s survey found out, for the first time this question was polled in this annual survey, that some one-half of people enrolled in HDHPs are keen to have a telemedicine visit, shown in the third chart. Health consumers have begun to figure out how to use their HDHPs and HSAs, notwithstanding a lack of useful price and quality information. Word-of-mouth is a major driver of referrals in health consumers cottoning on to peer-to-peer healthcare in social networks, both offline and online.

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Let’s Make a Deal: Patients Weigh Privacy Paybacks http://healthpopuli.com/2016/01/20/lets-make-a-deal-patients-weigh-privacy-paybacks/ http://healthpopuli.com/2016/01/20/lets-make-a-deal-patients-weigh-privacy-paybacks/#respond Wed, 20 Jan 2016 18:13:51 +0000 http://healthpopuli.com/?p=13916 “It depends” is the hedge-phrase that characterizes how Americans see disclosing personal information versus keeping private information private, according to the consumer survey report, Privacy and Information Sharing, published by the Pew Research Center (PRC) in January 2016. U.S. adults see a privacy trade-off, living in the convenience-context of 21st century digital economy in exchange for […]

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Pew Privacy office surveillance sharing health info and retail loyalty cards“It depends” is the hedge-phrase that characterizes how Americans see disclosing personal information versus keeping private information private, according to the consumer survey report, Privacy and Information Sharing, published by the Pew Research Center (PRC) in January 2016.

U.S. adults see a privacy trade-off, living in the convenience-context of 21st century digital economy in exchange for some form of value. The “it depends” is a factor of what kind of data is geing collected, especially by third parties, how long that data area retained, for what use — vis-à-vis what a person is trading in return which could be a hard dollar value, convenience, knowledge, or support of some kind.

Pew Privacy auto social media and smart thermostatPRC developed six scenarios describing consumers and the “it depends” frame of mind, shown in the first chart. The six scenarios are:

  • Office surveillance cameras
  • Sharing health information
  • Retail loyalty cards
  • Auto insurance
  • Free social media, and
  • Smart thermostat.

We’ll focus here in Health Populi on the scenario of sharing health information, although all have some adjacency to health, broadly defined.

“Sharing health information” was seen as acceptable by 52% of U.S. adults, with 20% saying, “it depends.” Fully one-fourth of Americans, 26%, said sharing health information is “unacceptable” under any conditions.

The scenario is defined as “a new health information website [is] being used by your doctor’s office to help manage patient records. Your participation would allow you to have access to your own health records and make scheduling appointments easier. If you choose to participate, you will be allowing your doctor’s office to upload your health records to the website and the doctor promises it is a secure site.”

This scenario is akin to an online patient portal, which most physicians and hospitals have been implementing as part of achieving their HITECH incentive for adopting electronic health records and “meaningfully using” them. Thus, from the health industry’s viewpoint, this scenario is fairly normal and mainstream.

However, from the consumer’s view, only one-half buy into the patient portal concept. For 1 in 5, “it depends.” And for 1 in 4 people, “no way” would I participate in a patient portal, even with easy scheduling online — a convenience that a majority of consumers are keen on in several previous surveys.

PRC points out that their previous surveys have found Americans sensitive about personal health information, concerned about how PHI could be re-used in ways that could jeopardize access to insurance, credit (say, for a mortgage), or a job application.

Older people are more open to sharing health data than younger people, Pew found, and people with higher education are, as well.

Overall, the “it depends” and privacy-absolutists are concerned about the following issues, which Pew gleaned through the survey:

  • The initial bargain might be fine but the follow-up by companies that collect the data can be annoying and unwanted
  • Scammers and hackers are a constant threat
  • Location data seems especially precious in the age of the smartphone
  • Profiling sometimes seems creepy (substitute “Big Brother” or “stalking” for “creepy”)
  • People are not happy when data are collected for one purpose but are used for other, often more invasive purposes

The flip-side of these concerns are the potential benefits of personal data sharing, which include:

  • Free, a good price for, say, social media, email addresses, online storage, and other digital goodies
  • Sharing can help “lubricate” commercial and social interactions
  • Certain realms are not inherently private and different rules about surveillance and sharing might apply.

The Pew Research Center surveyed 461 U.S. adults ages 18 or older in January and February 2015, which was a sub-sample of a 607 person panel culled by GfK in 2014. In addition, Pew conducted nine focus groups in January 2015 for additional qualitative insights.

Places Your Data May Go Harvard Privacy ProjectHealth Populi’s Hot Points:  The February edition of Scientific American includes an article in the Health section titled, “How Data Brokers Make Money Off Your Medical Records.” This essay echoes what I wrote in my paper, Here’s Looking At You: How Personal Health Information is Being Tracked and Used, published by the California HealthCare Foundation in February 2015.

See the third graphic which comes from the Harvard Privacy Project: the spiderweb-type lines show data flows of personal health information in the U.S. that is not covered by HIPAA. Most consumers are unaware what HIPAA covers, and knowing about these data flows would no doubt surprise many people.

There are many levels of health literacy required to become a fully-functioning, effective health care consumer in America in 2016. One of these onion-layers-of-literacy is becoming health data literate in terms of how to both ask for one’s personal health information (from physicians, hospital administrators, pharmacies, mental health professionals, and other providers), and how to be a good data steward and protector for one’s own PHI.

Share the diagram with your friends and family, as well as a link to the Scientific American column. While the Pew survey demonstrates that people are willing to make a deal for sharing their health data, just how and with whom to cut those deals continues to lack transparency and platforms for doing so. People must advocate for themselves, and for each other, in this Brave New World of Big Health Data.

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Consumers Take Better Preventive Care of Pets Than Themselves, CIGNA Finds http://healthpopuli.com/2016/01/18/consumers-take-better-preventive-care-of-pets-than-themselves-cigna-finds/ http://healthpopuli.com/2016/01/18/consumers-take-better-preventive-care-of-pets-than-themselves-cigna-finds/#comments Mon, 18 Jan 2016 16:31:25 +0000 http://healthpopuli.com/?p=13903 Nine in 10 pet owners know when their dog or cat is due for their shots. Eight in 10 women know the frequency with which they get manicures and pedicures. 80% of men know the mileage between old changes. But only 50% of family health care decision makers know their blood pressure, and only 20% […]

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People Care Deeply About the Wellbeing of Their Pets Not So Much WellbeingNine in 10 pet owners know when their dog or cat is due for their shots. Eight in 10 women know the frequency with which they get manicures and pedicures. 80% of men know the mileage between old changes.

But only 50% of family health care decision makers know their blood pressure, and only 20% know their biometric numbers like cholesterol and BMI.

Americans are great at doing preventive care for their pets and automobiles; but not so much for their own bodies and health, finds the report CIGNA Preventive Care Research, a survey of 1,000 U.S. consumers between 25 and 75 years of age who have health insurance and are the health care decision makers for their families. The survey was conducted in September 2015.

The data points showing the caretaking-chasm are the following. For personal health/care…

  • Only 55% know that they should go for an annual health check-up, lower among men
  • Only 50% of people know their blood pressure
  • Only 20% know their cholesterol levels or body mass index (BMI)
  • Only 45% of people realize that vaccinations and immunizations are are covered in their annual check-up
  • Less than 20% of people know they can get depression screening and alcohol and drug abuse assessments are part of the annual check-up
  • Only 45% of people know an annual check-up costs nothing for people who carry health insurance.

On the other hand, for non-health/care…

  • 85% of pet owners know when Fido and Maurice are due to get their shots
  • 80% of women are clear on the frequency of their manicures and pedicures
  • 80% of people are aware how frequently they need to change smoke detector batteries
  • 70% know their monthly premium for car insurance
  • 50% remember their college GPA.

Still, most people believe that an annual check-up “now” can help save money “later,” and that annual check-ups include appointments, tests and “steps you take to stay healthy.” 80% of people also say they know how to improve their numbers related to blood pressure, BMI and cholesterol.

Components of An Annual Health Check-UpHealth Populi’s Hot Points:  We see a health plan literacy gap in CIGNA’s data: a plurality of health plan members don’t realize that, even with insurance, they are subject to zero co-pay or cost for an annual preventive care visit. That visit includes the check-up, as well as other components as the consumer demands: shots (say, a shingle vaccine for an older person, or a flu shot for everyone in flu season); counseling about alcohol, substances, as well as counseling for obesity; and depression screening.

Given the rising levels of stress and peoples’ growing addiction to pain medications, these health plan benefits could be well-utilized among patients — but peoples’ concerns about having to pay for a wellness visit is, ironically, making them sick.

Well, at least Americans have healthy pets and well-oiled cars.

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