Mom is the Chief Health Officer of her family, she’s mobile, and seeking health information and community on-the-go.

But underneath the persona of the Mobile Mom, she’s consuming information and sharing perspectives on many other ‘screens,’ too. And that’s the challenge for marketers seeking to grab the attention of this key player in the health ecosystem.

There are new survey data from Enspektos‘s report, Digging Beneath the Surface: Understanding the Digital Health Mom, that are must-reading for health industry stakeholders who seek to motivate health behaviors among women, who are at once nurturing wellness, caregiving for sick people, and sharing opinions about health products and services in their social networks. In health and health care, Sisters are doing it for themselves and for their loved ones.

As a Chief Health Officer, 86% of Moms make the decision about which remedies her family uses. Two-thirds trust pediatricians but still go online before and after doctor’s visits to do their own research, according to BabyCenter. Mom is tech-savvy: one-half of online moms own smartphones and among these, 40% have downloaded health and wellness apps, and go social via mobile. The emergence of Pinterest has mobile moms sharing images and ideas: Pinterest users are predominantly female, between the age of 25 and 44: the sweet spot of mothering  young children. 95% of Moms overall are Internet users, and 76% of Moms are social network users, according to Emarketer’s projections based on the Women in the Labor Force report from the Bureau of Labor Statistics.

In health, social networking exerts a powerful force on Moms, 53% of whom say social networks influence their opinions on health and wellness.

Health Populi’s Hot Points: Mom’s a multi-screen consumer, as the chart illustrates. And the Internet continues to be the dominant health channel. Enspektos suggests that content providers looking to get Mom’s attention must “penetrate Moms’ filters” because only the most relevant and compelling content gets into her bandwidth.

There are two over-arching considerations here:

1. Health competes for Mom’s bandwidth with other priorities. Within health, different health content compete for attention. Understanding how Mom prioritizes, then how she values and ultimately acts on different health content areas, is one key to motivating a behavior.

2. The rush to mobile, without an overall strategic objective for an outcome, will waste resources and add to the growing roster of mobile health apps that may get downloaded, but not sustained use.

Remember that Mom is multi-screen, multi-priority, and uber-busy. Carefully thinking through health objectives, and then developing a communications strategy that integrates messages across comms platforms, will yield a far greater ROI (and ultimately behavior change) than a one-off, ready-fire-aim slick health app.

The saying goes, “you pays your money and you makes your choice.” In 2012, if you have a bolus of $20,700 to spend, you can choose between a health plan for a family of four, or a sedan for the same family.

That’s the calculation from the actuaries at Milliman, whose annual Milliman Medical Index is the go-to analysis on health care costs for a family of four covered by a preferred provider organization plan (PPO). While the 6.9% annual average cost increase is lower than the 7.3% in 2011, it is nonetheless, a record $1,335 real dollar increase at a rate that’s exactly 3 times the rate of inflation (Consumer Price Index, at 2.3% April 2011-April 2012).

The employee’s share of cost grew 7.2%, greater than last year’s trend of 6.9% year on year. This increase should be kept in the context that workers’ average wages grew about 2.6% in 2011.  Most health economists agree that wage growth has not kept pace with health care cost increases; where wages have gone up, they have largely been eaten up by health costs borne by employees, and then some.

In 2012, the employee contribution will total 42% of the health plan cost, comprising $5,114 contribution to health insurance and $3,470 out-of-pocket costs. This is separate from other health arrangements such as health savings accounts which would add to the employee’s OOP burden.

Milliman’s key takeaways for the 2012 MMI are that:

• Outpatient health care cost increases grew at under 9%, lower than the past four years. Still, outpatient costs have the highest rate of increase compared to other components of health care. comprising $3,699 in costs.
• Hospital inpatient care costs per day grew 7.6%. This is the largest cost component coupled with physician care. Hospital costs are $6,531 worth of health spending for a family of four on average.
• Pharmacy costs grew 7.3%, moderating (relatively) due to growing availability of generic Rx substitutes. However, watch for specialty drug costs to drive spending upward going forward. Pharmacy costs account for $3,056 in spending for a family of four in 2012.
• Physician costs grew 5% in the year, accounting for $6,647 worth of health spending for the family.

Health Populi’s Hot Points: I wrote about the rough equivalency between health plan costs and cars here in Health Populi in May 2011.  Thanks, Milliman, for picking up on my auto price metaphor (you can’t ring the Detroit roots out of this girl).

Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs.

Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey from the slide rule to mainframe computers, personal computers, laptops and today, smartphones; this is a journey from centralization to decentralization. He used that construct as a context for what the health care industry needs to undergo, from centralized centers of high-technology and knowledge (think: academic medical centers) to decentralized care where people live, work, play and pray: ultimately, into the home and patient’s hands (the Health Populi Holy Grail).

Christensen joked about a future scenario when confronted by St. Peter at the Gates deciding Clay’s eternal fate. He would ask the gatekeeper 3 questions, one of which would be, “Why did you only give us access to data about the past? How are we to sort out the future?” The answer, Christensen said, lies in the power of data analytics, giving a shout out to SAS’s core business.

He then described the history of synthetic fiber development at DuPont, which began in its first phase as a trial-and-error process, then moved through empirical testing and finally, precision development. This, too, is what Christensen sees as the evolution of life sciences, moving through evidence-based medicine (the second phase) toward personalized medicine, based on risk assessment that matches highest probability therapies for success with the individual person. Ultimately, the way health care is delivered in the U.S. today isn’t the right business model for dealing with chronic care, which consumes 80% of the nation’s health care dollars.

“Personhood” was a theme taken up in the second keynote by Dr. Berwick, who has been a long-time proponent of patient-centered health care. After a fascinating, quite candid behind-the-scenes discussion about his time inside the Beltway at CMS, he sobered the audience with a discussion of the Realpolitik of Health Reform and health care deficit driver.

Berwick then talked about the opportunity to drive waste out of the U.S. health system in several respects, from clinical waste where too much or too little care is given to each individual, to fraud and abuse where data analytics have shown great success in targeting maleficent health providers. His research has found that at least $1 in $3 of health spending could be conserved were the waste wrung out of processes.

Berwick’s five principles for re-making the U.S. health system are:

1. To put the patient/person first

2. To protect the disadvantaged (giving a nod to Hubert Humphrey’s approach)

3. To get to scale (pilots won’t do, with Berwick suggesting that health reform scale be done in regions and states)

4. Act locally

5. Return the money, to expand access and re-invest in health care that works.

Berwick concluded by providing several examples of health care providers that focus on the person at the center of delivery in team-based care models. Most notably is the AFHCAN model, part of the Alaska Native Tribal Health Consortium. AFHCAN is a telehealth provider that has innovated a cart and software suite that is mobile, to meet the needs of Alaskans who live far from health providers. This decentralized, distributed approach is the kind of innovation that Christensen envisions, moving expertise and technology away from “the center.” Outcomes improve, patient satisfaction drives upward, and costs fall. That’s meeting the Triple Aim.

Health Populi’s Hot Points: Ironically, this excellent conference left out a key voice in the conversation the entire day: that of the patient. While Berwick’s passion for putting the patient at the center was most welcome and highly relevant, the inclusion of a consumer health advocacy voice, whether a Consumers Union, a National Partnership for Women and Families, or similar, would have been a constructive lens and filter on the day’s discussions and health industry tracks of providers, life sciences, and health plans

It’s clear that Big Data will and must play a growing role in managing risk, finance, and uncertainty in health care. Protecting patient care, privacy and access mustn’t get lost as this innovation proliferates the health ecosystem.

“Knowing they may need to return at some later time, patients felt they were vulnerable and dependent on the good will of their physicians. Thus, deference to authority instead of genuine partnership appeared to be the participants’ mode of working,” asserts a study into physician-patient relationships published this week in Health Affairs.

The study’s title captures the top-line research finding Authoritarian Physicians and Patients’ Fear of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making. 

Researchers at the Palo Alto Medical Foundation Research Institute analyzed data on patients participating in focus grooups, from the age of forty and over, from five physician practices. The goal of the focus groups was to identify patieents’ beliefs about engaging in communication with physicians for shared clinical decision making. 

Most patients desired collaboration with their physicians, but they felt they had to conform with being a “good” patient — that is, someone who would not challenge the authority of their physician, or question a recommendation of that doctor. These patients felt a sort of ‘fear of retribution,’ in the words of the authors, both in terms of immediate  treaatment and future effects that could sour the physician on the patient and negatively influent their relationship.

Patients described their physicians as often being “authoritarian,” not “authoritative.” Some patients succumbed to the status quo — that is, not questioning doctors’ advice — and playing the role of “supplicant,” again the description of the researchers.

Tables turn, though, when patients return home, where they can seek health information to get a second opinion in the form online searching over the internet. Patients seek health information both before and after doctors’ visits, driven by their perspective that doctors don’t (1) spend sufficient time during the visit to explain themselves, and (2) being unable to comprehend all of the information the physicians tries to impart during that visit. The lack of time inhibits patients, as one described in their focus group that, “there is a little bit of an internal clock that starts to run…and I know for the doctor there’s going to be an internal clock, too.” The online world has no such clock: thus, patients feel empowered to learn “everything there is about [this] problem,” one patient described. The only way you get that is by doing your own work, a patient said.

Health Populi’s Hot Points:  The Palo Alto researchers point out that the population they queried was relatively more affluent and sophisticated (in terms of health literacy) than the mainstream U.S. Thus, this study’s revelations are particularly worrisome in that even the most engaged, educated patients cower in the face of communicating with their doctors. The prospects for shared decision making are very low under this scenario.

The recommendations are:

• To provide adequate reimbursement to physicians to engage in shared decision making
• To implement sound decision support tools that help inform and empower patients
• To reorganize care in terms of teams
• To recognize that doctors and patients have different perspectives about each other – especially for physicians to respect patients’ “person-hood.”

Finally, researchers recognize that the health system at large must demonstrate that it indeed values patient empowerment and engagement. Patients don’t trust that this is the case. Until providers — notably, physicians and hospitals — signal they’re open for a new kind of business that supports patient dialogue and partnership, we won’t get to the Holy Grail of shared decision making that can truly help us jump the curve toward more cost-effective health spending and outcomes.

The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%.

On the physician pay front, primary care doctors in the U.S. earn about $186,000 a year, compared with Australian colleagues who bring in about $92K a year, French peers at $96K per annum, Canadian PCPs earning $125,000, Germans at $131K, and British earning $160K.

When it comes to specialists, like orthopedic surgeons, the pay gap between doctors in the U.S. and colleagues overseas is much greater: on average orthopods earn $442,000 in the U.S. compared to British orthopedists earning $324K per annum, Canadians at $209K, Germans at $202K, Australians with $188K, and French, at $154K.

Hospital prices are also tops in the U.S. Per discharge, Americans spending $18,142; Germans spend $5,072, with an OECD median of $6,222. Thus, the U.S. hospital discharge cost is about 3 times that of other developed countries. 

It is no surprise that prescription drug prices in the U.S. are greater than in any other country in the OECD: prices for the 30 most commonly prescribed drugs in 2006-7 were indexed at 1.0 for the U.S. vs. other OECD nations. The overall OECD median was 0.51, with the lowest drug costs seen in New Zealand (o.34 on the index), France (0.44), Australia (0.49), with the next-highest country being Canada at a 0.77 index.

On the technology front, the U.S. has an above-average number of MRIs, CT scanners, PET scanners, and mammographs. Utilization and prices per scan, too, are greater in the U.S. than in other OECD countries. “This combination of pervasive medical technology and high prices showcases two potent drivers of U.S. health spending, and a possible explanation for the outsized share of resources we dedicate to health care relative to the rest of the world,” the Fund states in the report.

The newest aspect of health spending driver is obesity: the U.S. wins the global obesity contest hands-down, with 34% of the U.S. population scoring a BMI over 30. In contrast, the next most-obese nation studied by The Commonwealth Fund was New Zealand, with 26.5% of the population having a BMI over 30; other high scorers on the obesity league table were Australia (24.8%), Canada (24.2%), and the UK (23%). Other countries in the report had fewer than 20% of people with BMI’s over 30. The leanest folks live in Switzerland and Japan, according to the latest OECD health database.

Health Populi’s Hot Points:  With all that health spending, health outcomes in the U.S. don’t uniformly rank at the top of the OECD roster. The U.S. ranks higher for breast cancer and colorectal cancer survival (along with Norway). However, the U.S. ranks lower than median OECD for cervical cancer. The U.S. also has higher than average rates for conditions amenable to treatment (which I wrote about here in Health Populi) such as asthma, diabetes (measured by lower-extremity amputations per 100,000 people) and cardiac disease.

The Commonwealth Fund calculates that if the U.S. spent the same rate on health care as in Japan, the U.S. would save $1.25 trillion a year — more than the U.S. defense budget. The Fund notes that Japan has a fee-for-service system with no restrictions on specialists and hospital choice. The country also boasts advanced medical technology. What they do in Japan is regulate health prices.

Ultimately, higher prices for health services do what prices in other markets do: crowd out people who can’t afford services to seek substitutes. In health care, that’s not so easy to do, beyond seeking over-the-counter therapies from pharmacies as alternates for prescription drugs, and other self-help remedies. Many people turn to the internet for advice and crowdsourcing of health solutions. More of us are quantifying ourselves with the objective of staying healthy and trying to avoid entering the health system.

Ultimately, though, every health citizen needs a physician – a medical home – and as we age, a hospital bed, at some point, to deal with the growing burden of chronic conditions that inevitably hits every human. The market itself doesn’t sort this out on its own.

Once upon a time, patient satisfaction with visits to doctors’ offices used to be a function of bedside (exam room) manner, demeanor and responsiveness of the reception and insurance staff, and the age of magazines in the waiting room. Today, waiting time is a key factor, and social media is raising expectations around response time in health care.

See the first chart, based on data from PwC’s survey, Social Media “Likes” Healthcare, published in late April 2012. The poll found that when U.S. adults use social media in healthcare, at least 4 in 10 people want complaints and information requests responded to within a few hours, and a majority want resolution within a day or less — especially for appointments and follow-ups.

This week at the American Telemedicine Association meeting, Dr. Jay Sanders, one of the pioneers in telemedicine, talked about the impending explosion of retail health, saying that, “healthcare providers have largely failed to… use established channels of distribution and low-cost technologies to serve patients better.” The new generation of retail health providers understands that time is money to patients, and that customer service that leverages technologies people use in everyday life are equally relevant and applicable for personal health management. More importantly, time is precious when making medical decisions of an acute nature.

For more on Dr. Sanders and other telehealth innovators, see my report, Right Here, Right Now: Ten Telehealth Pioneers Make It Work, from California HealthCare Foundation.

Health Populi’s Hot Points:  The incumbent health care industry players should take this data point quite seriously. See the second chart, from Intuit’s survey of U.S. adults from 2011. It’s clear that about one-half of patient-health consumers would consider switching physicians if they don’t office electronic access to appointment scheduling, accessing lab results, and emailing patients, among other digital applications that people want. This piece of information should concentrate the collective mind of physicians, who may want to avoid providing patients with electronic access to schedules and personal health information. But when not doing so can lead to patients walking with their feet, and wallet, health providers should re-think their stance.

A discussion about consumers’ access to health information in Meaningful Use stage 2 is now brewing on the listserv for the Society for Participatory Medicine concerning the American Hospital Association’s view that hospitals should have 30 days to provide patients hospital discharge information — instead of within the proposed 3-day timeframe suggested in the original Meaningful Use criteria. We’re talking here about medication lists, discharge instructions to the home, lab test results, and other information crucial to making a safe transition to the home or step-down facility.

Patients expect at least as high a level of service from their health system they get from automobile repair shops, retailers, and banks. That the nation’s hospital association is bucking this consumer demand is short-sighted, unsafe for patients and their families, and counter to what technology-enabled customer service can deliver.

The most flexible workplaces are good for worker’s health: they yield the most engaged workforces, greater job satisfaction, increased commitment to the firm, better mental health and lower indicators of depression. But not all firms are all that flexible, which is the top line of the Family and Work Institute‘s 2012 National Study of Employers (NSE), funded by The Alfred P. Sloan Foundation.

What makes this survey different from others polling employers is that the NSE looks at the comprehensive array of total benefits offered to employees and their changing needs in terms of family, finance, and social lives.

In the past seven years, with the advent of the Recession and subsequent slow-to-no recovery, employers’ benefits have substantially changed in two ways: first, employees have more options for flexible work in terms of time and place; and second, employers have reduced opportunities for part-time work. New fathers have less time to take off following childbirth, even in the wake of the Family and Medical Leave Act of 1993. While more employers are offering Dependent Care Assistance Plans to help workers pay for child care with pre-tax dollars, fewer companies provide emergency or sick care options. Most employers do provide Employee Assistance Programs to help workers deal with problems and pressures (up to 74% in 2012 from 46% in 2005). And as regular Health Populi readers will know, wellness programs proliferate workplaces: the NSE found that 63% of employers offer wellness programs vs. 47% in 2005.

While employers offering health insurance persists, especially among larger companies, employees must pick up larger portions of premiums and higher copays. Among companies offering health insurance, 17% pay all of the premiums, 83% pay some of the premiums. Smaller firms were less likely than large ones to have increased employees’ premium co-pays year-on-year. However, smaller firms were less likely to provide wellness programs than larger companies. It’s encouraging to see that more employers are offering health benefits to unmarried partners of employees – up from 23% in 2005 to 38% in 2012, as the chart shows.

Firms that offer greater flexibility tend to be: non-profits, larger, have more women in their employ, have fewer union workers, have fewer racial or ethnic minorities in the workforce, have fewer hourly employees, and have more women and racial or ethnic minorities in top/senior positions.

Health Populi’s Hot Points:  It might seem rational to assume that in the post-recession period, U.S. employers would have reduced benefits and programs to assist workers. This is too simple a statement: while employees must have “more skin in the game” especially when it comes to health benefits, progressive employers are showing support through more artful design of benefits looking at whole-health and family and social dynamics, such as re-defining what is a “family.” By investing in greater flexibility for full-time workers, employers who do so are voting with dollars to promote whole health and lowering stress, which according to the employers polled by FWI yield greater productivity and company allegiance.

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA.

In enabling mobile physician visits, American Well and Consult A Doctor join Myca, which has offered mobile phone-based visits for clients for at least two years to employer clinic customers. In April 2010, my report, How Smartphones Are Changing Healthcare for Consumers and Providers, talked about Myca’s work with Qualcomm: the telecomms company armed traveling employees with mobile phones that could connect back to the company’s employee clinic.

It’s taken two years to see this innovation fan out to a broader base. With American Well’s and Consult A Doctor’s announcements, we’re moving up on the adoption curve beyond the first pioneer-adoption phase.

American Well’s news is their Online Care 6.0 update which enables individual consumers to access providers on the platform. Mobile access is supported for iPods, iPads, and iPhones, and the company expects two-way video encounters will be available this summer.

Consult A Doctor previewed an iPhone app to allow patients to connect with their doctors on-the-go. The TeleCare 3.0 platform is cloud-based, licensed to physicians, hospitals and health plans. One of Consult A Doctor’s distinctions is that audio from the telehealth sessions is recorded and included in a patient’s EHR.

Health Populi’s Hot Points:  Several factors are driving the mobile health market, and particularly the segment of mobile visits: a growing mobile workforce, consumers adopting mobile phone apps, physicians and nurse adopting mobile technology (especially tablets, and the doctor-beloved iPad), and payors’ passion to stem health cost increases. Both health plans and employers have demonstrated interest in adopting and reimbursing online visits, version 1.0, online via webcam and videoconference. Now, here come mobile visits. Watch for more platforms to emerge in the coming months.

The limiting factor on the supply side will be physicians, some of whom will be challenged by a new kind of workflow. Those who can jump the curve and revel in mobile platforms for patient visits will see a new revenue stream and, potentially, a more productive workflow. In addition to acute cases, doctors will find a platform that’s also useful for helping patients manage chronic conditions outside of the physician’s office.

Two reports this week suggest countervailing trends for employer-sponsored health benefits: the erosion of the health benefit among companies, and opportunities for those progressive employers who choose to stay in the health benefit game.

In 2010, nearly 50% of workers under 65 years of age worked for firms that did not offer health benefits. The uber-trend, first, is that the percentage of workers covered by employer-sponsored health insurance has declined since 2002. Workers offered the option of buying into a health benefit, as well as the percent covered by a health plan, have both fallen, according to the Employee Benefits Research Institute (EBRI), an organization that has long-tracked this trend. EBRI’s report on Employment-Based Health Benefits: Trends in Access and Coverage, 1997-2010, provides the details behind this declining picture.

Cost is a big determinant of why workers who are offered the health insurance option, don’t join the plan: the percentage of workers who declined coverage due to cost grew from 23.2% to 29.1% between 1997 and 2010.

Coupled with the EBRI report this week is MetLife’s 10th Annual Study of Employee Benefits Trends, which paints a hopeful picture for those so-called “progressive” employers who see opportunity in the fact that health care costs have “exploded” since MetLife launched its study a decade ago. The insurer has found that there is a cadre of innovative firms re-imagining total benefits to drive productivity, wellness, and worker engagement.They’re also re-defining “wellness” beyond physical health, understanding that employee stress caused by financial pressures can compromise productivity and total health, too. Thus, 3 in 4 employers recognize a responsibility to help employees achieve financial security.

But in the recession, employees are less loyal, looking to leave, and are a long way from feeling financially secure. The more progressive employers aren’t blind to this reality – the chasm of trust between employee and employer. This is one of the opportunities MetLife points out in the “shifting sands” of the economy: employees are counting on more help, and for the most part, employers are willing to fill that helpful role role. There is a loyalty gap that needs to be filled, MetLife finds, which has widened since 2008 when 40% of employees believed their employer had a sense of loyalty to them, but in 2011, only 32% felt that way.

Across all company sizes, 40% expect to maintain current benefits, with 30% doing so by cost-shifting to employees. Only 10% of firms expect to reduce benefits. The good news is that MetLife found that employees expect bigger cuts than employers plan to make.

Health Populi’s Hot Points:  MetLife identifies a segment of employers as “progressive,” those who are embracing change in the economy and in consumers as an opportunity to re-engineer benefits towards whole health – physical, mental and financial. What of the other companies who are less progressive, whom MetLife terms the “standards?” They’re not embracing wellness and personal fiscal health in the same way. In so doing, they risk a growing gap in loyalty between worker in company, and losing the most talented workers to other firms who are more enlightened. Those who stay on-the-job could be those less motivated, less engaged, and less productive. This can lead to an un-virtuous cycle, translating into less than optimal results for companies.

Still, it is exciting to witness more companies embracing a new wellness regime to improve employee health, and expanding the definition of “health” beyond the physical. Together, the EBRI and MetLife reports point out we’re at a fork in the road of health benefits. The most enlightened companies are embracing whole health in the total benefit package.

One-half of physicians believe they’re not fairly compensated for their work – in particular, those working in primary care. Only 11% of doctors considering themselves “rich.” Medscape’s 2012 Physician Compensation Report compiled data from over 24,000 U.S. physicians across 24 specialties and found the bulk of physicians to see themselves working harder and 1 in 4 making less money than last year.

This has led to growing frustration and worry, where some physicians are resenting the large pay gap between specialists and primary care. That frustration looks poised to increase with doctors concerned that accountable care will further eat into incomes, and increased regulation and administrative hassle “take the joy out of medicine,” as Medscape coined the feeling.

In 2011, pediatricians earned on average about one-half of what radiologists took home in pay: about $150K versus $315K. The top physician earners along with radiologists were cardiologists, urologists and orthopedic surgeons. The lowest-earners were pediatricians, internists and family medicine doctors. Still, while they are top-earners, orthopods’ and radiologists’ income declined an average of 10% between 2010 and 2011.

Physicians in single and multispecialty group practices, and those within healthcare organizations, earn higher incomes compared with colleagues in academia, outpatient clinics and solo practitioners.

If they had to do it all again, would physicians choose to be physicians? 54% would still pick medicine as a career…the other 46? Not so much…

Health Populi’s Hot Points: Economics is driving physician discontent in the United States. Not only are at least half of medical specialties seeing falling incomes, but the future potential for money looks dire in at least two respects: accountable care is seen by at least one-half of physicians as a cause for income to decline; and, regulations and paperwork eat further into profit margins for physician practices.

There are two important patient-facing effects that Medscape measured related to health economics. Look at the second chart: over one-third of doctors overall regularly discuss the cost of treatment with patients, and nearly one-half talk about costs when patients bring up the subject. Only 16% of doctors say they “never” talk about the cost of treatment with patients.

Second, the question of testing: 69% of doctors say they will not reduce testing to contain costs for two reasons:

• - 43% say, “no, because these guidelines are not in the patient’s best interest; and,
• - 24% say, “no, because I am still going to practice defensive medicine.”

Consider these data points as a statistic-about-to-change. What happens in accountable care and patient-centered medical home models? Then, guidelines become front-and-center as physicians’ are compensated based on more budget discipline, quality, team work, and performance. Physicians may not reduce testing to save costs in today’s discounted fee-for-service milieu; but as their income is rooted in team-based success, and not volume-driven, being more mindful about what tests are most appropriate and necessary will change this mindset. The impact may not immediate, but the lab business as we know it today will be impacted by this changing mentality and payment regime.

Beyond tests, the frustration of primary care doctors vis-a-vis physicians earning as much as double as they are will be another front-center issue in accountable care and PCMH, where primary care becomes the front-door for patient check-in, prevention, and early diagnosis. Income shifts may be inevitable, as population health management priorities share the stage with individual acute care. This is a discussion Americans haven’t yet had, and it will be heating up over the next few years.