A blog covering the health/care ecosystem and people.

In accounting, there’s a rule with acronym “LIFO;” this stands for “last in, first out,” which requires taking account of the most recent cost of products being the first ones to be expensed on the ledger. I’m thinking about LIFO when it comes to the American Health Care Act (AHCA) which narrowly passed through Congress yesterday by 4 votes, with a final tally of 217 to 213. Why “LIFO?” Because long-uninsured folks who just recently received access to health insurance as an on-ramp to health care services could lose this benefit, just months after joining the ranks of the insured. Among

The top healthiest eating communities tend to circle the perimeter of the map of the lower 48 U.S. states. In these towns, more than 72% of health citizens report healthy eating. These areas are located in California, Florida, and Massachusetts, among others. Areas with the lowest rates of healthy eating are concentrated generally south of the Mason-Dixon Line, in places like Arkansas, Kentucky, and Mississippi, and other states. In these places, fewer than 57% of people eat healthy. Eating healthy foods in moderation is a mighty contributor to personal and public health, discussed in the report, State of American Well-Being

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

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

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

Most US adults favor some kind of national health care plan, based on an Economist/YouGov poll conducted in April 2017. Six in ten people are for expanding so-called “Medicare for All,” where the health plan that currently serves older Americans would extend to all U.S. health citizens. Six in ten people would also favor a Federally-funded health insurance system that would cover all Americans — that is, universal health care. The table details this poll question by political party identification and family income. At least 3 in 4 Democrats would be more likely to favor either of the two healthcare

CNN called it, “the ancient perfume store you never heard of,” but the Officina Profumo-Farmaceutica di Santa Maria Novella had its literal roots in medicinal herbs. With scents wafting onto a 13th century Florence piazza, the Farmacia now operates as a pharmacy storefront for homeopathic and herbal supplements, along with perfumes and home scents. A visit to the pharmacy today is a journey into medicinal time-travel, back to the year 1221. I spent time in the pharmacy today to learn about the literal roots of the shop in medicinal herbs cultivated in a monastery garden and reformulated by monks into

This week I celebrate two spring holy holidays in one city that embraces spirituality, civility, and culture: Florence, Italy. Today, I had the special opportunity to tour Ospedale degli Innocenti: the Hospital of the Innocents. The hospital is now an institute for studying the culture and economics of children, and a museum telling a unique story of Florentine babies born in the early 15th century, spanning our contemporary era. The founding and root history of this beautiful place has lessons to teach us even today. It is key to realize, first, that Florentine humanism exalted the ideal virtues of the

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

Consumers love their supermarkets, fast food shops, retailers, delivery services, and banks. These industries rank highest in the 2017 Temkin Experience Ratings, my go-to source for understanding consumer service Nirvana. Health insurance companies and internet service providers (ISPs) are at the bottom of the Temkin Ratings, as shown in the first chart. Note that health plans range from a score approaching 70 to under 50, illustrating the very wide range of consumer experience from okay-to-good, too very poor. The top-ranked health plan was Kaiser Permanente, with a rating of 67%; Health Net was ranked the worst of the health plans

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

States that expanded Medicaid since the start of the Affordable Care Act made greater health system access improvements than those States that did not expand Medicaid, according to Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance. There’s good news and bad news in this report: on the upside, nearly all states saw health improvements between 2013 and 2015, and in particular, for treatment quality and patient safety. Patient re-admissions to hospitals also fell in many states. But on the downside, premature deaths increased in nearly two-thirds of states, a reversal in the (improving) national mortality

The future of wellness combines: Connected (you) Social IRL (in-real-life) Banishing bad (de-tabooing what’s traditionally seen as “bad”) Humanizing data, and The end of experts. These insights come from adidas, whose team developed a forecast of the future of fit, announced at the 2017 South-by-Southwest Festival in Austin this weekend. I had the honor of participating in this forecast and shepherding the SXSW panel on The End of Experts: Crowdsourcing Your Wellness at the adidas meet-up held over the weekend. The future of fit and wellness is Connected, because we are growing to understand that balancing many elements in our daily

The truest form of health reform and consumer-directed health care isn’t in a high-deductible health plan or a health savings account, and it doesn’t come out of Washington DC or your employer’s health benefits office. It comes from you in the form of self-care and DIY healthcare. In this case, think “inspired by sport, powered by you.” I’ll be participating on a panel at this weekend’s South-by-Southwest Festival in Austin, Texas, along with three wellness innovators: Nick Buettner of the Blue Zones project, Mary Liz McCurdy of Google, and John Wilbanks from Sage Bionetworks. Together, our quartet will brainstorm the

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

The American Psychological Association reports that Americans are experiencing greater levels of stress in 2017 for the first time since initiating the Stress in America Survey ten years ago in 2007. This is a statistically significant finding, APA calculated. The member psychologists of the American Psychological Association (APA) began to report that patients were coming to appointments increasingly anxious about the 2016 Presidential election. So the APA polled U.S. adults on politics for the first time in ten years of conducting the Stress in America survey. Two-thirds of Americans are stressed and/or anxious about the future of the nation, and

The plane has left the Orlando airport, and I’m looking back at the past week at the 2017 annual meeting of HIMSS, the annual health IT conference that has been my pleasure and (foot) pain to attend for the past two+ decades (for real). Walking the exhibition floor, I encountered some new flavors of imaging that went way beyond bits and bytes, data and technology. These images spoke to me of health, vitality, and life. I’m sharing them with you here, with no intention of selling you company products or services but simply sharing some images that speak to these

Patients are morphing into consumers, but with eyes wide open: they know about data breaches, and they increasingly demand healthcare services delivered on their own terms. I met with Accenture’s Dr. Kaveh Safavi, Frances Dare, and Jenn Francis at HIMSS17 to discuss their latest research into these two topics. In this post, I’ll cover the growing challenge of cybersecurity and what Accenture learned about consumer data breaches. Tomorrow I’ll discuss Accenture’s latest findings on the expectations of the evolving health/care consumer. [Spoiler alert: personal health information data security is one of those expectations]. At HIMSS17, the issue of cybersecurity is

The autonomous car is a metaphor for healthcare: that’s how my first interview kicking off the  HIMSS marathon began. The annual 2017 HIMSS conference isn’t your father’s or mother’s HIMSS of ten years ago, or even the HIMSS of 2010 — the year that financial incentives for EHR adoption began to stream from the HITECH Act of 2009, motivating thousands of healthcare providers to acquire and meaningfully use digital health records systems. Then, the HIMSS conference floor was abuzz with EHR frenzy. This week, over 43,000 people working at the intersection of healthcare and technology have converged in Orlando, Florida, for

Price increases and growing use of healthcare services will drive national health spending (NHE) in the U.S. to 20% of the nation’s economy by 2025, according to projections calculated by a team from the Centers for Medicare and Medicaid Services (CMS). Health spending will reach $3.6 trillion dollars this year. These were published in a Web-First article in Health Affairs on 15 February 2017 The caveat on these numbers is that the CMS team used economic models based on “current-law framework:” these make no assumptions about legislative changes that may occur in healthcare reform between 2017 and 2025. While that’s a

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

Health care is the top concern of American families, according to a Monmouth University Poll conducted in the week prior to Donald Trump’s Presidential inauguration. Among U.S. consumers’ top ten worries, eight in ten directly point to financial concerns — with health care costs at the top of the worry-list for 25% of people. Health care financial worries led the second place concern, job security and unemployment, by a large margin (11 percentage points) In third place was “everyday bills,” the top concern for 12% of U.S. adults. Immigration was the top worry for only 3% of U.S. adults; terrorism and

Americans are more than five times more likely to skip medication doses or not fill prescriptions due to cost than peers in the United Kingdom or Switzerland. U.S. patients are twice as likely as Canadians to avoid medicines due to cost. And, compared with health citizens in France, U.S. consumers are ten-times more likely to be non-adherent to prescription medications due to cost. It’s very clear that more consumers tend to avoid filling and taking prescription drugs, due to cost barriers, when faced with higher direct charges for medicines. This evidence is presented in the research article, Cost-related non-adherence to prescribed

Health and money are the two issues about which Americans have set New Year’s resolutions, according to the Harris Poll, Americans Look to Get Their Bodies and Wallets in Shape with New Year’s Resolutions. The top goals U.S. consumers have set for 2017 are to: Eat healthier, 29% of all U.S. adults Save more money, 25% Lose weight, 24% Drink more water, 21% Pay down debt, 17% Spend more time with family and friends, 15% Get organized, 15% Travel more, 15% Read more, 14% Improve relationships, 14%. There are some marked differences between American men versus women across these resolutions;

  Two in three U.S. consumers are willing to see a doctor online. American health consumers welcome the opportunity to engage in virtual healthcare services via telehealth. American Well’s 2017 Telehealth Index surveyed 2,100 U.S. adults 18 and over in August and September 2016 to gauge consumers’ views on healthcare services, access, and receptivity to virtual care modes of delivery. Underneath the 66% of consumers open to telehealth are demographic differences: people with children are more likely to value virtual care, as well as people between 45 and 54, the survey found. Note, though, that a majority of older Americans over

Among many health disparities which mar healthcare quality in the United States, there’s another one to add to the list: health and healthcare information access. Access to health care is underpinned in large part on a health consumer’s access to information about available health care services, their location, price, and if the patient is very fortunate to glean, quality. As people take on more responsibility for managing their health care utilization and financing in America, their access to information that is easy-to-find, clear, comprehensive and current is critical to personal and public health outcomes. But consumers are dissatisfied with the

Nine in 10 U.S. consumers think pharma and biotech put profits above patient interests, according to the latest Harris Poll studying reputation equity across organizations serving health care. Notice the relatively low position of the green bars in the first chart (with the exception of the impression for “strong financial performance); these are the pharma/biotech consumer impressions. The health industry stakeholders consumers believe would more likely place them above making money are health care providers, like doctors and nurses, hospitals, and pharmacists. Health insurance companies fare somewhat better than pharma and biotech in this Poll, although rank low on social

Digital health innovations were fast-proliferating at CES 2017. The bad news is there are so many of them, it’s dizzying and fragmented. The good news is that there are emerging health data ecosystems that will streamline consumers’ user experience so that people can derive knowledge, actionable advice and value out of using these tools. Walking miles of aisles in the Sands Convention Center in the first week of January 2017 can be a dizzying prospect, with hype and best-faces-forward in every single exhibitor at the show. In the health segment at CES, there’s a long list of digital tools to

Pain management is a growing story at CES 2017. I covered the topic of Sleep and Pain at CES one year ago in the Huffington Post, and this year, the category has grown in both number of innovations and mode of pain management. At CES 2017, there were exhibitors of FDA-approved devices, sleep-and-pain focused tech, wristbands for relaxation and nausea-management, and a $5,999 device for calming meditation that’s being used in addiction programs. What’s driving growth and acceptance of this health tech segment is the opioid crisis which has become a public health epidemic across the U.S. The maps with increasing orange

I’m at CES 2017 in Las Vegas all this week looking for signs of health in new technology announcements. While it’s no surprise there are hundreds of new and new-and-improved digital health innovations on the exhibition floor, you can look beyond those aisles to other companies who are new entrants in health. Arguably, these companies can bolster peoples’ health at least as much as activity tracking and calorie counting. Here are five examples I wrote about in my Huffington Post column yesterday, The Social Determinants of Health Live At CES 2017: Safety – Liberty Mutual Nutrition – Terraillon Healthy Sex

Consumers spend one in five dollars of their household budgets on healthcare in America. This fiscal reality is motivating more U.S. health citizens to seek information and control for their and loved ones’ health care. Personal health technologies will play a growing part in peoples’ self-care outside of the healthcare system and, increasingly, as part of their care prescribed by clinicians and (to some extent, for the short-term) paid-for by payors – namely, employers and government sponsors of health plans. This week is the Disneyland event for the personal tech aficionados known as CES (once called the Consumer Electronics Show).

Nurses rank, by far, the top profession for honest and ethics in the U.S. in the 2016 version of the annual Gallup poll on ethics in professions, Americans Rate Healthcare Providers High on Honest, Ethics, published this week. Since 1999, nurses have been #1 in this survey except for the year 2001, when firefighters scored the top spot in light of the 9/11 attack. Another consistency in this survey among U.S. consumers is that pharmacists and physicians top the list once again, after nurses, and the most-trusted professions in America. At the bottom of the roster, as in 2015, are Members

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

A plurality of Americans, 4 in 10, are dissatisfied with the healthcare costs they face. The level of dissatisfaction varies by a consumer’s type of health insurance, while overall, 42% of people are dissatisfied with costs… 48% of privately insured people are dissatisfied with thei healthcare costs 29% of people on Medicare or Medicaid are dissatisfied 62% of uninsured people are dissatisfied. Gallup has polled Americans on this question since 2014 every November. Dissatisfaction with healthcare costs is up from 38% from the period 2011-2013. As the line chart illustrates, the current levels of cost-dissatisfaction are similar to those felt

For the first time since 1993, expanding life expectancy in the United States has reversed, based on the latest report from the Centers for Disease Control, Mortality in the United States, 2015. “The last time U.S. life expectancy at birth declined was in 1993, when it dropped from 75.6 to 75.4, according to World Bank data,” as quoted in the Washington Post. Life expectancy at birth in 2015 was 78.8 years, a slight fall from 2014 at 78.9 years. The larger decline fell among men, from 76.5 to 76.3 years. For women, life expectancy at birth in 2015 was 81.2,

Several market forces are converging that boost patients’ ability to engage in their health and self-care, including peoples’ growing adoption of smartphones, demand for self-service and DIY lifestyles, and Americans’ growing responsibility as health consumers. Health consumers are using a growing array of self-health tools, enabled through digital technologies. However, these tools aren’t yet engaging some of the very people who need them the most: high-need, high-cost patients. Research into this situation is discussed in the December 2016 Health Affairs article, Many Mobile Heaath Apps Target High-Need, High-Cost Populations, But Gaps Remain, published in the December 2016 issue of Health Affairs. For

Spending on health care in the U.S. hit $3.2 trillion in 2015, increasing 5.8% from 2014. This works out to $9,990 per person in the U.S., and nearly 18% of the nation’s gross domestic product (GDP). Factors that drove such significant spending growth included increases in private health insurance coverage owing to the Affordable Care Act (ACA) coverage (7.2%), and spending on physician services (7.2%) and hospital care (5.6%). Prescription drug spending grew by 9% between 2014 and 2015 (a topic which I’ll cover in tomorrow’s Health Populi discussing IMS Institute’s latest report into global medicines spending). The topic of

Think “Hormel,” and you may have visions of SPAM, Chi-Chi’s salsa, Skippy peanut butter, and Dinty Moore corned beef hash. So what’s Hormel doing in the title of a Health Populi post, anyway, you might ask? Like many food companies, Hormel is broadening its product portfolio expanding with health. The company isn’t just moving to healthy eating for wellness’s sake, but boldly going where most food companies haven’t yet gone: developing products for people battling cancer. Vital Choices, a well-titled line of frozen meals, was developed by Hormel in collaboration with the American Cancer Society, Cancer Nutrition Consortium, the Culinary Institute

Thanksgiving is about gratitude, family and food, hopefully in abundance. In millions of American households, Thanksgiving has also come to mean holiday shopping in the form of deep discounts starting as early as 3 pm on Thanksgiving Day. Holiday shopping has become something of a competitive sport for value-motivated consumers, and fitness tracking devices will be a big seller for gift-giving. Think of this phenomenon as gifting connected and digital health for the holidays, and part of the morphing retail health landscape beyond the pharmacy and into Big Box, consumer electronics, and discount stores. The Consumer Technology Association (CTA) published

“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

I attended CES Unveiled in New York this week, which is a preview of what will be featured at the CES in Las Vegas in January 2017. CES, previously known as the Consumer Electronics Show, is celebrating a 50 year anniversary, having been born in Manhattan in 1967 when transistor radios, stereos, and black-and-white TVs were all the rage. Today, CES is the world’s largest innovation event, and the longest-lived. 10 of the original 1967 exhibitors still show at CES, including 3M, Philips, Sharp, SONY, Toshiba, and Westinghouse, among others. Meet George Jetson, who might have been an attendee at

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

Most U.S. hospitals have not put consumerism into action, a new report from KaufmanHall and Caden’s Consulting asserts from the second paragraph. Patient experience is the highest priority, but has the biggest capability gap for hospitals, the report calls out. KaufmanHall surveyed 1,000 hospital and health system executives in 100 organizations to gauge their perspectives on health consumers and the hospital’s business. KaufmanHall points out several barriers for hospitals working to be consumer-centered: Internal/institutional resistance to change Lack of urgency Competing priorities Skepticism Lack of clarity (vis-a-vis strategic plan) Lack of data and analytics. The key areas identified for consumer centricity

60% of Americans are currently trying to lose weight. So it shouldn’t be a surprise that when asked, “what’s the most serious health problem in the United States?” Americans say it’s obesity, tied with cancer, and ahead of heart disease and diabetes. Overweight and obesity are top-of-mind for most Americans, according to research conducted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and NORC at the University of Chicago. This research has created two reports which can be accessed at the link. The survey, conducted among 1,509 consumers in August and September 2016, found that Americans’ understanding of

There is growing support for a single payer healthcare system in America, found in the latest Gallup Poll and a survey the organization conducted earlier this year in May 2016. A slight majority of Americans favor a single payer system, shown in the first chart. By political party, that splits into 3 in 4 Democrats pro-single payer, and 4 in 10 Republicans (41%). Note that the 41% of Republicans who favor single payer is a much higher number than the 16% who favor keeping the Affordable Care Act in place. Gallup writes, “The general idea of a single payer system seems to

While American workers appreciate the benefits they receive at work, people are concerned about health care costs. And consumers’ collective response to rising health care costs is changing the way they use health care services and products, like prescription drugs. Furthermore, 6 in 10 U.S. health citizens rank healthcare as poor (27%) or fair (33%). This sober profile on healthcare consumers emerges out of survey research conducted by EBRI (the Employee Benefit Research Institute), analyzed in the report Workers Like Their Benefits, Are Confident of Future Availability, But Dissatisfied With the Health Care System and Pessimistic About Future Access and

If you need more proof that mainstream consumers are seeking health through the food they buy, look no further than this announcement about the new Good Housekeeping nutrition lab and launch of the new emblem:  “nutritionist approved.” The effort is underpinned by the Good Housekeeping Food and Nutrition Brand Lab Incubator, located in the GH Institute in New York City. The goal of the program is to empower consumers to “confidently navigate crowded supermarket shelves and make healthier purchases.” Ultimately, GH hopes to inspire people to make healthier food choices, and to inform food manufacturers with healthy product development and brand