A blog covering the health/care ecosystem and people.

Prescription drug formularies are getting more complex to drive cost-savings as well as promote adherence to drug regimens, as told by the data in the 2010-2011 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda Pharmaceuticals NA. The average rate of drug cost increases is 6.3%, compared to 4.4% in the 2009-2010 survey — the lowest rate of increase since this survey was launched. A key part of the story of the new value-based benefit design is told by the co-payment differentials for Rx drugs, shown in the chart. Health consumers who have three-tiered prescription drug insurance face an

Contrary to stereotypes, older people can adapt, learn, and use new products and services. The introduction of Medicare Part D five years ago was an experiment in public policy, with some policymakers fretting about seniors’ ability to navigate a new system. It appears Medicare Part D is a hit, and people are working well with it across gender, age cohorts, incomes (from very low to upper-income strata), educational levels, and especially very sick and disabled people. Among all seniors, 90% have prescription drug coverage. 61% of U.S. adults 65 and over have a Medicare prescription drug plan, 16% are covered by an employer-sponsored

Sex, drugs, rock and roll, Victoria’s secret bras manufactured with formaldehyde, motivating kids to move about more, and texting potential sex partners your latest STD test results: the 2010 Health 2.0 Conference in San Francisco was more about real, whole health and the person-patient than about cool new tech. Furthermore, the Health 2.0 Conference turned a lot of preconceptions on their head on October 7 and 8, 2010, in a standing-room–only ballroom at the Hilton Union Square. Who could have predicted that government employees would light the room up with high energy and innovative thinking more than a panel of illustrious

The $N zillion question – whether translated into Euros, yen, pounds, lira, or pesos – is how to get more quality care and access in national health systems, while curbing health spending. Health costs have increased faster than economic development in nearly all OECD countries in the past 15 years. For the acronym-challenged, the OECD is the Organization of Economic Cooperation and Development – comprised of, generally, the most economically developed nations on Earth. This week, health maestros from OECD nations are meeting to wrestle this intractable challenge. Health costs consume about 9% of OECD countries’ budgets. This proportion of national GDPs

Medical costs will grow between 10% and 11% in 2011, depending on whether an enrollee is opting for a PPO (11%), a POS (11.2%) or an HMO plan (10.2%). These growth rates are similar to 2010 increases, with the largest percentage growth projected for point-of-service plans from 10.6% in 2010 to 11.2% next year. These cost increases are roughly eight-times inflation in the consumer price index (CPI), gauged at 1.2% in July 2010 for urban consumers. The 2011 Segal Health Plan Cost Trend Survey reflects additional costs the benefits consultants that plan sponsors will incur to comply with the Affordable Care

The ePatient Connections (ePC) conference convened this week in the City of Brotherly Love, my town, Philadelphia. And indeed, the eHealth love did flow between health citizens and organizations that seek to serve them: technology developers and health providers, alike. My flying fingers recorded nearly fifty pages of notes, and these don’t even include two tracks’ worth of presentations — social networks in health and health games — because I was the emcee for mobile health track. However, this gave me the opportunity to get to know the 11 mHealth presenters and their organizations up-close-and-personal and to brainstorm with track attendees

People in the U.S. covered by employer-sponsored health insurance assess their health insurance choices with the help of their human resource departments. Here, Blondie and Dagwood are having a discussion about three alternatives: A low cost plan A higher cost plan with better coverage A high-deductible health plan for doctors who are outside of the plan’s network. Dagwood’s solution? “Stay healthy.” Would that it were so easy! Evaluating health insurance options is no simple task, even for the savviest, Consumer Reports-reading consumers. Health citizens who want to engage as health care consumers look for trusted sources on how to make rational

Cost-competitiveness is driving overall consumer satisfaction with pharmacies in 2010, 2.5 times the importance that cost had in 2009. But even so, customer service and convenience still trump price in the pharmacy. For brick-and-mortar pharmacies, the key factors driving consumer satisfaction are: Prescription order and pick-up process (convenience) The condition of the store Cost competitiveness Non-pharmacist staff The pharmacist. In 2010, cost competitiveness accounts for 24% of overall satisfaction among brick-and-mortar Rx shoppers; that number was 9% in 2009. The retail pharmacy chains garnering highest satisfaction nationally are the Good Neighbor Pharmacy, Health Mart, and The Medicine Shoppe Pharmacy, all awarded

The U.S. has among the lowest tax-to-GDP ratios in the developed world, including state and local taxes. Only Mexico, Turkey and Korea have lower tax-to-GDP ratios among OECD members, at somewhere between 20 and 28%. The Organization for Economic Cooperation and Development (OECD) believes that U.S. tax rates are, in fact, too low and, even with modest tweaks upward, “would still keep the overall tax burden at a relatively moderate level and not impose excessive costs,” OECD states in its Economic Survey of the U.S., released today. “Tax breaks have grown significantly since the major tax reform of 1986,” the report notes, and

Americans feel pretty helpless about their individual ability to lower health care costs. Most people look to health insurance companies and the pharmaceutical industry to be responsible for lowering health costs in the U.S. A survey from Chadwick Martin Bailey and South Street Strategy looks at Americans’ views on health reform and health care costs in late summer 2010 and finds people still confused about how health reform will impact them, and impotent in their ability to lower their costs. American Consumers Uncertain About Health Reform summarizes the survey results, with the top line finding that 74% of people expect that

The usual questions a rational health citizen might ask when selecting a physician based on quality aren’t consistently yielding the best choices, according to a study funded by The Commonwealth Fund, Associations Between Physician Characteristics and Quality of Care. Researchers found that individual physician-comparative parameters such as malpractice claims and disciplinary actions, years in practice or medical school ranking had no significant association with better quality performance. Female physicians (vs. male) and Board certification had small significance, 1.6 points and 3.3 points, respectively. This study’s results demonstrate that the metrics consumers assume should be useful proxies for physician quality aren’t as useful

The U.S. health system could conserve $170 billion in avoidable medical costs related to patients not taking prescription drugs as-prescribed. That’s known as “sub-optimal pharmacy care,” and it’s estimated that 3 in 4 prescription drug users fall into this category. In other words, only 1 in 4 patients on Rx drugs take their prescriptions as directed by their physicians (known as compliance) or weren’t prescribed the optima drug therapy in the first place. At least 1 in 4 patients never even fill their first prescription for a drug their physician has prescribed. CVS Caremark has found that health citizens can become more

In 2008, 2 in 3 people in the U.S. over 60 took 3 or more prescription drug medications in the past month, and 14% of kids 11 and under regularly took an Rx. The CDC’s National Center for Health Statistics latest issue brief on prescription drug use illustrates that prescription drugs are as much of American popular culture and life as fast-moving consumer goods. It’s the more intense use of Rx drugs, 5 or more, where the most significant growth has been since 1999-2000, when 6.3% of Americans took 5 or more prescription drugs in the past month. In 2007-8, the proportion

What will employers do with their health insurance sponsorship once health reform kicks into full-implementation in 2014? Will they drop coverage? There’s been some speculation that more employers would exit covering employees, but researchers at RAND see quite the opposite scenario. An additional 13.6 million workers will be offered health insurance coverage in a post-ACA America, based on a forecasting model the RAND team constructed. This increases the percentage of employers offering workers health insurance from 84.6% of workers to 94.6% of workers post-reform. The increase is driven, the model predicts, by two key factors: More demand for coverage by workers due

Detractors of direct-to-consumer advertising (DTC) contend that the ads promote consumers asking for pills they don’t often need, medicalize normal life conditions (such as menopause and sleeplessness), and drive up unnecessary medical spending. A team of researchers now finds that DTC can play an important, positive role in motivating health consumers to adopt healthy behaviors. “The intention to engage in healthy lifestyles was strengthened by exposure to familial risk cues in DTC ads and this effect was mediated through enhanced efficacy to take healthy actions,” the paper concludes. Familial risk cues engendered positive self-efficacy. This is the first empirical study that

Two reports, from Consumers Union and the AARP, put the pharmaceutical industry in the spotlight again this week, and not in a good way. First, Consumer Reports polled U.S. adults who take prescription drugs and found that 39% took some action to reduce costs. 27% didn’t take the Rx as prescribed: 16% didn’t fill the prescription, 12% took a drug past its expiration date, and 4% shared a prescription with someone else. These and other survey findings are discussed in Consumers say big pharma influence on docs is concerning, published in the Consumer Reports Health Blog on August 24, 2010. Second, the AARP calculated

“If you build it, he will come,” Shoeless Joe whispers to Ray in the baseball class movie, Field of Dreams. Ray then takes a leap of faith, building a baseball field on top of his corn fields there in the middle of Iowa, and miracles happen. Will it take a miracle for people to adopt health apps? A panel, now in the midst of PanelPicking as one of many Interactive sessions for South-by-Southwest 2011 (SXSW), will respond to that question. The panel is called, Health: Is There Really an App for That? Voting ends midnight CDT on Friday, August 27,

  Retail health clinics have served American health consumers for about a decade. What have we learned over these ten years? As retail clinics proliferate the U.S. health care ecosystem, what is their impact on the health system, health consumers, and the health economy? The RAND report, Policy Implications of the Use of Retail Clinics, responds to these issues. The key implications of RAND’s study are that: – Health programs should be designed and paid-for to incorporate the adoption of retail clinics and reduce fragmentation and dis-continuity of care. – Learn from the best practices and patient outcomes gained from

When it comes to their paper medical records, people are most concerned about their ability to access them when they need them. 28% of Americans are more concerned about access than inaccuracies, fraudulent use of the record, loss, or portability to a new doctor. Practice Fusion commissioned this survey of American adults and how they feel about various aspects of paper-based medical records. Overall, 1 in 5 people worry about inaccuracies or outdated information in their records; 1 in 6 are concerned that records will be stolen or used fraudulently, and 1 in 10 fret that records will be lost, won’t be

The Affordable Care Act (ACA), aka health reform, will move 32+ million Americans to the insured population, and looks to the primary care ‘front-end’ of health care delivery to take in these newly-covered patients. Today’s USA Today reports on the primary care shortage in America. How to reconcile the influx of new patients in the U.S. health system with the deficit of primary care providers? First, the Community Health Center is one part of the solution to the primary care supply challenge. Furthermore, CHCs are integrated into ACA, seen as a key component for redesigning American health care delivery to improve quality, lower

Best Buy is teaming up with Cardiac Science, targeting potential purchasers of electronic health records (EHRs) and noninvasive cardiac devices. The venture looks to take advantage of economic stimulus funding available through the HITECH Act aimed at motivating physicians to adopt EHRs. Cardiac Science is a medical device company focused on the noninvasive management of heart disease. Their products include defibrillators, ECG/EKG devices, stress testing equipment, Holter and vital sign monitors. These heart-hardware products are designed to connect with electronic health records systems in hospitals and physician offices. and are used in many settings outside of health institutions including schools, emergency

WellDoc received approval from the Food & Drug Administration (FDA) on August 2 2010 to market the company’s DiabetesManager system. This signals the regulator’s openness to mobile health solutions — a market moment that may usher in the new-and-improved era of personal health management. DiabetesManager uses the mobile phone as a platform for patients with Type 2 diabetes to gather, store and communicate personal health data such as blood glucose measurements; these data then feed into WellDoc’s algorithms that communicate personalized health coaching support back to patients in real-time. This process creates a closed-loop system that helps bolster patients’ decisions and behaviors throughout the day. Health

What is a luxury good? A good working definition is a good for which demand increases as income grows. Contrast this to a “necessity good,” something that people need regardless of level of income. Baby Boomers are morphing their idea of what constitutes a luxury good versus a necessity in light of the recession, according to a new study from New York Life, MainStay Investments Boomer Retirement Lifestyle Study, published August 5, 2010. The chart illustrates that 3 in 4 Boomers put health care costs as a top #1 or #2 retirement concern. Furthermore, 98% of Boomers called health care

A decade ago, I was engaged by a consumer health company to lead a scenario planning exercise on the future of the health consumer. We developed four scenarios, one of which was called something like “MicrosoftMerckGEGenMills.” In that futureworld, several Big Organizations would come together to serve consumers in caring for themselves outside of traditional care settings, like hospitals, doctors’ offices, and nursing homes. The beauty of scenario planning when done well is that, if you’ve done it for a long time, you sometimes get one right. Witness the New Deal between GE and Intel, partnering up to develop solutions

Social networking is key to women’s experience with the Internet, according to comScore’s report, Women on the Web: How Women are Shaping the Internet. Women spend 39% more time on social networks online than men do. comScore studied the “Mars versus Venus” differences between men and women online, discovering that gender stereotypes only go so far. The chart shows the differences between women and men and their e-retail relationships. In stereotypical “men” categories of computer hardware and software, and sports/outdoor, for example, men and women aren’t all that different — only a couple of percentage points difference at most for these categories. Health has

Meeting meaningful use for inpatient EHRs is the top priority among the many challenges health executives face when considering how the Patient Protection and Affordable Care Act (PPACA) will impact their organizations. Overall, 2 in 3 health execs place MU for inpatient EHRs as the “highest priority;” among health IT executives, the proportion citing this as the highest priority is 84%. The second-most pressing PPACA priority for health executives is preparing for new models of payment, cited by 17% of health execs overall, and 31% of non-IT executives. CSC surveyed health executives in July to gauge their temperatures on several PPACA line-items including

1 in 2 Americans are purchasing more generic brands, and 2 in 3 are brown-bagging lunch, according to a HarrisInteractive survey into consumers’ buying patterns 30 months into the recession. Titled, Americans Still Cutting Back on the Little Things to Save Money, Harris’s poll discovered that U.S. consumers are making a lot of micro-changes on a daily basis to deal with the economic downturn. Besides migrating toward generic products and away from branded ones, and not buying as many lunches out, they’re switching to refillable water bottles, using the hairdresser and barber less, cancelling media subscriptions (including magazines, newspapers and cable TV), and

People foresee that, in the future, the most trusted ‘channel’ for their engaging in their health will be…conversations with my doctor. This was found in the 2008 Edelman Health Engagement Barometer survey of health citizens polled in five countries — China, Germany, Russia, the United Kingdom and the United States. Those health citizens favoring the physician-conversation channel will welcome OpenNotes into their doctor-encounters behind the exam room door. The July 20, 2010, issue of the Annals of Internal Medicine talks about an initiative to, literally, open up doctors’ notes to their patients. As Dr.Tom DelBanco, et. al., attest in the article, “‘open notes’

Welcome, HolaDoctor, to the growing roster of consumer-facing health portals. La differencia, this time, is that HolaDoctor is an entirely Spanish-speaking website of comprehensive health information. The site focuses on health content and tools highly targeted to Hispanics and health issues of most concern. Known previously as DrTango, founded in 1999, HolaDoctor has at least 1.3 million Hispanic consumers who have registered on its site, and operates over 500 multilingual health websites under its corporate umbrella. The morphing from DrTango to HolaDoctor has to do with the organization’s launch of its consumer-focused health and wellness portal reaching out to Spanish speakers in the

“We are only as good in treating patients as the information we have,” opined Dr. David Blumenthal, the national coordinator for health information technology in the Department of Health and Human Services, during yesterday’s launch of the new regulations on the meaningful use (MU) of health information technology. In the health care world, yesterday featured a star-studded line-up (live and via webcast) that ushered in the long-awaited meaningful use regulations that provide the roadmap for the adoption of electronic health records (EHRs) for providers, hospitals and doctors alike. Simultaneously, Dr. Blumenthal’s 4-page summary of the reg’s was featured in a tidy, useful article in the New

As the recession continues to negatively impact U.S. business, employers are tightly managing benefits across-the-line, from health to housing and travel categories. Benefits overall are experiencing a downward trend versus 5 years ago. In the health arena, benefits that show staying power include wellness resources (covered by 75% of employers), on-site flu vaccinations (68%), wellness programs (59%), and 24-hour nurse lines (59%). On the downside, benefit programs that are expected to erode in the next 12 months are prescription drug coverage, dental insurance mail-order drug programs, and chiropractic coverage, among others shown in the chart. The Society for Human Resource

The recession has taught women how to shop for value, beyond toilet tissue, pantry staples and laundry detergent. Women are more value-conscious in 2010 for that category that once enjoyed ultra-high margins known as cosmetics. And where they’re finding value — along with price, convenience, and authenticity — is Walmart. According to The Benchmarking Company’s 2010 Pink Report, 71% of women in the U.S. shop for beauty and personal care products at Walmart. While Walmart was a cosmetics shopping destination before 2007 for half of U.S. women, the store has expanded its reach into new demographic segments post-recession. 8 in 10

While 1 in 2 health CIOs say they’ll be prepared to apply for stimulus funding to adopt electronic health records in 2011, 80% are concerned about their ability to meet the requirements of meaningful use (MU). This lack of confidence on the road to MU is based on a host of challenges, from reporting requirements and lack of clarity of MU criteria to availability of IT talent and worries about access to capital. PricewaterhouseCoopers’ Health Research Institute (PwC) surveyed 120 health care CIOs and IT executives and published the detailed findings in the report, Ready or not: On the road to

While practice economics have always been the lifeblood for doctors’ businesses, this year, 7 of their top 10 challenges have to do with some aspect of finance: rising costs, uncertainty of Medicare reimbursement, managing compensation, negotiating payer contracts, and collecting payments from patients themselves. The other key hassle in 2010 for physicians is selecting and implementing an electronic health records system, #3 in the top-of-mind challenges for American doctors. The Medical Group Management Association, the advocacy group for physicians working in groups, published a survey this week conducted among its members in February and March 2010. Notice all the yellow shading in the chart?

J.D. Power, an expert in understanding satisfaction across industries, has looked under the hood of employers and their satisfaction with health plans. In summary: it’s not only about the benefits and costs when it comes to health plan satisfaction. For employers, satisfaction is also based on near-equal parts of “service” in 3 guises: account servicing from the employer’s point of view (where more communication from the plan is seen as better than less); employee plan service experiences; and problem resolution. For the 4 in 5 employers who have had problems with health plans (that’s 79% of employers), it’s less about costs and

Bad debt and charity care as a proportion of hospitals’ total gross revenue increased for 9 in 10 hospitals in the U.S. according to the American Hospital Association’s press release, Hospitals Continue to Feel Lingering Effects of the Economic Recession. Today’s macroeconomic news that U.S. economic growth slowed in the first quarter of 2010 doesn’t bode well for hospitals or for patients, for whom the so-called “jobless recovery” in the nation creates financial insecurity and, more specifically, health care insecurity. Hospitals’ other negative economic impacts include depressed numbers of elective procedures (suffered by 72% of U.S. hospitals), depressed overall patient volumes

61% of American health citizens have difficulty paying for health insurance when they go out on the open market to purchase it as individual customers.  A survey from the Kaiser Family Foundation (KFF) finds that most people in the U.S. who go for health insurance on their own have trouble paying for it. 14 million people in the U.S. aren’t covered by employers and seek so-called non-group or individual health insurance policies. Premium increases for these policies averaged 20% in early 2010. Nearly 1/2 of these people are self-employed or work in small business. The average out-of-pocket health spending for

While 8 in 10 Americans say that their physicians should have access to information contained in their electronic medical record, only 8% of people said an EMR is available to them but they don’t use it. Fully 37% of American adults are not sure their physicians even have an EMR, according to a HarrisInteractive/HealthDay survey on e-health records conducted in June 2010. As the chart indicates, health consumers aren’t very engaged with other aspects of information applications that may be available to them, from scheduling a doctor’s visit over the Internet to accessing the results of lab trests via email. As Humphrey

Most health consumers define the value of drugs in terms of safety and efficacy first, then quality of life and cost second. These priorities are similarly shared by both biopharma executives and managed care management. Where consumers diverge with the two health industry stakeholders, though, is with respect to their power: while about 1 in 3 biopharma and managed care execs believe that patients will be influential in the success or failure of new therapies over the next five years, only 11% of patients say that “people like me” will be influential over what new drugs will be available in the

Medical costs will increase by 9% in 2011, a mere 0.5% less than 2010 cost growth. The fastest-growing components will be inpatient and outpatient costs, shown in the pie chart. 81% of premium costs are bound up in provider costs for hospitals and physicians — the two most significant factors of medical inflation. And Americans will bear even more medical costs, out-of-pocket (OOP), in 2011 in the form of greater coinsurance and deductibles. Behind the numbers: Medical cost trends to 2011 looks into employers’ crystal balls on health benefits for 2011. PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to

The most highly rated aspects of living in America are science and technology, The Constitution, quality of life, colleges and universities. What can’t get consumers’ respect are 4 systems of American life: the political system, the economic system, the education system, and the health care system. HarrisInteractive polled 2,503 Americans in May 2010 on how they felt about various elements of life in the U.S. Entertainment, movies and TV also rank high on Americans’ scorecard. Health Populi’s Hot Points: Roughly 2 in 3 Americans rate the nation’s health system fair or poor. While marginally more Republicans than Democrats like the U.S.

From bad driving behaviors to binge drinking and unprotected sex, the health-state of America’s high school population gets a grade of “R” for “risky.” The 2009 National Youth Risk Behavior Survey is out from the Centers for Disease Control from the good people at the Division of Adolescent and School Health, based on survey data among 16,410 young people grades 9-12 who live in all 50 states and the District of Columbia.  As you read the statistics, keep in mind these are self-reported among kids who are 14-18 years of age. Among the most high-risk health behaviors are the findings that: 1

1 in 2 parents is keen on going online with their kids’ pediatricians to refill prescriptions, get clinical advice, obtain lab results, and obtain immunization records. The National Poll on Children’s Health, conducted for the C.S. Mott Children’s Hospital at the University of Michigan, found that fewer than 10% of parents can currently go online for administrative tasks like scheduling an appointment or completing a form before going for a well-kid visit. But there’s pent-up demand for so-called ePediatrics, the poll discovered. The key obstacles to doctors engaging in ePediatrics, the survey researchers say, are doctors’ concerns about medical liability

1 in 2 global health citizens looks first to the Internet for advice to make health decisions; then, they look to doctors. This virtual tie for ‘first place’ in health information that supports health decision making is the New Second Opinion for at least one-half of the population, according to data gleaned through PricewaterhouseCoopers‘s Health Research Institute’s Global Consumer Survey. Traditional media, including print (newspapers and magazines) and broadcast (TV, radio) are go-to health information sources for about 1 in 4 health consumers. Social networking websites were found to be useful health information decision-support sources by 17% (say, nearly 1 in 5 people). Health

There’s good news and bad news when it comes to living longer: the good news is, yes, you’ve lived a healthier life and thus, you’re living a longer life. The bad news is that your lifetime health costs are greater than those for a person who’s not had good health. While current health costs for healthy retirees are lower than those for the unhealthy, the lifetime health costs for healthy people are higher. This finding comes from a study asking the question, Does Staying Healthy Reduce Your Lifetime Health Care Costs?, from the Center for Retirement Research (CRR) at Boston College. Here