A blog covering the health/care ecosystem and people.

Capitol Hill is keen to know more about telehealth and health care information technology. Today, I am participating in a roundtable discussion on mobile health as part of an event hosted by Qualcomm and the American Telemedicine Association. Why “mHealth” anyway? It’s because we’re a mobile society. As B.J. Fogg, the director of the Stanford Persuasive Technology Lab, wrote, “We don’t merely adopt cell phones; we marry them.” In our 24×7 lives, we’re project managing our entertainment, financial management, travel services, and shopping via mobile devices. Engaged health consumers ask, “why can’t I ‘DIY’ my health the way I manage other

Americans’ faith in their ability to obtain and pay for health care has eroded in 2010. Notwithstanding the fact that a health reform bill has passed and the nation’s macroeconomic measures appear to be picking up, people in the U.S. are losing confidence in their ability to access and pay for health care. The chart illustrates the downward trend in Americans’ perceived ability to access and pay for health care both in the past 3 months and in the next 3 months. Thomson Reuters bases the Consumer Healthcare Sentiment Index on looks back 3 months and ahead for 3 months.

Physicians spend 12% of their net revenue to cover administrative waste in the course of practicing medicine over a year. Simplifying payment and billing through a universal form would save doctors in the U.S. $7 billion (yes, “billion” with a “b”). This sad story of waste is detailed in a Web First article on the Health Affairs website titled, Saving Billions of Dollars – And Physicians’ Time — By Streamlining Billing Practices. The research comes from a team from Massachusetts General Hospital, and includes the institution’s CFO — to whom $7 billion is surely ‘real’ money. The authors point out that

In health and health care, the most important stakeholder the world over is…drum roll, please…The Patient/Health Citizen. In this month’s Harvard Business Review, that venerated publication cites 12 megatrends shaping health globally: Aging Personalized medicine and advancements in technologies Medical tourism New provider types beyond the doctor Rising costs Employers and payers influencing clinical decisions Evidence based medicine Prevention Philanthropy Environmental challenges Global pandemics Innovation and demand in developing economies. Where’s the person-patient, Harvard? People are engaging with the help of social networks, offline and on, empowering technologies and tools, and advice and support from each other. People-patients are the 13th megatrend. Patient-centricity,

As citizens morph into becoming health consumers, they’re adopting DIY tools on the same journey they’ve made into DIY entertainment, DIY financial management, DIY travel, and DIY photo development. The train’s left the station on DIY health, and mobile phones are one of the main tools in peoples’ armamentaria. Simple text messaging in health has been used for years in developing nations, who have leapfrogged ahead of the U.S. and many other wealthier nations that have a legacy of big-iron medical devices and closed health information systems. SMS is deployed in nations to combat the spread of HIV/AIDS, to remind mothers

Among the limiting factors that will prevent full realization of the benefits of health reform, one is most pressing: the deficit of primary care providers (PCPs). A comment in the April 21st 2010 Journal of the American Medical Association lays out the facts about the primary care shortage with several data points: 1. There are 900 million visits to physicians each year in the U.S. 50% of these go to 200,000 physicians who call themselves primary care clinicians. 2. Most of these visits deal with the super-sized conditions of diabetes, hypertension and obesity, along with infections and general exams. 3.

Urban and town design, coupled with transportation planning, have everything to do with health. As suburban sprawl became the fashion after World War II as the U.S. economy expanded the middle class, green spaces and sidewalks disappeared. As Joni Mitchell sang, we paved paradise and put up a parking lot. That proverbial parking lot serves the many autos that people drive as they traverse the highways funded by the U.S. Department of Transporatation and approved by town zoning managers. Health is tied to urban planning and transport because the dots directly connect from there to obesity, mental health, respiratory health, accessibility and

Health is not just the purview of  health care companies. It’s the job of all industries, according to consumers who live in 11 countries the world over. The headline finding of the 2010 Edelman Health Engagement Barometer is that Health is the New Green. As green has been a sustainability strategy for business these past several years, Health is following in Green’s footsteps, as Nancy Turett, Global President-Health for Edelman says, “to both propel and protect businesses.” Look at the chart: while nearly all consumers believe that bio/pharma, health providers, and the over-the-counter (OTC) and personal care industry should engage in health

In the global village of health care, where do Americans stand on issues compared with fellow health citizens in Canada, France, Germany, Switzerland and the United Kingdom? Deloitte Center for Health Solutions asked this very question and found some intriguing differences between people from six of the wealthiest countries on the planet. The most striking difference between the U.S. health system and the other 5 analyzed by Deloitte is that the U.S. has an employer-sponsored financing system coupled with public sector sponsorship for Medicare and Medicaid, along with health plans for Veterans and armed forces and their families. But it’s

As we journey through the health IT “gold rush,” what do we know we know about health information technology that can help us smooth the ride? That’s the theme of the April 2010 issue of Health Affairs, and the issue offers a rich compendium of learnings. Two HIT David’s, Blumenthal and Brailer, dialogue about health IT policy in the larger context of health policy overall. Brailer points to ARRA’s health IT stimulus funding in the HITECH Act as one of the spectacular events in the history of health policy which changed the world of health information technology overnight. Dr. Blumenthal emphasizes

The health economy has joined the growing ranks of sustainability issues for the U.S.  Federal debt and health policy are deeply entwined. That debt needs to be financed, the cost of which sucks money away from other uses…like health care. With the ominous title, The Specter of Financial Armageddon, the reader might imagine the journal article she’s reading is published in Forbes, Fortune, or the Financial Times. But this Armageddon is described in the New England Journal of Medicine, and it’s much more gripping than Avatar or the Clash of the Titans. The Titans, in this script, are the Federal deficit versus health

71% of Americans are worried about how to pay for rising health care and insurance costs. 6 in 10 Americans blame increases in the cost of health premiums on the profits of insurance companies and prescription drug manufacturers. 1 in 2 Americans point to hospital prices as the cause of higher health costs. Only 18% of people blame their own higher use of medical services as a prime cost of health care cost increases. This Harris Interactive/Health Day survey, Nearly Half of Americans Worried About Rising Health-Care Costs, examines Americans’ health care cost concerns and who’s to blame for them. In

While 2 in 3 American adults with no chronic health conditions go online to access health information, only 1 in 2 chronically ill people seek health information online. This irony here is that those who most need access to online information, support and tools don’t use them as much as people who are healthy. “The Internet access gap creates an online health information gap,” say Susannah Fox and Kristen Purcell of the Pew Internet & American Life Project in their landmark report, Chronic Disease and the Internet. It’s not that sicker people aren’t interested in accessing health information; it’s that

  The health care cost crisis has hit at least 1 in 2 American families, based on the latest Kaiser Family Foundation Health Tracking Poll. KFF found that 30% of Americans have had trouble paying medical bills in the past 12 months. Challenges paying for health care increase if you’re black, Hispanic, earning under $40,000 a year, or….in poor health. There are two angles on dealing with the costs of health care dealt with in the KFF poll. First, looking to the government to regulate health costs: 42% of Americans said the government doesn’t regulate the cost of health insurance

I’m in a country this week where 66% of health providers have adopted 9 of 14 critical electronic health applications, according to a study from The Commonwealth Fund. According to the same study, only 26% of U.S. providers have opted into these functions.    As I amble across cobblestoned and craggy streets, looking up to frescoe’d facades on 500 year old palazzi, church domes and the bluest sky ever, the signs of the Italian Renaissance are everywhere in walkable Florence, Italy.     But it’s not all art and architecture, gelato and chianti for me this week. It’s also the techno-reality

As more health workers go mobile, whether telecommuting or as home health road warriors, managers are concerned, first and foremost, with mobile security as the top ranking required component of mobile user management tools. Data security in general ranks highly int he minds of health managers, 90% of whom told Forrester that this was a critical or high IT security priority as they were entering 2010. In a survey conducted for Fiberlink, a communications company, Forrester found that 89% of health care organizations have some employees working out of the office at least one day per week, and 87% of

It’s been a year since the American Recovery and Reinvestment Act and the HITECH Act got the president’s signature. Since then, there have been countless meetings of standards-setters, CIO experts and medical informatics pros, all opining on the meaning of “meaningful use,” the criteria for certifying electronic health records and the vision for a Nationwide Health Information Network. As they asked in “Seasons of Love” from Rent, “525,600 minutes…how do you measure a year?” The chorus’s response: “In cups of coffee, in inches, in miles, in laughter, in strife.” And 525,000 journeys to plan. That’s about the number of physicians

Two-thirds of physicians own smartphones, Dan Hesse, CEO of Sprint, told the standing-room-only crowd at HIMSS as he kicked off the first keynote session of the 2010 annual meeting. With the emergence of the 4G network in 2010, we’ve got the infrastructure for delivering remote care with the kind of image quality even the most eagle-eyed radiologist will require, according to this telecomms CEO.Other parts of the world that spend a much lower percentage of GDP on health care have leapfrogged the U.S. in mobile health. Globally, there are more mobile phones adopted than PCs, TVs, and cars combined. Mobile

While Congress and the President arm-wrestled through the Health Summit, the private sector doesn’t sit still waiting in a frozen state for the result of inside-Beltway-health-baseball. Employees/consumers and employers have aligning in mutual self-interest when it comes to health care benefits, costs, and disease management, according to a survey sponsored jointly by Deloitte and the International Society of Certified Employee Benefit Specialists, 2010 Top Five Total Rewards Priorities Survey. This latest recession has focused the minds of companies and their workers and driven the collective priority of managing health costs while maintaining job and retirement security. In this 16th annual

Three major consumer and health industry brand names are coming together to launch a telehealth home monitoring project: GE, Intel and the Mayo Clinic. Each organization has a deep bench and history in the health vertical, covering different segments of the market. With this project, 3 industry leaders partner to learn about home health monitoring’s challenges and opportunities in real-life, with real people. The project goal is to evaluate the effectiveness of daily in-home monitoring technology measured in 2 ways: reduced hospital admissions and reduced visits to the emergency room. For the project, Intel brings its Health Guide into the

This year, it’s academics, experts, and industry analysts we trust — as for a “person like yourself?” Not as much — but in health, it is different.The Edelman Trust Barometer for 2010 finds that specialists are the most credible sources for information about companies. Edelman cites a ‘trust rebound’ since last year, except for general news media, including radio news, TV news, and print news which are seen as less trustworthy year-on-year.Conversations with friends and peers also lost ground as a credible source of information on companies. What’s most striking this year is that consumers’ views on corporate reputation aren’t

Anthem is robo-calling enrollees to kvetch about health plan price hikes of up to 39%. Then they’re asking these customers whether they plan to dis-enroll — that is, to quit their health plan enrollment. The move would impact as many as 700,000 health citizens in California. Let me take you back to your freshman economics class (and if you didn’t take that class, let me enlighten you on the 101 version) of “the market.” A perfect market, Samuelson told us in his standard Econ 101 text, was dependent on: Lots of buyers and lots of sellers No-cost entry and no

With President Clinton’s stent operation of February 11, Americans are reminded of the epidemic of heart disease which will cost the nation $503 billion in 2010. Heart disease and stroke kill 1 in 3 Americans. But 25% of heart and stroke patients say they can’t afford the treatment they need, whether they lack insurance coverage or don’t have the money to pay for services, medicines, and procedures. The situation is tougher for stroke patients than CVD patients: 32% of stroke patients don’t have sufficient coverage to deal with their conditions. 16% of heart/stroke patients under 65 don’t have any health

Adam Bosworth has been working very hard since he left Google Health to build an application that engages, inspires, and assists health citizens to manage their health. That effort is called Keas, and this week the project welcomes a partner that should further help people along their health journeys. For some people fortunate enough to be well, they may want to engage with daily lifestyle choices that increase their chances of staying well. For those people diagnosed with a chronic condition they want to manage, life is more complex beyond managing daily white carbohydrate intake, fat calories, and pedometer-measured steps.

Here’s a health economics riddle: what do one dime, one nickel, and four pennies get you in the year 2019? Health care costs’ value carved out of every single dollar. That’s the forecast coming out of the Centers for Medicare and Medicaid Services (CMS) in a report in Health Affairs, as of this year the payor of more than 50% of the health care bills in the U.S. Ironically, the government’s taken over health care, with or without Congressional Democrats or President Obama’s direct hand in the scenario. That’s $4.5 trillion, the entire economic output of the United States of

So much for America’s ability to manage health care costs without health reform: health costs will increase in the double-digits this year, according to Buck Consultants‘ 21st National Health Care Trend Survey. This annual survey monitors medical trend — the factors that drive cost increases. These include inflation, service utilization, technology, adding new programs, changes in service mix, and benefit mandates. The chart illustrates that medical trend varies across plans — but not my much. High-deductible consumer-driven health plans expect growth of 10.4%: hardly a significantly lower rate of growth than for the most open, rich plans (PPO, POS). Buck

  Did you ever play the whac-a-mole game? As Wikipedia describes it, “A typical Whac-A-Mole machine consists of a large, waist-level cabinet with five holes in its top and a large, soft, black mallet. Each hole contains a single plastic mole and the machinery necessary to move it up and down. Once the game starts, the moles will begin to pop up from their holes at random. The object of the game is to force the individual moles back into their holes by hitting them directly on the head with the mallet, thereby adding to the player’s score.”   Health care

In 2010, health isn’t a top policy priority for Americans. Instead, the top 3 concerns are the economy, jobs and terrorism. At least 8 in 10 Americans cite these 3 areas at the top of their lists. Medicare, health care, and health insurance fall below Social Security and education, according to The Pew Research Center For The People & The Press‘s latest survey into Americans policy priorities. It is Medicare, in fact, that ranks above health care and health insurance for more Americans. Roughly 1 in 2 Americans cite health insurance or health care as a top priority for 2010.

Ensuring that all Americans have health insurance has fallen below other more pressing health reform issues such as tax credits for small business, health insurance exchanges, and front-burner health insurance regulations like guaranteed issue and covering dependents to age 25. Kaiser Family Foundation’s (KFF) latest Health Tracking Poll demonstrates Americans’ continued divide on the major health reform issues. About the same proportion, 56% and 55%, support covering at least 31 million uninsured and no federal money going toward abortion, respectively. A majority of Americans does not support the individual mandate and penalty for individuals not buying health insurance continues. Only

The population of “ePharma” consumers is growing faster than growth of Internet users overall, according to Manhattan Research‘s ePharma Consumer report. In fact, the number of American adults seeking information on prescription drugs online has tripled in the last five years, now numbering 100 million health consumers. This 9th version of the ePharma Consumer study looks at condition and health sites, video, ratings, search engines, product sites, wikis, and other online sources where consumers can access information on prescription drugs and conditions. Meredith Abreu-Ressi, Vice President of Research at the firm, presented some top-line findings to a webinar audience today.

Americans living in the south are the hungriest citizens in the nation, according to a study from the Meals on Wheels Association (MOWA). Senior Hunger in the United States: Differences Across States and Rural Areas discovered that underneath the overall statistic that hunger is a growing industry in the U.S., it’s even worse among older Americans. 700,000 more seniors faced the risks of hunger in 2007 than in 2001, MOWA found. There is great geographic variability for senior hunger: the risk of hunger among seniors ranges from a low of 1.5% in North Dakota to 12.3% in Mississippi. Health Populi’s

Most Americans (71%) are very concerned about their long-term financial future, according to the Principal Financial Well-Being Index data from the fourth quarter of 2009. The #1 factor that has negatively impacted American workers’ overall financial well-being in the past decade was the surge in the price of gas in the summer of 2008 when the barrel of oil rose to $147. The drop in the real estate market and Dow Jones Index also eroded Americans’ financial health, they told Principal Financial. The financial downturn in the U.S. has bolstered Americans’ personal valuation of health benefits, as the chart illustrates.

4 in 10 American doctors use an electronic medical record (EMR) or electronic health record (EHR), according to the Centers for Disease Control. However, most of these systems are not fully functioning. These data come from the National Ambulatory Medical Care Survey (NAMCS) which is conducted by the National Center for Health Statistics (NCHS) in the CDC. The NAMCS measures activity in physician offices including patient visits and other aspects, including use of EMRs and EHRs. What does it mean for an EMR/EHR to be fully “functioning?” First, a well-used system covers the basics including patient demographics, problem lists, clincal

The 2010 Consumer Electronics Show (CES) held in Las Vegas showcased countless consumer-facing health applications, from mobile phone apps to home health monitoring. There were both a Digital Health Summit and a Silvers Summit held at the Show, featuring a mix of hardware, software and — importantly — service. But not all vendors at the show were techno-optimists when it came to actually selling direct-to-consumer. “We can’t invest further in all things required because we don’t see a market,” said the director of technology programs for Sharp Laboratories of America, Deepak Ayyagari, according to MSNBC. What’s the primary barrier to

James Surowiecki calls David Cutler “the most important health care economist in the U.S. today,” and I think he’s right. Among his many accomplishments, Cutler has profoundly helped to shape President Obama’s mindset on health care. Surowiecki, a columnist for New Yorker‘s The Financial Page, interviewed David Cutler on his views on health reform, posted December 31, 2009, for a New Yorker video. “It’s an amazingly good step forward for the country,” Cutler told Surowiecki. “It’s something we’ve tried to do for 80 years so the timing is right.” Cutler bases his “good step” on 3 key principles: 1. What

National Geographic, well-known for pictures that move the soul and educate the mind, now speaks to us about health economics.The graphic pictured here comes from the National Geographic blog. The line chart was constructed from statistics gathered by the Organization for Economic Co-operation and Development (OECD) on health spending, utilization, and life expectancy published in OECD Health Data 2009.The lines illustrate health spending versus life expectancy; the line thickness represents number of visits to doctors.The U.S. data are featured on the upper red line. The conclusion presented by the graph is that while the U.S. spends far more per capita

As I write this blog post, my final of 2009, the Senate has just passed the $871 billion health bill, 60-39. There is still reconciliation to be done, so it ain’t over ’til it’s over.Even as a health reform bill passes, remember Confucius – a journey of a thousand miles begins with a single step. Changing health care clinically, adminsitratively, and politically in the U.S. is a more-than-thousand-mile trek: a marathon to be sure, and not a sprint.So what can we expect while we’re expecting Federally-legislated health reform?Lots of action on the ground, in States and in the private sector.

The 3 top-of-mind concerns for Americans at year-end are the economy, jobs, and health care. The top 3 hasn’t substantially changed since April, when the AP-GfK Poll collected data showing that other issues on Americans’ collective mind included terrorism, the deficit, taxes, energy, and relations with other countries. We’re ending up the year pretty happy overall — 78% of Americans say they’re “very” or “somewhat” happy as of mid-December. At the same time, 1 in 2 Americans think the U.S. is headed in the “wrong direction,” while 46% say we’re headed right. Worries about gas prices have somewhat abated, with

The size of a primary care physician practice is a major factor in whether those physicians use care management tools for managing chronic conditions in patients.Care management tools are most widely used in groups with over 50 physicians and group/staff model HMOs. In Expectations Outpace Reality: Physicians’ Use of Care Management Tools for Patients with Chronic Conditions from the Center for Studying Health System Change (HSC), researchers found that physicians’ use of tools varies widely even among those measures that have been proven to be effective.HSC surveyed 7 care management tools: Written materials for patient education Nurse managers to coordinate

 “Don’t be embarrassed by your body. Learn to love it,” the voice on the video positively commands. Comcast, are you listening?   Channel 4 in the United Kingdom hosts the television show, Embarrassing Bodies. There’s also a website providing health information that is detailed, audacious, graphic, and absolutely engaging.   On it, you’ll see close-ups of breasts, testicles, vulvae, and most other body parts in Grey’s Anatomy that are suitable for self-examination. The show launched in April 2008 and was watched by over 12 million people. Since there, Embarrassing Bodies has seen countless downloads of health videos, page views on

Who do you trust the most in America? Nurses, pharmacists, doctors, and police officers. Who’s least trusted? Elected officials in Congress, car salesmen, stockbrockers, and…HMO managers. Gallup‘s annual Honesty and Ethics of Professions poll is out and finds that health providers and front-line health workers rank highest in the nation. Nearly 9 in 10 Americans say nurses have the highest integrity, followed by 2 in 3 Americans ranking pharmacists and doctors as high or very high. Integrity grades aren’t so high, though, for chiropractors and psychiatrists, ranked very high or high in ethics among 34% and 33% of Americans, respectively.

Improving efficiency and reducing costs is even more important to organizations today as it was last year. IT is a strategic investment for these objectives, discussed in IT in the new normal in the McKinsey Quarterly, December 2009. McKinsey surveyed corporate IT execs about the impact of the recession on IT. Despite the economic downturn — traumatic in several industry sectors — IT is seen as central to economic success. In fact, CxOs expect even greater IT investments next year. Organizations are keen to invest when they see a payback: in lowering costs, in improving effectiveness. The pressure in the

While the U.S. Federal government gets regularly dissed in 2010 for all kinds of trespasses, there’s one area where they’re looking really good: online health websites. ForeSee Results found in their study, 2009 Healthcare Benchmark – Online Customer Satisfaction: Key Driver of Success and Future Use of Healthcare Websites, that more Americans rank government health websites higher in user satisfaction than any private sector segment, including pharmaceutical manufacturers’ sites, hospitals’ sites, and insurance companies’ websites. To be fair, pharmas come within one percentage point of government sites: while 79% of Americans are satisfied with government-provided health info online, 78% are

Obesity is stronger than smoking, at least when it comes to which factor plays a larger role in killing you sooner vs. later. An 18 year old in 2005 who quits smoking would increase his life expectancy by 0.31 years. However, if that young adult had a BMI greater than 25 — even after quitting smoking — his life would be reduced by 0.71 years. “Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy,” a study in the December 3 2009 issue of the New England Journal of Medicine, finds that for all the good efforts in smoking

The book Connected was recommended by my colleague, intellectual beacon and friend, Susannah Fox of the Pew Internet & American Life Project. In the midst of late nights analyzing health reform scenarios and medical microeconomics, I’ve made the time to read this book in its entirety. It’s been a worthwhile investment. Previously, the authors of Connected, Nicholas Christakis and James Fowler, found evidence on connectedness in health in the areas of obesity, smoking cessation, binge drinking, and other lifestyle behaviors that directly impact good or bad health.  This week, another team of innovative thinkers led by John Caccioppo from the

We count our blessings for which we are thankful this Thanksgiving weekend. Our health, our families, peace in our lives and around the globe…Health, yes, if we’re lucky. Now, think the unthinkable: some time, you’re going to get sick. Die, eventually.Now, ask yourself a few questions…Would you prefer to die at home or in the hospital? Who will advocate for you when that time comes?Do you have a living will? We who are engaged with Engaged with Grace ask you to not only get engaged yourself…but add this slide to the end of your presentations to spread this important message.Health

With the announcement of Verizon Connected Health Services, the telecommunications company is following on the pioneering work of Dr. Jay Sanders, arguably one of the godfathers of telemedicine, and the contemporary pioneer, American Well. Datamonitor predicts that the telehealth market will growth from $2.4 billion in 2009 to $6.1 bn in 2012. Verizon announced the program in a press release yesterday, which said that the business unit will focus on facilitating remote consultations and other programs like continuing medical education through a consultancy, “Telehealth Collaboration Services.” Verizon already has about 500 staff serving customers in the health vertical. Verizon says

Reports on the demise of the retail health clinic aren’t reading the tea leaves right, says Deloitte’s Center for Health Solutions.While total retail clinics in operation numbered just over 1,000 in 2009, with modest growth since 2007, Deloitte forecasts growth exceeding 3,000 clinics by 2014. MinuteClinic and Take Care make up 72% of clinic market share in the U.S. The remainder of the clinic market is quite fragmented, with Wal-Mart taking on a hybrid model (both operating and sharing operations with local health systems). The majority of clinics are co-located in pharmacies. What’s going to drive accelerating growth of retail

Health providers believe they’ll need to make better use of technology to offset proposed cuts in Medicare reimbursement, according to a survey by IVANS.IVANS, the IT solutions provider, conducted this survey to gauge health providers’ perspectives on health reform and the impact of proposed Medicare cuts on operations.About 1 in 3 health providers views technology as a way to deal with downward trends in Medicare reimbursement, as the chart illustrates. Thus, providers are connecting the dots between the role of health care IT to reduce operating expenses, especially administrative costs.In the conclusion of its survey summary report, IVANS, which competes