A blog covering the health/care ecosystem and people.

The best patient I ever knew was also one of The Greatest Generation in World War II. Charles Sarasohn, my father, fought in the frontlines of the Pacific theatre in the Philippines and beyond, as part of the scrappy team known as The Jungleers. They made their way on foot through the jungle terrain with machete in hand and determination in their heart. They fought for freedom. They fought for Us. When we get caught up in the day-to-day stresses of life in 2009, we need to more often remember the warriors who fought for our right to live the

Some people believe they’re worth more dead than alive. When it comes to patient deaths in hospitals, that may indeed be the case. At least patients who die in hospitals cost more than inpatients who survive their stays. According to the Agency for Healthcare Research and Quality (AHRQ), patient deaths in hospitals cost about $20 billion, based on AHRQ’s analysis of 765,651 hospital patient deaths in 2007. The average cost of a patient death in hospital was $26,035 over the course of 8.8 days. The average cost of an inpatient stay in 2007 was $9,447 generated over the course of

59% of U.S. physicians say their patients have difficulty paying for health care and medicines. The foot soldiers of American health care are front-line primary care physicians (PCPs). Compared to their colleagues in ten other developed countries, American PCPs say their nation is far behind other countries’ health systems in at least three ways: Patients’ access to health care The use of financial incentives to improve quality The use of health information technology, where U.S. physicians say 46% of doctors use EMRs versus over 90% of doctors in Australia, Italy, the Netherlands, New Zealand, Norway, Sweden, and the U.K. The

On one hand, it can be said that enrollment in consumer-directed and high-deductible health plans in 2009 grew by 33% in the past year. On the other hand, the total proportion of Americans enrolled in private plans who was in a CDHP or HDHP was 4%. While this represents growth by definition, it’s instructive to look at the chart and note that 34% of employers did not offer employees an HDHP or CDHP in 2009 — up from 28%. That is, substantially fewer employers offered a consumer-directed plan this year compared to the previous 3 years this survey has been

Between 2007 and 2008, 18% of American women between 18 and 64 years of age were uninsured. 1 in 10 women in this age group were enrolled in Medicaid. Two-thirds of women were covered by either employer-sponsored plans or public insurance such as Medicare and military-related plans, or ESI (employer-sponsored insurance). Kaiser Family Foundation has published the latest data from the Urban Institute which pooled 2008 and 2009 iterations of the Current Population Surveys, based on the March 2009 Survey from the Bureau of the Census. The proportion of women covered by employer-sponsored insurance varies substantially across the 50 United

There’s more evidence that linking patients online to targeted programs that help them manage chronic conditions not only results in better patient outcomes — the process results in lowering costs for care. The DASH for Health program is an online tool that helps health consumers change nutrition and exercise behaviors. A pilot program to test the cost-effectiveness of DASH was offered by EMC Corporation, an employer based in Massachusetts, to its employees as a free, opt-in benefit. Data generated through employees’ use of the program was gathered and analyzed by researchers from Boston University’s Schools of Medicine and Public Health.

Small business is the working poor of American industry when it comes to health insurance access: they simply cannot afford to pay for it. This means that workers in small businesses — which is where most new jobs are created — probably won’t have access to health insurance at work. Workers who don’t receive health coverage from employers are unlikely to get coverage on the individual market or from any other source, according to Insurance at Risk: Small Business Employees Risk Losing Coverage. This report was compiled by a team from the Department of Health and Human Services (DHHS), synthesizing

Managing health care costs and achieving a high quality health system aren’t parallel goals – they’re inter-related and two sides of one coin. Adding more enrollees to existing poorly integrated health delivery organizations will simply increase costs while delivering sub-optimal outcomes to patients. In its 13th annual report card on the U.S. health system, the National Committee for Quality Assurance (NCQA)’s The State of Health Care Quality 2009 adds more statistical evidence to the argument for health reform in America. 2009 has seen “meager progress” according to the President of NCQA, Margaret O’Kane. In her introduction to the report, O’Kane

Poverty is a problem for all of us…and it reaches across the generations. The health effects of poverty begin in early childhood and persist through a person’s lifetime. Poor children have a higher rate of asthma and lower rates of cognitive development. By middle age, diabetes and heart disease hit the poor harder than more affluent Americans. Among older Americans, those living below the poverty line are far more likely to have three or more chronic conditions than those whose incomes are four times greater than the poverty line. Poverty costs not only the poor, but the overall U.S. economy

The proliferation of health care report cards has not seen an uptake by the majority of health citizens in the U.S. In fact, there are more than 200 health quality ratings programs accounted for by the Agency for Healthcare Research and Quality (AHRQ), yet few consumers use them to make choices about providers or health services.Since maternity services are among the most consumer-facing health services that people might use in the course of their lifetime, the California HealthCare Foundation (CHCF) wondered how to “nudge” people to use quality ratings to inform their choices. The Issue Brief, From Here to Maternity:

NPR featured a story called, “How the Modern Patient Drives Up Health Care Costs” on October 12, 2009. The theme connected dots between so-called consumer-driven health care and patients who demand the latest in health technology which may not be appropriate or even useful, thus driving up costs unnecessarily. NPR attributes three driving forces in building The Modern Patient: 1. Direct-to-consumer advertising for prescription drugs, beginning in the middle-1980s; this exposed health citizens to medication names and conditions which motivated some consumers to ask for specific medications and question physicians’ choice of other meds. 2. The adoption of the Internet,

If mobile medical services were available to Americans today, 40% would use the service in addition to seeing their doctors.23% of people would replace the doctor with mobile medical services. 1 in 3 people wouldn’t use the service at all. Welcome to the era of “m”-everything — mobile-everything, 24×7. And health is a natural partner for “m.” These stats come from a survey released by CTIA-The Wireless Association, in conjunction with The Harris Poll. The poll was conducted among American adults in September 2009. The 23% of health citizens who would use mobile health services instead of going to the

Today I’m at the Health 2.0 Conference in San Francisco, where I’ll be moderating a panel of the “consumer aggregators” in health care. “Say what?” those of you who don’t speak Health 2.0? Consumer aggregators are the places online where lots of health citizens go en masse for health information, support, advice, and tools. Today’s panel brings Google Health, Microsoft and WebMD together to talk about trends in health care consumers online. I’ll set the context describing the “N” of health citizens going online using data from the 9th Cybercitizen Health Study from Manhattan Research coupled with Susannah Fox’s data

The number of Americans seeking health information online reached 157.5 million people — 1.6 times the number of online health seekers found in 2005. The number of Americans seeking online information about prescription drugs grew to 102.3 million people — double the number of Americans researching Rx’s online in 2005.Manhattan Research’s 9th and latest Cybercitizen Health survey, released on October 2, 2009, firmly establishes the fact that mainstream Americans are becoming ePatients. These findings support what Susannah Fox found earlier this year in her Pew Internet & American Life survey, The Social Life of Health Information. That poll estimated that

Health information technology (HIT) will prove positive for health quality and expanded access to health care, according to 3 in 4 American adults. 64% of Americans believe HIT implementation will help to reduce health care costs.A poll supported by the Career College Association and TechAmerica found broad-based support for HIT. While many health reform alternatives appear to be splitting American sentiment, HIT seems to be a unifying force for health improvement in the U.S.The positive sentiment toward HIT crosses age, gender, and socioeconomic status. Most health citizens see HIT as a personal health enabler, as well: 3 in 5 Americans

Today the cost of health for each health-insured employee in the U.S. is $10,743. In 10 years, the cost will nearly triple to $28,530, if the status quo continues. The status quo here is a 10.2% average annual rate of health cost increase, which was the rate experienced between 2001 and 2009. Hewitt has worked with the Business Roundtable analyzing the ‘costs of inaction’ relating to health reform. They asked the unthinkable question: ‘what if the U.S. does nothing to change the health system?”The report bears the yin/yang title, The Perils of Inaction and the Promise of Effective Action, with

In a meeting yesterday in Boston, I was reminded by the CEO of Blue Cross and Blue Shield of Massachusetts, Cleve Killingsworth, the great work of the New England Healthcare Institute (NEHI) on clinical waste. NEHI’s magnum opus on clinical waste shines a light on hundreds of studies which illustrate standards of care that, goether, could eliminate the 30% of health spending that is clinically wasteful and often deleterious to Americans’ health. These include using beta-blockers for patients with high blood pressure, measuring hemoglobin A1c for diabetics, among the many other evidence-based health tactics. The definition of “clinical waste” =

It’s cost above everything when it comes to U.S. employers and health reform.Employers are key stakeholders in health reform, and 80% say they’re closely watching Congress’s movements on the subject. 9 in 10 employers say that if the final health plan passed increases their costs, they’ll likely reduce benefits to employees.In addition, 4 in 10 businesses would pass increased health care costs onto their customers in the form of higher prices, and 3 would reduce jobs as well as reduce compensation to workers.The Towers Perrin Health Care Reform Pulse Survey was conducted online in July 2009 among 433 human resource

Health plans and pharmaceutical companies at most to blame for the problems facing the U.S. health system, according to Americans surveyed in the latest Harris Poll. But while 9 in 10 Americans blame health insurers, and 8 in 10 blame pharmas, there’s also plenty of blame to go around to politicians on both sides of the aisle, business, hospitals, and doctors. These health care players, however, don’t deserve as much blame — not the ‘great deal of blame’ that most Americans ascribe to either health insurers or drug companies. Least to blame, according to the Poll? Presidents Clinton and Obama.

“It should be done in the beginning. We should be in the design. I want to know from the get-go.” “I think by the time you’re getting involved in the process, it’s already leaped over you and gone down the highway, and you’re behind.” “We all know that it is going to steamroll over all of us.” These three comments represent the continuum of consumer perspectives on health IT design. These real-life statements come out of the results of 20 focus groups conducted by the Agency for Health Care Research and Quality on the topic of Consumer Engagement in Development

The abbreviated version of this Ballad appeared in today’s Washington Post’s Healthcare Rx panel. This original version was too long for the site, so I’m posting here in Health Populi for those of you die-hard Beatles and health reform fans…enjoy! Good morning, good morning. I want to tell you that I find myself in a mash-up this week of health politics and The Beatles….please, please me by indulging me in my recap of President Obama’s speech through the lens of The Beatles, remastered… Yesterday, I saw him standing there, in the joint session of Congress, where I saw more than

The health industry should pay attention to Mintel’s latest insights into consumers’ mindsets. The long and winding downturn in the economy has inspired five consumer trends… Trust. With FDA recalls of sick food, banks’ lack of liquidity for consumer lending, and governments the world over breaking faith with citizens, peoples’ trust in institutions continues to erode. 66% of Americans say they have less trust in financial services companies due to the economy. 6 in 10 Americans continue to worry about food safety. Control. Among the most affluent Americans, 2 in 5 say that spending less will become their new household

The total drain on the U.S. GDP for eleven of the most prominent chronic health conditions is over $1 trillion annually.The other side of that coin is that by improving treatment and earlier diagnosis of these conditions, productivity, tax revenues and GDP could grow. The Burden of Disease: The Economic Case for Investment in Quality Improvement and Medical Progress from United Bioscience’s Center for Health Economics and Science Policy looks at 11 chronic and 2 acute conditions and quantifies the cost to the U.S. economy. The chart illustrates the upper end of the costs that the Center found, based on

Health disparities persist in the U.S., notwithstanding the fact that America spends more per capita and in aggregate than any other nation on the planet.An example of a health disparity is that in the U.S., patients receive needed care less than 60% of the time. For example, in 2005, African-American women were 10% less likely to have been diagnosed with breast cancer, however, they were 34% more likely to die from breast cancer compared to non-Hispanic white women, according to The Office of Minority Health in the US Dept. of Health and Human Services. The Institute of Medicine (IOM) finds

Americans are growing increasingly concerned about covering health care costs in the future. Those people age 55-64 are most concerned, with rising concerns among seniors. Furthermore, women are more concerned about health costs (recent and future) than men, as are people with lower education, income, and fair or poor health status. Not surprisingly, uninsured people had the lowest health care consumer confidence in July 2009. Those are the bottom-lines of the Robert Wood Johnson Foundation Health Care Consumer Confidence Index (RWJF Index), just published for July 2009. The Index measures how U.S. adults feel about their financial access to health

Health plan cost trends will increase more than four times more than the annual increase in the average hourly wage of American workers in 2010. It’s the same ol’ song into 2010 as health cost trends for plans will see double-digit increases as high as 13.3% for fee-for-service (FFS) plans. Even the most tightly managed plans in HMOs expect over 10% cost trend in 2010. Prescription drug cost trend will be moderately bent back, with drug plans expected to increase by an average of 9.1% for retail. This is a drop from 2009, when Rx trend costs at retail rose

There is no hard evidence supporting that health care delivered in the U.S. is “truly exceptional,” according to an analysis of available quantitative sources on health quality from the Urban Institute.The issue of access barriers to health care is given some deep consideration. The U.S. is one of three countries which has a ‘sizable’ portion of citizens lacking health insurance coverage, along with Mexico and Turkey. For many quality measures, the report finds, “quality and access are intrinsically linked.”Specifically, both uninsurance and under-insurance can lead to health consumers skipping medicines, suggested lab tests, and appointments with physicians — due to

13% of the $2.4 trillion U.S. health economy could be saved by improving adherence to medication, according to an analysis from the New England Healthcare Institute (NEHI).   Poor medical adherence leads to poor outcomes and increased medical costs, as described in NEHI’s report, Thinking Outside the Pillbox: a System-wide approach to improving patient medication adherence for chronic disease..   NEHI identified poor medication adherence as a key component in the overall waste and inefficiency in American health care, where poor adherence leads to preventable worsening of disease and increasing health risks — especially among people with chronic disease(s). Since

Health care in the U.S. is directly shaped, financed and delivered in the context of the national economy. The recession in America impacts health care in many ways that the Robert Wood Johnson Foundation (RWJF) recently explored in an off-the-record meeting in June 2009 including representatives from health care, the public sector, business, insurance, policy and research. The results of this meeting are synthesized in an issue brief from RWJF, Impact of the Economy on Health Care, published in August 2009. This report describes the economy’s impact on the structure of health delivery, providers, public health, and utilization. Insurance coverage.

The four ‘health don’ts’ are never to smoke, lose weight, move around, and eat well.A new study, Healthy Living is the Best Revenge, appears in the August 10/24 2009 issue of the Archives of Internal Medicine which addresses the roots of chronic disease. The researchers, a cross-Atlantic team from the CDC and the German Institute of Human Nutrition, find that the four ‘don’ts’ lead to a reduced incidence of cancer, heart disease and diabetes. The four specific statistics that lead to better health are: Body Mass Index (BMI) less than 30 3.5 hours a week of exercise, minimum Never smoking

Money and modernization are the roots of the main challenges facing physicians in 2009. Among the top ten most challenging issues facing American doctors, 7 in 10 directly involve economics, two involve data and reporting, and one–recruiting physicians–fell two places since last year’s survey.According to the 2009 survey of physicians by the Medical Group Management Association, physicians are most concerned with: Dealing with operating costs increasing faster than practice revenues, Maintaining income as reimbursement is declining, and Selecting and implementing an electronic health records (EHR) system. Medical Practice Today, 2009 details the results of MGMA’s survey of 2,007 physicians conducted

U.S. adults spent $33.9 billion on complementary and alternative medicine (CAM) in 2007. The largest expenditure on CAM was on self-care costs of $22.0 billion, the largest component of which was $14.8 billion spent on non-vitamin, non-mineral natural products. In addition, Americans spent $11.9 out-of-pocket (OOP) on practitioners such as chiropractic, osteopathic manipulation, naturopathy and chelation therapy; $4.1 billion on yoga (equal to 12% of the total), $2.9 billion on homeopathy, and $0.2 billion on relaxation techniques.   The National Health Statistics Reports series published Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United

The use of anti-depressant medications nearly doubled between 1996 and 2005, according to an analysis published in the August issue of the Archives of General Psychiatry. In 2005, 10.1% of Americans used anti-depressant meds, compared with 5.8% in 1996. A key trend underneath the dramatically increased use of anti-depressant meds was the decline in talk therapy (psychotherapy). Nearly 1 in 3 people who used anti-depressants in 1996 were engaged in psychotherapy, but in 2005, only 1 in 5 participated in talk therapy. Researchers used data from the Agency for Healthcare Research and Quality’s (AHRQ’s) Medical Expenditure Panel Surveys (MEPS), which

iPods and iPhones, Flip videos and pocket-sized digital cameras are way-cool and innovative. Pharmaceuticals? Not so much. According to Ipsos’s survey into global consumers’ perceptions of what’s innovative, the top which at least 1 in 2 Americans find innovative are electronic media, computers, cameras and video equipment. Household products are ranked innovative by about 1 in 3 Americans. Pharmaceuticals? Fewer than 1 in 3 Americans. In fact, pharmaceuticals are pretty close in terms of innovation in the mind of consumers falling between household products and food and beverages. The good news for pharma? Banks and deodorant are seen as less

“Internet provides public with health care information that they value and trust and which often stimulates discussion with their doctors,” concludes the latest Harris Poll into cyberchondria, a term that the organization began using in 2002. But Harris Poll’s survey yields a different conclusion for me that I think is a sign of the times: the proportion of health info seekers sharing information with physicians is declining. Take a look at the graph that I constructed from Harris’s data asking the question, “In the past year, have you ever discussed with your doctor the information you found online?” The propotion

Middle-class Americans – those with incomes from $44,000 to $88,000 — face mounting out-of-pocket costs that are eroding household disposable income available for food, shelter, and energy line items.While most of the uninsured are from lower-income families, 11 million of the uninsured live in middle class working families. Most of the growth of the uninsured between 2004 and 2007 — 70% — is in the middle class. The chart tells the tale: the gap between health premium increases and workers’ wages continues to widen, making health insurance unaffordable for more working families. Health Care and the Middle Class: More Costs

How to “widen the front door to health care?” asks PricewaterhouseCoopers in a report on alternatives to universal coverage.PwC describes the crisis of U.S. health care as having “jammed access.” Their multi-pronged solution includes getting efficient, innovating with new care models, aligning incentives, and greater teamwork among providers.PwC points to the emergency department as the most jammed entry point in the U.S. health system, noting that health citizens having trouble accessing providers – primary care, specialists and mental health providers alike.But this isn’t just a supply-side problem: it’s also about patient engagement before people get sick, as the chart above

Notwithstanding a weak economy and global competitive pressures on U.S. business, American employers prefer a status quo scenario with a complement of wellness, chronic care management and evidence-based care combined with greater consumer-direction in the form of tax credits to buy private health insurance.Aon Consulting surveyed 1,100 employers in June 2009 and found that 93% of employer benefits managers favor continuing with an employer-based health care system. At the same time, 81% reject a Canadian-style national health plan replacing the current system. And two-thirds of employers oppose an employer mandate.According to Aon Consulting’s Health Care Reform Survey Report, the top

53.1% of Americans believe that health care is a human right, according to a poll from Zogby International done in June 2009.This was one of a very long list of questions Zogby asked Americans during the week of 6/18 through 6/22/09. I’ve waded through 242 pages of a PDF file available from Zogby describing every kind of permutation of feeling among Americans and health reform. Zogby explored how Americans view employer mandates for health insurance, tax proposals for levying a tax on households earning $250K and over, capping prescription drug prices, cutting costs for home care, among many other tactics.Of

A snapshot of children’s health in America would reveal what all snapshots do: positive and negative spaces.On the positive side of the kids’ health ledger, the percent of children covered by health insurance increased from 87% in 2007 to 89% in 2008. Furthermore, the number of kids receiving recommended vaccines increased since 2002. And, heavy drinking among kids is down. On the downside, environmental hazards are increasingly compromising kids’ health. First, the proportion of children living in counties in which one or more air pollutants were above allowable levels has grown. Second, housing problems have dramatically grown: in 2007, 43%

Notwithstanding the promise of nearly $20 billion in stimulus funding to support the adoption of electronic health records, hospitals are between a rock and a hard place when it comes to laying out capital for HIT investments. Based on the latest Most Wired Hospitals survey, even the Most Wired among American hospitals have had to suspend and/or cut back planned HIT projects. Where they can calculate an ROI, hospitals are focusing on projects with higher rates of return. As I opined in my write-up for iHealthBeat on the 2009 HIMSS conference, Connectedness, Communities, Capital: Putting HITECH in Context, this year,

We’re #1! is a cheer usually reserved for a point of pride: for a class valedictorian, perhaps, or a winning ball team. But in the game of health economics, being #1 isn’t something to be proud of when the investment doesn’t net out to a reasonable return.   The 2009 OECD Health Data set is out, and this year’s top line message doesn’t differ much from last year’s: the US spends a whole lot more money on health care, and gets a whole lot less in terms of life expectancy, infant morbidity, and epidemic obesity rates which inevitably lead to

Four in 10 Americans say they’ve become more conservative in the past 2 years. By a factor of 2:1, more Americans have turned more conservative versus more liberal. The shift for members of all three political parties has been to the right.     This right-shift finding comes from the Gallup Poll of June 14-17, 2009, on annual trends in Americans’ political ideology.   As of June 2009, 40% of Americans call themselves conservative compared to 37% in 2008. This is the highest level of self-described conservativism among Americans since 2004.   Why might this mean for health reform in 2009?

There’s another, complementary track to take to reform American health care that will streamline workflow, cut down on paperwork and save money: administrative simplification. While not a sexy phrase, it’s a very attractive option that will help to contain costs. The UnitedHealth Center for Health Reform & Modernization (UHC), part of UnitedHealth Group, issued its report into this topic, Health Care Cost Containment – How Technology Can Cut Red Tape and Simplify Health Care Administration. UHC found $332 billion in medical cost savings through 12 proposals that group into the following themes:1. For patients, go electronic: use automated cards for

I was reminded by a short story in the Kansas City Star over the weekend about a report from the Congressional Budget Office published in November 2007. In The Long-Term Outlook for Health Care Spending, the CBO forecasts that health spending – including Medicare, Medicaid, and all other spending — will consume the entire U.S. gross domestic product in 2082 projected health care spending cost continues at historical averages. The chart illustrates this trajectory.The Obama Administration’s focus on cost containment is aiming squarely at this future state. For their part, industry stakeholders have been ante’ing up their bets on how

A powerful, simple, nudge has been discovered by researchers at Wharton’s Leonard Davis Institute — it’s directly paying people to be healthy. Readers of Health Populi should already know about P4P, pay-for-performance, being adopted in Medicare and by other payers to incent health providers to provide health care that demonstrates health outcomes. In this health citizen-facing version, call it “pay-for-performance-for-patients,” P4P4P. Kevin Volpp is the Wharton professor who’s been studying how to move health consumers toward healthier behaviors. He’s written articles for journals like, “Asymmetric Paternalism to Improve Health Behaviors” in JAMA. His logic trail follows the Sunstein and Thaler

There are a million stories in the naked city when it comes to personal health information…many of which end up very badly. At the very point in our lives when when we’re fighting for our life, or for the life or ‘good death’ of our loved one, we too-often find ourselves also fighting to access our health data. This absurd, appalling scenario steals a basic right away from health citizens: our ability to fully participate in our own health decisions and care. A Declaration of Health Data Rights has been launched on four simple, elegant, personal precepts: that We the

“Advertising carried on blood pressure monitors at 20,000 stores reaches more than 1 million users a day,” a press release from Lifeclinic International boasted this week. According to the Lifeclinic website, “the blood pressure monitor is free for consumers to use. So it’s no surprise that our blood pressure monitors are a recognized consumer destination, attracting customers and building store traffic daily by offering shoppers an important service. Lifeclinic said that because 52 customers per store use its Health Stations every day.” Let’s hearken back to the sage words of economist Milton Friedman: there is no such thing as a

This week, a report from the Congressional Budget Office tells us that if Senator Kennedy’s health care plan were to be implemented, 16 million Americans might still be uninsured even after the nation spent $1 trillion for a package meant to deliver universal coverage. CBO budget director Douglas Elmendorf told USA Today, “It’s going to be a long, hard slog” to find savings in U.S. health delivery without “harming health.” Here are some areas to consider…without harming health… 1. Administrative waste costs. Estimates for the cost of paper and inefficiency reach as high as 30% of U.S. health costs. Check