A blog covering the health/care ecosystem and people.

Peter Orszag, the Director of the Office of Management and Budget, believes that health costs are the #1 driver of America’s long-term deficit. The inexorable increase of health costs are plaguing the Federal budget, Governors’ state budgets, employers’ bottom-lines and ability to compete globally, and household budgets. Things are looking up for next year when it comes to health costs in 2010 – they’ll continue to grow at double-digit rates, according to Buck Consultants, the employer benefits consultancy. Buck’s 2009 National Health Care Trend Survey finds that costs for all flavors of health plans – including PPOs, POS, HMO and

Health engagement helps to bolster health citizens’ positive health outcomes. Microsoft has released the 2009 Health Engagement Survey, focusing on health plan enrollees’ online behaviors and perceptions of the U.S. health system. Microsoft found that 1 in 2 Americans view the U.S. health system as ‘fragmented,’ which creates challenges in helping people manage their health care and health behaviors. These people tend more to look online for health information, versus turning to health professionals or health plans. Furthermore, when seeking health information online, people make more reactive than proactive decisions. As the chart illustrates, 2/3 of people search topics on

There’s a groundswell driving social media in health care in America, from Silicon Valley to Boston, Miami to…Omaha? Strategy& (former Booz and Company) and the Center for Health Transformation convened a roundtable discussion in Omaha, Nebraska, in March 2009 following up a discussion the company had in 2008 with stakeholders in diabetes. In that meeting, the opportunities generated by social media in the field of diabetes were explored, with respect to improving peoples’ access to information for health and wellness, as well as how to use social media to influence policy and positive health behaviors. As I pointed out in my

Two reports come at the issue of workplace benefits with different perspectives. Together, they combine to find that workers value benefits in 2009 more than they have in the past — and especially as the economic pressures on workers’ households is increasing. Workscape’s Annual Benefits Study for 2009 illustrates several impacts of the economy on health benefits. 3 in 4 human resources professionals see employees’ having a heightened appreciation of benefits. The declining economy clearly has increased awareness and appreciation of workplace benefits. With respect to health benefits, roughly one-half of small and mid-size employers now offer employees at least

When I Googled “meaningful use” this morning just before writing this post, the search yielded over 10 million results. Googling “meaningful use and patient” gets you over 1 million results. Dr. Ted Eytan wrote a post on his blog, Ted Eytan, MD, on May 28, 2009, which captures the core of meaning of “meaningful use.” He titled the post, “Is It Meaningful If Patients Can’t Use It?”The bottom line: it’s not meaningful, Dr. Ted says, if patients can’t see everything. Dr. Ted met with a group of healthy thinkers in Washington DC this week to discuss patient empowerment in health;

Thinking healthy isn’t the same as acting healthy. The gap between what lifestyle behaviors people perceive build health, versus what actually contributes to health, can lead to less than optimal health outcomes. Based on Yankelovich’s 2009 Health & Wellness Segmentation Study, only one-half of people believe that taking medicines as prescribed is “very important” to maintaining health. Only six in 10 believe that exercising regularly is very important to health. One in six people also believe that getting regular physicals and eating a well-balanced diet are very important to maintaining health. Yankelovich found that people identified other lifestyle behaviors as

The road to universal coverage will be paved more slowly as the Obama administration comes to terms with the impact of the recession on the general economy, the national deficit, and RealHealthPolitik. An interview with Peter Orszag in this morning’s Financial Times (London’s daily business newspaper) featured a sentence that gave me a double take; it was, “The president has said he wants a path to universal coverage.” A path is not an end-game or an outcome: it is a process, a journey. I believe that Orszag, the head budgeteer and Director at the Office of Management and Budget, carefully

$16,771 is roughly the cost of health care for an American family of four in 2009, according to the Milliman Medical Index. If the median family income in 2008 was about $67,000, then health care costs represent about 25% of the annual household paycheck (remember, that’s gross, not net, income). As the chart illustrates, 1 in 3 health care dollars goes to physicians, with another third paid to inpatient services. Outpatient services and prescription drugs consume 15-17 cents on the health dollar in 2009. The greatest increase in cost trends in 2008-9 is with hospital outpatient services, which grew more

Them thats got shall get Them thats not shall lose So the Bible said and it still is news Mama may have, papa may have But God bless the child that’s got his own. So wrote and sang Billie Holiday in 1939. Seventy years later, you can take this classic blues tune as the anthem for the perceptual chasm between people who have and don’t have health insurance in the U.S. Uninsured people tend not to like their health care very much. If you’re insured, you’re pretty happy about your health care coverage. In a national survey of 1,000 U.S.

Generic drug dispensing reached 2 in 3 prescriptions (64.1%) in 2008 from 59.7% in 2007. Drug trend, defined as growth in prescription drug spending, increased 3.3%. What’s driving spending up? Diabetes therapies, rheumatological drugs, seizure drugs, antiviral drugs, and cancer and transplant drugs. What’s pushing spending down? Generic drugs for lowering lipids and OTCs for allergy meds. Welcome to Medco’s Drug Trend Report, unveiled at the company’s Symposium this week. The report analyzes trends, up and down, in prescription drug spending and utilization. This year, one of the key upward trend drivers is stunning: that the obesity epidemic is a

What is value in health care? Every year we spend more and seem to get less, John Seng, Founder of Spectrum, told attendees of a webinar on the Spectrum Health Value Study on 12th May 2009. As we consumers spend more of our own money, we’ll be looking for greater value and “health ROI” from our health spending. Measuring value across a population is confounded by the fact that what one person decides to spend on ‘health’ can be different from another’s health spending choices. In other words, our personal health “marketbaskets” for health spending vary from person to person.

Here’s a riddle that appeared in today’s Wall Street Journal and The New York Times:“It’s the most valuable thing on earth. All the money in the world can’t buy it. Those who have it don’t always appreciate it. Those who’ve lost it will do anything to get it back. What is it?” Readers of Health Populi should well know the answer to this riddle: it’s health. And what’s healthymagination? It’s GE’s new strategy to reinvent itself in health care. The three-legged strategic stool of healthymagination are: To lower the costs of health care To increase peoples’ access to health services

In an era where employers and benefit plans are embracing consumer-driven health plans and health reimbursement accounts, enrollees have seen their out-of-pocket costs for health care increase. Higher cost burdens have led to many health consumers to behave as, well, consumers — self-rationing themselves off of various health services to conserve health spending. Most Americans believe that lowering cost sharing would increase health engagement — that is, better health behaviors — for people who are participating in wellness and health programs as well as for people on drug regimens managing chronic conditions. These findings come from the Employee Benefits Research

This chart appeared in Sunday’s New York Times in an opinion piece called, “American Epidemics, a Brief History” by Howard Markel and Sam Potts. Markel is a professor at my alma mater, the University of Michgian School of Public Health, and Potts is a graphic designer. Their point is neatly captured in this exquisite, simple diagram: that all epidemics in the U.S. share a few themes: 1. Epidemics lead to scapegoating of those thought to have caused the problem; the H1N1’s scapegoat du jour is immigrants. 2. Epidemics are often blamed on living “unclean” lives. 3. Epidemic literacy among people

The recession is shaping a new consumer segment, coined the Downturn Generation by Information Resources (IRI). Members of the Downturn Generation are transforming the ways they shop, eat, and care for their homes and themselves. 2 in 3 consumers believe their financial condition is worse than it was one year ago, and 71% say they have less wealth than they did. IRI identifies 3 segments: Optimists, who agree that “things will get better during the next 12 months” and have selectively cut back purchases; for them, sacrifices are a last resort. Maintainers, who agree that “the economy won’t get worse,

Declining admissions, growing bad debt, rising interest expenses, falling reimbursements, illiquid capital markets, layoffs, cutbacks, and crashing credit ratings…these are the co-morbidities of the American hospital-as-patient in the 2009 economy.  The American Hospital Association (AHA) has revisited its landmark survey on the U.S. hospital economy published in November, and today released The Economic Crisis: The Toll on the Patients and Communities Hospitals Serve.  AHA has found that the economy is having devastating consequences on both individual patients and the larger communities that the hospitals serve. 9 in 10 hospitals have made cutbacks to services by cutting staff, administrative expenses, and

3 in 4 Americans believe that scientific evidence is not always clear when differentiating between different treatment options for their health. Yesterday, as I moderated the the kick-off Great Debate session of the Health 2.0 Conference, co-hosted by the Center for Information Therapy in Boston, I felt this was a key tension between the fields of Health 2.0 — the use of web 2.0 tools in health, especially among health citizens — and Information Therapy, which aims to ‘prescribe’ the right information at the right time for the right patient in the process of care. The public belief in scientific

As employees assume more personal and financial burden for health and welfare, they also take on new attitudes and perceptions of value. This is one of the underlying precepts of the Health Populi blog, and it’s directly addressed in MetLife’s seventh annual Study of Employee Benefits Trends. While people take on more responsibility for health and retirement savings, they’re looking to employers for more counsel and support to help them manage the risks involved with both. In this regard, the chart illustrates a key finding from the study. There are large gaps in the perception of value between employees and

Mobile technologies will be more important to health organizations in 2009 than they were in 2008, for 8 in 10 health executives. Motorola has published the 2009 Enterprise Mobility Barometer for the health care industry, and the top line message is health mobility is in demand. Underlying mobility in health are the key investment areas for health providers in 2009: electronic health records (EHR), computerized physician order entry (CPOE), and medication administration to both streamline processes and reduce medication errors. Mobility in health apps relates to three aspects of health care: mobilizing the enterprise itself; freeing workers from immobile techs

The outlook for the U.S. hospital sector will remain negative well into 2010, based on my reading of credit rating reports from Fitch, Moody’s and Standard & Poors. Hospitals are dealing with the recession adopting a broad and deep range of strategies, inventoried in a comprehensive survey issued by the Healthcare Financial Management Association (HFMA), How Hospitals Are Combating the Financial Downturn. One hat I wear in my work-life is as a health economist; sometimes, clients in the health arena engage me as an economist looking at the macroeconomy’s impact on the health microeconomy. One such client engagement found me

Into the Mainstream and onto the U.S. Mainland, American Well will be offered in Minnesota by the Blue Cross and Blue Shield of Minnesota (BCBSMN) health plan. This is a market signal that online health has come to Main Street. When American Well first launched in the state of Hawaii, some critics said that was an anomalous market, a one-off that didn’t represent the breakthrough that others of us believed it to be. Furthermore, others have criticized that American Well’s model could not play a role in the future of the primary care medical home. American Well has countered this

Every 1 additional prescription per 100 that is filled with a generic Rx in the Rochester NY region yields $82 million in annual cost savings to the community: specifically, to employers, consumers and health plans. The Blue Cross Blue Shield Association presented findings from a survey and featured best practices from member plans in a webinar, “Generic Drugs Can Be Good for Your Health and Your Wallet.” Blues Plans believe that implementing generic drug programs can help Americans access drugs at an affordable cost. In BCBSA’s health reform recommendations, Pathway to Covering America, there are 5 key points: four are

Clay Shirkey wrote the book, Here Comes Everybody, and yesterday he focused his theme on ‘Here Comes Every Patient.’ Shirkey’s theme is that “everybody” — from my 12 year old daughter and her Gen X/Gen Y mentors, to the 80-year old grandma who Googles — is pressuring institutions and organizations to deal with them on their terms. The implications for the health system here are huge.What’s encouraging from the institutional standpoint were some observations made by two hospital CIOs during the HIMSS press conference covering this year’s annual survey of hospital CIOs. Denni McColm of the rural Missouri Citizens Memorial

Americans’ problems paying medical bills are increasing, especially for those people managing chronic conditions. In 2007, 3 in 10 people with chronic conditions were in families with problems paying medical bills, compared to 21% of people in 2003. According to Financial and Health Burdens of Chronic Conditions Grow, a Tracking Report from The Center for Studying Health System Change (HSC) published in April 2009, there were 20 million chronically ill adults with medical bill problems in 2007 – and one in 4 of them went without a prescription because of cost. HSC’s report focuses on working–age adults, 65% of whom

As electronic health records get a starring role in the economic stimulus package in the U.S., Americans are thinking through who to trust with their personal health data. 3 in 4 Americans trust health providers above all other “data stewards” for handling their personally identified information, according to a BBC America survey conducted by The Harris Poll, published March 30, 2009. The least trusted handlers for personal information are social networking sites such as Facebook and MySpace, and Search and Portal sites like Google and Yahoo! There are differences in trust factors across generations. The older the American, the less

Two of the top new products launched in 2008 were Zyrtec and alli, according to IRI in their March report, 2008 New Product Pacesetters: The Role of Innovation in a Down Economy. In fact, non-food new product introductions were more successful than food intros in 2008. IRI says this is due to shoppers “taking their personal care into their own hands.” For example, in-sourcing spa treatments to the home instead of spending time (and money) at the spa, and buying home remedies instead of seeing the doctor. Health-at-home is also permeating foodstuffs that are in breakthrough products. The chart shows

This week’s New England Journal of Medicine provides something of a real-world mini-primer for everyone’s radar on electronic health records and the HITECH funding included in ARRA, the economic stimulus bill. The cautionary paragraph, offered by Mandl and Kohane in their essay, No small change for the health information economy, is: “We take it as a given that health care software must be interoperable and secure and must protect patient privacy. But these qualities are not sufficient to produce an optimal system, which must evolve on a health care platform that extends beyond PCHRs to include other critical infrastructural components,

2 in 3 Americans believe that, “we must make it a priority to give every single American quality affordable health care,” according to a poll from Rasmussen Reports. There are dramatic differences on the issue of universal health coverage between Democrats and Republicans, however. 90% of Democrats agree that health for all is a national priority, compared with 37% of Republicans and 55% of Independents. Democrats put health care at #1; Republicans and Independents cite reducing the deficit as a first priority. Health Populi’s Hot Points: Watch for the 63% number to increase in the next few months if unemployment

1 in 4 people with chronic conditions (25%) are delaying care. The percent of people delaying care is even higher for Baby Boomer women (39%) and Latinos (43%). Delaying care crosses all income groups; 22% of people with household incomes of at least $50,000 also delay care. In “Re-Forming Health Care: Americans Speak Out about Chronic Conditions and the Pursuit of Healthier Lives,” the National Council on Aging highlights a survey of 1,000 people over 44 years of age with chronic conditions and reveals the tough challenge they face in managing their care. At the extreme, patients feel a sense

A few more consumers are engaging with their health and health care system, according to Deloitte’s second survey into health care consumers in the U.S. Perhaps that’s because 9 in 10 Americans believe that health care costs are a threat to their personal financial security — regardless of whether they have health insurance or whether they’re sick.Deloitte’s 2009 Survey of Health Care Consumers, in this second year of the study, finds health citizens more anxious and more critical of their health system.As the angst grows, though, so, it seems, do behaviors that demonstrate greater health engagement — at least for

When citizens have more financial skin in the health care game, do they behave more like consumers — looking for and finding value-based health care? And will that behavior lower health care costs? According to 30 years of this social experiment, the jury is still out. But value-based plans may be emerging as a useful model to promote rational use of care that works, while increasing consumer satisfaction. The Employee Benefit Research Institute (EBRI) held a forum to debate the track record of consumer-directed health plans in December 2008, Outlook for Consumer/Patient Engagement in Health Care—30 Years into the Experiment.

The current economic state of the American consumer-citizen is directly impacting the fiscal health of the American hospital.As fewer patients are seeking care for hospital services, providers are struggling to make ends meet. Over 50% of hospitals had a negative total margin in the fourth quarter of 2008; the year before, 31% of hospitals had a negative total margin.The Colorado Hospital’s DATABANK project has compared financial data for 658 U.S. hospitals and published their findings in, The Impact of the Economic Crisis on Health Services for Patients and Communities.While these data do not represent all U.S. hospitals, this report can

2 in 3 Americans are concerned about being able to afford health care and prescription drugs. While middle-aged Americans aged 45-54 are the most concerned (76% of the cohort), even 54% of younger people between 18 and 34 years of age are worried about health care costs.HarrisInteractive/HealthDay’s latest suvey into personal health economics finds that people are delaying or avoiding consuming care due to cost. The most common health encounters Americans are avoiding due to cost include:– Dental visits (34%) – Physician visits (28%)– Not receiving a medical test, treatment or follow-up recommended by a doctor (23%)– Prescription drug fills

While the policy wonks and economists and legislators and lobbyists convene to come to “yes” on a coherent approach to health reform for America, there is some (literally) low-hanging fruit that will help the nation bend the health cost curve: it’s healthy eating. Last year, the only two stocks on the Dow Jones Index that moved in a positive direction were Walmart and McDonald’s. Both have received bad raps concerning their role in the nation’s diabesity. Surprisingly, McDonald’s ended up on Health magazine’s list of the Top 10 America’s Healthiest Fast Food Restaurants this week. With 14,000 locations, this chain

Most people who receive email messages from pharmaceutical companies tend to like it. 9 in 10 believe it’s a good way to learn about new products entering the market — nearly as many people as those who like receiving travel offers via email. This finding comes from Epsilon‘s Email Branding Study, released in early March 2009. Consumers see a very valuable aspect of email from pharma companies is receiving coupons to use in paying for prescription drugs, as well as learning about products. A third value of email from drug companies is receiving a source of support in personal medical

American consumer sentiment over the past year feels and looks like a rollercoaster ride in freefall, ever driving downward as the chart shows. It’s jobs and health costs forcing the downward trajectory. More than stock market declines and saving for retirement, Americans fear two things most in this recession: losing their job, and the costs of health care. 38% of Americans cite unemployment as their biggest concern in early February 2009. Unemployment fears are shared by both men and women. Younger Americans are more concerned about losing a job (50%) than older people (22%) — who are more concerned about

Why was per capita spending on people enrolled in Medicare $2,500 more in East Long Island, NY, than in San Francisco in 2006? Did the folks in New York get better care and achieve better outcomes than those on the west coast? The answer is, “no.” Welcome to the world of health care cost variation, the topic of an important paper published in the February 26, 2009, issue of New England Journal of Medicine, “Slowing the Growth of Health Care Costs – Lessons from Regional Variation.” This research is important because it shines a light on the critical issue of

A new black box warning has arrived on the U.S. health care scene: the lack of health insurance is hazardous to your health. In 2004, the Institute of Medicine (IOM) recommended that Congress act to get the U.S. to universal health coverage by 2010. Today, the rate of uninsurance in the U.S. increases by the month as health costs continue to rise. Thus, the IOM notes today in a new report, “there is no evidence to suggest that the trends driving loss of insurance coverage will reverse without concerted action.” The Institute’s latest report into the nation’s state of health

We’re living in the hype cycle of the HIT portion of the economic stimulus package. Lest we get too carried away, a survey sponsored by NCR reminds us that hospitals are rationing their health IT spending in 2009.Only 15% of hospital leaders say the economy is having ‘no effect’ on their IT spending. Otherwise, 36% are cautious; 14% are slowing down spending; 19% of leaders are postponing ‘some’ purchases; and, 16% are postponing all non-essential projects. Hospitals are facing declining revenues in the recession. Coupled with rising joblessness, hospitals’ financial health is eroding. The negative impact of hospitals’ declining fiscal

In the top 100 most social brands determined by Vitrue, not a single one is directly related to health or health care.Among the most visible industry sectors in top 100 are: Automobile manufacturers (Ford, Honda, Lincoln, GM and Mercedes rank highest among the autos). All-things-Apple including the #1 socially-ranking iPhone, #3 Apple corporate, #7 iPod, and the Mac itself at #16. Broadcasters including #2 ranked CNN, MTV, Turner, Fox News, and ABC all in the top 25. Food is very social, with Starbucks, Coke, Pepsi, McDonalds, Subway, Red Bull, Wendy’s, Burger King, Sprite, Chili’s, KFC and Taco Bell in the

The Mobile Phone Congress is buzzing in Barcelona, and there are signs that the sector is healthier than other parts of the global economy. Despite the downturn in economies ’round the world, mobile phones are a bright spot bringing happy ringtones to the otherwise dismal forecast in consumer spending. According to Nielsen’s research into the mobile phone market released at the Congress, U.S. and European mobile consumers plan to increase their adoption of mobile data services in the next two years. Nearly 71% of consumers expect to use the mobile Internet on a daily basis. According to Tellabs, “mobile data

Virtually all doctors are worried that patients aren’t filling their prescriptions. In addition to not filling Rx’s, physicians are most concerned about patients’ skipping doses, splitting pills, discontinuing other treatments, sharing prescriptions, and taking expired meds.Physician survey on generic drug use, a survey from Epocrates, the clinical decision support company. As the chart shows, doctors’ choices to prescribe generic drugs are often driven by their patients. In one out of 4 instances, physicians say either the patient prefers a generic or the patient asks for a generic drug. In 1 in 5 doctors, they “always” prescribe generics if available. Doctors

The number of people searching for prescription drug information online has tripled in five years, according to the latest insights from Manhattan Research‘s ePharma Consumer study. 90 million Americans looked for Rx information in 2008, compared with 25 million in 2003, Mark Bard, the president of Manhattan Research (MR), told a group of webinar attendees on 9th February 09. Bard and his team at MR call these 90 million, “ePharma Consumers.” Fewer than 50 million people searched online for any health information in 2002; that reached 150 million in 2008. MR’s database is very rich and large, enabling the firm

Published a few months before her death, It’s Always Something is the autobiography from the great Gilda Radner, who died of ovarian cancer 20 years ago at the age of 42.    In the case of cancer, that “something” is all-too-often the case of under-insurance to cover treatment. High out-of-pocket costs for treatment, coupled with insurance premium payments, can force cancer patients to incur big debt or, ultimately, forgo treatment. Spending to Survive is a comprehensive and detailed report from Kaiser Family Foundation (KFF) and the American Cancer Society (ACS). The report’s subtitle, “cancer patients confront holes in the health

Observing the growth in Internet web site traffic is a perfect reflection of what’s going on in the economy. In 2008, the greatest growth in site-types was in job search, women’s-oriented content, coupons, and politics. Online gaming and gambling also gained a lot of eyes in 2008. And, visitors to online classified ads grew by 27%, while traditional print channels – notably newspapers – took a direct hit. In classifieds, it’s about people trying to save and make money through the purchase and sale of used items, according to comScore‘s report, “The comScore 2008 Digital Year in Review.” The big

In 2008, mass media coverage of vaccines seemed more focused on pop celebrity fights, pro- and con-, versus scientific revelations. Will 2009 yield more knowledge and less confusion? 2008 was something of an Amanda Peet-versus-Jenny McCarthy show, pro v. con, taking place on the covers of People magazine and in YouTube videos. But just in the past few weeks, there’s been a subtle shift in news about vaccines toward more solid information. The headline points are: Minnesota children came down with the Hib virus, with blame going first to the Hib vaccine shortage and possibly, too, to 3 in 5

In this $819 bailout, post-Lehman Bros., post-Madoff, era, Americans are looking for clear, jargon-free, transparent information. According to a survey from Siegel+Gale, the branding consultancy, the two new “marketing imperatives” are transparency and authenticity. While the financial market implosion is top-of-mind among consumers in this economic downturn, it’s not only financial statements that Americans criticize. After mortgage applications, the second most difficult-to-understand form is the explanation of benefits (EOB) for a health insurance claim. And fifth on this list of difficult financial forms is the Medicare statement, after Federal tax returns and investment account statements. These and other findings about

4 in 5 Americans would choose generic drugs over brand name drugs, according to The Harris Poll conducted among American adults in December 2008. In Substantial Increase in Public Preference for Generic over Brand Name Drugs, Harris found that the proportion of people who would more often pick branded drugs fell by nearly one-half, from 32% in October 2006 to 19% in December 2008. The 93% of Americans who bought prescription drugs in 2008 increased purchases at discount stores like Wal-Mart, Target and Sam’s Club (owned by Wal-Mart). In October 2006, 13% of Americans bought drugs at these kinds of

Drugs are becoming a luxury product in the U.S. for a growing number of citizens. The Center for Studying Health System Change (CSHSC) found that the proportion of Americans under age 65 who are having problems paying for prescription drugs grew from 10.3% in 2003 to 13.9% in 2007. This is a 35% increase.This finding comes from the Center’s tracking report, More Nonelderly Americans Face Problems Affording Prescription Drugs.CSHSC dug into data from the Center’s 2007 Health Tracking Household Survey to come up with this finding. The survey data reveals that, in 2007, 36.1 million Americans did not get prescription