A blog covering the health/care ecosystem and people.

While reading the August 16/17 2008 issue of the Financial Times to keep up with the global political news in Russia and Georgia, and Olympic medal drama in Beijing, I ran across a story that hit much closer-to-home: “Bitter pills in fight for drugstore dominance.” The announcement by CVS Caremark that it would acquire the Longs Drugs store chain for over $2.5 billion is the latest salvo in the battle for the neighborhood pharmacy. This is CVS’s major incursion into California and other western states, where Walgreens enjoys a dominant market share. The most important point in the FT article

Rite Aid, a top retail pharmacy chain, awarded its first Fill Up & Fuel Up gasoline gift cards this week. I’ve been writing about gas ‘n health care since the inception of the Health Populi blog; see this inaugural post.Now comes a pharmacy connecting the dots between consumer spending categories: the interdependency of fuel and prescription drugs.As the differences between price tiers of prescription drugs have increased over the past ten years, I’ve often asked pharma clients the question: what is the consumer’s marginal value of that $20 (or $30 or $50) co-payment compared to something else on their shopping

People love their grocery stores, but still hate Big Tobacco and Big Oil. The Harris Poll’s annual survey of how Americans view the nation’s industries is out for 2008, and health care organizations — except for hospitals — continue to lose favor with the public.For over a decade, the poll has asked whether a particular industry is doing a “good or a bad job serving consumers.” In addition to supermarkets, people like the jobs done by online search engines, computer hardware companies and software, hospitals, and Internet service providers. The worst scores are given for tobacco, oil, managed care companies

There’s a disconnect between who Americans believe is responsible for their personal health status, and who should pay for health care.On the first question — personal responsibility for health choices — 82% of Americans believe that they alone are responsible for their health.However, only 44% believe that they should bear no responsibility for paying for health care. The Vitality Group, a subsidiary of Discovery Holdings Ltd., surveyed Americans and found that most people (59%) look to their employer to bear at least some responsibility for health costs. Nearly 1 in 2 (46%) see the government as payer.Only 56% of Americans

Incentives for wellness in the workplace are gaining favor among employers, according to a survey jointly conducted by the ERISA Council (ERIC) and the National Association of Manufacturers. Only 30% of employers offering wellness programs are measuring the results of these activities. Of those who measure, 83% of employers have seen positive or break-even ROIs for these investments. The proportion of companies using incentives to promote employer-sponsored health and wellness programs increased to 71% in 2008 from 62% in 2007. Although employers are being drawn to offer these incentives, there is a wide range of value for them. The average

It will be no surprise to Health Populi readers that the U.S. has a pretty poor record in managing chronic care. How bad those results are depends on whether you’re insured. All of this may seem rather intuitive, but the latest research published in the Annals of Internal Medicine is important. In A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults, published August 5, 2008, the team from the Cambridge Health Alliance/Harvard Medical School dove into detailed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Until this study,

Health providers want to provide quality care and improve patient satisfaction. Really, they do. It’s just that pesky problem of declining reimbursements getting in the way of meeting those two key business objectives.This dilemma comes to you courtesy of a survey conducted by IVANS, Inc., the company that helps providers process health transactions. IVANS found that about 50% of provider derive over 50% of their income from Medicare. As Medicare continues to be fiscally challenged, providers’ fiscal pain from this payer will increase.IVANS predicts that, “as the baby boomer generation retires and the demand for medical services increases, the operational

HarrisInteractive’s latest poll on Americans searching for health information online begs the question: “Has the number of cyberchondriacs declined?” The pure stats show that 1 in 2 American adults searched for health information in the past month — about the same proportion as last year (within the statistical sampling error). So can we assume that the number of people going online for health info has plateaued? Health Populi’s Hot Points: I would consider this finding as a natural maturation of a market. What’s underneath the number needs further analysis: just what are people doing in health online? The next layers

Leave it to Wal-Mart to continue to grow its franchise in health through yet another revenue center: this time, it’s telemedicine. The company will pilot telemedicine through retail clinics in Houston, Texas, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach. Instead of employing nurse practitioners, the medical model for this

There’s a new wiki in the health social media town, Medpedia. Among the most popular online sources for health information is Wikipedia. Millions of people search Wikipedia daily for insights into medical conditions, drugs, and procedures. Now comes the announcement of a sharply-focused wiki from the most credible of academic health institutions: Harvard, Michigan (my alma mater), Stanford, UC-Berkeley, and a host of other highly-branded health associations and stakeholders including the NIH, the CDC, and the FDA. Medpedia estimates it will cover information on at least 30,000 conditions/diseases and 10,000 drugs. The press release on Medpedia’s website terms the project,

Very few people talk about prescription drugs online. Most of these conversations are happening in the offline world of phone calls, cafes, and water coolers. This finding by the Keller Fay Group, a marketing organization that specializes in word-of-mouth (WOM) marketing, first surprised me. So I contacted Ed Keller, CEO of the Group, to talk about the implications of this number. I asked Ed what the 10% online means versus the 74% offline. He said, “The Keller Fay data is a helpful reminder that whatever is happening in the world of digital media is still only a fraction of all

Medical tourism gets a lot of buzz these days, estimated to be a $60 billion industry. Aggressive projections forecast the industry will reach $100 billion in 2012.The U.S. being an employer-based insurance system for health, employers are the primary conduits of health insurance in the U.S. (along with government). As many consider incorporating medical tourism into benefit plans, it makes sense that the National Business Group on Health has prepared a primer to medical tourism.The NBGH’s Issue Brief, “Medical Tourism: What Employers Need to Know,” lays out the latest statistics on the global market for health care services, and some

While the economy and the War take the top spots for American voters’ concerns in the 2008 election season, there’s a topic that touches every citizen that is getting short-shrift: science, and its relationships to health. 85% of Americans want a Presidential debate on the role of science in meeting the nation’s major challenges, according to a poll by Research!America and ScienceDebate2008.com. This is an area with no Democrat/Republican gap. A majority of people want to know how science would inform the Presidential candidates’ policy making. Those “major challenges” that science could impact include health care, energy, education, national security,

It’s a universal scenario that physicians face patients carrying into the exam room Internet-based information. Manhattan Research found that 94% of doctors report having to deal with patients who bring information printed off the Internet. What’s important is that these patients get more time with their doctors in the exam room. Manhattan Research calls these patients, “healthcare overachievers.” They essentially get rewarded for being informed, where the reward is in the form of more time with the clinician. Adding to the health information access literature is Burst Media, whose study into consumers’ search for wellness found that two-thirds of Americans

In this season’s Health System Idol contest, the U.S. loses to most other developed countries. One in three Americans would like to “completely rebuild” the U.S. health system, according to The Harris Poll conducted in ten nations.   And another 50% believe that, “fundamental changes are needed to make it work better.”   Harris also measured ‘unpopularity’ with another metric: asking whether, “the system works pretty well and only minor changes are necessary.” Adding this yin to the other yang, the mash-up is still the same: the U.S. plays last fiddle to the rest of the world’s health system orchestra.

Consumers are interested in a variety of financial instruments to help them purchase health care. However, even when given a choice to shop for and eventual purchase insurance, millions of people don’t. Consumers are confused about health plan choices and need help in financial decision making. Data from McKinsey presented in an essay, What consumers want in health care, analyzes results from a survey of about 3,000 retail health consumers. According to McKinsey, “many consumers aren’t accustomed to shopping for health insurance, so they are not prepared for this additional responsibility.” One of the most surprising, sobering findings is that

A gap in broadband access between low-income Americans and the wealthy, as well as lower penetration in African-American households, persists. This, as greater adoption in the overall American population has increased. It’s another case where the rich get richer; here, that takes the form of people with broadband deepening their online relationships and activities, which those without broadband slide further behind the 24×7 online world. In fact, many of those with broadband have shown demand (that is, they’re paying for) premium services like fiber-to-the-home. The Pew Internet & American Life Project continues their important research into the impact of the

This week we’re blessed with two excellent new reports on health spending asking, do we get what we pay for? The answer is, well, sometimes — particularly when you follow the perverse incentives that lead you on the money trail of waste, ineffectiveness and, worst of all, poor health outcomes. PricewaterhouseCoopers‘ Health Research Institute and the Center for Studying Health System Change offer their views on this topic with slightly different lenses. In You Get What You Pay For, PwC examines 20 health systems and finds that managing costs is the top ranked factor for reengineering payment systems throughout. Costs

The latest Kaiser Family Foundation Health Tracking Poll is out, polled in the early part of June 2008. The chart on the right illustrates the trajectory of the economy and persistence of Iraq as top-of-mind voter issues, and the quick rise of gas prices just displacing health care as the third issue in voters’ minds. This relegates health care to #4, dropping from its #2 position just six months ago. What the details under this spiderweb of line graphs show, however, is that health care economics is the #1 health care issue people want presidential candidates to address. A majority

There are some 40 million dues-paying members of the AARP, whose minimum age of membership is 50. AARP has found its constituents vary little from young’uns when it comes to online social networking, gaming, and news access. The headline here is that both 50+ and under 20s feel their online social communities are important — but even more people 50+ (70%) say this than younger people do (58%). In a study conducted with the Center for the Digital Future at the USC Annenberg School for Communication, the AARP found that older Americans feel their online communities are as important as

“Patients are a largely untapped resource of medical data,” according to Farzad Mostashari, MD, MSPH, assistant commissioner with the New York City Department of Health and Mental Hygiene. One of the biggest challenges in implementing a personal health record (PHR) is how to get a person’s health data into the record. The solution lies in Health in Everyday Living, an ‘e-primer’ published by Project HealthDesign. Now, with the input of Observations of Daily Living (ODL), the PHR could truly reflect a 360-degree view of a person’s health. Project HealthDesign has been studying PHRs in action through grantees’ field projects. Taking

“The paths of healthcare systems in many countries are increasingly unsustainable.” This judgment provides the context for a new report from IBM in its Healthcare 2015 series, Healthcare 2015 and care delivery: delivery models refined, competencies defined.“Unsustainability” in health care comes in the guises of health cost growth, quality problems and preventable errors, lack of access for many people, and increasing incidence of chronic disease.IBM expects that some short-term changes will address these problems, including: Piecemeal health reforms such as targeted prevention programs — but not comprehensive, systemic reform. Increasing consumer responsibility for financing personal health services. Globalization and local

Would pushing broadband out to the furthest reaches of rural America fill gaps in health care? A project in Pennsylvania thinks so. ConnecttheDocs is a Pennsylvania Medical Society project that is expanding broadband to physicians who are without it. Those docs with ‘lower’ broadband might also have access to faster quality speeds. The goal: to improve health care in Pennsylvania, especially in rural areas. Why do physician practices need broadband access? ConnecttheDocs says that access to broadband is the first step in adopting technologies that can improve the quality and safety in health care. The services that broadband underpins that

Nestle’s Purina has decided to expand the prominent pet food brand into pet health insurance. According to MediaPost‘s coverage of the story, the new insurance product will be called PurinaCare. It will offer a portfolio of insurance products with varied premiums and deductibles, covering “everything from routine vaccinations and flea and tick medications to major surgeries and cancers. After meeting a chosen deductible level, consumers will make a 20% co-pay per procedure and can be reimbursed for the remainder.” It was fascinating to hear that, “Coverage fees vary based on geographic location, pet breed, pet age and other variables.” Is

I awoke today to the news that a big piece of Ranbaxy, the Indian generics drugs giant, will be acquired by Daiichi Sankyo, the Japanese pharmaceutical company. This merger of giants is a reminder that, while the mantra of “health care is local” holds true most of the time these days, the times they are a’changing.Pharma, of course, has been a global industry for a long time. But bringing generics into a novel pharma company is a newer phenomenon. We know that in a BRICs (Brazil-Russia-India-China) and clicks world, drug pricing transparency and heath cost management are radically changing health

Happy National Health IT Week! Two giants in their respective industry spaces came together today to find out whether health information between a personal health record (PHR) can be interoperable with data from other sources. I sat on a teleconference today featuring Kaiser Permanente (KP) and Microsoft (MSFT) discussing their project that will bring together KP’s My Health Manager personal health record with MSFT’s HealthVault. KP and MSFT will test data exchange between HealthVault and My Health Manager. According to KP’s Anna-Lisa Silvestre, vice president of online services, KP has about 3 million active users of the PHR (among KP’s

Employees are split on whether employer wellness programs intrude on privacy, according to an Issue Brief from the Center for Studying Health System Change (CSHC). Health and Wellness: the shift from managing illness to promoting health details the results of interviews conducted in 12 metropolitan American communities in 2007: Boston, Cleveland, Greenville, Indianapolis, Lansing, Little Rock, Miami, northern New Jersey, Orange County, Phoenix, Seattle, and Syracuse. Employee wellness programs are growing in the marketplace as employers try to stem ever-increasing costs, both direct and indirect. This is real money: a report from the American Hospital Association estimated that three chronic

The overwhelming majority of women — 90% of them — are the primary health care decision makers in their family. Six in 10 of them have trouble navigating the health system, according to the American Academy of Family Physicians (AAFP). Sorting out the labyrinth that is U.S. health care is especially challenging for younger women (18-34) — 3 in 4 of whom find the system difficult to navigate. The AAFP commissioned a survey, Fixing Health Care: What Women Want, by Harris Interactive to examine American women’s views on the U.S. health system: what’s working, what’s not, and what’s needed. It’s

Growth in spending on Medicare and Medicaid is a function of (1) the aging of the population and (2) trends in the cost of health care. The Congressional Budget Office (CBO) has published an issue brief, Accounting for Sources of Projected Growth in Federal Spending on Medicare and Medicaid, which finds that health care cost growth per beneficiary relative to GDP growth will be a greater driver of health spending than the aging of the population.   The bottom-line: over half of the growth in federal spending on Medicare and Medicaid is attributable to health care costs per person growing

Divided We Fail is taking a page out of the propaganda scripts of World War II and Ronald Reagan: they’re going straight to Hollywood.Divided We Fail is a health reform advocacy group that brings together parties who traditionally have broken much bread together, with each stakeholder organization archetype emphasized by me in quotes: the AARP, the Business Roundtable (“Big Business”), the National Federation of Independent Business (“The Voice of Small Business”), and the Service Employees International Union (“Labor”). Together, their mission is to bring rational dialogue into the U.S. health reform debate. I’ve written about them in Health Populi here.Divided

Renenber the hair product ad for Clairol Herbal Essence shampoo that ran in the 1980s where one woman tells another, who tells another, who tells another about the merits of the shampoo? Social media behaved in just this way when women share their personal stories about allergies they developed when wearing the same style of bra. Here’s the post from December 23, 2007, from Catherine145. She says, “I recently bought a Victoria Secret padded demi bra. I am also dieting so when my top began to itch I originally associated it with the fact that everything was shrinking.” She then spoke with

The top risks facing retirees and those contemplating retirement are: the cost of health care; inflation’s impact on investments; affordability of long-term care; and, the cost of living, and living longer. Understanding and Managing the Risks of Retirement: 2007 Risks and Process of Retirement Survey Report, from the Society of Actuaries, summarizes findings from a survey of Americans age 45 to 80. Pre-retirees are even more anxious about risks than current retirees. But for both, health care is the most concerning of risks. The difference between these groups is that pre-retirees are more concerned about funding adequate health care, versus

$15,609 could cover a lot of household needs for the average American family in the course of a year: utilities, mortgage, gas tank fills.   It’s also the cost of health care to cover a family of four in 2008.   Milliman notes that the average annual medical cost for a family of four increased by 7.6% from 2007 to 2008. This rate of increase is lower than the 8.4% average annual increase between 2003-2007; however, the burden of overall expense is “steadily shifting to employees,” Milliman attests.   Health spending splits into five components, as the Milliman Medical Index

Consumers, at least Californians, do a lot of looking for health information on the Internet — but very little health management.   California HealthCare Foundation (CHCF) has taken a snapshot of Californians’ use of the Internet in health care. The profile is presented in CHCF’s report, Just Looking: Consumer Use of the Internet to Manage Care.   Topline: insured, more affluent, and younger people use the Internet in health searching.   The most popular care-related uses on the Internet include searching for information about conditions and drugs, finding a physician, checking ratings, and looking for claims and benefit information online.

There’s a new New Yorker cartoon I’m using in a presentation today to a health plan titled, “Starbucks goes downscale: drinks for the post-latte economy.” Three new drinks are offered in the economic downturn-menu: instant coffee with Cremora, the Big Gulp of “American joe,” and my personal favorite, “The Floyduccino.” It’s this last drink I forecast will have the biggest uptake given the blues that we’re all feeling due to economic woes.The Floyduccino is coffee with a shot of Wild Turkey: “good for what ails ya.”In the latest Gallup poll published May 12, 2008, 9 in 10 Americans feel the

Older workers will work longer to keep health coverage. But even as they do so, they’ll confront a dwindling supply of medical specialists. Watson Wyatt (WW) found that people over 50 years of age who receive health benefits from employers and don’t expect to receive these benefits in retirement are 16.5 percentage points less likely to retire than people who have health coverage from another source (such as a spouse’s health insurance plan, Medicare/Medicaid, COBRA). In its report, Predictive Factors for Retirement Timing, WW identifies the main factors influencing when Americans will retire, including health and non-health considerations. The key

The world is flat, but American manufacturers have known that since before Tom Friedman published the book on the subject. Globalization means American companies compete with foreign trade partners. The New America Foundation calculates that U.S. manufacturers pay an average of $2.38 an hour for health benefits, while trade partners pay only $0.96 an hour. That’s the bottom-line in the Foundation’s paper, Employer Health Costs in a Global Economy: A Competitive Disadvantage for U.S. Firms. The percent of payroll devoted to health benefits is about 13% for American manufacturers, and 5% for foreign trade partners. That adds up to one

There is more evidence that remote health care can improve health outcomes. Say ‘hello’ to the Virtual Integrated Practice (VIP). The term was coined by the Rush-Presbyterian Medical Center, where a team has been refining the VIP model for the past four years. The VIP’s objective is to improve chronic disease management for older people by deploying an interdisciplinary team using communications technology. The main challenges in primary care for VIP’s target patient population are: • Multiple chronic problems• Polypharmacy• Physical disability• Functional impairment, and• Economic stressors. The Holy Grail here is that when these patients are optimally-managed, VIP can

American voters are overwhelmingly paying attention to presidential candidates’ positions on health care, according to a poll published by the Catholic Health Association of the United States (CHA). CHA released the survey as part of the Robert Wood Johnson Foundation‘s Cover The Uninsured Week, in which CHA has participated since the effort’s inception. After the big issue of national security — terrorism, Iraq — voters point to jobs and the economy (40%) and health insurance (21%) as the top two domestic issues of highest priority for the next president. This prioritization is consistent with that reported out of the Kaiser

I had an unsettling conversation yesterday with someone in-the-know about consumer credit markets. Consumer credit covers everything from credit cards to auto and home equity loans. The expert expects that a deepening consumer credit crisis will loom until late in 2010. Food and credit card debt are seen as a “serious problem” by 18% of Americans. Just before this consumer-credit realization, I read the latest poll, Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses, from the Kaiser Family Foundation which finds that, for every 1 percent increase in unemployment, there is a 1.1 million person rise in the

The demand for health care appears to be somewhat elastic….in economic terms. We economists define a good or service as elastic when the quantity demanded changes with a change in the price. This is happening to demand for Lasik surgery, a topic covered in the 24 April 08 New York Times. Data demonstrating the phenomenon of the elasticity of demand in health care comes from a fascinating, short poll conducted by QualityHealth, called the Health Opin III Survey. QualityHealth is a consumer health portal which is part of the larger company, MTS, which does interactive marketing. Overall, 73% of Americans

Confidence in the FDA has hit bottom. The latest survey on trust in the FDA comes from HarrisInteractive, who regularly surveys the public’s faith in the regulator. Consumers see the FDA’s #1 job as “ensuring the safety and efficacy of new prescription drugs,” cited by 61% of the public; however, 58% of people have a negative view of the FDA’s role in this job, compared to only 35% who think positively about the FDA’s performance in this key role. This latest drop in confidence in the FDA is driven by the Heparin scare, blogged about here in Health Populi back

We’ve lost a major force for good in health care. Dr. Jerome Grossman, once CEO of Tufts-New England Medical Center, passed away yesterday. He was only 68, an example of another good-man-dying-too-young. Dr. Grossman’s ideas made big impacts on American health care for decades. He chaired many Institute of Medicine (IOM) panels and wrote countless pieces in peer-reviewed journals (including the seminal Crossing the Quality Chasm report). He was one of the earliest proponents of analyzing quality and medical outcomes in health care. He was an early champion and adopter of information technology in health care. Listen to a podcast

Media magnate Barry Diller’s got his eyes on health advertising. His media portfolio company IAC has entered into a deal with the HealthCentral network for a new advertising network which aims to be the #2 site-of-choice for health ad placement after WebMD (with about 40 million monthly visitors). HealthCentral will be IAC’s exclusive channel for pharmaceutical ads. IAC will be HealthCentral’s channel for consumer health products (e.g., OTCs and wellness goods). HealthCentral operates 35 health sites and 10 million visitors each month. IAC operates Evite, Match.com, Ticketmaster, Ask.com, Citysearch, and HSN (Home Shopping Network), among other consumer sites. IAC’s sites

In the land that innovated Supersizing, the U.S. has also mastered the art of wasteful health spending served up in a mega-portion of $1.2 trillion (yes, trillion). That’s over 50% of health spending. Half. About 8% of Gross Domestic Product. This Big News is brought to you by those hardworking researchers at PricewaterhouseCoopers’ Health Research Institute (PwC) in their report, The Price of Excess: identifying waste in healthcare spending. The topline finding is: “Eliminating waste in one sector may actually increase it in another.” Here’s why: while individual health care organizations try their best to rationalize costs and achieve efficiencies,

While fiscal, billing and back office technologies universally proliferate home care, only 17% of agencies use some type of telehealth systems. However, 32% of agencies with over $6mm in annual revenue provide telehealth services. Thus, size matters when it comes to home health adopting telehealth technologies. These are just a couple of many important benchmarks published in the National Study on the Future of Technology and Telehealth in Home Care. Billed as the largest telehealth study in the history of home care, Philips unveiled this report in conjunction with the 13th annual American Telemedicine Association conference in Seattle. Philips partnered

Health financing in retirement is a growing concern among American workers, according to EBRI‘s 18th annual Retirement Confidence Survey.Over 4 in ten retirees today are spending more than they expected to on health. Last year, 40% of retirees said they were more concerned about their financial future than they were right after they retired. This year, 54% say they’re now more concerned about that financial future. Some of the insecurity derives from workers’ perceptions that employers could stop sponsoring health insurance during retirement. Only 34% of workers expect to have access to employer-paid health insurance in retirement, compared to 42%

Small companies have a tough time covering health insurance. They are less likely to offer it and more price-sensitive to it compared to larger firms. They lack the bargaining power of bigger companies. Smaller firms also offer plans of lower quality, according to a new study from the Kauffman-RAND Institute for Entrepreneurship Public Policy (KRI). KRI compared trends in HI coverage among big and small firms between 2000 and 2005. They found that in 2005, overall, the average firm spent 7% to 10% of payroll on HI. The smallest firms with fewer than 11 employees had substantially greater cost growth

In FY 2007, the U.S. Centers for Disease Control and Prevention (CDC) received only $6 billion in funding — a 5% drop from the previous year. At the same time, the Federal government cut $8 million from CDC’s funds for chronic disease prevention and health promotion. And in our post-Katrina, post-9/11 world, Congress and the Bush Administration cut CDC’s program for upgrading state and local emergency preparedness capacity by $56 million — a nearly 7% drop in funding. What’s wrong with this picture?It’s called Shortchanging America’s Health, as portrayed in the new report of the same name from the Trust