A blog covering the health/care ecosystem and people.

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

“When thinking about health care priorities for the next president and Congress to address, dealing with the high price of prescription drugs tops the public’s list while issues specific to the Affordable Care Act (ACA), such as repealing provisions of the law or repealing the law entirely, are viewed as top priorities by fewer Americans,” according to the Kaiser Health Tracking Poll for October 2016 – the last such survey to be taken before the 2016 Presidential election. The poster child snapshot image representing the high cost of prescription drugs is the increase in cost for an EpiPen, which among

Large employers are taking more control over health care costs and quality by pressuring changes to how care is actually delivered, based on the results from the 2017 Health Plan Design Survey sponsored by the National Business Group on Health (NBGH). Health care cost increases will average 5% in 2017 based on planned design changes, according to the top-line of the study. The major cost drivers, illustrated in the wordle, will be specialty pharmacy (discussed in yesterday’s Health Populi), high cost patient claims, specific conditions (such as musculoskeletal/back pain), medical inflation, and inpatient care. To temper these medical trend increases,

Spending on health care in America will comprise $1 in every $5 of gross domestic product in 2025, according to National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected to Shape Spending and Enrollment, featured in the Health Affairs July 2016 issue. Details on national health spending are shown by line item in the table, excerpted from the article. Health spending will grow by 5.8% per year, on average, between 2015 and 2025, based on the calculations by the actuarial team from the Centers for Medicare and Medicaid Services (CMS), authors of the study. The team noted that the Affordable Care

6 in 10 people in the US would like to replace the Affordable Care Act with a national health insurance program for all Americans, according to a Gallup Poll conducted on the phone in May 2016 among 1,549 U.S. adults. By political party, RE: Launch a Federal/national health insurance plan (“healthcare a la Bernie Sanders”): Among Democrats, 73% favor the Federal/national health insurance plan, and only 22% oppose it; 41% of Republicans favor it and 55% oppose it. RE: Repeal the ACA (“healthcare a la Donald Trump”): Among Democrats, 25% say scrap the ACA, and 80% of Republicans say to do

There’s an overall feeling of angst about healthcare in America among both health care consumers and the people who provide care — physicians and administrators. On one thing most healthcare consumers and providers (can agree: that the U.S. health care system is on the wrong track.  Another area of commonality between consumers and providers regards privacy and security of health information: while healthcare providers will continue to increase investments in digital health tools and electronic health records systems, both providers and consumers are concerned about the security of personal health information. In How We View Healthcare in America: Consumer and Provider Perspectives,

The factors of where people are born, live, work and age — social determinants — shape human health more than health care. Yet in the U.S. much more resource per capita is funneled into healthcare services than into social ones. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity was published by The Kaiser Commission on Medicaid and the Uninsured in November 2015, calling attention to the opportunity and wisdom of baking health into all public policy. The social determinants of health (SDOH) include economic stability, the physical environment and neighborhood, education, food, community and

Health costs in America will grow faster (again), and health outcomes have improved in the past decade. This week, two of the most important health journals feature health economics data and analyses that paint the current landscape of the U.S. health care system – the good, the warts, and the potential. Health Affairs provides the big economic story played out by the forecasts of the Centers for Medicare and Medicaid Services (CMS) in National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends. The topline of the forecast is that health spending growth in the U.S. will annually average

While shopping is a life sport, and even therapeutic for some, there’s one product that’s not universally attracting shoppers: health insurance. McKinsey’s Center for U.S. Health System Reform studied people who were qualified to go health insurance shopping for plans in 2015, covered by the Affordable Care Act. McKinsey’s consumer research identified six segments of health insurance plan shoppers — and non-shoppers — including 4 cohorts of insured and 2 of uninsured people. The insureds include: Newly-insured people, who didn’t enroll in health plans in 2014 but did so in 2015 Renewers, who purchased health insurance in both 2014 and

In the November 2014 mid-term elections, Democrats tend to favor continuing the Affordable Care Act (ACA) as-is, and Republicans favor scrapping it, scaling it back, or fully replacing the law with something yet to be defined. But it’s hard to read just where the ACA will end up after tomorrow’s election, because many key battleground states are too close to call…and the two major parties have such polar views on health reform. What’s most significant this year is that those most likely to vote are less likely to vote for a congressional candidate who supports the ACA (40%) than would

Concerns about Death Panels and government restricting health services for people that have been key arguments used against the Affordable Care Act’s (ACA) detractors and, even before the advent of the ACA, proposed health reforms under President Clinton. But it’s peoples’ self-rationing in the U.S. health system that’s causing true rationing — driven by high deductible health plans (HDHPs) that are fast-growing in the health insurance market, and by the high cost of specialty drugs and prescriptions. There are plenty of data demonstrating the consumer health rationing trend being collected and reviewed by think tanks like RAND here, and by The

A vast majority of people shopping for a health plan on a Health Insurance Exchange for coverage in 2014 obtained information online via websites. One-half of these shoppers used only online information, and 29% combined both websites and other sources like direct assistance, informal assistance, and via (offline) media. In the Health Reform Monitoring Survey from the Urban Institute Health Policy Center, a research team, funded by the Robert Wood Johnson Foundation and the Ford Foundation, looked into data collected from the Health Reform Monitoring Survey in March 2014 at the end of the 2014 open enrollment period for the

  At last year’s annual HIMSS conference, I had the pleasure of experiencing Bill Clinton’s keynote speech in New Orleans, which I wrote about here. As a long-time member of HIMSS, this was a great moment in my many years attending HIMSS conferences. Another special moment in HIMSS conference history happened today, as, I had the honor of attending Hillary Clinton’s keynote speech at HIMSS 2014 in Orlando today. I am blessed with fast-typing fingers thanks to my mother’s genes, and took constant notes during Hillary’s talk. My favorite paragraphs are quoted below, indicating “Applause” pauses where Hillary was lauded.

Three-quarters of us are concerned about health care, a fraction fewer than those of us worried about the economy. Underneath stress about healthcare, people are worried about costs and the impact of the Affordable Care Act (ACA). Say hello to the Healthcare Worry Scale, developed by Chase Communications, a firm focused on marketing and media, largely in the health industry. Chase found that: – 93% believe that their health care costs will continue to increase – 49% say the ACA’s impact is a “major” worry – 43% say getting a disease, medical condition, or injury that health insurance doesn’t fully

We who are charged with forecasting the future of health and health care live in a world of scenario planning, placing bets on certainties (what we know we know), uncertainties (what we know we don’t know), and wild cards — those phenomena that, if they happen in the real world, blow our forecasts to smithereens, forcing a tabula rasa for a new-and-improved forecast. There are many more uncertainties than certainties challenging the tea leaves for the new year, including the changing role of health insurance companies and how they will respond to the Affordable Care Act implementation and changing mandates

In the aftermath of the snafu that was/is the failed launch of the Affordable Care Act’s Health Insurance Exchange comes, today via Reuters, an article called Obama’s tech expert becomes target over healthcare website woes. The piece, by Roberta Rampton and Sarah McBride, states that Todd Park, Chief Technology Officer at The White House, “now finds himself among a handful of officials with targets on their backs as Republicans try to root out who is responsible for this month’s glitch-ridden rollout of Healthcare.gov,” going on to say that “The White House trotted him out in July to talk up the new version”

In game-scoring unit terms, 52 is the number of hours an average American spends seeking health information online each year. The 1 (hour) is roughly equivalent to the approximate total time a patient spends with a physician (an average of 3 visits, with an average time per vision of 20 minutes). Thus, 52:1. This means that the average U.S. health consumer spends much more time DIYing her health using digital information resources than speaking face-to-face with their physician in the doctor’s office. Still, the physician continues to be a go-to source for health information, according to Makovsky, a health communications

You might see potato and I might see po-tah-to when looking at the Affordable Care Act – health reform — but it’s clear we don’t want to call the whole thing off. (Go to 1:44 seconds in this video to get my drift, thanks to the Gershwin’s). I’m talking about the latest August 2013 Kaiser Health Tracking Poll from Kaiser Family Foundation finds a health citizenry suffering ennui or a form of split personality about health reform: while many Americans don’t believe the Affordable Care Act (ACA) will help them, most don’t want Congress to de-fund it, either. Several graphs from

Women are the Chief Health Officers of their families and in their communities. But stress is on the rise for women. Taking an inventory on several health risks for American women in 2013 paints a picture of pain: of overdosing, caregiver burnout, health disparities, financial stress, and over-drinking. Overdosing on opioids. Opioids are strong drugs prescribed for pain management such as hydrocodone, morphine, and oxycodone. The number of opioid prescriptions grew in the U.S. by over 300% between 1999 and 2010. Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.

Consumers misunderstand health insurance, according to new research published in the Journal of Health Economics this week. The study was done by a multidisciplinary, diverse team of researchers led by one of my favorite health economists, George Loewenstein from Carnegie Mellon, complemented by colleagues from Humana, University of Pennsylvania, Stanford, and Yale, among other research institutions. Most people do not understand how traditional health plans work: the kind that have been available on the market for over a decade. See the chart, which summarizes top-line findings: nearly all consumers believe they understand what maximum out-of-pocket costs are, but only one-half do.

When Secretary Sebelius calls, I listen. It’s a sort of “Help Wanted” ad from the Secretary of Health and Human Services Kathleen Sebelius that prompted me to write this post. The Secretary called for female bloggers to talk about the benefits of The Affordable Care Act last week when she spoke in Chicago at the BlogHer conference. Secretary Sebelius’s request was discussed in this story from the Associated Press published July 25, 2013. “I bet you more people could tell you the name of the new prince of England than could tell you that the health market opens October 1st,” the

Employers who provide health insurance are getting much more aggressive in 2013 and beyond in terms of increasing employees’ responsibilities for staying well and taking our meds, shopping for services based on cost and value, and paying doctors based on their success with patients’ health outcomes and quality of care. Furthermore, nearly one-half expect that technologies like telemedicine, mobile health apps, and health kiosks in the back of grocery stores and pharmacies are expected to change the way people regularly receive health care. What’s behind this? Increasing health care costs, to be sure, explains the 18th annual survey from the National

While there is big uncertainty about how health reform will roll out in 2014, and who will opt into the new (and improved?) system, health cost growth will slow to 6.5% signalling a trend of moderating medical costs in America. Even though more newly-insured people may seek care in 2014, the costs per “unit” (visit, pill, therapy encounter) should stay fairly level – at some of the lowest levels since the U.S. started to gauge national health spending in 1960. That’s due to “the imperative to do more with less has paved the way for a true transformation of the

The number of retail health clinics will double between 2012 and 2015, according to a research brief from Accenture, Retail medical clinics: From Foe to Friend? published in June 2013. What are the driving market forces promoting the growth of retail clinics? Accenture points to a few key factors: Hospitals’ need to rationalize use of their emergency departments, which are often over-crowded and incorrectly utilized in cases of less-than-acute care. In addition, hospitals are now financially motivated under the Affordable Care Act (ACA, health reform) to reduce readmissions of patients into beds (particularly Medicare patients with acute myocardial infarction [heart attacks],

If you have $22,030 in your wallet, you can buy: A princess-cut diamond A Ford Focus 4-door A year’s tuition at James Madison University (in-state, 2013-14) A health plan for a family of four. The 2013 Milliman Medical Index gauges the annual health care costs for a typical American family at $22,030, up $1,302 from 2012 — a 6.3% increase, nearly 6x the all-items increase of 1.1% for the U.S. Consumer Price Index from April 2012-April 2013. That 1.1% includes the costs of food and energy, along with cars, tobacco, shelter, and other consumer goods. In 2013, the average family will

One in three workers does not feel financially secure. The proportion of Americans who feel “not at all secure” grew to 16% from 12% between 2011 and 2012, based on the question, “When it comes to paying your bills and keeping up with living expenses, how financially secure do you feel these days?” Women are much more likely than men to feel financially insecure, representing a 33% growth rate in financial insecurity. These sobering financial statistics come to us from the UNUM study, 2012 Employee Education and Enrollment Survey: Employee Perspectives on Financial Security, published May 8, 2013. Based on the question asked – paying

Strange political bedfellows have come together to draft a formula for dealing with spiraling health care costs in the U.S. iin A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment from the Bipartisan Policy Center (BPC). The BPC was founded by Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. This report also involved Bill Frist, Pete Domenici, and former White House and Congressional Budget Office Director Dr. Alice Rivlin who together work with the Health Care Cost Containment Initiative at the BPC. The essence of the 132-page report is that the U.S. health system is

  Patient satisfaction survey scores have begun to directly impact Medicare payment for health providers. Health plan members are morphing into health consumers spending “real money” in high-deductible health plans. Newly-diagnosed patients with chronic conditions look online for information to sort out whether a generic drug is equivalent to a branded Rx that costs five-times the out-of-pocket cost of the cheaper substitute. While health care report cards have been around for many years, consumers’ need to get their arms around relevant and accessible information on quality and value is driving a new market for a Yelp, Travelocity, or Zagat in

  As the Affordable Care Act, health reform, aka Obamacare, rolls out in 2013, American health insurance shoppers will look for sources of information they can trust on health plan quality and customer service satisfaction — as they do for automobiles, mobile phone plans, and washing machines. For many years, one of a handful of trusted sources for such insights has been J.D. Power and Associates. J.D. Power released its 2013 Member Health Plan Study (the seventh annual survey) and found that most consumers currently enrolled in a health plan have had a choice of only “one” at the time

At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The

If you receive health insurance benefits from your employer, you’ll see a new line item on your W-2, courtesy of the Internal Revenue Service: the cost of employer-sponsored group health plan coverage. This new piece of data, shown in Box 12, DD information, comes as part of health reform, The Affordable Care Act, which requires employers with over 250 workers to show how much they spend on employer-sponsored health benefits in total. This is the employer’s premium cost, and does not include the covered worker’s out-of-pocket spending (e.g., copays, coinsurance and deductibles). It is being furnished on W-2’s “for informational

Costco and Aetna announced that the Big Box retailer would expand its marketing of Aetna health insurance policies to card-carrying members in California. Costco has already been selling health insurance through stores in Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas and Virginia. Later in 2013, Aetna plans will be available in Costco stores in other state markets. BTW, Costco operates stores in 42 U.S. states (as well as Canada, the UK, Taiwan, Korea, Japan, Australia, and Mexico). All together, the company serves 37 million households. The Costco Personal Health Insurance Program offers five plans, a network of health providers, and

Reducing health care costs far outranks improving quality and safety, improving the public’s health, and upping the customer experience as Americans’ top priority for President Obama’s health care agenda, according to a post-election poll conducted by PwC’s Health Research Institute. In Warning signs for health industry, PwC’s analysis of the survey results, found that 7 in 10 Americans point to the high costs of health care as their top concern in President Obama’s second term for addressing health care issues. Where would cost savings come from if U.S. voters wielded the accountant’s scalpel? The voters have spoken, saying, Reduce payments

There are many forks in the road facing us in the U.S. for deficit reduction, as the picture shows. This is the cover graphic for Choices for Deficit Reduction, a report from the Congressional Budget Office (CBO) published November 2012. Those roads could be labeled “Medicare” and “Medicaid,” as health is the #1 deficit driver for the American economy — most notably, Medicare and long-term care services financed via Medicaid. The CBO expects that per capita spending on health care, already at 18% of the national economy in 2012, will continue to grow faster than spending on other goods and

The average annual premiums for employer-sponsored health insurance in 2012 are double what they were a decade ago in terms of both total premium and worker contribution increases. The picture shows the story, according to the 2012 Employer Health Benefits Survey from the Kaiser Family Foundation (KFF). This annual survey polls small, mid-size and large employers to assess their updates for providing health insurance and prescription drug coverage to active and retired employees. The percentage growth of health costs in the past year were a “modest” 4%, according to KFF. Modest is a relative term: this single digit increase is indeed much

Health payers and plans are realigning their business operations to get closer to consumers. Anticipating the impact of the Affordable Care Act (ACA), coupled with the continuing trend toward consumer-driven health plans, Chilmark Research published the 2012 Benchmark Report: Payer Adoption of Emerging Consumer Tech in August 2012. John Moore, industry analyst and founder of Chilmark, and I had an email exchange to discuss the report. JSK: Why is this topic so timely now? JM: Payers have been trying for years to engage their members with less than stellar results. The advent of new consumer technologies such as social media, mobile,

Physicians’ wellbeing dropped in July: while providers’ mental health stayed sound since June, it’s financial, physical and social health that’s dragging providers’ overall wellness down. QuantiaMD, the social network exclusively for doctors, launched the Physician Wellbeing Index in January 2012. The Index measures four aspects of physician-reported wellbeing: physical, mental, financial, and social health. QuantiaMD says it’s the world’s only measure of “how physicians are doing as people.” Based on the Index, QuantiaMD tailors content to meet the needs of the physicians in the social network. In July, the chart illustrates that doctors’ wellbeing slipped in 3 of the 4

Calling Don Draper, Donny Deutsch, and the spirit of David Ogilvy: the President needs you. The President must sell the Affordable Care Act to the American people now that Justice Roberts wrote the Supreme Court’s historic 5-4 majority opinion supporting the Act, and especially the individual mandate. He argued for the majority that while the mandate is unconstitutional under the Commerce Clause which would “command people to buy insurance,” he said that the mandate is a de facto tax, as people who would choose to opt out of insurance would have an alternative of paying an IRS fine. Senator Eric

Since the advent of the Great Recession of 2008, more Americans have been splitting pills, postponing needed visits to doctors, skipping dental care, and avoiding recommended medical tests due to the cost of those health care services. Call it health care self-rationing: the Kaiser Family Foundation (KFF) has been tracking this trend for the past several years, and the proportion of American adults rationing health demand is up to 58%. This KFF Health Tracking Poll interviewed 1,218 U.S. adults age 18 and older via landline and cell phone in May 2012. As the chart illustrates, 38% of people are “DIYing” health care

The saying goes, “you pays your money and you makes your choice.” In 2012, if you have a bolus of $20,700 to spend, you can choose between a health plan for a family of four, or a sedan for the same family. That’s the calculation from the actuaries at Milliman, whose annual Milliman Medical Index is the go-to analysis on health care costs for a family of four covered by a preferred provider organization plan (PPO). While the 6.9% annual average cost increase is lower than the 7.3% in 2011, it is nonetheless, a record $1,335 real dollar increase at

There’s intriguing fine print in the latest CBO analysis on the impact of the Affordable Care Act (ACA) on employer-sponsored health insurance in the U.S. CBO finds there will be 3 to 5 million working Americans without employer-sponsored health insurance due to the implementation of the ACA, according to the report, CBO and JCT’s Estimates of the Effects of the Affordable Care Act (ACA) on the Number of People Obtaining Employment-Based Health Insurance. Originally, the CBO and Joint Committee on Taxation (JCT) estimated that the number of people obtaining health insurance coverage through their employer would be 3 million people lower in 2019 under

The ability to get the data is the #1 obstacle that will slow the adoption of data analytics in health care, according to IBM’s report, The value of analytics in healthcare: from insights to outcomes. Healthcare “high performers,” as IBM calls them, use data analytics for guiding future strategy, product research and development, and sales and marketing functions. 90% of healthcare CIOs told IBM that developing “insight and intelligence” were key focuses of their organizations over the next 3 to 5 years. Underneath this macro objective are 3 business goals that data analytics addresses in healthcare: to improve clinical effectiveness

There are few issue areas within the Beltway of Washington, DC, that have enjoyed more support across the political aisle than health care information technology. In 2004, George Bush asserted that every American would/should have an electronic medical record by 2014. Since then, Democrats and Republicans alike have supported the broad concept of wiring the U.S. health information infrastructure. With the injection of ARRA stimulus funds earmarked in the HITECH Act to promote health providers’ adoption of electronic health records, we’re now on the road to Americans getting access to their health information electronically. It won’t be all or even

To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow. However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in

The U.S. public’s views on health reform — the Affordable Care Act (ACT) – remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health

The signs of the primary care crisis in America are visible: A growing number of visits to the emergency room for treating commonplace ailments Waiting lists for signing up with and queuing lines to see primary care doctors Fewer med students entering primary care disciplines Maldistribution of primary care practitioners (PCPs) in underserved areas, rural, exurban and urban. The implementation of the Affordable Care Act will (try to) enroll at least 30 million newly-insured health citizens into the U.S. health system. That’s the objective: whether being insured will actually provide people access to needed primary care is a big question given the current supply of

Walmart is increasing premium sharing costs for employees subscribing to health insurance, and cutting the benefit for part-timers. Quoted in the New York Times, a company rep said, “over the last few years, we’ve all seen our health care rates increase and it’s probably not a surprise that this year will be no different. We made the difficult decision to raise rates that will affect our associates’ medical costs.” In so doing, Walmart told the Times that they will, “strike a balance between managing costs and providing quality care and coverage.” MarketWatch wrote that Walmart will increase health care premium costs

With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011. Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level

The traditional venues for retail health are found in pharmacies, grocery chains, and on the ground floor storefronts in hospitals. Joining these bricks-based models are digital, online health ventures that are expanding the definition and space of retail health. This week, two announcements illustrate this phenomenon, from American Well and Active Doctors. American Well, which launched in 2008, is an online physician consultation service in the U.S. that has successfully worked with health plans to channel consults to patients in Hawaii, Minnesota, and New York, among other local programs. Last year, American Well went live with the Rite Aid pharmacy chain in Pennsylvania. This week, American