A blog covering the health/care ecosystem and people.

I have seen the future of food and it is in Italy at a grocery chain called Conad, which launched a locavore-focused brand called Sapori & Dintorni. Here in Florence, Italy, where I’m spending a week’s holiday with my family, we stay in an apartment in the Oltrarno – just south of the Arno River, up a short hill from the southern tip of the Ponte Vecchio, the old bridge known for its gold and silver jewelry. But the real gem in this neighborhood is that grocery store, whose Sapori & Dintorni label represents food sourced from Italy’s great food

A consumer who is faced with greater financial skin-in-the-healthcare game, cost-sharing, is expected to become a smart shopper for lower-priced health products and services. When it comes to patients given prescriptions for medicines, the theory is that patients will choose less expensive generic drugs over brand names it people think the cheaper meds are good substitutes. This is referred to as the generic-drug dispensing rate (GDR). But the theory doesn’t consistently hold true in real life, a study from the Employee Benefit Research Institute (EBRI), Brand-Name and Generic Prescription Drug Use After Adoption of a Full-Replacement, Consumer-Directed Health Plan With a

In our increasingly-DIY society, most consumers expect high levels of access and customer service from the organizations with whom we engage. With more consumers reaching into their pockets to pay for health services and products, the health industry is increasingly a retail-facing environment. So expect quality service levels from their healthcare touch points. The pharmaceutical and prescription drug touch point is not exempt from this expectation, as learned by an Accenture survey analyzed in Great Expectations: Why Pharma Companies Can’t Ignore Patient Services. As the first picture shows, 70% of patients think pharma companies are responsible for bundling information and services

The CEO of a family-owned grocery store chain wrote a letter to New York State lawmakers to support $65 million worth of spending on a computer system for health information in the state. That grocer is Danny Wegman, and that project is the Statewide Health Information Network, aka SHIN-NY. In his letter beginning, “Dear New York Legislator,” Wegman identifies several benefits he expects would flow out of the health IT project: 1. Improve health care for all New Yorkers 2. Lower health care costs, through reducing hospital readmission rates and reducing duplicate testing. 3. Lead to health data “liquidity” (my

Health data is everywhere, but not much useful to drink. Is #bigdata in health care at the top of the Hype Cycle? And how do we humanize it, make it relevant and useful for our everyday life? In other words, can this data help us hack our lives and health for the better? That question has been on my mind for the past couple of years since the convergence of big data and data analytics and health has emerged. Yesterday at the 2014 South-by-Southwest happening, I attended a panel discussion called Hacking Your Life For Better Health (#hacklife on Twitter).

With health costs increase increasing at 4.4% in 2014, a slightly higher rate of growth than the 4.1% seen in 2013. While this is lower than the double-digit increases U.S. employers faced in 2001-2004, it’s still twice the rate of general consumer price inflation. That’s what the first graph shows, based on the The 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care.  Employers generally want to continue to provide health insurance…for the time being. 92% of companies expect to make changes in health plan provisions in 2014, with 1 in 2 anticipating “significant

Returning to terra firma following last week’s convening of the 2014 annual HIMSS conference…taking some time off for family, a funeral, the Oscars, and dealing with yet another snowstorm…I now take a fresh look back at #HIMSS14 at key messages. In random order, the syntheses are: Healthcare in America has entered an era of doing more, with less...and health information technology is a strategic investment for doing so. The operational beacon going forward is moving toward The Triple Aim: building population health, enhancing the patient’s experience, and lowering costs per patient. The CEO of Aetna, Mark Bertolini, spoke of the

3 in 4 people in America will buy health care at retail with a subsidy within just a few years, according to Mark Bertolini, CEO of Aetna. Bertolini was the first keynote speaker this week at the 2014 HIMSS conference convened in Orlando. Bertolini’s message was grounded in health economics 101 (about which frequent readers of Health Populi are accustomed to hearing). A healthy community drives a healthy local economy, and healthier people are more economically satisfied, Bertolini explained. The message: health care can move from being a cost driver to being an economic engine. But getting to a healthy

As more U.S. health citizens enroll in high-deductible health plans – now representing about 30% of health-insured people in America – health plan members are being called on to play the role of consumer. Among the most important choices the health consumer makes is for a physician. Ratings sites and health care report cards ranking doctors by various characteristics have been in the market for over a decade. However, little has been known on the public’s knowledge about the availability of these information sources, nor of peoples’ use of physician rating sites. This question is addressed in Public Awareness, Perception, and

Bravo! to CVS/pharmacy who today announced it would pull tobacco products from store shelves by October 2014. “The sale of tobacco products is inconsistent with our purpose,” the company’s press release asserts. The move will cost CVS $1.5 billion in revenue annually, as the company seeks to consolidate its position as a health company. CVS/pharmacy is part of CVS Caremark, which includes the retail pharmacy chain (the second-largest in the U.S.), a pharmacy benefit management company (Caremark), and retail health clinics (Minute Clinics). CVS Caremark also participates in a healthy communities program issuing grants for projects that focus on health

  More than twice as many people value the opinions of friends and family for health care provider choices than turn to online ratings for doctors’ bedside manner, waiting times, or clinical quality, according to the Altarum Institute Survey of Consumer Health Care Opinions, Fall 2013, released on January 8, 2014. 1 in 3 consumers also looks into the cost and quality of services recommended by nurses, doctors, labs and hospitals before choosing a provider. However, most people (4 in 5) say they are comfortable asking their doctor about how much treatment will cost: 43% are “very comfortable,” and 38% somewhat comfortable,

Madame Onassis got nothing on you, Rod Stewart complimented in his hit You Wear It Well in 1972. Now we can all wear it well, based on the fashion-meets-health-mashups at the 2014 Consumer Electronics Show. Several events underline this observation at the CES this year: – Fitbit has signed up Tory Burch to put her mark accessorizing the company’s activity trackers – The CSR Bluetooth smart pendant was designed with the chic jeweler Cellini; the device can receive alerts from an iPhone (think: medication adherence, or a message from mom in Florida). This is featured in the first photo. –

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

  See the yellow highlighted rows? That single yellow bar at the top, that’s hospitals; at the bottom, you’ll see pharma, health insurance, and managed care. Hospitals, trusted; pharma, insurance, managed care? Down south on the trust barometer with oil, tobacco, phone companies and social media. The Harris Poll has gauged U.S. consumers’ views on honesty and trustworthiness across industries for the past ten years. Over those ten years, trust in these industries has eroded, from huge falls-from-grace for banks (a 17 point fall), packaged food (falling 12 points), and computer hardware and software substantially falling, as well. Hospitals are

The 2013 Mobile Health Summit was hosted by HIMSS at The Gaylord Resort in suburban Washington DC, taking place over 4 days during the mid-atlantic region’s iciest conditions in years. But inside the cocoon of this convention space, 5,000 conveners took in demonstrations of innovations using mobile platforms and standards that extend health services, knowledge and self-help tools to people and providers. Several themes emerged out of the meeting… Lots of apps, too few business models.  There are too many apps and not enough companies, Esther Dyson noted in a keynote session during which she dialogued with two Steve’s: Steven

Employers who sponsor health insurance in America are at a fork on a cloudy road: they know that they’re in the midst of changes happening in the U.S. health system. Except for one certainty: that health care costs too much. So employers’ plans for health benefits in 2014 strongly focus on getting a return-on-investment from health spending in an uncertain climate, according to Deloitte’s 2013 Survey of U.S. Employers. Key findings are that: Employers will grow their use of workers’ cost-sharing, continuing to shift more financial responsibility onto employees They will expand other tactics they believe will help address cost

People who are diagnosed with at least one chronic medical condition are more likely to seek information online, use social media to understand peer patients’ reviews on drugs and treatments, and learn from other patients about their personal health experiences. While that’s encouraging news for a health empowerment headline, the underlying challenge that should prevent congratulatory fist-bumps among patient-engagement proponents is that people living with chronic disease are less likely to have internet access. Why? Because chronically ill people tend to be older and less educated, and they’re also less likely to be working. Simply put, “People living with chronic

While working people in the U.S. are feeling better about the nation’s economy, Americans aren’t putting much money into savings for retirement. The reasons for this are many, but above all is what Mercer calls “the specter of health care costs in retirement” in the Mercer Workplace Survey for 2013. In addition to peoples’ concerns about future health care costs, reasons for not putting money away for the future include flat personal income, slow economic growth and financial literacy challenges around how much 401(k) savings can be tax-deferred. On the slow economic growth perception, Mercer found that, on the upside, people

4 in 5 U.S. patients – 81% of them – want an equal say in health care decisions with their care provider, according to a 2013 Institute of Medicine study. At the same time, patients choose to take “drug holidays,” opting out of taking three or more doses of medicines in a row, or adopt “trail mix” approaches to taking prescriptions, casually and inappropriately mixing Rx drugs. Welcome to your world, pharma industry: where people say they want control, but somehow don’t exercise it in the way you — drug companies — define as “compliance” or “adherence.” Customer experience in

People who received health care in the U.S. between the second quarters of 2012 and 2013 faced 38% higher out-of-pocket costs, growing from $1,862 to $2,568 in just one year. These were payments for common procedures like joint replacements, Caesarean sections, and normal births. At the same time, consumers’ access to revolving credit lines fell by $1,000 over the twelve months. (Credit lines here include bank-issued credit cards, store credit cards, and home equity loans). The TransUnion Healthcare Report from TransUnion, the credit information company, paints a picture of tightening money for all consumers in the face of rising household

Patient and health engagement is the flavor du jour in health circles these days, from the corridors of hospitals to the caffeinated marketing meetings in Big Pharma’s east coast meet-ups. But there’s no standard agreement on what we mean by peoples’ health engagement, whether by patient or well consumer. In Market Insights: The Evolution of Consumer Engagement in Health Care, Porter Research endeavors to deepen our understanding of this important concept. In the introductory section of the paper, “Understanding Engagement,” Porter proffers that industry – providers, payers and employers – consider engagement as “changing consumer behavior through increased participation in consumers’ own health

The current role of health insurance at work is that it’s the “benefits” part of “compensation and benefits.” Soon, benefits will simply be integrated into “compensation and compensation.” That is, employers will be transferring risk to employees for health care. This will translate into growing defined contribution and cost-shifting to employees. Health care sponsorship by employers is changing quite quickly, according to the 2013 Aon Hewitt Health Care Survey published in October 2013. Aon found that companies are shifting to individualized consumer-focused approaches that emphasize wellness and “health ownership” by workers to bolster behavior change and, ultimately, outcomes. The most

Online shopping for health care can drive costs down, according to research conducted by HealthSparq, a company that works with health insurance companies to channel health cost information to plan members (that is, consumers). Healthsparq partnered with one of the company’s health insurance company clients to conduct this study, which demonstrated that, over two years, consumers who used an online treatment cost estimator saved money on care for hernia conditions, digestive conditions, and women’s health issues. It’s early days for health care price transparency in health care, but HealthSparq’s findings demonstrate positive evidence that when consumers are offered a tool

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

By 2022, $1 in every $5 worth of spending in the U.S. will go to health care in some way, amounting to nearly $15,000 for each and every person in America. From biggest line item on down, health spending will go to payments to: Hospitals, representing about 32% of all spending Physicians and clinical costs, 20% of spending Prescription drugs, 9% of spending Nursing, continuing care, and home health care, together accounting for over 8% of health spending (added together for purposes of this analysis) Among other categories like personal care, durable medical equipment, and the cost of health insurance.

Mobilising Healthcare, a new report from Juniper Research, segments the mobile health sector into “healthcare” and “health & fitness” segments. The research summary notes that fitness is a relatively new market compared with health “care,” which has been around for eons. Fitness, the analysts say, “is exempt from government intervention.” Mobile healthcare (“mHealth”) applications explored include SMS health messaging, remote health provision such as cardiac monitoring, electronic health records and personal health records. In mFitness, Juniper looks into mobile tech for athletes and fitness conscious people, and activity tracking including heart function, distance, respiration, and perspiration, among other parameters. mHealth

Since the advent of the so-called consumer-directed health care era in the mid-2000s, there’s been a love-gap between health plan members of traditional plans, living in Health Plan World 1.0, and people enrolled in newer consumer-driven plans – high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs). That gap in plan satisfaction continues, according to the Employee Benefits Research Institute (EBRI)’s poll of Americans’ consumer engagement in health care. The survey was conducted with the Commonwealth Fund. As the bar chart illustrates, some 62% of members in traditional plans were satisfied (very or extremely) with their health insurance in 2012.

Only 1 in 4 U.S. adults over 30 know what “personalized medicine” (PM) really is, and only 8% of people feel very knowledgeable about the concept based on Consumer Perspectives on Personalized Medicine from GfK, published online in August 2013. GfK surveyed 602 online adults 30 years and over between February and March 2013 drawn from the company’s KnowledgePanel sample of U.S. adults. Only 4% of people who have heard of personalized medicine describe it accurately as “medicine based on genome/genetic make up.” About one-half of people (52%) defined PM as medical care, treatment, or medicine geared toward individual needs. The poll

Insurance premium costs grew 4% for families between 2012 and 2013, with workers now bearing 39% of health premiums in 2013 compared with only 26% ten years ago, in 2003. That’s a 50% increase in health plan premium “burden” for working families, by my calculation. This snapshot of health insurance in 2013 comes to us from the 2013 Employer Health Benefits Survey, provided by the Kaiser Family Foundation (KFF) and the Health Research & Educational Trust (HRET). This research is one of the most important annual reports to hit the health care industry every year, and this year’s analysis provides strategic context

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.

Consumers in America are spending more, and especially at the grocery store. Most people say they want to eat healthy — but, although they’re spending more at the food store, one-half of supermarket shoppers say cost is the main obstacle for healthy eating. 2 in 3 U.S. grocery shoppers define health and wellness as being physically fit and active, and over half believe that feeling good about yourself is another facet of health. Not being overweight equals health for about one-half of U.S. shoppers. The Why? Behind the Buy, from Acosta Sales & Marketing, explores buying patterns among U.S. consumers

There’s an issue that doctors and patients don’t discuss that’s among the most important contributors to ill health: it’s money, and it’s something Alexandra Drane calls an “Unmentionable.” Alex, Founder, Chief Visionary, and Board Chair at Eliza Corporation, coined Unmentionables as those aspects of daily living which everyone deals with, but few like to talk about: like sex (whether too much, too little), drugs (abusing), drinking (too much), toileting problems (such as incontinence or pooping problems), sleep trouble, and caring for others (not ourselves so much). These daily life challenges can negatively impact health, with financial stress being one of

Health consumers, meet a new player in your health care world: the bank. Financial services companies will play a growing role in U.S. health care as patients morph into health care consumers responsible for making more money-based decisions about their health care. This shift could make paying for health care just like paying other bills in the consumer retail market. And that’s a new role for health providers – doctors and hospitals – to fill. The Impact of Growing Patient Financial Responsibility on Healthcare Providers, prepared for Citi Enterprise Payments by Boundary Information Group, discusses what the impact of consumers’ payments in

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],

Giving health consumers more skin in the game doesn’t always lead to them making sound health decisions. Over four years in consumer-directed health plans, enrollees used one-quarter fewer visits to doctors every year and filled one fewer prescription drugs. CDHP members also received fewer recommended cancer screenings, and visited the emergency room more often. These rational health consumer theory-busting findings were published in the June 2013 issue of the Health Affairs article, Consumer-Directed Health Plans Reduce The Long-Term Use of Outpatient Physician Visits And Prescription Drugs by Paul Fronstin of the Employee Benefit Research Institute and colleagues from IBM and RxEconomics,

Nearly 100% of employers are likely to continue to provide health insurance benefits to workers in 2014, moving beyond a “wait and see” approach to the Affordable Care Act (ACA). As firms strategize tactics for a post-ACA world, nearly 40% will increase emphasis on high-deductible health plans with a health savings account, 43% will increase participants’ share of premium costs, and 33% will increase in-network deductibles for plan members. Two-thirds of U.S. companies have analyzed the ACA’s cost impact on their businesses but need to know more, according to the 2013 survey from the International Foundation of Employee Benefit Plans (IFEBP).

While the blockbuster erectile dysfunction (ED) drug has been shipped directly to consumer’s homes for years via pharmacy benefits management companies and specialty pharmacy retailers catering to the ED segment, Pfizer wants in on the transaction and has decided to get into the Direct-to-Consumer (DTC) distribution business for a prescription drug. Call this market development Direct-to-Home, or DTH. This is a kind of sentinel event signaling a pharmaceutical manufacturer cutting out the middle-man (read: retail pharmacy), and in this case getting up-close-and-personal with users of a drug that represents quality of life. Another motivation for Pfizer is trying to stem

Why has health cost growth in the U.S. slowed in the past few years? It’s mostly due to the economy, argues the Kaiser Family Foundation in Assessing the Effects of the Economy on the Recent Slowdown of Health Spending. The answer to this question is important because, as the American economy recovers, it begs the next question: will costs increase faster once again as they did in previous go-go U.S. economies, further exacerbating the budget deficit problems in the long-term? KFF worked with Altarum to develop an economic model to answer these questions. The chart illustrates the predicted vs. actual

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

As a result of implementing the Affordable Care Act (health reform), most U.S. health executives crystal balls foresee health care insurance premiums will increase over 10% in the next three years. 4 in 10 predict premiums will grow over 25% over the next 3 years. This sobering forecast comes out of a Munich RE Health survey conducted among 326 health industry executives in March 2013. Those polled included representatives from health plans, managed care, disease management firms, and health insurance brokers and agents. How do health execs expect employers would deal with such fast-rising health premium costs? Why shift more

  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

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

  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

Only two U.S. states have comprehensive health care price transparency regulations that ensure citizens’ access to clear and open health price information. While those two states, Massachusetts and New Hampshire, earn an “A” in the Report Card on State Price Transparency Laws, an addition five state earn a “B,” with the remainder of the United States garnering a “C” or less. The map illustrates that most states are red states, earning the lowest score of “F.” With the growth of high-deductible health plans (under the umbrella of so-called “consumer-directed” plans) where health consumers pay thousands of dollars to meet a spending

I endured what very few people could (or would) do in the past ten days: I traveled to New Orleans to the annual conference of HIMSS, the Health Information Management Systems Society, which features hundreds of suppliers to the health care information technology industry. I returned home to kiss my family hello and goodbye, and a day later flew to Austin for the annual South-by-Southwest conference for music, movie and digital folks. The health track at SXSW has grown over the past five years, and provides a start contrast to “health care” as embodied at HIMSS, and “health” translated through

  The U.S. economy is largely built on consumer purchasing (the big “C” in the GDP* – see note, below Hot Points). Americans have universally embraced their role as consumers in virtually every aspect of life — learning to self-rely in making travel plans, stock trades, photo development, and purchasing big-dollar hard goods (like cars and washing machines). Consumers transact these activities thanks to usable tools and information that empower them to learn, compare, and execute smarter decisions. That is, in every aspect of life but in health care. While the banner of “consumerism” in health care has been flown

This week, I had a conversation with a physician whom I consider quite patient-engaged, who uses an EHR, and who works with one of the most wired health organizations in the United States. I complained to her that my user-generated data from my Bodymedia armband, Fitbit, Withings scale, among other #QuantifiedSelf devices, can’t find their way through the cloud to my doctors’ electronic health records or my patient portal. Her reaction was surprising to me. She was not so keen on the idea, saying, “It’s the physician workflow” that’s the problem. The wordle on workflow comes from Dr. Chuck Webster

There are many ways to measure and express “patient engagement.” One such metric is “patient activation,” innovated by Dr. Judith Hibbard, long affiliated with the University of Oregon. Dr. Hibbard has written extensively about the Patient Activation Measure, PAM, first described in 2004. She and a team of researchers have determined that the higher a patient’s PAM score, the lower their health costs. Hibbard et. al. published these findings in the February 2013 issue of Health Affairs, which is entirely devoted to patient engagement – a top topic in Health Populi. The team analyzed the medical records of 33,163 patients