A blog covering the health/care ecosystem and people.

U.S. consumers rank supermarkets, fast food chains, retailers, and banks as their top performing industries for experience according to the 2018 Temkin Experience Ratings. Peoples’ experience with health plans rank at the bottom of the roster, on par with rental cars and TV/Internet service providers. If there is any good news for health plans in this year’s Temkin Experience Ratings compared to the 2017 results, it’s at the margin of “very poor” performance: last year, health plans has the worst performance of any industry (with the bar to the furthest point on the left as “low scoring”). This year, it

In healthcare, we use the word “toxicity” when it comes to taking a new medicine, especially a strong therapy to cure cancer. That prescription may be toxic as a harmful side effect on our journey to getting well. The concept of “financial toxicity” for cancer patients was raised by concerned clinicians at Sloane-Kettering Medical Center, who discussed the topic on 60 Minutes in 2014 and have published papers on the issue. Beyond strong medicines, a new financial toxicity has emerged for patients due to hospital inpatient admissions. A new article in the New England Journal of Medicine studies Myth and

            I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. The speaker at this event was Paul Krugman, who won the Nobel Prize for Economics 10 years ago and today is an iconic op-ed columnist at the New York Times And Distinguished Professor of Economics at the City University of New York (CUNY). I admit to being a bit of a groupie for Paul Krugman’s work. It tickles me to look at Rise Global’s list of the Top 100 Influential Economists:

Along with artificial intelligence, patient engagement feels like the new black in health care right now. Perhaps that’s because we’re just two weeks out from the annual HIMSS Conference which will convene thousands of health IT wonks, users and developers (I am the former), but I’ve received several reports this week speaking to health engagement and technology that are worth some trend-weaving. As my colleague-friends Gregg Masters of Health Innovation Media (@2healthguru) and John Moore of Chilmark Research (@john_chilmark)  challenged me on Twitter earlier this week: are we scaling sustained, real patient engagement and empowerment yet? Let’s dive into the

Stories about three fashion brands have me thinking about women and their health economics. Stay with me. Target unveiled its new line of clothing, Universal Thread, which features pieces that are accessible to women who may be dealing with physical limitations or sensory challenges. I first read about Universal Thread on The Mighty website, which is a community of over 1 million people interested in connecting on health and disabilities. As The Mighty described, the brand Universal Thread, “is centered around denim since it is a staple in many women’s wardrobes, but denim can be uncomfortable for many people with disabilities

Health care ranks highest among working Americans as the top critical issue facing the country, well above terrorism, the role of the Federal government, unemployment and jobs, education, immigration and taxes. Over half of American workers also rate the country’s healthcare system as “poor” or “fair,” based on the results of the EBRI/Greenwald & Associates Health and Workplace Benefits Survey. Workers dissatisfaction with U.S. healthcare is based largely on cost: one-half of workers experienced an increase in health care costs in the past year. Furthermore, only 22% are satisfied with the cost of their health insurance plan, 18% are satisfied

Health care costs cause anxiety for U.S. adults, regardless of their affluence, we learn in Uncertainty About Healthcare, the latest Stress in America poll from the American Psychological Association. The big stat is that 2 in 3 Americans say the cost of health insurance is a stressor for them or their loved ones, whether the person earns more or less than $50,000 a year. Underneath that top-line are some demographic differences. Millennials are most concerned about access to mental health care compared with Boomers and older adults. Reproductive care access is of most interest to Millennials and Gen Xers. Two-thirds

When patients feel disrespected in a medical exam room, they will be less likely to follow instructions they receive from a doctor. Research from the Altarum Institute revealed this fundamental finding. The chart shows that feeling respected reduces  a patient’s diabetes medication adherence by a factor of nearly 2x, and is a risk factor for poorly managed diabetes. Furthermore, consumers who feel disrespected by providers are three times more likely to not believe doctors are accurate sources of information than consumers who do feel respected. And, patients with diabetes who do not feel respected are one-third more likely to have poorly

Concerns about health care are, by a large margin, the top domestic policy issue U.S. voters identified as they enter 2018. The proportion of Americans citing healthcare as the top public agenda priority grew by 50% since 2016, from 31% two years ago to 48%. Taxes rank #2 this year, garnering 31% of Americans’ concerned, followed by immigration, which has remained flat cited by about one-in-four Americans. The Associated Press (AP)-NORC Center for Public Affairs Research polled 1,444 U.S. adults 18 and over between November 30 and December 4, 2017 for this survey. While one-half of Americans would like the

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation. Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence. In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of

At this moment, the healthcare job I’d least like to have is that of a non-profit hospital Chief Financial Officer (CFO). Five news stories, published in the past 24 hours, tell the tale: First, Moody’s forecast for non-profit hospitals and healthcare in 2018 is negative due to reimbursement and expense pressures. The investors report cited an expected contraction in cash flow, lower reimbursement rates, and rising expense pressures in the midst of rising bad debt. Second, three-quarters of Federally Qualified Health Centers plan to lay off staff given lack of budget allocations resulting from Congressional inaction. Furthermore, if the $3.6

It takes more than enrolling in a high-deductible health plan (HDHP) for someone to immediately morph into an effective health care “consumer.” Research from Dr. Jeffrey Kullgren and his team from the University of Michigan found that enrollees in HDHPs could garner more benefits from these plans were people better informed about how to use them, including how to save for them and spend money once enrolled in them. The team’s research letter was published in JAMA Internal Medicine on 27 November 2017. The discussion details results of a survey conducted among 1,637 people 18 to 64 years of age

The math is straightforward. Assume “A” equals $59.039, the median household income in 2016. Assume “B” is $18,142, the mean employer-sponsored family insurance premium last year. B divided by A equals 30.7%, which is the percent of the average U.S. family’s income represented by the premium cost of health insurance. Compare that to what American households spent on food: just over $7,000, including groceries and eating out (which is garnering a larger share of U.S. eating opportunities, a topic for another post). Thus, health care represents, via the home’s health insurance premium, represents 2.5 times more than food for the

THINK: money and love. To find health, working-aged people seek financial stability and good relationships, according to the Consumer Health POV Report from Welltok, meQuilibrium, and Zipongo, featured in their webinar broadcast today. The online consumer survey was conducted among 2,000 full-time working U.S. adults in August 2017, segmented roughly into thirds by Boomers (37%), Gen Xers (32%), and Millennials (31%). Much lower down the priority list for healthy living are managing food, sleep, and stress based on the poll. Feeling stress is universal across most consumers in each of the three generational cohorts, especially related to work and finance.

4 in 5 Americans are aware of potential changes to healthcare policy brewing in Washington, DC. 92% of them are concerned about those changes, according to Healthcare Consumers in a Time of Uncertainty, the fifth annual survey from Transamerica Center for Health Studies. Peoples’ most-shared fears are losing their coverage for pre-existing conditions, out-of-pocket spending, and a ban on lifetime limits. That boils down to one thing: cost. That is, cost, for having to spend money on services not-covered by their health insurance plan; cost for out-of-pocket items under-insured, denied, or requiring coinsurance or co-payments; and, catastrophic costs that rise beyond

For each dollar spent on healthcare in the United States, families paid 28 cents, according to the U.S. National Health Expenditure Accounts for 2015. Welcome to the new era of Americans and medical banking, with new insights provided by the largest of banks, JP Morgan Chase, in Paying Out-of-Pocket: The Healthcare Spending of 2 Million U.S. Families, from JP Morgan Chase. Chase is the largest bank in America based on its assets. They’ve mined 2.3 million de-identified records of Chase consumers in their banking network to learn about customers’ healthcare spending. These data represent spending between 2013 and 2016, detailed

Most U.S. patients want healthcare providers to offer cost information before a procedure, and whether doctors offer financial options to help them extend payments over time. This is an automotive or home appliance procedure we’re talking about. It’s healthcare services, and American patients are now the third largest payors to providers in the nation. Thus, the title of a new report summarizing a consumer survey from HealthFirst notes, “It’s Never Too Soon to Communicate Pricing and Payment Options. The study found that two-thirds of U.S. consumers would like healthcare providers to discuss financing options; however, only 18 percent of providers have

Happy anniversary to me…well, to the Health Populi blog! It’s ten years this week since I launched this site, to share my (then) 20 years of experience advising health care stakeholders in the U.S. and Europe at the convergence of health, economics, technology, and people. To celebrate the decade’s worth of 1,791 posts here on Health Populi (all written by me in my independent voice), I’ll offer ten health/care milestones that represent key themes covered from early September 2007 through to today… 1. Healthcare is one-fifth of the national U.S. economy, and the top worrisome line item in the American

Three-quarters of patients’ decisions on whether to seek services from healthcare providers are impacted by high deductible health plans. This impacts the finances of both patients and providers: 56% of patients’ payments to healthcare providers are delayed some of the time, noted in Optimizing Revenue: Solving Healthcare’s Revenue Cycle Challenges Using Technology Enabled Communications, published today by West. Underneath that 56% of patients delaying payments, 12% say they “always delay” payment, and 16% say they “frequently delay” payment. West engaged Kelton Global to survey 1,010 U.S. adults 18 and over along with 236 healthcare providers to gauge their experiences with

    The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016. The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month. The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA. It’s

As we look for signs of stability in U.S. health care, there’s one stakeholder that’s holding firm: employers providing healthcare benefits. Two studies out this week demonstrate companies’ commitment to sponsoring health insurance benefits….with continued tweaks to benefit design that nudges workers toward healthier behaviors, lower cost-settings, and greater cost-sharing. As Julie Stone, senior benefits consultant with Willis Towers Watson (WLTW), noted, “The extent of uncertainty in Washington has made people reluctant to make changes to their benefit programs without knowing what’s happening. They’re taking a wait-and-see attitude.” First, the Willis Towers Watson 22nd annual Best Practices in Health Care Employer

  Patients want their doctors to know what their personal costs for medicines are; 42% of patients also believe their doctor is aware of how much they spend on prescription drugs. However, 61% of these people have not talked with doctors about drug prices. Nor do most doctors have access to this kind of information at the individual patient level. One important tactic to addressing overall healthcare costs, and managing the prescription drug line item in those costs, is discussed in Doctors and Pharmacists: An Underused Resource to Manage Drug Costs for Older Adults, a report on a survey sponsored

On July 23, 1967, I was a little girl wearing a pretty dress, attending my cousin’s wedding at a swanky hotel in mid-town Detroit. Driving home with my parents and sisters after the wedding, the radio news channel warned us of the blazing fires that were burning in a part of the city not far from where we were on a highway leading out to the suburbs. Fifty years and five days later, I am addressing the subject of health equity at a speech over breakfast at the American Hospital Association 25th Annual Health Leadership Summit today. In my talk,

  6 in 10 people diagnosed with a chronic condition do not feel they’re doing everything they can to manage their condition. At the same time, 67% of healthcare providers believe patients aren’t certain about their target health metrics. Three-quarters of physicians are only somewhat confident their patients are truly informed about their present state of health. Most people and their doctors are on the same page recognizing that patients lack confidence in managing their condition, but how to remedy this recognized challenge? The survey and report, Strengthening Chronic Care, offers some practical advice. This research was conducted by West

Americans are most worried about healthcare costs among all financial concerns; most people in the U.S. also believe the Federal government should ensure that all people have health coverage. Two polls published in the past week point to the fact that most U.S. health citizens are concerned about health care for themselves and their families, driving a growing proportion of people to favor a single-payer health system. The first line chart illustrates a dramatic trajectory up of the number of American identifying healthcare costs as their #1 financial problem, rising from 10% of people in 2013 to 17% in 2017.

Health care costs will trend upward by 6.5% in 2018 according to the forecast, Medical Cost Trends: Behind the Numbers 2018, from PwC’s Health Research Institute. The expected increase of 6.5% is a half-percentage point up from the 2017 rate of 6.0%, which is 8% higher than last year’s rate matching that of 2014. PwC’s Health Research Institute has tracked medical cost trends since 2007, as the line chart illustrates, when trend was nearly double at nearly 12%. The research consider medical prices, health care services and goods utilization, and a PwC employer benefit cost index for the U.S. The key

Patients, evolving into health consumers, seek a better healthcare experience. While most people are pretty satisfied with their medical care, cost and confusion reign. This is the topline finding of a study from Oliver Wyman appropriately titled, Complexity and Opportunity, a survey of U.S. health consumers’ worries and wants. Oliver Wyman collaborated on the research with the FORTUNE Knowledge Group. Consumers’ biggest healthcare concerns deal with costs: rising insurance premiums; greater out-of-pocket costs for care not covered by insurance; and, the growing costs of prescription drugs together rank as the top 3 healthcare concerns in this study. After costs, consumers cite government

If you had $27,000 in your wallet, would you spend it on a 2017 Kia Optima sedan, 28 shares of Amazon stock, or healthcare? $26,944 is this year’s estimate of what healthcare will cost a family of four in the U.S., based on the 2017 Milliman Medical Index (MMI). This is based on the projected total costs of healthcare for a family covered by an employer-sponsored PPO plan. Milliman, the actuarial consulting firm, has conducted the MMI going back to 2001. I’ve watched the rise and rise of this index for years, explained annually in the Health Populi blog since its inception

In accounting, there’s a rule with acronym “LIFO;” this stands for “last in, first out,” which requires taking account of the most recent cost of products being the first ones to be expensed on the ledger. I’m thinking about LIFO when it comes to the American Health Care Act (AHCA) which narrowly passed through Congress yesterday by 4 votes, with a final tally of 217 to 213. Why “LIFO?” Because long-uninsured folks who just recently received access to health insurance as an on-ramp to health care services could lose this benefit, just months after joining the ranks of the insured. Among

Former Surgeon General Dr. Regina Benjamin was the first person who quoted to me, “Health isn’t in the doctor’s office. It’s where people live, work, play and pray,” imparting that transformational mantra to me in her 2011 interview with the Los Angeles Times. I wrote about that lightbulb moment here in Health Populi. Dr. Benjamin was the 18th Surgeon General, appointed by President Obama in 2009. As “America’s Doctor,” she served a four-year term, her mission focused on health disparities, prevention, rual health, and children’s health. Today, Dr. Benjamin wears many hats: she’s the Times Picayune/NOLA.com professor of medicine at

Health care costs are out-of-reach for more Americans, among both people who have insurance through the workplace or via health insurance exchanges. The first chart illustrates the growing healthcare affordability challenge for American health consumers, discussed in a data note to the Kaiser Family Foundation Health Tracking Poll in March 2017. In 2017, 43% of consumers found it difficult to meet the health care deductible before insurance would kick in 37% of consumers found it difficult to pay for the cost of health insurance each month 31% said it was difficult to pay for copayments for doctor visits and prescription drugs.

U.S. counties with better health have better performing economies. There’s a direct link between healthy people and a healthy economy, where healthier regions enjoy lower unemployment and higher incomes, according to the Blue Cross Blue Shield Health Index. When compared to counties with a median BCBS Health Index score, counties within the top 10 percent had: A per capita income that’s $3,700 higher than the median 10-year economic growth that’s 3.5% higher An unemployment rate half a point lower. The Blue Cross Blue Shield Association (BCBSA) worked with Moody’s Analytics (part of the Moody’s financial services company) on this second edition of this

Geography is destiny, Napoleon is thought to have first said. More recently, the brilliant physician Dr. Abraham Verghese has spoken about “geography as destiny” in his speeches, such as “Two Souls Intertwined,” The Tanner Lecture he delivered at the University of Utah in 2012. Geography is destiny for all of us when it comes to our health and well-being, once again proven by Gallup-Healthways in The State of American Well-Being 2016 Community Well-Being Rankings. The darkest blue circles in the U.S. map indicate the metro areas in the highest-quintile of well-being. The index of well-being is based on five metrics, of consumer self-ranking

Results of two polls published in the past week, from the Kaiser Family Foundation and Pew Research Center, demonstrate growing support for the Affordable Care Act, aka Obamacare. The Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid was published 24 February 2017. The first line chart illustrates the results, with the blue line for consumers’ “favorable view” on the ACA crossing several points above the “unfavorable” orange line for the first time since the law was signed in 2010. The margins in February 2017 were 48% favorable, 42% unfavorable. While the majority of Republicans continue to be solidly

An abbreviated version of this post appeared in the Huffington Post on 9 February 2017. This version includes the Health Populi Hot Points after the original essay, discussing the consumer’s context of retail experience in healthcare and implications for the industry under Secretary of Health and Human Services Tom Price — a proponent of consumer-directed healthcare and, especially, health savings accounts. We’ll be brainstorming the implications of the 2016 CAQH Index during a Tweetchat on Thursday, February 16, at 2 pm ET, using the hashtag #CAQHchat. America ranks dead-last in healthcare efficiency compared with our peer countries, the Commonwealth Fund

Healthcare consumers are in a “state of denial,” according to research conducted for Alegeus, the consumer health benefits company. Overall, 3 in 4 consumers feel fear when it comes to their healthcare finances: most people worry about being hit with unexpected healthcare costs they can’t afford, and nearly half fear they won’t be able to afford their family’s healthcare needs. The wordle illustrates consumers’ mixed feelings about healthcare: while people feel frustrated, overwhelmed, powerless, confused and skeptical about healthcare in America, there are some emerging adjectives hinting at growing consumer health muscle-building: optimistic, hopeful, supported, engaged, accountable. Still, denial and

Health and money are the two issues about which Americans have set New Year’s resolutions, according to the Harris Poll, Americans Look to Get Their Bodies and Wallets in Shape with New Year’s Resolutions. The top goals U.S. consumers have set for 2017 are to: Eat healthier, 29% of all U.S. adults Save more money, 25% Lose weight, 24% Drink more water, 21% Pay down debt, 17% Spend more time with family and friends, 15% Get organized, 15% Travel more, 15% Read more, 14% Improve relationships, 14%. There are some marked differences between American men versus women across these resolutions;

  Two in three U.S. consumers are willing to see a doctor online. American health consumers welcome the opportunity to engage in virtual healthcare services via telehealth. American Well’s 2017 Telehealth Index surveyed 2,100 U.S. adults 18 and over in August and September 2016 to gauge consumers’ views on healthcare services, access, and receptivity to virtual care modes of delivery. Underneath the 66% of consumers open to telehealth are demographic differences: people with children are more likely to value virtual care, as well as people between 45 and 54, the survey found. Note, though, that a majority of older Americans over

Nine in 10 U.S. consumers think pharma and biotech put profits above patient interests, according to the latest Harris Poll studying reputation equity across organizations serving health care. Notice the relatively low position of the green bars in the first chart (with the exception of the impression for “strong financial performance); these are the pharma/biotech consumer impressions. The health industry stakeholders consumers believe would more likely place them above making money are health care providers, like doctors and nurses, hospitals, and pharmacists. Health insurance companies fare somewhat better than pharma and biotech in this Poll, although rank low on social

More Americans are worried about their out-of-pocket health care costs than they are about repealing the Affordable Care Act (ACA), according to the Kaiser Family Foundation (KFF) Health Tracking Poll published 6th January 2017, the first KFF poll for the new year. Cost worries fall into two buckets of concerns: the cost of health care, and the cost of prescription drugs. Managing the opioid epidemic falls in third place after health care costs. Repealing the Affordable Care Act? It’s #4 on Americans’ health care priorities as of mid-December 2016, followed by shrinking the Federal’s government’s role in and spending on

Health citizens in America will need to be even more mindful, critical, and engaged healthcare consumers in 2017 based on several factors shaping the market; among these driving forces, the election of Donald Trump for U.S. president, the uncertain future of the Affordable Care Act and health insurance, emerging technologies, and peoples’ growing demand for convenience and self-service in daily life. The patient is increasingly the payor in healthcare. Bearing more first-dollar costs through high-deductible health plans and growing out-of-pocket spending for prescription drugs and other patient-facing goods and services, we’re seeking greater transparency regarding availability, cost and quality of

The global market for spending on medicines will high $1.5 trillion by 2021, according to the latest forecast from QuintilesIMS. Drug spending grew about 9% in the past two years, and is expected to moderate to 4 to 7 percent annually over the next five years. That dramatic 9% growth was heavily driven by new (expensive) specialty drugs to treat Hepatitis C (e.g., Harvoni and Sovaldi) and cancer therapies that hit the market in the past couple of years. There will be a “healthy level” of new innovative meds coming out of the drug pipeline in the next several years

“See me, feel me, touch me, heal me,” is the lyrical refrain from The Who’s Tommy. These eight words summarize what Deloitte has learned from the firm’s latest look into healthcare consumers, published in the report, Health plans: What matters most to the health care consumer. U.S. consumers’ demands for health care are for: Personalization from doctors, hospitals, and other care providers — the most important priority; Economically rational coverage and care choices; Convenience-drive access and care experience; and, Digitally connected care. Personalization is Job 1: “Consumers want to be heard, understood, and given clear directions through a personalized health care

Healthcare is going direct-to-consumer for a lot more than over-the-counter medicines and retail clinic visits to deal with little Johnny’s sore throat on a Sunday afternoon. Entrepreneurs recognize the growing opportunity to support patients, now consumers, in going shopping for health care products and services. Those health consumers are in search of specific offerings, in accessible locations and channels, and — perhaps top-of-mind — at value-based prices as defined by the consumer herself. (Remember: value-based healthcare means valuing what matters to patients, as a recent JAMA article attested). At this week’s tenth annual Health 2.0 Conference, I’m in the zeitgeist

Federal healthcare program costs are the largest component of mandatory spending in the U.S. budget, according to An Update to the Budget and Economic Outlook: 2016 to 2026 from the U.S. Congressional Budget Office (CBO). Federal spending for healthcare will increase $77 billion in 2016, about 8% over 2015, for a total of $1.1 trillion. The CBO believes that number overstates the growth in Medicare and Medicaid because of a one-time payment shift of $22 bn to Medicare (from 2017 back into 2016); adjusting for this, CBO sees Federal healthcare spending growing 6% (about $55 bn) this year. The driver

The average hospital cost per day in the U.S. is $5,220. In Switzerland it’s $4,781, and in Spain that inpatient day looks like a bargain at $424. An MRI in the U.S. runs, on average, $1,119. In the UK, that MRI is $788, and in Australia, $215, illustrated in the first chart. Drug prices are strikingly greater in the U.S. versus other developed nations, as shown in the first chart for Xarelto. If you live in the U.S. and have a television tuned in during the six o’clock news, chances are you’ve seen an ad for this drug featuring Arnold

Health care payment responsibility continues to shift from employers to employee-patients, More of those patients are morphing into financially burdened health consumers, according to TransUnion, the credit agency and financial risk information company, in the TransUnion Healthcare Report published in June 2016. Patients saw a 13% increase in their health insurance deductible and out-of-pocket (OOP) maximum costs between 2014 and 2015. At the same time, the average base salary in the U.S. grew 3% in 2015, SHRM estimated. Thus, deductibles and OOP costs grew for consumers more than 4 times faster than the average base salary from 2014 to 2015.  In

Today is Financial Wellness Day. Do you know how financially well you are? Let me take a crack at that answer, even though I haven’t seen your bank account (which you may not even have as over 20% of people in the US are, as financial services companies would call you “un-banked” or “under-banked”.) You have some level of fiscal stress, ranging from a little to a lot. You aren’t taking all of your summer vacation your employer extends to you. You’re spending around $1 in every $5 of your household budget on health care. And your sleep isn’t as

Two news items published in the past week point to the yin/yang of cancer survivorship and the high prices of cancer drugs. The good news: a record number of people in the US are surviving cancer, according to the American Cancer Society. That number is 15.5 million Americans, according to a study in the cancer journal CA. Note the demographics of cancer survivors: One-half are 70 years of age and older 56% were diagnosed in the past ten years, and one-third in the past 5 years Women were more likely to have had breast cancer (3.5 mm), uterine cancer (757,000),