A blog covering the health/care ecosystem and people.

The rising costs of health care in America, and consumers’ growing cost burdens, has many impacts on the U.S. health ecosystem. In particular, patients have been self-rationing due to costs, without necessarily paying attention to quality or medical outcomes. Doctors have begun to pay more attention to costs and their impacts on patients in their practices, addressed in today’s New York Times article, Treatment costs could influence doctors’ advice to patients. Andrew Pollack writes in the Times about the morphing role of doctors, some of whom are taking on the mantle of being a “steward of society,” as characterized by

There’s a new member in the C-suite in health care, and her name is the Chief Patient Officer (CPO). That new role in health-town is filled by Dr. Anne Beal, appointed by Sanofi, the global biopharma company, to fill this new job description. Here she is, shaking hands with Colin Powell in one of the many awards ceremonies where Dr. Beal’s work in public health has been lauded. But what is a CPO? Because it’s a new job, Dr. Beal can create the role, at least within the environment and mission of Sanofi and the larger life sciences world. Some

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

That’s a useful and timely question, given the news that Castlight Health will launch its IPO with valuations north of $1 billion. Yes, “billions,” and according to a  MarketWatch analysis, “it’s a bargain at $1 billion.” So then – do we anticipate a bubble? asked Marc Monseau of the Mint Collective, the convener of our panel who brought together Robert Stern, a successful health-tech entrepreneur whose latest venture, @PointofCare, focuses on patient engagement; Marco Smit of Next Innovation Health Partners (parting from the Health 2.0 Conference family where he led Health 2.0 Advisors for several years); and me. Some key

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

While the prescription drug bill makes up about 10% of U.S. national health spending, the fastest-growing component of pharmacy spending is specialty medications. These are categorized as “specialty” drugs because they rarely have generic equivalents, and treat serious or life-threatening diseases (such as cancer, MS, and rheumatoid arthritis). They are also “special” because specialty pharmaceuticals average $3,000 per patient per month and can surpass $100,000 a year for certain products. As a result, the top two goals for managing specialty medications among employers are #1, to reduce inappropriate utilization, and #2, to reduce drug acquisition costs, based on a survey

There’s truly good news for public health about smoking: January 11th marked the 50th anniversary of the U.S. Surgeon General’s Report on Smoking and Health. That’s five decades’ worth of progress raising peoples’ awareness about the toxic impact of nicotine and chemicals embodied in cigarettes, and deleterious impacts on health and the economy. As a result, smoking rates have been cut in half since 1964, as the downward-sloping graph illustrates. With that happy news in my subconscious, I took a long walk, tracked by my digital device, through the Venetian Hotel in Las Vegas last week, bound for the 2014 Consumer Electronics

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

Coast-to-coast, stress is the modus vivendi for most Americans: 55% of people feel stressed in every day life, according to a study from Televox. A Stressful Nation: Americans Search for a Healthy Balance paints a picture of a nation of physically inactive people working too hard and playing too little. And far more women feel the stress than men do. 64% of people say they’re stressed during a typical workday. 52% of people see stress negatively impacting their lives. And nearly one-half of people believe they could better manage their stress. As a result, physicians say that Americans are experiencing negative

Ordering up and financing health care in the U.S. looks like the proverbial Chinese food menu, picking and paying for “one from column A, and one from column C.” But that’s no way to operate a well-oiled machine for delivering quality health care, according to Healthcare Shifts from á la Carte to Prix Fixe from Strategy&, an analysis of the fragmented, high-cost and only fair quality American health system. One solution to this challenge is bundled payment. “No one has an overarching view of the entire process,” the report opines, “with an eye toward improving customer service, quality, or costs.” Further exacerbating the sub-optimal

  Money and health are two things most people don’t like to talk about. But if people and their doctors spoke more about health and finance, outcomes (both fiscal and physical) could improve. In late October 2013, Best Practices for Communicating with Patients on Financial Matters were published by the Healthcare Financial Management Association (HFMA). Michael Leavitt, former head of the Department of Health and Human Services, led the year-long development effort on behalf of HFMA, with input from patient advocates, the American Hospital Association, America’s Health Insurance Plans, the American Academy of Family Physicians and the National Patient Advocate Foundation, along

Consumers embrace ongoing dialog with the companies they do business with, Varolii Corporation toplines in a survey report, What Do Customers Want? A Growing Appetite for Customer Communications. Across all vertical industries consumers trust for this dialogue, health care organizations – specifically doctors, pharmacists, and insurance companies – are the most trusted. Examples of “welcome-comms” would be reminders about upcoming appointments or vaccinations (among 69% of people), notices to reorder or pick up a prescription (57%), and messages encouraging scheduling an appointment (39%). In banking, notices about fraudulent activity on one’s account is the most welcomed message beating out appointment

When we say the phrase “side effects,” what do we think of? The FDA says that “all medicines have benefits and risks. The risks of medicines are the chances that something unwanted or unexpected could happen to you when you use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage.” There’s a new risk in town in health care, and it’s the equivalent of an upset stomach when it comes to a co-pay for a branded on-formulary drug, or liver damage if it involves a coinsurance percent of “retail”

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

U.S. health consumers faced greater out-of-pocket health care costs in 2012, especially for outpatient services (think: doctors’ visits) and generic drugs, as presented in The 2012 Health Care Cost and Utilization Report  from the Health Care Cost Institute (HCCI) published in September 2013. At the same time between 2011 and 2012, wages grew about 3%, remaining fairly flat over the past decade as health care costs continued to grow much faster. HCCI found that per capita (per person) out-of-pocket growth for outpatient visits amounted to an average of $118 between 2011 and 2012. But the biggest share of out-of-pocket costs for

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

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.

  Most Americans are concerned about their ability to for medical bills, even when they have health insurance. As a result, most are comfortable asking their doctor about how much their medical treatment will cost. People are becoming savvier health care shoppers largely because they have to: 37% of people in the U.S. have an annual health insurance deductible over $2,000, according to the Spring/Summer 2013 Altarum Institute Survey of Consumer Health Care Opinion, published on 11th July 2013. Many of the media stories coming out of the Altarum survey since its publication have been about people and their trust in

The American health infrastructure is not First World or First Rate, based on the outcomes. This, despite spending more on health care per-person than any country on the planet. Two seminal reports are out this week reminding Americans that our return-on-investment in health spending is poor. The first research comes from JAMA titled  The State of US Health, 1990-2010:  Burden of Diseases, Injuries, and Risk Factors. There is some good news in this report at the top line: that life expectancy for Americans increased in the two decades from 75.2 years to 78.2 years. But this positive quantitative outcome comes with

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

The only type of health plan whose membership grew in 2012 was the consumer-directed health plan (CDHP), according to a survey from Mercer, the benefits advisors. Two-thirds of large employers expect to offer CDHPs by 2018, five years from now. 40% of all employers (small and large) anticipate offering a CDHP in five years. The growth in CDHPs going forward will be increasingly motivated by the impending “Cadillac tax” that will be levied on companies that currently offer relatively rich health benefits. Furthermore, Mercer foresees that employers will also expand wellness and health management programs with the goal of reducing health

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,

While having money in the bank is always a prescription for feeling well, having a bank account is a precursor to getting health insurance under the Affordable Care Act. That fact could prevent millions of people who are eligible for health insurance premium subsidies under health reform from enrolling in a health plan. The issue of banking the un-banked in health is a little talked-about detail that, if overlooked, will scuttle the best-laid plans for health reform. That’s because if people enroll in health insurance, their monthly premiums will need to be debited from a bank account. So, without a

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).

Only 1 in 5 Americans got the minimum recommended amount of physical activity in 2011, based on guidelines offered by the U.S. Centers for Disease Control. More men than women met the standard: 23.4% of men versus 17.9% of women. There are wide variations across the 50 states, as the map shows, with the healthiest folks exercise-wise living in the west, Alaska, upper midwest, and New England. The range runs from a 12.7% low in West Virginia and Tennessee to 27.3 at the high end in Colorado. That bar is set at 150 minutes a week (that’s 2.5 hours) of

Comparing health care prices in the U.S. with those in other developed countries is an exercise in sticker shock. The cost of a hospital day in the U.S. was, on average, $4,287 in 2012. It was $853 in France, a nation often lauded for its excellent health system and patient outcomes but with a health system that’s financially strapped. A routine office visit to a doctor cost an average of $95 in the U.S. in 2012. The same visit was priced at $30 in Canada and $30 in France, as well. A hip replacement cost $40,364 on average in the

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

It’s America Saves Week (February 25-March 2, 2013). Do you know what your savings rate is? If you’re in the center of the American savings bell curve, you probably don’t have a savings plan with specific goals and don’t know your net worth. Two-thirds of U.S. adults say they have sufficient emergency savings for unexpected expenses like a visit to a doctor. However, only one-half of non-retired people believe they’re saving enough for a retirement where they’ll have a “desirable standard of living.” This six annual survey by the Consumer Federation of America, the American Savings Education Council, and the

While 50% of Americans feel they have a sound financial position, the other half is living paycheck to paycheck. 8% say they can’t even pay for essentials. The second annual Allstate “Life Tracks” Poll finds American adults split between have’s and have not’s, with even the “have’s” feeling less than financially literate. There is an equal split between people who feel they’re in an “excellent” or “good” financial position compared with those who feel they’re in financially “fair” or “poor” shape. Men feel more financially secure than women; 3 in 4 single parents feel less well-off compared to the average

There’s good news on the macro-health economics front: the growth rate in national health spending in the U.S. fell in 2011, according to an analysis published in Health Affairs January 2013 issue. Furthermore, this study found that consumers’ spending on health has fallen to 27.7% of health spending, down from 32% in 2000, based on three spending categories: 1. Insurance premiums through the workplace or self-paid 2. Out-of-pocket deductibles and co-pays 3. Medicare payroll taxes. A key factor driving down health spending is the growth of generic drug substitution for more expensive Rx brands. Generics now comprise 80% of prescribed

When it comes to taking on personal responsibility, the #1 New Year’s Resolution is to engage in fitness and exercise, cited by 43% of U.S. adults, followed by healthy eating, noted by 37% of people. Other resolutions involving personal responsibility are Family (26%) Spirituality and faith (22%) Managing personal finances (22%. This survey was undertaken as part of Liberty Mutual’s The Responsibility Project (RP), which is taglined: “Explore what it means to do the right thing.” Launched in 2008, Liberty Mutual’s RP has been diving into the many aspects of daily living for which we, each of us, could take responsibility…including

It’s the morning after the historic 2012 Presidential Election, with President Barack Obama winning a second term in the face of a sputtering economy and eventual Fiscal Cliff as of December 31, 2012. As we toast with our beverage of choice that night, we will also be worrying about our top financial concerns: how we’ll fund our retirements, and how we’ll pay for health care eventually, and now while we’re actively employed. The Harris Poll of November 5, 2012, reveals that 3 in 4 people in the U.S. who aren’t yet retired worry they won’t have enough money to slow

Wired magazine, longtime evangelist for all-things-tech, has played a growing role in serving up health-tech content over the past several years, especially through the work of Thomas Goetz. This month, Wired featured an informative section on living by numbers — the theme of a new Wired conference held 15-16 October 2012 in New York City. This feels like the week of digital health on the east coast of the U.S.: several major meetings have convened that highlight the role of technology — especially, the Internet, mobile platforms, and Big Data — on health. Among the meetings were the NYeC Digital Health conference, Digital

Being a doctor isn’t a happy profession in 2012: 3 in 5 doctors say that, if they could, they’d retire this year. Over three-fourths of physicians are pessimistic about the future of their profession. 84% of doctors feel that the medical profession is in decline. And, over 1 in 3 doctors would choose a different professional if they had it all to do over again. The Physicians Foundation, a nonprofit organization that represents the interests of doctors, sent a survey to 630,000 physicians — every physician in the U.S. that’s registered with the AMA’s Physician Master File — in March-June

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

Most U.S. companies will increase the dollar value of health incentives offered to workers in 2012, based on the annual survey from Fidelity Investments and the National Business Group on Health addressing employers’ plans for health benefits. 3 in 4 employers used incentives in 2011 to engage employees in wellness programs, with an average incentive value of $460. This number was $260 in 2009. The poll found that employers expect employees to improve their personal health, and will increasingly ration access to benefits based on employees’ engagement with health criteria. Employers’ approaches to incentives have begun to adopt value-based benefit design strategies that

Americans love their cars, their houses, and their food. Based on a survey by ING Direct, the financial services company, these are the last 3 things we would sacrifice to save money. On the other hand, the most dispensable things for Americans include day care/nannies, cleaning services, education, and gifts. Women would be more likely to sacrifice health and fitness than men in the U.S. The ING survey compares the U.S. with eight other nations including Australia, Austria, Canada, France, Germany, Italy, Spain, and the United Kingdom. Health and fitness appear more highly valued by people in France and Spain;

  This is open enrollment season for those workers fortunate enough to (1) still be employed and (2) still be offered a health benefit. It’s also the season of economic decline. According to Watson Wyatt, these workers are making different health and benefit decisions in this fiscally-constrained era. Watson Wyatt has released its 2008 version of the report, Employee Perspective on Health Care. Some of the most dramatic health behavior changes this year include: Only 19% of employees are willing to pay higher premiums to keep deductibles and copayments lower. In 2007, 38% were willing to do so. 66% of

I’ve been looking at health care through a retail lens for some time. Perhaps it’s that I’m a rag trader’s daughter, or that I’ve been known to like shopping, that I have clients in consumer goods, or that I understand how tiered drug pricing impacts the consumption of medicines (answer: it’s all of the above). I’ve just reviewed the latest trend report from PricewaterhouseCoopers and TNS Retail Forward on the future of retailing. My mind is connecting the dots between the future of retail and the American health care consumer. Four future retail trends are already embedding in health care