Un-directed Americans in a consumer-directed healthcare world
U.S. employers have been implementing various flavors of consumer-directed health plans for the better part of a decade. But consumers feel neither “directed” nor especially competent in managing their way through these plans. It appears that employers also have their own sort of health plan illiteracy when it comes to understanding health reform — the Affordable Care Act — according to the 2013 Aflac WorkForces Report (AWR) based on a survey of 1,900 benefits managers and over 5,200 U.S. workers conducted in January 2013. While you might know the Aflac Duck, you may not be aware that Aflac is the
The Slow Economy Has Slowed Health Spending
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
Bending the cost-curve: a proposal from some Old School bipartisans
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
Food = Health for employers, hospitals, health plans and consumers
Food is inextricably bound up with health whether we are well or not. Several key area of the Food=Health ecosystem made the news this week which, together, will impact public and personal health. On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. Michelin, whose bulky advertising icon Bibendum has more than one “spare tire,” introduced a program to combat health issues, including but not limited to BMI and high blood pressure, according to the
US Health Executives Predict the ACA Will Increase Health Insurance Premiums
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
The need for a Zagat and TripAdvisor in health care
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
U.S. Health Costs vs. The World: Is It Still The Prices, and Are We Still Stupid?
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
The Not-So-Affordable Care Act? Cost-squeezed Americans still confused and need to know more
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,
The Rationale for CVS “Sticking” (vs. “Carroting”) It To Employees for Wellness
The Boston Herald was one of the first newspapers talking about CVS requiring workers to disclose personal health information…”or pay a $600 a year fine,” as the LA Times succinctly put the situation. The story is that CVS Caremark, the pharmacy and Rx benefits management company, is implementing a health screening program to measure height, weight, body fat, and blood pressure. These metrics are commonly collected in the process known as health risk appraisals (HRAs), which most large employers have begun to implement to help employees prevent the onset of chronic disease (think: “metabolic syndrome,” diabetes combined with overweight, for
Most consumers will look to health insurance exchanges to buy individual plans in 2013
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
Arianna and Lupe and Deepak and Sanjay – will the cool factor drive mobile health adoption?
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
Bill Clinton’s public health, cost-bending message thrills health IT folks at HIMSS
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
The future of sensors in health care – passive, designed, integrated
Here’s Ann R., who is a patient in the not-too-distance-future, when passive sensors will be embedded in her everyday life. The infographic illustrates a disruption in health care for people, where data are collected on us (with our permission) that can help us improve our own self-care, and help our clinicians know more about us outside of their offices, exam rooms and institutions. In Making Sense of Sensors: How New Technologies Can Change Patient Care, my paper for the California HealthCare Foundation, I set out to organize the many types of sensors proliferating the health care landscape, and identify key
Health consumers don’t understand overtreatment, and their role in driving health costs
Overuse of health care is defined as the delivery of health care services for which the risks outweigh the benefits, according to a study into the utilization of ambulatory care health services published in the January 28, 2013, issue of JAMA Internal Medicine (the new title for the Archives of Internal Medicine). “Trends in the Overuse of Ambulatory Health Care Services in the United States” found that, of the estimated $700 billion that is wasted annually in U.S. health care, overuse comprises about $280 billion – over one-third of waste — equal to over 10% of total health spending in
Wealthy Americans’ top financial concern is affording health care in retirement
The wealthiest Americans’ top financial concern is being able to afford healthcare and support they’ll need in old age. The #2 financial concern among wealthy investors is worrying about the financial situation of their children and grandchildren, closely followed by a major family health problem occurring and someone to care for them in their old age. These health-financial worries come out of a survey among 2,056 U.S. investors age 25 and over who have at least $250,000 in investable assets conducted by UBS in January 2013. UBS found that staying health and fit is investors’ top objective, with 73% of wealthy
Health cost transparency on the W-2: sticker shock at the point-of-paystub
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
Dark chocolate as health food – a healthy salute to Valentine’s Day
On a recent Whole Living segment on Martha Stewart’s Sirius XM radio channel, I learned of the artisan chocolatier, Gnosis. The company, whose name is Greek for “knowledge,” grew out of the kitchen of a holistic health counselor, Vanessa Berg, who began to make nutritionally-infused sweets for her private clientele. Word-of-mouth made its way to a buyer from Whole Foods, who subsequently did a deal with Berg to sell Gnosis goods in some of the company’s stores in New Jersey and New York. Here’s a link to the radio interview. Chocolate is a health food for this company, and for
Butter over guns in the minds of Americans when it comes to deficit cutting
Americans have a clear message for the 113th Congress: I want my MTV, but I want my Medicare, Medicaid, Social Security, health insurance subsidies, and public schools. These budget-saving priorities are detailed in The Public’s Health Care Agenda for the 113th Congress, conducted by the Kaiser Family Foundation, Robert Wood Johnson Foundation, and the Harvard School of Public Health, published in January 2013. The poll found that a majority of Americans placed creating health insurance exchanges/marketplaces at top priority, compared with other health priorities at the state level. More people support rather than oppose Medicaid expansion, heavily weighted toward 75%
Aetna and Costco – the broker is ‘us’
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
Retail and work-site clinics – medical homes for younger adults?
The use of retail and work-site health clinics is up, and their consumers skew young. Overall, 27% of all U.S. adults have stepped into a walk-in clinic in the past two years. But only 15% of people 65 and over have used such a clinic. This begs the question: are retail and on-site clinics at the workplace filling the role of medical homes for younger adult Americans? The Harris Interactive/HealthDay poll published in January 2013 discovered that use of retail clinics grew from 7% in 2008 to 27% in 2012. The largest age cohort using walk-in clinics is people between
Cost-conscious health consumers are adopting personal health IT
People enrolled in consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs) are more cost-conscious than those enrolled in more traditional plans, according to Findings from the 2012 EBRI/MGA Consumer Engagement in Health Care Survey from the Employee Benefit Research Institute (EBRI), published in December 2012. The logic behind CDHPs and HDHPs is that if health plan enrollees have more “skin in the game” — that is, personal financial exposure — they’ll behave more like health “consumers.” By 2012, 36% of employers with over 500 employees offered either HRA- or HSA-eligible plans. About 15% of working age adults are enrolled
People want more control over health care in the midst of rising costs: a tale of two surveys
Two surveys of American consumers point to their growing concern over (1) rising costs and (2) wanting control over their care. More than 1 in 3 U.S. adults put off health care due to costs in the past year, a Gallup poll found. As shown in the graph, this is the highest proportion of people forgoing care due to cost since Gallup began asking the question in 2012. This survey was conducted in November 2012. There are differences between people without insurance and those with commercial or public sector plans such as Medicare and Medicaid. Over one-half of uninsured people
Wired health: living by numbers – a review of the event
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
Aetna finds consumers aren’t very empowered in health
Americans find health insurance decisions the second most difficult major life decision only behind saving for retirement (36%) and slightly more difficult than purchasing a car (23%), via Aetna’s Empowered Health Index Survey. Why are health insurance choices so tough? Consumers told Aetna that the available information is confusing and complicated (88% percent), there is conflicting information (84%) and it’s difficult to know which plan is right for them (83%). Based on this survey’s findings, millions of Americans indeed feel dis-empowered by health care decision making. Who is empowered? Aetna says the empowered are likely to be more affluent, insured, married, take
Employers grow onsite health clinics, and employer-sponsored telemedicine will grow
With “Zero” large employers expecting to drop health insurance, as reported in the Washington Post, companies are getting creative and innovative about how to manage workers’ health and wellness, while addressing ever-growing costs. One strategy that’s getting more traction is the re-invention of the onsite health center. Towers Watson‘s 2012 Onsite Health Center survey report, finds that one-half of employers view establishing an onsite health center as a linchpin to enhancing productivity and health in the workplace. Following close behind productivity is the onsite health center’s promise of reducing medical costs, improving access to care, and the traditional reason for providing onsite
Wellness takes hold among large employers – and more sticks nudge workers toward health
Employee benefits make up one-third of employers’ investments in workers, and companies are looking for positive ROI on that spend. Health benefits are the largest component of that spending, and are a major cost-management focus. In 2012 and beyond, wellness is taking center stage as part of employers’ total benefits strategies. In the 2012 Wellness & Benefits Administration Benchmarking study, a new report from bswift, a benefits administration company, the vast majority of large employers (defined as those with over 500 workers) are sponsoring wellness programs, extending them to dependents as well as active workers. Increasingly, sticks accompany carrots for
Employees will bear more health costs to 2017 – certainty in an uncertain future
Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in
The selling of a health plan, part two
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
The Online Couch: how “safe Skyping” is changing the relationship for patients and therapists
Skype and videoconferencing have surpassed the tipping point of consumer adoption. Grandparents Skype with grandchildren living far, far away. Soldiers converse daily with families from Afghanistan and Iraq war theatres. Workers streamline telecommuting by videoconferencing with colleagues in geographically distributed offices. In the era of DIY’ing all aspects of life, more health citizens are taking to DIY’ing health — and, increasingly, looking beyond physical health for convenient access to mental and behavioral health services. The Online Couch: Mental Health Care on the Web is my latest paper for the California HealthCare Foundation. Among a range of emerging tech-enabled mental health
Health costs will increase in 2013, and employees will bear more: can wellness programs help stem the rise?
Health spending will increase by 7.5% in 2013, with employees’ contributions rising for in-network deductibles, prescription drugs and emergency room visits. 3 in 4 employers, seeking to control rising health expenses, will offer wellness programs, even though a vast majority can’t yet measure an ROI on them. The Health and Well-Being: Touchstone Survey Results from PriceWaterhouseCoopers (PwC). PwC points out that the 7.5% medical cost increase is historically lower than in recent years, as a result of structural changes in the health care market including: A sluggish economy Growing focus on cost containment Lower utilization of health services by patients Employers’ efforts
Trust and authenticity are the enablers of health engagement
Without trust, health consumers won’t engage with organizations who want to cure them, sell to them, promote to them, help them. Here’s what I told a group of pharmaceutical marketers at The DTC Annual Conference in Washington , DC, on April 9, 2010. Let’s start with the World Health Organization’s definition of health: that is, the state of complete physical, mental and social wellbeing, and not just the absence of disease. This definition is being embraced by health citizens long before the silos in the health industry – including pharma – get it. That’s an important mindset to take on as
Health insurance costs have doubled in 10 years; the average monthly contribution is nearly $300
Health insurance premiums for a family increased 131% between 1999 and 2009, according to the latest survey from Kaiser Family Foundation (KFF) and Health Research & Educational Trust’s (HRET’s) Employer Health Benefits 2009 among employers. KFF and HRET have conducted this survey since 1999. In 2009, in raw number terms, family health insurance costs employers, on average, $13,375. Workers pay $3,515 of this premium, on average about 26% of the total. This approaches nearly $300 out of a monthly paycheck. Worker contributions substantially vary between small and large employers: the contribution is nearly $1,000 more if you work in a
Nearly 1 in 2 women delayed health care in the past year due to costs – the economic impact on a woman’s physical, emotional, and fiscal health
Nearly 1 in 2 women put off seeking health care because the cost was too high. The kinds of services delayed included visits to the doctor, medical procedures, and filling prescription medications. The fourth annual T.A.L.K. Survey was released this week by the National Women’s Health Resource Center (NWHRC), focusing on the declining economy and its impact on women and three dimensions of their health — physical, emotional, and fiscal. 40% of women say that their health has worsened in the past five years due to increasing stress and gaining weight, according to the survey. One of the most interesting
For those with health insurance, a growing bounty of benefits
For those employees fortunate enough to receive health insurance from work, there’s a bountiful array of health care services that are still covered by plans. The International Foundation of Employee Benefit Plans (IFEBP) polled its membership in late 2007 and found that employers are not only continuing to cover a broad range of services, but also new services the likes of which weren’t covered even two years ago…from medical tourism to biofeedback. These results are documented in IFEBP’s publication, Health Care Benefits: Eligibility, Coverage and Exclusions. The usual suspects are covered by well over 97% of employers, such as ER
Steel, Coffee Beans and Health Care
The UAW and GM have been debating health care as Friday’s deadline for their national contract approaches. This round of negotiation is about survival. Yesterday, I covered the rising costs of employer-sponsored health insurance. Today, let’s visit the intimately-related topic of retiree health benefits. These are eroding even faster than health benefits for employed workers. Many employers have significantly scaled back health benefits for retirees. Currently, one in three large employers offers retire benefits, compared with two in three in the late 1980s. Consider the predicament of the company ranked #3 on the 2006 Fortune 500 list, General Motors. Retirees