A blog covering the health/care ecosystem and people.

The three winners of the 2019 Nobel Prize for Economics — Banerjee and Duflo (both of MIT) and Kremer (working at Harvard) — were recognized for their work on alleviating global poverty.” “Over 700 million people still subsist on extremely low incomes. Every year, five million children still die before their fifth birthday, often from diseases that could be prevented or cured with relatively cheap and simple treatments,” The Nobel Prize website notes. To respond to this audaciously huge challenge, Banerjee, Duflo and Kremer asked quite specific, granular questions that have since shaped the field of development economics — now

As patients have taken on more financial responsibility for first-dollar costs in high-deductible health plans and medical bills, hospitals and health care providers face growing fiscal pressures for late payments and bad debt. Those financial pressures are on both sides of the health care payment transaction, stressing patients-as-payors and health care financial managers alike. I’m speaking to health industry stakeholders on patients-as-payors at Cerner’s Now/Next conference today about the patient-as-payor, a person primed for engagement. That’s as in “Amazon-Primed,” which patients in their consumer lives now use as their retail experience benchmark. But consumers-as-patients don’t feel like health care today

from Gallup’s 2019 survey into Americans’ Views of U.S. Business Industry Sectors. Since reaching a relative high regard in 2015, the pharma industry reputation among consumers has declined each year since to the low this year with 58% of Americans having a negative view. This was a 31 percentage point drop in reputation in one year. This is one negativity point above peoples’ low regard for the Federal government. Gallup notes that Americans are over two times more likely to rank the pharmaceutical industry negatively (58%) as positively (27%). The healthcare industry, apart from pharma, didn’t fare well this year in

Marc Iskowitz, Executive Editor of MM&M, warmly welcomed me to the Haymarket Media soundproof studio in New York City yesterday. We’d been trying to schedule meeting up to do a live podcast since February, and we finally got our mutual acts together on 6th August 2019. Here’s a link to the 30-minute conversation, where Marc combed through the over 500 endnotes from HealthConsuming‘s appendix to explore the patient as the new health care payor, the Amazon prime-ing of people, and prospects for social determinants of health to bolster medicines “beyond the pill.” https://www.pscp.tv/MMMnews/1eaJbvgovBYJX Thanks for listening — and if you

This year, an employer-sponsored PPO for a family of four in the U.S. will cost $28,386, a 3.6% increase over 2018, according to the 2019 Milliman Medical Index (MMI). Based on my annual read of this year’s Index, the PPO costs roughly the same as a new Dodge Charger or a year attending the engineering school at Alfred University. The Milliman MMI team has updated the methodology for the Index; the chart shown here is my own, recognizing that the calculations and assumptions beneath the 2019 data point differ from previous years. The key points of the report are that:

“It’s the prices stupid,” Uwe Reinhardt and Gerard Anderson and colleagues asserted in the title their seminal Health Affairs manifesto on U.S. healthcare spending. Sixteen years later, yesterday on 8th July 2019, a Federal U.S. judge blocked, in the literal last-minute, a DHHS order mandating prescription drug companies to publish “retail prices” of medicines in direct-to-consumer TV ads. I was getting this post on transparency together just before that announcement hit the press, so this post would have had a different nuance yesterday compared with today. And that’s how health care politics and economics in America roll these days. Welcome to

“Drugmakers Push Their Prices Higher” is the top story under the Business & Finance banner in today’s Wall Street Journal. That’s in terms of drugs’ list prices, which most patients don’t pay. But drug costs to patients are in the eye of the beholder, who in a high-deductible plan or Medicare Part D donut hole becomes the first-dollar payer. Patients continue to face rising drug costs, pushing them into what I’ve been thinking about as luxury-goods territory. The economic definition of a luxury good is a product for which demand increases more than proportionally as income rises, so that spending

In the U.S. each year between 2006 and 2016, employees’ healthcare cost sharing grew 4.5%. In that decade, Americans’ median wages rose 1.8% a year, PwC notes in their annual report, Medical cost trend: Behind the numbers 2020 from the firm’s Health Research Institute. Medical cost trend is the projected percent growth in healthcare costs over a year based on an equivalent benefit package from one year to the next. As the first chart shows, trend will grow 6% from 2019 to 2020. This is an increase of 0.3 percentage points up from 5.7% for 2019, which was flat from

Employers, health care providers, unions, leaders and — first and foremost, consumers — must come together to build a more accessible, affordable health care system in America, proposes a call-to-action fostered by a Families USA coalition called Consumers First: The Alliance to Make the Health Care System Work for Everyone. The diverse partners in this Alliance include the American Academy of Family Physicians, AFSCME (the largest public service employees’ union in the U.S.), the American Benefits Council (which represents employers), the American Federation of Teachers (AFT), First Focus (a bipartisan children’s advocacy organization), and the Pacific Business Group on Health

Health care costs rank ahead of Americans’ money-worries about low wages and availability of cash, paying for college, house payments, taxes, and debt, according to the latest Gallup poll on peoples’ most important family financial problems in 2019. Medical costs have, in fact, ranked at the top of this list for three years in a row, with a five percentage point rise between 2018 and 2019. No other financial concern had that growth in increase-of-money-worries in the past year. Health care costs rank the top financial problem for people across all income levels. One in five families (19%) earning under

Consider the voice of a patient before the advent of the Internet in the digital 1.0 world, and then the proliferation of social networks in v 2.0. One patient could talk with another over their proverbial neighborhood fence, a concerned parent at the PTA meeting with others dealing with a children’s health issue, or a recovering alcoholic testifying in person at an AA session. Today, the voice of the patient is magnified one-to-many, omnichannel and multi-platform — via video, blogs, podcasts, social networks, listservs….and, yes, still in live forums like AA meetings, church basements, Y-spaces, and the Frazzled Cafe meet-ups

The average 65-year old couple retiring in 2019 will need to have a cash nest-egg of $285,000 to cover health care and medical expenses through retirement years, Fidelity Investments calculated. Fidelity estimates the average retiree will allocate 15% of their annual spending in retirement on medical costs. As if that top-line number isn’t enough to sober one up, there are two more caveats: (1) the $285K figure doesn’t include long-term care, dental services and over-the-counter medicines; and, (2) it’s an after-tax number. So depending on your tax bracket, you have to earn a whole lot more to net the $285,000

Spending on medical care costs crowded out other household spending for millions of Americans in 2018, based on The U.S. Healthcare Cost Crisis, a survey from West Health and Gallup. Gallup polled 3,537 U.S. adults 18 and over in January and February 2019. One in three Americans overall are concerned they won’t be able to pay for health care services or prescription drugs: that includes 35% of people who are insured, and 63% of those who do not have insurance.   Americans borrowed $88 billion in 2018 to pay for health care spending, West Health and Gallup estimated. 27 million Americans

There’s little agreement between Democrats and Republicans on a plethora of issues in American public life. But one issue that brings U.S. citizens together is agreement that the cost of health care is too high in the country, and that pharma, health plans, and providers are to blame. Welcome to health politics in America as of March 2019, according to The Public and High U.S. Health Care Costs, a poll conducted by POLITICO and the Harvard T.H. Chan School of Public Health. The first chart illustrates the common ground shared by Americans by party affiliation, with vast majorities across parties playing

Medical costs in America are still the top contributor to personal bankruptcy in the U.S., a risk factor in two-thirds of bankruptcies filed between 2013 and 2016. That’s a sad fiscal fact, especially as more Americans gained access to health insurance under the Affordable Care Act, according to a study published this month in the American Journal of Public Health (AJPA). Between 2013 and 2016, about 530,000 bankruptcies were filed among U.S. families each year associated with medical reasons, illustrated in Table 1 from the study. The report, Medical Bankruptcy: Still Common Despite the Affordable Care Act, updates research from 2007 which

“The Fourth Industrial Age,” Dr. Abraham Verghese writes, “has great potential to help, but also to harm, to exaggerate the profound gap that already exists between those who have much and those who have less each passing year.” Dr. Verghese asserts this in his forward to Deep Medicine, Dr. Eric Topol’s latest work which explores the promise of artificial intelligence (AI), Big Data, and robotics — three legs of the Fourth Industrial Age stool. [If you don’t know the work of Dr. Verghese, and since you’re reading the Health Populi blog, you must get to know Dr. V now. Your

Seeking health information online along with researching other patients’ perspectives on doctors are now as common as booking dinner reservations and reading restaurant reviews, based on Rock Health’s latest health consumer survey, Beyond Wellness for the Healthy: Digital Health Consumer Adoption 2018. Rock Health has gauged consumes’ digital health adoption fo a few years, showing year-on-year growth for “Googling” health information, seeking peer patients’ physician and hospital reviews, tracking activity, donning wearable tech, and engaging in live telehealth consultations with providers, as the first chart shows. The growth of tracking and wearable tech is moving toward more medical applications beyond fitness

I’m glad to be getting back to health economic issues after spending the last couple of weeks firmly focused on consumers, digital health technologies and CES 2019. There’s a lot for me to address concerning health care costs based on news and research published over the past couple of weeks. We’ll start with the centerpiece that will provide the overall context for this post: that’s the ongoing research of Gerard Anderson and colleagues under the title, It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt. It is bittersweet to

Nearly one-half of Americans are quite concerned they won’t have enough money to pay for medical care, according to the latest Gallup poll. Health insurance in-security is mainstream as of November 2018, when Gallup polled U.S. adults about views on healthcare costs. It’s a major concern among six in ten people that their health plan would require they pay higher premiums or a bigger portion of their healthcare expenses. It’s also a big concern for four in ten people that someone in their family would be denied health insurance covering for a pre-existing condition, or that they might have to

Most people in the U.S. believe that the Federal government should ensure that their fellow Americans, a new Gallup Poll found. This sentiment has been relatively stable since 2000 except for two big outlying years: a spike of 69% in 2006, and a low-point in 2003 of 42%. In 2006, Medicare Part D launched, which may have boosted consumers’ faith in Federal healthcare programs. In contrast, in 2013 the Affordable Care Act was in implementation and consumer-adoption mode, accompanied by aggressive anti-“Obamacare” campaigns in mass media. That’s the top lighter green line in the first chart. But while there’s majority support

One in three working-age people in the U.S. have seen a doctor about something stress-related. Stress is a way of American life, based on the findings in The United States of Stress, a survey from Everyday Health. Everyday Health polled 6,700 U.S. adults between 18 and 64 years of age about their perspectives on stress, anxiety, panic, and mental and behavioral health. Among all sources of stress, personal finances rank as the top stressor in the U.S. Over one-half of consumers say financial issues regularly stress them out. Finances, followed by jobs and work issues, worries about the future, and relationships cause

In American health economics, there’s a demand side and a supply side. On the demand side, we’ve done a poor job trying to nudge patients and consumers toward rational economic decision making, lacking transparency, information symmetry, and basic health literacy. On the supply side, we’ve engaged in a medical arms race allocating capital resources to shinier and shinier new things, often without cost-benefit rationale or clinical evidence. On that supply side, though, I met up with an innovation that can help to bend the capital cost curve of how we envision and build new hospitals and clinics. This week, I

California’s Governor Jerry Brown signed into law a net neutrality bill this weekend. Gov. Brown’s proverbial swipe of the pen accomplished two things: he went back to the Obama-era approach to ensure that internet service providers treat all users of the internet equally; and, he prompted the Department of Justice, representing the Trump Administration’s Federal Communications Commission (FCC), to launch a lawsuit. California, home to start-ups, mature tech platform companies (like Apple, Facebook and Google), and countless digital health developers, is in a particularly strategic place to fight the FCC and, now, the Department of Justice. Nearly two dozen other states

The prices of medicines prescribed in outpatient settings rose, on average, 10.3% in 2018. Wages increased about 2.6%, and consumer prices, 1.3%, based on the 2019 Segal Health Plan Cost Trend Survey. Segal forecasts that medical cost trends will moderate for 2019, lower than 2018 rates. But to the patient, now feeling like a consumer dealing with high-deductibles and the growing sticker shock of specialty drug prices, a so-called “moderate” trend still feels like a big bite in the household budget. Specifically, specialty drug trend is expected to be 14.3% in 2019, compared with 17.7% in 2018 — still several

The complexity of the U.S. healthcare system erodes Americans’ health literacy, Accenture asserts in their report, The Hidden Cost of Healthcare System Complexity.                             And that complexity costs, Accenture calculated, to the tune of nearly $5 billion in administrative cost burden to payors. Accenture developed a healthcare system literacy index to quantify the relationship between peoples’ understanding of how health insurance works and what a lack of understanding can cost the system. The index looks at consumer comprehension of health insurance terms like premium, deductible, copayment, coinsurance, out-of-pocket

In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia. The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line)

The two top stressors in American life are jobs and finances. “My weight” and my family’s health follow just behind these across the generations. Total Well-Being, a research report from Fidelity Investments, looks at the inter-connections between health and wealth – the combined impact of physical, mental, and fiscal factors on our lives. The first chart summarizes the study’s findings, including the facts that: One-third of people have less than three months of income in the bank for emergency Absenteeism is 29% greater for people who don’t have sufficient emergency funds saved People who are highly stressed tend not to

President Trump and his administrative have been trying to make the ACA fail, claim most U.S. adults. Thus, the public holds the POTUS and the Republican party responsible for moving the Affordable Care Act forward….or not, according to the July 2018 Kaiser Health Tracking Poll conducted by the Kaiser Family Foundation (KFF). Health care will be a key issue in the 2018 mid-term elections that will be held in November. Among U.S. voters’ key health care concerns in 2018, one ranks “most” or “very important” for two-thirds of Americans: that is continuing to protect people with pre-existing health conditions. Other issues

While the vast majority of Americans say that science has made life easier for most people, and especially for health care, people are split in questioning the financial cost and value of medical treatments, the Pew Research Center has found. The first chart illustrates the percent of Americans identifying various aspects of medical treatments as “big problems.” If you add in people who see these as “small problems,” 9 in 10 Americans say that all of these line items are “problems.” In the sample, two-thirds of respondents had seen a health care provider for an illness or medical condition in

There are countless chasms in the U.S. this moment in social, political, and economic perspectives. but one issue is on the mind of most American voters where there is evidence of some agreements: health care, as evidenced in the June 2018 Health Tracking Poll from Kaiser Family Foundation. Top-line, health care is one of the most important issues that voters want addressed in the 2018 mid-term elections, tied with the economy. Immigration, gun policy, and foreign policy follow. While health care is most important to voters registered as Democrats, Republicans rank it very important. Among various specific health care factors, protecting

As I walked by windows with Marvel-inspired superhero characters, I stopped to read their talk-bubbles: “strengthen your savings, power your financial quest, be the hero of your money, be one with your budget.” The top-line message here is that you can be your own fiscal superhero. The sign read, Capital One Cafe with Peet’s Coffee. But was it a bank branch or a cafe? I asked myself, passing by this sign yesterday morning at the corner of Walnut and 18th Streets in center city Philadelphia. It’s both, as it turned out, and when I entered I found a welcoming, beautifully

When it comes to healthcare costs, lines that decline over time are generally seen as good news. That’s how media outlets will cover the top-line of PwC’s report Medical cost trend: Behind the numbers 2019. However, there are other forces underneath the stable-looking 6.0% medical trend growth projected for 2019 that will impact healthcare providers, insurers, and suppliers to the industry. There’s this macro-health economic story, and then there’s the micro-economics of healthcare for the household. Simply put: the impact of growing financial risk for healthcare costs will be felt by patients/consumers themselves. I’ve curated the four charts from the

  Health care features prominently in the nearly-300 slides curated by Mary Meeker in her always- informative report on Internet Trends 2018.  Meeker, of Kleiner Perkins, released the report as usual at the Code Conference, held this year on 30 May 2018 in Silicon Valley. I’ve mined Meeker’s report for several years here on Health Populi: 2017 – Digital healthcare at the inflection point, via Mary Meeker 2015 – Musings with Mary Meeker on the digital/health nexus 2014 – Healthcare at an inflection point: digital trends via Mary Meeker 2013 – The role of internet technologies in reducing healthcare costs – Meeker

What could $28,166 buy you in 2018? A new car? A year of your child’s college education? A plot of land for your retirement home? Or a year of healthcare for a family of four? Welcome to this year’s edition of the Milliman Medical Index (MMI), one of the most important forecasts of the year in the world of the Health Populi blog and THINK-Health universe. That’s because we’re in the business of thinking about the future of health and health care through the health economics lens; the MMI is a key component of our ongoing environmental analysis of the

Expect “new combinations” of industry actors and technologies to reorganize and re-imagine healthcare, with an eye on both price and investments in customer experience (CX), PwC envisions in their latest report on The New Health Economy in the Age of Disruption. In this vision, healthcare will be a more flexible marketplace underpinned by data, platforms, and workers. Yes, it’s challenging to get from here-to-there, but PwC explains just how this can happen. Four archetypes, models, of healthcare deals have begun to emerge in the marketplace, illustrated by the Big Deals and announcements reshaping the industry in the past couple of years:

Chronic diseases are what kill most people in the world. In the U.S., the chronic disease burden takes a massive toll on both public health and mortality, accounting for 7 in 10 deaths in America each year. That personal health toll comes at a high price and proportion of national health expenditures. A new alliance between Livongo and Cambia Health seeks to address that challenge, beginning with diabetes and scaling to other chronic conditions. Livongo has proven out the Livongo for Diabetes program, which has demonstrated positive outcomes in terms of patient satisfaction and cost-savings. The plan with Cambia is

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

Amazon is planning to extend Prime subscriptions to people enrolled in Medicaid for the discount price of $5.99 a month instead of the recent price increase to $12.99/month or $99 a year. The $5.99 a month calculates to a 27% break on the annual Prime membership cost. Medicaid enrollees who want to take advantage of the deal must provide Amazon with a scan or image of the card they use for their benefit (either Medicaid or EBT). These consumers can enroll annually, for a maximum of four years. Here’s what the Seattle Times, Amazon’s hometown newspaper, said about the program.

If we’re playing a game of “majority rules,” then everyone in America would have the right to affordable health care, according to a new poll from The Commonwealth Fund. The report is aptly titled, Americans’ Views on Health Insurance at the End of a Turbulent Year. The Fund surveyed 2,410 U.S. adults, age 19 to 64, by phone in November and December 2017. This is the sixth survey conducted by the Fund to track Americans’ views of the Affordable Care Act; the first survey was fielded in mid-to-fall 2013. 9 in 10 working-age adults say “yes” indeed, my fellow Americans

Albertsons, the grocery group with popular brands like Acme, Safeway, and Vons, announced a merger with Rite Aid, the retail pharmacy chain. The deal has been discussed as Albertsons’ move to succeed in light of growing competition from Amazon and Whole Foods, the proposed CVS/Aetna merger, and Walgreens’ possible purchase of AmerisourceBergen (finalizing its acquisition of over 1,900 Rite Aid stores). If played out well, the combination could become an important player in the evolving U.S. health/care ecosystem that brings a self-care front-door closer to consumers, patients and caregivers. “The new company is expected to serve more than 40 million

In 2020, national health expenditures (NHE) in the United States will exceed $4 trillion to cover 334.5 million Americans. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40 of health spending per person. I sat in on a press call today with researchers from the Office of the Actuary working in the Centers for Medicare and Medicaid Services (CMS) to review the annual forecast of the NHE, published in Health Affairs in a statistically-dense eleven page article titled, National Health Expenditure Projections, 2017-2026: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth. What are those “fundamentals” pushing up healthcare spending?

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

Two mature companies in their respective healthcare spaces came together earlier this month to extend healthcare services where patients live and doctors work, via telehealth services. Philips, celebrating 127 years in business this year, has gone all-in on digital health across the continuum of care, from prevention and healthy living to the ICU and hospital emergency department. American Well is among the longest operating telehealth companies, founded in 2006. Together, these two established organizations will transcend physician offices and ERs and deliver virtual care in and beyond the U.S. I had the opportunity to sit down with Ido Schoenberg, MD,

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

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

To pay for tax cuts, take money from foreign aid if you must, 1 in 2 Americans say. But do not touch my Medicaid, Medicare, or Social Security, insist the majority of U.S. adults gauged by the November 2017 Kaiser Health Tracking Poll. This month’s survey looks at Americans’ priorities for President Trump and the Congress in light of the GOP tax reforms emerging from Capitol Hill. While reforming taxes is considered a top priority for the President and Congress by 3 in 10 people, two healthcare policy issues are more important to U.S. adults: first, 62% of U.S. adults

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

Old-age inequality among current retirees in the U.S. is already greater than in ever OECD country except Chile and Mexico, revealed in Preventing Ageing Unequally from the OECD. Key findings from the report are that: Inequalities in education, health, employment and income start building up from early ages At all ages, people in bad health work less and earn less. Over a career, bad health reduces lifetime earnings of low-educated men by 33%, while the loss is only 17% for highly-educated men Gender inequality in old age, however, is likely to remain substantial: annual pension payments to the over-65s today are