A blog covering the health/care ecosystem and people.

With lower expectations of and satisfaction with health care, Millennials in America seek three things: available, accessible, and affordable services, research from the Transamerica Center for Health Studies has found. Far and away the top reason for not obtaining health insurance in 2018 was that it was simply too expensive, cited by 60% of Millennials. Following that, 26% of Millennials noted that paying the tax penalty plus personal medical expenses were, together, less expensive than available health options. While Millennials were least likely to visit a doctor’s office in the past year, they had the most likelihood of making a

The rolls of the uninsured are growing in America, the latest Gallup-Sharecare Poll indicates. The U.S. uninsurance rate rose to 12.2% by the fourth quarter of 2017, up 1.3 percentage points from the year before. 2017 reversed advancements in health insurance coverage increases since the advent of the Affordable Care Act, and for the first time since 2014 no states’ uninsured rates fell. The 17 states with declines in insurance rates were Arizona, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa, Missouri, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Among these, the greatest

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

        Between 2012 and 2017, the number of US consumers who shopped online for health insurance grew by three times, from 14% to 42%, according to a survey from Connecture. Cost first, then “keeping my doctor,” are the two top considerations when shopping for health insurance. 71% of consumers would consider switching their doctor(s) to save on plan costs. Beyond clinician cost, health plans shoppers are also concerned with prescription drug costs in supporting their decisions. 80% of consumers would be willing to talk with their doctors about prescription drug alternatives, looking for a balance between convenience

Healthcare tops the list of Americans’ concerns, tied with a dissatisfaction for government, this month (May 2017). According to a Gallup poll published 12 May, poor government leadership and healthcare are together the most important problem currently facing the U.S. Immigration, the economy, jobs, and race relations are distance 3rd places in this survey, which was conducted during the first week of May 2017 among 1,011 U.S. adults 18 years and older. The highest percent of Americans citing healthcare as America’s most important problem was 26%, found in August/September 2008 when town hall meetings round the country were protesting healthcare

“Take Governor John Kasich’s explanation for expanding Medicaid: ‘For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.’” So quotes President Barack Obama in the Journal of the American Medical Association, JAMA, in today’s online issue. #POTUS penned, United States Health Care Reform: Progress to Date and Next Steps. The author is named as “Barack Obama, JD,” a nod to the President’s legal credentials. Governor Kasich, a Republican, was one of 31 Governors who

Consumers are extremely price-sensitive when it comes to shopping for health insurance. The cost of health insurance premiums, deductibles and copays, prescription drug coverage and out-of-pocket expenses rank higher in the minds of health insurance shoppers than the list of doctors and hospitals included in a health plan for health consumers in 2015. The Employee Benefit Research Institute (EBRI) surveyed 1,500 workers in the U.S. ages 21-64 for their views on workers’ satisfaction with health care in America. The results of this study are compiled in EBRI’s March 2016 issue of Notes, Views on Employment-based Health Benefits: Findings from the 2015 Health

There’s an overall feeling of angst about healthcare in America among both health care consumers and the people who provide care — physicians and administrators. On one thing most healthcare consumers and providers (can agree: that the U.S. health care system is on the wrong track.  Another area of commonality between consumers and providers regards privacy and security of health information: while healthcare providers will continue to increase investments in digital health tools and electronic health records systems, both providers and consumers are concerned about the security of personal health information. In How We View Healthcare in America: Consumer and Provider Perspectives,

U.S. consumers are spending $1 in every $5 dollars in the household on health care, and personal cost curves aren’t going to bend down anytime soon. Three surveys published in April confirm my financially unwell forecast for American health citizens. Kaiser Family Foundation’s April 2015 Health Tracking Poll finds most people say health care costs or going up or holding flat, shown in the first diagram from the KFF survey. U.S. adults told KFF the top health care priorities for the President and Congress should focus on health costs, such as: Making sure high-cost drugs for chronic conditions, such as HIV,

40% of U.S. consumers trust Big Retail to manage their health; 39% of U.S. consumers trust healthcare providers to manage their health. What’s wrong with this picture? The first chart shows the neck-and-neck tie in the horse race for consumer trust in personal health management. The Walmart primary care clinic vs. your doctor. The grocery pharmacy vis-a-vis the hospital or chain pharmacy. Costco compared to the chiropractor. Or Apple, Google, Microsoft, Samsung or UnderArmour, because “digitally-enabled companies” are virtually tied with health providers and large retailers as responsible health care managers. Welcome to The Birth of the Healthcare Consumer according

While there’s little evidence that the short-term impact of the Affordable Care Act has limited job growth or driven most employers to drop health insurance plans, the ACA has spawned a “cottage industry” of health companies since 2010, according to PwC. As the ACA turned five years of age, the PwC Health Research Institute led by Ceci Connolly identified at least 90 newcos addressing opportunities inspired by the ACA: Supporting telehealth platforms between patients and providers, such as Vivre Health Educating consumers, such as the transparency provider HealthSparq does Streamlining operations to enhance efficiency, the business of Cureate among others

People with more financial skin in the health care game are more likely to act more cost-consciously, according to the latest Employee Benefits Research Institute (EBRI) poll on health engagement, Findings from the 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey published in December 2014. Health benefit consultants introduced consumer-directed health plans, assuming that health plan members would instantly morph in to health care consumers, seeking out information about health services and self-advocating for right-priced and right-sized health services. However, this wasn’t the case in the early era of CDHPs. Information about the cost and quality of health care services was scant,

The corporate reputation, brand equity, of the health insurance continues to be low relative to other financial service industry benchmarks, found in the ACSI Finance and Insurance Report 2014. Customer satisfaction with health insurance companies fell between 2013 and 2014, especially attributed to higher costs hitting consumers in group (employer-based) policies. The 2014 American Customer Satisfaction Index (ACSI) is informed by interviews with 6,819 consumers interviewed via phone and email between July and September 2014. Customers of financial services companies (banks, credit unions, health insurance, life insurance, property & casualty, and internet brokerages) were asked to provide their opinions about named-firms

In the November 2014 mid-term elections, Democrats tend to favor continuing the Affordable Care Act (ACA) as-is, and Republicans favor scrapping it, scaling it back, or fully replacing the law with something yet to be defined. But it’s hard to read just where the ACA will end up after tomorrow’s election, because many key battleground states are too close to call…and the two major parties have such polar views on health reform. What’s most significant this year is that those most likely to vote are less likely to vote for a congressional candidate who supports the ACA (40%) than would

National health spending will comprise 19.3% of U.S. gross domestic product in 2023, nearly $1 in $5 of all American spending. This statistic includes the expenditure categories for health spending as defined by the Centers for Medicare and Medicaid Services (CMS), Office of the Actuary. The number includes hospital care, personal health care, professional services (physicians and other professionals), home health, long term care, retail sales of prescription drugs and durable medical equipment, and investment in capital equipment, among other line items. The forecast was published in Health Affairs article, National Health Expenditure Projections, 2013-23: Faster Growth Expected With Expanded

It costs $23,215 to cover a family of four for health care, according to the 2014 Milliman Medical Index (MMI), the annual gauge of healthcare costs from the actuarial firm. The growth rate of 5.4% from 2013 is the lowest annual change since Milliman launched the Index in 2002. This is equivalent to a new Toyota Prius or a tonne of tin. While employers cover most of these costs, the portion employees bear continues to increase. This year, insured workers will take on 42% of the total, or on average, $9,695. This is up by $552 over 2013, or 6%

“The surge in HDHP enrollment is causing patients to become consumers of healthcare,” begins a report documenting the rise of patients making more payments to health providers. Patients’ payments to providers have increased 72% since 2011. And, 78% of providers mail paper statements to patients to collect what they’re owed. “HDHPs” are high-deductible health plans, the growing thing in health insurance for consumers now faced with paying for health care first out-of-pocket before their health plan coverage kicks in. And those health consumers’ expectations for convenience in payment methods is causing dissatisfaction, negatively affecting these individuals and their health providers’

U.S. consumer spending on health care is boosting the nation’s economy, based on some new data points. First, health care spending grew at an annual rate of 5.6% at the end of 2013, USA Today reported. This was the fastest-growth seen in ten years, reversing the fall of health spending experienced in the wake of America’s Great Recession of 2008. Furthermore the Centers for Medicare and Medicaid Services (CMS) anticipates health spending to grow by 6.1% in 2014 with the influx of newly-insured health plan members. Healthcare was responsible for one-fourth of America’s GDP growth rate of 2.6%, which is

When the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term. But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit. If

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

In the aftermath of the snafu that was/is the failed launch of the Affordable Care Act’s Health Insurance Exchange comes, today via Reuters, an article called Obama’s tech expert becomes target over healthcare website woes. The piece, by Roberta Rampton and Sarah McBride, states that Todd Park, Chief Technology Officer at The White House, “now finds himself among a handful of officials with targets on their backs as Republicans try to root out who is responsible for this month’s glitch-ridden rollout of Healthcare.gov,” going on to say that “The White House trotted him out in July to talk up the new version”

The Affordable Care Act (ACA) was signed in March 2010; that month, 57% of U.S. adults did something to self-ration health care, such as splitting prescription pills, postponing necessary health care, and putting off recommended medical tests, according to the Kaiser Family Foundation (KFF) Health Tracking Poll of March 2010. 57% of U.S. adults are still self-rationing health care in September 2013, according to KFF’s latest Health Tracking Poll, completed among 1,503 U.S. adults just two weeks before the launch of the Health Insurance Marketplaces on October 1, 2013. As of September 2013, only 19% of U.S. adults said they had heard

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

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.

Most Americans don’t understand what a health savings account (HSA) is – including people who are enrolled in the plans. While health literacy is generally acknowledged to be a public health challenge in America, health insurance literacy is not well recognized. Yet in the emerging consumer-directed health plan era of U.S. health care, peoples’ lack of understanding of health financial accounts will get in the way of people who really need care seeking care at the right time. This leads to greater health spending later when the consumer-patient can develop a health condition that could have been prevented (say, pre-diabetes

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

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions? Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange. This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces. What’s driving this new wrinkle in retail health care are: U.S. health citizens morphing into consumers,

In June 2013, even though news about the economy and jobs is more positive and ObamaCare’s promise of health insurance for the uninsured will soon kick in, most Americans are concerned about (1) money and (2) the costs of health care. The Kaiser Health Tracking poll of June 2013 paints an America worried about personal finances and health, and pretty clueless about health reform – in particular, the advent of health insurance exchanges. Among the 25% of people who have seen media coverage about the Affordable Care Act (alternatively referred to broadly as “health reform” or specifically as “ObamaCare”), 3

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

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

If you have $22,030 in your wallet, you can buy: A princess-cut diamond A Ford Focus 4-door A year’s tuition at James Madison University (in-state, 2013-14) A health plan for a family of four. The 2013 Milliman Medical Index gauges the annual health care costs for a typical American family at $22,030, up $1,302 from 2012 — a 6.3% increase, nearly 6x the all-items increase of 1.1% for the U.S. Consumer Price Index from April 2012-April 2013. That 1.1% includes the costs of food and energy, along with cars, tobacco, shelter, and other consumer goods. In 2013, the average family will

Two in 3 Americans are uncomfortable with their financial situation. And most are totally oblivious to how much money they will need to spend on health care in the future. Seven in 10 people expect to spend less than 10% of their monthly retirement income on medical and dental expenses; but the real number is 30% of income needed for health care in retirement, according to The Urban Institute. The Wellness for Life survey, conducted for Aviva, the life and disability company, collaborating with the Mayo Clinic, finds an American health citizen out of touch with their personal health economics.

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

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

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

  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

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

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

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

Two in 3 employees (62%) can’t estimate how much their employers spend on health benefits. Of those who could estimate the number (which is, on average, about $12,000 according to the 2012 Milliman Medical Index), most weren’t very confident in their guess. Some 23% calculated the monthly spend by employers was less than $500 a month — less than 50% the actual contribution. Thus, most U.S. health consumers don’t fully value the amount of cash their employers spend on their health care, according to a poll from the National Business Group on Health, Perceptions of Health Benefits in a Recovering

There’s a long-held belief among us long-time health industry analysts that Americans spend more time shopping around for cars and washing machines than for health plans and doctors. Consumer Reports is betting that’s going to change, now that Consumers Union has decided to lend its valuable, trusted brand to developing report cards on physicians, having already rated hospitals and heart surgeons. CR will call their version of the doctor’s report card Patient Experience Ratings. CR has first entered the competitive medical market of Massachusetts, and has unveiled reports on 500 primary care physicians in the state. CR worked with  physician survey

Transparency, data-based pharmacy decisions, incentivizing patient behavior, and outcomes-based payments will reshape the environment for marketing pharmaceutical drugs in and beyond 2012. Two reports published this week, from Express Scripts–Medco and PwC, explain these forces, which will severely challenge Pharma’s mood of market ennui. Express-Scripts Medco’s report on 9 Leading Trends in Rx Plan Management presents findings from a survey of 318 pharmacy benefit decision makers in public and private sector organizations. About one-half of the respondents represented smaller organizations with fewer than 5,000 employees; about 20% represented jumbo companies with over 25,000 workers. The survey was conducted in the

A $10 increase in a health plan premium drove up to 3% of retired University of Michigan employees to leave the plan, according to a study from U-M published in Health Economics, The Price Sensitivity of Medicare Beneficiaries. The U-M researchers analyzed the behaviors of 3,182 retirees over four years, to assess the impact of price on beneficiaries’ health plan choices. During the four years, the premium contribution for retirees increased significantly. The researchers conducted this study, in part, to anticipate how Americans will respond to health insurance exchanges in 2014 as they bring health plan information to the market

While the vast majority of people find value in electronic health records (EHRs) — both those whose doctors currently use them and those patients whose personal health information still resides in paper-based systems — most remain concerned about their patient rights, privacy and security of that data.  Making IT Meaningful: How Consumers Value and Trust Health IT, a report based on a survey from the National Partnership for Women & Families (NPWF) published in February 2012, weaves the story of an American public, keen to have their PHI digitized, but deeply concerned about their rights to access and protect that

This morning during my still-dark-at-5:15 am walk, my iPod was motivating me to “get up offa that thing,” as James Brown was motivating me to “release the pressure.” Two minutes into the song, he urges, “Get into the sunshine, church is out.” This brought to mind a publication I’ve taken time to review from the General Accounting Office (GAO) report to the U.S. Congress, Health Care Price Transparency – Meaningful Price Information Is Difficult for Consumers to Obtain Prior to Receiving Care, published in September 2011. While employers and health plans want consumers to become more engaged in their health, a key barrier facing