A blog covering the health/care ecosystem and people.

On their list of top financial worries, 1 in 2 Americans is most concerned about not having enough money for retirement, not being able to pay medical costs if they get sick, and not being able to maintain a desired standard of living. Gallup’s annual Economy and Personal Finance poll, conducted in early April 2014, finds that even in the wake of a healthier economy, people feel health-finance insecure. While ability to pay medical bills ranked #2 on the list of 9 fiscal worries, the proportion of Americans with this concern fell from a high of 62% in 2012 to

People are spending more out of their own pockets on health care, and particularly for medications. There are two sides to the medicine-spending coin: there’s the low-end which are generic drugs, most of which carry a co-pay of $10 or less. Then there’s the high end of specialty pharmaceuticals, a fast-growing category of very expensive products for which many consumers dearly pay — if and when they choose to take their doctors’ recommendations. In Medicine use and shifting costs of healthcare, IMS Institute for Healthcare Informatics reports that while (inexpensive) generic drugs comprise 86% of prescriptions in the U.S., it’s high

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

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

  Charges for medical, pharmacy and dental services can vary by more than 300%. This means that in one place, a procedure that costs $100 can cost $300 for the same treatment in another location or practice, discovered by Change Healthcare in their latest Healthcare Transparency Index 2013 Q3 Report, published in January 2014. The 300% is the average overall across dozens of health services used by the 67,000 plan members Change Healthcare analyzed based on health plan enrollees’ health care utilization in the third quarter of 2013. These health care services include office visits (behavioral health, physical therapy and

This post appeared in my Huffington Post column on January 16, 2013. In the afterglow of the 2014 Consumer Electronics Show (CES), away from the neon lights of Las Vegas, 4D curved TV screens, and uber-hip Google Glass wearers, a big question remains: Do we, the people, really want to tech our way to self-health? The number of digital health companies exhibiting at CES grew by 40 percent, exceeding 300 based on the count of the International Consumer Electronics Association, sponsor of the event. The hockey-stick growth of “wearable technology” seen at the 2014 Consumer Electronics Show begs the question: Are there

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

Gird your wallets, U.S. consumers: watch the dollars flow out-of-pocket for prescription drugs in 2014, as predicted by the 2013-2014 Prescription Drug Benefit Cost and Plan Design Report published by the Pharmacy Benefit Management Institute (PBMI) this week. Constraints covering most plan members are: Step therapy Prior authorization (to get approvals to fill high-cost drugs, notably growth hormones, injectables, controlled substances, Retin-A, and medications for sleep disorders, and Compulsory 90 day refills at retail (90-day dispensing for chronic meds). This Report, sponsored by Takeda, is the gold standard of drug benefit trends, having been published since 1995. Average 30-day copayments

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

This week in America, the concept of “health care consumer” is in a tug-of-war, and those of us trying to behave as such feel bloodied in the skirmish. One side of the tug-of-war is the obvious, post October 1st reality of the sad state of the Health Insurance Exchanges. This has been well covered in mass media, right, left and center. And Americans polled by Gallup last week express their knowledge of that fact — even if they didn’t know what Healthcare.gov was on the 1st of October. The first chart shows that health care is now a front-burner issue

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”

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

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

Where can you shop the health and beauty aisles, pick up some groceries and a prescription, get a flu vaccine, and weigh in on Obamacare and what digital health tools you like? Why, at one of several thousand retail stores where you can find a SoloHealth kiosk. As of yesterday afternoon, over 32 million encounters were recorded on SoloHealth kiosks, based on an app I saw on the company CEO Bart Foster’s smartphone. Kiosks are locatted around the United States in retailers including Walmart and Sam’s Clubs, along with major grocery chains like Schnuck’s and Publix, and the CVS pharmacy

Over 1 in 5 people in the U.S. have not had enough money to buy food for themselves or their families in the past year, according to the August 2013 Gallup Healthways Index. This is as many consumers as those who couldn’t afford food during the deepest months of the last recession. Lack of access to food is a challenge for a cadre of Americans who lack access to other basic needs such as shelter and health care. Gallup’s Basic Access Index looks at this market basket, and has found that Americans’ access to basic needs at 81.4 in August

1 in two people who are insured and have a regular doctor are interested in trying out an electronic medical record. But they need a doctor or nurse to suggest this, and they need it to be easy to use. The EMR Impact survey was conducted by Aeffect and 88 Brand Partners to assess 1,000 U.S. online consumers’ views on electronic medical records (EMRs): specifically, how do insured American adults (age 25 to 55 who have seen their regular physician in the past 3 years) view accessing their personal health information via EMRs? Among this population segment, 1 in 4 people (24%)

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,

When it comes to who’s most responsible for reducing the cost of health care in America, most doctors put the onus on trial lawyers, health insurance companies, pharma and medical device manufacturers, hospitals, and even patients. But physicians themselves ? Not so much responsibility – only 36% of doctors polled said doctors should assume major responsibility in reducing health care costs. And, in particular, most U.S. physicians have no enthusiasm for reducing health care costs by changing payment models, like penalizing providers for hospital re-admissions or paying a group of doctors a fixed, bundled price for managing population health. Limiting

Urgent care centers are growing across the United States in response to emergency rooms that are standing-room-only for many patients trying to access them. But can urgent care centers play a cost-effective, high quality part in stemming health care costs and inappropriate use of ERs for primary care. That’s a question asked and answered by The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? from the Center for Studying Health System Change by Tracy Yee  et. al. The Research Brief defines urgent care centers (UCCs) as sites that provide care on a walk-in basis, typically during regular

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

Health consumers, meet a new player in your health care world: the bank. Financial services companies will play a growing role in U.S. health care as patients morph into health care consumers responsible for making more money-based decisions about their health care. This shift could make paying for health care just like paying other bills in the consumer retail market. And that’s a new role for health providers – doctors and hospitals – to fill. The Impact of Growing Patient Financial Responsibility on Healthcare Providers, prepared for Citi Enterprise Payments by Boundary Information Group, discusses what the impact of consumers’ payments in

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,

If you have health insurance, chances are you take several actions to bolster your health such as take vitamins and supplements (which 2 in 3 American adults do), take medications as prescribed (done by 58% of insured people), and tried to improve your eating habits in the past two years (56%). Most people with insurance also say they exercise at least 3 times a week. Fewer people who are uninsured undertake these kinds of health behaviors: across-the-board, uninsured people tend toward healthy behaviors less than those with insurance. This is The Prevention Problem, gleaned from a survey conducted by TeleVox

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).

One in three workers does not feel financially secure. The proportion of Americans who feel “not at all secure” grew to 16% from 12% between 2011 and 2012, based on the question, “When it comes to paying your bills and keeping up with living expenses, how financially secure do you feel these days?” Women are much more likely than men to feel financially insecure, representing a 33% growth rate in financial insecurity. These sobering financial statistics come to us from the UNUM study, 2012 Employee Education and Enrollment Survey: Employee Perspectives on Financial Security, published May 8, 2013. Based on the question asked – paying

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

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

  Exploiting Big Data in industry is Big News these days, and nowhere is the potential for leveraging the concept greater than in health care. McKinsey & Company estimates that harnessing big data across five dimensions of health care could yield nearly one-half trillion dollars’ worth of value in The ‘big data’ revolution in healthcare. The chart summarizes McKinsey’s calculations on the value of Big Data in health care at its maximum. Before digging into the value potential, just what is Big Data in health care? Statistics and information are generated in the health care system about patients: say, during visits

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,

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

Today’s Health Populi is devoted to Steven Brill and his colleagues at TIME magazine whose special report, Bitter Pill: Why Medical Bills Are Killing Us, is required reading for every health citizen in the United States. Among many lightbulb moments for readers, key findings from the piece are: Local hospitals are beloved charities to people who live in their market – Brill calls these institutions “Non-Profit Profitmakers). They’re the single most politically powerful player in most Congressional districts The poor and less affluent more often pay the high chargemaster (“retail list”) price for health products and services vs. the wealthy

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 care costs for workers lucky enough to receive health insurance at work nearly doubled since 2002. Wages in that decade grew by 33%. This growing affordability gap between health costs vs. wages is shown in the chart. Health consumers in America sharply perceive this gap, according to an analysis of eight focus groups, Consumer Attitudes on Health Care Costs: Insights from Focus Groups in Four U.S. Cities from the Robert Wood Johnson Foundation. To health-covered workers, though, health care “costs” are defined as out-of-pocket health spending for insurance premiums, co-payments and deductibles that come out of paychecks and pocketbooks — not

PwC has seen the future of health care for the next year, and the crystal ball expects to see the following: Affordable Care Act implementation, with states playing lead roles The role of dual eligibles Employer’s role in health care benefits Consumers’ role in coverage Consumers’ ratings impact on health care Transforming health delivery Population health management Bring your own device Pharma’s changing value proposition The medical device industry & tax impact. In their report, Top health industry issues of 2013: picking up the pace on health reform, PwC summarizes these expectations as a “future [that] includes full implementation of

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

Health benefit costs grew a relatively low 4.1% in 2012 (5.4% for large employers), largely due to companies moving workers into lower-cost consumer-directed health plans. Last year, benefit costs grew at an annual rate of 6.1%, representing about a 30% fall in year-on-year cost growth for companies. And, coverage is up to 59% of employees having ticked down to 55% for the past couple of years. Employers expect about a 5% increase for 2013. Mercer’s National Survey of Employer-Sponsored Health Plans analysis finds that U.S. employers are looking toward 2014, when they’ll be covering more uninsured workers, and using this advance

In the wake of Hurricane Sandy, there are strange bedfellows coming together this week. First strange bedfellow moment for me this week was the video of Governor Chris Christie and President Barak Obama embracing and working together in storm-turn New Jersey yesterday. Saints be praised! to see a Republican and Democrat coming together, working together, consoling citizens together. In health care this week, another welcome strange bedfellow event is the statement issued by Catalyst for Payment Reform (CPR), an advocacy group of business, labor unions (notably, the AFL-CIO), and consumer advocates promoting broadly available information for consumers about the price and quality

The first day of the Health 2.0 Conference in San Francisco kicked off with a video illustrating the global reach of the Health 2.0 concept, from NY and Boston to Mumbai, Madrid, London, Tokyo and other points abroad. Technology is making the health world flatter and smarter…and sometimes, increasing problematic fragmentation, which is a theme that kept pinching me through the first day’s discussions and demonstrations. Joe Flowers, health futurist, offered a cogent, crisp forecast in the morning, noting that health care is changing, undergoing fundamental economic changes that change everything about it. These are driving us to what may

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

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

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

With the stunning Supreme Court 5-4 majority decision to uphold the Patient Protection and Affordable Care Act (ACA), there’s a Roberts’ Rules of (Health Reform) Order that calls for liberating primary care beyond the doctors’ office. That’s because a strategic underpinning of the ACA is akin to President Herbert Hoover’s proverbial “chicken in every pot:” for President Obama, the pronouncement is something like, “a medical home for every American.” But insurance for all doesn’t equate to access: because 32-some million U.S. health citizens buy into health insurance plans doesn’t guarantee every one of them access to a doctor. There’s a

50% more women than men are worried about health care affordability and access in the U.S., revealed in a new Kaiser Opinion Poll, the Health Security Watch, based on interviews from May 2012. Overall, about the same proportion of men and women had problems paying medical bills in the past year — 26% vs. 27%, respectively. However, when it comes to self-rationing health care — delaying or skipping treatment due to cost — gender gap shows, with 52% of men and 64% of women delaying or skipping health care. Underneath these numbers are even greater gaps between men and women.

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 is a precursor to health engagement. Trust impacts health outcomes such as a patient’s willingness to follow a doctor’s or health plan’s instructions. Two new studies point out that U.S. consumers don’t trust every touchpoint in the health system. Online medical information has become a trusted channel. Health plans? Not so much. Wolters Kluwer’s Health Q1 Poll on Self-Diagnosis found that consumers trust online health information to inform themselves — even for self-diagnosis. 57% of U.S. adults turn to the Internet to find answers to medical information; 25% “never” do, and 18% rarely do. Two-thirds of people say they trust