The pharmaceutical landscape for 2012 and beyond: balancing cost with care, and incentives for health behaviors
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 health plan or a car: health insurance for a family of four exceeds $20K in 2012
The saying goes, “you pays your money and you makes your choice.” In 2012, if you have a bolus of $20,700 to spend, you can choose between a health plan for a family of four, or a sedan for the same family. That’s the calculation from the actuaries at Milliman, whose annual Milliman Medical Index is the go-to analysis on health care costs for a family of four covered by a preferred provider organization plan (PPO). While the 6.9% annual average cost increase is lower than the 7.3% in 2011, it is nonetheless, a record $1,335 real dollar increase at
Improving health care through Big Data: a meeting of the minds at SAS
Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs. Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey
Employers who offer more flexibility yield healthier workforces
The most flexible workplaces are good for worker’s health: they yield the most engaged workforces, greater job satisfaction, increased commitment to the firm, better mental health and lower indicators of depression. But not all firms are all that flexible, which is the top line of the Family and Work Institute‘s 2012 National Study of Employers (NSE), funded by The Alfred P. Sloan Foundation. What makes this survey different from others polling employers is that the NSE looks at the comprehensive array of total benefits offered to employees and their changing needs in terms of family, finance, and social lives. In the past seven years,
The decline and potential renaissance of employer-sponsored health benefits: EBRI and MetLife reports tell the story
Two reports this week suggest countervailing trends for employer-sponsored health benefits: the erosion of the health benefit among companies, and opportunities for those progressive employers who choose to stay in the health benefit game. In 2010, nearly 50% of workers under 65 years of age worked for firms that did not offer health benefits. The uber-trend, first, is that the percentage of workers covered by employer-sponsored health insurance has declined since 2002. Workers offered the option of buying into a health benefit, as well as the percent covered by a health plan, have both fallen, according to the Employee Benefits Research Institute (EBRI), an organization that
Social media in health help (more) people take on the role of health consumer
One in 3 Americans uses social media for health discussions. Health is increasingly social, and PwC has published the latest data on the phenomenon in their report, Social media ‘likes’ healthcare: from marketing to social business, published this week. PwC polled 1,060 U.S. adults in February 2012 to learn their social media habits tied to health. Among all health consumers, the most common use of social media in health is to access health-related consumer reviews of medications or treatments, hospitals, providers, and insurance plans, as shown in the graph. Social media enables people to be better health “consumers” by giving them peers’
$12 water and $10 premium increases: how price elasticity is contextual in health and life
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
A $132 doctor’s visit in Hanoi, Vietnam: a diagnosis, value-based health care and a new friend
$132 won’t go far in a U.S. emergency room, but in Vietnam, it gets you first class treatment, a highly-trained and empathetic French doctor, and cheap prescriptions, as well. You could call it Presidential treatment, as a certificate from the White House was proudly displayed in the lobby waiting area sent in appreciation of great care received by President George W. Bush. After arriving in Hanoi two nights ago, following three airline flights over nearly 24 hours, our daughter developed a rough cough that gave her chest pains. We gave the condition one day to improve and then spoke with
Wellness Ignited! Edelman panel talks about how to build a health culture in the U.S.
Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative
Employers shopping for value in health – Towers Watson/NBGH 2012 survey results
Employers expect total health costs to reach $11,664 per active employee this year, over $700 more than in 2011. Employees’ share of that will be nearly $3,000, the highest contribution by workers in history. In 2012, workers are contributing 34% more to health costs than they did 5 years ago. The metric is that for every $1,000 employers will spend on health care in 2012, workers will pay $344 for premium and out-of-pocket costs. Still, health care cost increases are expected to level off to about 6% in 2012, that’s still twice as great as general consumer price inflation. with
Rising cost of healthcare a headache among affluent Americans
For the third year in a row, wealthy Americans cite increasing health costs as their top financial concern. Furthermore, 1 in 3 affluent Americans are more concerned about the financial stress that could accompany a health event than they are about how that condition could affect their quality of life. Merrill Lynch Wealth Management, part of Bank of America, conducted the firm’s annual poll among 1,000 Americans with investable assets of at least $250,000, in December 2011. The investment firm has looked at richer Americans’ views on financial concerns since 2009. The chart shows rising health care costs to be
Moving from operational efficiency to personalized healthcare value – IBM on redefining success in healthcare
A health system that’s built to last: this is the latest sound-bite echoing through health policy circles. The theme of sustainability is permeating all matters of policy, from education and business to health care. Enter IBM, with a rigorous approach to Redefining Value and Success in Healthcare: Charting the path to the future, from the group’s Healthcare and Life Sciences thinkers. What’s inspiring about this report is the team’s integrative thinking, bridging the relationship between operational effectiveness built on a robust information infrastructure that enables team-based care (the “collaboration” aspect in the middle of the pyramid), which then drive personalized healthcare
Consumer engagement in health: greater cost-consciousness and demand for cost/quality information
People enrolled in consumer-directed health plans (CDHPs) are more likely than enrollees in traditional health insurance products to be cost-conscious. In particular, CDHP members check prices before they receive health care services, ask for generic drugs versus branded Rx’s, talk to doctors about treatment options and their costs, and use online cost-tracking tools. Furthermore, CDHP members are also more likely to use wellness programs offered by their employers, and are offered “carrots” to participate in them in the forms of financial rewards and other incentives, as well as reduced health care insurance premiums. The 7th annual Employee Benefits Research Institute
Employees predict reduced benefits in 2012; one-half expect layoffs
On the face of the raw data, tbe good news from the U.S. Bureau of Labor Statistics on the nation’s employment picture was an additional 120,000 jobs in November. This drove the unemployment rate down to 8.6%. Underneath that number, though, remains what is still a shaky economy for both workers and those seeking full employment to match what they might have lost as a result of their layoffs. First and foremost, most people who are fortunate to still have their jobs see 2012 as a year where the benefits they receive through their employers will fall, according to the Randstad Employee Attachment Index,
The New American Dream: personal sustainability, not wealth
The Great American Recession of 2008 will reawaken in 2012, Goldman Sachs expects. In the current economic climate of a jobless recovery and dropping home values, the definition of The American Dream has changed. It’s more about personal fulfillment than financial gain, according to the 2011 MetLife Study of The American Dream: The Do-It-Yourself Dream. This is the rise of the “do-it-yourself” American Dream, MetLife found in its survey of 2,420 online adults conducted in September-October 2011. Across the generations — from Silent (born between 1920 and 1945) to Gen Y (born between 1978 and 1993), this redefining concept is relatively consistent.
What’s baked into the Affordable Care Act? Half of Americans still don’t realize there’s no-cost preventive care
The U.S. public’s views on health reform — the Affordable Care Act (ACT) – remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health
Retail health is hot, especially for the young, affluent and not particularly sick
Walmart issued a Request for Information to expand its retail health footprint in the communities in which the world’s largest company operates. That was a strong sign that retail health has surpassed a tipping point. Now, there are hard data to support this observation from a RAND Corporation research team. Trends in Retail Clinic Use Among the Commercially Insured, published in the November 25, 2011, issue of The American Journal of Managed Care, quantifies retail clinic utilization among a group of Aetna health plan enrollees between 2007 and 2009. In those two years, use of retail clinics grew 10-fold. RAND looked
Employers aren’t engaging with patient/health engagement
The vast majority of employers who sponsor health benefits look at those benefits as part of a larger organization culture of health. While one-third are adopting value-based health plan strategies — doubling from 16% in 2010 to 37% in 2011 — only 3% of employers are taking an integrated view of value-based benefits and corporate wellness. This is the second year for the International Foundation of Employee Benefit Plans (IFEBP) and Pfizer to examine employers’ approaches to value-based health care (VBHC). As explained by Michael Porter, the guru on health value chains, value in health care focuses on the patient at
Prescription drug spend in 2012: moving from “educating” patients to empowering them
The growth in prescription drug costs covered by employers and Rx plan sponsors are driving them to adopt a long list of utilization management and price-tiering strategies looking to 2012, according to the 2011-2012 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda Pharmaceuticals. The average drug trend for 2011 — that is, the average annual percentage increase in drug cost spending — was 5.5%, 1.5 percentage points greater than general price inflation of about 4%. The generic fill rate was 73% of prescription drugs purchased at retail. While drug price inflation is expected to increase in 2012, plan
Get into the sunshine, church is out – the GAO report on health care price transparency
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
Walmart’s rollback of health insurance for employees: just another employer facing higher health care costs?
Walmart is increasing premium sharing costs for employees subscribing to health insurance, and cutting the benefit for part-timers. Quoted in the New York Times, a company rep said, “over the last few years, we’ve all seen our health care rates increase and it’s probably not a surprise that this year will be no different. We made the difficult decision to raise rates that will affect our associates’ medical costs.” In so doing, Walmart told the Times that they will, “strike a balance between managing costs and providing quality care and coverage.” MarketWatch wrote that Walmart will increase health care premium costs
Unretirement: the number of Americans planning to retire at 67 is plummeting
Two publications this week reinforce the new reality of health and financial insecurity: The Vanishing Middle America issue of Advertising Age (October 17, 2011 issue) and the Sun Life Financial U.S. Unretirement Index – Fall 2011 with the subtitle, “Americans’ trust in retirement reaches a tipping point.” The chart shows the retirement coin’s two sides: since 2008, the proportion of people in the U.S. who expect to retire by 67 dropped from 52% down to 35%; and, those who believe they will be working full-time (I emphasize “full,” not “part,” time) grew from 19% to 29%. 61% of working Americans plan to
Americans’ new normal in health: paying attention and responding to costs
The passage of health reform in the U.S. has not enhanced peoples’ confidence in the American health system. In fact, U.S. health consumers’ high confidence level in the future of employer-sponsored health benefits has eroded over the past ten years, according to the Employee Benefit Research Institute‘s (EBRI) 2011 Health Confidence Survey: Most Americans Unfamiliar with Key Aspect of Health Reform. Most people are dissatisfied with the U.S. health system overall, with 27% of U.S. adults rating the system as “poor” and 29% giving a rating of “fair.” High costs may be at the root of peoples’ dissatisfaction with the U.S. health
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
I was invited to be a Judge for the upcoming CES 2025 Innovation Awards in the category of digital health and connected fitness. So grateful to be part of this annual effort to identify the best in consumer-facing health solutions for self-care, condition management, and family well-being. Thank you, CTA!
Thank you Team Roche for inviting me to brainstorm patients as health citizens, consumers, payers, and voters in the Healthcare Transformers series.
For the past 15 years, the annual CES conference in Las Vegas has been my go-to meeting for updating my research and network in digital health and consumer-facing electronics that people find meaningful for their well-being, families, and home lives. I'll be back in Vegas in January for a full week of Media Days, one-on-one meetings, and speaking about my perspectives on health consumers.