A blog covering the health/care ecosystem and people.

…and I’m not talking about GE here (or here). Most people (75%) still view phone calls as the communication mode that best bolsters their relationships compared with texting (66%), picture messaging (35%), sharing on social networks (31%), emailing (25%), , and video chatting (9%). U.S. Cellular, the mobile phone company, surveyed 527 customers in April 2013 to learn about how wireless communication can bring “Better Moments” to peoples’ lives. In particular, people say that mobile phones help them: Communicate more frequently (77%) Share experiences right away (66%) Share moments that would have otherwise been missed (52%). 9 in 10 people take pictures on

The headline for the HarrisInteractive/HealthDay mobile health (mHealth) survey reads, “Lots of Americans Want Health Care Via Their Smartphones.” But underneath that bullish forecast are statistics illustrating that the heaviest users of health care services in America — people 65 and over — have the least interest in mHealth tools. Overall, 37% of U.S. adults are interested in managing health via smartphones or tablets: about 1 in 3 people. As the chart shows, the greatest interest in communicating with doctors via mobile phones and tablets is among people 25-49. Reminders to fill prescription and participate in wellness programs is also

The notion of consumers’ greater skin in the game of U.S. health care — and the underlying theory of rational economic men and women that would drive people to greater self-care — permeated the agenda of the 2nd annual Consumer Health & Wellness Innovation Summit, chaired by Lisa Suennen of Psilos Ventures. Lisa kicked off the meeting providing a wellness market landscape, describing the opportunity that is the ‘real’ consumer-driven health care: people getting and staying well, and increasing participation in self-management of chronic conditions. The U.S. health system is transforming, she explained, with payors beginning to look like computer

Tablets, wearables, smartphones, video and QR codes: these are fast-growing platforms moving data around the global economy. They’re also fast=growing platforms for health care where we live, work, play and pray. Mary Meeker’s annual presentation on Internet Trends at the D11 Conference, is fresh off the virtual press in its shiny new 2013 version. Meeker has been with the investment firm Kleiner Perkins Caulfield Byers (KPCB) since 2011, and was with Morgan Stanley from 1991 to 2010. She’s a veteran who’s watched the Internet basically from The Beginning. Of the 117 slides in her informative, gargantuan deck (a Meeker hallmark every

Food is inextricably bound up with health whether we are well or not. Several key area of the Food=Health ecosystem made the news this week which, together, will impact public and personal health. On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. Michelin, whose bulky advertising icon Bibendum has more than one “spare tire,” introduced a program to combat health issues, including but not limited to BMI and high blood pressure, according to the

Consumers who patronize Walgreens can get rewarded for tracking their physical activity   For the Steps with Balance program kickoff, self-tracking consumers can earn 20 points for every mile walked or run and 20 points for tracking weight. Walgreens implemented the Walk with Walgreens program in 2012. The program won an Effie Award for an outstanding marketing program. With the success of Walk with Walgreens, the retail pharmacy company has expanded the program beyond simple steps to include weight tracking and health goals for earning loyalty points. The program enables a few of the most popular self-tracking devices to sync so

The latest in SoLoMo (Social, Local, Mobile) Health is a gamified tool coupled with a hardware kiosk, known as higi. The brainchild of Michael Ferro, a successful dotcom entrepreneur who now owns the Chicago Sun-Times, higi’s mission is to help people – particularly younger peeps – to take better care of themselves by scoring points and, as a result, social connections. Higi’s an African word for origin, so the health tool has some aspects relating to being in a tribe — a kind of health tribe. It also has a fun sound to it, Ferro noted, which sets the vibe

If it’s March, it must be time for South by Southwest (SXSW), the annual conference weaving music, film and interactive tracks of speakers and conferees that overcrowds and excites Austin, Texas, with a cool vibe and even cooler ideas. I’ll be participating on Sunday 10 March 2013 at 5 pm on a panel, Sitting Will Kill You: Can Mobile Save Us?, featuring Fran Melmed, developer of the HotSeat app that nudges us to all Get Up Offa Our Things when living our typical sedentary lives; Peter Katzmarzyk, public health researcher who knows all about the relationship between too much sitting

Patients are getting comfortable with remote health care – that is, receiving care from a health provider at a distance via, say, telehealth or via a Skype-type of set-up. Furthermore, 70% of people globally saying they would trust an automated device to provide a diagnosis that would help them determine whether or note they needed to see a doctor. Based on the findings from Cisco‘s survey summarized in the Cisco Connected Customer Experience Report – Healthcare, published March 4, 2013, just-in-time for the annual 2013 HIMSS conference, a majority patients the world over are embracing health care delivered via communications

Traditional venture capital in health care is so 2010: welcome to The Greenhouse Effect: How Accelerators Are Seeding Digital Health Innovation, explained in a new report from California HealthCare Foundation written by Aaron Apodaca. Aaron clearly explains the growing interest in and influence of health accelerators, which grew out of the first era of the Internet (read: dot-com bust v 1.0) and the founding of the Y Combinator, an internet incubator that made relatively small investments in exchange for equity positions in start-ups. Health accelerators emerged around 2011, first with Rock Health in San Francisco, which was quickly followed by

“ACOs most assuredly will not…deliver the disruptive innovation that the U.S. health-care system urgently needs,” wrote Clay Christensen, godfather of disruptive innovation, et. al., in an op-ed in the Wall Street Journal of February18, 2013. In the opinion piece, Christensen and colleagues make the argument that Accountable Care Organizations (ACOs) as initially conceived won’t address several key underlying forces that keep the U.S. health care industry in stasis: Physicians’ behavior will have to change to drive cost-reduction. Clinicians will need “re-education,” the authors say, adopting evidence-based medicine and operating in lower-cost milieus. Patients’ behavior will have to change. This requires

This week, I had a conversation with a physician whom I consider quite patient-engaged, who uses an EHR, and who works with one of the most wired health organizations in the United States. I complained to her that my user-generated data from my Bodymedia armband, Fitbit, Withings scale, among other #QuantifiedSelf devices, can’t find their way through the cloud to my doctors’ electronic health records or my patient portal. Her reaction was surprising to me. She was not so keen on the idea, saying, “It’s the physician workflow” that’s the problem. The wordle on workflow comes from Dr. Chuck Webster

The proliferation of mobile health (mHealth) apps appears to be an abundant cornucopia of “lite” tools that look simple to access and easy to use. But this growing menu of a la carte choices that promise to keep us healthy, track our numbers, and access useful health information can also, in the words of three Dutch health researchers, “drive us crazy.” Why mobile health app overload drives us crazy, and how to restore the sanity, by Lex van Velsen and colleagues, makes the case that the plethora of mHealth apps available in online app stores is a fragmented, disorganized marketplace

Consumers want multiple functions on single devices, smooth transitions from one screen to another, and value-laden experiences in the post-recession economy. I wrote about this phenomenon during the week of the 2013 Consumer Electronics Show, highlighting Accenture’s survey on consumer attitudes toward technology — the connected home as consumer medical home. In the fast-evolving mobile health (mHealth) era, the consumer-facing suppliers are fast-responding to these customer demands. This is fostering consumer-centered interoperability in mHealth. On the health care system and professional side of health IT, getting to interoperability remains elusive and slow-going, with a customer base (hospitals, physicians) that’s 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

1 in 3 U.S. adults have enough trust in online health resources that they’ve gone online to diagnose a condition for themselves or a friend. “For one-third of U.S. adults, the Internet is a diagnostic tool,” according to Health Online, the latest survey on online health from the Pew Internet & American Life Project. Nearly one-half of these people eventually sought medical attention. One-third did not. Women are more likely to do online medical diagnoses than men do, as do more affluent, college-educated people. When people perceive they’re ‘really’ sick, 70% get information and care from a health professional and

Over one-third of U.S. consumers plan to buy a new fitness technology in the next year, especially women. They’ll buy these at mass merchants (females in particular, shopping at Target and Walmart), sporting goods retailers (more male buyers here), online and at electronics stores like Best Buy. These potential buyers consider themselves in good or excellent physical health. They’ll see the latest applications on retail store shelves in pedometers, calorie trackers, fitness video games, digital weight scales, and heart rate monitors that will be launched this week at the 2013 Consumer Electronics Show in Las Vegas. In advance of the

85% of U.S. health consumers say that emails, text messages, and voicemails are at least as helpful as in-person or phone conversations with health providers, according to the TeleVox Healthy World study, Technology Beyond the Exam Room. The study was based on surveys conducted with over 2,200 health providers across specialties, and 1,015 U.S. adults over 18. Furthermore, one in 3 consumers admit to being more honest when talking about medical needs via automated voice response systems, emails or texts than face-to-face with a health provider. And 3 in 10 consumers believe that receiving digital health communications from providers such

  41% of Americans are comfortable using websites that allow them to check health symptoms. Furthermore, 25% of people trust online symptom checkers, mobile apps and home-based vital sign monitors as much as they trust their doctor. In fact, roughly the same proportion uses these tools instead of going to see the doctor, according to a consumer survey from Royal Philips Electronics (Philips). The infographic illustrates some of Philip’s top-line findings from this poll, conducted among 1,003 U.S. adults 18 and over in November 2012. Over one-third of Americans also believe that technology allows them to monitor their health — a

  One in two doctors is burned out. Physicians are seeing more patients in a day and spend less time with each of them. This leads to job burnout, and greater probability for medical errors and eventual liability challenges, along with feeling pushed toward early retirement. In a study published in August 2012 in the Archives of Internal Medicine, Mayo Clinic researchers learned that physicians are more burned out than workers in any other profession. And those at greatest risk of “being on a hamster wheel,” as Dr. Jeff Cain, president-elect of the American Academy of Family Physicians describes the scenario, are primary

Notwithstanding the fact that most phones on U.S. streets are “smart” ones, most adults surf the net for health information, and most people try to change a health habit each year, Americans haven’t adopted healthier long-term relationships with food. The International Food Information Council has conducted the Food & Health Survey: Consumer Attitudes Toward Food, Safety, Nutrition & Health poll since 2006, thus enabling us to track peoples’ attitudes and behaviors over the past several years. The latest polling results appear in Is it Time to Rethink Nutrition Communications? A 5-Year Retrospective of Americans’ Attitude toward Food, Nutrition, and Health online in

The ubiquity of mobile phones, increasingly smart ones (one-half of all mobile phones in the U.S. ), means people are walking around, working, playing and driving with self-tracking devices and ultra-mini computers in their pockets and totebags. 52% of smartphone owners seek health information on their phones, and overall 1 in 3 people seek health information on all mobile phones — nearly doubling the percent of those seeking health info via mobile in 2010 (17%). People who are sicker, caregivers, and those who have had a big change in health are also more prone to using phones for health, as

There are many definitions of mobile health, and Elsevier is adding another to the list. The world’s largest medical publisher has taken its new clinical search tool, ClinicalKey, on the road. Coined the ClinicalKey Experience Tour, Elsevier is coming to a medical center near you to enable clinicians, medical librarians, and health care administrators to give ClinicalKey a spin in their hospital’s parking lot. The challenge: the amount of new medical information doubles every 5 years, while 4 in 5 physicians say they have less than five hours a month to keep up with this, according to a DoctorDirectory survey. At the same time, health care providers feel hard-pressed

4 in 5 health consumers expect doctors not only to treat them when they’re sick, but to keep them healthy. “In sickness and in health” now morphs over to the doctor-patient relationship, beyond the marriage vow. Better Health through Better Patient Communications, a survey from Varolii, finds that people are looking for health, beyond health care, from their physicians. Varolii is a customer interaction company that claims to have interacted with 1 in 3 Americans through some sort of company communication: they work with major Fortune 1000 companies, including banks, airlines, retail, and, yes, health care. They recently attracted  a

A teddy bear in the arms of a child with diabetes can change health care. At least, Jerry the Bear can. Yesterday kicked off the sixth autumn mega-version of the Health 2.0 Conference in San Francisco. Co-founded by Matthew Holt and Indu Subaiya, a long-time health analyst and physician, respectively, this meeting features new-new tools, apps and devices aimed at improving individual and population health, as well as health processes and workflows for physicians, hospitals, pharma, and other stakeholders in the health care ecosystem – even health lawyers, who met on October 7 to discuss up-to-the-minute  e-health law issues. Yesterday was

Target, the beloved retail channel for many design-minded value-conscious consumers, has opted in to mobile health through its purchase of SMARTCOACH mobile health coaching devices. SMARTCOACH is part of a growing category of wearable devices that monitor health behaviors like walking and calories consumed. What differentiates SMARTCOACH is the “coach” element, which provides real-time feedback throughout the day. Most other devices in the market simply track and record data. And it’s feedback loops that more experts say are key to sustaining health behavior change. Target will bring the device into stores for purchase in the fall. Like some other wearable

One-half of the members of Kaiser Permanente use the plans’ personal health record system, MyHealthManager. The most-used function of MyHealthManager is accessing lab results, according to KP. Now that Quest, the lab and health information company, has launched the mobile phone app, Gazelle, more health citizens will have access to lab test results. This could be a health-activating opportunity inspiring patient engagement. While Gazelle is a fully functional personal health record (PHR), it’s the connection to lab test results that’s the lightbulb moment. PHRs have been available to health consumers for over a decade. There are millions of users of

Skype and videoconferencing have surpassed the tipping point of consumer adoption. Grandparents Skype with grandchildren living far, far away. Soldiers converse daily with families from Afghanistan and Iraq war theatres. Workers streamline telecommuting by videoconferencing with colleagues in geographically distributed offices. In the era of DIY’ing all aspects of life, more health citizens are taking to DIY’ing health — and, increasingly, looking beyond physical health for convenient access to mental and behavioral health services. The Online Couch: Mental Health Care on the Web is my latest paper for the California HealthCare Foundation. Among a range of emerging tech-enabled mental health

Half of patients globally expect that mobile health will improve health care. These health citizens expect that mobile health will help them manage their overall health, chronic conditions, how they manage their medications and measure and share their vital health information. Welcome to the new mobile health world, a picture captured in PwC’s report, Emerging mHealth: Paths for growth, published in June 2012 and written by the Economist Intelligence Unit. Patients’ views on mHealth are bullish, and while most doctors and payors share that vision, they also expect mHealth to come into focus more slowly, recognizing the institutional, cultural and

  One-third of employers will increase investments in wellness programs in 2013. Employers look to these programs to reduce health care costs, to create a culture of health, to improve workforce productivity, and to enhance employee engagement. Workers say wellness programs are important in their choice of employer. But while employers and employee chasm agree on that point, there’s a gap between how employers see the programs’ benefits, and how aware (or unaware) employees are. Call this a Wellness Literacy Gap, akin to health literacy and health plan literacy. Over one-half of employers believe employees understand the programs they offer,

On May 23, 2012, Pfizer announced its teaming with EatingWell magazine to launch a mobile app for patients on Lipitor. Eight days later, on May 31, 2012, generic versions of Lipitor will hit the market. Lipitor is the best-selling drug in pharmaceutical history, to-date. Sales of the product top $125 billion. While generic atorvastatin has been available in the U.S. since November 2011 from two manufacturers, low prices for the generic will drop to $10 or less for a month’s supply at the end of May. This is Pfizer’s first foray into a prescription drug-affiliated app. The free mHealth app,

Mom is the Chief Health Officer of her family, she’s mobile, and seeking health information and community on-the-go. But underneath the persona of the Mobile Mom, she’s consuming information and sharing perspectives on many other ‘screens,’ too. And that’s the challenge for marketers seeking to grab the attention of this key player in the health ecosystem. There are new survey data from Enspektos‘s report, Digging Beneath the Surface: Understanding the Digital Health Mom, that are must-reading for health industry stakeholders who seek to motivate health behaviors among women, who are at once nurturing wellness, caregiving for sick people, and sharing

Nearly 1 in 2 U.S. adults now uses social media in health, according to Manhattan Research’s latest look into Cybercitizens, fielded in Q311. That 45% of U.S. health consumers use social media in health is a significantly higher percentage than recent studies fielded by PwC and Deloitte, which have found about 1 in 3 consumers using social media for health. Manhattan Research defines social media use in health as having created or consumed health-related user-generated content on blogs, social networks, health ratings websites, online health communities and message boards, or patient testimonials. Key findings are that, 14% of health-social media folks are

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

Highmark is the next health plan to launch mobile health programs, signalling a tipping point in health insurance companies getting up-close-and-personal with members’ wellness. Encouraging Words of Wisdom is a personal nutrition coaching program for plan enrollees who meet with dieticians. Members can opt-in to receive motivational text messages and support ongoing commitments to healthy eating. One such message reads, “The best food comes in its own package.” Another app enables members to find a doctor using GPS or to calculate their co-pay amount for a service. Highmark’s head of health services strategy said in the company’s press release, “We understand

With mobile health consumer market projections for ranging from $7 billion to $43 billion, according to PricewaterhouseCoopers, a casual reader might think that a plethora of health citizens are tracking their health, weight, food intake, exercise, and other observations of daily living by smartphones and tablets. But as the chart shows, health self-trackers number around 1 in 20 U.S. adults, according to a survey conducted for HIMSS Analytics and sponsored by Qualcomm Life. HIMSS Analytics’ report, A New Prescription for Chronic Disease: remote monitoring devices, was published in conjunction with the annual HIMSS conference which highlights the latest health information technology

How electronically connnected and communicative are nations’ health information infrastructures? Accenture has answered that question in its report, Making the Case for Connected Health. Accenture built a “connected health maturity index,” analyzing a nation’s level of health information exchange among users along with their level of health IT adoption among specialists and primary care doctors. Adoption was defined across four HIT functions: administrative tools, electronic patient notes, electronic alerts/reminders, and computerized decision support systems. Health information exchange was defined across seven connectivity dimensions: electronic communications, e-notifications, e-referrals, e-access to clinical data about patients who see a different provider, e-prescribing, and

At the ConvUrgent Care Symposium in Orlando, attendees from the worlds of clinics, ambulatory care, hospital beds, pharmacies, medical devices, life sciences, health information, health IT, health plans, academic medical centers and professional medical societies came together to share and learn about the morphing landscape of retail health. The topline message: primary care is everywhere, and based on the response to my keynote talk this morning, every stakeholder segment gets it. My mantra, courtesy of the U.S. Surgeon General Regina Benjamin: don’t look at health in isolation, that is, where the doctor and hospital are. Health happens wherever the person

It’s January and the #1 most popular post-New Year’s resolution is to lose weight, get fit, and live well. The signs of this are manifested in ads featuring Janet Jackson promoting Nutrisystem, Jennifer Hudson dueting with her then-and-now selves pitching Weight Watchers, as well as the new Weight Watchers for Men promotion starring Charles Barkley. But there are new signs that losing weight and getting fit are going beyond “diets” and food plans: research shows that moving around and getting exercise can help people sustain hard-earned weight loss more than just changing food intake and “dieting.” So the Apple store

The market for health and wellness has traditionally included over-the-counter medicines, gym memberships, and vitamins/minerals/supplements. In 2012, the boundaries of health/wellness are blurring beyond these line items toward preventive medical services and consumer electronics. This morphing market is discussed by Cambridge Consultants in their report on the disruptions driving The Business of Health & Wellness: Engaging consumers and making money. Cambridge correctly introduces this analysis by saying that economics, the growing prevalence of chronic diseases, an aging population, and demand consumers are shaping health/wellness, “recharacterizing” the market as one driven by “life events.” Cambridge sees that health consumers are changing their spending

This week’s mHealth Summit in Washington, DC, features scores of presentations, posters, and corporate announcements demonstrating the typical chaos of emerging technology markets: the Big Question at this stage on S-curves for new tech is always, “what’s the timing of the pace of change,” or for you mathematically-inclined readers, “what’s the slope of the mHealth adoption curve?” Before we address that question, let’s be transparent about the fact that there are several definitions of just what ‘mHealth’ is: purists may conceive it as covering only those health tools and applications that ‘go’ mobile–that is, that are deployed via mobile phones and

More people with higher levels of concern about their health feel they are in good health, see their doctors regularly for check-ups, take prescription meds “exactly” as instructed, feel they eat right, and prefer lifestyle changes over using medicines. And 40% of these highly-health-concerned people have also used a health technology in the past year. At the other end of the spectrum are people with low levels of health concern: few see the doctor regularly for check-ups, less than one-half take their meds as prescribed by their doctors, only 31% feel they eat right, and only 36% feel they’re in

3 in 4 of the Fortune 50 companies are part of the U.S. health economy in some way. Only 1 in 3 of these is in traditional health industries like pharmaceutical and life science companies, insurance, and businesses in the Old School Health Care value chain. 2 in 3 of the Fortune 50 companies involved in health are in new-new segments. In their report, The New Gold Rush, PricewaterhouseCoopers (PwC) identifies four roles for “prospectors” in the new health economy which will represent 20% of the GDP by 2019: Fixers Connectors Retailers, and Implementers. These are the disruptive roles that will

The past year has seen a huge jump in the number of hours that physicians spend online; at the margin, the increase is due to physicians’ use of online via mobile platforms. Meredith Abreu-Ressi, President of Manhattan Research, shared her insights into the firm’s study, Taking the Pulse (v. 11), with me today. The top-line finding of the annual survey is that health professionals have quickly adopted mobile platforms in health — with special attention paid to Apple products, the iPhone and the iPad. Manhattan Research has tracked physicians’ use of online health resources for over a decade. They’ve found

In an interview in March 2011 with the Los Angeles Times, Dr. Regina Benjamin, the U.S. Surgeon General, said, “We can’t look at health in isolation. It’s not just in the doctor’s office. It’s got to be where we live, we work, we play, we pray. If you have a healthy community, you have a healthy individual.” Ford’s announcement last week that the automaker would team up with WellDoc to incorporate mobile health sensors into the company’s SYNC connectivity system  follows Toyota’s mhealth concept, the RiN, launched in 2007. Among various applications envisioned at this preliminary stage: Glucose monitors, from Medtronic, will

With non-communicable diseases (NCDs) killing two-third’s of the Earth’s residents — not malaria, HIV or other infectious diseases — the World Health Organization calls lifestyle-borne chronic conditions a “slow-motion catastrophe.” The solution for addressing this global challenge isn’t just about deploying more doctors and medical technology in hospitals and bricks-and-mortar institutions. The real health reform is about infrastructure-independent care and feeding that bolsters peoples’ health where they live, work, play and pray, as characterized by the U.S. Surgeon General Dr. Regina Benjamin in the Los Angeles Times on March 13, 2011. Today I’ll be participating on the eHealth track at the J.

Patient engagement improves health outcomes. But deploying patient empowerment and engagement tools involve many challenges, among them: privacy, security, integrity of medical records, liability, and payment. These have prevented health providers – doctors and hospitals – from adopting strategies to more closely engage patients. From the patient’s perspective, though, many patients have project-managed their own approaches to engagement with online and mobile health tools, such as participating in peer-to-peer health social networks, downloading and using mobile health apps, and monitoring calories, weight and sleep through devices like FitBit, Zeo, and the Withings scale. The Institute for Health Technology Transformation (iHT2) published the

“Ward and June Cleaver have left the building,” observe analysts at Nielsen. “The white, two-parent, ‘Leave it to Beaver’ family unit of the 1950s has evolved into a multi-layered, multi-cultural construct dominated by older, childless households,” starts a report from The Nielsen Company, The New Digital American Family. Whatever ethnic flavor this Digital Family may represent, there’s one equalizer across all of them: the smartphone, which is owned by households across cultures and income levels. First, the socio-demographics paint a picture of increasingly multi-cultural households. Recent immigrants to the U.S. accounted for 90% of population growth from 2000-2010, over-indexing for Hispanic and

The environmental landscape for pharmaceutical manufacturers and retail pharmacies is marked with landmines, yield signs, and cautionary wild cards: health reform, supply chain dynamics, specialty drug pricing, pharmacogenomics, and the high burden of chronic disease among them. But the crux of the challenge for achieving optimal outcomes has less to do with these factors than it does with consumer behavior: specifically, the chasm between what people/health consumers say they want versus what people actually do. Express Scripts calls this “The Intent-Behavior Gap,” and it’s the theme of the company’s 2010 Drug Trend Report, Complex Challenges, New Solutions. The cost of sub-optimal pharmacy behaviors are huge: in 2010, pharmacy-related waste