A blog covering the health/care ecosystem and people.

“What if…healthcare happened where we live, work, play, pray and shop, delivering the highest levels of retail experience?” I asked and answered in my book HealthConsuming: From Health Consumer to Health Citizen. The chapter called “The new retail health” began with that “what if,” and much of the book responded with the explanation of patients evolving toward health consumers and, ultimately, health citizens empowered and owning their health and care. This week, Dollar General announced the hiring of its first Chief Medical Officer, Dr. Albert Wu. With that announcement, America’s largest dollar-store chain makes clear its ambitions to join a

In the COVID-19 pandemic, health care spending in the U.S. increased by a relatively low 6.0% in 2020. This year, medical cost trend will rise by 7.0%, expected to decline a bit in 2022 according to the annual study from PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2022. What’s “behind these numbers” are factors that will increase medical spending (the “inflators” in PwC speak) and the “deflators” that lower costs. Looking around the future corner, the inflators are expected to be: A COVID-19 “hangover,” leading to increased health care services utilization Preparations for the next pandemic, and

When a new technology or product starts to get used in a market, it follows a diffusion curve whose slope depends on the pace of adoption in that market. For telehealth, that S-curve has had a very long and fairly flat front-end of the “S” followed by a hockey stick trajectory in March and April 2020 as the COVID-19 pandemic was an exogenous shock to in-person health care delivery. The first chart from the CDC illustrates that dramatic growth in the use of telehealth ratcheting up since the first case of COVID-19 was diagnosed in the U.S. Virtual care has

Health care has increased its role in popular culture over the years. In movies in particular, we’ve seen health care costs and hassles play featured in plotlines in As Good as it Gets [theme: health insurance coverage], M*A*S*H [war and its medical impacts are hell], and Philadelphia [HIV/AIDS in the era of The Band Played On], among dozens of others. And this year’s Oscar winner for leading actor, Anthony Hopkins, played The Father, who with his family is dealing with dementia. [The film, by the way, garnered six nominations and won two]. When I say “Oscar” here on the Health

The Wall Street Journal featured the grocery chain Kroger in an article yesterday titled, COVID-19 Vaccinations, Tests Give Boost to Kroger’s Health Ambitions. “With 2,250 pharmacies and 220 clinics largely in the Midwest and the southern U.S., Kroger is the fourth-largest pharmacy operator by script count,” the Journal noted, adding details about Walmart, CVS Health, and Walgreens all fast-expanding their respective health care footprints. As more consumers view their homes as personal and safe health havens, there is no shortage of suppliers in the food, retail, and mobility sectors working fast to meet that demand for convenient and accessible services.

With a vaccine supply proliferating in the U.S. and more health citizens getting their first jabs, there’s growing optimism in America looking to the next-normal by, perhaps, July 4th holiday weekend as President Biden reads the pandemic tea leaves. But that won’t mean Americans will be ready to return to pre-pandemic health care visits to hospital and doctor’s offices. Now that hygiene protocols are well-established in health care providers’ settings, at least two other major consumer barriers to seeking care must be addressed: cost and access. The latest (March 2021) Kaiser Family Foundation Tracking Poll learned that at least one

Five years ago, in 2016, the W2O Group said that, “Relevance is reputation.” That year the firm began to study the relevance of, well, relevance for organizations especially operating in the health/care ecosystem. 2020 changed everything, the W2O team asserts, now issuing its latest look into the issue through the Relevance Quotient. Relevance is built on recognizing, meeting and exceeding stakeholder expectations of organizations. In the Relevance Quotient methodology, W2O Group defines key stakeholders as employees, patients (including the sick and the well, caregivers, consumers, et al), health care providers, advocacy groups, analysts and investors, policy makers, journalists and media outlets.

The growing use of APIs in health information technology innovation for patient care has been a boon to speeding development placed in the hands of providers and patients. Using APIs can help drive interoperability and make data “liquid” and useable. APIs can enable “Data liberación,” a concept proposed by Todd Park when he worked in the Obama administration. Without securing patients’ personal health data leveraging APIs, those intimate details are highly hackable explained in All That we Let In, a report from Knight Ink and Appr0ov. It is likely that behind growing health data hacks is the marginally greater financial

Physicians in the U.S. are experiencing “death by 1,000 cuts,” according to the 2021 Medscape Physician Burnout & Suicide Report. Medscape polled 12,339 physicians representing over 29 specialties between late August and early November 2020 to gauge their feelings about work and life in the midst of the coronavirus pandemic. Medscape researched its first Physician Lifestyle Report in 2012. That research focused on physician “happiness” and work-life satisfaction. In 2013, the issue of burnout was called out on the cover of the report, shown here with the question, “does burnout affect lifestyle?” In 2015, the Physician Lifestyle Report was titled,

The pandemic has digitally transformed those people who could work from home, school at home, and undertake daily life-flows as health citizens tried to keep the coronavirus (and other people) at-a-distance. “Emerging hand-in-hand with place displacement, activity displacement is simply about the change in how people do things. Almost overnight, school lessons and doctors’ appointments were online. Yoga classes, concerts and weddings were streamed via Zoom,” Fjord Trends 2021 from Accenture Interactive observes. “Historically, people have often been quick to adopt new digital technology and slower to adapt to what it can help them achieve,” Fjord noted. But COVID-19 has

In the U.S., the latest read on supply-and-demand for COVID-19 vaccines illustrates a gap between what had been promised for the first phase of vaccine rollout versus the reality of supply chain challenges, cold storage, and 50-state and local fragmentation at the last mile for U.S. health citizens. An op-ed published in yesterday’s Washington Post by Dr. Robert Wachter of UCSF and Dr. Ashish Jha of Brown University found these two wise physicians feeling “punched in the face” with the state of coronavirus vaccination in America. As a result, they soberly, pragmatically recommended administering just the first jab of vaccine

explained in a new report from EY co-sponsored by the American Hospital Association (AHA) and the AHA Center for Health Innovation. Digital Transformation – Anywhere Care envisions “health care with no address, or bringing care to the consumer or patient rather than expecting the patient to go to the hospital” as a “vital sign” of health care’s changes going into the new year of 2021. COVID-19 accelerated a movement in which I’ve been involved for over a decade, known as “participatory health.” In its early phase in the U.S., Dr. Tom Ferguson identified the emerging role of the internet in

Staying home, being clean, staying entertained, eating well, and self-caring for healthcare….these are the major factors underpinning the twenty fastest-growing brands of 2020, based on Morning Consult’s annual look at the topic. Let’s look into these categories by brand, and connect the dots for health, medical care, and well-being… Connectivity as a social determinant of health. Zoom was the fastest-growing brand of the year, with 26% of U.S. consumers saying they would consider purchasing the service in November compared with 11% in January. Zoom morphed from a business meeting platform to a consumer and family-connecting service spiking on holidays like

Before the coronavirus pandemic, patients had been transforming into health care payors, bearing high deductibles, greater out of pocket costs, and financial risk shifting to them for medical spending. In the wake of COVID-19, we see health consumers-as-payors impacted by the pandemic, as well as for existing diagnoses and chronic care management. There is weakening in U.S. consumers’ overall household finances, the latest report from the U.S. Bureau of Economic Analysis (BEA) asserted (published 25 November 2020). In John Leer’s look into the BEA report in Morning Consult, he wrote, “Decreases in income, the expiration of unemployment benefits and increased

When it comes to patients, health care providers have been hit hard in two ways in the wake of the COVID-19 pandemic. Hit #1 has been the direct negative impact of the coronavirus on health care volumes and patients not utilizing hospitals and doctors’ services, avoiding physical encounters in health care sites Hit #2 has been the negative impact of patient experience for those health consumers who sought health care services during the pandemic — and had a negative response to the encounter. Accenture explored this phenomenon in their latest report, Elevating the Patient Experience to Fuel Growth. In the

One in two U.S. adults say their concerns about personal health and wellness increased in the past year: in particular, stress and anxiety, and sleep and eating habits. Despite spending more time at home due to the COVID-19 pandemic, few people believe they live in a “healthy home.” The vast majority of consumers are concerned about some aspect of their home’s health, like air or water quality, according to Healthy Home Technologies , a report published in October 2020 by the Consumer Technology Association (CTA), convener of the annual CES. For the research, CES interviewed 1,500 U.S. adults in late

In the first six months of the COVID-19 pandemic, telehealth was a “bright spot in the ‘new normal,’” according to a report from J.D. Power, Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist. But as the report’s title asserts, most telehealth users experienced obstacles to accessing and using virtual care platforms that drove less positive consumer experiences. Overall, the telehealth segment achieved a higher consumer satisfaction score (860 points out of 1,000) than other sectors J.D. Power has studied including health insurance, insurance and financial services. J.D. Power assessed two categories of telehealth vendors: direct-to-consumer (DTC) and

COVID-19 is re-shaping all industries, especially health care. And the pharma industry is challenged along with other health care sectors. In fact, the coronavirus crisis impacts on pharma are especially accelerated based on how the pandemic has affected health care providers, as seen through research from Accenture published in Reinventing Relevance: New Models for Pharma Engagement with Healthcare Providers in a COVID-19 World. For the study, Accenture surveyed 720 health care providers in general practice, oncology, immunology, and cardiology working in China, France, Japan, the United Kingdom, and the U.S., in May and June 2020. Top-line, Accenture points to four

The pandemic has become a sort of forcing function on all aspects of daily living, include health care. Deloitte’s latest wave of health care consumer market research updates the COVID-19 impacts on the U.S. health care landscape and asks the question in the study report’s title: “Are consumers already living the future of health?” For the general survey of U.S. Health Consumers, Deloitte polled 4,522 U.S. adults 18 and older online in February and March 2020. Deloitte conducted an additional 1,510 interviews with consumers in April to gauge peoples’ perspectives on the pandemic, health and well-being. In the Great Lockdown

While I’m on holiday this week, restoring and re-setting, I’ve been sharing pages from my ABCovid-19 Journal with readers of Health Populi. I created this journal during the early phase of the pandemic in the U.S., as a form of art therapy, creative outlet, and learning. Today is Day 4 of sharing: we consider the letters “P” through “T,” and what I saw in the early coronavirus era. P is for pandemic This “P” was self-evidence in our collective early COVID-19 lexicon. The “P” word was uttered by the Secretary General of the World Health Organization on March 11, confirming

The coronavirus pandemic accelerated many trends and new workflows for patients and consumers, and health care providers, too. The convergence of basic needs like hygiene and safety, financial and health security, and living-working-learning-and-cooking-at-home has turbocharged a migration of more acute care delivered at home. I explore this growing concept in my latest essay on Medecision’s Liberation blog, How the Pandemic Is Accelerating the Hospital-At-Home Concept. The key points are that: Hospital-at-home services (H-a-H) combine home visits with virtual care and remote monitoring Think: advanced home care, enabled through virtual health technologies and wrap-around services both clinical and scaled social determinants

The phrase, “burden of health care,” has two usual meanings: one, to do with the massive chronic care burden, and the other, involving costs. There’s a third area of burden in U.S. health care — the onerous patient experience in finding and accessing care, assessed in the 2020 Change Healthcare – Harris Poll Consumer Experience Index. Two in three U.S. consumers feel like “every step of the healthcare process is a chore.” That burdensome patient experience leads to one in two people in America avoiding seeking care, the poll found. That’s not just self-rationing health care due to costs, but due

Patients embraced virtual care and communications at very high rates in the first months of the pandemic, and want to continue to use telehealth platforms after the pandemic ends. The new era of virtual care has begun and is here to stay, Accenture expects in its latest look at How COVID-19 will permanently alter patient behavior, a patient survey conducted in May 2020. Accenture polled 2,700 patients around the world, 450 participants each from China, France, Germany, Japan, the U.K., and the U.S. Patients represented one of three conditions, with one-third each managing cardiovascular, immunology/rheumatology, and oncology. Topline, consumers “faced

Within days of the coronavirus pandemic emerging in the U.S., health care providers set up virtual care arrangements to convene with patients. Three months into the COVID-19 crisis, how have patients felt about these telehealth visits? In Patient Perspectives on Virtual Care, Kyruus answers this question based on an online survey of 1,000 patients 18 years of age and older, conducted in May 2020. Each of these health consumers had at least one virtual care visit between February and May 2020. The key findings were that: Engaging in a virtual visit was a new-new thing for 72% of people Patients’

You’ve heard the one about three characters walking into a bar. A new collaboration between United Airlines, Cleveland Clinic and Clorox reminded me of that scenario, and that in the age of the coronavirus pandemic, collaboration can bolster our health. In the era of COVID-19, people — consumers. patients managing chronic conditions, and caregivers (whether for younger or older loved ones) — are concerned about contracting the virus. In U.S. states where governors mandated shelter-at-home for much of the first half of 2020, millions of people have become conditioned to physically distance, wear face coverings, and #StayHome. In particular, workers

The 21st Century Cures Act emphasizes patients’ control of personal health information. ONC rules issues in March 2020 called for more patient-facing health tools and apps to bolster health consumer engagement and empowerment. But the emergence of the coronavirus in the U.S. revealed many weakness in the American health care system, one of which has been health inequities faced by millions of people — especially black Americans, who have sustained higher rates morbidity and mortality for COVID-19. There have also been digital health divides found in the COVID-19 pandemic, discussed in a timely essay in JAMA, Digital Health Equity as

Stress is up, smoking increasing, drinking more alcohol….Americans are tapping into a variety of coping mechanisms in the coronavirus outbreak, with health on their collective minds. Toluna and Harris Interactive are collaborating on the COVID-19 Barometer, publishing biweekly data on consumers’ views on the coronavirus pandemic. The data here are a snapshot of consumers taken through the Toluna-Harris poll conducted among 1,047 U.S. adults between 9-20 April 2020. The first chart shows various life-flows Americans have adopted in April, all risk factors impacting peoples’ overall health status and mental well-being. There were demographic differences across these factors: more women felt

Millions of dollars and developers’ time have been invested in conceiving and making digital health tools. Yet with that bullish supply side of digital health,  there was a marked decline in peoples’ use of them in the past two years, found by Accenture in their latest health consumer survey, Digital is Transforming Health, So Why is Consumer Adoption Stalling? Use of mobile apps to track personal health activity fell from nearly 1 in 2 consumers to 1 in 3. Use of wearable tech nearly halved, from 33% to 18%, between 2018 and 2020. Some, but not necessarily a majority, of

With our HealthConsuming “health is everywhere” ethos, this post updates some of the most impactful recent retail health developments shaping consumers’ health/care touchpoints beyond hospitals, physicians, and health plans. For inspiration and context, I’ll kick off with Roz Chast’s latest New Yorker cartoon from the February 3rd 2020 issue — Strangers in the Night, taking place in a Duane Reade pharmacy. Roz really channels the scene in front of the pharmacy counter, from Q-tips to vitamins and tea. And it’s hummable to the tune of, well, Strangers in the Night. Check out the 24-hour pharmacist under the pick-up sign. Now,

One in two people over 50 bought a piece of digital technology in the past year. Three in four people over fifty in America now have a smartphone. One-half of 50+ Americans use a tablet, and 17% own wearable tech. The same percentage of people over 50 own a voice assistant, a market penetration rate which more than doubled between 2017 and 2019, AARP noted in the 2020 Tech and the 50+ Survey published in December 2019. For this research, AARP worked with Ipsos to survey (online) 2,607 people ages 50 and over in June and July 2019. Across all

The topline of this year’s annual Gallup Poll into honesty and ethics of professions finds nurses sustaining their reign as the top trusted profession in America. But it’s also important to point out that four of the top five most ethical professions are people working on the front lines of health care: doctors (#3), pharmacists (#4) and dentists (#5). Engineers rank second this year after nurses, edging ahead of doctors and pharmacists who typically have ranked 2nd and 3rd each year in the past decade. One of these years, pharmacists’ reputation fell as the profession was associated with being a

Today is Day 1 of two Media Days at #CES2020 in Las Vegas, kicking off this manic week of the Consumer Electronics Show at the Mandalay Bay convention center. For several years, I’ve convened with journalists and industry analysts from around the world for these two days before the “official” opening of CES to hear the latest news from some of the largest tech-focused companies on Earth. Announcements come from across industry sector — from automotive and transportation, telecoms, consumer goods, entertainment, social media, travel, and retail…with platform technologies playing a role including but not limited to AI, AR/VR/XR (the

As Boomers age, they’re adopting mobile and smart technology platforms that enable people to communicate with loved ones, manage retirement investment portfolios, ask Alexa to play Frank Sinatra’s greatest hits, and manage prescription refills from the local grocery store pharmacy. Last week, the Giant Eagle grocery chain was the first pharmacy retailer to offer a new medication management skill via Alexa. That program has the potential to change our Medicare members manage meds at home to ensure better adherence, supporting better health outcomes and personal feelings of efficacy and control. [As an aside, consumers really value pharmacies embedded in grocery

While customer satisfaction with health insurance plans slightly increased between 2018 and 2019, patient satisfaction with hospitals fell in all three settings where care is delivered — inpatient, outpatient, and the emergency room, according to the 2018-2019 ACSI Finance, Insurance and Health Care Report. ACSI polls about 300,000 U.S. consumers each year to gauge satisfaction with over 400 companies in 46 industries. For historic trends, you can check out my coverage of the 2014 version of this study here in Health Populi. The 2019 ACSI report bundles finance/banks, insurance (property/casualty, life and health) and hospitals together in one document. Health

“Google’s ‘Project Nightingale’ Gathers Personal Health Data on Millions of Americans,” the Wall Street Journal reported in today’s paper and on the WSJ.com website. The story started with the scenario that, “Search giant is amassing health records from Ascension facilities in 21 states; patients not yet informed.” Here’s Ascension’s press release on the collaboration, described in the title as “healthcare transformation.” Note: this release was written after the Wall Street Journal published this story. And, according to the WSJ reporting, “Neither patients nor doctors have been notified. At least 150 Google employees already have access to much of the data

While 75 million people in the U.S. have a smart speaker at home, only 1 in 13 Americans have used a voice assistant like Alexa or Google Assistant for health care. But over one-half of consumers would like to access a voice assistant for some aspect of their health care, according to a study from Orbita and Voicebot, Voice Assistant Consumer Adoption in Healthcare. The study polled 1,004 U.S. adults 18 and over in September 2019. In 2019, few health care providers have adopted voice assistants into their workflows. The report calls out one big barrier to early adoption especially

“Listen to your patient; he is telling you the diagnosis,” Dr. William Osler is quoted to have said around the turn of the 20th century. Dr. Osler had been a strong advocate for the physician-patient conversation to inform the doctor’s diagnostic acumen and improve patient outcomes. This year is the centennial of Dr. Osler’s passing, so it’s especially timely that I introduce this post with his legendary assertion in the context of kicking off the 2019 Medecision Liberation conference. This meeting convenes the company’s clients, partners, and staff to share best practices, spark insights and learnings, and enable networking between

Patients’ experiences with the health care industry fall short of their interactions with other industries — namely online retail, online banking and online travel, a new survey from Cedar, a payments company, learned. Survata conducted the study for Cedar among 1,607 online U.S. consumers age 18 and over in August and September 2019. These study respondents had also visited a doctor or hospital and paid a medical bill in the past year. One-third of these patients had a health care bill go to collections in the past year, according to Cedar’s 2019 U.S. Healthcare Consumer Experience Study. Among those people

Older people are re-framing their personal images and definitions of aging, from continuing to work past typical retirement age, Skyping and texting with grandchildren, and traveling to destinations well beyond the “snowbird” locales of Florida and Arizona to more active and often charitable/volunteer situations in developing economies. And so, too, are older folks re-imagining how and where their health care services could be delivered and consumed. Most people over 50 years of age are cautious but open to receiving health care virtually via telehealth platforms, according to the National Poll on Healthy Aging from my alma mater, the University of Michigan. U-M’s

“Digital transformation” is the corporate strategy flavor of the moment across industries, and the health are sector isn’t immune from the trend. As this 13th year of the annual Health 2.0 Conference kicks off this week, I’m focused on finding digital health innovations that engage people — consumers, caregivers, patients, health citizens all. This year’s conference will convene thought leaders across a range of themes, and as is the Health 2.0 modus operandi, live demo’s of new-new things. As Health 2.0 kicks off today in pre-conference sessions, there is useful context described in a new report from the American Hospital

Health care system financing, delivery, and workflows widely vary across nations around the world. Philips surveyed health care professionals and consumers living in 15 countries, from North America to Asia, and found that these health systems share one over-arching objective: to provide quality care with improved experiences for both patients and healthcare professionals. Being Philips, what underpins that quality and experience is technology; Philips explored telehealth, AI, digital health records (DHRs), and other digital health tools that can engage patients. Philips published results from this global study in The Future Health Index 2019, themed “Transforming healthcare experiences, exploring the impact

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

Patients in the U.S. are confused, cost-challenged and lacking control, according to The Consumer Healthcare Paradox from Maestro Health, an employee health and benefits company. Data illustrating that “paradox” is shown in the second chart: while 78% percent of patients told Maestro Health their health care experience is positive, 69% feel they lack control over their patient journey. Quality health care in America is too expensive, 79% of consumers said. Furthermore, one in two U.S. patients had received a medical bill that was higher than they anticipated it would be. Finally, one in two U.S. patients said the quality of

A “one layered delivery network through which patients can move seamlessly as they age and their needs evolve” will be the new health care platform to meet patients’ demands by 2030, according to a forecast from KPMG’s Healthcare and Life Sciences Institute. In Healthcare 2030: The consumer at the center, the KPMG team explores the demographic shifts and market drivers that will challenge the health care industry in the current U.S. delivery and financing system. The lens on that 2030 future is a consumer-centric delivery model that KPMG believes will be a solution to dealing with a demographic divide between

By Susannah Fox, Jane Sarasohn-Kahn and Lisa Suennen I’ve lived long enough to have learned The closer you get to the fire the more you get burned But that won’t happen to us Cause it’s always been a matter of trust           A Matter of Trust, by Billy Joel If you’re in health care and don’t live under a rock, you have probably heard that United Health Group (UHG) has acquired PatientsLikeMe (PLM).  After the announcement, there was a lot of sound and fury, some of which signified nothing, as the saying goes, and some which signified a lot.

“Health is now everyone’s business,” Shaheed Peera, Executive Creative Director of Publicis LifeBrands, said this week at the 2019 Cannes Lions awards. Shaheed also led the Health & Wellness jury at Cannes Lions 2019, the mission of which is to, in the words of the award’s portal, “celebrate creativity for personal wellbeing.” The Grand Prix Lions award for Health & Wellness went to IKEA for the company’s ThisAbles campaign. ThisAbles is a project pioneered by IKEA’s team in Israel, looking to improve everyday living for people with special needs through  well-designed IKEA products. IKEA collaborated with non-profit organizations to develop

There are many forms of magic inspired by Disney, the company. There’s the obvious attraction, the Magic Kingdom, that was Walt’s original destination vision, “imagineered” in 1932. Then there are other kinds of magic. The one I’m deep into in the moment is inspiration, ideation, and “reimagineering” my own thinking about work, legacy, and social justice. I’m grateful to have had the opportunity to spend much of this week at the inaugural Disney Institute Women’s Leadership Summit. The Institute convened about 300 women (and a handful of brave “He-for-She” men keen on diversity) in Orlando to learn about and brainstorm

Most U.S. healthcare providers are spending more time, effort and capital with an eye to engaging with patients-as-consumers, a trend quantified in the report, the 2019 State of Consumerism in Healthcare: The Bar is Rising from Kaufman Hall, summarizing results from this year’s healthcare consumerism index survey conducted among about 200 healthcare providers. “Legacy organizations will need premier-level consumer capabilities to compete in today’s increasingly consumer-centric environment,” Kaufman Hall recommends. Providers identified the key capability gaps for consumer-centric care as improving the consumer experience, offering a variety of facility-based access points, utilizing digital tools for health engagement, providing price transparency,

Over the ten years between 2007 and 2017, U.S. consumer spending for education, food and health care substantially grew, crowding out spending for other categories like transportation and housing. Furthermore, income disparity between wealthy Americans and people earning lower-incomes dramatically widened: between 2007-2017, income for high-income earners grew 1,305 percent more than lower-incomes. These two statistics set the kitchen table for spending in and beyond 2019, particularly for younger people living in America, considered in  Deloitte’s report, The consumer is changing, but perhaps not how you think. The authors are part of Deloitte Consulting’s Retail team. The retail spending data