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CVS + Aetna: An Inflection Point for American Healthcare

The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal is valued at $69 billion. I wrote about this inflection point for U.S. healthcare four weeks ago here in Health Populi. CVS is both the biggest pharmacy and pharmacy benefit manager in the U.S., as the first chart shows. In my previous post, I talked about the value of vertical integration bringing together the building blocks of retail pharmacy and pharmacist care, retail clinics, the PBM (Caremark), along with Aetna’s health plan member base and business. As Amazon and other

 

Consumers Seek Health Engagement Everywhere: the Case for Alcohol and Breweries

More consumers are seeking health-making opportunities everywhere, both within and outside of traditional healthcare touch-points. That includes peoples’ consumption of beer. We learned from the Edelman Health Engagement Barometer that consumers seek to engage for health beyond healthcare organizations – namely, hospitals, providers, over-the-counter medicines, pharma and insurance. What was perhaps the most surprising industry segment consumers called on for personal health engagement was brewing and alcohol. Fully 8 in 10 consumers expect brewing and spirits companies to engage in health. The bar chart shows this finding, arraying beer and liquor producers on par with retail and consumer technology, along

 

High-Deductibles Do Not Automatically Inspire Healthcare Consumerism

It takes more than enrolling in a high-deductible health plan (HDHP) for someone to immediately morph into an effective health care “consumer.” Research from Dr. Jeffrey Kullgren and his team from the University of Michigan found that enrollees in HDHPs could garner more benefits from these plans were people better informed about how to use them, including how to save for them and spend money once enrolled in them. The team’s research letter was published in JAMA Internal Medicine on 27 November 2017. The discussion details results of a survey conducted among 1,637 people 18 to 64 years of age

 

TIME Magazine’s Best Inventions – Health-y Things and Privacy Questions

Health permeates a plethora of TIME magazine’s 25 Best Inventions of 2017. From head to foot, health is the mother of invention, based on TIME’s curation of “the best” things launched to market in the past year. Starting with “the head,” the Oculus Go virtual reality (VR) headset from Facebook. While the first function with which VR is associated is fun and games, Dr. Brennan Spiegel at UCLA Geffen School of Medicine has been proving out VR‘s value in helping patients deal with pain and medical management. Keep your eye on his and others’ research into VR’s use in healthcare. The

 

Movin’ Out(patient) – The Future of the Hospital is Virtual at UPMC

In 2016, most consultations between patients and Kaiser-Permanente Health Plan were virtual — that is, between consumers and clinicians who were not in the same room when the exam or conversation took place. Virtual healthcare may be the new black for healthcare providers. Mercy Health System in St. Louis launched a virtual hospital in 2016, covered here in the Health Populi post, “Love, Mercy, and Virtual Healthcare.” Intermountain Healthcare announced plans to build a virtual hospital in 2018. And, earlier this month, UPMC’s CEO, Jeffrey Romoff, made healthcare headlines saying, “UPMC desires to be the Amazon of healthcare.” UPMC, aka University of Pittsburgh

 

Rx Delivery to the Patient’s Door: Home Is Where the Health/Care Is

Talk about the last mile in healthcare. CVS Pharmacy will deliver prescription drugs to patients’ homes, the company announced this week. “Same-day prescription delivery gives customers the easy option of having the pharmacy they trust deliver right to their front door at no cost,” Helen Foulkes, President of CVS Pharmacy, said in the press release. Rx home delivery may not be “the” last mile to conquer all healthcare access challenges, but it’s nonetheless a signal that healthcare industry suppliers are focusing on helping patients streamline their health-consumer lives. In this case, it’s also CVS morphing towards Amazon’s Prime delivery model. Amazon

 

Evidence is Growing for Using Digital Health Apps, Says IQVIA

The evidence of the value of digital health tools is growing, based on research published in The Growing Value of Digital Health, from the IQVIA Institute for Human Data Science. With this report, the IMS Institute ushers in the organization’s new name, IQVIA Institute (THINK: “I” for “IMS,” and “Q” for “Quintiles). This is the organization’s third report on digital health, following the original analysis from 2013, updated in 2015. Here’s my take on the 2013 report, which found that 36 mobile health apps represented one-half of all downloads. On a conference call held last week, the company’s SVP and Executive

 

Health Care Is 2.5 More Expensive Than Food for the Average U.S. Family

The math is straightforward. Assume “A” equals $59.039, the median household income in 2016. Assume “B” is $18,142, the mean employer-sponsored family insurance premium last year. B divided by A equals 30.7%, which is the percent of the average U.S. family’s income represented by the premium cost of health insurance. Compare that to what American households spent on food: just over $7,000, including groceries and eating out (which is garnering a larger share of U.S. eating opportunities, a topic for another post). Thus, health care represents, via the home’s health insurance premium, represents 2.5 times more than food for the

 

A Health Consumer Perspective on CVS+Aetna

  A response to Amazon’s potential moves in healthcare and pharmacy…strategic positioning for the post-Trump healthcare landscape…vertical integration to better manage healthcare utilization and costs…these, and other rationale have been offered by industry analysts and observers of the discussions between CVS and Aetna, for the former to acquire the latter. “A pharmacy chain buying a health insurance company?” many have asked me over the past few days. These inquiring minds include people who work both inside and outside of health/care. I ask back: in 2017 and in the future, “What is a pharmacy? What is a health plan?” See the

 

Health (Healthcare, Not So Much) Abounds in Prophet’s Top 50 Brands

U.S. consumers’ most-valued brands include Apple, Google, Amazon, Netflix, Pinterest, Android, Spotify, PIXAR, Disney and Samsung, according to  the 2017 Brand Relevance Index from Prophet. The top 50 are shown in the first chart. On the second chart, I’ve circled in red the brands that have reach into healthcare, health, fitness, and wellness. Arguably, I could have circled every brand in the top 50 because in one way or another, depending on the individual, people find health “everywhere” that’s relevant to them based on their own definitions and value-systems. This is Prophet’s third year conducting this study, and I was

 

Most Consumers Would Trust a Health Info Site “Prescribed” by Their Doctor

Most consumers access the Internet for health information before they ask their doctor for the same information. But virtually everyone who goes online for health information would trust a website recommended to them by their doctor, according to the dotHealth Consumer Health Online – 2017 Research Report. This survey was conducted on behalf of dotHealth, an internet registry company channeling “.health” domains to organizations in the broad health and healthcare landscape. [FYI, both Health Populi and JaneSarasohnKahn are also registered with .health domains, having availed ourselves of this service at launch]. Six in 10 consumers who have used the internet in the

 

What Health Plans Must Learn from Amazon

One in two U.S. consumers told Aflac that enrolling in health insurance should feel like an experience on Amazon. But health consumers still lack that high benchmark retail experience with health plans, based on new research published in HealthMine’s 2017 Health Intelligence Report focusing on communication and digital healthcare tools. “Most members believe health plan communications are impersonal and centered around bills rather than healthcare guidance,” HealthMine asserts in the introduction to the report. That’s about as un-Amazon as we can imagine.   Top findings from HealthMine’s research are that: 3 in 4 consumers don’t think their health insurance plan

 

What Patients Feel About Technology, Healthcare Costs and Social Determinants

U.S. consumers feel positive about the roles of technology and social determinants in improving healthcare, but are concerned about costs, according to the 2017 Patient Survey Report conducted for The Physicians Foundation. The survey gauged patients’ perspectives across four issues: the physician-patient relationship, the cost of healthcare, social determinants of health, and lifestyle choices. Two key threads in the research explain how Americans feel about healthcare in the U.S. at this moment: the role of technology and the cost of health care. First, the vast majority of consumers view technology, broadly defined, as important for their health care. 85% of people

 

Consumers Use Digital Health Tools But Still Struggle with Health Literacy

While more U.S. patients are use digital health tools and take on more clinical and financial decision making for their health care, people also have gaps in health engagement and health literacy. Three studies published in early October 2017 provide insights into the state of healthcare consumerism in America. The 2017 UnitedHealthcare Consumer Sentiment Survey found that a plurality of Americans (45%) turn first to primary care providers (doctors or nurses) as their source for the first source of information about specific health symptoms, conditions or diseases. 28% of people also use the internet or mobile health apps as their

 

The Rx is UX: A Prescription for EHRs and Patient Engagement

It’s National Health IT Week (#NHIT Week), and I’m revisiting research published earlier this year to connect the dots between EHR implementation (good news: it’s nearly universal in doctors’ offices and hospitals) and patients embracing their health information (not-so-much). What’s missing: UX design and respect for peoples’ life-flows.  Most physician practices and hospitals in the U.S. have installed electronic health records (EHRs). But in a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse. “How do we make it easier for patients to request and manage their

 

The Patient Is The Vector: Health 2.0 – Day 2 Learnings

  Question: “What is the opposite of ‘patient-centered care?'” asked a panelist on Day 1 of the 11th Annual Health 2.0 Conference. Answer: “‘Physician-centered care.'” Even physicians today see the merits of patient engagement, as this survey from New England Journal of Medicine found earlier this year. Since the launch of the first Health 2.0 Conference in 2007, the patient has played a growing role in session content and, increasingly, on the big stage and panel breakout sessions. A panel I attended on Day 2 convened five developers of patient engagement platforms and digital tools to help healthcare look and

 

Leveraging the Essential Data of Life: Health 2.0 – Day 1 Learnings

The future of effective and efficient healthcare will be underpinned by artful combinations of both digital technologies and “analog humans,” if the first day of the Health 2.0 Conference is a good predictor. Big thoughts about a decentralized future in healthcare kicked off Day 1 of the 11th annual Health 2.0 Conference in Santa Clara, CA. The co-founders of Health 2.0 (H20), Matthew Holt and Indu Subaiya, explained the five drivers of the tech-enabled health future. 1. The new interoperability, underpinned by FHIR standards and blockchain. “FHIR” stands for fast healthcare interoperability resources, which are informatics standards that enable data

 

To Meet Health Consumers’ Digital Demands, Think Netflix and Verizon

  Health consumers have become savvy about the role of technology in their healthcare, according to a survey from Ambra, a company that is in the health cloud business. The survey paints a picture of health consumers hungry for digital health connections. The most popular activities patients do online for health were: To research symptoms and treatments To renew and/or fill prescriptions To view lab reports To make appointments To pay medical bills To correspond with the nurse or doctor To view imaging reports To get virtual care, and, To participate in patient communities. To meet patients where they want

 

Americans and Prescription Drugs: Cost, Misuse, and Self-Rationing

In 2017, Americans’ relationship with prescription drugs can be characterized in three ways: cost-rationing, misuse, and abuse. Three new studies about medicines in America paint this picture, brought to light by the AARP, Truven Analytics, and Quest Diagnostics. First, let’s look at the cost issue covered by AARP. AARP tracks the cost of prescription drugs among its constituents, namely people 50 years of age and over. The data were published in AARP’s Rx Price Watch Report, Trends in Retail Prices of Specialty Prescription Drugs Widely Used by Older Americans, 2006-2015. The average annual cost for one specialty medication used for

 

Decline in Pharmacy Reputations Related to Prescription Drug Prices, J.D. Power Finds

Cost is the number one driver among consumers declining satisfaction with pharmacies, J.D. Power found in its 2017 U.S. Pharmacy Study. Historically in J.D. Power’s studies into consumer perceptions of pharmacy, the retail segment has performed very well, However, in 2017, peoples’ concerns about drug prices negatively impact their views of the pharmacy — the front-line at the point-of-purchase for prescription drugs. In the past year, dissatisfaction with brick-and-mortar pharmacies related to the cost of drugs and the in-store experience. For mail-order drugs, consumer dissatisfaction was driven by cost and the prescription ordering process. Among all pharmacy channels, supermarket drugstores

 

Transparency in Drug Prices, from OTC to Oncology

While on vacation in Bermuda, I found a box of private label ibuprofen for $2.45 for 20 – 200mg tablets, and one for Advil PM for $10.50 for the same number of pills, same strength. I’ve just returned from a lovely week’s holiday. When I travel, whether for work or vacation, it’s always a sort of Busman’s Holiday for me as I love to seek out health destinations wherever I go. So it was natural for me to spot the Dockyard Pharmacy at the port in Hamilton and wander in. I made my way back to the well-stocked pharmacy counter,

 

Patients’ Healthcare Payment Problems Are Providers’, Too

Three-quarters of patients’ decisions on whether to seek services from healthcare providers are impacted by high deductible health plans. This impacts the finances of both patients and providers: 56% of patients’ payments to healthcare providers are delayed some of the time, noted in Optimizing Revenue: Solving Healthcare’s Revenue Cycle Challenges Using Technology Enabled Communications, published today by West. Underneath that 56% of patients delaying payments, 12% say they “always delay” payment, and 16% say they “frequently delay” payment. West engaged Kelton Global to survey 1,010 U.S. adults 18 and over along with 236 healthcare providers to gauge their experiences with

 

Cost and Personalization Are Key For Health Consumers Who Shop for Health Plans

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

 

Price-Shopping for Healthcare Still A Heavy Lift for Consumers

Most U.S. consumers support the idea of price-shopping for healthcare, but don’t practice it. While patients “should” shop for health care and perceive differences in costs across providers, few seek information about their personal out-of-pocket costs before getting treatment. Few Americans shop around for health care, even when insured under a high-deductible health plan, conclude Ateev Mehrotra and colleagues in their research paper, Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information. The article is published in Health Affairs‘ August 2017 issue. The bar chart shows some of the survey results, with the top-line finding

 

Learning From Adam Niskar – Living Beyond The Wheelchair

After diving into Walnut Lake in suburban Detroit, Adam Niskar sustained a spinal injury that would paralyze much of his body for the rest of his life. The trauma didn’t paralyze his life and living, though. But today, my family will celebrate that life at Adam’s memorial service. Adam was my cousin. He was one of the best-loved people on the planet, and that was part of a therapeutic recipe that sustained him from the traumatic accident in 1999 until Monday, July 31st, 2017, when Adam passed away from complications due to an infection that, this time around, his body

 

Pharmacies Morph Into Primary Care Health Destinations

The business and mission of pharmacies are being re-shaped by several major market forces, most impactful being uncertain health reform prospects at the Federal level — especially for Medicaid, which is a major payor for prescription drugs. Medicaid covered 14% of retail prescriptions dispensed in 2016, according to QuintilesIMS; Medicare accounted for 27% of retail prescriptions. “But if affordability, accessibility, quality, innovation, responsiveness and choices are among the standards that will be applied to any future changes, pharmacy has strong legs to stand on,” Steve Anderson, president and CEO of the National Association of Chain Drug Stores, said in the PoweRx Top 50

 

The Art of Emojis in Constipation-Conversation

“Constipation is hard. Talking about it is even harder,” reads a card I received from the senior director of marketing at Synergy Pharmaceuticals. Emojis-meet-direct-to-consumer pharmaceutical promotion in a new campaign from the drug company, which is embarking on a disease education campaign to bring greater awareness to the condition of chronic idiopathic constipation (CIC). This condition impacts 14% of the global population. The messengers for this effort are a cast of emojis who populate a continuum from constipation-to-diarrhea and every poop step in-between. Meet The Poop Troop: Stressed-Out Stooly Clogged Chris Left-Out Lumpy Plugged-Up Paulie Miss La Poop Mr. Smooth Sausage Sally

 

Patients Switch Doctors Based on Service, Not Just Care or Costs – Think “Text”

There’s more evidence of shopping behavior among patients: there’s new data showing that patients-as-consumers switch healthcare providers not due to quality of care or costs, but because of lack of service. I discovered one key verb and feature patient-consumers expect from doctors: it’s the ability to text, for appointment reminders, alerts, treatments, and communicating with the practice. SolutionReach, in the business of patient engagement, conducted a survey among 500 consumers asking about primary care providers, communication experience and satisfaction levels. The company presented the research results in a webinar on 29 June 2017. The research was also written up in

 

Consumer Experience Is An Integral Part of the Healthcare Experience

Patient satisfaction should be baked into healthcare provider service goals, according to Prioritizing the Patient Experience from West Corporation, the communications company. West is in the business of improving communications systems, and has a vested interest in expanding comms in health. This research polled patients and providers to assess how each healthcare stakeholder perceives various patient satisfaction issues, which when done well are grounded in sound communications strategy and technologies. Patient satisfaction is directly linked to the bottom lines of healthcare organizations, West contends, due to two key drivers: Evolving payment models are increasingly tying patient satisfaction to reimbursements; and,

 

Helping People On A Path to Better Health with CVS @Retail

“Helping people on their path to better health” is the mission-mantra of CVS Health. Re-branded from its previous identity as CVS/pharmacy, the organization convened a Health Innovation Summit with its vendor partners whose products fill the front-of-store shelves to empower, inspire and support consumers to manage health and wellness for themselves and their families. I was grateful for the opportunity to provide the first talk for the day, setting the context for the evolving retail health/care landscape with the consumer at the center. The consumer is, at any point in a 24-hour day: a person wearing many hats (a worker,

 

Healthcare Cost Concerns Trump All Others Across the Generations

Patients, evolving into health consumers, seek a better healthcare experience. While most people are pretty satisfied with their medical care, cost and confusion reign. This is the topline finding of a study from Oliver Wyman appropriately titled, Complexity and Opportunity, a survey of U.S. health consumers’ worries and wants. Oliver Wyman collaborated on the research with the FORTUNE Knowledge Group. Consumers’ biggest healthcare concerns deal with costs: rising insurance premiums; greater out-of-pocket costs for care not covered by insurance; and, the growing costs of prescription drugs together rank as the top 3 healthcare concerns in this study. After costs, consumers cite government

 

From Hospitality to Health-pitality to Sportspitality

“Stay well, even on the road,” welcomes the chain of EVEN Hotels. That message from a hospitality company is part of the growth of the retail health landscape, driven by consumers’ desire to live well and make healthy decisions every day – even during business trips. The message is that, “Wellness is more than a word. It’s your way of life. But when it’s time to travel, it all falls apart,” Who among us road warriors for work doesn’t get that message? This is a real trend that engaged health consumers have begun to demand. A friend of mine traveled this week

 

Amazon’s Health Care Building Blocks

In the past few weeks, two announcements from Amazon point to a strategy, whether intended or my dot-connecting, that the ecommerce leader has the health of its customers in its sights. In late May, CNBC first published the news that Amazon was seeking out a candidate to be a general manager for a pharmacy business. Here’s the video telling the story. Getting into the retail pharmacy channel is in itself a huge message to this health industry segment, which is very competitive between chain pharmacies (led by CVS, Walgreens, and Rite-Aid), grocery pharmacies (the largest of which are Kroger and

 

As High Deductible Health Plans Grow, So Does Health Consumers’ Cost-Consciousness

A person enrolled in a high-deductible health insurance plan is more likely to be cost-conscious than someone with traditional health insurance. Cost-consciousness behaviors including checking whether a plan covers care, asking for generic drugs versus a brand name pharmaceutical, and using online cost-tracking tools provided by health plans, according to the report, Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey from EBRI, the Employee Benefit Research Institute. A high deductible is correlated with more engaged health plan members, EBRI believes based on the data. One example: more than one-half of people enrolled

 

The Consumer Trust Deficit In Health Engagement

While trust in major institutions is eroding the world over, peoples’ trust in healthcare is on the rise, according to the 2017 Edelman Trust Barometer. Still, compared to other industry sectors, healthcare is still barely positive — and just one spot ahead of financial services. When it comes to trust, “the healthcare industry is making slow but steady progress,” notes Kym White who leads Edelman’s healthcare practices. Consumers’ trust in the five healthcare segments of pharmaceutical/drug companies, consumer health/over the counter, biotech/life sciences, insurance and hospitals/clinics is improving over 2016. In the U.S., for pharma and biotech, trust is reversing a

 

Everyone wants to change American health care: seeking a quality, patient-centric system

Americans don’t agree on much these days in our 50/50 world. But there’s one area of universal agreement among citizens: changing the health system. Rich, lower income, New Englanders, Southerners, Dems and Republicans — all want change when it comes to health care. According to the latest Commonwealth Fund survey, Public Views on U.S. Health System Organization: A Call for New Directions, 8 in 10 Americans believe the U.S. health system needs “fundamental change” or “complete rebuilding.” As people have adopted information technologies in their daily lives in the form of wireless phones, broadband, and “project managing” life tools online