A blog covering the health/care ecosystem and people.

Americans are most worried about healthcare costs among all financial concerns; most people in the U.S. also believe the Federal government should ensure that all people have health coverage. Two polls published in the past week point to the fact that most U.S. health citizens are concerned about health care for themselves and their families, driving a growing proportion of people to favor a single-payer health system. The first line chart illustrates a dramatic trajectory up of the number of American identifying healthcare costs as their #1 financial problem, rising from 10% of people in 2013 to 17% in 2017.

Most US adults favor some kind of national health care plan, based on an Economist/YouGov poll conducted in April 2017. Six in ten people are for expanding so-called “Medicare for All,” where the health plan that currently serves older Americans would extend to all U.S. health citizens. Six in ten people would also favor a Federally-funded health insurance system that would cover all Americans — that is, universal health care. The table details this poll question by political party identification and family income. At least 3 in 4 Democrats would be more likely to favor either of the two healthcare

The American Psychological Association reports that Americans are experiencing greater levels of stress in 2017 for the first time since initiating the Stress in America Survey ten years ago in 2007. This is a statistically significant finding, APA calculated. The member psychologists of the American Psychological Association (APA) began to report that patients were coming to appointments increasingly anxious about the 2016 Presidential election. So the APA polled U.S. adults on politics for the first time in ten years of conducting the Stress in America survey. Two-thirds of Americans are stressed and/or anxious about the future of the nation, and

Health care is the top concern of American families, according to a Monmouth University Poll conducted in the week prior to Donald Trump’s Presidential inauguration. Among U.S. consumers’ top ten worries, eight in ten directly point to financial concerns — with health care costs at the top of the worry-list for 25% of people. Health care financial worries led the second place concern, job security and unemployment, by a large margin (11 percentage points) In third place was “everyday bills,” the top concern for 12% of U.S. adults. Immigration was the top worry for only 3% of U.S. adults; terrorism and

A plurality of Americans, 4 in 10, are dissatisfied with the healthcare costs they face. The level of dissatisfaction varies by a consumer’s type of health insurance, while overall, 42% of people are dissatisfied with costs… 48% of privately insured people are dissatisfied with thei healthcare costs 29% of people on Medicare or Medicaid are dissatisfied 62% of uninsured people are dissatisfied. Gallup has polled Americans on this question since 2014 every November. Dissatisfaction with healthcare costs is up from 38% from the period 2011-2013. As the line chart illustrates, the current levels of cost-dissatisfaction are similar to those felt

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

Healthcare is going direct-to-consumer for a lot more than over-the-counter medicines and retail clinic visits to deal with little Johnny’s sore throat on a Sunday afternoon. Entrepreneurs recognize the growing opportunity to support patients, now consumers, in going shopping for health care products and services. Those health consumers are in search of specific offerings, in accessible locations and channels, and — perhaps top-of-mind — at value-based prices as defined by the consumer herself. (Remember: value-based healthcare means valuing what matters to patients, as a recent JAMA article attested). At this week’s tenth annual Health 2.0 Conference, I’m in the zeitgeist

  Three years after the launch of the Affordable Care Act (ACA), the big picture of employer-sponsored health benefits in the U.S. show stability, with modest changes in costs being kept in check by a growing younger workforce, according to the 2016 ADP Annual Health Benefits Report. Roughly 9 in 10 employees in large companies are eligible to participate in health insurance plans at the workplace, with two-thirds of people participating, shown in the chart. Younger people, under 26 years of age, have much lower participation rates than those over 26, with many staying on their parents’ plans (taking advantage of

“Take Governor John Kasich’s explanation for expanding Medicaid: ‘For those that live in the shadows of life, those who are the least among us, I will not accept the fact that the most vulnerable in our state should be ignored. We can help them.’” So quotes President Barack Obama in the Journal of the American Medical Association, JAMA, in today’s online issue. #POTUS penned, United States Health Care Reform: Progress to Date and Next Steps. The author is named as “Barack Obama, JD,” a nod to the President’s legal credentials. Governor Kasich, a Republican, was one of 31 Governors who

Reluctantly accepting the Affordable Care Act, health executives and their architects now see opportunities for re-imagining the hospital and health care services, according to Healthcare Industry Trends, a publication that’s part of the 2015 Building & Development Leadership Series provided by Mortenson, a construction services firm that’s active with healthcare organizations. Mortenson conducted a survey at the 2015 ASHE Planning, Design, and Construction Summit, the results of which were published in this report. The over 300 respondents included healthcare executives, facilities managers, and healthcare architects. Thus the lens on the data in this survey is through the eyes of physical

The top 3 urgent health problems facing the U.S. are closely tied for first place: affordable health care/health costs, access to health care, and the Ebola virus. While the first two issues ranked #1 and #2 one year ago, Ebola didn’t even register on the list of healthcare stresses in November 2013. Gallup polled U.S. adults on the biggest health issues facing Americans in early November 2014, and 1 in 6 people named Ebola as the nation’s top health problem, ahead of obesity, cancer, as well as health costs and insurance coverage. Gallup points out that at the time of

Concerns about Death Panels and government restricting health services for people that have been key arguments used against the Affordable Care Act’s (ACA) detractors and, even before the advent of the ACA, proposed health reforms under President Clinton. But it’s peoples’ self-rationing in the U.S. health system that’s causing true rationing — driven by high deductible health plans (HDHPs) that are fast-growing in the health insurance market, and by the high cost of specialty drugs and prescriptions. There are plenty of data demonstrating the consumer health rationing trend being collected and reviewed by think tanks like RAND here, and by The

It’s Independence Day week in America, and our British friends at The Lancet, the UK’s grand peer reviewed medical journal, dedicate this week’s issue to the Health of Americans – exploring life, death (mortality), health costs, chronic disease, and the Pursuit of Healthiness. This project is a joint venture between The Lancet and the U.S. Centers for Disease Control (CDC) which took 18 months to foster, called The Health of Americans Series. Americans mostly die from chronic diseases, aka non-communicable diseases, which are largely amenable to lifestyle changes like eating right, quitting smoking, drinking alcohol in moderation, and moving around more. 1 in

Three-quarters of us are concerned about health care, a fraction fewer than those of us worried about the economy. Underneath stress about healthcare, people are worried about costs and the impact of the Affordable Care Act (ACA). Say hello to the Healthcare Worry Scale, developed by Chase Communications, a firm focused on marketing and media, largely in the health industry. Chase found that: – 93% believe that their health care costs will continue to increase – 49% say the ACA’s impact is a “major” worry – 43% say getting a disease, medical condition, or injury that health insurance doesn’t fully

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

In health care, when money is tight, labor inputs like nurses and doctors stretched, and patients wanting to be treated like beloved Amazon consumers, what do you do? Why, innovate and thrive. This audacious Holy Grail was the topic for a panel II moderated today at the Connected Health Symposium, sponsored by Partners Heathcare, the Boston health system that includes Harvard’s hospitals and other blue chip health providers around the region. My panelists were 3 health ecosystem players who were not your typical discussants at this sort of meeting: none wore bow ties, and all were very entrepreneurial: Jeremy Delinsky

By 2022, $1 in every $5 worth of spending in the U.S. will go to health care in some way, amounting to nearly $15,000 for each and every person in America. From biggest line item on down, health spending will go to payments to: Hospitals, representing about 32% of all spending Physicians and clinical costs, 20% of spending Prescription drugs, 9% of spending Nursing, continuing care, and home health care, together accounting for over 8% of health spending (added together for purposes of this analysis) Among other categories like personal care, durable medical equipment, and the cost of health insurance.

In game-scoring unit terms, 52 is the number of hours an average American spends seeking health information online each year. The 1 (hour) is roughly equivalent to the approximate total time a patient spends with a physician (an average of 3 visits, with an average time per vision of 20 minutes). Thus, 52:1. This means that the average U.S. health consumer spends much more time DIYing her health using digital information resources than speaking face-to-face with their physician in the doctor’s office. Still, the physician continues to be a go-to source for health information, according to Makovsky, a health communications

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

Most Americans don’t understand what a health savings account (HSA) is – including people who are enrolled in the plans. While health literacy is generally acknowledged to be a public health challenge in America, health insurance literacy is not well recognized. Yet in the emerging consumer-directed health plan era of U.S. health care, peoples’ lack of understanding of health financial accounts will get in the way of people who really need care seeking care at the right time. This leads to greater health spending later when the consumer-patient can develop a health condition that could have been prevented (say, pre-diabetes

Insurance premium costs grew 4% for families between 2012 and 2013, with workers now bearing 39% of health premiums in 2013 compared with only 26% ten years ago, in 2003. That’s a 50% increase in health plan premium “burden” for working families, by my calculation. This snapshot of health insurance in 2013 comes to us from the 2013 Employer Health Benefits Survey, provided by the Kaiser Family Foundation (KFF) and the Health Research & Educational Trust (HRET). This research is one of the most important annual reports to hit the health care industry every year, and this year’s analysis provides strategic context

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions? Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange. This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces. What’s driving this new wrinkle in retail health care are: U.S. health citizens morphing into consumers,

3 in 4 Americans say that out-of-pocket costs are the main reason they decide whether or not to seek preventive care, in A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans from TeleVox, the communications company, published in June 2013. TeleVox surveyed over 1,015 U.S. adults 18 and over. That’s the snapshot on seeking care externally: but U.S. health consumers aren’t that self-motivated to undertake preventive self-care separate from the health system, either, based on TeleVox’s finding that 49% of people say they routinely exercise, and 52% say they’ve attempted to improve eating habits.

In June 2013, even though news about the economy and jobs is more positive and ObamaCare’s promise of health insurance for the uninsured will soon kick in, most Americans are concerned about (1) money and (2) the costs of health care. The Kaiser Health Tracking poll of June 2013 paints an America worried about personal finances and health, and pretty clueless about health reform – in particular, the advent of health insurance exchanges. Among the 25% of people who have seen media coverage about the Affordable Care Act (alternatively referred to broadly as “health reform” or specifically as “ObamaCare”), 3

The only type of health plan whose membership grew in 2012 was the consumer-directed health plan (CDHP), according to a survey from Mercer, the benefits advisors. Two-thirds of large employers expect to offer CDHPs by 2018, five years from now. 40% of all employers (small and large) anticipate offering a CDHP in five years. The growth in CDHPs going forward will be increasingly motivated by the impending “Cadillac tax” that will be levied on companies that currently offer relatively rich health benefits. Furthermore, Mercer foresees that employers will also expand wellness and health management programs with the goal of reducing health

In the $3 trillion economy that is American health care, the role of information technology is central to transforming this huge piece of U.S. fiscal activity. This week convened the fourth annual Health Datapalooza (HDP) in Washington DC, with the underlying theme, “health engagement is the blockbuster drug of the 21st century” (quoting Leonard Kish). This meeting of over 2,000 registrants – huge growth from the first year’s 400 attendees — is organized by the Health Data Consortium (HDC) , whose CEO Dwayne Spradlin kicked off remarks on Day 2 of HDP4. He described the HDC, a public-private collaboration led

Nearly 100% of employers are likely to continue to provide health insurance benefits to workers in 2014, moving beyond a “wait and see” approach to the Affordable Care Act (ACA). As firms strategize tactics for a post-ACA world, nearly 40% will increase emphasis on high-deductible health plans with a health savings account, 43% will increase participants’ share of premium costs, and 33% will increase in-network deductibles for plan members. Two-thirds of U.S. companies have analyzed the ACA’s cost impact on their businesses but need to know more, according to the 2013 survey from the International Foundation of Employee Benefit Plans (IFEBP).

U.S. employers have been implementing various flavors of consumer-directed health plans for the better part of a decade. But consumers feel neither “directed” nor especially competent in managing their way through these plans. It appears that employers also have their own sort of health plan illiteracy when it comes to understanding health reform — the Affordable Care Act — according to the 2013 Aflac WorkForces Report (AWR) based on a survey of 1,900 benefits managers and over 5,200 U.S. workers conducted in January 2013. While you might know the Aflac Duck, you may not be aware that Aflac is the

Strange political bedfellows have come together to draft a formula for dealing with spiraling health care costs in the U.S. iin A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment from the Bipartisan Policy Center (BPC). The BPC was founded by Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. This report also involved Bill Frist, Pete Domenici, and former White House and Congressional Budget Office Director Dr. Alice Rivlin who together work with the Health Care Cost Containment Initiative at the BPC. The essence of the 132-page report is that the U.S. health system is

  Patient satisfaction survey scores have begun to directly impact Medicare payment for health providers. Health plan members are morphing into health consumers spending “real money” in high-deductible health plans. Newly-diagnosed patients with chronic conditions look online for information to sort out whether a generic drug is equivalent to a branded Rx that costs five-times the out-of-pocket cost of the cheaper substitute. While health care report cards have been around for many years, consumers’ need to get their arms around relevant and accessible information on quality and value is driving a new market for a Yelp, Travelocity, or Zagat in

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

If you receive health insurance benefits from your employer, you’ll see a new line item on your W-2, courtesy of the Internal Revenue Service: the cost of employer-sponsored group health plan coverage. This new piece of data, shown in Box 12, DD information, comes as part of health reform, The Affordable Care Act, which requires employers with over 250 workers to show how much they spend on employer-sponsored health benefits in total. This is the employer’s premium cost, and does not include the covered worker’s out-of-pocket spending (e.g., copays, coinsurance and deductibles). It is being furnished on W-2’s “for informational

Costco and Aetna announced that the Big Box retailer would expand its marketing of Aetna health insurance policies to card-carrying members in California. Costco has already been selling health insurance through stores in Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas and Virginia. Later in 2013, Aetna plans will be available in Costco stores in other state markets. BTW, Costco operates stores in 42 U.S. states (as well as Canada, the UK, Taiwan, Korea, Japan, Australia, and Mexico). All together, the company serves 37 million households. The Costco Personal Health Insurance Program offers five plans, a network of health providers, and

There’s good news on the macro-health economics front: the growth rate in national health spending in the U.S. fell in 2011, according to an analysis published in Health Affairs January 2013 issue. Furthermore, this study found that consumers’ spending on health has fallen to 27.7% of health spending, down from 32% in 2000, based on three spending categories: 1. Insurance premiums through the workplace or self-paid 2. Out-of-pocket deductibles and co-pays 3. Medicare payroll taxes. A key factor driving down health spending is the growth of generic drug substitution for more expensive Rx brands. Generics now comprise 80% of prescribed

Bob Blendon and his can-do team at the Harvard School of Public Health have done the heavy lifting for us by analyzing 36 telephone polls (that’s “polls,” not “poles”) looking at the role of health reform in the 2012 election cycle. I knew Bob Blendon when I was affiliated for a decade with Institute for the Future, and Blendon was affiliated as well as health politics consultant to the health team. He is the guru on this topic, so when I spotted his article, Understanding Health Care in the 2012 Election in this week’s New England Journal of Medicine, I dashed

There were nearly 6 million patient visits to retail health clinics in 2009. Such visits to retail clinics rose four-fold between 2007 and 2009, according to a RAND study published in the September 2012 issue of Health Affairs. Visits for prevention versus acute care in 2009 were roughly evenly split, with 47.5% and 51.4% of people over 18 seeking prevention vs. acute care from retail clinics, respectively. The most common acute care complaints in the retail setting were upper respiratory infections, pharyngitis, otitis externa, conjunctivitis, urinary tract infections, and allergies. What’s underneath the impressive rise is important to parse out

Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in

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

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

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

There’s intriguing fine print in the latest CBO analysis on the impact of the Affordable Care Act (ACA) on employer-sponsored health insurance in the U.S. CBO finds there will be 3 to 5 million working Americans without employer-sponsored health insurance due to the implementation of the ACA, according to the report, CBO and JCT’s Estimates of the Effects of the Affordable Care Act (ACA) on the Number of People Obtaining Employment-Based Health Insurance. Originally, the CBO and Joint Committee on Taxation (JCT) estimated that the number of people obtaining health insurance coverage through their employer would be 3 million people lower in 2019 under

Chronic illness represents $3 of every $4 of annual health spending in the U.S. That’s about $1.5 trillion. Living Well With Chronic Illness, a report from The Institute of Medicine (IOM), issues a “call for public health action” to address chronic illness through: – Adopting evidence-based interventions for disease prevention – Developing new public policies to promote better living with chronic disease – Building a comprehensive surveillance system that integrates quality of life measures, and – Enhancing collaboration among health ecosystem stakeholders: health care, health, and community non-healthcare services. The IOM recognizes the social determinants that shape peoples’ health status

To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow. However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in

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

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 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

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context, The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350 The car buyer could purchase a Mini-Cooper with $20,000 The investor could invest $20K to yield $265,353 at a 9% return-on-investment. The MMI increased 7.3% between 2010 and 2011, about the same

Differences in race, ethnicity and income drive online health disparities, according to a poll from The Washington Post/Kaiser Family Foundation (KFF)/Harvard University Race and Recession Survey, based on data from early 2011. The underlying issue here is the online digital divide, which still persists for African Americans and Hispanics of lower socioeconomic status. Overall, 84% of U.S. adults use the Internet or email at least occasionally. However, only 69% of African Americans and 64% of Hispanics with less than $40,000 annual income use the Internet or email. However, income flattens Internet/email use: for people who earn over $40K a year, 95% of whites, 94% of African