A blog covering the health/care ecosystem and people.

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

Physicians’ wellbeing dropped in July: while providers’ mental health stayed sound since June, it’s financial, physical and social health that’s dragging providers’ overall wellness down. QuantiaMD, the social network exclusively for doctors, launched the Physician Wellbeing Index in January 2012. The Index measures four aspects of physician-reported wellbeing: physical, mental, financial, and social health. QuantiaMD says it’s the world’s only measure of “how physicians are doing as people.” Based on the Index, QuantiaMD tailors content to meet the needs of the physicians in the social network. In July, the chart illustrates that doctors’ wellbeing slipped in 3 of the 4

  On Tuesday, 9 July 2012, health industry stakeholders are convening in Philadelphia for the first CONVERGE conference, seeking to ignite conversation across siloed organizations to solve seemingly intractable problems in health care, together. Why “converge?” Because suppliers, providers, payers, health plans, and consumers have been fragmented for far too long based on arcane incentives that cause the U.S. health system to be stuck in a Rube Goldbergian knot of inefficiency, ineffectiveness and fragmentation of access….not to mention cost increases leading us to devote nearly one-fifth of national GDP on health care at a cost of nearly $3 trillion…and going up.

There’s a long-held belief among us long-time health industry analysts that Americans spend more time shopping around for cars and washing machines than for health plans and doctors. Consumer Reports is betting that’s going to change, now that Consumers Union has decided to lend its valuable, trusted brand to developing report cards on physicians, having already rated hospitals and heart surgeons. CR will call their version of the doctor’s report card Patient Experience Ratings. CR has first entered the competitive medical market of Massachusetts, and has unveiled reports on 500 primary care physicians in the state. CR worked with  physician survey

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

Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs. Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey

The price of physician services, proliferation of clinical technology and the cost of obesity are the key drivers of higher health spending in the U.S., according to The Commonwealth Fund‘s latest analysis in their Issues of International Health Policy titled, Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, published in May 2012. The U.S. devotes 17.4% of the national economy to health spending, amounting to about $8,000 per person. The UK devotes about 10%, Germany 11.6%, France, 11.8%, Australia 8.7%, and Japan, 8.5%. On the physician pay front, primary care

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA. In enabling mobile physician visits, American Well and Consult A Doctor join Myca, which has offered mobile phone-based visits for clients for at least two years to employer clinic customers. In April 2010, my report, How Smartphones Are Changing Healthcare for Consumers and Providers, talked about Myca’s work with Qualcomm: the telecomms company armed traveling employees with mobile phones that could connect

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

Cue up the song “Hey Big Spender” from the Broadway hit, Sweet Charity, when you read the January 2012 AHRQ report with the long-winded title, The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009.” The report’s headline is that 1% of the U.S. population consumed 20% of all health costs spent in the U.S. in 2008 and 2009, illustrated by the chart. These Big Health Spenders tend to be in poor or fair health, older, female, non-Hispanic whites and people with only publicly-provided health insurance. Their mean expenditure was $90,061. The top 10%

Most U.S. primary care physicians realize the health of their patients is largely out of their hands — with their social needs ranking as important as addressing their medical conditions, according to the 2011 Physicians’ Daily Life Report, conducted on behalf of the Robert Wood Johnson Foundation by Harris Interactive in September-October 2011, results published in November 2011. In fact, unmet social needs are directly leading to worse health for Americans, say 9 in 10 doctors. With that recognition, most physicians feel they’re unable to address patients’ health concerns caused by unmet social needs. This has led to most doctors confessing

“56 million U.S. Consumers Access Medical Information from Electronic Health Records,” asserted Manhattan Research’s press release of October 12, 2011. This statistic, fresh out of the firm’s 2011 Cybercitizen Health survey, is among several stunning numbers that demonstrate a growing trend: U.S. health citizens’ embrace of their personal health information in digital formats, via electronic channels. To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together,

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

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

Doctors practicing in the U.S. are becoming increasingly conscious of the increasing costs of health care. Most consider themselves cost-conscious, and are considering the impact of their practice patterns — in terms of prescribing medicines, tests, and procedures — on the nation’s health bill. In fact, most physicians feel they have a responsibility to bring down health costs. This perspective on physicians comes from the survey report, The new cost-conscious doctor: Changing America’s healthcare landscape, from Bain & Company, published in March 2011. Bain spoke with over 300 U.S. physicians to assess their perspectives on managing costs, drug and device usage, and

About one-half of physician practices used an electronic health record (EHR) as of late 2010, with 36% of groups still storing health records in paper charts. While 1 in 2 physician groups in the U.S. have implemented electronic health records, they confess that they haven’t yet optimized their use. Only 16% of medical groups have implemented EHRs and believe their practices have optimized their EHRs. But optimization has its rewards: over 1 in 3 groups that have had sufficient time to fully implement their EHRs report decreased practice operating costs. Furthermore, 41% of these fully-operational EHR environments have seen physician productivity increase. With the subtitle, “snapshot of

There’s a lot of chatter about Meaningful Use in the context of electronic health records adoption; if you Googled the term today you’d find millions of references to the concept. The Centers for Medicare and Medicaid Services (CMS)’s website offers three main components of Meaningful Use as specified in The American Recovery and Reinvestment Act of 2009: – The use of a certified EHR in a meaningful manner, such as e-prescribing – The use of certified EHR technology for electronic exchange of health information to improve quality of health care – The use of certified EHR technology to submit clinical quality and other

“Life well shared” is the tagline for Reader’s Digest. The publication began in 1922 and was, until 2009, the #1 best-selling magazine in the U.S. (losing its position to Better Homes and Gardens). How does a magazine that’s over eight decades old stay relevant? More digital offerings appeared in 2010. And, in 2011, Reader’s Digest is collaborating with one of the most well-used and -respected online health social networks, OrganizedWisdom (OW). How did this collaboration come to be? I spent some quality time in February 2011 with Unity Stoakes, co-founder of OW with Steven Krein, in New York City, the geographic HQ of OW.

The majority of both doctors and people in the U.S. support sharing information to improve health care in the U.S. by reducing medical errors, cutting avoidable costs, better coordinating patient care, measuring progress on improving quality and safety, and improving public health priorities such as heart disease and obesity. What’s also clear is that both the public isn’t very familiar with the details of the HITECH Act which provides incentives for their doctors to adopt electronic health records. While 64% of doctors are familiar with the incentive program, only 14% of the public is. The Markle Foundation conducted parallel surveys to measure the public’s and doctors’ views

While 41% of small physician practices – defined as those with 9 or fewer physicians – are doing ‘worse’ than last year, doctors are generally enthused by new technology, based on Practice Fusion‘s 2011 State of the Small Practice survey. The key challenges facing doctors in small practices are the costs of operations and administrative burdens (cited by 31% of small practice physicians) and insurance reimbursement delays and payments, noted by 1 in 4 doctors in small settings. 59% of doctors in small practices said that new technology such as electronic health records (EHRs), websites and smartphones have “made things easier” for

At least one-half of U.S. patients do not believe they have the information they need to manage their conditions once they leave the doctor’s office. Furthermore, most people feel their physicians don’t communicate with them enough about specific kinds of information, including online resources, information about prescription drugs and side effects, and diet. These insights come out of a survey conducted by MedTera, a patient education and marketing firm that serves the life sciences and health care industry. Key findings from the study illustrate the chasm between patients and their doctors when it comes to people feeling equipped to manage disease

At least one-third of American adults use social media for some aspect of health. Most seek health information online, and increasingly via mobile platforms. While many physicians engage in social networks on a peer-to-peer basis in Sermo and Ozmosis, among others, most physicians have avoided social networks where their patients and health citizens interact. The American Medical Association (AMA) released guidelines to help physician members enter the social media fray. There are five areas of recommendations: Protect privacy: using settings to protect personal information and content on social networking sites Monitor internet persona: routinely monitor presence on the internet to ensure that information is accurate

Improving patient care, reducing practice costs, growing revenues and attracting new patients are top-of-mind for a majority of doctors in the U.S. What about electronic medical records (EMRs)? Not so high on physicians’ priority lists, according to the second annual health IT survey conducted in July 2010 by CompTIA. When it comes to spending on health information technology, group practices told CompTIA they plan to spend more in 2011, whereas solo practices will keep IT spending flat. Among doctors who have already implemented EMRs, they’re looking for faster systems that are easier to use, cost less, and have greater interoperability. While cloud computing

More patients find doctor is not in, NPR asserted on August 30, 2010, as part of its ongoing series covering the primary care shortage in America. To understand why this statement is so important, let’s go back to the definition of “primary care.” The American Association of Family Physicians says the domain of primary care includes the primary care physician, other physicians who include some primary care services in their practices, and some non-physician providers. Central to the concept of primary care is the patient, according to AAFP. Thus, the first definition of primary care, AAFP says, is “care provided by physicians specifically

The Affordable Care Act (ACA), aka health reform, will move 32+ million Americans to the insured population, and looks to the primary care ‘front-end’ of health care delivery to take in these newly-covered patients. Today’s USA Today reports on the primary care shortage in America. How to reconcile the influx of new patients in the U.S. health system with the deficit of primary care providers? First, the Community Health Center is one part of the solution to the primary care supply challenge. Furthermore, CHCs are integrated into ACA, seen as a key component for redesigning American health care delivery to improve quality, lower

People foresee that, in the future, the most trusted ‘channel’ for their engaging in their health will be…conversations with my doctor. This was found in the 2008 Edelman Health Engagement Barometer survey of health citizens polled in five countries — China, Germany, Russia, the United Kingdom and the United States. Those health citizens favoring the physician-conversation channel will welcome OpenNotes into their doctor-encounters behind the exam room door. The July 20, 2010, issue of the Annals of Internal Medicine talks about an initiative to, literally, open up doctors’ notes to their patients. As Dr.Tom DelBanco, et. al., attest in the article, “‘open notes’

While practice economics have always been the lifeblood for doctors’ businesses, this year, 7 of their top 10 challenges have to do with some aspect of finance: rising costs, uncertainty of Medicare reimbursement, managing compensation, negotiating payer contracts, and collecting payments from patients themselves. The other key hassle in 2010 for physicians is selecting and implementing an electronic health records system, #3 in the top-of-mind challenges for American doctors. The Medical Group Management Association, the advocacy group for physicians working in groups, published a survey this week conducted among its members in February and March 2010. Notice all the yellow shading in the chart?

Who do you trust the most in America? Nurses, pharmacists, doctors, and police officers. Who’s least trusted? Elected officials in Congress, car salesmen, stockbrockers, and…HMO managers. Gallup‘s annual Honesty and Ethics of Professions poll is out and finds that health providers and front-line health workers rank highest in the nation. Nearly 9 in 10 Americans say nurses have the highest integrity, followed by 2 in 3 Americans ranking pharmacists and doctors as high or very high. Integrity grades aren’t so high, though, for chiropractors and psychiatrists, ranked very high or high in ethics among 34% and 33% of Americans, respectively.

The Barbie doll was born in March 1959, marking this month her 50th birthday. She began life as a beach beauty and fashion model in a zebra-striped swimsuit. By 1965, she scored many careers including American Airlines Stewardess, Nurse, Teacher, and Astronaut. In 2006, USA Today named her one of the Top 101 Most Influential People Who Never Lived. It took 28 years for Barbie to morph into Doctor Barbie, shown in the photo on the left. Note the tagline printed on the front bottom of the box: “She changes from doctor to glamorous date!” This first Doctor Barbie came

I “leave” you for the year with some great, good, and less-than-sanguine expectations for health care in 2008. These are views filtered through my lens on the health care world: the new consumer, health information technology, globalization, politics, and health economics.  Health politics shares the stage with Iraq. Health care is second only to Iraq as the issue that Americans most want the 2008 presidential candidates to talk about, according to the latest Kaiser Health Tracking Poll. Several candidates have responded to the public’s interest with significant health care reform proposals. But major health reform – such as universal access