A blog covering the health/care ecosystem and people.

J.D. Power, the company best known for evaluating consumers’ experiences with automobiles, published its 2016 Fitness Band Device Satisfaction Report this week. The bar chart summarizes overall satisfaction with activity tracking wristbands, led by Samsung with the highest index score, followed by Garmin. Below the average index were LG, Fitbit, and Jawbone. Samsung’s top grade translates into J.D. Power’s methodology as “among the best” fitness bands, based on a 1,000 point scale. Samsung’s high ranking was earned based on particularly strong scores for customer satisfaction in comfort, reliability, and ease of use. Garmin’s customer service was also highly rated, along

“Work is the second most common source of stress, just behind financial worries,” introduces The Business of Healthy Employees report from Virgin Pulse, the company’s 2016 survey of workplace health priorities published this week. Virgin Pulse collaborated with Workforce magazine, polling 908 employers and 1,818 employees about employer-sponsored health care, workers’ health habits, and wellness benefit trends. Workplace wellness programs are becoming more holistic, integrating a traditional physical wellness focus with mental, social, emotional and financial dimensions for 3 in 4 employers. Wearable technology is playing a growing role in the benefit package and companies’ cultures of health, as well

Coloring books are best sellers in bookstores, craft merchandisers, newspaper stands, and on Amazon. Now, they’re joining the health and wellness world. The market growth of coloring books has been recognized in national media like the Washington Post, who called the phenomenon, “a bright spot in the financial results of publishers and retailers alike.” Nielsen Bookscan estimated that 12 million were sold in 2015, up from 1 million in 2014. Publishers Weekly covered the craze in November 2015. A Forbes column said, “The adult coloring craze continues and there is no end in sight.” Some of the mental health benefits

Hippocrates is often quoted as saying, “Let food be thy medicine and medicine be thy food.” While some researchers argue that Hippocrates knew the difference between ‘real’ medicine and clinical therapy, there’s no doubt he appreciated the social determinant of health and wellness that food was 1,000 years ago and continues to be today. Taking a page, or prescription note, from the good doctor’s Rx pad, food retailers, healthcare providers, local food banks, and State healthcare programs are working the food-as-medicine connection to bolster public health. One approach to food-as-medicine is promoting the purchase of fresh fruits and vegetables — the

There’s growing recognition of the role of food in health, on both the supply side of grocers, food growers and consumer marketers; and, among consumers who are, increasingly, shopping for food with health on their minds. 8 in 10 consumers in the U.S. enter a grocery store thinking about the health attributes of what they’re about to choose from the aisles that are stocked with more gluten-free, GMO-labelled, and organic products, according to the 2015 Deloitte Pantry Study. Our physicians have begun to “prescribe” food, especially as the collective BMI of Americans has reached medically catastrophic levels. See this forecast from

Nearly 1 in 2 people own at least one wearable device, up from 21% in 2014; one-third of people own more than one such device that tracks some aspect of everyday life, according to PwC’s latest research on the topic, The Wearable Life 2.0 – Connected living in a wearable world, from PwC. Wearable technology in this report is defined as accessories and clothing incorporating computer and advanced electronic technologies, such as fitness trackers, smart glasses (e.g., Google Glass), smartwatches, and smart clothing. Specifically, 45% of people own a fitness band, such as a Fitbit, the most popular device in this

Faced with the increasing financial responsibility for healthcare payments, and a desire to manage pain and disease via “natural” approaches, more U.S. consumers are seeking and paying for non-conventional or naturopathic therapies — complementary and alternative medicine (CAM). Health and Healing in America, The Harris Poll conducted among U.S. adults, learned that two in three Americans see alternative therapies as safe and effective. 1 in 2 people see alternative therapies as reliable. And most people believe that some of these treatments, like chiropractic and massage therapy, should be reimbursed by health insurance companies. Seven in 10 Americans have used alternative

Where you live in America determines what you might pay for healthcare. In this health economic scenario, as Napoleon is rumored to have said, “geography is destiny.” If you’re searching for low-cost health care, Ohio may just be your state of choice. The map illustrates these health care disparities across the U.S. in 2015, when the price of a single service could vary by more than 200% between one state and another: say, Alaska versus Arizona, or Wisconsin compared to Florida. Even within states, like Ohio, the average price of a pregnancy ultrasound in Cleveland ran nearly three times that received in

The most prestigious occupation in America is being a doctor, agreed by 90% of U.S. adults. 90% of them would also encourage their child to pursue a career in medicine. Politician? 70% of parents would discourage a child from pursuing that career path, according to The Harris Poll’s survey on occupational prestige. The top-prestige professions are: Doctor, agreed by 90% Scientist, 83% Firefighter, 80% Military officer, 78% Engineer, 76% Nurse, 76% Architect, 72% Emergency medical tech, 72% Veterinarian, 71% Police office, 67%% Teacher, 65% Entrepreneur, 65% Chef, 62% Athlete, 62% Lawyer, 62% Musician, 61%. All other professions fell below 60%

People who more consistently track their calories and food intake are more likely to be fiscally fit than people who do not, suggesting a link between healthy eating and financially wellness. I learned this through a survey conducted in February 2016 among 4,118 people using the Lose It! mobile app, which enables people to track their daily nutrition. Some 25 million people have downloaded Lose It! The app is one of the most consistently-used mobile health tools available in app stores. The Rutgers School of Environmental and Biological Sciences has explored the financial impact of improved health behaviors, asserting that,

Today is International Women’s Day. Being a woman is a social determinant of health (for the worse). To mark the occasion of the Day, The International Labour Organization (ILO) published a report on women and work yesterday, finding that in the 178 countries studied, inequality between women and men persists across labor markets. And while there’s been progress in women’s education over the past twenty years, this hasn’t resulted in women advancing career paths and wage equality. It struck me this morning, reading both (paper versions of) the Wall Street Journal and the Financial Times that the latter had two FT-sponsored ads marking

“The best healthcare must involve kindness and instill trust,” reads the title of a Huffington Post UK article written by David Haslam, Chair of NICE, the National Institute for Health and Care Excellence. NICE (an appropriate acronym for the article’s sentiment) is in fact not an institution known for charity or do-goodness, but is the organization that is charged with assessing the cost-effectiveness and -benefit of medical innovations — drugs, devices, procedures and processes. Haslam writes that kindness and trust connote “care, community and friendship.” These factors have a profound impact on health outcomes, Haslam has observed. Trust drives health

All over the world, people define their health and wellness across many dimensions…physical, mental, financial, and appearance. In Florence, Italy, I happened upon a riff on this last component on “look good, feel good” at the Coin Department store located on Via Del Calzaiuoli in central Firenze. Welcome to Coin’s Health&Beauty Store. The two photos tell a story about health, where we live, work, play, and shop, the mantra for public health focused on the social determinants of health beyond healthcare. Here at Coin, adjacent to the holistic brands of Clarins and other luxury labels, is a pharmacy along with

In a growing on-demand society, coupled with a burden of more out-of-pocket health care costs, U.S.health consumers tend to vote with their pocketbooks for healthcare based on cost and convenience, at least when it comes to prescription drug demand, according to the Finn Futures Health Poll conducted by Finn Partners. The survey was conducted in November 2015 among 1,000 U.S. online adults. 51% of consumers have been with their current health plans and primary care physicians for three years or less, which Finn Partners sees as a sign that brand loyalty isn’t a top motivation for health consumers signing on

Most people in the U.S. acknowledge that their richest country in the world has a broken healthcare system, especially when it comes to costs. A handful of think tanks and lawmakers offer fixes for American healthcare. Now there’s a new problem-solver in healthcare town, Health:Further, and they aim to move U.S. health forward by building bridges between stakeholders in the U.S. health ecosystem. My longtime colleague and friend, Andre Blackman of Pulse+Signal, has joined the organization as “Producer.” Here, we’ll learn more from my (JSK) interview with Andre (AB) about the organization, their mission, and plans to go beyond “disruption”

“It depends” is the hedge-phrase that characterizes how Americans see disclosing personal information versus keeping private information private, according to the consumer survey report, Privacy and Information Sharing, published by the Pew Research Center (PRC) in January 2016. U.S. adults see a privacy trade-off, living in the convenience-context of 21st century digital economy in exchange for some form of value. The “it depends” is a factor of what kind of data is geing collected, especially by third parties, how long that data area retained, for what use — vis-à-vis what a person is trading in return which could be a hard dollar

As we concluded our panel on The Wizards of Maternal Health kicking off today’s launch of the 2016 Digital Health Summit, co-located with the 2016 CES (Consumer Electronics Show) in Las Vegas, our diverse team concurred that there’s more than enough “technology” on the convention floor. The challenge now for health is to make connections between the islands of devices, and generate meaningful data and culturally contextual information and support for consumers (patients, caregivers, people) and health providers. Here at the CES, it’s all about the supply side of the equation – for health, that means digital health tools, wearables,

It’s Christmastime, so I’m thinking about connections. “Connectivity” can be social (offline and online), which is indeed a health factor (see Christakis and Fowler on being Connected). But the kind of connectivity to which I’m referring is broadband, WiFi, the kind most often associated with data plans, cable to the home, and free WiFi at your favorite coffee or fast food joint. That kind of connectivity is also a social determinant of health, and is increasingly becoming so for all people. Yet as peoples’ need for internet connectivity is fast growing, especially for health, home broadband connectivity has reached a

Among TIME magazine’s 25 best inventions of 2015, most relate directly or adjacently to health and health care. Among the 25 are: The EKO Stethoscope A gluten-sniffing sensor, the 6SensorLabs Nima The Sproutling baby monitor Nike Flyease 8 shoes, that you can tie with one hand Cogni-Toys Dino, the toy that talks back A smart refrigerator that can fix you a glass of nutrient-enriched water The TZOA environmental tracker for personal pollution sensing, measuring atmosphere in a specific area (e.g., temperature, particulates such as dust, pollen, mold, and car exhaust), and UV ­exposure Doppler Labs Here Active Listening earbuds The

Food + Drink, Beauty, Tech + Innovation, Retail, Lifestyle…JWT pulls out their crystal ball for 2016, and I see health, everywhere. The Future 100 – Trends and Change to Watch in 2016 is J. Walter Thompson Intelligence Innovation Group’s annual trend forecast, which I highly value and mine each year to help THINK-Health continue to hone our own environmental analyses for health and healthcare. [Here’s what I wrote one year ago about JWT’s 2015 forecast]. Health is baked into JWT’s 2016 trendscape, well beyond their “Health” chapter. Even the report’s introduction is health-flavored: “As forecasters, we’re watching the rapid metabolism

For the first time since 2008, a majority of Americans say government is responsible for ensuring that people have health insurance. The first chart shows the crossing lines between those who see government-assured health insurance in the rising dark green line in 2015, and people who see it as a private sector responsibility. The demographics and sentiments underneath the 51% are important to parse out: people who approve of the Affordable Care Act are over 3x more likely to believe in government sponsoring health insurance versus those who disapprove, 80% compared with 26%. The demographic differences are also striking, detailed

The Old School retail clinic is going beyond checking your child’s ear infection and sore throat, giving immunizations and filling out back-to-school forms just-in-time over LaborDay  weekend. The new-new retail clinic is supporting patients’ chronic disease management, partnering with academic medical centers, and bolstering medication management. Accenture’s bullish forecast is titled “US Retail Health Clinics Expected to Surge by 2017,” making the case that these brick-and-mortar providers are shifting from a relatively limited retail scope to a broader and deeper clinical focus. The so-called surge in the number of retail clinics is projected to be nearly 50% growth between 2014 and 2017,

Consumers are most concerned about health care costs among their kitchen table issues, above their ability to afford the utility bill, housing, food, or gas and transportation costs. The October 2015 Kaiser Family Foundation Health Tracking Poll finds 4 in 10 Americans finding it difficult to afford health care, including 16% of people earning $90,000 a year or more. Underneath that worrying healthcare cost umbrella are the price of prescription drugs, which the majority of Democrats, Independents, and Republicans all agree need to be “limited” by government regulation. Ensuring that the public have affordable access to high-cost drugs for chronic conditions

The fastest-growing category of products and services at Health 2.0 is consumer-facing digital health, and a panel of companies demonstrated various flavors of the New Retail Health. One of the most prominent companies featured in Health 2.0’s conferences from the inception has been MyFitnessPal (MFP), a long-time helpful tool I’ve used to manage my own health-life. Under Armour acquired MFP earlier this year, which I covered here in Health Populi. Under Armour’s original mission was to make all athletes better. With the company’s acquisition of MyFitnessPal, Under Armour continued its morphing from a textile and sports gear company to a

8 in 10 people in the U.S. say that Medicare as well as private health insurance plans should pay for discussions held between patients and doctors about hatlhcare at the end-of-life. The September 2015 Kaiser Family Foundation Health Tracking Poll asks people their opinions about talking end-of-life with their doctors. The vast majority of people support the concept and physicians being paid for holding such conversations in doctor-patient relationship. The question is germane because the Obama Administration has announced plans to pay doctors for office visits to discuss end-of-life (EOL) issues with Medicare patients. There isn’t a huge variation across

Direct-to-consumer retail health options are fast-growing in the U.S. health ecosystem. CVS Health brought three telemedicine vendors to its pharmacy brick-and-mortar stores. CVS also acquired Target’s pharmacies, expanding its retail health footprint. Rite Aid has added HealthSpot kiosks to its pharmacies, while Walgreens expanded its relationship with MDLive. And, Cox Cable acquired Trapollo to bring remote health monitoring into subscribers’ homes, along with the cable company’s venture with Cleveland Clinic, Vivre Health. Coupled with the growing supply side of telemedicine vendors, the latest National Business Group on Health survey found that most large employers plan to expand the telemedicine services they

Will fitness tracking take off in middle and rural America? The larger question is whether people really, truly want to engage in health and, if so, how? My colleague and friend Dr. Carol Torgan, who curates the most extensive wearable tech Pinterest board and writes extensively about the subject in her blog Kinetics: From Lab Bench to Park Bench, was struck by my recent blog post, Health, Wearables and the IoT in the Windy City. That weekend I was in Chicago, Carol was visiting a rural region in the state of Virginia and spent time at a county fair. The quintessential

Most consumers think favorably when they picture doctors, food manufacturers, banks, and airlines. But the pharma industry continues to be lumped with Big Oil and health insurance in the minds of U.S. consumers, industries for which more than 50% of people in America share unfavorable impressions. The August 2015 Kaiser Family Foundation Health Tracking Poll focuses a lot on the pharmaceutical industry. The link to the poll is here: http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/ Key findings from the survey tell a story about a health citizenry highly suspicious of pharma: 72% of Americans think that drug costs are unreasonable 74% of people think patients in

From elite soccer and football fields to youth athletes in public school gyms, wearable technology has come to sports bringing two big benefits of gathering data at the point of exercise: to gauge performance and coach back to the athlete in real time, and to prevent injury. I discussed the advent of the Internet of Things in sports on the Scoop and Score podcast with Andrew Kahn, sports journalist and writer, and Stephen Kahn, sports enthusiast and business analyst. [In full disclosure these two Kahn’s are also my brilliant nephews.] We recorded the podcast on July 14, 2015, the day

Patients in the U.S. are transforming into health care consumers, and in 2015 there are 3 underlying forces shaping that new consumer. This week kicks off the annual BIO conference in Philadelphia, and today Klick Health, the digital communications firm, convenes a group of thought leaders in healthcare to brainstorm markets, financing, and the state of pharmaceutical and life science innovation. An underlying theme throughout this meet-up is patient’s role in health/care. Patients are people, consumers, caregivers, mothers, fathers, sisters, brothers, friends, neighbors, community members, taxpayers, all. We’re old, we’re young, we’re mobile and not-so-much, we’re amputees, we’re migraneurs, we’re cancer

People in the U.S. spend over five-and-a-half hours a day with digital media in 2015, with time on mobile devices exceeding use of laptop and desktop computers. The growth of mobile means people are using and seeking more just-in-time services in daily living, and this has big implications for health/care, based on the annual mega-report on Internet Trends from Mary Meeker, KPCB’s internet analyst. “People” in health/care are patients, consumers and caregivers; people in health/care are also health plan administrators, employer benefits managers, doctors, nurses, allied health professionals, financial managers in hospitals, pharmacists, and the entire range of humans who

The spiritual and emotional top the physical in women’s definition of “health,” based on a multi-country survey conducted in Brazil, Germany, Japan, the UK and the U.S. The Power of the Purse, a research project sponsored by the Center for Talent Innovation, underscores women’s primary role as Chief Medical Officers in their families and social networks. The research was sponsored by health industry leaders including Aetna, Bristol-Myers Squibb, Cardinal Health, Eli Lilly and Company, Johnson & Johnson, Merck & Co., Merck KGaA, MetLife, Pfizer, PwC, Strategy&, Teva, and WPP. The study’s summary infographic is titled How the Healthcare Industry Fails

Call it a Silver Million Anniversary, if you will: The MinuteClinic just saw its 25 millionth patient. This is a milestone in the evolution and growth of retail health in America, a trend-marker in this growing health industry segment that will become increasingly used by consumers, patients, parents, and caregivers. CVS bought the MinuteClinic in 2006, when the organization treated seven illnesses. Today, MinuteClinic offers 65 services and vaccinations in nearly 1,000 clinics located in 31 states and Washington, DC. In addition, MinuteClinic will grow the number of clinic locations in both existing and new markets. The company will open

In recent weeks, an enormous amount of money has been raised by organizations using information technology to move health/care to people where they live, work, and play… This prompted one questioner at the recent ANIA annual conference to ask me after my keynote speech on the new health economy, “Is the hospital going the way of the dinosaur?” Before we get to the issue of possible extinction of inpatient care, let’s start with the big picture on digital health investment for the first quarter of 2015. Some $429 mm was raised for digital health in the first quarter of 2015,

Living my mantra of Health is Everywhere, where we live, work, play, pray, and shop, I am always on the lookout for signs of health in my daily life. Today I’m in Washington, DC,  speaking on a webinar led by the National Council on Patient Information and Education (NCPIE), discussing the findings in a survey of U.S. adults on self-care health care – my shorthand for healthcareDIY. And the hashtag for the webinar also speaks volumes: #OwnYourHealth. Here’s the link to the survey resources. On my walk from Farragut North Metro station to a nearby office where the meeting will take place,

Alex Gourley, President of The Walgreen Company, addressed the capacity crowd at HIMSS15 in Chicago on 13th April 2015, saying his company’s goal is to “make good health easier.” Remember that HIMSS is the “Health Information and Management Systems Society” — in short, the mammoth health IT conference that this year has attracted over 41,000 health computerfolk from around the world. So what’s a nice pharmacy like you, Walgreens, doing in a Place like McCormick amidst 1,200+ health/tech vendors?  If you believe that health is a product of lifstyle behaviors at least as much as health “care” services (what our

40% of U.S. consumers trust Big Retail to manage their health; 39% of U.S. consumers trust healthcare providers to manage their health. What’s wrong with this picture? The first chart shows the neck-and-neck tie in the horse race for consumer trust in personal health management. The Walmart primary care clinic vs. your doctor. The grocery pharmacy vis-a-vis the hospital or chain pharmacy. Costco compared to the chiropractor. Or Apple, Google, Microsoft, Samsung or UnderArmour, because “digitally-enabled companies” are virtually tied with health providers and large retailers as responsible health care managers. Welcome to The Birth of the Healthcare Consumer according

Financial wellness is integral to overall health. And the proliferation of high-deductible health plans for people covered by both public insurance exchanges as well as employer-sponsored commercial (private sector) plans, personal financial angst is a growing fact-of-life, -health, and -healthcare. Ask any hospital Chief Financial Officer or physician practice manager, and s/he will tell you that “revenue cycle management” and patient financial medical literacy are top challenges to the business. For pharma and biotech companies launching new-new specialty drugs (read: “high-cost”), communicating the value of those products to users — clinician prescribers and patients — is Job #1 (or #2,

Health is the hot topic at SXSW. While edgy new movies and hot music are the foundational elements of the annual South-by-Southwest festival, health and health care are the fast-growing themes at the meet-up, where the new-new, month-old beautiful JW Marriott Hotel by the Convention Center hosted most of the digital health track sessions. Digital health today goes well beyond mobile apps and genomic futures. Philips was a major presence this year at SXSW with its vision, shared by me, THINK-Health, and the HeathcareDIY team, of connected health where we live, work, play, pray and learn. In the case of

2 in 3 people in the U.S. would use a mobile app to manage their health, especially for diet and nutrition, medication reminders, tracking symptoms, and recording physical activity. The fifth annual Pulse of Online Health survey from Makovsky finds that digital health is blurring into peoples’ everyday lives. We’ve covered previous Makovsky digital health surveys here on Health Populi; last year, we focused on consumers managing risk in digital health platforms, and in 2013, the state of seeking health information online. That most consumers would go beyond health information search to the more engaging pursuit of managing health over

1 in 3 U.S. adults used some form of complementary and alternative medicine (CAM) in the U.S. in 2012, led by fish oil in the herbal supplements category, and yoga in the services category. While use of complementary products and services in health has remained unchanged at about 34% of Americans using CAM, the adoption of yoga in American life has doubled among adults in the past decade to about 1 in 10 adults doing some form of yoga. The report, the Use of Complementary Health Approaches in the U.S., a National Health Interview Survey conducted for the National Center for

65 million people know that food journaling works for losing weight, that it’s engaging to do on a well-designed app, and that health is social. MyFitnessPal (MFP) has the distinction of being a top health app used longer by more people and more effectively than probably any other mobile health tool. Under Armour, the athletic goods company, now has MFP under its corporate umbrella, along with Endomondo, another very popular motivating mobile health tool. You may know Under Armour as a company that manufactures and markets functional workout gear. But this deal is so not about the wearable. It’s about

The FTC has weighed in on privacy and security and the Internet of Things (IoT) in a report published on 27th January 2015. When it comes to IoT and devices that connect to the internet, the FTC will focus on Enforcing privacy laws Educating consumers and business on privacy and security for connected devices Participate in multi-stakeholder groups such as the NTIA’s team considering guidelines for facial recognition, and Advocate with other agencies, at the state level, and with courts. The report summarizes input received in a FTC workshop conducted in November 2013 with IoT industry experts, and offers recommendations

“Health care spending grows at lowest-ever rate,” USA Today celebrated in their December 3, 2014 headline. The announcement was drawn from national health spending data gleaned from an annual report from the Centers for Medicare and Medicare Services (CMS), which tallied U.S. health spending at $2.9 trillion. From the bird’s-eye view, slowing healthcare cost growth is indeed good news. But from the point-of-view of consumers’ own pockets, health care costs are rising. And, a survey published today by Gallup points to this reality: that people in American say the most important financial problem they face is healthcare costs, tied for first place

2015 is already becoming a year where bedfellows of different stripes are joining together to build a health care ecosystem well beyond hospitals, doctors and health plans. Announcements launched last week at the 2015 Consumer Electronics Show in Las Vegas, and coming out this week at the J.P. Morgan Conference in San Francisco, the first two weeks of 2015 reveal that new entrants and legacy health stakeholders are crossing corporate and cultural chasms to (try and) solve challenges that prevent us from getting to that Holy Grail of The Triple Aim: improving health care outcomes, driving down per capita costs,

Health is where we live, work, play and pray — my and others’ mantra if we want to truly bend (down) the cost curve and improve medical outcomes. If we’re serious about achieving the Triple Aim — improving public health, lowering spending, and enhancing the patient/health consumer experience (which can drive activation and ongoing engagement) — then you see health everywhere at the 2015 Consumer Electronics Show in Las Vegas this week. With this post, I’ll share with you the major themes I’m seeing at #CES2015 related to health, wellness, and DIYing medical care at home. The meta: from health care to self-care.

Men are from Mars and Women, Venus, when it comes to managing health and using digital tools and apps, based on a poll conducted by A&D Medical, who will be one of several hundred healthcare companies exhibiting at the 2015 Consumer Electronics Show this week in Las Vegas. Digital health, connected homes and cars, and the Internet of Things (IoT) will prominently feature at the 2015 Consumer Electronics Show in Las Vegas this week. I’ll be attending this mega-conference, meeting up with digital health companies and platform providers that will enable the Internet of Healthy “Me” — consumers’ ability to self-track,

“Disruption” is a well-used word these days in business and, in the past few years, in the health care business. That’s because there’s a general consensus that the U.S. health care system is broken. “System” is a word that I shouldn’t use as my friend J.D. Kleinke smartly argued that it’s that lack of system-ness that makes using the phrase “health care system” an Oxymoron. The fragmented health care environment creates innumerable pain points when accessing, receiving, and paying for services. And it’s women who feel so much of that pain. In that context, I’m gratified and humbled to be one

Consumers’ growing health care cost burden is competing with other household spending: basic costs for Americans are eroding what’s left of the traditionally-defined Middle Class. At the front end of health costs is the health insurance premium, the largest single line item for a family. It looks like a big number because it is: Milliman gauged the cost for an employer to cover a family of four in a PPO in the U.S. at around $23K, with the employee bearing an increasing percent of the premium, copays, coinsurance, and a larger deductible this year than last, on average. There are