A blog covering the health/care ecosystem and people.

We want to go outside, drive our cars, shop for groceries, stay and get healthy. These are the key themes coming out of the 2021 Axios Harris Poll 100 on the most visible brands with high (and low) reputations among U.S. consumers. In the top-ranked “excellent” and “very good” brands numbered 1 through 50, we find five core health care brands that were most visible to U.S. consumers: Moderna ranked #3, Pfizer #7, CVS Health #24, Walgreens #46, and Kaiser Permanente #47. The only pure healthcare brand in the bottom 50 was Johnson & Johnson at #72, between Dollar General

One in five people in the U.S. cannot afford to pay for quality health care — an especially acute challenge for Black and Hispanic Americans, according to a West Health-Gallup poll conducted in March 2021, a year into the COVID-19 pandemic. “The cost of healthcare and its potential ramifications continues to serve as a burdensome part of day-to-day life for millions of Americans,” the study summary observed. Furthermore, “These realities can spill over into other health issues, such as delays in diagnoses of new cancer and associated treatments that are due to forgoing needed care,” the researchers expected. The first table

2021 is the 20th anniversary of the University of Michigan Center for Value-Based Insurance Design (V-BID). On March 10th, V-BID held its annual Summit, celebrating the Center’s 20 years of innovation and scholarship. The Center is led by Dr. Mark Fendrick, and has an active and innovative advisory board. [Note: I may be biased as a University of Michigan graduate of both the School of Public Health and Rackham School of Graduate Studies in Economics].   Some of the most important areas of the Center’s impact include initiatives addressing low-value care, waste in U.S. health care, patient assistance programs, Medicare

The more health consumers use health and wellness services at retail, the greater their satisfaction and brand-love, according to a new report from J.D. Power. J.D. Power found that peoples’ Net Promoter Scores were higher among those folks who used at least one health and wellness service at a brick-and-mortar pharmacy, shown in the first chart. That NPS-delta was 15 points between consumers who used no services (rating an NPS of 55) versus people using at least 2 services (awarding an NPS score of 70). Consumers using more health and wellness services also spent more money at the drug store, a

The COVID-19 pandemic forced consumers to define what were basic or essential needs to them; for most people, those items have been hygiene products, food, and connectivity to the Internet. There’s another good that’s essential to people who are patients: prescription drugs. A new report from CoverMyMeds details the current state of medication access weaving together key health care industry and consumer data. The reality even before the coronavirus crisis emerged in early 2020 was that U.S. patients were already making painful trade-offs, some of which are illustrated in the first chart from the report. These include self-rationing prescription drug

Patients in the U.S. have been self-rationing medical care for many years, well before any of us knew what “PPE” meant or how to spell “coronavirus.” Nearly a decade ago, I cited the Kaiser Family Foundation Health Security Watch of May 2012 here in Health Populi. The first chart here shows that one in four U.S. adults had problems paying medical bills, largely delaying care due to cost for a visit or for prescription drugs. Fast-forward to 2020, a few months into the pandemic in the U.S.: PwC found consumers were delaying treatment for chronic conditions. In October 2020, The American Cancer

The first year of the coronavirus pandemic in America was a kind of stress test on the U.S. health care system, revealing weak links and opportunities for bad behavior. “These are not just about individual instances or bad apples,” Dr. Vikas Saini, President of The Lown Institute, explained, referring to them as “cautionary tales” of the current state of U.S. health care. Dr. Saini and his colleague Shannon Brownlee released the annual Lown Institute 2020 Shkreli Awards this week, highlighting their ten most egregious examples of the worst events in U.S. health care that happened in the past year —

Yesterday, IQVIA presented their end-of-year data based on medical claims in the U.S. health care system tracking the ups, downs, and ups of the coronavirus in America. IQVIA has been tracking COVID-19 medical trends globally from early 2020. The plotline of patient encounters for vaccines, prescribed medicines, foregone procedures and diagnostic visits to doctors begs the question: in 2021, will Americans be “sicker,” discovering later-stage cancer diagnoses, higher levels of pain due to delayed hip procedures, and eroded quality of life due to leaky guts? Here are a few snapshots that paint a picture for greater morbidity and potentially more “excess

2020 marked the centennial anniversary of the 19th Amendment to the U.S. Constitution, giving women the right to vote. In this auspicious year for women’s voting rights, as COVID-19 emerged in the U.S. in February, women’s labor force participation rate was 58%. Ironic timing indeed: the coronavirus pandemic has been especially harmful to working women’s lives, the Brookings Institution asserted last week in their report in 19A: The Brookings Gender Equality Series. A new study from Tia, the women’s health services platform, looks deeply into COVID-19’s negative impacts on working-age women and how they would advise the next occupant of

One in two people in the U.S. are concerned that a major health event in their family would lead to bankruptcy, up 5 percent points over the past eighteen months. In a poll conducted with West Health, Gallup found that more younger people are concerned about medical debt risks, along with more non-white adults, published in their study report, 50% in U.S. Fear Bankruptcy Due to Major Health Event. The survey was fielded in July 2020 among 1,007 U.S. adults 18 and older. One of the basic questions in studies like these is whether a consumer could cover a $500

The use of health and wellness services delivered in retail pharmacies is growing, and health consumers’ satisfaction increases with use. That’s the headline for J.D. Power’s 2020 U.S. Pharmacy Study. This is the 12th year of J.D. Power’s U.S. Pharmacy Study, this year based on a survey of 13,378 pharmacy customers who filled a prescription between June 2019 and February 2020. The study assessed four retail prescription drug channels for consumers: brick and mortar chain drug stores, brick and mortar mass merchandisers, supermarket pharmacies, and mail order. The top ranked brands were: For brick and mortar chains, Good Neighbor Pharmacy

Nine in ten Americans is concerned about the price of prescription drugs in the wake of the coronavirus pandemic, Gallup and West Health found in their survey on the cost of healthcare, published today. A majority of people across political party share this concern: overall, 88% of U.S. adults are concerned about rising drug prices in response to COVID19, split across party ID with: 94% of Democrats, 86% of Independents, and 84% of Republicans. By demographics, more women than men are concerned about rising costs for the three health care spending categories the survey studied: drug prices, insurance premiums, and

Patients in the U.S. are self-rationing care in the era of COVID-19 by cutting spending on health care visits and prescription drugs. The coronavirus pandemic’s impact on health consumers’ spending varies depending on whether the household is generally a healthy family unit, healthy “enthusiasts,” dealing with a simple or more complex chronic conditions, or managing mental health issues. PwC explored how COVID-19 is influencing consumers’ health care behaviors in survey research conducted in early April by the Health Research Institute. The findings were published in a May 2020 report, detailing study findings among 2,533 U.S. adults polled in early April

This week, Hims & Hers announced they would be a new consumer-facing retail channel for coronavirus testing. You can order the test here for $150 cash out-of-pocket. The packaging states that this is a saliva test, “to detect current presence of COVID-19.” The fine print on the Hims website states: This test has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. This test has not been FDA cleared or approved. This test has been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens. This test

Health care pocketbook issues rank first and second place for Americans in these months leading up to the 2020 Presidential election, according to research from POLITICO and the Harvard Chan School of Public Health published on 19th February 2020. This poll underscores that whether Democrat or Republican, these are the top two domestic priorities among Americans above all other issues polled including immigration, trade agreements, infrastructure and regulations. The point that Robert Blendon, Harvard’s long-time health care pollster, notes is that, “Even among Democrats, the top issues…(are) not the big system reform debates…They’re worried about their own lives, their own

Among all Americans, the most popular approach for improving the health care in the U.S. isn’t repealing or replacing the Affordable Care Act or moving to a Medicare-for-All government-provided plan. It would be to improve the current health care system, according to the Bipartisan Policy Center’s research reported in a Bipartisan Rx for America’s Health Care. The BPC is a truly bipartisan organization, co-founded by Former Democratic Senate Majority Leaders Tom Daschle and George Mitchell, and Former Republican Senate Majority Leaders Howard Baker and Bob Dole. While this political week in America has revealed deep chasms between the Dems and

Health care continues to be the top-ranked voting issue in the U.S. looking to the November 2020 Presidential and Congressional elections. The Kaiser Family Foundation conducts the monthly poll which gauges U.S. adults’ perspectives on health care, and this month’s January 2020 Kaiser Health Tracking Poll explores Americans’ views on broad healthcare reform plans and specific medical policy issues. Overall, Americans point to prescription drug costs and the preservation of the Affordable Care Act’s protections for people with pre-existing conditions, the first chart tells us. Third and fourth on voters’ minds are protecting patients from surprise medical bills and better

Next week, the Consumer Technology Association (CTA) will convene CES, the Consumer Electronics Show, where over 180,000 tech-minded people from around the world will convene to kick the tires on new TVs, games, smart home devices, 5G connections, 3-D printing, drones, and to be sure, digital health innovations. At #CES2020, exhibitors in the health/care ecosystem will go well beyond wearable devices for tracking steps and heart rate. I’ll be meeting with wearable tech innovators along with consumer electronics companies and retailers. I’ve also scheduled get-togethers with pharma and life science folks, health plan people, and execs from consumer health companies.

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

The idea of health care consumerism isn’t just an American discussion, Deloitte points out in its 2019 global survey of healthcare consumers report, A consumer-centered future of health. The driving forces shaping health and health care around the world are re-shaping health care financing and delivery around the world, and especially considering the growing role of patients in self-care — in terms of financing, clinical decision making and care-flows. With that said, Americans tend to be more healthcare-engaged than peer patients in Australia, Canada, Denmark, Germany, the Netherlands, Singapore, and the United Kingdom, Deloitte’s poll found. Some of the key behaviors

Several new studies reveal that more patients are feeling and living out their role as health care payors as medical spending vies with other household line items. This role of patient-as-the-payor crosses consumers’ ages and demographics, and is heating up health care as the top political issue for the 2020 elections at both Federal and State levels. In research from HealthPocket, 2 in 5 Americans said they needed to reduce other household expenses to be able to afford their monthly insurance premiums. Four in ten consumers said their monthly health insurance premiums were increasing. One in four people in the

ABBA sang the song “Money Money Money” back in 1976. The lyrics feel, sadly, spot-on when thinking about health care costs, job-lock and Americans’ home economics in 2019. “Work all night, I work all day, to pay the bills I have to pay Ain’t it sad And still there never seems to be a single penny left for me That’s too bad… Money, money, money must be funny In the rich man’s world.” That year, ’76, wasn’t just the U.S. bicentennial — it was a year when the U.S. allocated 8.6% of the nation’s Gross Domestic Product for health care.

A study in JAMA published this week analyzed research reports that have measured waste in the U.S. health care system, calculating that 25% of medical spending in America is wasted. If spending is gauged at $3.8 trillion, waste amounts to nearly $1 trillion. If spending is 18% of the American gross domestic product (GDP), then some 4.5% of the U.S. economy is wasted spending by the health care system and its stakeholders. In “Waste in the US Health Care System,” a team from Humana and the Univrsity of Pittsburgh recalibrated the previous finding of 30% of wasted spending to the 25%,

from Gallup’s 2019 survey into Americans’ Views of U.S. Business Industry Sectors. Since reaching a relative high regard in 2015, the pharma industry reputation among consumers has declined each year since to the low this year with 58% of Americans having a negative view. This was a 31 percentage point drop in reputation in one year. This is one negativity point above peoples’ low regard for the Federal government. Gallup notes that Americans are over two times more likely to rank the pharmaceutical industry negatively (58%) as positively (27%). The healthcare industry, apart from pharma, didn’t fare well this year in

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

This year, an employer-sponsored PPO for a family of four in the U.S. will cost $28,386, a 3.6% increase over 2018, according to the 2019 Milliman Medical Index (MMI). Based on my annual read of this year’s Index, the PPO costs roughly the same as a new Dodge Charger or a year attending the engineering school at Alfred University. The Milliman MMI team has updated the methodology for the Index; the chart shown here is my own, recognizing that the calculations and assumptions beneath the 2019 data point differ from previous years. The key points of the report are that:

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

“It’s the prices stupid,” Uwe Reinhardt and Gerard Anderson and colleagues asserted in the title their seminal Health Affairs manifesto on U.S. healthcare spending. Sixteen years later, yesterday on 8th July 2019, a Federal U.S. judge blocked, in the literal last-minute, a DHHS order mandating prescription drug companies to publish “retail prices” of medicines in direct-to-consumer TV ads. I was getting this post on transparency together just before that announcement hit the press, so this post would have had a different nuance yesterday compared with today. And that’s how health care politics and economics in America roll these days. Welcome to

Looking at this photo of the 2020 Democratic Party Presidential candidate debater line-up might give you a déjà vu feeling, a repeat of the night-before debate. But this was Round 2 of the debate, with ten more White House aspirants sharing views — sometimes sparring — on issues of immigration, economic justice, climate change, and once again health care playing a starring role from the start of the two-hour event. The line-up from left to write included: Marianne Williamson. author and spiritual advisor John Hickenlooper, former Governor of Colorado Andrew Yang. tech company executive Pete Buttigieg, Mayor of South Bend,

In reading the July/August issue of Eating Well magazine this week, I came across this ad which I scanned for you to see yourself: “We believe in food as medicine.” Signed, Kroger Health. Here’s the introductory text in the full-page ad: “As Kroger Health, our vision is to help people live healthier lives. And now, more than ever, through our experts, innovation, and technology, we’re uniquely positioned to bring that vision to life,” the copy read. “We know food,” the text continued, as part of The Kroger Co. which is the largest grocery chain in the U.S. celebrating 135 years

Americans consumed 17.6 prescriptions per person in 2018, two in three of which treated chronic conditions. Welcome to Medicine Use and Spending in the U.S. , the annual review of prescription drug supply, demand and Rx pricing dynamics from the IQVIA Institute for Human Data Science. In a call with analysts this week in which I participated, the Institute’s Executive Director Murray Aitken discussed the report which looks back at 2018 and forward to 2023 with scenarios about what the U.S. prescription drug market might look like five years from now. The report is organized into four sections: medical use

As patients now assume the role of health consumer, they rationally expect retail-level experiences with greater first-dollar payment for health insurance, health care services and medical products like prescription drugs. Consumers know what good retail looks and feels like, and are focusing that experiential lens on health care, Aflac found when their Workforces Survey polled Americans on their desirable health insurance shopping experience. One in two people said it should feel, “like Amazon,” and another 20% of folks said, “like retail.” Chapter 3 of HealthConsuming is titled, “How Amazon Has Primed Health Consumers,” and explains this re-shaping of patient expectations.

The 2019 Edelman Trust Barometer measured the biggest gap in trust for the healthcare industry between the U.S. “informed public” and the mass population. Fewer American women, too, trust the healthcare industry than men do. “This inequality of trust may be reflective of the mass population continuing to feel left behind as compared to others, even as they recognize the advances that are being made that could benefit them. Given tone and tenor of the day, and particularly among mass population, healthcare may continue to see increasing demands for change and regulation,” Susan Isenberg, Edelman’s head of healthcare, notes in

Pharmaceutical company executives are testifying in the U.S. Congress this week on the topic of prescription drug costs. One of those medicines, insulin, cost a patient $5,705 for a year’s supply in 2016, double what it cost in 2012, according to the Health Care Cost Institute. Know that one of these insulin products, Lilly’s Humalog,  came onto the market in 1996. In typical markets, as products mature and get mass adoption, prices fall. Not so insulin, one of the many cost components in caring for diabetes. But then prescription drug pricing doesn’t conform with how typical markets work in theory.

There’s little agreement between Democrats and Republicans on a plethora of issues in American public life. But one issue that brings U.S. citizens together is agreement that the cost of health care is too high in the country, and that pharma, health plans, and providers are to blame. Welcome to health politics in America as of March 2019, according to The Public and High U.S. Health Care Costs, a poll conducted by POLITICO and the Harvard T.H. Chan School of Public Health. The first chart illustrates the common ground shared by Americans by party affiliation, with vast majorities across parties playing

“Patients as Consumers” is the theme of the Health Affairs issue for March 2019. Research published in this trustworthy health policy publication covers a wide range of perspectives, including the promise of patients’ engagement with data to drive health outcomes, citizen science and participatory research where patients crowdsource cures, the results of financial incentives in value-based plans to drive health care “shopping” and decision making, and ultimately, whether the concept of patients-as-consumers is useful or even appropriate. Health care consumerism is a central focus in my work, and so it’s no surprise that I’ve consumed every bit of this publication. [In

National health spending in the U.S. is expected to grow by 5.7% every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth, published yesterday by Health Affairs. For context, note that general price inflation in the U.S. was 1.6% for the 12 months ending January 2019 according to the U.S. Bureau of Labor Statistics. This growth rate for health care costs exceeds every period measured since the high of 7.2% recorded in 1990-2007. The bar chart illustrates the

Most patient visits to doctors result in a prescription written for a medicine that people retrieve from a pharmacy, whether retail in the local community or via mail order for a maintenance drug. This one transaction generates a lot of data points, which individually have a lot of importance for the individual patient. Mashed with other patients’, prescription drug utilization data can combine with more data to be used for population health, cost-effectiveness, and other constructive research pursuits. At HIMSS19, there’s an entire day devoted to a Pharma Forum on Tuesday 12 February, focusing on pharma-provider-payor collaborations. Allocating a full

Today, as Congress kicks off hearings about the cost of prescription drugs in the United States, IQVIA published its 2019 report on The Global Use of Medicine in 2019 and Outlook to 2023. The top-line of the research is the robust pharma market growth will be driven by two factors, and limited by two others: spending in the U.S. and emerging markets (coined “pharmerging” by IQVIA) will push up spending, while limiting factors on growth will be increasing generics and expiration of brand patents. The U.S. will continue to be the number 1 prescription drug spender in the world to

All health/care is retail now in America. I say this as most people in the U.S. who have health insurance must take on a deductible of some amount, which compels that insured individual to spend the first dollar on medical services up until they meet their financial commitment. At that point, health insurance kicks in, and then the insured may have to spend additional funds on co-payments for general medicines and services, and coinsurance for specialty drugs like injectables and high-cost new therapies. The patient is a consumer is a payor, I asserted today during my talk on the expanding

As #CES2019 kicks off in Las Vegas with today’s first Media Day, the Consumer Technology Association presented its forecast on the 5 Technology Trends to Watch in 2019 — and they all play into health, wellness, and medical care. The five trends are: Artificial Intelligence on the Rise Envisioning the Smart Home of the Future Digital Health Tech Empowers Patients Esports and Sports Technology, and Smart Cities Promote Resilience. Here are how these five mega-trends can bolster our health and healthcare products and services over the next decade. AI is indeed on-the-rise in healthcare: as I have begun planning my agenda for

As the CVS + Aetna merger crosses its last regulatory hurdle at the close of 2018, we enter 2019 facing a fast-growing and -morphing retail health landscape. I brainstormed retail health yesterday with Patrick Freuler, CEO of Audicus (developer of hearing aids sold direct-to-consumer over-the-counter) and Shai Gozani, CEO of NeuroMetrix, maker of the Quell device for pain management. The three of us will be on a panel addressing retail health disruption at CES 2019 on 9th January 2019 at the Digital Health Summit. I explained to Shai what I’m going to say in my talk about retail health at

As Tip O’Neill’s mantra goes, “All politics is local.” In the U.S. 2018 midterm elections, healthcare voting seems to have translated as a local issue, falling into O’Neill’s axiom. In this election, healthcare was the most important voting issue for consumers, PwC found, ranking above the economy, national security, and education. On this morning after 2018 midterm election results are (mostly) out, it looks like healthcare was a local and state issue for U.S. 2018 midterm voters. The Democrats flipped more than 23 seats in the U.S. House of Representatives to gain control of that chamber. The Senate is up

    CVS Health’s acquisition of Aetna was approved this week by U.S. Federal regulators after months of scrutinizing the antitrust-size-market control implications of the deal. I wrote this post on the deal as an inflection point in American healthcare on 3rd December 2017 when CVS and Aetna announced their marriage intentions. This post updates my initial thoughts on the deal, given the morphing US healthcare market on both the traditional health services front and fast-evolving retail health environment. The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal

California’s Governor Jerry Brown signed into law a net neutrality bill this weekend. Gov. Brown’s proverbial swipe of the pen accomplished two things: he went back to the Obama-era approach to ensure that internet service providers treat all users of the internet equally; and, he prompted the Department of Justice, representing the Trump Administration’s Federal Communications Commission (FCC), to launch a lawsuit. California, home to start-ups, mature tech platform companies (like Apple, Facebook and Google), and countless digital health developers, is in a particularly strategic place to fight the FCC and, now, the Department of Justice. Nearly two dozen other states

Patients are the new healthcare payors, and as such, taking on the role of health consumers. In fact, health and wellness consumers have existed since a person purchased the first toothpaste, aspirin, heating pad, and moisturizing cream at retail. Or consulted with their neighborhood herbalista, homeopathic practitioner, therapeutic masseuse, or skin aesthetician. Today, the health and wellness consumer can DIY all of these things at home through a huge array of products available in pharmacies, supermarkets, Big Box stores, cosmetic superstores, convenience and dollar stores, and other retail channels – increasingly, online (THINK, of course, of Amazon — more on

Using digital health tech is a new normal for U.S. consumers, including Seniors, found in the 2018 digital health consumer survey from Deloitte. The title of the report, “Consumers are on board with virtual health options,” summarizes the bullish outlook for telehealth. That’s the consumer-demand side of the equation. But the tagline begs the supply side question: “Can the health care system deliver?” For a decade or longer, we’ve noted the slow uptake of telehealth and digital health tools among healthcare providers. But the consumer pressures, along with evidence-based self-service options for health – both for “care” and for wellness,

More U.S. employers are growing activist roles as stakeholders in the healthcare system, according to the 2019 Large Employers Health Care Strategy and Plan Design Survey from the National Business Group on Health (NBGH). Consider the Amazon-Berkshire Hathaway-JPMorgan Chase link up between Jeff Bezos, Warren Buffet, and Jamie Dimon, as the symbol of such employer-health activism. The NBGH report is based on survey results collected from 170 large employers representing 13 million workers and 19 million covered lives (families/dependents). This annual survey is one of the most influential such reports released each year, providing a current snapshot of large employers’ views

In the USA, July 4th celebrates the adoption of the Declaration of Independence on that day in 1776. For people with diabetes, July 4th is also an inflection point when blood glucose spikes and kicks off a rise in blood sugar levels through autumn to New Year’s Eve. The team at Livongo observed this by mining 20 million blood glucose measures among its community of people with diabetes. This research debuted in the inaugural Insights Report, Diabetes Across America: Seasons, Regions & More. I appreciated the opportunity to discuss these findings with Dr. Jennifer Schneider, Chief Medical Officer at Livongo. I