A blog covering the health/care ecosystem and people.

Eat food, not too much, mostly plants, Michael Pollan advised us on the cover of his breakthrough book on nutrition in America, In Defense of Food.  In Las Vegas, it’s not too easy to live and eat  according to Pollan’s Food Rules. We’re at a fork in the road when it comes to food, retail grocery shopping, and health, which is an intersection I’m increasingly working in these days. The Groceryshop conference is further informing my understanding of the landscape of the technology that’s enabling the consumer’s ability to curate, purchase, and receive the food they want to satisfy hunger and

There’s a shortage of medical providers in the United Kingdom, a nation where healthcare is guaranteed to all Britons via the most beloved institution in the nation: The National Health Service. The NHS celebrated its 70th anniversary in July this year. The NHS “supply shortage” is a result of financial cuts to both social care and public health. These have negatively impacted older people and care for people at home in Great Britain. This article in the BMJ published earlier this year called for increasing these investments to ensure further erosion of population and public health outcomes, and to prevent

Today, October 16, is World Food Day. At Health Populi and THINK-Health, we celebrate the birthday of the Food and Agriculture Organization (FAO), allied with the United Nations. FAO was founded to address malnutrition and bolster a sustainable, healthy food supply for people. World Food Day 2018 has four objectives: Don’t waste food Produce more food with fewer resources Advocate for #ZeroHunger by 2030, and, Adopt a healthier, more sustainable diet. All four of these pillars play a role in health, but I’ll focus today on the fourth: the role of food as a major social determinant of health. Hunger

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

Most consumers look to every industry sector to help them engage with their health. And those companies include the insurance industry and financial services firms, we found in the 2010 Edelman Health Engagement Barometer. John Hancock, which covers about 10 million consumers across a range of products, is changing their business model for life insurance. Here’s the press release, titled, “John Hancock Leaves Traditional Life Insurance Model Behind to Incentivize Longer, Healthier Lives.” “We fundamentally believe life insurers should care about how long and well their customers live. With this decision, we are proud to become the only U.S. life insurance

Consumers who have long purchased over-the-counter medicines, anti-dandruff shampoo, whitening toothpaste, and cosmetics-with-benefits at food, drug and mass merchant retailers are switching to other places to shop for health, new data from AT Kearney and GMDC have found. The two organizations have collaborated to launch a new  benchmarking study into health-beauty-wellness (HBW) sales, launched this weekend at the GMDC HBW Conference in Orlando. Overall, 2017 to 2018 year-on-year, HBW sales were flat-to-no growth, notwithstanding the consumer and influencer buzz around the categories.       This study uncovered some very important trends underneath the macro numbers that tell a story

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

Most Americans have been surprised by a medical bill, a NORC AmeriSpeak survey found. Who’s responsible? Nearly all Americans (86% net responsible) first blame health insurance companies, followed by hospitals (82%). Fewer U.S. patients blamed doctors and pharmacies, although a majority of consumers still put responsibility for surprise healthcare bills on them (71% and 64% net). Most of the surprise bills were for charges associated with a physician’s service or lab test. Most surprise charges were not due to the service being excluded from a health plans provider network. The poll was conducted among 1,002 U.S. adults 18 and over

In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia. The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line)

With the acquisition of GreatCall, a mature player in the aging-tech space, Best Buy is doubling down on consumer health technology@retail. This week at Best Buy. the electronics retailer,  it’s out with CDs and in with technology for aging at home. The company announced that it would buy GreatCall for $800 million. A snippet from the announcement from Best Buy’s press release is shown in the first diagram, noting that GreatCall’s membership is approaching 1 million subscribers who use mobile phones and connected devices, “providing peace of mind to their loved ones.” Beyond the obvious “falling and I can’t get

All sectors who are stakeholders in the healthcare ecosystem aren’t created equal, Accenture explains in their report, Healthcare’s future winners and losers. Observing the influx of new flavors of entrants like Amazon and Google, start-ups like Iora Health, Oscar and FetchMD, begs the question: how will legacy healthcare system players fare? Who will survive, and what will be the success factors that bolster long-term viability? To answer that question, Accenture points to three market trends that set “new rules” in healthcare: Blurred lines, which are the grey areas and adjacencies between technology, service, finance, and retail The middle of nowhere,

While Amazon and Google get lots of positive PR and media attention as major healthcare industry disruptors, don’t forget about two big “W’s,” Walgreens and Walmart, in the healthcare innovator mix. I recently read The Four in which Scott Galloway explains the dominance of Amazon, Apple, Google and Facebook in consumers’ everyday lives. These four tech-behemoths each have their particular designs on healthcare innovation, or disruption in the eyes of, say, Epic and Cerner working on health IT systems, or GE and IBM if you’ve been pioneers in health data or big-iron information technology. Then in the past week, the

If you live in one of nine U.S. states, your chances of having heart disease are greater than living in the 41 others. This geography-as-destiny for heart conditions is examined in The Burden of Cardiovascular Diseases Among US States, 1990-2016 published in JAMA Cardiology. Researchers analyzed data on cardiovascular disease mortality, nonfatal health outcomes, and risk factors by age, sex, and year from 1990 to 2016 for the U.S. population. The outcome used to measure health by state was cardiovascular disease disability-adjusted life-years, or DALYs (FYI, “DALYs” are a commonly used metric in health economics research).   Pennsylvania While overall cardiovascular

America’s agricultural roots go deep, from the native Patuxet tribe that shared maize with Mayflower settling Pilgrims in southern New England, to biodynamic and organic winemakers in Sonoma County, California, operating today. In 2016, 21.4 million full- and part-time jobs were related to agriculture and food sectors, about 11% of total U.S. employment. Farming is an integral part of a nation’s food system, so the Union of Concerned Scientists developed the 50-State Food System Scorecard to gauge the state of farming and food in the U.S. on several dimensions: diet and health outcomes, farming as an industry and economic engine,

There are countless chasms in the U.S. this moment in social, political, and economic perspectives. but one issue is on the mind of most American voters where there is evidence of some agreements: health care, as evidenced in the June 2018 Health Tracking Poll from Kaiser Family Foundation. Top-line, health care is one of the most important issues that voters want addressed in the 2018 mid-term elections, tied with the economy. Immigration, gun policy, and foreign policy follow. While health care is most important to voters registered as Democrats, Republicans rank it very important. Among various specific health care factors, protecting

Consumers have health goals across many dimensions, topped with eating well, getting fit, reducing stress, sleeping better, feeling mentally well, and improving personal finances. That’s an ambitious health-and-wellness list, identified in the Health Ambitions Study, the first such research Aetna has published. Six in ten people are looking to food and nutrition for health, whether as “medicine” to deal with chronic conditions, for weight loss or general wellness, which is a frequent theme here on Health Populi. Consumers embrace their food habits as a key self-care determinant of health. Fitness, cited by most consumers, is also a can-do, self-powered activity

Taking a page out of Hippocrates, “let food be thy medicine and medicine be thy food,” consumers are increasingly shopping for groceries with an appetite for health, found in research published this week by the International Food Information Center cleverly titled, An Appetite for Health. The top line: over two-thirds of older adults are managing more than one chronic condition and looking to nutrition to help manage disease. Most consumers have that “appetite for health” across a wide range of conditions, with two rising to the top as “extremely important:” heart health and brain function. Other top-ranked issues are emotional/mental

What could $28,166 buy you in 2018? A new car? A year of your child’s college education? A plot of land for your retirement home? Or a year of healthcare for a family of four? Welcome to this year’s edition of the Milliman Medical Index (MMI), one of the most important forecasts of the year in the world of the Health Populi blog and THINK-Health universe. That’s because we’re in the business of thinking about the future of health and health care through the health economics lens; the MMI is a key component of our ongoing environmental analysis of the

This is what happened to pharma stock prices on Friday after President Trump and Secretary of Health and Human Services Alex Azar outlined their new policies focusing on prescription drug prices. The graph is the Nasdaq U.S. Smart Pharmaceuticals Index (NQSSPH) from May 11, 2018, the date when POTUS and Secretary Azar made their announcement. What this upward driving curve indicates, from the start of stock trading in the morning until the ring of the closing bell, is that the pharma industry players, both manufacturers and PBMs, were quite delighted with what they heard. The blueprint for restructuring the prescription drug industry,

Expect “new combinations” of industry actors and technologies to reorganize and re-imagine healthcare, with an eye on both price and investments in customer experience (CX), PwC envisions in their latest report on The New Health Economy in the Age of Disruption. In this vision, healthcare will be a more flexible marketplace underpinned by data, platforms, and workers. Yes, it’s challenging to get from here-to-there, but PwC explains just how this can happen. Four archetypes, models, of healthcare deals have begun to emerge in the marketplace, illustrated by the Big Deals and announcements reshaping the industry in the past couple of years:

While the use of medicines continues to rise in the U.S., spending grew by only 0.6% in 2017 after accounting for discounts and rebates. In retail and mail-order channels, net spending fell by 2.1%. Prescription drug spending on branded products grew nearly $5 billion less than in 2016; generic drug spending fell by $5.5 billion, according to Medicine Use and Spending in the U.S., a report from the IQVIA Institute for Health Data Science. The report reviews medicines spending in 2017 looking forward to 2022. There were over 5.8 billion prescriptions dispensed in 2017, and generic drugs accounted 90% of

As the nation battles an obesity epidemic that adds $$ costs to U.S. national health spending, there are many opportunities to address this impactful social determinant of health to reduce health spending per person and to drive public and individual health. In this post, I examine a few very current events in the food-as-medicine marketspace. Big Food as an industry gets a bad rap, as Big Tobacco and Big Oil have had. In the case of Big Food, the public health critique points to processed foods, those of high sugar content (especially when cleverly marketed to children), and sustainability. But

U.S. consumers rank supermarkets, fast food chains, retailers, and banks as their top performing industries for experience according to the 2018 Temkin Experience Ratings. Peoples’ experience with health plans rank at the bottom of the roster, on par with rental cars and TV/Internet service providers. If there is any good news for health plans in this year’s Temkin Experience Ratings compared to the 2017 results, it’s at the margin of “very poor” performance: last year, health plans has the worst performance of any industry (with the bar to the furthest point on the left as “low scoring”). This year, it

The U.S. spent nearly twice as much as other wealthy countries on healthcare, mostly due to higher prices for both labor and products (especially prescription drugs). And, America spends more on administrative costs compared to other high-income countries. What do U.S. taxpayers get in return for that spending? Lower life spans, higher maternal and infant mortality, and the highest level of obesity and overweight among our OECD peer nations. These sobering statistics were published in Health Care Spending in the United States and Other High-Income Countries this week in JAMA, the Journal of the American Medical Association. The study analyzes

In 2018, spending on branded prescription drugs will fall in wealthy countries, while spending on specialty drugs will increase, resulting in flat medicines spending. In the U.S., net spending on medicines will fall in 2018 and remain flat at about $800 per person, according to forecasts in 2018 and Beyond: Outlook and Turning Points, from the IQVIA Institute for Human Data Science. “Concerns about existing medicine costs have captured significant attention,” the introduction warns, setting the stage for slowing growth. Key factors for slow growth include payor concerns about budgets and the consideration of value when deciding on access for new

“Health agencies will have to become at least as sophisticated as other consumer/retail industries in analyzing a variety of data that helps uncover root causes of human behavior,” Gartner recommended in 2017. That’s because “health” is not all pre-determined by our parent-given genetics. Health is determined by many factors in our own hands, and in forces around us: physical environment, built environment, and public policy. These are the social determinants of health, but knowing them even for the N of 1 patient isn’t quite enough to help the healthcare industry move the needle on outcomes and costs. We need to

This blog appears today as part of a #HIMSS18 primer series for attendees, and the industry at large, to discuss major health IT issues that will help move health and healthcare delivery forward in 2018 – and beyond. I’m grateful to HIMSS to be one of 20 Social Media Ambassadors appointed for this year’s conference, which convenes in Las Vegas at the Sands Expo Center from March 5 to 9th, 2018.  Prioritizing the patient-as-consumer through my health economic lens, the biggest priorities will be: Engaging patients in self-care and driving health and health plan literacy to better manage constrained access

Health care ranks highest among working Americans as the top critical issue facing the country, well above terrorism, the role of the Federal government, unemployment and jobs, education, immigration and taxes. Over half of American workers also rate the country’s healthcare system as “poor” or “fair,” based on the results of the EBRI/Greenwald & Associates Health and Workplace Benefits Survey. Workers dissatisfaction with U.S. healthcare is based largely on cost: one-half of workers experienced an increase in health care costs in the past year. Furthermore, only 22% are satisfied with the cost of their health insurance plan, 18% are satisfied

The fact that the average U.S. employer committed to spend nearly $27,000 a year for a PPO to cover a family of 4 in America in 2017 is the most important rationale underlying the announcement that Amazon, Berkshire-Hathaway, and JP Morgan made on 30th January 2017. That news immediately shook Wall Street trading, sending downward shocks down the proverbial spines of healthcare insurance plans and suppliers to the industry — legacy healthcare companies that scale patient-members and healthcare supplies, like pills and surgical implants. The “new competition” chart published in the Wall Street Journal in the morning illustrates those shock

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

Journalists and industry analysts from around the globe have come to Las Vegas which, this week, is the mecca for new-new electronic things that companies think consumers will be keen to buy. On media day 1, I spoke with a colleague from the Netherlands who covers audio, a sector that’s certainly in disruption; an automotive analyst from India covering autonomous vehicles; and, a mobile tech guru based in Dubai, to identify just a few of my media friends who have gathered here to research and write on their respective beats. In these conversations, there are some common buzzwords floating around

As 2018 approaches, consumers will gather healthy New Year’s Resolutions together. Entering the New Year, most Americans are also dealing with concerns about healthcare costs, cybersecurity, and caring – for physical health, mental stress, and the nation. Healthcare costs continue to be top-of-mind for consumer pocketbook issues. Entrenched frugality is the new consumer ethos. While the economy might be statistically improving, American consumers’ haven’t regained confidence. In 2018, frugality will impact how people look at healthcare costs. 88% of US consumers are likely to consider cost when selecting a healthcare provider, a Conduent survey found. Physicians know this: 81% of

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

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

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

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

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

Just a few days since CVS Health announced the company would be working with mega-health insurer Anthem on a prescription drug management program, the pharmacy chain today is reportedly in talks to buy Aetna, the national health insurance company, according to CNBC and other credible news outlets like the Wall Street Journal. Remember that Aetna’s bid to acquire Humana was scuttled earlier this year after many months of negotiation and positioning, along with FTC scrutiny about antitrust. That insurance merger “died” on one day in February 2017 along with an Anthem-CIGNA deal, covered here by CNN. A deal between CVS

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

Old-age inequality among current retirees in the U.S. is already greater than in ever OECD country except Chile and Mexico, revealed in Preventing Ageing Unequally from the OECD. Key findings from the report are that: Inequalities in education, health, employment and income start building up from early ages At all ages, people in bad health work less and earn less. Over a career, bad health reduces lifetime earnings of low-educated men by 33%, while the loss is only 17% for highly-educated men Gender inequality in old age, however, is likely to remain substantial: annual pension payments to the over-65s today are

4 in 5 Americans are aware of potential changes to healthcare policy brewing in Washington, DC. 92% of them are concerned about those changes, according to Healthcare Consumers in a Time of Uncertainty, the fifth annual survey from Transamerica Center for Health Studies. Peoples’ most-shared fears are losing their coverage for pre-existing conditions, out-of-pocket spending, and a ban on lifetime limits. That boils down to one thing: cost. That is, cost, for having to spend money on services not-covered by their health insurance plan; cost for out-of-pocket items under-insured, denied, or requiring coinsurance or co-payments; and, catastrophic costs that rise beyond

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

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

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

Getting health insurance at work means also having prescription drug coverage; 99% of covered workers’ companies cover drugs, based on the 2017 Employer Health Benefits Survey released by the Kaiser Family Foundation (KFF). I covered the top-line of this important annual report in yesterday’s Health Populi post, which found that the health insurance premium for a family of four covered in the workplace has reached $18,764 — approaching the price of a new 2017 small car according to the Kelley Blue Book. The complexities of prescription drug plans have proliferated, since KFF began monitoring the drug portion of health benefits

When a family eats together, they eat more nutritiously, A family that shares 3 or more meals together each week has a 24% greater consumption of nutritious food. Yet only one-half of families in the U.S. with kids under 18 eat dinner together every night of the week, a Gallup poll found. It’s National Family Meals Month. Eating together as a family is a social determinant of health, and the Food Marketing Institute dedicates the month of September to promote the old school concept of the “family meal.” Nutrition habits are built from early childhood. More kids are showing interest

Happy anniversary to me…well, to the Health Populi blog! It’s ten years this week since I launched this site, to share my (then) 20 years of experience advising health care stakeholders in the U.S. and Europe at the convergence of health, economics, technology, and people. To celebrate the decade’s worth of 1,791 posts here on Health Populi (all written by me in my independent voice), I’ll offer ten health/care milestones that represent key themes covered from early September 2007 through to today… 1. Healthcare is one-fifth of the national U.S. economy, and the top worrisome line item in the American

9 in 10 hospitals and health systems prioritize improving the consumer/patient experience, but only 30% of providers are building these capabilities. This consumer experience gap was found by Kaufman Hall in their survey research published in the report, 2017 State of Consumerism in Healthcare: Slow Progress in Fast Times. Digital health innovations will play big roles in supporting that consumer health experience for most health providers: 58% prioritize offering digital tool and information for consumer engagement, and 56% of providers look to develop a range of virtual/telehealth access points. But it appears that while healthcare providers’ spirits are willing, their flesh

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