A blog covering the health/care ecosystem and people.

My latest essay for Medecision’s Liberation site digs into the sobering statistics on clinical burnout across the medical professions. From doctors to nurses, physician assistants and other licensed allied health human capital, our health care providers are in a world of hurt. This was initiated with the emergence of the COVID-19 pandemic. But the public health crisis, Delta variant, and lack of universal precautions adopted by U.S. health citizens have exacerbated an already-challenging scenario for individual clinicians and the organizations with whom they work and collaborate. But there’s an even bigger picture, and that’s the risk clinician burnout in its

The COVID-19 pandemic exacerbated food insecurity in the U.S., a situation that was already challenging for millions of American families before the public health crisis emerged. While several Congressional and administrative actions were implemented in 2020 and the first half of 2021, the issue of food insecurity — defined as being unable to acquire enough food due to insufficient money or resources — remains a tragic aspect of daily living for many Americans — and especially for children who live in households where jobs have been lost and incomes reduced. Nutrition security has also been a health risk where people

The Catholic Health Association (CHA) is urging Americans to “love thy neighbor” by getting the COVID-19 vaccine, Sister Mary Haddad wrote in an editorial published in Modern Healthcare, published on September 3, 2021. Sister Mary is CEO and President of CHA. “Some may suggest that there are moral and religious concerns to receiving the COVID-19 vaccine,” Sister Mary observed. “We strongly affirm the position of the leaders of the Catholic Church: the vaccines are morally acceptable and getting vaccinated is “an act of love.” she asserted. CHA launched a portal on the act of love, featuring lots of science-based articles

A majority of Democrats, Independents, and Republicans agree that nurses are underpaid. Most Americans across political parties also believe that hospital executives are overpaid, according to a poll from The Associated Press-NORC Center for Public Affairs Research. The survey analysis is aptly titled, Most Americans Agree That Nurses and Aides Are Underpaid, While Few Support Using Federal Dollars to Increase Pay for Doctors, . Insurance executives are also overpaid, according to 73% of Americans — an even higher percent of people than the 68% saying hospital execs make too much money. In addition to nurses being underpaid, 6 in 10

The rise of digital health investment and growing role of technology in health care services only accelerated during the COVID-19 pandemic. At the same time, people took on their own versions of digital transformation at home, for work, for school, for cooking, shopping, and indeed, for health care. But with digital health adoption gains has come some ambivalence and mixed signals, Accenture has discovered in its 2021 Health and life Sciences Experiences Survey released this week during the HIMSS Annual Conference. As the report concludes, “people’s sentiments and behaviors” with respect to technology in health care “provide no clear answer.”

“Self-care” took on new meaning and personal work-flows for people living in and through the coronavirus pandemic in the U.S. Acosta, the retail market research pro’s, updated our understanding consumers evolving as COVID-19 Has Elevated the Health and Wellness Trends of the Recent Years, results of a survey conducted among in May 2021. In the U.S., consumers’ take on self-care has most to do with healthy eating and nutrition (for 1 in 2 people), getting regular medical checkups (for 42%), taking exercise, relaxing, using vitamins and supplements, and getting good sleep. Healthy relationships are an integral part of self-care for

The ultimate health and wellbeing of an adult depends on the factors that shape us when we are children. A new, deep report from the OECD, Measuring What Matters for Child Well-being and Policies, spells out the many domains of experience that, together, bolster our whole health as we grow from child to adult. The first chart presents the OECD’s framework for measuring child well-being, calling out the nature of being “aspirational.” This re-look at children’s health data is aspirational because it is laying out how to best measure child well-being to set the bar higher for doing so. It addresses

COVID-19 reshaped people around the world, one-half of whom are re-defining their personal purpose and life-goals. This sense of purpose extends to peoples’ willingness to buy or patronize companies who do not meet their needs for health, safety, sustainability and trust. For example, two in three of these people would switch travel brands if they felt health and safety weren’t up to par, discovered in Life Reimagined – Mapping the motivations that matter for today’s consumers, from Accenture’s Voices of Change series. In May 2021, Accenture polled over 25,000 consumers globally, in 22 countries, and found that one-half of people

In the COVID-19 pandemic, health care spending in the U.S. increased by a relatively low 6.0% in 2020. This year, medical cost trend will rise by 7.0%, expected to decline a bit in 2022 according to the annual study from PwC Health Research Institute, Medical Cost Trend: Behind the Numbers 2022. What’s “behind these numbers” are factors that will increase medical spending (the “inflators” in PwC speak) and the “deflators” that lower costs. Looking around the future corner, the inflators are expected to be: A COVID-19 “hangover,” leading to increased health care services utilization Preparations for the next pandemic, and

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

To all the Moms I’ve loved and lost and those I still blessed to have in my life…. I’m thinking about our collective and individual health this 2021 Mother’s Day weekend. There are three themes that whirl in the current Moms’ Health Mix: The impact of the COVID-19 pandemic on mothers’ health and life Mom-economics and the She-Cession — the financial roots of health inequity, and The larger context that is the persistence of women’s health disparities. First, the impact of the coronavirus and the economy have been intertwined, hitting women hard in terms of physical health, work, mental health

Spending on medicines, globally, will rebound this year and rise above pre-pandemic levels through 2025. Between 2021 and 2025, the annual growth global growth rate for prescription drugs spending is expected to range from 3% to 6%, a $1.6 trillion bill for the worlds’s total Rx medicines market. That relatively low single-digit growth rate is tempered by savings from biosimilars and the loss of brand exclusivity (that is, more generics coming to market). On the faster-growth side, we can expect two big therapeutic areas to drive spending upward: oncology and immunology, projected to expand by 9% to 12% each year

Our feet have become an important health focus during the pandemic, as the importance of exercise-as-medicine and mental health helper has looked to walking, running, and biking as good-for-us physical activities. The Mayo Clinic published an informative piece on Feet and the COVID-19 Pandemic, and the Cleveland Clinic posted advice on exercising during the pandemic earlier this month with the strong recommendation of walking. So it makes sense that the apparel category whose brand equity grew most between 2020 and 2021 was footwear, announced in the Brand Finance Apparel 50. Each year, Brand Finance evaluates the value of “brands,” as

The COVID-19 pandemic has re-shaped consumers for work, school, fitness, cooking, and certainly for health care. PwC’s Health Research Institute has combed through their consumer survey data and developed insights on health consumers, shared in a summary titled Consumer health behavior and the COVID-19 pandemic: What we’ve learned. Most U.S. consumers would be likely to have a clinician visit their homes for several kinds of medical care, including: “DIY care,” as PwC exemplifies as a home strep or flu test, or remote monitoring, likely among 85% of people A chronic care visit, likely for 78% of consumers A visit for

As the coronavirus crisis stretched from weeks into months, now over one year since being defined as a pandemic, U.S. consumers have made significant investments into their homes for working, educating students, cooking, and working out. Welcome to the “rebalancing of the homebody economy,” in the words of McKinsey, out with new data on consumer sentiment during the coronavirus crisis. The continued penetration of vaccines-into-arms in the U.S. is fanning optimism in terms of household economics, personal spending — especially on experiences that get folks “out” of the house. Still, the Homebody Economy will persist even post-COVID, with a growing

The Wall Street Journal featured the grocery chain Kroger in an article yesterday titled, COVID-19 Vaccinations, Tests Give Boost to Kroger’s Health Ambitions. “With 2,250 pharmacies and 220 clinics largely in the Midwest and the southern U.S., Kroger is the fourth-largest pharmacy operator by script count,” the Journal noted, adding details about Walmart, CVS Health, and Walgreens all fast-expanding their respective health care footprints. As more consumers view their homes as personal and safe health havens, there is no shortage of suppliers in the food, retail, and mobility sectors working fast to meet that demand for convenient and accessible services.

A Year into our collective coronavirus experience, Americans remain stressed, with physical health taking a back seat to our daily grinds based on the 2021 Stress in America survey from the American Psychological Association (APA). The APA has been updating us on U.S.-stress for several years, and more frequently since the start of the COVID-19 pandemic at the start of 2020. In their latest report, APA updates their previous profiles of Americans’ stress looking into different demographic groups and coping mechanisms. The topline, across all adults living in America, is that one-half have delayed or cancelled health care services. One-half has

Expanding omni-channel, data-driven, cost-effective health care in the community, tailoring that care, and attending to mental health paint the picture of health through the lens of CVS Health. The company published the Health Trends Report 2021 today, calling out ten forces shaping health care this year. Those themes are, The Year of the Pharmacist The Next Step Forward in Cardiac Care Cancer Needs a Better Roadmap The EHR Hits Its Stride The Mental Health Shadow of COVID-19 Tailor Care to the Older Patient More Agents that Predict Disease Paying for the New Medical Miracle Virtual Care Goes Mainstream, and Diabetes

With a third vaccine approved by the FDA for licking COVID-19, brought to market by Johnson & Johnson, the U.S. can expect an uptick in vaccinations among fellow health citizens. That’s such welcome news and a positive outlook for a healthier 2021. But there’s another angle on 2021 for which health care providers and health citizens alike should prepare: that is the excess deaths that will happen due to patients postponing needed health care, diagnostic tests, and preventive services that stem from people avoiding care in doctor’s offices and hospitals. The chart here comes from IQVIA’s latest study into COVID-19’s

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

Over the next 20 years, health care spending in the U.S. will migrate toward well-being and the early detection of disease, away from the funding of America’s sick-care system, according to Breaking the cost curve, a forecast of U.S. health economics in the year 2040 from Deloitte. Current spending on health care in America is roughly $4 trillion (with a “t”) dollars, approaching 20% of the nation’s economy. By 2040, spending is projected to be $8.3 trillion based on future health trends — not historic workflows and delivery mechanisms which would consume an additional $3.5 trillion — close to what we

“Yes,” we concurred on our session convened by the American Telemedicine Association (ATA) EDGE session today. “We” was a trio including Antoinette Thomas (@NurseTechExec1), Chief Patient Experience Officer with Microsoft, David Ryan (@DavidPRyan), former long-time Global Head of Intel’s Health/Life Science business; and, me. Antoinette posed three questions for all of us to brainstorm, addressing various aspects of health equity. We covered, The theory that telemedicine should increase health equity — where are we and what are the barriers to getting there? The role of social determinants of health in creating equitable opportunities for health citizens; and, Entering a post-pandemic world,

On U.S. Election Night, November 3, 2020, CNN’s John King stood in front of the “Key Race Alert” screen, announcing state-by-state polling results with the oft-used headline, “Too Early To Call.” That persistent media-moment was stressful for the millions of voters watching the multiple hairline-close battles from state to state. Then there was that company logo strategically placed at the lower left corner of the screen, as in “Brought to you by Calm.” Calm is but one of a growing portfolio of tools that health citizens can use to manage anxiety and stress, get to sleep (and stay sleeping), and

The pandemic has digitally transformed those people who could work from home, school at home, and undertake daily life-flows as health citizens tried to keep the coronavirus (and other people) at-a-distance. “Emerging hand-in-hand with place displacement, activity displacement is simply about the change in how people do things. Almost overnight, school lessons and doctors’ appointments were online. Yoga classes, concerts and weddings were streamed via Zoom,” Fjord Trends 2021 from Accenture Interactive observes. “Historically, people have often been quick to adopt new digital technology and slower to adapt to what it can help them achieve,” Fjord noted. But COVID-19 has

In 2020, the COVID-19 pandemic drove U.S. consumers to increase spending on electronics, notably laptops, smartphones, and desktop computers. But the coronavirus era also saw broadband households spending more on connecting health devices, with 42% of U.S. consumers owning digital health tech compared with 33% in 2015, according to research discussed in Supporting Today’s Connected Consumer from Parks Associates. developed for Sutherland, the digital transformation company. Consumer electronics purchase growth was, “likely driven by new social distancing guidelines brought on by COVID-19, which requires many individuals to work and attend school from home. Among the 26% of US broadband households

In the U.S., the latest read on supply-and-demand for COVID-19 vaccines illustrates a gap between what had been promised for the first phase of vaccine rollout versus the reality of supply chain challenges, cold storage, and 50-state and local fragmentation at the last mile for U.S. health citizens. An op-ed published in yesterday’s Washington Post by Dr. Robert Wachter of UCSF and Dr. Ashish Jha of Brown University found these two wise physicians feeling “punched in the face” with the state of coronavirus vaccination in America. As a result, they soberly, pragmatically recommended administering just the first jab of vaccine

explained in a new report from EY co-sponsored by the American Hospital Association (AHA) and the AHA Center for Health Innovation. Digital Transformation – Anywhere Care envisions “health care with no address, or bringing care to the consumer or patient rather than expecting the patient to go to the hospital” as a “vital sign” of health care’s changes going into the new year of 2021. COVID-19 accelerated a movement in which I’ve been involved for over a decade, known as “participatory health.” In its early phase in the U.S., Dr. Tom Ferguson identified the emerging role of the internet in

Staying home, being clean, staying entertained, eating well, and self-caring for healthcare….these are the major factors underpinning the twenty fastest-growing brands of 2020, based on Morning Consult’s annual look at the topic. Let’s look into these categories by brand, and connect the dots for health, medical care, and well-being… Connectivity as a social determinant of health. Zoom was the fastest-growing brand of the year, with 26% of U.S. consumers saying they would consider purchasing the service in November compared with 11% in January. Zoom morphed from a business meeting platform to a consumer and family-connecting service spiking on holidays like

When it comes to patients, health care providers have been hit hard in two ways in the wake of the COVID-19 pandemic. Hit #1 has been the direct negative impact of the coronavirus on health care volumes and patients not utilizing hospitals and doctors’ services, avoiding physical encounters in health care sites Hit #2 has been the negative impact of patient experience for those health consumers who sought health care services during the pandemic — and had a negative response to the encounter. Accenture explored this phenomenon in their latest report, Elevating the Patient Experience to Fuel Growth. In the

Two in three U.S. consumers skipped or delayed getting in-person medical care in 2020. One in 2 people had a telehealth visit int he last year. Most would use virtual care again. The coronavirus pandemic has mind-shifted how patients envision a health care visit. Today, most consumers prefer the idea of getting health care at home compared with going to a doctor’s office. Most Americans also like the idea of recovering at home instead of at a medical facility after a major medical event, according to the report, Health-at-Home 2020: The New Standard of Care Delivery from CareCentrix. COVID-19 has

The first six months into the coronavirus pandemic shocked the collective system of U.S. consumers for living, learning, laboring, and loving. I absorbed all kinds of data about consumers in the wake of COVID-19 between March and mid-August 2020, culminating in my book, Health Citizenship: How a virus opened hearts and minds, published in September on Kindle and in print in October. In this little primer, I covered the five trends I woven based on all that data-immersion, following up the question I asked at the end of my previous book, HealthConsuming: when and how would Americans claim their health

As the COVID-19 pandemic emerged in the U.S., Americans were already Primed for ecommerce — even in health care. The coronavirus accelerated the digital transformation on people as consumers — and consumers as health consumers. Today, Amazon announced the company’s launch of Amazon Pharmacy. Watch for earth-shaking (negative) impacts on the incumbent pharmacies like CVS, Rite-Aid, Walgreens, as well as discount and ecommerce players such as GoodRx. [Sidebar: as of 10 am this morning, the announcement “sunk” the retail pharmacy stocks, according to TheStreet.com]. Some context: this announcement builds on Amazon’s previous major move into pharmacy with its acquisition of

The COVID-19 pandemic has accelerated health care providers’ and plans’ investment in digital technologies while reducing capital spending on new physical assets, we learn in Building resilience during the COVID-19 pandemic and beyond from the Deloitte Center for Health Solutions. What must be built (or truly re-built), health care leaders believe, is first and foremost trust, followed by financial viability to ensure long-term resilience and sustainability — for the workforce, the organization, the community, and leaders themselves. For this report, Deloitte interviewed 60 health care chief financial officers to gauge their perspectives during the pandemic looking at the future of

Over one-half of Americans would likely use virtual care for their healthcare services, and one in four people would actually prefer a virtual relationship with a primary care physician, according to the fifth annual 2020 Consumer Sentiment Survey from UnitedHealthcare. What a difference a pandemic can make in accelerating patients’ adoption of digital health tools. This survey was conducted in mid-September 2020, and so the results demonstrate U.S. health consumers’ growing digital health “muscles” in the form of demand and confidence in using virtual care. One in four people would consider online options as their first-line to evaluating personal health

Yesterday, the 4th of November 2020, the cable network CNN published a story titled, “Survive election uncertainty with these expert tips on how to cope.” That morning-after-the-Election-night-before followed CNN’s allying on #2020Elections night with the Calm app — a marketing alliance meant to address the real phenomenon of political stress that has been ramping up in the U.S. for several years. I liked Teen Vogue‘s coverage of the story best, and linked it here, but you can also view lenses on the event in: Adweek, Meditation App Calm Was the Most 2020 Brand Partner for CNN’s Election Coverage, whose key

It is said that a picture tells a thousand words. This picture tells an even quicker story that can save lives: “Masks work.” The backstory: Kansas Governor Laura Kelly issued a mask mandate on July 2, 2020. The rationale: That was two days before Independence Day, the holiday weekend when she and state public health officials anticipated health citizens would abandon their personal efforts to physically distance and cover faces to avoid contracting or spreading the coronavirus. This was the message directly communicated to U.S. residents by the White House Coronavirus Task Force that week before Independence Day. The backlash: 

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

2020 will be remembered for disruption and dislocation on many fronts; among the major blips in the year will be it remembered as the largest funding year for digital health recorded, according to Rock Health’s report on the 3Q2020 digital health funding. This funding record (“already” before year-end, tallied by the third quarter as Rock Health notes) was driven by “mega”-deals accelerated during the public health crisis of COVID-19. In the third quarter of 2020, some $4 billion was invested in U.S. based digital health start-ups adding up $9.4 billion in 2020….so far. This is $1.2 billion more than two

In January 2020, before we knew how to spell “coronavirus,” millions of consumers were already “Amazon-Primed” for everyday life-flows and consumer behaviors. The pandemic has accelerated consumer trends already in motion early this year when the Consumer Technology Association (CTA) convened the annual CES 2020 in Las Vegas. I covered the event here in Health Populi, as I have for most of the past decade, highlighting the growth of digital health and, this year, the expanding Internet of Healthy Things called-out by Dr. Joseph Kvedar in 2015. What a difference a public health crisis makes, accelerating digital health beyond fitness

The coronavirus pandemic has spawned many side-effects re-shaping consumers’ everyday lives. Among them, more time at home, DIY life-flows, and financial well-being are driving growth of self-care health care. An article in the latest Drug Store News talks about consumers growing more health-conscious, adopting natural, homeopathic products. “It’s about more than washing your hands,” David Salazar explains. “Fending off illness has become a state of mind for many consumers throughout the COVID-19 pandemic.” In feeling dis-empowered in the face of the pandemic – with the first shock of the Great Lockdown and stay-at-home mandates – we’ve taken on more do-it-yourself behaviors, from

“This surge of people experiencing acute behavioral health problems…has the potential to further impact the healthcare system for years to come,” a report from McKinsey expects looking at the hidden costs of COVID-19’s impact on U.S. health care. The coronavirus pandemic has taken a toll on Americans’ mental health, with anxiety and depression growing as a side-effect to worries about the virus itself, the long Great Lockdown in much of the country, and the economic recession that has particularly impacted women and people of color. I covered depression impacts due to COVID-19 here in Health Populi yesterday, and wanted to

COVID-19 is re-shaping all industries, especially health care. And the pharma industry is challenged along with other health care sectors. In fact, the coronavirus crisis impacts on pharma are especially accelerated based on how the pandemic has affected health care providers, as seen through research from Accenture published in Reinventing Relevance: New Models for Pharma Engagement with Healthcare Providers in a COVID-19 World. For the study, Accenture surveyed 720 health care providers in general practice, oncology, immunology, and cardiology working in China, France, Japan, the United Kingdom, and the U.S., in May and June 2020. Top-line, Accenture points to four

The pandemic has become a sort of forcing function on all aspects of daily living, include health care. Deloitte’s latest wave of health care consumer market research updates the COVID-19 impacts on the U.S. health care landscape and asks the question in the study report’s title: “Are consumers already living the future of health?” For the general survey of U.S. Health Consumers, Deloitte polled 4,522 U.S. adults 18 and older online in February and March 2020. Deloitte conducted an additional 1,510 interviews with consumers in April to gauge peoples’ perspectives on the pandemic, health and well-being. In the Great Lockdown

Welcome back to my ABCovid-19 Journal, which I created/curated in the early weeks of the coronavirus pandemic. This week, I’m sharing all the letters of the alphabet with you which reminded me keywords and themes emerging as we were learning about this dastardly public health threat beginning early in 2020. In today’s Health Populi blog I bring you letters “K” through “O,” continuing through the rest of the alphabet tomorrow and Friday while I’m on a lake-side holiday that’s good for mind, body, and spirit. K is for Kirkland, Washington state In the U.S., one of the earliest hotspots for

My friends… It’s time in this pandemic journey that I take a full week to re-charge and bask in the midst of nature, a lake, farm-to-table food, wine-making, and the love of and therapeutic time with my wonderful husband. My gift to you all this week, 10th – 14th August, is to share with you pages from my “ABCovid-19 Journal” that I created/curated in the first weeks of the coronavirus pandemic. We all have our hacks for managing stress and discomfort, and in the first weeks of COVID-19, this was my life-saver. Journaling is one of my self-care strategies; think

Pass me the Clorox…tip the UPS driver…love thy grocer. These are our daily life-flows in the Age of COVID-19. Our basic needs are reflected in the new 2020 Axios-Harris Poll, released today. For the past several years, I’ve covered the Harris Poll of companies’ reputation rankings here in Health Populi. Last year, Wegmans, the grocer, ranked #1; Amazon, #2. In the wake of the COVID-19 pandemic, U.S. consumers’ basic needs are emerging as health and hygiene, food, and technology, based on the new Axios-Harris Poll on the top 100 companies. This year’s study was conducted in four waves, with the

With growing coronavirus case hotspots in southern and western states, more Americans perceive the pandemic is worsening this summer, shown by a Gallup poll published 20 July 2020. Gallup titles the analysis, Americans’ social distancing steady as pandemic worsens. The first table organizes Gallup’s data by demographics, illustrating a significant gap between how women perceive the exacerbating pandemic compared with men. In early June, roughly one-third of both men and women saw COVID-19 was getting “worse”; five weeks later, in the second week of July, men and women’s perceptions were 12 points apart with more women concerned about the situation

Advertising Age announced their list of the top 20 brands in 2020 this week. Ad Age’s lens on these was heavily tinted by consumers’ lives coping with the coronavirus pandemic: “The coronavirus has brought new attention to typically boring, decades-old consumer staples, while hastening the rise of digital newcomers that were only just beginning to gain traction pre-pandemic,” Ad Age explains in the introduction to the list of the selected brands. As the editors of the MadMen-and-Women’s most influential industry publication, they explain, “Ad Age chronicles 20 brands that are having a moment.” This moment to them as well as

Whether healthcare spending in 2021 increases by double-digits or falls by one-third directly depends on how the coronavirus pandemic will play out over the rest of 2020, based on PwC’s annual report on medical cost trends for 2021. The three cost scenarios are based on assumptions shown in the fine print on the first chart: The medium scenario, a sort of “return to normal” where medical trend could stay even at 6.0%, equal to the 2020 trend. This assumes that healthcare spending recovers by October 2020 as patients return to hospitals and doctors’ offices for regular care patterns. In 2021,