A blog covering the health/care ecosystem and people.

As we wrestle with just “what” health care will look like “after COVID,” there’s one certainty that we can embrace in our health planning and forecasting efforts: that’s the persistence of telehealth and virtual care into health care work- and life-flows, for clinicians and consumers alike and aligned. There’s been a flurry of research into this question since the hockey-stick growth of telemedicine visits were evident in March 2020, just days after the World Health Organization uttered the “P-word:” pandemic. Three recent reports (among many others!) bolster the business and clinical cases for telehealth in America in terms of: A

We are all caregivers now. The COVID-19 pandemic has touched and continues to re-shape our daily lives. One reality that the coronavirus era has revealed is that caregiving is a daily life-flow for everyone around the world. In the U.S., this has particularly acute impacts — physical, emotional, and financial. The 2020 AARP report on caregiving was published this month, and the survey research into caregivers uncovered fresh insights about caregivers’ demographics, financial stressors, and intensity of tasks both in volume and time. In addition, more caregivers are looking for and turning to technology to help them hack effort, time

Millions of mainstream, Main Street Americans entered 2020 feeling income inequality and financial insecurity in the U.S. The coronavirus pandemic is exacerbating financial stress in America, hitting women especially hard, based on PwC’s 9th annual Employee Financial Wellness Survey COVID-19 Update. For this report, PwC polled 1,683 full-time employed adults between 18 and 75 years of age in January 2020. While the survey was conducted just as the pandemic began to emerge in the U.S., PwC believes, “the areas of concern back in January will only be more pronounced today,” reflecting, “the realities of the changing employee circumstances we are

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

Stress is up, smoking increasing, drinking more alcohol….Americans are tapping into a variety of coping mechanisms in the coronavirus outbreak, with health on their collective minds. Toluna and Harris Interactive are collaborating on the COVID-19 Barometer, publishing biweekly data on consumers’ views on the coronavirus pandemic. The data here are a snapshot of consumers taken through the Toluna-Harris poll conducted among 1,047 U.S. adults between 9-20 April 2020. The first chart shows various life-flows Americans have adopted in April, all risk factors impacting peoples’ overall health status and mental well-being. There were demographic differences across these factors: more women felt

As the coronavirus pandemic’s curve of infected Americans ratchets up in the U.S., people are seeking comfort from listening to Dolly Parton’s bedtime stories, crushing on Dr. Anthony Fauci’s science-wrapped-with-empathy, and streaming the Tiger King on Netflix. These and other self-care tactics are taking hold in the U.S. as most people are “social distancing” or sheltering in place, based on numbers from the early April 2020 Kaiser Family Foundation health tracking poll on the impact of the coronavirus on American life. While the collective practice of #StayHome to #FlattenTheCurve is the best-practice advice from the science leaders at CDC, the NIAID

There’s evidence in this week’s JAMA of a dose-response relationship between peoples’ steps and lower mortality. In other words: more steps done daily is statistically significantly associated with death from all causes. Furthermore, step intensity didn’t make a difference in mortality rates, shown in the JAMA-published study, Association of Daily Step Count and Step Intensity With Mortality Among US Adults. The publication of this study is incredibly well-timed given the fact that hundreds of millions of people around the world are in lockdown, #StayHome lifestyles this week, and will be for many weeks to come. Going outside for fresh air

One in two Americans trust the Centers for Disease Control for the facts on the coronavirus pandemic, and 43% trust the World Health Organization. But there’s a huge trust deficit when it comes to trusting President Donald Trump on the facts about COVID-19, a poll from Morning Consult and The Hollywood Reporter found. 2,200 U.S. adults were surveyed between 12 and 15 March 2020 on the coronavirus pandemic and their perspectives on the media and political leaders’ information credibility. For news on the pandemic, only one in five Americans believed the President and 18%, the Vice President, Mike Pence, followed

Will the coronavirus inspire greater adoption of telehealth in the U.S.? Let’s travel to Shanghai, China where, “the covid-19 epidemic has brought millions of new patients online. They are likely to stay there,” asserts “The smartphone will see you now,” an article in the March 7th 2020 issue of The Economist. The article returns to the advent of the SARS epidemic in China in 2003, which ushered in a series of events: people stayed home, and Chinese social media and e-commerce proliferated. The coronavirus spawned another kind of gift to China and the nation’s health citizens: telemedicine, the essay explains. A

Anne Case and Angus Deaton were working in a cabin in Montana the summer of 2014. Upon analyzing mortality data from the U.S. Centers for Disease Control, they noticed that death rates were rising among middle-aged white people. “We must have hit a wrong key,” they note in the introduction of their book, Deaths of Despair and the Future of Capitalism. This reversal of life span in America ran counter to a decades-long trend of lower mortality in the U.S., a 20th century accomplishment, Case and Deaton recount. In the 300 pages that follow, the researchers deeply dive into and

The coronavirus has shaken U.S. consumer confidence, both in terms of financial markets and personal health risks. COVID-19 is re-shaping peoples’ behavior and daily choices, from using public transit to choosing where to shop, based on Morning Consult’s National Tracking Poll #200276 conducted February 28-March 1, 2020. Morning Consult surveyed 2,200 U.S. adults, finding that 3 in 4 Americans were concerned about the coronavirus outbreak. The first chart from the survey shows various consumer activities by peoples’ likelihood of choosing to do them. Clearly, our daily life-flows outside of our homes have been impacted by our perceived risks of the coronavirus:

Outpatient revenue is crossing the curve of inpatient income. This is the new reality for U.S. hospitals and why I’ve titled this post, “outpatient is the new inpatient,” a future paradigm for U.S. hospitals This realization is informed by data in a new report from Deloitte, Where have the many hospital inpatient gone? The line chart illustrates Deloitte’s top and bottom line: “The shift toward outpatient is happening and will likely have a tremendous impact on operations, business models, staffing, and capital. Health systems should prepare for the future today and start thinking not only about how to manage their

With our HealthConsuming “health is everywhere” ethos, this post updates some of the most impactful recent retail health developments shaping consumers’ health/care touchpoints beyond hospitals, physicians, and health plans. For inspiration and context, I’ll kick off with Roz Chast’s latest New Yorker cartoon from the February 3rd 2020 issue — Strangers in the Night, taking place in a Duane Reade pharmacy. Roz really channels the scene in front of the pharmacy counter, from Q-tips to vitamins and tea. And it’s hummable to the tune of, well, Strangers in the Night. Check out the 24-hour pharmacist under the pick-up sign. Now,

Americans who have commercial health insurance (say, through an employer or union) are rarely thought to face barriers to receiving health care — in particular, primary care, that front line provider and on-ramp to the health care system. But in a new study published in the Annals of Internal Medicine, commercially-insured adults were found to have visited primary care providers (PCPs) less often, and 1 in 2 had no PCP visits in one year. In Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016, the researchers analyzed data from a national sample of adult health

As consumers in the U.S. wrestle with accessing and paying for medical benefits, there’s another sort of health benefit people increasingly understand, embrace, and consume: food-as-medicine. More people are taking on the role of health consumers as they spend more out-of-pocket on medical care and insurance, and seeking food to bolster their health is part of this behavior change. One in four Americans seek health benefits from food, those who don’t still seek the opportunity to use food for weight loss goals, heart health and energy boosting, according to the 2019 Food & Health Survey from the International Food Information

Physicians are evolving as digital doctors, embracing the growing role of data generated in electronic health records as well as through their patients using wearable technologies and mobile health apps downloaded in ubiquitous smartphones, described in The Rise of the Data-Driven Physician, a 2020 Health Trends Report from Stanford Medicine Stanford Medicine interviewed 523 physicians and 210 medical students and residents in September and October 2019 to assess clinicians’ perspectives on digital health topics for this study. The study title citing the “data-driven physician” is based on the key survey finding that doctors are preparing to embrace data, from both traditional

The top two health care concerns facing Americans are out-of-pocket costs and prescriptions drug costs, according to a poll published today in Morning Consult. Apropos to my title of this post, the survey was sponsored by the Bipartisan Policy Center, whose mission is to promote, cross-party affiliations, “health, security and opportunity for all Americans.” Health care is the top issue driving voters’ choices in the 2020 elections for most Americans. The economy follows second with 44% of voters, then immigration with 33% of Americans keen on the issue. For overall healthcare reform, the plurality of Americans prefer improving the current system

In CTA’s 2020 Consumer Tech Forecast launched yesterday at Media Day 1 at CES, Steve Koenig VP of Research, said that, “digital health is an ecosystem of ecosystems.” Health, medical and wellness trends featured large in the forecast, which brought together key trends for 5G, robotics, voice tech, AR/VR/XR, and the next iteration of IoT — which Steve said will still be called “IoT,” but in this phase will morph into the “Intelligence of Things.” That speaks to Steve’s phrase, “ecosystem of ecosystems,” because that’s not just “digital” health — that’s now the true nature of health/care, and what is

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.

The new year will see a “looming tsunami” of high prices in healthcare, regulation trumping health reform, more business deals reshaping the health/care industry landscape, and patients growing do-it-yourself care muscles, according to Top health industry issues of 2020: Will digital start to show an ROI from the PwC Health Research Institute. I’ve looked forward to reviewing this annual report for the past few years, and always learn something new from PwC’s team of researchers who reach out to experts spanning the industry. In this 14th year of the publication, PwC polled executives from payers, providers, and pharma/life science organizations. Internally,

There’s something like cognitive dissonance as I prepare my 2020 Health Populi TrendCast of what to expect in the health/care ecosystem in the new year. One of my key pillars for health-making is food-as-medicine, and that opportunity in this moment resonates in this holiday season with Dickens’ “Best of Times, Worst of Times” context-setting that kicks off Great Expectations. In the “best of times” part of the food+health equation, we recognize the growing role of grocery stores, food-tech and food manufacturers in the health/care landscape. A current example comes from Kroger, partnering with Ascension’s health system in Tennessee, enhancing the organization’s

While customer satisfaction with health insurance plans slightly increased between 2018 and 2019, patient satisfaction with hospitals fell in all three settings where care is delivered — inpatient, outpatient, and the emergency room, according to the 2018-2019 ACSI Finance, Insurance and Health Care Report. ACSI polls about 300,000 U.S. consumers each year to gauge satisfaction with over 400 companies in 46 industries. For historic trends, you can check out my coverage of the 2014 version of this study here in Health Populi. The 2019 ACSI report bundles finance/banks, insurance (property/casualty, life and health) and hospitals together in one document. Health

On the demand side of U.S. health care economics, patients are now payors as health consumers with more financial skin in paying medical bills. As consumers, people have great expectations from the organizations on the supply side of health care — providers (hospitals and doctors), health insurance plans, pharma and medical device companies. But as payors, health consumers face challenges in getting care, so great expectations are met with frustration and eroding trust with the system, according to the latest Connected Healthcare Consumer report from Salesforce published today as the company announced expansion of their health cloud capabilities. This is

Health and our health information are deeply personal. Changing health care and inspiring positive health behaviors is hard to do. But we must and we will, a group of inspiring and inspired people who work across the health/care ecosystem affirmed this week in Dallas at the conference of Medecision Liberation 2019. I was engaged at this conference to wear several hats — as a keynote speaker, a sort of “emcee,” and, finally, to trend-weave the many talks and discussions happening throughout the meeting. This post is my synthesis of the summary I delivered live at the end of the conference,

As patients have taken on more financial responsibility for first-dollar costs in high-deductible health plans and medical bills, hospitals and health care providers face growing fiscal pressures for late payments and bad debt. Those financial pressures are on both sides of the health care payment transaction, stressing patients-as-payors and health care financial managers alike. I’m speaking to health industry stakeholders on patients-as-payors at Cerner’s Now/Next conference today about the patient-as-payor, a person primed for engagement. That’s as in “Amazon-Primed,” which patients in their consumer lives now use as their retail experience benchmark. But consumers-as-patients don’t feel like health care today

Older people are re-framing their personal images and definitions of aging, from continuing to work past typical retirement age, Skyping and texting with grandchildren, and traveling to destinations well beyond the “snowbird” locales of Florida and Arizona to more active and often charitable/volunteer situations in developing economies. And so, too, are older folks re-imagining how and where their health care services could be delivered and consumed. Most people over 50 years of age are cautious but open to receiving health care virtually via telehealth platforms, according to the National Poll on Healthy Aging from my alma mater, the University of Michigan. U-M’s

“Digital transformation” is the corporate strategy flavor of the moment across industries, and the health are sector isn’t immune from the trend. As this 13th year of the annual Health 2.0 Conference kicks off this week, I’m focused on finding digital health innovations that engage people — consumers, caregivers, patients, health citizens all. This year’s conference will convene thought leaders across a range of themes, and as is the Health 2.0 modus operandi, live demo’s of new-new things. As Health 2.0 kicks off today in pre-conference sessions, there is useful context described in a new report from the American Hospital

“Every company is a tech company,” Christopher Mimms asserted in the Wall Street Journal in December 2018. Connectivity, artificial intelligence, and automation are now competencies every company must master, Mimms explains. This ethos underpins Humana’s decision to join CTA, the Consumer Technology Association which hosts CES every January in Las Vegas. If you read this blog, you know one of the fastest-growing “aisles” at the annual conference is digital health. Humana joined up with CTA’s Health and Fitness Technology Division this month. Last year, Humana hired Heather Cox in the new post of Chief Digital Health and Analytics Officer, reporting directly

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

Today, I am speaking with marketing leaders who are members of CHPA, the Consumer Healthcare Products Association on this very topic. This is CHPA’s 2019 Marketing Conference being held at the lovely historic Hotel du Pont in Wilmington, DE. The gist of my remarks will be to focus on the evolving retail health ecosystem, with my HealthConsuming lens on health/care, everywhere. And timing is everything, because today is International Self-Care Day to promote peoples’ health engagement. The plotline begins with a tale of two companies — CVS/health and Best Buy — discussing these two organizations’ approach to acquiring companies to expand

Of the $401 billion that will flow through retailers for consumer technology products, many of the fastest-emerging categories will play a role as platforms for health and medical care at home and in wearable tech. This is my tea-leaf read from reviewing the projections in the report, U.S. Consumer Technology Sales and Forecasts, July 2019, from the Consumer Technology Association (CTA). [CTA is annual convener of CES, the world’s largest consumer electronics meet-up.] Along with artificial intelligence (AI) and fast 5G networking, the forecast also quantifies growth prospects for smart speakers, home robots, wireless earbuds, smartwatches. and in-vehicle technology —

Today is July 15, and my email in-box is flooded with all flavors of Amazon Prime’d stories in newsletters and product info from ecommerce sites — even those outside of Amazon from beauty retailers, electronics channels, and grocery stores. So I ask on what will probably be among the top ecommerce revenue generating days of all time: “What could health care look like when Amazon Prime’d?” I ask and answer this in my book, HealthConsuming, as chapter 3. For context, this chapter follows two that explain how patients in the U.S. have been morphing into health consumers based on how health

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

There are many forms of magic inspired by Disney, the company. There’s the obvious attraction, the Magic Kingdom, that was Walt’s original destination vision, “imagineered” in 1932. Then there are other kinds of magic. The one I’m deep into in the moment is inspiration, ideation, and “reimagineering” my own thinking about work, legacy, and social justice. I’m grateful to have had the opportunity to spend much of this week at the inaugural Disney Institute Women’s Leadership Summit. The Institute convened about 300 women (and a handful of brave “He-for-She” men keen on diversity) in Orlando to learn about and brainstorm

“How should we define ‘health?'” a 2011 BMJ article asked. The context for the question was that the 1948 World Health Organization definition of health — that health is, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”– was not so useful in the 21st century. The authors, a global, multidisciplinary team from Europe, Canada and the U.S., asserted that by 2011, human health was marked less by infectious disease and more by non-communicable conditions that could be highly influenced, reversed and prevented through self-care by the individual and public health policy

People want to make health with their health care providers, and they want more than care from them: most patients are looking for support with healthy eating, exercise, emotional support, sleep, stress management, social relationships, and financial health. And in case physicians, nurses and pharmacists aren’t sufficiently business with that punch-list for health, two in three U.S. patients would also like to receive help in finding a higher purpose. This is the health consumer’s mass call-out for holistic health, Welltok discovered in a survey conducted among over 1,600 U.S. adults in March 2019. The results are detailed in the assertively 

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

There’s no denying the growth of telehealth, virtual visits, remote health monitoring and mHealth apps in the healthcare landscape. But these growing technologies don’t replace the role of real estate in health, wellness and medical care. Health care is a growing force in retail real estate, according to the ICSC, the acronym for the International Council of Shopping Centers, which has been spending time analyzing, in their words, “what landlords should know in eyeing tenants from a $3.5 trillion industry.” Beyond the obvious retail clinic segment, the ICSC points out a key driving growth lever for its stakeholders, recognizing that,

People over 50 in the U.S. that are likely to vote in the 2020 Presidential election are keenly interested in lowering the cost of prescription drugs, according to a survey conducted by AARP in February and March 2019. Most people over 50 take prescription drugs daily; one-third take two or three Rx’s regularly, and one in five older people take six or more prescription medicines regularly. Thus, prescription drugs are part of most older Americans’ daily life-flows and household spending considerations. About two-thirds of older people who are likely to vote say that Rx prices are “unreasonable,” including 67% of

We are all Homo informaticus these days, multi-channel, multi-platform beings using digital platforms. “Computing is not about computers anymore. It is about living,” Nicholas Negroponte wrote in Being Digital. He said that in 1995. In that quarter-century since Negroponte made that prescient observation, we come to better understand that being a Digital Society has its upsides and downfalls, alike. We need a “new needs model” for the digital age, asserts a new report, Human Needs in a Digital World, the 2019 Digital Society Index report from the Dentsu Aegis network. Taking Maslow’s Hierarchy of Needs as a basic construct, the Index

Health is everywhere, I find in my travels and in my community. I’m in Chicago at the Becker’s health care conference with VisitPay this week, and had the opportunity to take a walk around the corner from the Hyatt Regency to the Illinois Center to visit one of the few Amazon Go stores operating in the U.S. Here’s what I found in my search for all-things-healthy at retail. You cannot enter an Amazon Go store without downloading the app that’s freely available in your operating system’s appstores for Apple, Google and, yes, Amazon. The app was quick to download, but

There’s little Americans, by political party, agree upon in 2019. One of the only issues bringing people together in the U.S. is prescription drug prices — that they’re too high, that the Federal government should negotiate to lower costs for Medicare enrollees, and that out-of-pocket costs for drugs should be limited. The Kaiser Family Foundation has been tracking this topic for a few years, and this month, their March 2019 Health Tracking Poll shows vast majorities of Democrats, Independents and Republicans all share these sentiments. It’s not that patients who take prescription drugs don’t appreciate them – most (58%) say medicines

Across generations, from younger to older patients, cost, transparency and convenience drive consumer satisfaction, Accenture’s latest health consumer survey found. I had the opportunity to brainstorm the study’s findings in real-time on the day of survey launch, 12 February, with Dr. Kaveh Safavi, Brian Kalis, and Jenn Francis at HIMSS19. Our starting point was the tipping-point statistic that over 50% of people in the U.S. have chosen to use a non-traditional health care setting. Those non-traditional sites of care include walk-in and retail clinics, outpatient surgery centers, virtual health (whether on the phone, on video or via mobile apps), on-demand services,

Ten years ago, two brothers, physicians both, started up a telemedicine company called American Well. They launched their service first in Hawaii, where long distances and remote island living challenged the supply and demand sides of health care providers and patients alike. A decade later, I sat down for a “what’s new?” chat with Roy Schoenberg, American Well President and CEO. In full  transparency,  I enjoy and appreciate the opportunity to meet with Roy (or very occasionally Ido, the co-founding brother-other-half) every year at HIMSS and sometimes at CES. In our face-to-face brainstorm this week, we covered a wide range

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

Our homes should nurture our health. In addition to nutrition and good food, positive relationships, clean air and water, and the basic needs that bolster whole health, technology is playing a growing role to help us manage health at home. At CES 2019, I spent time with Roy Jakobs, Chief Business Leader of Personal Health with Philips, to discuss the company’s evolving portfolio of products that help fulfill the mission to support people across their own continuum of health. Following CES, I wanted to further dive into one part of the portfolio very important to family health at home: the

Health begins at home. I found evidence for that, beyond my own N of 1 understanding, in a research article published in the UK in 2000 by Lyn Harrison and Frances Heywood. Lyn and Frances tested three assumptions that they believed linked housing and health: that housing contributes to health; that housing is not routinely included in health or social planning;’ and that the potential contribution of primary care is wasted. Their conclusion: that the housing-health link was not receiving the recognition that connection needs. Nearly two decades later, that housing-health link still isn’t universally embraced by health care stakeholders. But

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