A blog covering the health/care ecosystem and people.

A new documentary and educational campaign on health equity will be launched on May 1st, 2022, from Oprah’s Harpo Productions studio partnering with The Smithsonian Channel. The Color of Care documents stories of people who have lost loved ones in the COVID-19 pandemic as well as expert interviews with frontline workers and public health experts and researchers sharing data on systemic racism in health care that has underpinned racial health disparities since slavery was instituted in America. Oprah’s website talked about the project, quoting her saying,      “At the height of the pandemic, I read something that stopped me in

Compared with health citizens living in other wealthy countries, people living in the U.S. are still among the least likely to have a regular doctor or place to go for care. Thus, millions of Americans continue to lack access to primary care compared with peers in other nations, according to a report from The Commonwealth Fund. The Commonwealth Fund has tracked primary care access for many years, and over time has found the United States to lack the kind of primary care “backbone” that many wealthy nations have — whose health citizens also enjoy much better health outcomes that relate

s in the seventh annual 2022 Brand Relevance Index from Prophet. The research developed a list of 50 companies representing what Prophet characterizes “the brands that people can’t live without in 2022.” For the 7th year in a row, Apple tops the study. Following Apple, the nine companies rounding out the top ten most relevant brands were Peloton, Spotify, Bose, Android, Instant Pot, Pixar, Fitbit, TED, and USAA. There are relative newbies in this list, representing consumers’ collective response to the COVID-19 pandemic and new life-flows. Put Calm and AfterPay in that category, along with Beyond Meat, and Zelle. The

There’s more evidence that doctors and patients, both, want to use telehealth after the COVID-19 pandemic fades. Doximity’s second report on telemedicine explores both physicians’ and patients’ views on virtual care, finding most doctors and health consumers on the same page of virtual care adoption. For the physicians’ profile, Doximity examined 180,000 doctors’ who billed Medicare for telemedicine claims between January 2020 and June 2021. Telemedicine use did not vary much across physician age groups. Doctors in specialties that manage chronic illnesses were more likely to use telehealth: endocrinology (think: diabetes), gastroenterology, rheumatology, urology, nephrology, cardiology, ENT, neurology, allergy, and

The Future of Wellness in 2022 is, “shifting from a ‘feel-good’ luxury to survivalism as people seek resilience,” based on the Global Wellness Institute’s forecast on this year’s look into self-care and consumer’s spending on health beyond medical care — looking beyond COVID-19. GWI published two research papers this week on The Future of Wellness and The Global Wellness Economy‘s country rankings as of February 2021. I welcomed the opportunity to spend time for a deep dive into the trends and findings with the GWI community yesterday exploring all of the data, listening through my health economics-consumer-technology lens. First, consider

One of the best parts of watching the biggest U.S. football game of the year are the ads which can provide great entertainment in-between touchdowns, time-outs, and referees’ video replays. This year, Ad Age provides us with an early inventory of some of the high-expectation commercials, including the usual suspects like Budweiser, Google, TurboTax, and Avocados from Mexico. For the first time, cryptocurrency brands will advertise on the  Super Bowl, too. But I’m most looking forward to seeing the 30-second spot from Hologic, the medical technology company. AdWeek wrote, quoting a Hologic press release, “As a leader in women’s health,

People around the world have made health a “proactive priority,” most important to live a longer, healthier life, to avoid preventable diseases, to protect against disease, and to look and feel healthier, according to NielsenIQ’s latest health and wellness report. As the triangle here illustrates, NielsenIQ has turned Maslow’s Hierarchy of Needs upside down, shifting protective and physical needs to the top rung and altruistic — the “me-to-we” ethos — at the base. Note the translations of these needs, on the ride, into the “care” flows — moving from urgent care down to self-care, preventive care, innovative care, and selfless

With the collective pandemic-era pivot of people working from home, remote schooling at home, repurposing our homes for entertainment and fitness, and showing off home-baked goods on Instagram, has consumers’ comfort with new technologies accelerated? Morning Consult assessed this question in a poll timed to coincide with CES 2022, the annual conference dedicated to innovations in consumer electronics. “Is the public ready for the innovations coming out of the 2022 Consumer Electronics Show?” the Morning Consult team asked. “While brands may enjoy the initial buzz over these launches, it often takes a while for the public to become comfortable enough

As we enter COVID-19’s “junior year,” one unifying experience shared by most humans are feelings of pandemic fatigue: anxiety, grief, burnout, which together diminish our mental health. There are many signposts pointing to the various flavors of mental and behavioral health challenges, from younger peoples’ greater risk of depression and suicide ideation to increased deaths of despair due to overdose among middle-aged people. And about one-in-three Americans has made a 2022 New Year’s resolution involving some aspect of mental health, the American Psychiatric Association noted approaching the 2021 winter holiday season. Underneath this overall statistic are important differences across various

In October 2021, the Consumer Technology Association (CTA) announced that Robert Ford, CEO and President of Abbott, would give a keynote speech at CES 2022, the world’s largest annual convention of the technology industry. “This marks the first time in CES history that a healthcare company will take the mainstage for a keynote at the show,” CTA’s press release stated. I covered this announcement in the Health Populi blog at the time, and today want to double-down on the significance of Ford’s leading presence at #CES2022. When announced, the news was a signal that health care and the larger tech-enabled

Best Buy continues to grow its health/care market footprint and service portfolio through remote health monitoring, first announced in the press release, Best Buy to acquire Current Health to help make home the center of health. The financial deal was disclosed yesterday at £300 million, about $400 million US dollars (FYI, Current Health is based in Scotland, thus value given in pounds sterling, with a particularly strong US $ exchange right now at 1.34). Remote monitoring has been part of Best Buy Health’s vision from the time the company explained its big audacious goals for the health ecosystem in 2018

Even with growing inflation in the U.S. and post-pandemic job growth in 2021, the cost of health insurance premiums rose faster than either the price of goods or wages. That family health plan premium reached $22,221, an increase of 22% since 2016, we learn in the annual report from Kaiser Family Foundation, 2021 Employer Health Benefits Survey. This report is our go-to encyclopedia of statistics on health insurance year-after-year, surveying companies’ annual health insurance strategies for coverage and tactics for managing spending and workers’ health outcomes. This 2021 update takes into account the impacts and influence of COVID-19 on workers’

As we see the medical and acute care sector moving toward health and wellness, there’s a sort of equal and opposite reaction moving from the other end of the continuum of health/care: that is, wellness and fitness companies blurring into health care. Let’s start with the news about CrossFit and 23andMe, then synthesize some key market forces that will help us anticipate more ecosystem change for 2022 and beyond. CrossFit announced the company’s launch of CrossFit Precision Care, described as primary care that provides personalized, data-driven services for “lifelong health,” according to the press release for the program. The service

“More than a year and a half into the COVID-19 outbreak, the recent spread of the highly transmissible delta variant in the United States has extended severe financial and health problems in the lives of many households across the country — disproportionately impacting people of color and people with low income,” reports Household Experiences in America During the Delta Variant Outbreak, a new analysis from the Robert Wood Johnson Foundation, NPR, and the Harvard Chan School of Public Health. As the HLTH conference convenes over 6,000 digital health innovators live, in person, in Boston in the wake of the delta

A new look into Americans’ views on health privacy from Morning Consult provides a current snapshot on citizens’ concerned embrace of technology — worried pragmatism, let’s call it. This ambivalence will flavor how health citizens will adopt and adapt to the growing digitization of health care, and challenge the healthcare ecosystem’s assumption that patients and caregivers will universally, uniformly engage with medical tools and apps and technologies. More Boomers are concerned with health data app privacy than Gen Z consumers, as the chart illustrates. 46% of U.S. adults said that health monitoring apps were not an invasion of privacy; 32%

In 2020, Genentech launched its first study into health inequities. The company spelled out their rationale to undertake this research very clearly: “Through our work pursuing groundbreaking science and developing medicines for people with life-threatening diseases, we consistently witness an underrepresentation of non-white patients in clinical research. We have understood inequities and disproportionate enrollment in clinical trials existed, but nowhere could we find if patients of color had been directly asked: ‘why?’ So, we undertook a landmark study to elevate the perspectives of these medically disenfranchised individuals and reveal how this long-standing inequity impacts their relationships with the healthcare system

In April 2020, telemedicine morphed into mainstream medical care as hospitals and physicians risk-managed exposure to infection by meeting with patients, virtually, when possible. By March 2020, telehealth channels were replacing visits to doctors and emergency departments as shown in the first chart from the CDC’s report on the early pandemic period. By the spring of 2021, telehealth use stabilized, but health systems had built the processes and policies to deliver on the promise of omni-channel health care — from the patient’s home and hands (via smartphones) into community sites closer-to-home, and returning to brick-and-mortar medical buildings. Welcome to Telehealth

Rising costs, generational shifts, digital transformation, and fast-growing investments in new health care models and technologies are forcing change in the legacy health care, noted in the State of Consumerism in Healthcare 2021: Regaining Momentum, from Kaufman, Hall & Associates. As the title of Kaufman Hall’s sixth annual report suggests, health care consumers are evolving — even if the traditional healthcare system hasn’t uniformly responded in lock step with more demanding patients. Kaufman Hall analyzed 100 health care organizations in this year’s consumerism survey to assess their readiness to embrace consumer-centric strategies, understand how the industry prioritizes these approaches, evaluate

“We don’t un-learn,” Dr. Amy Abernethy asserted as she shared her pandemic perspectives on a panel with 2 other former U.S. health policy and regulatory leaders. The three spoke about navigating compliance (think: regulations and reimbursement) in an uncertain world. An uncertain world is our workplace in the health/care ecosystem, globally, in this moment. So to give us some comfort in our collective foxhole, my last post for this week of immersion in #HIMSS21 is based on the keynote speech of Michael Dowling, CEO of Northwell Health. Dowling keynoted on the theme of “Leading for the Future,” sharing his lessons

The COVID-19 pandemic sparked a reappraisal of value-based care, a shift to remote and virtual care, and acceleration of healthcare stakeholders’ investments in Artificial Intelligence-based solutions, Philips discovered in the 2021 Future Health Index, the company’s latest survey conducted among 2,800 health care leaders working in 14 countries. This week at the 2021 annual HIMSS conference, Philips is “making the case for moving to the cloud,” discussing the Philips HealthSuite, a cloud-based platform for connecting providers and patients, devices (and the data they generate), and care across the health care continuum. That’s a big promise and vision, so to kick

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.”

When we say the word “pharmacy,” we might picture the Main Street brick-and-mortar chain drugstore that dispenses medicines from behind the counter in the far back of the building, and sweet and salty snacks at the front by the cashier. In fact, “pharmacy” is the jumping off point for the expanding and increasingly beloved retail health ecosystem, J.D. Power found in the company’s latest 2021 U.S. Pharmacy Study. Each year, J.D. Power assesses consumers’ perceptions of pharmacies by category, including those retail chains along with supermarket operated, mass merchants, and mail order channels. This is the 13th year of the

There is no doubt that the COVID-19 pandemic motivated health care providers, payers, and patients to adopt digital tools and contact-less services, allowing people to deliver and receive medical care. Still, 18 months into the pandemic, now endemic and in its fourth wave of cases spiking around the world and in many parts of the U.S., some aspects of “digital transformation” seem not to have fully transformed American healthcare, we learn in HIMSS’s annual 2021 State of Healthcare Report. HIMSS collaborated with the organizations Trust  Accenture, The Chartix Group, and ZS on this year’s research. Nine in ten clinicians have recommended

Cain Brothers is a 100+ year old financial services firm with a strong health care experience, now part of KeyBanc. A recent “House Calls” memo and podcast from two company analysts detailed the state of Medicaid, Motherhood and America’s Future: Giving Birth to Better Maternity Outcomes. Christian Pesci and David Johnson’s in-depth discussion detailed their bottom-line that, “maternity care in the U.S. is in crisis but poised for rapid evolution…(recognizing) that an uncoordinated system with misaligned incentives harms too many individuals, families, and communities.” They lay out the crisis as follows: Medicaid funds nearly one-half of births in the U.S.

Post-pandemic, the consumer’s priority purchases are grocery, nesting, and health, according to David Shah, a leading thinker about social and design trends. David presented the latest Pantone forecast on color and society in NewTopia – A Balance of Color Opposites – Color for a Post-COVID World this week. I had the opportunity to attend the session, and want to share the health and wellness-related insights David shared in his fast-paced view on the role of color in bolstering wellbeing and community looking out to 2022/23. For context, Pantone plays a role in your life you might not realize. In health

We’ve long know that “the patient” has been an under-utilized resource in the U.S. healthcare system since Dr. Charles Safran testified with that statement to Congress way back in 2004…an era where bipartisanship for health IT was a real thing. Today, with the insights of Alexandra Drane (Founder of ARCHANGELS) and Dr. Nirav Shah (of Stanford University), we know that caregivers are among the most over-utilized resources in the U.S. healthcare system — overused, over-stressed, under-paid, detailed n How Health Systems Can Care for Caregivers, published in the NEJM Catalyst July 2021 issue. In this study, Drane and Shah analyze

The U.S. will be short as many as 124,000 physicians in 2034, according to The Complexities of Physician Supply and Demand Projections From 2019 to 2034 from the Association of American Medical Colleges (AAMC). Published 11th June 2021, the report was prepared by IHS Markit Ltd. and updates AAMC’s six previous annual reports on physician workforce projections. In this year’s projections, AAMC considers the long-term implications of the COVID-19 pandemic on physician supply, new to this report. Another timely feature in the 2021 study is the Health Care Utilization Equity Scenario which provides a baseline looking at inequities in access

Two studies published in May 2021 illustrate the value and importance of telehealth to patients in 2020, and a disconnect among many C-level executives working in hospitals, academic medical centers, and other care provider organizations. Together, the two reports from J.D. Power and BDO illustrate some mis-alignment between the demand and supply side of telehealth. On the consumer demand side, patients’ growing use of telehealth in the COVID-19 pandemic along with more frequent digital contacts with health plans bolstered member satisfaction, discovered by the J.D. Power 2021 U.S. Commercial Member Health Plan Study. J.D. Power has conducted the U.S. Commercial

When a new technology or product starts to get used in a market, it follows a diffusion curve whose slope depends on the pace of adoption in that market. For telehealth, that S-curve has had a very long and fairly flat front-end of the “S” followed by a hockey stick trajectory in March and April 2020 as the COVID-19 pandemic was an exogenous shock to in-person health care delivery. The first chart from the CDC illustrates that dramatic growth in the use of telehealth ratcheting up since the first case of COVID-19 was diagnosed in the U.S. Virtual care has

Most people in the U.S. who have received at least one COVID-19 vaccine shot have a welcoming side-effect: peace of mind and mental health, according to a survey conducted by Walgreens in April 2021. Three in four people said that getting vaccinated positively impacted their mental health, feeling some kind of relief, thankfulness, or optimism, among other sentiments. Walgreens conducted the poll online among 1,500 U.S. adults over 18 years of age between April 19 and 21st, 2021. The activities people are most excited to do once vaccinated with full immunity are to see family and friends (among 60% of

While the “in-person” visit to a doctor or medical professional continues to rank first as consumers’ most-trusted information source, the virtual doc or clinician rose in trust during the COVID-19 pandemic, according to Euromonitor’s latest read on Consumer Health: Changes in Consumer Behaviour during COVID-19 . The first four most-trusted sources for health information in 2021 remained the same short-list from 2020: doctors in-person, pharmacists, nutritionists and dieticians, and government or NGOs. But fifth place slipped from family and friends to the pharma industry, and sixth in line went to virtual doctors or medical professionals rising from 9th place in

In the summer of 2020, four months into the pandemic, one-half of people living in the U.S. felt worry or stress related to the coronavirus that had a negative impact on their mental health. Over a year into the COVID-19 in America, nearly one-half of people still have negative mental health impacts due to the coronavirus, based on research from the Kaiser Family Foundation (KFF) published in their April 2021 update on the mental health impact of the COVID-19 pandemic. Note the line in the bar chart from the study has flat-lined and settled at just about 50% of U.S.

The United States has among the highest per capita incomes in the world. The U.S. also has sustained among the highest death rates per 100,000 people due to COVID-19, based on epidemiological data from the World Health Organization’s March 28, 2021, update. Higher incomes won’t prevent a person from death-by-coronavirus, but risks for the social determinants of health — exacerbated by income inequality — will and do. I have the good fortune of access to a study group paper shared by Paul Sheard, Research Fellow at the Mossaver-Rahmani Center for Business and Government at the Harvard Kennedy School. In reviewing

Trust in the technology industry has crashed to an all-time low based on the 2021 Edelman Trust Barometer. As Richard Edelman, CEO, concisely asserted, “Tech loses its halo.” The first chart shows the one-year trend on trust across industries through U.S. consumers’ eyes. Most industries lost citizens’ trust between 2020 and 2021, most notably, Technology, dropping the greatest margin at 9 points Retail, falling 7 points, Entertainment. falling 5 points, and, Fashion and automotive declining by 4 points. Several sectors’ trust equity rose in the year, especially healthcare growing by 8 points and food and beverage rose slightly by 2

COVID-19 ushered in the era of our homes as safe havens for work, shopping, education, fitness-awaking, bread-baking, and health-making. In my latest essay written for Medecision, I weave together new and important data and evidence supporting the basic social determinant of health — shelter, housing, home — and some innovations supporting housing-as-medicine from CVS Health, UnitedHealth Group, AHIP, Brookings Institution, the Urban Land Institute, and other stakeholders learning how housing underpins our health — physical, mental, financial. Read about a wonderful development from Communidad Partners, working with the Veritas Impact Partners group, channeling telehealth to housing programs serving residents with

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.

After a year of living with and “in” the coronavirus pandemic, younger people in the U.S. have had to deal with over twelve months of quarantine and lockdown, going to school remotely from home, and distancing from friends. For most young people, the public health crisis has been more about that social distancing from friends, a collective sense of isolation, and mental and behavioral health impacts. These dynamics and these young health citizens’ coping mechanisms are captured in the report, Coping with COVID-19: How Young People Use Digital Media to Manage Their Mental Health. Three organizations collaborated to conduct and

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

The coronavirus pandemic accelerated digital transformation of organizations, including health care providers. But another patient side-effect of COVID-19 has been the digital transformation of many patients, documented by data gathered by Rock Health and Stanford Center for Digital Health and analyzed in their latest report explaining how the public health crisis accelerated digital health “beyond its years,” noted in the title of the report. Rock Health and Stanford commissioned an online survey among 7,980 U.S. adults from early September to early October 2020 to gauge peoples’ interest in and utilization of digital health tools and telehealth. Rock Health has conducted a consumer digital

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

The growing use of APIs in health information technology innovation for patient care has been a boon to speeding development placed in the hands of providers and patients. Using APIs can help drive interoperability and make data “liquid” and useable. APIs can enable “Data liberación,” a concept proposed by Todd Park when he worked in the Obama administration. Without securing patients’ personal health data leveraging APIs, those intimate details are highly hackable explained in All That we Let In, a report from Knight Ink and Appr0ov. It is likely that behind growing health data hacks is the marginally greater financial

At the start of CES 2021, I had the opportunity to catch up with Karsten Russell-Wood, Portfolio Marketing Leader, Post Acute & Home, Connected Care at Philips. We brainstormed just as CES 2021 was going to “open,” virtually, for the consumer electronics conference’s first all-virtual meeting. Philips, a longtime major exhibitor at CES, created an entirely new online experience for the CES attendees – a sort of virtual gallery of different exhibits that are accessed from a single point in a “room” with various entry points. One of the company’s key messages for CES 2021 was health care delivered outside

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

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 coronavirus pandemic disrupted and re-shaped the annual CES across so many respects — the meeting of thousands making up the global consumer tech community “met” virtually, both keynote and education sessions were pre-recorded, and the lovely serendipity of learning and meeting new concepts and contacts wasn’t so straightforward. But for those of us working with and innovating solutions for health and health care, #CES2021 was baked with health goodness, in and beyond “digital health” categories. In my consumer-facing health care work, I’ve adopted the mantra that our homes are our health hubs. Reflecting on my many conversations during CES

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 numerology, the symbolic meaning behind the number “21” is death and re-birth. In tarot cards, 21 is a promise of fulfillment, triumph, and victory. How apropos that feels right now as we say goodbye and good riddance to 2020 and turn the page for a kinder, gentler, healthier New Year. It would be sinful to enter a New Year as challenging as 2021 promises to be without taking the many lessons of our 2020 pandemic life and pain into account. For health care in America, it is a time to re-build and re-imagine a better, more equitable landscape for

From appointment scheduling to checking in, payment and clinical encounter follow-up, patients now expect digital experiences across the health care continuum….and really great ones, like they get from Amazon and other platforms that earn high net promoter scores. That is the big message from the 2020 Healthcare Consumer Experience Study published by Cedar, based on the input of 1,502 U.S. adults who paid a medical bill between October 2019 and October 2020. The timing of this study coincided with the start of the COVID-19 pandemic in the U.S. through at least seven months of American patients’ experiences in 2020. Two-thirds