A blog covering the health/care ecosystem and 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

The COVID-19 pandemic accelerated a whole lot of digital transformation for people staying home. For digital natives, that wasn’t such an exogenous shock. For older people who are digital immigrants, they will remember their initial Zoom get-together’s with much-missed family, ordering groceries online in the first ecommerce purchase, and using telemedicine for the first time as a digital health front-door. Laurie Orlov,  tech industry veteran, writer, speaker and elder care advocate, is the founder of the encyclopedic Aging and Health Technology Watch website. She takes this propitious moment to assess The Future of Wearables and Older Adult in a new report.

“Compare digital health to airlines, cruise lines, and other industries” and the sector looks quite privileged, opined Matthew Holt in a discussion on a study diving deeply into the State of Digital Health, conducted by Catalyst @ Health 2.0 and sponsored by WIPFLI.. The research was conducted among 335 respondents, which included 182 digital health companies polled between November 2020 and March 2021. Digital health companies represented 60% of the sample, the other 40% of which were consulting firms, subsidiaries of providers/payers/life science companies and tech corporations, and investors. As Matthew called out, the digital health sector has a relatively

The pandemic accelerated many Very Big Deals in digital health venture capital investment, mergers and acquisitions, and the re-emergence of SPACs in health care. A closer look at this activity points to a key trend that will persist post-pandemic: that telehealth and the broader theme of virtual care is re-shaping how health care is delivered. This graphic comes out of my current thinking about telehealth across the continuum of care. Before the pandemic, the dominant work-flow for telemedicine was for triage, primary care and pediatrics (think: your child registers a 105-degree fever on a Saturday night and the pediatrician’s office

In the COVID-19 pandemic, as peoples’ daily lives shifted closer and closer to home, and for some weeks and months home-all-the-time, health care, too, moved beyond brick-and-mortar hospitals and doctors’ offices. The public health crisis accelerated “what’s next” for health care delivery, detailed in A New Era of Virtual Health, a report published by TripleTree. TripleTree is an investment bank that has advised health care transactions since 1997. As such, the team has been involved in digital health financing and innovation for 24 years, well before the kind of platforms, APIs, and cloud computing now enabling telehealth and care, everywhere. The

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

The coronavirus pandemic exposed weaknesses in the U.S. health care system that existed before the public health crisis. What lessons can be learned from the COVID-19 stress-test to build American health care back better? The National Academy of Medicine is publishing nine reports addressing health stakeholder segments impacted and re-shaped by COVID-19 — for public health, quality and safety, health care payers, clinicians, research, patients-families-communities, health product manufacturers, digital health, and care systems. The report on health care systems and providers was released this week:  COVID-19 Impact Assessment: Lessons Learned and Compelling Needs was authored by experts on the front-line

Investments in the digital health sector have fast-grown in the past decade, reaching $14bn in 2020 based on Rock Health’s latest read on the market. The COVID-19 pandemic accelerated the field across many industry segments. With such turbocharged growth on the supply side, Beazley, experts in specialty insurance, explores the risks of digital health and wellness in a new report, Digital health, telehealth and wellness: Attitudes to risk and insurance. With great potential for both innovation and reward comes great risks: Beazley points to the facts that, over two-thirds of digital health companies lack insurance coverage for medical malpractice 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

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

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

The coronavirus pandemic has exposed major weaknesses in the U.S. health care system, especially laying bare inequities and inertia in American health care, explained in The Progress We Need: Ten Health Care Imperatives for the Decade Ahead from Manatt Health. The report details the ten objectives that are central to Manatt’s health care practice, a sort of team manifesto call-to-action and North Star for the next decade. Their ten must-do’s for bending the cost curve while driving constructive change for a better health care system are to: Ensure access Achieve health equity Stability the safety net and rebuild public health

“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,

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

Spending on connected health monitoring devices in the U.S. will reach $845 million based on the forecast of the Consumer Technology Association, convening the annual 2021 CES this week in a virtual format. CTA unveiled the 2021 key trends we’ll see presented this week through the online exhibition hall and in educational sessions on the CES.Tech platform. Six major themes emerge at #CES2021: digital health, robotics and drones, 5G connectivity, vehicle technology, smart cities, and over all — digital transformation. All of these have applications in health and health care, especially accelerated in need by the COVID-19 pandemic which has

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

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

In the wake of the coronavirus pandemic, women have experienced more than the direct physical, clinical impact of COVID-19: beyond “lives,” women’s livelihoods, financial health and emotional well-being have been hard-hit. This is true on both a global basis as well as in the United States. In that context, last week I engaged in a fascinating conversation with Varsha Rao, CEO of Nurx, to discuss the current state of women and health/care in America, and some thoughts about the future. If you’ve had the TV on sometime since March 2020, one of many millions of people in the U.S. spending

By April 2020, over one million Medicare members were receiving health care via telemedicine. The graph here shows you the hockey-stick growth for virtual care use by older Americans into the second month of the coronavirus pandemic. The COVID-19 public health crisis up-ended all aspects of daily living in America for people of all ages. For older Americans, avoiding the risk of contracting the tricky virus in public, and especially, in health care settings, became Job 1. The pandemic thus nudged older people toward adopting digital lifestyles for daily life, for shopping, for praying, and indeed, for health care. Laurie

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

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

In the first six months of the COVID-19 pandemic, telehealth was a “bright spot in the ‘new normal,’” according to a report from J.D. Power, Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist. But as the report’s title asserts, most telehealth users experienced obstacles to accessing and using virtual care platforms that drove less positive consumer experiences. Overall, the telehealth segment achieved a higher consumer satisfaction score (860 points out of 1,000) than other sectors J.D. Power has studied including health insurance, insurance and financial services. J.D. Power assessed two categories of telehealth vendors: direct-to-consumer (DTC) and

The coronavirus pandemic has revealed the importance of connectivity, WiFi, broadband, as a social determinant of health and living. Connecting from our homes — now our health hubs, workplaces, schools, entertainment centers, and gyms — is necessary like air and water for survival across daily life flows. Digital connectivity can ameliorate social isolation and anxiety, bolster mental health, and access needed medical care via telehealth channels. As a result of the pandemic, staying connected is more important than ever for older people, Best Buy Health learned in a survey of U.S. adults. Insights from this study have informed the launch

Home is where the health is, we know in the wake of the COVID-19 pandemic. To be sure, many of us who have been preaching that our ZIP codes are more impactful to our health than our genetic codes have known the evidence backing the social and behavioral determinants of health for a long time. This week, Parks Associates convened the Connected Health Summit, focused on the theme of consumer engagement and innovation. I attended all three days’ worth of sessions in this well-planned and -executed virtual meeting. In this post, I’ll weave my favorite themes of consumer health engagement

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

In the midst of the coronavirus pandemic, two certainties emerge in the lives of physicians: they are generating less revenue, and they have adopted more virtual care in practices. The Physicians Foundation surveyed 3,513 physicians in July 2020 on their perspectives on COVID-19 and how the pandemic has impacted practices and patients. This study is part one of three conducted by the Foundation this year, subtitled the “COVID-19 Impact Edition” of the 2020 Survey of America’s Physicians which the Foundation conducts each year. Merritt Hawkins conducted the study on behalf of the Foundation, shifting the focus to the pandemic. This

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

The coronavirus pandemic accelerated many trends and new workflows for patients and consumers, and health care providers, too. The convergence of basic needs like hygiene and safety, financial and health security, and living-working-learning-and-cooking-at-home has turbocharged a migration of more acute care delivered at home. I explore this growing concept in my latest essay on Medecision’s Liberation blog, How the Pandemic Is Accelerating the Hospital-At-Home Concept. The key points are that: Hospital-at-home services (H-a-H) combine home visits with virtual care and remote monitoring Think: advanced home care, enabled through virtual health technologies and wrap-around services both clinical and scaled social determinants

The coronavirus pandemic has been a wake-up call for patients-as-consumers, seeking lower-touch health care services at home or closer-to-home in community health hubs. The need for a holistic platform the serves up a continuum-of-care tools across the patient journey became evident in a matter of months, Capgemini Research Institute calls out in The Health Fix, a research report assessing peoples’ perspectives on health care in the Age of COVIOD-19. Capgemini conducted a survey among over 2,000 consumers living in France, Germany, the United Kingdom, and the U.S. in mid-June 2020. The report found three big shifts in global health citizens’

In the U.S., the use of telehealth services tripled in the past year, as healthcare providers limited patients from in-person visits for care and patients sought to avoid exposure to the coronavirus in medical settings. With this alignment of virtual care supply-and-demand, it is like telehealth will see “permanent usage increases,” according to Parks Associates’ survey report, COVID-19 – Impact on Telehealth Use and Perspectives. Parks Associates fielded this study the second half of May 2020, surveying 5,008 heads-of-broadband households balancing the sample of respondents for age, gender, income, and education. The report reminds us for context that at the

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

Within days of the coronavirus pandemic emerging in the U.S., health care providers set up virtual care arrangements to convene with patients. Three months into the COVID-19 crisis, how have patients felt about these telehealth visits? In Patient Perspectives on Virtual Care, Kyruus answers this question based on an online survey of 1,000 patients 18 years of age and older, conducted in May 2020. Each of these health consumers had at least one virtual care visit between February and May 2020. The key findings were that: Engaging in a virtual visit was a new-new thing for 72% of people Patients’

Health care providers stood up virtual health care services with lightning speed as the coronavirus pandemic emerged in the U.S. Telehealth and its various flavors enabled both patients and providers to manage the risk of contracting the virus, especially at a time when little was known about the nature of transmission, treatment and prevention — except for washing hands, covering one’s face, and isolating when showing symptoms. In Electronic Consultations (eConsults): A Triple Win for Patients, Clinicians, and Payers, the Milbank Memorial Fund explores the evidence supporting the growth of asynchronous electronic consultation encounters between patients and clinicians. Note that

Today kicks off the first all-virtual conference of the ATA, the American Telemedicine Association. ATA’s CEO Ann Mond Johnson and team turned on a dime over the past few months, migrating the already-planned live conference scheduled in early May to this week, all online. I’ll be midwifing a panel this afternoon at 440 pm Eastern time, initially focused on how health care can garner patient loyalty. That theme was given to us in the fourth quarter of 2019, when initial planning for ATA 2020 had begun. What a difference a few months make. Not only has ATA pivoted to an

Some 6 in 10 people in the U.S. have been financially impacted by COVID-19. Those most negatively affected by the pandemic tend to be younger, Gen Z age group and African-American, 63% of whom felt financial pressure directly due from the virus and the national economic lockdown. By late May 2020, 34% of black Americans had lost their jobs compared with 21% in late April, compared with 18% of white consumers, reported in The COVID-19 Pandemic’s Financial Impact on U.S. Consumers, survey research from TransUnion. This post describes data from TransUnion’s Wave 9 report, which polled 2,086 U.S. adults 18

The 21st Century Cures Act emphasizes patients’ control of personal health information. ONC rules issues in March 2020 called for more patient-facing health tools and apps to bolster health consumer engagement and empowerment. But the emergence of the coronavirus in the U.S. revealed many weakness in the American health care system, one of which has been health inequities faced by millions of people — especially black Americans, who have sustained higher rates morbidity and mortality for COVID-19. There have also been digital health divides found in the COVID-19 pandemic, discussed in a timely essay in JAMA, Digital Health Equity as

By May 14th, 2020, one-half of consumers in the U.S. expected they would schedule a medical appointment in the next two months. “As the country emerges from COVID-19, we’re watching consumer confidence shift back to where it was prior to the onset of this crisis,” noted Dr. Brad Bowman, Chief Medical Office at Healthgrades. The company published the COVID-19 Patient Confidence Study, a survey launched in late March. Since the first poll was conducted on March 27th, Healthgrades has conducted the study weekly among 200 patients age 18 and over to gauge peoples’ “confidence” in making typical health care decisions through

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

“We’re not getting back to business as usual any time soon,” Sage Growth Partners and Blackbook Research introduce their latest report on the COVID-19 pandemic, As the Country Reopens Safety Concerns Rise. One of the areas that won’t be getting “back to business” soon will be patients’ visits to doctors’ offices, hospitals, and urgent care centers, the report notes, based on a survey conducted among 591 U.S. consumers on April 28 and 29, 2020. Millions of U.S. health consumers’ feel unsafe, an increase among those who feel that way compared with SGP/Blackbook’s study from last month, a concern that ratcheted

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

On Monday, 6th April 2020, the Prime Minister of New Zealand, Jacinda Ardern, has determined that the Easter Bunny and the Tooth Fairy are essential workers in our age of the coronavirus pandemic. The PM has posted an Easter egg coloring project on her Facebook page to support children (and people like me who like to color) in the #StayHome era. In the U.S., the day before on Sunday 7th April, Dr. Deborah Birx advised Americans that, “The next two weeks are extraordinarily important. This is the moment to not be going to the grocery store, not going to the

In the midst of growing inpatient admissions and test results for COVID-19, Congress is working as I write this post to finalize a round of legislation to help Americans with the costs-of-living and (hopefully) health care in a national, mandated, clarifying way. Right now in the real world, real patients are already being treated for COVID-19 in American hospitals. Patients are facing health care costs that may result in multi-thousand dollar bills at discharge (or death) that will decimate households’ financial health, particularly among people who don’t have health insurance coverage, covered by skinny or under-benefited plans, and/or lack banked

With President Trump’s somber speech from the Oval Office last night, we wake up on 12th March 2020 to a ban on most travel from Europe to the U.S., recommendations for hygiene, and call to come together in America. His remarks focused largely on an immigration and travel policy versus science, triaging, testing and treatment of the virus itself. Here is a link to the President’s full remarks from the White House website, presented at about 9 pm on 11 March 2020. Over the past week, I’ve culled several studies and resources to divine a profile of the U.S. consumer

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:

Most employers and their workers see the benefits of digital health in helping make health care more accessible and lower-cost, according to survey research published in Health on Demand from Mercer Marsh Benefits. Interestingly, more workers living in developing countries are keener on going digital for health than people working in wealthier nations. Mercer’s study was global, analyzing companies and their employees in both mature and growth economies around the world. In total, Mercer interviewed 16,564 workers and 1,300 senior decision makers in companies. The U.S. sample size was 2,051 employees and 100 decision makers. There’s a treasure trove of insights