A blog covering the health/care ecosystem and people.

The fifth annual survey on consumer engagement in health care from the Employee Benefit Research Institute (EBRI) finds that members of consumer-driven health plans (CDHPs) are more cost-conscious than enrollees in traditional health plans. These members also tend to be more engaged in wellness and health promotion programs. Health engagement happens among this group in a variety of behaviors; enrollees in CDHPs are more likely to, Check whether the plan would cover care Ask for generic drugs vs. brands Talk to doctors about drug and treatment options, and their respective costs Have a budget to manage health care expenses And

American health citizens are burned out on risk communication from pharmaceutical companies. They’d prefer simpler approaches through websites like WebMD and icons like the Consumer Reports‘ multishape “moons” to learn about health risks. ORC Guideline, an info GROUP company, identified a health risk information overload in their latest survey of American adults, conducted in late October 2009. The company presented data at the recent FDA meeting on promoting regulated medical products using the Internet and social media on November 13, 2009. The top-line finding is that there’s an increase in the percent of Americans who feel there’s too much emphasis

We count our blessings for which we are thankful this Thanksgiving weekend. Our health, our families, peace in our lives and around the globe…Health, yes, if we’re lucky. Now, think the unthinkable: some time, you’re going to get sick. Die, eventually.Now, ask yourself a few questions…Would you prefer to die at home or in the hospital? Who will advocate for you when that time comes?Do you have a living will? We who are engaged with Engaged with Grace ask you to not only get engaged yourself…but add this slide to the end of your presentations to spread this important message.Health

With the announcement of Verizon Connected Health Services, the telecommunications company is following on the pioneering work of Dr. Jay Sanders, arguably one of the godfathers of telemedicine, and the contemporary pioneer, American Well. Datamonitor predicts that the telehealth market will growth from $2.4 billion in 2009 to $6.1 bn in 2012. Verizon announced the program in a press release yesterday, which said that the business unit will focus on facilitating remote consultations and other programs like continuing medical education through a consultancy, “Telehealth Collaboration Services.” Verizon already has about 500 staff serving customers in the health vertical. Verizon says

Reports on the demise of the retail health clinic aren’t reading the tea leaves right, says Deloitte’s Center for Health Solutions.While total retail clinics in operation numbered just over 1,000 in 2009, with modest growth since 2007, Deloitte forecasts growth exceeding 3,000 clinics by 2014. MinuteClinic and Take Care make up 72% of clinic market share in the U.S. The remainder of the clinic market is quite fragmented, with Wal-Mart taking on a hybrid model (both operating and sharing operations with local health systems). The majority of clinics are co-located in pharmacies. What’s going to drive accelerating growth of retail

Health providers believe they’ll need to make better use of technology to offset proposed cuts in Medicare reimbursement, according to a survey by IVANS.IVANS, the IT solutions provider, conducted this survey to gauge health providers’ perspectives on health reform and the impact of proposed Medicare cuts on operations.About 1 in 3 health providers views technology as a way to deal with downward trends in Medicare reimbursement, as the chart illustrates. Thus, providers are connecting the dots between the role of health care IT to reduce operating expenses, especially administrative costs.In the conclusion of its survey summary report, IVANS, which competes

Yesterday and today, the FDA is listening to stakeholders at the nexus of social media and health relate their perspectives on the benefits of social media in health. The topic in its full title is “Promotion of FDA-Regulated Medical Products Using the Internet and Social Media Tools.” This is a long-anticipated meeting that’s discussing the benefits, drawbacks and true stories about the Internet in health — in particular, related to pharmaceuticals and medical devices. Full coverage online has been provided by igniteHealth, a health marketing agency, that’s tracking all tweets and presentations from the event. Representatives testified from a range

Hospitals generally see the value of patient portals. In these projects, their highest-value goals are improving the quality of health care, enhancing patient experiences, empowering health consumers, and personalizing information. Geonetric conducted their eHealth Insight survey in August 2009 to learn more about hospitals goals and priorities for patient-facing Internet portals. Over 60% of hospitals and clinics who responded to the survey understood the value of a patient portal. One in 4 respondents had already built such a portal, and one-third looked to develop one in the next year. Ironically, while goals for portals were highly consumer-focused, future functional priorities

When it comes to the adoption of electronic health records, it’s good to be urban, large, and teach. According to the latest report on EHR adoption, Health Information Technology in the United States: On the Cusp of Change, 2009, fewer than 2% of American hospitals used a comprehensive electronic health record (EHR) in 2008, 7.6% had a “basic” EHR based on the definition generated by an expert panel conducted by the Robert Wood Johnson Foundation, the Massachusetts General Hospital, and the George Washington University — the team that developed this full report on the state of EHRs in U.S. hospitals.The

59% of Americans want to receive test results via email. 1 in 2 would like to use email to request prescription refills, confirming appointments, telling doctors about their conditions, and asking questions about new conditions. Email is now the preferred communications medium for consumers in health. Second to email, using doctors’ websites would also be welcomed by many health consumers, especially for prescriptions and appointments. Physicians’ websites are somewhat less desirable communications platforms for communicating about personal health conditions. It is still too early for consumers en masse to embrace text messaging in health. Women were more likely than men

As I nurse my flu symptoms, I’m struck in real-time by being a sick patient in a sick health system. Last Friday 30th October, I was suffering classic flu symptoms and after 2 days of trying to muddle through with home remedies, homeopathic products and OTCs, I contacted my doctor’s office first thing in the morning. I was told that my doctor was out for the day, and was referred to another physician in the practice. By noon, that doctor had phoned in a prescription for Tamiflu to my pharmacy. The office told me to follow up with my doctor

IBM is dropping the $20 co-payment for employees’ visits to primary care doctors. The Wall Street Journal covers this story today. The “no co-pay” scheme will cover employees enrolled in IBM’s self-insured health plan — excluding workers enrolled in HMOs. Overall, IBM has 115,000 employees and spends $1.3 billion on health care. The WSJ quotes SVP of IBM’s human resources Randy MacDonald, who said that emphasizing primary care is part of an overall “wellness” strategy that tries to keep costs low by preventing illness. Health Populi’s Hot Points: The data point of one U.S. company dropping a $20 payment for

Small business is the working poor of American industry when it comes to health insurance access: they simply cannot afford to pay for it. This means that workers in small businesses — which is where most new jobs are created — probably won’t have access to health insurance at work. Workers who don’t receive health coverage from employers are unlikely to get coverage on the individual market or from any other source, according to Insurance at Risk: Small Business Employees Risk Losing Coverage. This report was compiled by a team from the Department of Health and Human Services (DHHS), synthesizing

Managing health care costs and achieving a high quality health system aren’t parallel goals – they’re inter-related and two sides of one coin. Adding more enrollees to existing poorly integrated health delivery organizations will simply increase costs while delivering sub-optimal outcomes to patients. In its 13th annual report card on the U.S. health system, the National Committee for Quality Assurance (NCQA)’s The State of Health Care Quality 2009 adds more statistical evidence to the argument for health reform in America. 2009 has seen “meager progress” according to the President of NCQA, Margaret O’Kane. In her introduction to the report, O’Kane

Use of the Internet by older Americans leads to a reduction in the prevalence of depression, according to a study published by the Phoenix Center for Advanced Legal & Economic Public Policy Studies. This research highlights the macro-benefit of deploying broadband to all health citizens. Internet Use and Depression Among the Elderly analyzed a data sample of 7,000 Americans age 55 and older from the University of Michigan’s Health and Retirement Study household survey. This survey instrument polls over 22,000 older Americans every two years. The data used by Dr. George S. Ford and Dr. Sherry G. Ford in the

NPR featured a story called, “How the Modern Patient Drives Up Health Care Costs” on October 12, 2009. The theme connected dots between so-called consumer-driven health care and patients who demand the latest in health technology which may not be appropriate or even useful, thus driving up costs unnecessarily. NPR attributes three driving forces in building The Modern Patient: 1. Direct-to-consumer advertising for prescription drugs, beginning in the middle-1980s; this exposed health citizens to medication names and conditions which motivated some consumers to ask for specific medications and question physicians’ choice of other meds. 2. The adoption of the Internet,

Today I’m at the Health 2.0 Conference in San Francisco, where I’ll be moderating a panel of the “consumer aggregators” in health care. “Say what?” those of you who don’t speak Health 2.0? Consumer aggregators are the places online where lots of health citizens go en masse for health information, support, advice, and tools. Today’s panel brings Google Health, Microsoft and WebMD together to talk about trends in health care consumers online. I’ll set the context describing the “N” of health citizens going online using data from the 9th Cybercitizen Health Study from Manhattan Research coupled with Susannah Fox’s data

The number of Americans seeking health information online reached 157.5 million people — 1.6 times the number of online health seekers found in 2005. The number of Americans seeking online information about prescription drugs grew to 102.3 million people — double the number of Americans researching Rx’s online in 2005.Manhattan Research’s 9th and latest Cybercitizen Health survey, released on October 2, 2009, firmly establishes the fact that mainstream Americans are becoming ePatients. These findings support what Susannah Fox found earlier this year in her Pew Internet & American Life survey, The Social Life of Health Information. That poll estimated that

Health information technology (HIT) will prove positive for health quality and expanded access to health care, according to 3 in 4 American adults. 64% of Americans believe HIT implementation will help to reduce health care costs.A poll supported by the Career College Association and TechAmerica found broad-based support for HIT. While many health reform alternatives appear to be splitting American sentiment, HIT seems to be a unifying force for health improvement in the U.S.The positive sentiment toward HIT crosses age, gender, and socioeconomic status. Most health citizens see HIT as a personal health enabler, as well: 3 in 5 Americans

Today the cost of health for each health-insured employee in the U.S. is $10,743. In 10 years, the cost will nearly triple to $28,530, if the status quo continues. The status quo here is a 10.2% average annual rate of health cost increase, which was the rate experienced between 2001 and 2009. Hewitt has worked with the Business Roundtable analyzing the ‘costs of inaction’ relating to health reform. They asked the unthinkable question: ‘what if the U.S. does nothing to change the health system?”The report bears the yin/yang title, The Perils of Inaction and the Promise of Effective Action, with

In a meeting yesterday in Boston, I was reminded by the CEO of Blue Cross and Blue Shield of Massachusetts, Cleve Killingsworth, the great work of the New England Healthcare Institute (NEHI) on clinical waste. NEHI’s magnum opus on clinical waste shines a light on hundreds of studies which illustrate standards of care that, goether, could eliminate the 30% of health spending that is clinically wasteful and often deleterious to Americans’ health. These include using beta-blockers for patients with high blood pressure, measuring hemoglobin A1c for diabetics, among the many other evidence-based health tactics. The definition of “clinical waste” =

It’s cost above everything when it comes to U.S. employers and health reform.Employers are key stakeholders in health reform, and 80% say they’re closely watching Congress’s movements on the subject. 9 in 10 employers say that if the final health plan passed increases their costs, they’ll likely reduce benefits to employees.In addition, 4 in 10 businesses would pass increased health care costs onto their customers in the form of higher prices, and 3 would reduce jobs as well as reduce compensation to workers.The Towers Perrin Health Care Reform Pulse Survey was conducted online in July 2009 among 433 human resource

Without health insurance, too many sick kids can’t attend school, learn, and get themselves out of poverty. Without health insurance, a single mother with kids can’t get the job she needs to pay taxes, take care of her kids, and give them a role model whom her daughters can emulate. Without health care insurance, Americans lose their economic security. That was the message of Wade Henderson, president of the Leadership Council on Civil Rights. He spoke at a plenary session of the annual meeting of the Agency for Healthcare Research and Quality (AHRQ) today, on a panel dealing with the

Most Americans with health insurance say the health system works for ‘me.’ On the other hand, these same health citizens don’t really understand how their health plans work. As a corollary, they don’t really ‘get’ the fundamental issues of health reform, either. CIGNA surveyed 1,001 American adults in July 2009 in conjunction with its online educational portal, learn4yourhealth.The health plan found that: – 79% of Americans with health insurance say the current system “works for them.” – Most Americans understand their mortgages, cell phones, cable TV, retirement plans, and car warranties ahead of understand their health plan. – Most Americans

The health industry should pay attention to Mintel’s latest insights into consumers’ mindsets. The long and winding downturn in the economy has inspired five consumer trends… Trust. With FDA recalls of sick food, banks’ lack of liquidity for consumer lending, and governments the world over breaking faith with citizens, peoples’ trust in institutions continues to erode. 66% of Americans say they have less trust in financial services companies due to the economy. 6 in 10 Americans continue to worry about food safety. Control. Among the most affluent Americans, 2 in 5 say that spending less will become their new household

There are four pillars that, together, provide the foundation to Bending the Curve on health costs in the U.S.: 1. Invest in better information and tools (including incentives and comparative effectiveness). 2. Transition to accountable payment systems that reward lower-cost, higher quality care (i.e., make fee-for-service ‘less attractive over time’). 3. Restructure insurance markets to pool risk outside of employment and promote on quality and cost (including scaling back employer subsidies in favor of value-based benefit design). 4. Support and encourage better choices among health citizens (e.g., nudge through copays and tiering and measure outcomes along the way). Bending the

Americans’ confidence in health care is up, according to Thomson Reuters’ latest Healthcare Indexes: Consumer Confidence. Overall, Thomson Reuters finds that healthcare confidence rose 12% between March and July 2009.Americans’ confidence in their ability to pay for health care in the “next three months” increased by 18% in the four month period. Furthermore, more Americans believe they’ll be able to access necesary health services such as routine and urgent care in the next 3 months.Healthcare confidence is highest amongst the population over 65, and lowest in the youngest age cohort. Health confidence increases with income and education, although significantly increased

“The cause of my life,” he said, was health care ensured for all Americans. His health care legislative passion began in 1966 as he learned about the challenges facing Boston residents in public housing and their lack of access to health care. These residents were meant to receive health care at the city’s teaching hospitals, which were located some four miles away from the housing project. This distance and the logistics within the hospitals and clinics took some of the residents many hours to access care. Since then, there’s a long list of health care legislation that Senator Kennedy shepherded

There is no hard evidence supporting that health care delivered in the U.S. is “truly exceptional,” according to an analysis of available quantitative sources on health quality from the Urban Institute.The issue of access barriers to health care is given some deep consideration. The U.S. is one of three countries which has a ‘sizable’ portion of citizens lacking health insurance coverage, along with Mexico and Turkey. For many quality measures, the report finds, “quality and access are intrinsically linked.”Specifically, both uninsurance and under-insurance can lead to health consumers skipping medicines, suggested lab tests, and appointments with physicians — due to

Some hospitals’ margins improved in the first quarter of 2009 according to data from Thomson Reuters. However, Fitch and Moody’s, the credit ratings agencies, expect continued declines through 2009.Thomson Reuters does report that while total margin improved for all types of hospitals, there was a wide variation in Q1 of 2009. Compare the top quartile, bringing at least 7% margins, versus the bottom quartile, reporting total margins of -1% or less. Smaller and larger community hospitals had the largest margins, and major teaching hospitals among the lowest margins.In August 2009, Moody’s finds that most U.S. hospitals are still experiencing declines

The relationship between patients and their physicians is a key driver in how and if people proactively manage their health. But cost often gets in the way of that relationship between a patient-consumer and a primary care doctor. The #1 reason why Americans deter proactive health care is cost. No American, whether insured and unemployed or working and covered, is immune from postponing or otherwise actively managing care when they are still well, according to a survey from IBM on health consumers in the U.S. 55% of Americans say they can’t afford the cost of wellness visits out-of-pocket. This is

If you read Health Populi then you’re as confounded as I am by the plethora of polls on Americans’ views on health reform. In the past month, I have received a press release (or two or three) from Rasmussen, ABC-Washington Post, CBS-NY Times, Fox News, Gallup-USA Today, Robert Wood Johnson Foundation, Kaiser Family Foundation, NBC-Wall Street Journal, NPR, Pew, and Quinnipiac, among other pollsters, measuring the changing temperature of Americans on health reform.I’ve wrestled with how to handle the conflicting, confounding, wide-ranging statistics yielded by these surveys. My solution to this challenge comes tailor-made in this week’s New England Journal

Today’s Los Angeles Times features a story in their health beat called, “In healthcare debate, ‘reality’ is in dispute.” All-comers have arrived on the ever-more populated health reform opinion stage, from Sarah Palin (calling President Obama’s plan “downright evil”) to Nancy Pelosi calling town hall protestors “unAmerican.” To counter the disses and naysayers, the White House has put online its own reality-checking website at http://www.whitehouse.gov/realitycheck/. Two perspectives must tether said ‘reality’ and our underlying principles for health reform: putting and keeping the patient/citizen in the center, and getting real about health care costs. Well-timed and highly relevant as usual, the

The use of anti-depressant medications nearly doubled between 1996 and 2005, according to an analysis published in the August issue of the Archives of General Psychiatry. In 2005, 10.1% of Americans used anti-depressant meds, compared with 5.8% in 1996. A key trend underneath the dramatically increased use of anti-depressant meds was the decline in talk therapy (psychotherapy). Nearly 1 in 3 people who used anti-depressants in 1996 were engaged in psychotherapy, but in 2005, only 1 in 5 participated in talk therapy. Researchers used data from the Agency for Healthcare Research and Quality’s (AHRQ’s) Medical Expenditure Panel Surveys (MEPS), which

iPods and iPhones, Flip videos and pocket-sized digital cameras are way-cool and innovative. Pharmaceuticals? Not so much. According to Ipsos’s survey into global consumers’ perceptions of what’s innovative, the top which at least 1 in 2 Americans find innovative are electronic media, computers, cameras and video equipment. Household products are ranked innovative by about 1 in 3 Americans. Pharmaceuticals? Fewer than 1 in 3 Americans. In fact, pharmaceuticals are pretty close in terms of innovation in the mind of consumers falling between household products and food and beverages. The good news for pharma? Banks and deodorant are seen as less

Comparative-effectiveness is a cornerstone in President Obama’s vision of health reform, and is a component of the ARRA stimulus package. But if it’s just about a pill-to-pill comparison, it won’t do Americans’ public health much good.In an insightful perspective in the July 23rd 2009 issue of the New England Journal of Medicine, Dr. Kevin Volpp and Anup Das of the University of Pennsylvania urge us to, “think beyond Medication A versus Medication B.”Diving deep into the example of smoking cessation – still a major public health challenge in the U.S. – the researchers compare the odds ratios of various quit-smoking

In October 2008, about one month before the presidential election, 62% of Americans said it was “more important than ever to take on health care reform.” By July 2009, 56% of Americans agreed with that statement.Thus, more than one-half of Americans still believe in passing health reform in 2009, although the majority is somewhat eroding. The Kaiser Health Tracking Poll of July 2009 from the Kaiser Family Foundation continues to monitor Americans’ collective temperature on issues shaping health reform.Still, twice as many Americans say that the U.S. will be better off than worse off if Congress passes health reform —

4 in 5 Americans believe that it is important for President Obama to include health reform in addressing the economic crisis in the U.S., according to The Robert Wood Johnson Foundation Health Care Consumer Confidence Index based on data gathered in June 2009.While the mass media headlines on this survey in the past 24 hours have generally been, “health confidence is rising in America,” the data underneath this pronouncement is not nearly as sanguine as that headline implies. Women, people with lower health status, less education, and Baby Boomers of pre-retirement age are most likely to feel “health insecure” according

The news that Michigan’s unemployment rate passed 15% ushers in the next depressing phase of joblessness in America. As of mid-July 2009, 15 states have unemployment rates of 10% or higher. In the U.S., unemployment quickly leads to uninsurance. According to The Clock is Ticking: More Americans Losing Health Coverage, 44,230 more people are losing health coverage every week. This report, published by Families USA in July 2009, provides state-by-state statistics of unemployment. By detailing state-specific insurance losses on a weekly, monthly and annual basis, the report provides a pace-of-change profile of health care as a local phenomenon. The data

“This is the most significant economic crisis in the Internet era and a unique period of information seeking and communication.” This sentence sets the stage for the latest report from the Pew Internet & American Life Project which finds that 2 in 3 Americans have used the Internet in the past year to cope with the recession. Pew calls this 69% of Americans, “online economic users.” If information is power, then the Internet is providing Americans with the ammunition to deal with both personal financial challenges as well as general understanding of the economic downturn. The most important searches online

Health care costs for employers who cover health insurance for workers will increase 9% in 2010 — well ahead of general price inflation and workers’ earnings. However, the recession will, “temper medical costs,” according to PricewaterhouseCoopers‘ Behind the numbers: Medical cost trends for 2010. With employers — that is, business and profits — taking it on the chin in 2009, employees can expect even greater cost burdens for health benefits in 2010, PwC says. 42% of employers will increase employees’ contributions to benefits, and 41% will also increase medical cost sharing. At the same time, over 2 in 3 employers

55% of Americans search user-generated health content, including: 36% who look for health information on Wikipedia 36% who read online health forums and message boards 27% who read health blogs. The content is useful, too: 57% of people who used it said their online searching led to productive conversations with their physicians. So finds the survey on Consumer Reaction to DTC Advertising of Prescription Drugs, the 12th annual study from Rodale‘s publications Prevention, Men’s Health and Women’s Health magazines. The Food and Drug Administration’s Division of Drug Marketing, Advertising, and Communication (DDMAC) also provides technical support for this study. The

There are many surveys that are looking at whether Americans are willing to pay for health reforms: in particular, to cover the uninsured. This is a conceptual question: we don’t really know how people will really feel once they are mandated by tax law or other mechanism to reach into their pockets. Still, it’s instructive to take a look at the range of possibilities. The Kaiser Public Opinion Data Note of July 2009 looks at “Footing the Bill” for health reform. KFF examines the plethora of polls’ questions on willingness to pay for expanding coverage, from CBS/New York Times, Quinnipiac

Health care is, broadly speaking a local good, just like Senator Tip O’Neill used to say about politics: that “all politics is local.” Secretary of Health and Human Kathlees Sebelius launched the website The Heatlh Care Status Quo on the HealthReform.Gov portal, profiling each of the 50 States and their current level of health care and “need for health reform,” according to the Secretary. We learn about a medical bankruptcy case in South Florida through the eyes of Dorothy Carmone, a self-employed cancer patient. Health care for Dorothy, and for all of us, is personal. Each state profile details level

A powerful, simple, nudge has been discovered by researchers at Wharton’s Leonard Davis Institute — it’s directly paying people to be healthy. Readers of Health Populi should already know about P4P, pay-for-performance, being adopted in Medicare and by other payers to incent health providers to provide health care that demonstrates health outcomes. In this health citizen-facing version, call it “pay-for-performance-for-patients,” P4P4P. Kevin Volpp is the Wharton professor who’s been studying how to move health consumers toward healthier behaviors. He’s written articles for journals like, “Asymmetric Paternalism to Improve Health Behaviors” in JAMA. His logic trail follows the Sunstein and Thaler

There are a million stories in the naked city when it comes to personal health information…many of which end up very badly. At the very point in our lives when when we’re fighting for our life, or for the life or ‘good death’ of our loved one, we too-often find ourselves also fighting to access our health data. This absurd, appalling scenario steals a basic right away from health citizens: our ability to fully participate in our own health decisions and care. A Declaration of Health Data Rights has been launched on four simple, elegant, personal precepts: that We the

“Advertising carried on blood pressure monitors at 20,000 stores reaches more than 1 million users a day,” a press release from Lifeclinic International boasted this week. According to the Lifeclinic website, “the blood pressure monitor is free for consumers to use. So it’s no surprise that our blood pressure monitors are a recognized consumer destination, attracting customers and building store traffic daily by offering shoppers an important service. Lifeclinic said that because 52 customers per store use its Health Stations every day.” Let’s hearken back to the sage words of economist Milton Friedman: there is no such thing as a

What newspaper is better positioned than the Washington Post to host a bunch of people who observe health to respond to Big Questions facing health reformers and citizens in 2009? It’s the Washington Post’s Healthcare Rx series. On a weekly basis, you can read what these people have to stay about a broad range of health reform issues with which President Obama, Congress, and health citizens are wrestling: Angela Glover Blackwell, CEO and Founder of PolicyLink Ceci Connolly, WaPo’s own national health policy analyst. Chisara N. Asomugha, a pediatrician and Robert Wood Johnson Clinical Scholar at Yale University Chris T.

Peter Orszag, the Director of the Office of Management and Budget, believes that health costs are the #1 driver of America’s long-term deficit. The inexorable increase of health costs are plaguing the Federal budget, Governors’ state budgets, employers’ bottom-lines and ability to compete globally, and household budgets. Things are looking up for next year when it comes to health costs in 2010 – they’ll continue to grow at double-digit rates, according to Buck Consultants, the employer benefits consultancy. Buck’s 2009 National Health Care Trend Survey finds that costs for all flavors of health plans – including PPOs, POS, HMO and