A blog covering the health/care ecosystem and people.

40% of American hospitals have seen drops in inpatient admissions, according to the American Hospital Association.In the AHA’s survey, Report on the Economic Crisis: Initial Impact on Hospitals, it’s clear that hospitals are already experiencing the effects of the economic downturn. CEOs are considering several cost-cutting tactics in dealing with this financial crisis: 56% of CEOs are postponing renovations or plans to increase capacity 45% are delaying purchase of clinical technology or equipment 39% are postponing investments in new information technology. The AHA polled 736 hospital CEOs, concluding the survey in November 2008. Additional data was available from AHA’s DATABANK

While the front pages of U.S. and business newspapers are featuring the story of the health-cost hampered Big (and increasingly smaller) 3 automakers looking for a mega-loan, most employers still want to play a key role in the U.S. health system. It’s the legacy of providing health care benefits to the ever-growing list of retirees from GM, Ford and Chrysler that’s crippling the industry. That, and a few other issues — among them, drivers’ preferences for gas-efficient, stylish and high performing cars. Simply put, lots of Americans prefer autos built overseas. Beyond the auto manufacturers, though, a new survey from

Moody’s, the credit rating agency, offers their post-election impressions in their special comment, U.S. Healthcare Industry: Credit Implications of the U.S. Election. Barack Obama’s campaign roughed out principles for health reform across three issue areas: Access and affordable health care Cost reduction Public health. Moody’s took these as lenses over the state of health care in the U.S. to predict how these principles could play out in an Obama administration. Promoting access to health care in the U.S. could be a positive for hospitals and medical device manufacturers, whose sheer volumes of patients would increase and uncompensated care and bad

71% of Americans have cut household expenses as a result of the financial crisis in the U.S.,according to a new poll from BearingPoint, conducted by Zogby International. Here is more evidence that personal and family health decisions aren’t made in a vacuum separate from other household financial decisions: they’re part and parcel of the kitchen table conversation in our homes. The financial impacts have hit women relatively harder than men, and blacks and Hispanics somewhat harder than whites, according to BearingPoint’s data. How the economic downturn impacts health behaviors varies by health issue, and who the treatment is for: Nearly

While the economy ranks as the #1 issue on American voters’ minds, it means way more to Obama voters (56%) than it does to McCain voters (40%).Health care, too, is a higher priority issue to Obama voters (14%) than to McCain voters (9%).The poll by Kaiser Family Foundation and Harvard School of Public Health, conducted in September 2008, was released by the sponsors in the October 30 issue of the New England Journal of Medicine.McCain and Obama voters share some sympathies with each other when it comes to making health care and insurance more affordable, with 44% of McCain voters

Johnson & Johnson (J&J) has acquired the online health coaching company, HealthMedia. This will move the health supply company up the health care value chain further into the provision of health services. Nine years ago, I teamed with a Big Pharma on a scenario planning exercise about consumers and health care. One of our scenarios told the future-story of the consolidation/integration of information technology, pharma/life sciences, and health services to benefit consumer health. We now meet up with this future-story, and it’s J&J’s to tell.   I’ve written here in Health Populi about Walmart’s move toward pharmacy benefits management and

The increasing cost trends of drug supplies, staffing, and liability have driven up costs for medical group practices above revenues they collected in 2007. Primary care groups were especially hit by practice costs exceeding revenues. The revenue side is simple: declining reimbursements have hit most group practices. Overall, multispecialty group practices saw a 5.5% increase in revenue, and operating cost increases of 6.5%. The Medical Group Management Association represents about 270,000 physicians who work in some 13,500 groups. These statistics come out of their annual report, the Cost Survey: 2008 Reports Based on 2007 Data, released at the MGMA’s annual

Addressing the U.S. Economy is Job 1, 2 and 3 for the next President, according to the latest and last Kaiser Family Foundation poll on American voters’ priorities (Kaiser Health Tracking Poll, Issue 11, October 2008).2 in 3 Americans say, far and away, the key issue for Messrs. McCain and Obama to talk about is The Economy. The underlying headline here is that the War and health care tie for a distant second place in voters’ minds. But wait! There’s more on health care to consider. Given the economic straits of the U.S., more than 6 in 10 voters say

In the past several months, there’s been some wringing of hands and some pronouncements of glasses-half-empty concerning health reform and technology innovation. For us glass-half-full types, here’s something to consider… 15,000 physicians in the state of Michigan began to electronically link up today. The new online service has been developed by Covisint, whose roots are in the automotive industry. Covisint’s client is the Michigan State Medical Society, which looks to the new MSMS Connect network to enable the state’s 15,000 doctors to do e-prescribing, secure messaging, and practice management online. You can learn more about the project here. Covisint is

Today, the loneliest job in American isn’t being the Maytag repair man. And the hardest job in America isn’t necessarily the Presidency. It’s being a state governor. Take Pennsylvania (the state I call my home). Governor Ed Rendell sought the position with an explicit goal of expanding health insurance to uninsured Pennsylvanians. After two years in the job, Rendell is facing declining tax revenues, increasing costs. Rendell is already facing a $281 million deficit in this fiscal year, which could increase to over $1 billion. A detailed analysis of this story was published by PR Newswire, Pennsylvania’s Loss of Employer

The headline is that CFOs are having trouble accessing credit. What will that mean for health benefits? A survey of American CFOs and comptrollers from Grant Thornton has found that over half of CFOs have seen credit costs increase. 2/3 find credit harder to come-by than in 2007. 1 in 2 CFOs think the U.S. economy will remain the same over the next 6 months. The #1 pricing pressure concern is employee benefits — 55% are most concerned about benefits, including health and pensions. In the short term — six months out — 23% of employers expect their headcount to

Rising costs continue to change the way Americans use the health care system. That’s the tagline for the 2008 Health Confidence Survey published by the Employee Benefits Research Institute (EBRI), released October 7. Cost increases over the past year have directly changed health care consumers’ behaviors in the system. 74% of people choose generic drugs over brands, compared to 60% in 2007. 63% of people talk to the doctor about treatment options and costs, versus 53% in 2007. And, most alarmingly, 62% of Americans go the doctor only for “more serious conditions or symptoms,” compared to 48% last year. EBRI

“When normal Americans know who the Secretary of the Treasury is, that’s notgood.”— Will Durst comedian Do Americans know who the Secretary of Health and Human Services is yet?*It’s been an intense week of on-again, off-again Congressional votes to rescue financial markets. Two remarks this week generated that Oprah lightbulb moment for me. First, I listened to Laura D’Andrea Tyson, former chair of the Council of Economic Advisors under President Clinton, and currently Dean of the Haas School of Business at UC-Berkeley (and an advisor to Barack Obama). Tyson spoke with Rachel Maddow on MSNBC on 29th September about the

The sixth leading cause of death in the United States is the lack of health insurance, according to Critical Condition, a new documentary on the perils of being uninsured in the U.S. Being uninsured beats diabetes and HIV/AIDS on the Top Ten List of causes of death in America, according ot the Institute of Medicine. The PBS series POV features the chilling documentary, Critical Condition, on Tuesday, 30th September 2008. You can check your local listings here for broadcast times on your local PBS station.Critical Condition highlights the stories of four uninsured Americans with advanced stages of diabetes, cancer, liver

Consumers don’t understand the language of health plans and, thus, don’t know how to use them. Market research published by Regence, which covers 3 million Blues plan enrollees in Idaho, Oregon, Utah and Washington, says that consumers face a “steep learning curve” when it comes to health insurance lingo. Regence’s study asked 961 health plan members to review their insurance bill and define terms used in it. The plan found that: 60% of plan members answered correct only 50% of the time. Only 4% of plan members achieved an 80% score. People are embarrassed to ask questions about what words

Over 20 million American households are now wireless-only when it comes to phone connections. Nielsen’s paper, Call My Cell: Wireless Substitution in the United States, quantifies the growth of households who are abandoning landline phones in favor of wireless. Nielsen attributes the recent growth in this untethered segment to home economics, where the average landline phone in America costs about $40 a month ($480 a year). Increasingly, Nielsen says, households are committing to “wireless substitution” — dropping the landline. The trend in cord-cutting consumers is growing at 3 to 4 percentage points a year and isn’t abating. Most likely not

Corporate executives are concerned about three main issues when it comes to health care: 1. Maintaining ERISA’s national standards, 2. Focusing on health care quality and cost, and3. Worrying about negative impacts of changing tax treatment for employer health benefits.The Miller & Chevalier/American Benefits Council Corporate Health Care Policy Forecast surveyed American employers in August 2008. The key findings of the survey are:…87% of respondents think employees would prefer to get health insurance through employers even if similarly priced options were available through other sources. …Support for maintaining ERISA is solid at 91%. 84% of corporate execs are against state-level

Over the past couple of weeks, the eHealth world learned that RevolutionHealth engaged Morgan Stanley, the investment bank, to help assess the company’s ‘alternatives.’ The early talk was to raise capital, but the tenor seems to have switched to sales or merging. One talked-about suitor for Steve Case’s start-up is Everyday Health. This news comes on the heels of a new comScore report that reports 21% growth in the ‘health information’ site category, from 57 million visitors in July 2007 to 69 million in July 2008. #1 in health search portals continues to be WebMD, which grew by 3% year

In 2007, the percentage of people in the U.S. with health insurance increased to 82.8%, up from 82.1% in 2006. This increase in the insured resulted from growth in enrollment in government insurance programs — namely, Medicaid. The proportion of Americans with employer-based plans was stable between 2006 and 2007 at 62.2%. These statistics were published in the latest Employee Benefits Research Institute (EBRI) Issue Brief, No. 321. Health Populi’s Hot Points: The EBRI’s report is based on 2007 data. Trust me: 2008 is not 2007. We’ve seen tremendous upheaval in both the U.S. macroeconomy and in American householders’ microeconomies.

Health benefit costs will increase in 2009 by just under 6%. This would be a slightly slower rate compared with the past several years, according to Mercer, the benefits consulting firm that calculated health cost growth of about 6% each year since 2005. Mercer’s finding that health benefits costs are slowing down next year echoes the same message previously delivered by Aon, and covered here in Health Populi in August. However, Aon projected nearly 10% health cost growth. Mercer forecasts that 5.7% would be the lowest increase in more than 10 years. In total cost terms, Mercer calculates that costs

73.3 million Americans are enrolled in employer-sponsored health insurance. Two in 3 of these enrollees were in a plan that required them to meet an annual deductible. The average annual deductible for a single insured was $682 in 2006, and $1,300 for a family deductible.The lowest deductibles were paid by people working in state and local government ($462). The highest were paid by construction workers, which were very nearly twice the deductibles of government employees at $934.A deductible is a fixed dollar amount that an insured must pay during a plan benefit year before a plan starts to pay for

Providing price and quality information is viewed as a Holy Grail among health plans and providers, who see transparency as the key for igniting health care consumerism. However, that Grail remains elusive, as issues of tool usefulness and consumer trust cloud the market. A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency, a report from those indefatigable folks at the Center for Studying Health System Change (CSHSC), explains that health plans are ramping up transparency efforts in what is still an early phase of market development and adoption. CSHSC looked at two aspects of transparency: price and quality.

Americans trust pharmacies and drug stores a whole lot more than they do health plans, according to a survey from the Better Business Bureau and Gallup.However, the percentage of people with lots of trust in pharmacies and drug stores fell by 9 points between September 2007 and April 2008. The proportion of Americans trusting health care insurers stayed the same in that seven-month period.What factors affected Americans’ trust in businesses in the spring of 2008? 77% of consumers cited that increasing prices for food, health care and energy had negative impacts.What would strengthen trust in business? 86% of Americans said

The Internet rivals books, magazines and newspapers is the #1 source for Americans seeking health information. Friends and family come a very, very close second. TV and radio rank lower, with only 15% of people relying on these media for personal health information. The tracking report from the Center for Studying Health System Change (CSHSC), Striking Jump in Consumers Seeking Health Care Information, finds that 56% of Americans looked for health information in 2007. Use of the Internet doubled, from 16% in 2001 to 32% in 2007. While all Americans increased their health information seeking behavior, it’s highly correlated to

Health care continued to take 4th place beneath Americans’ concerns about the economy, the Iraq War, and gas prices, according to the Kaiser Family Foundation tracking poll published for August 2008. 1 in 2 voters place the economy in first place; 1 in 4 ‘voted’ for Iraq. Health care is the #3 issue among Democrats; for Republicans, terrorism ranks even higher than health care concerns as the single most important issue in their vote for the President. The top challenge in health care across parties is making it more affordable, believed by about 50% of voters in both parties as

Rite Aid, a top retail pharmacy chain, awarded its first Fill Up & Fuel Up gasoline gift cards this week. I’ve been writing about gas ‘n health care since the inception of the Health Populi blog; see this inaugural post.Now comes a pharmacy connecting the dots between consumer spending categories: the interdependency of fuel and prescription drugs.As the differences between price tiers of prescription drugs have increased over the past ten years, I’ve often asked pharma clients the question: what is the consumer’s marginal value of that $20 (or $30 or $50) co-payment compared to something else on their shopping

People love their grocery stores, but still hate Big Tobacco and Big Oil. The Harris Poll’s annual survey of how Americans view the nation’s industries is out for 2008, and health care organizations — except for hospitals — continue to lose favor with the public.For over a decade, the poll has asked whether a particular industry is doing a “good or a bad job serving consumers.” In addition to supermarkets, people like the jobs done by online search engines, computer hardware companies and software, hospitals, and Internet service providers. The worst scores are given for tobacco, oil, managed care companies

There’s a disconnect between who Americans believe is responsible for their personal health status, and who should pay for health care.On the first question — personal responsibility for health choices — 82% of Americans believe that they alone are responsible for their health.However, only 44% believe that they should bear no responsibility for paying for health care. The Vitality Group, a subsidiary of Discovery Holdings Ltd., surveyed Americans and found that most people (59%) look to their employer to bear at least some responsibility for health costs. Nearly 1 in 2 (46%) see the government as payer.Only 56% of Americans

It will be no surprise to Health Populi readers that the U.S. has a pretty poor record in managing chronic care. How bad those results are depends on whether you’re insured. All of this may seem rather intuitive, but the latest research published in the Annals of Internal Medicine is important. In A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults, published August 5, 2008, the team from the Cambridge Health Alliance/Harvard Medical School dove into detailed data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Until this study,

Health providers want to provide quality care and improve patient satisfaction. Really, they do. It’s just that pesky problem of declining reimbursements getting in the way of meeting those two key business objectives.This dilemma comes to you courtesy of a survey conducted by IVANS, Inc., the company that helps providers process health transactions. IVANS found that about 50% of provider derive over 50% of their income from Medicare. As Medicare continues to be fiscally challenged, providers’ fiscal pain from this payer will increase.IVANS predicts that, “as the baby boomer generation retires and the demand for medical services increases, the operational

HarrisInteractive’s latest poll on Americans searching for health information online begs the question: “Has the number of cyberchondriacs declined?” The pure stats show that 1 in 2 American adults searched for health information in the past month — about the same proportion as last year (within the statistical sampling error). So can we assume that the number of people going online for health info has plateaued? Health Populi’s Hot Points: I would consider this finding as a natural maturation of a market. What’s underneath the number needs further analysis: just what are people doing in health online? The next layers

Leave it to Wal-Mart to continue to grow its franchise in health through yet another revenue center: this time, it’s telemedicine. The company will pilot telemedicine through retail clinics in Houston, Texas, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach. Instead of employing nurse practitioners, the medical model for this

There’s a new wiki in the health social media town, Medpedia. Among the most popular online sources for health information is Wikipedia. Millions of people search Wikipedia daily for insights into medical conditions, drugs, and procedures. Now comes the announcement of a sharply-focused wiki from the most credible of academic health institutions: Harvard, Michigan (my alma mater), Stanford, UC-Berkeley, and a host of other highly-branded health associations and stakeholders including the NIH, the CDC, and the FDA. Medpedia estimates it will cover information on at least 30,000 conditions/diseases and 10,000 drugs. The press release on Medpedia’s website terms the project,

Very few people talk about prescription drugs online. Most of these conversations are happening in the offline world of phone calls, cafes, and water coolers. This finding by the Keller Fay Group, a marketing organization that specializes in word-of-mouth (WOM) marketing, first surprised me. So I contacted Ed Keller, CEO of the Group, to talk about the implications of this number. I asked Ed what the 10% online means versus the 74% offline. He said, “The Keller Fay data is a helpful reminder that whatever is happening in the world of digital media is still only a fraction of all

Medical tourism gets a lot of buzz these days, estimated to be a $60 billion industry. Aggressive projections forecast the industry will reach $100 billion in 2012.The U.S. being an employer-based insurance system for health, employers are the primary conduits of health insurance in the U.S. (along with government). As many consider incorporating medical tourism into benefit plans, it makes sense that the National Business Group on Health has prepared a primer to medical tourism.The NBGH’s Issue Brief, “Medical Tourism: What Employers Need to Know,” lays out the latest statistics on the global market for health care services, and some

It’s a universal scenario that physicians face patients carrying into the exam room Internet-based information. Manhattan Research found that 94% of doctors report having to deal with patients who bring information printed off the Internet. What’s important is that these patients get more time with their doctors in the exam room. Manhattan Research calls these patients, “healthcare overachievers.” They essentially get rewarded for being informed, where the reward is in the form of more time with the clinician. Adding to the health information access literature is Burst Media, whose study into consumers’ search for wellness found that two-thirds of Americans

People enrolled in high-deductible health plans tend to make more risky health decisions than those enrolled in lower-deductible plans, according to a study published in the July/August issue of Health Affairs. In Do Consumer-Directed Health Plans Drive Change In Enrollees’ Health Care Behavior? the authors find the answer is, “yes,” probably. Enrollees in the high-deductible CDHP were more likely to forgo medical care to save money. The study distinguishes between potentially risk health behavior like forgoing a visit to the doctor when ill, versus cost-saving behavior such as choosing to have a less-costly diagnostic test.In the risky category, behaviors included

A gap in broadband access between low-income Americans and the wealthy, as well as lower penetration in African-American households, persists. This, as greater adoption in the overall American population has increased. It’s another case where the rich get richer; here, that takes the form of people with broadband deepening their online relationships and activities, which those without broadband slide further behind the 24×7 online world. In fact, many of those with broadband have shown demand (that is, they’re paying for) premium services like fiber-to-the-home. The Pew Internet & American Life Project continues their important research into the impact of the

Access to broadband is a health-y technology, according to Connected Nation, a non-profit organization with the mission of reducing the digital divide in America. Their goal: to ensure access to broadband across Kentucky, one of the most rural states in the U.S. “Our work improves the lives of people who were once left behind; renews hope for rural communities; increases the number of high-tech companies and jobs; and nurtures an environment for lifetime learning, improved health care, and superior quality of life,” according to the organization’s progress report for 2007. According to results gleaned from their project, Connected Kentucky, peoples’

Americans — both insured and uninsured people — are delaying health care due to cost and health-system challenges, according to the latest Tracking Report from the Center for Studying Health System Change (CSHSC). Delaying care is particularly acute for people who are in poor or fair health, and those with low-income. Here’s another example of a gap between rich and poor Americans growing wider. Overall, the Center calculates that in 2007, 20% of Americans reported not getting or delaying necessary care at some point in the previous year. But the Center points out that the gap between insured and uninsured

In the further morphing of health services into consumer products, people want to personalize health plans. Deloitte has further sliced and diced the findings of The 2008 Survey of Health Care Consumers, which I wrote about in Health Populi here on 21st February 2008. I really appreciate Deloitte’s consumer segmentation, which attempts to get at differences between peoples’ preferences for health engagement and empowerment. For example, while there is a cadre of consumers who are “online and onboard” and fully engaged with their health behaviors and choices, another group is considered “casual and cautious.” One area of relative homogeneity among

Consumers, employers, payers and providers agree that information flows are critical to helping stem health care costs. While there is shared concern about health care costs, there is also a shared desire for more, accessible information and better online tools for managing it. TriZetto‘s report, Research Shows Healthcare Market Constituents Seek Information as Key to Solving the Affordability Crisis, surveys the landscape of stakeholders in American health care and lays out a rational approach to what the IT services firm calls integrated health care management. TriZetto lays out five key themes that drive the imperative toward integrated health care management:

Would pushing broadband out to the furthest reaches of rural America fill gaps in health care? A project in Pennsylvania thinks so. ConnecttheDocs is a Pennsylvania Medical Society project that is expanding broadband to physicians who are without it. Those docs with ‘lower’ broadband might also have access to faster quality speeds. The goal: to improve health care in Pennsylvania, especially in rural areas. Why do physician practices need broadband access? ConnecttheDocs says that access to broadband is the first step in adopting technologies that can improve the quality and safety in health care. The services that broadband underpins that

Nestle’s Purina has decided to expand the prominent pet food brand into pet health insurance. According to MediaPost‘s coverage of the story, the new insurance product will be called PurinaCare. It will offer a portfolio of insurance products with varied premiums and deductibles, covering “everything from routine vaccinations and flea and tick medications to major surgeries and cancers. After meeting a chosen deductible level, consumers will make a 20% co-pay per procedure and can be reimbursed for the remainder.” It was fascinating to hear that, “Coverage fees vary based on geographic location, pet breed, pet age and other variables.” Is

It’s the end of the school year in my household, and for pharmacies, too — they’ve received pretty good marks from Consumer Reports, one of the most influential arbiters of health grading. CR’s comprehensive survey on pharmacies is in its June 2008 issue. The headline: independent pharmacies can offer higher levels of service, access, and approachability for health consumers. Independents got the high score of 92 compared to other pharmacies, whose ratings ranged from 91 for the Medicine Shoppe chain and Publix supermarkets, to a low of 79 for Wal-Mart, Giant-Eagle, Walgreens, Longs Drugs, Eckerd, and a 78 for Rite-Aid.

Call it not separate, but certainly unequal. Such is the state of health outcomes in America. The Robert Wood Johnson Foundation (RWJF), the nation’s largest health philanthropy, is spending $300 million of its endowment to address this longstanding problem. The Health Resources and Services Administration defines health disparities as “population-specific differences in the presence of disease, health outcomes, or access to health care.” In plain English: health disparities are gaps in the quality of care that occur across racial, ethnic, and socioeconomic groups. RWJF commissioned the brilliant folks at the Dartmouth Atlas Project to provide details into disparities across several

Once again, the Employee Benefit Research Institute (EBRI) brings you health economics news to keep you awake at night. In the EBRI’s latest Issue Brief, Savings Needed to Fund Health Insurance and Health Care Expenses in Retirement: Findings from a Simulation Model, you will learn all you need to know, and more, about how much more you’ll have to save if you’re a Boomer looking to retire about ten years from now. The bottom-line: you probably don’t have near enough saved to cover health care. And these numbers do not factor in long-term care. In the table here, I’ve compared

Employers who are most likely to provide health care and economic security benefits tend to be larger, in business longer, with more unionized employees, more ethnic diversity in top positions — and they are more profitable than their competitors — according to the 2008 National Study of Employers. The Alfred P. Sloan Foundation funded this study researched by The Families and Work Institute (FWI). The Institute, whose slogan is, “When work works,” also recently published the 2008 Guide to Bold New Ideas For Making Work Work. This survey of 1,100 employers builds on FWI’s 1998 Business Work-Life Study. Thus, the

Divided We Fail is taking a page out of the propaganda scripts of World War II and Ronald Reagan: they’re going straight to Hollywood.Divided We Fail is a health reform advocacy group that brings together parties who traditionally have broken much bread together, with each stakeholder organization archetype emphasized by me in quotes: the AARP, the Business Roundtable (“Big Business”), the National Federation of Independent Business (“The Voice of Small Business”), and the Service Employees International Union (“Labor”). Together, their mission is to bring rational dialogue into the U.S. health reform debate. I’ve written about them in Health Populi here.Divided