A blog covering the health/care ecosystem and people.

Chronic disease will account for 2/3 of all deaths globally in the next 25 years. “We have to move from illness to wellness. Businesses will have to invest in wellness. There is no choice. It’s not philanthropy. It’s enlightened self-interest,” according to Shrinivas Shanbhag, the Medical Adviser at Reliance Industries in India. A new report from PricewaterhouseCoopers (PwC) and the World Economic Forum, Working Towards Wellness: The Business Rationale, details the future of chronic disease to 2030. Globally, today’s emerging BRIC economies — Brazil, Russia, India and China — will lose millions of productive life-years due to the sorts of

ePrescribing = safety, lower costs, and better health care. This consensus was clear last week during a major meeting of stakeholders at The Brookings Institution discussing the prospects and barriers to ePrescribing (eRx). Matthew Holt and I wrote a report back in 2006 for the California HealthCare Foundation where we discussed the opportunities and barriers for eRx. Two-and-one-half years have passed since that report was written. So 30 months later, continue to read this blog to learn about how Medicare, physicians, PBMs, Congress and pharmacies are getting into Kumbaya mode for eRx. While the actual number of ePrescribers is something

Wal-Mart continued its first-mover tactics in health by dropping the price of prescriptions again. This time, the target (sorry for the pun) is maintenance meds which Wal-Mart will price at $10 for 90 days’ supply. This move puts Wal-Mart squarely in the pharmacy benefits management (PBM) segment vis-à-vis ExpressScripts, Medco, and the big PBM players. The 3-month mail order med business is the lucrative turf of PBMs. Wal-Mart’s first move into this space was in 2006 when the company priced many 30-day scrips at $4, shaking up the industry. I wrote about that market disruption here in January 2008. Wal-Mart

There is more evidence that remote health care can improve health outcomes. Say ‘hello’ to the Virtual Integrated Practice (VIP). The term was coined by the Rush-Presbyterian Medical Center, where a team has been refining the VIP model for the past four years. The VIP’s objective is to improve chronic disease management for older people by deploying an interdisciplinary team using communications technology. The main challenges in primary care for VIP’s target patient population are: • Multiple chronic problems• Polypharmacy• Physical disability• Functional impairment, and• Economic stressors. The Holy Grail here is that when these patients are optimally-managed, VIP can

It’s a 50/50 America again. This time, half of us are thriving, and half of us are struggling.News of that Great American Chasm is brought to you by the Gallup-Healthways Wellbeing Index. I wrote about The Gallup-Healthways Wellbeing Index in March here when the project was first announced. The profile of the collective American mind-body-spirit was unveiled yesterday based on the poll’s first 100,000 interviews.It’s not a pretty picture.According to the survey’s definition, people who are thriving: having basic needs met (food, clothing, shelter) earn higher incomes have lower burdens of disease report fewer sick days enjoy better working environments.

People trust health insurance companies to hold their health spending information more than they trust banks, according to a survey from Medavante. In Cure the Confusion: The Consumer Experience of Online Healthcare, Medavante found that consumers perceived that health plans have less bias than financial institutions. Yet, 80 million Americans bank online. Still, trust in online banking is eroding. Earlier this month, Bankrate’s survey asserted that Americans are very concerned about identity theft. This is beginning to impact their online behavior with banks. This is a new finding. Other data sources assert that consumers lack trust in health plans when

People — citizens, patients, caregivers, “consumers” — are early adopters of social media in health, compared to other industry stakeholders including providers, plans, payers, and suppliers such as pharmas and medical equipment companies.This is but one of many findings in my report, The Wisdom of Patients, which was published yesterday by the California HealthCare Foundation.The report covers the origins of social media in the morphing of Web 1.0 to 2.0; the current state of social media in health; business models, opportunities and obstacles; a glimpse into the fuzzy future of Health 2.0; and, profiles several of the most pioneering figures

I just returned from voting in the State of Pennsylvania primary. My husband and I decided to go when the polls opened at 7 am, and the line was out the door of our local fire company, our polling place. We expect record voter turnout in Pennsylvania, which is a good thing. I’ve been analyzing the latest Kaiser Health Tracking Poll: Election 2008. Health care as the top 1 or 2 issue among voters has fallen to #3 after the Economy and Iraq. This is a big shift since Kaiser conducted its poll in December 2007, when the Economy ranked

Here’s an effective, efficient and efficacious Rx for understanding options for health reform: watch the PBS presentation of Frontline’s Sick Around the World. You can watch the video or download a podcast. Here’s the transcript from a roundtable hosted by Kaiser Family Foundation featuring TR Reid, the producer of the program, along with Uwe Reinhardt and Tsung-Mei Cheng as respondents to the documentary. TR Reid of the Washington Post has been a Kaiser Fellow over the past year. He’s created what hasn’t been seen before: in a short sixty minutes, an engaging, informative comparison of health systems that’s clear and

The U.S. health system is poorly structured to meet the needs of aging Americans, especially the millions of Boomers who are beginning to turn 65 years of age. The IOM’s Committee on the Future Health Care Workforce for Older Americans looked at the health needs of Americans over 65 years of age. They conclude that the health care workforce includes everyone involved in a patient’s care: beyond the traditional definition of workers such as health professionals and “direct care workers” (such as nurse aides, home health aides, and personal care aides), the IOM add informal caregivers — that would be

The latest piece in the medical privacy jigsaw puzzle is online behavioral advertising (OBA). Last week, the Federal Trade Commission (FTC) received comments from the Network Advertising Initiative (NAI) on the agency’s proposed principles for OBA. As part of this filing, the NAI has published in draft its own approach to behavioral ad targeting in health, included in the NAI’s Self-Regulatory Code of Conduct for Online Behavioral Advertising. Online behavioral advertising (OBA) is the process whereby the online consumer’s search behavior is analyzed across multiple websites and then categorized for use in advertising online. NAI’s members are reputed to cover

Hospitals are major employers in their local markets; they are often the largest provider of jobs in a community. In its latest TrendWatch report, Beyond Healthcare: The Economic Contribution of Hospitals, the American Hospital Association details the economic impact of hospitals in each of the fifty states. The bottom-line: hospital employment generates economic ripple effects way beyond the direct jobs provided in health care. Hospitals employ more than 5 million people nationwide – making them the second-largest employer in the private sector – and account for more than 4% of employment most everywhere. The Department of Labor calculates that private-sector

More employers will more aggressively manage employee health, based on Hewitt‘s latest survey of 500 U.S. companies.Hewitt’s poll found that 88% of employers are looking to invest for the longer-term (a 3-5 year time horizon) to improve employees’ health and productivity. This has dramatically grown from 63% last year.This is a matter of dollars-and-cents among employers. Hewitt found that employees see a direct link between spending for health and long term productivity outcomes — and management of costs, both direct and out-of-pocket for employees.In a parallel survey among 30,000 employees conducted by Hewitt, only 12% believe that companies should play

Six in ten U.S. physicians support a national health plan to achieve universal coverage. A 2002 poll among American doctors was updated in 2007 to determine how physicians’ feelings about national health insurance (NHI) may have changed in the 5 year period. In 2002, 49% favored a national plan. In 2007, 59% supported such a plan. The chart on the left details findings by physician specialty. Not surprisingly, more generalist doctors favor a national health plan compared to specialists, although there is still support for national insurance by a plurality of specialists and the support has grown over five years.

According to the latest poll from HarrisInteractive and the Harvard School of Public Health, less than 1 in 2 Americans believe that health care in the U.S. is the best system in the world. Harris and Harvard measured how Americans feel about the U.S. health system compared to those of Canada, France and Great Britain. The poll was taken among American adults age 18 and over in early March 2008. In the “we’re better than you” contest, 40% say the U.S. system is better than Canada, 31% say we’re better than France, and 37% say we’re better than the UK.

Among my top 3 HIMSS lightbulb moments was, appropriately, at a roundtable held by GE Healthcare. Of course, I learned in outline form about GE’s strategy for electronic health records and digital imaging and personalized medicine. This, I was prepared for. Then I took a look at a schematic drawing with a patient at the center and GE’s many health touchpoints around the circumference. Ponder for a moment those touchpoints: the Centricity EMR; the huge installed base of digital imaging technologies throughout the US (and the world); personalized medicine and women’s health; and, diagnostics. Then there is NBC Universal. Say,

In 2005 that is, according to the Kaiser Family Foundation’s (KFF) latest research into employer-sponsored health care titled Employer Health Insurance Costs and Worker Compensation. KFF analyzed six years’ worth of employers’ health insurance cost data and found their premiums increased 78% in the six years as wages grew only 19%. It’s useful to dive into these data and learn that employers with higher-wage employees spend more per hour on health insurance than those in lower-wage occupations. However, although technical, executive/managerial, and professional occupations had some of the highest health costs per hour, KFF found that as a share of

Say hello to the Gallup–Healthways Well-Being Index (GHWBI). This is intended to be a new generation of quantifying a person’s health in a holistic sense. If it lives up to its promise, the Index could help to transform health in communities. Gallup-Healthways are defining “health” broadly, based on the World Health Organization definition of health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Suiting this holistic definition, the Index will dive deep into the factors that shape our health, such as a person’s: Access to and affordability of basic

Last week, I was fortunate to meet with a group of health providers representing some of the best-and-brightest, most innovative delivery systems in the U.S. The subject was innovation, and as I presented a forecast of scenarios for health reform, the conversation inevitably moved to the subject of how to manage health costs if/when we add the uninsured into the American health insured population. There is a typical response to this question that many of us pull out of our health-econ PowerPoint deck: that “we’re” already paying high costs for this population in the form of emergency room visits and

There is much to report in the area of prescription drugs, not much of which will bring joy to my pharmaceutical phriends. First, following the money (hey, it’s me, the health economist), AARP brings out its latest Watchdog Report which details the rising prices of 220 brand name Rx’s most used by older people covered by Medicare Part D since the plan’s inception two years ago. These prices have risen much faster than the rate of general inflation. The average price increase in 2007 was 7.4%, over 250% of inflation in the period (=2.9%). For people with multiple chronic conditions,

The second meeting of the Health 2.0 Conference kicked off today in San Diego. The weather is pleasant in this town, and so is the crowd. The excitement engendered at the first Health 2.0 Conference held in September 2007 in San Francisco continues to grow at this meeting, which is focused on how consumers-people-patients can connect with providers, payors, and employers using Web 2.0 tools. American Well trated us to a “deep dive” into their new service, which will go live in June 2008. Roy Schoenberg, MD, MPH, the CEO of American Well, demonstrated their concept of the “online health

Welcome to the new health math in America: > education = > life > income = > life less income = less life less income = more chronic illness Got that? A new report from the Robert Wood Johnson Foundation (RWJF), Overcoming Obstacles to Health, codifies the relationship between socioeconomics and health. Health disparities go way beyond simple race and ethnicity categories — the combination of income, education, wealth, and neighborhood conditions could be more useful in explaining differences in Americans’ health status. Based on per capita GDP, Americans should live nearly three years longer than we do. Instead, we

Here’s the story that trumps any HIMSS announcement today because it sets the context for the future health of health care in America: spending on health care could double by 2017. This would calculate to $1 in every $5 in our economy. The story, written by researchers from the Centers for Medicare and Medicaid Services (CMS), was published yesterday in Health Affairs. That’s the macro view; within that spending trajectory, more would shift from the private to the public sector. The burdens will be on Medicare (read: the first phase of Baby Boomer retirements) and Medicaid. At a steady growth

Two-thirds of Americans support state-mandated health insurance, with roughly the same percent supporting a tax increase to cover the uninsured. Welcome to the latest picture of health care consumers, brought to you by those clever researchers at the Center for Health Solutions at Deloitte. Deloitte’s 2008 Survey of Health Care Consumers presents the latest numbers on Americans and how they feel about the US health system, health politics, and innovations in health care delivery. The survey was conducted among people age 18-75 in September 2007. Top-line: 9 in 10 Americans don’t believe they are prepared to meet the costs of

Six of the 7 largest publicly-traded health insurers had profits increasing 10% or more in 2007. However, for many of these plans, medical loss ratios went up, too. The February 25th issue of American Medical News explores this fiscal phenomenon. American Medical News is the weekly newspaper targeted to physicians. AMNews’s mission is to keep doctors apprised of the latest information they need to know for practicing the business of medicine. The story is potentially potent for doctors because Wall Street analysts are focusing in on medical loss ratios — that is, the cost of health services provided by an

What do you stand on covering the uninsured in America? Do you support government mandates for health insurance or a market-based approach? Should the Federal government directly negotiate drug prices with pharma companies? Go visit Health Central’s Healthcare ’08 website to visually see where you stand on health issues compared to the Presidential candidates. Since the site’s inception early this year, many candidates have dropped out. As of today, there are two Democratic candidates (Clinton and Obama), and three Republicans (Huckabee, McCain, and Paul). The measurement tool which HealthCentral calls “the Poligraph” is a clever two-by-two matrix arrayed on six

Sicko has come to that great time-honored health model of England. I’m heading to London this week, and in preparation received a report to review published for the Parliament’s House of Commons Health Committee on NICE — the National Institute for Health and Clinical Excellence. You can think of this Committee akin to the U.S. Senate Subcommittee on Health. It’s responsible for assessing spending, administrative issues, and policy for the UK’s Department of Health (the peer of the U.S. Department of Health and Human Services), which is responsible for the National Health Service (NHS). NICE was established nearly a decade

Just in case you’re feeling lonely about the state of health care costs in the U.S., note that we’re in good company: medical costs will accelerate around the world over the next five years. Watson Wyatt brings you this news based on the results of a poll conducted among 85 insurers that cover medical for global employers in the Americas, Africa, Asia and Europe. The benefits consulting group found that health cost increases are growing faster than rates of inflation in 80% of countries surveyed. Thus, hyperinflation of health costs isn’t just an American malaise, but a problem for most

Snoopy’s googling for his American Dream. He lost it somewhere in the trajectory of rising energy prices, health costs and personal debt. The American Dream is defined, first and foremost, as financial security, in MetLife‘s second annual American Dream survey. Concerns abound in the American worker’s mindset focused on dropping home values, incrasing energy costs, and rising personal debt. Thus, only one in three Americans believe they’ve achieved the Dream of financial security. Still, three-quarters of Americans believe it’s possible to achieve this Dream in their lifetime. Nearly all Americans see themselves working harder than ever “to get by.” Half

Pundits are focused on the impact on search and ads, but I’ll be quick to point out that the breaking news that Microsoft has bid $44+ billion for Yahoo! has big implications for health. Yahoo! has made a successful mark in health on many fronts. One of many distinctions, for example, is Yahoo! Health & Wellness Groups where countless people convene to meet, share, and debate health issues, from medications and their side effects to what to do when you’re newly diagnosed. It’s all about the stories and the sharing and the wisdom of health crowds over there. If you’re

While fairly satisfied with their own health care, Washingtonians are frustrated about health care costs and the lack of access to care for their fellow Americans. These findings are similar to a similar poll of Iowans conducted by CodeBlueNow!, an advocacy organization focused on health reform. Health Populi blogged about the Iowa survey here. The most striking similarity between both polls is that people don’t trust the government to reform the health system. Instead, health professionals and the “common people” are seen as trusted health reformers. There is mass dissatisfaction with the costs of health care, about which 2/3 of

What nations deliver consumer-centric health care? The top five destinations for consumer-friendly health systems would be Austria, the Netherlands, France, Switzerland, and Germany, at least according to the latest iteration of the Euro-Canadian Health Care Index (ECHCI). The US is not part of this analysis. The concept of consumerism in health care has migrated to Europe. The Health Consumer Powerhouse, a self-described “do-tank” (as opposed to “think-tank”) based in Brussels and Stockholm, innovated and perenially updates the ECHCI. This year, the Powerhouse has added sister-nation Canada to the mix, and the results are fascinating. A key objective for the Index

What motivates a consumer to choose one health plan over another, or commit to managing his newly-diagnosed chronic condition, or take on health behaviors to keep her well? It’s their values, stupid. Borrowing from the fields of social psychology and health behavior and education, the Employee Benefit Research Institute (EBRI) has published a provocative paper on how consumer-directed health plans (CDHPs) risk failure when plans and providers ignore consumers’ inner values. Listening to Consumers: Values-Focused Health Benefits and Education offers insights into the current complexion of CDHPs and how consumers make health decisions. Among the reports’ findings are that, Some

Nine years from now, one in every 5 dollars will go to health care for older Americans. This forecast is presented in detailed context in a new report published by the Kaiser Family Foundation. Financing Medicare: An Issue Brief reminds us that Medicare is among the fastest-growing Federal programs in the U.S. By 2016, Medicare spending will exceed that of the forecasted cost of Social Security in 2028. These findings are based on the budget estimates presented by the Congressional Budget Office in August 2007.Simply said, it is escalating health care costs that cause Medicare to consume increasing chunks of

Getting access to physicians’ opinions is Big Business. Now, institutional investors will have access to the brains of doctors through a relationship between Goldman Sachs and Epocrates, the point-of-care health information company. Why is this so important? Because the health sector in the U.S. is now valued at over $2 trillion, according to a new estimate published by CMS this week. The prescription drug program, known as Medicare Part D, was responsible for driving health costs above the $2 trillion mark. This piece of the national economy can be an attractive place for investors to seek returns; however, not every

Break out the Bordeaux and eat those escargots: France ranks first in preventing deaths, according to a new study from The Commonwealth Fund. Compared to 19 industrialized countries, the US ranks dead (pardon the pun) last. The top three nations who do best at preventing death are France, Japan and Australia. The study in Health Affairs found that if the US health system performed as well as these three countries, we would see 101,000 fewer deaths each year. In Measuring the Health of Nations, Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine, the authors

Pharmaceutical companies spend twice as much money on marketing as they do on research and development, according to a new study published in PLoS Medicine, an online peer-reviewed journal. According to the study, U.S. drug companies spent $57.5 billion on marketing versus $31.5 billion on R&D, in 2004.The chart on the right details the researchers’ updated estimates on pharmaceutical companies’ promotion. The authors, Marc-André Gagnon and Joel Lexchin, are Canadian academics who built a new estimation model for pharma marketing expenditures. They begin their paper by critiquing data from IMS, which is the primary pharma marketing information source used by

Patients with at least one chronic condition spend more than five times of those with no chronic conditions. Increase the number of chronic conditions to five or more, and people have 25 times the inpatient hospital spending — the high-priced line item in the medical bill.Bottom line: “By the late 20th century and continuing into the 21st century, the major reason for mortality and morbidity in the United States and other industrialized countries has become chronic disease.”In Chronic Conditions: Making the Case for Ongoing Care, Dr. Gerard Anderson of Johns Hopkins quantifies the relationship between chronic disease and health spending.

While many health analysts usually point to California as the state for vanguard health movements, I keep my eye on Minnesota. Once again, I discovered a new-new health project that I expect will be a model that will be replicated. The Health Care Scoop is among the first epinions.com-style websites where patient/consumers can log their opinions about local health care experiences with plans and providers. While many health plans have begun to provide report cards on quality and price lists for services, the Scoop is among the first social media websites provided by a health plan that allows the good,

The National Federal of Independent Business (NFIB) laid out its latest principles for health reform. This “voice of small business” says that universal access to health care is especially important to small businesses in the US. The NFIB believes that the most important issue facing small business for the past twenty years has been access to quality, affordable health care. NFIB cites several reasons for supporting universal access. Access to affordable health insurance options has been a particular problem for small business in the US, which employs so many of the millions of uninsured workers in America. This segment of

Here’s a recipe for starting a vaccine revolution without breaking any eggs: take one Goliath in the health care industry with a disposable fast-tracking manufacturing method, and combine with a David-sized novel biotech company with a speedy way of growing cells. Mix, bake, and wait one-half of the usual time to yield a vaccine. Welcome to a new era in vaccine development, brought to you by GE Healthcare (aka Goliath) and Novavax (aka David). These two partners think they’ve got a speedy way of making a pandemic flu vaccine. The potential for this venture could significantly impact global public health.

A new survey from HarrisInteractive reveals that one in 3 patients don’t think doctors have a complete picture of their medical history. But if the doctor has an electronic medical record (EMR), 9 out of 10 Americans want access to it. Compared to the same survey done in 2006, more consumers have faith in EMRs’ ability to reduce medical errors (57% of consumers thought that the use of EMRs could decrease the frequency of errors in 2006; in 2007, 63% did). On privacy, consumers appear to be trusting EMRs more. Overall, 60% of Americans believe that the benefits of EMRs

Not sufficient, that is, to guarantee access to health care. The latest release of that great publication of the Centers for Disease Control, Health 2007, has the theme of health care access at its core. Think of Health 2007 as the State of the States’ Health (all 50 collectively). This is the 31st annual version of this huge compendium. The book features updated data that paints a comprehensive picture about Americans’ health care, health status, financing, and resources (financial, labor, technological). Health 2007 is one of my health care “must-reads” each year; it makes me feel better about paying my

Perhaps our collective shopping jones has kicked in, but The Regence Group of Blues plans has found that more consumers are comparison shopping for health services these days. A new survey from the Blues plans that cover the Pacific Northwest Idaho, Oregon, Utah and Washington found that the number of people who comparison shop based on price and quality for medical services has grown to 70%. Note that this study was framed to assess Internet-based shopping habits. That consumers adopt information-seeking behaviors in health care is a sine qua non for consumerism: information availability, access, flow and consumption makes markets

A pack of cigarettes ranges in price from a low of $3.35 in South Carolina to a high of $6.45 in New Jersey. But the real personal costs of cigarettes — per pack smoked — are 66 times greater (in the case of that smoking South Carolinian). The analysis can be found in a new working paper for the National Bureau of Economic Research. W. Kip Viscusi and Joni Hersch calculate this cost in terms of personal health risks: for a man, each pack of cigarettes smoked reduces the value of his life by $222; for a woman, each pack

Employer costs for health coverage are rising twice as fast as general price increases. This is leading to more employers dropping health coverage for employees. Mercer brings us this evidence in their new health cost survey, to be published in March 2008. The consultancy found that health costs increased 6.1%, equivalent to 2006 cost increases. This equated to $7,983 per employee. The forecast for 2008 is a 5.7% health cost price increase. These cost increases are outpacing wage increases. More small employers – where job growth is – are exiting health coverage, according to Mercer. The percentage of small employers

Talking to your parents about their future living arrangements is difficult. I’ve been there. Trust me. A new study from AARP, who knows a thing or two about dealing with older people, sheds some light on the challenge. It’s easy for me to say this, but…it’s good to plan ahead and have these conversations before your parent becomes sick, or infirm, or both. According to AARP’s report, Are Americans Talking with Their Parents About Independent Living: A 2007 Study Among Boomer Women, most women 45 and over have had this talk with parents, but most have not made plans ahead

The Mayo Clinic, one of the most prestigious names in health care, is planning to open several retail clinics in early 2008. Does this signal the beginning of an upper tier of retail clinic — where Nordstrom- or Neimans-meets-medicine? At this early stage, Mayo’s plans are to locate the branded “Mayo Express Care” centers around their immediate target market of Rochester, Minnesota, which includes part of Wisconsin. By implementing this plan, Mayo, known for its stellar inpatient services, expands its reach into community-based primary care role. Mayo was named one of America’s best hospitals by US News and World Report

Evidence-based medicine (EBM) can reduce health spending, according to two analysts at the Congressional Budget Office. Note that there’s a piece of legislation in Congress to fund EBM research.The very level-headed essay in the November 8th issue of the New England Journal of Medicine explains the positive role that EBM could play in preventing Medicare and Medicaid from consuming 20% of the GDP by 2050.Peter Orszag and Philip Ellis, the CBO’s Director and senior analyst, respectively, talk about the merits of marrying EBM — which generates information about the effectiveness of medical treatments — with rewarding clinicians when they adopt