A blog covering the health/care ecosystem and people.

One-third of Americans are following a specific eating pattern, including intermittent fasting, paleo gluten-free, low-carb, Mediterranean diet, and Whole 30, among dozens of other food-styles in vogue in 2018. It’s mainstream now that Americans are shopping food for health, with eyes focused on heart health, weight, energy, diabetes, and brain health, according to the 2018 Food & Health Survey from IFIC, the International Food Industry Council Foundation. But underneath these healthy eating intentions are concerns about the cost of nutritious foods, IFIC reports. And this aspect of home health economics can sub-optimize peoples’ health. Consider the first graph on consumers’

This is what happened to pharma stock prices on Friday after President Trump and Secretary of Health and Human Services Alex Azar outlined their new policies focusing on prescription drug prices. The graph is the Nasdaq U.S. Smart Pharmaceuticals Index (NQSSPH) from May 11, 2018, the date when POTUS and Secretary Azar made their announcement. What this upward driving curve indicates, from the start of stock trading in the morning until the ring of the closing bell, is that the pharma industry players, both manufacturers and PBMs, were quite delighted with what they heard. The blueprint for restructuring the prescription drug industry,

The rolls of the uninsured are growing in America, the latest Gallup-Sharecare Poll indicates. The U.S. uninsurance rate rose to 12.2% by the fourth quarter of 2017, up 1.3 percentage points from the year before. 2017 reversed advancements in health insurance coverage increases since the advent of the Affordable Care Act, and for the first time since 2014 no states’ uninsured rates fell. The 17 states with declines in insurance rates were Arizona, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa, Missouri, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Among these, the greatest

Expect “new combinations” of industry actors and technologies to reorganize and re-imagine healthcare, with an eye on both price and investments in customer experience (CX), PwC envisions in their latest report on The New Health Economy in the Age of Disruption. In this vision, healthcare will be a more flexible marketplace underpinned by data, platforms, and workers. Yes, it’s challenging to get from here-to-there, but PwC explains just how this can happen. Four archetypes, models, of healthcare deals have begun to emerge in the marketplace, illustrated by the Big Deals and announcements reshaping the industry in the past couple of years:

Three-fourths of healthcare providers experienced a data breach in 2017, according to the HIMSS 2018 Cybersecurity Survey. Health data insecurity is the new normal. A big piece of addressing the cybersecurity healthcare challenge is educating people who work in healthcare settings, and that has been under-funded. Only 41% of healthcare workers say they receive security training, a Forrester study learned in January 2018. Forrester also found that while healthcare organizations have experienced some of the most egregious cyberattacks, the industry allocates a smaller proportion of IT budgets to security compared with than other organizational types at a rate of 22%

In the U.S., trust in the healthcare industry declined by 9 percentage points in just one year, declining from 62% of people trusting — that’s roughly two-thirds of Americans — down to 53% — closer to one-half of the population. I covered the launch of the 2018 Edelman Trust Barometer across all industries here in Health Populi in January 2018, when this year’s annual report was presented at the World Economic Forum in Davos as it is each year. The Edelman team shared this detailed data on the healthcare sector with me this week, for which I am grateful. Check

This is the second post of three written to summarize what I learned participating in Medecision’s annual meeting with the company’s partners, held March 27-29, 2018 at the Ritz-Carlton in Dallas, TX.  I concluded the first of this three-part series with Dr. Don Rucker’s belief that, “Patients are the massive use-case for interoperability.” This second post focuses on the key role of designing for healthcare – for patients, caregivers, providers, all industry sector workers indeed. And designing information to make it beautiful, useable, meaningful. You’ll read about Renaissance Man/Doctor Andrew Chacko MD, a board-certified physician, French and Physics student at the Naval

As the nation battles an obesity epidemic that adds $$ costs to U.S. national health spending, there are many opportunities to address this impactful social determinant of health to reduce health spending per person and to drive public and individual health. In this post, I examine a few very current events in the food-as-medicine marketspace. Big Food as an industry gets a bad rap, as Big Tobacco and Big Oil have had. In the case of Big Food, the public health critique points to processed foods, those of high sugar content (especially when cleverly marketed to children), and sustainability. But

In the US, when it comes to life and death, it’s good to live in Hawaii, Utah, Minnesota, North Dakota, and Iowa — the top five states with the greatest life expectancy and healthy life expectancy at birth in 2016. For health and longevity, sorry to see the lowest five ranked states are Washington DC which ranks last, along with Mississippi, Louisiana, South Carolina, and Alabama. This sober geography-is-health-destiny update was published this week in JAMA, The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. The first chart illustrates states down the left

Half of U.S. patients were offered online access to their health records by providers or insurers, and one-half of them accessed the EHR at least once in the last year.  One in four of those offered online EHR access looked at them more than 3 times. It takes a good nudge from a provider to motivate a patient to access online medical records, found by ONC in their latest research into consumers’ use of EHRs detailed in Individuals’ use of online medical records and technology for health needs, the ONC Data Brief No. 40, published April 2018. he concept of

The most beloved company in America is Amazon, according to the 2018 Harris Poll Reputation Quotient Rankings which were published on 22nd March 2018. This was the third year in a row that Amazon garnered the top position in this corporate reputation poll, which gauges consumers’ views on workplace environment, social responsibility, emotional appeal, financial performance, vision and leadership, and products and services. Mr. President, why pick on Americans’ favorite brand? The brand defines the 2018 consumer’s benchmark for a best-retail experience, which is what people increasingly expect across the various interactions they have throughout a day. [As a sidebar,

What a difference a couple of weeks make…. On 1st March 2018, two over-arching issues remained with me leaving Las Vegas and #HIMSS18: the central, recognized role of cybersecurity threats in healthcare, and the growing use of consumer-facing technologies for self- and virtual care. Eighteen days later, we all learned about Cambridge Analytica’s misuse of 50 million Americans’ social network data posted on Facebook. We who work in healthcare must pose the questions: going forward, how trusting will patients, consumers and caregivers be sharing their personal health information (PHI)? Will people connect dots between their Facebook lives – and their

If it’s true that “your ZIP code is more important than your genetic code,” you’d look for a job in 22046, buy a house there, and plant your roots. You’d find yourself in Falls Church, Virginia, named number one in the Healthiest Communities rankings of 500 U.S. towns. You can see a list of all of the communities here. The project is a collaboration between the Aetna Foundation and U.S. News & World Report, with help from the University of Missouri Center for Applied Research and Engagement Systems (CARES) and a team from the National Committee on Vital and Health

There’s a potential large obstacle that could prevent the full benefits of the current go-go, bullish forecasts for artificial intelligence (AI) to help make healthcare better: a decline in consumers’ willingness to share their personal data. Along with the overall erosion of peoples’ trust in government and other institutions comes this week’s revelations about Facebook, Cambridge Analytica, and the so-called Deep State. Three-fourths of Americans believe that some type of “Deep State” in the federal government exists, a new poll from Monmouth University published yesterday. I clipped the responses to three of the survey’s most relevant questions here. Not only

Girls Rule the World, Beyoncé has told us. But not when it comes to digital health…at least until 2018, as Fitbit has announced a woman-focused smartwatch called the Versa which is expected to hit the market in April 2018. The waterproof Versa will measure heart rate, do the usual fitness tracking metrics, and enable women to track their menstrual cycle. Fitbit has been quite clear that the device isn’t for conception or contraception. The watch will be priced at $199 at retail, a much lower price-point than the Apple Watch at $329. So here Fitbit also has an argument for

Nearly one-half of Americans experienced a personal data breach in the past three years, the third annual national cybersecurity survey found. Ensuring privacy and cybersecurity should become integrated into the healthcare industry’s consideration of a patient’s consumer experience. This makes sense, given that privacy and cybersecurity ranked the second highest priority to hospitals and healthcare providers polled in HIMSS 2018 Healthcare Leadership Survey. Providers put patient safety as #1. Appropriately, privacy and security were hot topics at HIMSS Annual Conference this year, in respond to providers’ demands for more education and concerns around the challenges. Let’s put these concerns in

            I greatly appreciated the opportunity today to attend a luncheon at the HX360 meeting which convened as part of the 2018 HIMSS Conference. The speaker at this event was Paul Krugman, who won the Nobel Prize for Economics 10 years ago and today is an iconic op-ed columnist at the New York Times And Distinguished Professor of Economics at the City University of New York (CUNY). I admit to being a bit of a groupie for Paul Krugman’s work. It tickles me to look at Rise Global’s list of the Top 100 Influential Economists:

“It’s not about shiny new technologies but about designing relationships to truly impact the patient at the center of the disconnected ecosystem,” asserted Amy Cueva, Founder and CXO of the design consultancy Mad*Pow. That patient is a consumer, a caregiver; it’s you and me, Cueva explained. To reconnect the fragmented pieces of healthcare delivery, Cueva said, mantra-style, “collaboration is the new innovation.” And collaboration with patients, caregivers — the people for whom that healthcare is aimed — is the optimal workflow for effectively, enchantingly designing healthcare. In a talk she delivered at the Innovation Summit in a preconference meet-up at the annual

On July 18, 2017, Neil Gomes, Chief Digital Officer at Thomas Jefferson University and Jefferson Health in Philadelphia, tweeted this: When I saw this tweet, I was especially struck by Gomes’s phrase, “Designed & developed with heart/love by my @DICEGRP.” That’s Jefferson’s health solutions group that focuses on digital innovation and consumer experience. Here’s a health system that’s focused on that customer experience, which has become a critical success factor for healthcare to thrive. That’s because, as Steve Laughlin, VP and General Manager of IBM’s Global Consumer Group recently explained to me, a consumer’s last great customer experience becomes the

“Health agencies will have to become at least as sophisticated as other consumer/retail industries in analyzing a variety of data that helps uncover root causes of human behavior,” Gartner recommended in 2017. That’s because “health” is not all pre-determined by our parent-given genetics. Health is determined by many factors in our own hands, and in forces around us: physical environment, built environment, and public policy. These are the social determinants of health, but knowing them even for the N of 1 patient isn’t quite enough to help the healthcare industry move the needle on outcomes and costs. We need to

Over four in 10 U.S. workers were enrolled in a high-deductible health plan in the first 9 months of 2017, according to the latest research published by the National Center for Health Statistics, part of the Centers for Disease Control in the U.S. Department of Health and Human Services. The report details Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-September 2017. About 28 million people were uninsured in the U.S. in 2017, about the same proportion as in 2016 — but nearly 20 million fewer than in 2010, as the line chart illustrates. The

Along with artificial intelligence, patient engagement feels like the new black in health care right now. Perhaps that’s because we’re just two weeks out from the annual HIMSS Conference which will convene thousands of health IT wonks, users and developers (I am the former), but I’ve received several reports this week speaking to health engagement and technology that are worth some trend-weaving. As my colleague-friends Gregg Masters of Health Innovation Media (@2healthguru) and John Moore of Chilmark Research (@john_chilmark)  challenged me on Twitter earlier this week: are we scaling sustained, real patient engagement and empowerment yet? Let’s dive into the

In 2020, national health expenditures (NHE) in the United States will exceed $4 trillion to cover 334.5 million Americans. That equates to 18.4% of the Gross Domestic Product (GDP) and $12,230.40 of health spending per person. I sat in on a press call today with researchers from the Office of the Actuary working in the Centers for Medicare and Medicaid Services (CMS) to review the annual forecast of the NHE, published in Health Affairs in a statistically-dense eleven page article titled, National Health Expenditure Projections, 2017-2026: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth. What are those “fundamentals” pushing up healthcare spending?

Stories about three fashion brands have me thinking about women and their health economics. Stay with me. Target unveiled its new line of clothing, Universal Thread, which features pieces that are accessible to women who may be dealing with physical limitations or sensory challenges. I first read about Universal Thread on The Mighty website, which is a community of over 1 million people interested in connecting on health and disabilities. As The Mighty described, the brand Universal Thread, “is centered around denim since it is a staple in many women’s wardrobes, but denim can be uncomfortable for many people with disabilities

Let’s change the conversation and put healthcare over  politics.  Sounds just right, doesn’t it? If you’re reading Health Populi, then you’re keen on health policy, health economics, most of all, patients: now playing starring roles as consumers, caregivers, and payors in their own care. Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), has assembled a diverse group of health care leaders who care about those patients/people, too, appropriately named the United States of Care. Founders include Dr. Bill Frist, former Republican U.S. Senator from Tennessee, Dave Durenberger, former Republican U.S. Senator from Minnesota, and

It’s February 1st, which marks the first of 28 days of American Heart  Month – a time to get real, embrace, learn about, and engage with heart health. Heart disease kills 610,000 people in the U.S. every year, equal to 1 in 4 deaths in America. It’s the leading cause of death for both men and women in the U.S. Knowing your blood pressure is an important step for managing the risks of heart disease. That hasn’t yet been available to those of us who quantify our steps, weight, sleep, food intake, and other health metrics. In 2017, Hugh Langley

Trust in the United States has declined to its lowest level since the Edelman Trust Barometer has conducted its annual survey among U.S. adults. Welcome to America in Crisis, as Edelman brands Brand USA in 2018. In the 2018 Edelman Trust Barometer, across the 28 nations polled, trust among the “informed public” in the U.S. “plunged,” as Edelman describes it, by 23 points to 45. The Trust Index in America is now #28 of 28 countries surveyed (that is, rock bottom), dropping below Russia and South Africa. “The public’s confidence in the traditional structures of American leadership is now fully

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

Two in five U.S. physicians feels burned out, according to the Medscape National Physician Burnout & Depression Report for 2018. This year, Medscape explicitly adds the condition of “depression” to its important study, and its title. In 2017, the Medscape report was about bias and burnout. Physicians involved in primary care specialties and critical care are especially at-risk for burnout, the study found. One in five OBGYNs experience both burnout and depression. Furthermore, there’s a big gender disparity when it comes to feeling burned out: nearly one-half of female physicians feel burnout compared with 38% of male doctors. Being employed by

On this day appreciating the legacy of Martin Luther King, Jr., I post a photo of him in my hometown of Detroit in 1963, giving a preliminary version of the “I Have a Dream” speech he would deliver two months later in Washington, DC. Wisdom from the speech: “But now more than ever before, America is forced to grapple with this problem, for the shape of the world today does not afford us the luxury of an anemic democracy. The price that this nation must pay for the continued oppression and exploitation of the Negro or any other minority group

We’re spending more time at CES 2018 calling out the societal and health impacts of technologies, especially for children and under-served people. How surprised and delighted I am to find a positive, enchanting impact at the convergence of kids and tech…from a duck. When I say “duck,” there are a few images that probably swim up in your mind’s eye: Donald, Daisy, Daffy, Howard, Darkwing, and the brand-famous Aflac Duck (who has his own Twitter handle @AflacDuck). It’s this last-named web-footed feathered friend who is a major star here at CES 2018 in the persona of My Special Aflac Duck.

Journalists and industry analysts from around the globe have come to Las Vegas which, this week, is the mecca for new-new electronic things that companies think consumers will be keen to buy. On media day 1, I spoke with a colleague from the Netherlands who covers audio, a sector that’s certainly in disruption; an automotive analyst from India covering autonomous vehicles; and, a mobile tech guru based in Dubai, to identify just a few of my media friends who have gathered here to research and write on their respective beats. In these conversations, there are some common buzzwords floating around

The pharmaceutical industry is facing a multitude of political, regulatory, and financial uncertainties in and beyond 2018. But there’s one thing I know for sure about pharma’s morphing business model: it’s that patients are playing a growing role in the industry’s future well-being. That is, if the industry can meet health consumers where they want to be met. Patients want more communication and support from pharma companies, a new study from Accenture found. In fact, over one-third of patients tell their health care providers about pharma patient-service programs: this chart from Accenture’s study illustrates the top seven ways providers hear

For this end-of-year post leading into 2018, I choose to address the big topic of how long we live in America, and what underpins the sobering fact that life expectancy is falling. Life expectancy in the United States declined to 78.6 years in 2016, placing America at number 37 on the list of 137 countries the World Economic Forum (WEF) has ranked in their annual Global Competitiveness Report 2017-2018. The first chart shows the declining years for Americans compared with health citizens of Australia, France, Canada, Finland, and the UK. While Australians’ and Britons’ life expectancies declined from 2015-16, their

As I am finalizing my schedule for meet-ups at CES in Las Vegas for early January 2018, I’m thinking about digital devices and wearable tech, connected cars, smart homes, and the Internet of Things through my all-health, all-the-time lens. My friends at TrendWatching write today about the automaker, Volkswagen, which has a division called MOIA started in 2016. VW, like most car manufacturers, is working on strategies to avoid being disrupted and made irrelevant as tectonic forces like autonomous cars and shared rides innovate and re-define the nature of personal transportation. MOIA is a brand and a self-described “social movement.”

Today’s FCC’s repeal of the net neutrality rules for internet service providers will have an impact on healthcare — in particular, the channeling of telehealth services. “The Federal Communication Commission overturned a two-year-old set of rules passed during the Obama administration to protect consumers against bad behavior from their Internet service providers, overriding protests from consumer groups and Internet companies,” USA Today wrote just after the ruling. The concern from advocates to keep net neutrality is that the large ISPs — AT&T, Comcast, and Verizon, among them — could be so-called “bad actors” in favoring fast-lane communications for certain content versus

This month, two hospital mega-mergers were announced between Ascension and Providence, two of the nation’s largest hospital groups; and, between CHI and Dignity Health. In terms of size, the CHI and Dignity combination would create a larger company than McDonald’s or Macy’s in terms of projected $28 bn of revenue. (Use the chart of America’s top systems to do the math). For context, other hospital stories this week discuss in southern New Jersey. And this week, the New Jersey Hospital Association annual report called the hospital industry the “$23.4 billion economic bedrock” of the state. Add a third important item

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal is valued at $69 billion. I wrote about this inflection point for U.S. healthcare four weeks ago here in Health Populi. CVS is both the biggest pharmacy and pharmacy benefit manager in the U.S., as the first chart shows. In my previous post, I talked about the value of vertical integration bringing together the building blocks of retail pharmacy and pharmacist care, retail clinics, the PBM (Caremark), along with Aetna’s health plan member base and business. As Amazon and other

Nearly one-half of Americans are challenged by low financial well-being. Compared to emotional/mental, job/career, social, physical, and financial, it’s this last lens on personal health that gets the lowest ratings for the largest number of Americans. The second most worrying factor diminishing well-being is a tie between physical health and social health. Welcome to The uncomfortable reality of financial wellbeing, a report on the 2017 Financial Mindset Study Highlights from Alight Solutions, an HR services company. The first chart arrays the well-being rankings across the five factors, showing that just over one-half of Americans have more positive views on their emotional

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness. We each have our stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma. Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” bit unwanted, futile care. When you’re

To pay for tax cuts, take money from foreign aid if you must, 1 in 2 Americans say. But do not touch my Medicaid, Medicare, or Social Security, insist the majority of U.S. adults gauged by the November 2017 Kaiser Health Tracking Poll. This month’s survey looks at Americans’ priorities for President Trump and the Congress in light of the GOP tax reforms emerging from Capitol Hill. While reforming taxes is considered a top priority for the President and Congress by 3 in 10 people, two healthcare policy issues are more important to U.S. adults: first, 62% of U.S. adults

Yesterday, the FDA approved a “digital ingestion tracking system,” the first drug in the U.S. that has an ingestible (in other words, safely edible) sensor built into the pill. That sensor tracks that the medication was taken, which helps with adherence, meant to help ensure that patients who are prescribed the medicine do indeed take the regimen as prescribed. Once ingested, the sensor in the pill communicates to a wearable patch on the patient that then communicates information to a mobile health app that tracks the pill-taking via smartphone. Patients can allow their family and clinicians access to that information

Above the economy, trust in government, crime, war, terrorism, and taxes, health care is the top cause of stress in America. For ten years, the American Psychological Association has gauged Americans’ collective mood in their ongoing study, Stress in America. The latest report is The State of Our Nation, published this month, finding that we’re at the “lowest point in our nation’s history” according to 59% of Americans. The 2016 national election in the U.S. raised the stress-stakes, when APA released a stress study we discussed here in Health Populi. The election season was a source of stress for 52%

The evidence of the value of digital health tools is growing, based on research published in The Growing Value of Digital Health, from the IQVIA Institute for Human Data Science. With this report, the IMS Institute ushers in the organization’s new name, IQVIA Institute (THINK: “I” for “IMS,” and “Q” for “Quintiles). This is the organization’s third report on digital health, following the original analysis from 2013, updated in 2015. Here’s my take on the 2013 report, which found that 36 mobile health apps represented one-half of all downloads. On a conference call held last week, the company’s SVP and Executive

  A response to Amazon’s potential moves in healthcare and pharmacy…strategic positioning for the post-Trump healthcare landscape…vertical integration to better manage healthcare utilization and costs…these, and other rationale have been offered by industry analysts and observers of the discussions between CVS and Aetna, for the former to acquire the latter. “A pharmacy chain buying a health insurance company?” many have asked me over the past few days. These inquiring minds include people who work both inside and outside of health/care. I ask back: in 2017 and in the future, “What is a pharmacy? What is a health plan?” See the

“With Mad Men still in charge, ad campaigns miss the mark,” an editorial published this week in the Financial Times asserts. Leave it to a fiscally conservative British publication to be spot-on about a particularly, but not uniquely, American challenge, in this post-Weinstein (Miramax), -Price (Amazon), and today, -Halperin (MSNBC) moment of sexual harassment revelations. In health/care, women are key consumers, buyers and influencers, yet under-represented in the Mad Men demographic of senior advertising executives, as the data-driven FT essay points out. So it’s especially heartening to find this month a few examples of empowering, inspiring ad campaigns getting health/care marketing

THINK: money and love. To find health, working-aged people seek financial stability and good relationships, according to the Consumer Health POV Report from Welltok, meQuilibrium, and Zipongo, featured in their webinar broadcast today. The online consumer survey was conducted among 2,000 full-time working U.S. adults in August 2017, segmented roughly into thirds by Boomers (37%), Gen Xers (32%), and Millennials (31%). Much lower down the priority list for healthy living are managing food, sleep, and stress based on the poll. Feeling stress is universal across most consumers in each of the three generational cohorts, especially related to work and finance.

Old-age inequality among current retirees in the U.S. is already greater than in ever OECD country except Chile and Mexico, revealed in Preventing Ageing Unequally from the OECD. Key findings from the report are that: Inequalities in education, health, employment and income start building up from early ages At all ages, people in bad health work less and earn less. Over a career, bad health reduces lifetime earnings of low-educated men by 33%, while the loss is only 17% for highly-educated men Gender inequality in old age, however, is likely to remain substantial: annual pension payments to the over-65s today are