A blog covering the health/care ecosystem and people.

“ACOs most assuredly will not…deliver the disruptive innovation that the U.S. health-care system urgently needs,” wrote Clay Christensen, godfather of disruptive innovation, et. al., in an op-ed in the Wall Street Journal of February18, 2013. In the opinion piece, Christensen and colleagues make the argument that Accountable Care Organizations (ACOs) as initially conceived won’t address several key underlying forces that keep the U.S. health care industry in stasis: Physicians’ behavior will have to change to drive cost-reduction. Clinicians will need “re-education,” the authors say, adopting evidence-based medicine and operating in lower-cost milieus. Patients’ behavior will have to change. This requires

4 in 10 Americans got flu shots in this epidemic season, and most of these didn’t receive their immunization in their doctor’s office. The Flu Vaccination Survey from Ipsos Public Affairs, conducted in January 2013, paints a picture of U.S. health consumers who are project managing their personal approaches to preventing the flu in this historically hard-hitting flu season. The most expressed demand for flu shots has been among people 55 and over, one-half of whom have received vaccinations, with the lowest use been in the 25-35 year age group. Geographically, the most covered health citizens live in New England

The use of retail and work-site health clinics is up, and their consumers skew young. Overall, 27% of all U.S. adults have stepped into a walk-in clinic in the past two years. But only 15% of people 65 and over have used such a clinic. This begs the question: are retail and on-site clinics at the workplace filling the role of medical homes for younger adult Americans? The Harris Interactive/HealthDay poll published in January 2013 discovered that use of retail clinics grew from 7% in 2008 to 27% in 2012. The largest age cohort using walk-in clinics is people between

People enrolled in consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs) are more cost-conscious than those enrolled in more traditional plans, according to Findings from the 2012 EBRI/MGA Consumer Engagement in Health Care Survey from the Employee Benefit Research Institute (EBRI), published in December 2012. The logic behind CDHPs and HDHPs is that if health plan enrollees have more “skin in the game” — that is, personal financial exposure — they’ll behave more like health “consumers.” By 2012, 36% of employers with over 500 employees offered either HRA- or HSA-eligible plans. About 15% of working age adults are enrolled

In the wake of Hurricane Sandy, there are strange bedfellows coming together this week. First strange bedfellow moment for me this week was the video of Governor Chris Christie and President Barak Obama embracing and working together in storm-turn New Jersey yesterday. Saints be praised! to see a Republican and Democrat coming together, working together, consoling citizens together. In health care this week, another welcome strange bedfellow event is the statement issued by Catalyst for Payment Reform (CPR), an advocacy group of business, labor unions (notably, the AFL-CIO), and consumer advocates promoting broadly available information for consumers about the price and quality

4 in 5 health consumers expect doctors not only to treat them when they’re sick, but to keep them healthy. “In sickness and in health” now morphs over to the doctor-patient relationship, beyond the marriage vow. Better Health through Better Patient Communications, a survey from Varolii, finds that people are looking for health, beyond health care, from their physicians. Varolii is a customer interaction company that claims to have interacted with 1 in 3 Americans through some sort of company communication: they work with major Fortune 1000 companies, including banks, airlines, retail, and, yes, health care. They recently attracted  a

Employee benefits make up one-third of employers’ investments in workers, and companies are looking for positive ROI on that spend. Health benefits are the largest component of that spending, and are a major cost-management focus. In 2012 and beyond, wellness is taking center stage as part of employers’ total benefits strategies. In the 2012 Wellness & Benefits Administration Benchmarking study, a new report from bswift, a benefits administration company, the vast majority of large employers (defined as those with over 500 workers) are sponsoring wellness programs, extending them to dependents as well as active workers. Increasingly, sticks accompany carrots for

With the stunning Supreme Court 5-4 majority decision to uphold the Patient Protection and Affordable Care Act (ACA), there’s a Roberts’ Rules of (Health Reform) Order that calls for liberating primary care beyond the doctors’ office. That’s because a strategic underpinning of the ACA is akin to President Herbert Hoover’s proverbial “chicken in every pot:” for President Obama, the pronouncement is something like, “a medical home for every American.” But insurance for all doesn’t equate to access: because 32-some million U.S. health citizens buy into health insurance plans doesn’t guarantee every one of them access to a doctor. There’s a

Skype and videoconferencing have surpassed the tipping point of consumer adoption. Grandparents Skype with grandchildren living far, far away. Soldiers converse daily with families from Afghanistan and Iraq war theatres. Workers streamline telecommuting by videoconferencing with colleagues in geographically distributed offices. In the era of DIY’ing all aspects of life, more health citizens are taking to DIY’ing health — and, increasingly, looking beyond physical health for convenient access to mental and behavioral health services. The Online Couch: Mental Health Care on the Web is my latest paper for the California HealthCare Foundation. Among a range of emerging tech-enabled mental health

  One-third of employers will increase investments in wellness programs in 2013. Employers look to these programs to reduce health care costs, to create a culture of health, to improve workforce productivity, and to enhance employee engagement. Workers say wellness programs are important in their choice of employer. But while employers and employee chasm agree on that point, there’s a gap between how employers see the programs’ benefits, and how aware (or unaware) employees are. Call this a Wellness Literacy Gap, akin to health literacy and health plan literacy. Over one-half of employers believe employees understand the programs they offer,

Transparency, data-based pharmacy decisions, incentivizing patient behavior, and outcomes-based payments will reshape the environment for marketing pharmaceutical drugs in and beyond 2012. Two reports published this week, from Express Scripts–Medco and PwC, explain these forces, which will severely challenge Pharma’s mood of market ennui. Express-Scripts Medco’s report on 9 Leading Trends in Rx Plan Management presents findings from a survey of 318 pharmacy benefit decision makers in public and private sector organizations. About one-half of the respondents represented smaller organizations with fewer than 5,000 employees; about 20% represented jumbo companies with over 25,000 workers. The survey was conducted in the

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA. In enabling mobile physician visits, American Well and Consult A Doctor join Myca, which has offered mobile phone-based visits for clients for at least two years to employer clinic customers. In April 2010, my report, How Smartphones Are Changing Healthcare for Consumers and Providers, talked about Myca’s work with Qualcomm: the telecomms company armed traveling employees with mobile phones that could connect

Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative

There’s intriguing fine print in the latest CBO analysis on the impact of the Affordable Care Act (ACA) on employer-sponsored health insurance in the U.S. CBO finds there will be 3 to 5 million working Americans without employer-sponsored health insurance due to the implementation of the ACA, according to the report, CBO and JCT’s Estimates of the Effects of the Affordable Care Act (ACA) on the Number of People Obtaining Employment-Based Health Insurance. Originally, the CBO and Joint Committee on Taxation (JCT) estimated that the number of people obtaining health insurance coverage through their employer would be 3 million people lower in 2019 under

Most U.S. companies will increase the dollar value of health incentives offered to workers in 2012, based on the annual survey from Fidelity Investments and the National Business Group on Health addressing employers’ plans for health benefits. 3 in 4 employers used incentives in 2011 to engage employees in wellness programs, with an average incentive value of $460. This number was $260 in 2009. The poll found that employers expect employees to improve their personal health, and will increasingly ration access to benefits based on employees’ engagement with health criteria. Employers’ approaches to incentives have begun to adopt value-based benefit design strategies that

Over 20% of U.S. families had problems paying medical bills in 2010 — about the same proportion as in 2007. The Center for Studying Health System Change found this datapoint “surprising,” given the Great Recession of 2008 that lingers into 2012. However, HSC points out that the leveling of medical bill problems may be a “byproduct” of reduced medical care utilization; in Health Populi-speak, self-rationing of health care. In the Tracking Report, Medical Bill Problems Steady for U.S. Families, 2007-2010, HSC analyzed data from the 2010 Health Tracking Household Survey and discovered that since 2003, the proportion of families facing problems with medical debt

The vast majority of employers who sponsor health benefits look at those benefits as part of a larger organization culture of health. While one-third are adopting value-based health plan strategies — doubling from 16% in 2010 to 37% in 2011 — only 3% of employers are taking an integrated view of value-based benefits and corporate wellness. This is the second year for the International Foundation of Employee Benefit Plans (IFEBP) and Pfizer to examine employers’ approaches to value-based health care (VBHC). As explained by Michael Porter, the guru on health value chains, value in health care focuses on the patient at

The signs of the primary care crisis in America are visible: A growing number of visits to the emergency room for treating commonplace ailments Waiting lists for signing up with and queuing lines to see primary care doctors Fewer med students entering primary care disciplines Maldistribution of primary care practitioners (PCPs) in underserved areas, rural, exurban and urban. The implementation of the Affordable Care Act will (try to) enroll at least 30 million newly-insured health citizens into the U.S. health system. That’s the objective: whether being insured will actually provide people access to needed primary care is a big question given the current supply of

Walmart is increasing premium sharing costs for employees subscribing to health insurance, and cutting the benefit for part-timers. Quoted in the New York Times, a company rep said, “over the last few years, we’ve all seen our health care rates increase and it’s probably not a surprise that this year will be no different. We made the difficult decision to raise rates that will affect our associates’ medical costs.” In so doing, Walmart told the Times that they will, “strike a balance between managing costs and providing quality care and coverage.” MarketWatch wrote that Walmart will increase health care premium costs

With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011. Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context, The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350 The car buyer could purchase a Mini-Cooper with $20,000 The investor could invest $20K to yield $265,353 at a 9% return-on-investment. The MMI increased 7.3% between 2010 and 2011, about the same

The traditional venues for retail health are found in pharmacies, grocery chains, and on the ground floor storefronts in hospitals. Joining these bricks-based models are digital, online health ventures that are expanding the definition and space of retail health. This week, two announcements illustrate this phenomenon, from American Well and Active Doctors. American Well, which launched in 2008, is an online physician consultation service in the U.S. that has successfully worked with health plans to channel consults to patients in Hawaii, Minnesota, and New York, among other local programs. Last year, American Well went live with the Rite Aid pharmacy chain in Pennsylvania. This week, American

“If nothing else, the health reform bill has signaled the beginning of the end of the health plan as we know and love it,” David Brailer, once health IT czar under President GW Bush and now venture capitalist, is quoted in Reuters on Hot Healthcare Investing Trends for 2011. One health plan Brailer called out that could be relevant in the post-reform, post-recessionary US health world is Humana. I had the opportunity to spend time with Paul Kusserow, Chief Strategy Officer for Humana, during the HIMSS11 meeting. Our conversation began with me asking why the chief strategist for Humana would

“Employers and health insurers, through benefit design and medical management, are now playing a larger role in curbing use of healthcare services….spurring a more permanent cultural shift in consumer behavior,” Moody’s writes in a special comment dated February 16, 2011. “This will continue to constrain healthcare demand even as the economy recovers.” The chart illustrates one of the main reasons for the so-called “constrained healthcare demand:” increasing costs on health consumers. Look at the slope of the line on average out-of-pocket maximum costs for an employee receiving health insurance at work: the raw number grew from $2,742 in 2008 to

Affluent Baby Boomers in the U.S. foresee a retirement with a more active lifestyle, with a better standard of living and engagement in work. 1 in 4 see continuing their education or learning a new trade, and 1 in 5 anticipate starting or furthering their business. These aspirations are tempered with many financial concerns — top among them being rising health care costs and expenses (a concern for 2 in 3 affluent Boomers), and ensuring that retirement assets will last throughout their lifetime (a worry among 1 in 2 Boomers). Merrill Lynch surveyed affluent U.S. adults on their retirement concerns

1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform. Employers’ perspectives on the Affordable Care Act/health reform are mixed, according to a survey conducted by the Midwest Business Group on Health, co-sponsored by the National Business Coalition on Health, Business Insurance and Workforce Management. Not surprisingly, these views vary by whether the firm is large (>500 employees) or small. More large employers support the creation of Health Insurance Exchanges and would expand wellness services;

3 in 4 American workers who receive health insurance at the workplace have been impacted by increasing health care costs. As a result, more are self-rationing health care; this is taking many forms, including delaying visits to the doctor, skipping a recommended visit, and not filling prescriptions written by the doctor. Most concerning is that the 14% drop in the percent of employees trying to take better care of themselves in the past year, according to Employee Perspectives on Health Care: The Affordability Gap, from Towers Watson. As health costs rise, employee satisfaction is falling — this is particularly true

Since 2000, American workers’ contributions to health insurance premiums more than doubled, to nearly $4,000 a year from $1,619 ten years earlier. The total premium going to health insurance per worker for family coverage is $13,770 in 2010, with nearly $10,000 being borne by the employer. Workers’ share of premium increased 147%, and employers’ grew 114%. The Kaiser Family Foundation/Health Research & Educational Trust’s (KFF/HRET) annual 2010 Employer Health Benefits survey tells the story of health insurance costs that continue to grow, the rates of which depend on the type of health insurance purchased. For example, workers in high-deductible health plans saw

Large employers expect health care costs to increase by 8.9% in 2011, up from 7.0% in 2011. To stem cost increases, employers will adopt an array of tactics, most prominently offering consumer-directed health plans (CDHPs) and expanding wellness programs that encourage incentives to healthy lifestyles. These expectations come from Large Employers’ 2011 Health Plan Design Changes, a survey report from the National Business Group on Health poll of large employers. 1 in 5 employers say CDHPs are the most effective approach for managing health care cost growth, as shown in the chart. 61% of employers will off CDHPs in 2011, 20% of whom will

As the recession continues to negatively impact U.S. business, employers are tightly managing benefits across-the-line, from health to housing and travel categories. Benefits overall are experiencing a downward trend versus 5 years ago. In the health arena, benefits that show staying power include wellness resources (covered by 75% of employers), on-site flu vaccinations (68%), wellness programs (59%), and 24-hour nurse lines (59%). On the downside, benefit programs that are expected to erode in the next 12 months are prescription drug coverage, dental insurance mail-order drug programs, and chiropractic coverage, among others shown in the chart. The Society for Human Resource

61% of American health citizens have difficulty paying for health insurance when they go out on the open market to purchase it as individual customers.  A survey from the Kaiser Family Foundation (KFF) finds that most people in the U.S. who go for health insurance on their own have trouble paying for it. 14 million people in the U.S. aren’t covered by employers and seek so-called non-group or individual health insurance policies. Premium increases for these policies averaged 20% in early 2010. Nearly 1/2 of these people are self-employed or work in small business. The average out-of-pocket health spending for

Medical costs will increase by 9% in 2011, a mere 0.5% less than 2010 cost growth. The fastest-growing components will be inpatient and outpatient costs, shown in the pie chart. 81% of premium costs are bound up in provider costs for hospitals and physicians — the two most significant factors of medical inflation. And Americans will bear even more medical costs, out-of-pocket (OOP), in 2011 in the form of greater coinsurance and deductibles. Behind the numbers: Medical cost trends to 2011 looks into employers’ crystal balls on health benefits for 2011. PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to

The growth of consumer-directed health plans (CDHPs) continues as employers look for ways to rationalize their health spending in the midst of annual double-digit health cost increases. By 2015, 61% of large employers will off CDHPs. Overall, 45% of employers think they’ll be offering CDHPs in five years. These data were found through the Mercer National Survey of Employer-Sponsored Health Plans, sponsored by the American Association of Preferred Provider Organizations (AAPPO), published in April 2010. In 2009, 15% of all employers offered a CDHP: this grew from 10% in 2008. 18% of employers are likely to offer a CDHP this

Inflation in the U.S. fell by 0.4% in 2009, the first such annual decline in the Consumer Price Index since 1955. At the same time, health care costs for American employers grew 7.3% per capita in 2009. As the chart health spending increased nearly 5%, with employers’ costs increasing even more quickly over the year. This was especially twice-as-onerous for small and mid-sized companies whose costs grew much faster than for larger companies, whose rate of increase actually fell in the year. These sobering statistics were calculated by Thomson Reuters and published in Helathcare Costs Rise More Than 7 Percent

While the stock market and companies’ profitability improves, much of that has been done on the backs of employees: through reductions in force and job cuts, and re-working of benefits. Health benefits are a prime target for cost management as companies try to survive through the long recovery. Combined with insurance companies’ cost increases (most notably and recently Anthem’s announcement of up-to-39% increases in premium costs), employers who choose to continue to provide health insurance to employers are in a bind. According to the 15th annual survey from National Business Group on Health/Towers Watson, employers faced cost increases of 7%

So much for America’s ability to manage health care costs without health reform: health costs will increase in the double-digits this year, according to Buck Consultants‘ 21st National Health Care Trend Survey. This annual survey monitors medical trend — the factors that drive cost increases. These include inflation, service utilization, technology, adding new programs, changes in service mix, and benefit mandates. The chart illustrates that medical trend varies across plans — but not my much. High-deductible consumer-driven health plans expect growth of 10.4%: hardly a significantly lower rate of growth than for the most open, rich plans (PPO, POS). Buck

Rosie the Riveter reminds us to Honor Labor. In that vein, with the Labor Day holiday upon us, this post assembles data to paint the latest picture of health insurance and the American worker in 2009…  Workscape’s Annual Benefits Study for 2009 found that employees have a heightened appreciation of benefits. The declining economy clearly has increased awareness and appreciation of workplace benefits.  Trends In Underinsurance And The Affordability Of Employer Coverage, 2004-2007, in Health Affairs online, found eroding health insurance coverage among employers who continued to provide insurance, and further moves for employees to have more financial “skin in

Every 1 additional prescription per 100 that is filled with a generic Rx in the Rochester NY region yields $82 million in annual cost savings to the community: specifically, to employers, consumers and health plans. The Blue Cross Blue Shield Association presented findings from a survey and featured best practices from member plans in a webinar, “Generic Drugs Can Be Good for Your Health and Your Wallet.” Blues Plans believe that implementing generic drug programs can help Americans access drugs at an affordable cost. In BCBSA’s health reform recommendations, Pathway to Covering America, there are 5 key points: four are

Because of high premiums, only 9 percent of unemployed workers have COBRA coverage. Maintaining Health Insurance During a Recession: Likely COBRA Eligibility, a study from The Commonwealth Fund (CMWF), clarifies how COBRA is actually used by unemployed people in the U.S. CMWF calculates that: – Two of three working adults are eligible to buy into COBRA under the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) if they became unemployed. – Under COBRA, workers pay 4 to 6 times their current premium for health benefits. – Thus, only 9 percent of unemployed workers have COBRA coverage due to the high price

The U.S. employer sponsored health system is experiencing some bipolar behavior: there is a cadre of large employers who want to continue sponsoring health benefits as part of overall compensation. But, for at least one in 3 employers, most would not be willing to pay $50 per member per month to cover health for an employee.   According to Mercer‘s survey of employers released October 21st, 2008, What Price Universal Health Coverage?, the rejoinder is: any price is too high.   4 in 10 employers say the main reason they do not offer health coverage is simply that they cannot

If employers got their collective hands on Aladdin’s lamp, they’d wish for: Increased employee accountability Reduced health risks Tailored health management programs that account for risk Health data and measurement tools that feed into analytics and outcomes measures, and Integrated and well-managed benefits and programs. These wishes are brought to you by Hewitt Associates’ 2008 survey, The Road Ahead: Driving Productivity by Investing in Health.   38% of employers plan to develop strategies for employee health and productivity in the next 1 to 2 years; 21% plan to do so within 3 to 5 years. 1 in 5 (19%) aren’t

$15,609 could cover a lot of household needs for the average American family in the course of a year: utilities, mortgage, gas tank fills.   It’s also the cost of health care to cover a family of four in 2008.   Milliman notes that the average annual medical cost for a family of four increased by 7.6% from 2007 to 2008. This rate of increase is lower than the 8.4% average annual increase between 2003-2007; however, the burden of overall expense is “steadily shifting to employees,” Milliman attests.   Health spending splits into five components, as the Milliman Medical Index

For those employees fortunate enough to receive health insurance from work, there’s a bountiful array of health care services that are still covered by plans. The International Foundation of Employee Benefit Plans (IFEBP) polled its membership in late 2007 and found that employers are not only continuing to cover a broad range of services, but also new services the likes of which weren’t covered even two years ago…from medical tourism to biofeedback. These results are documented in IFEBP’s publication, Health Care Benefits: Eligibility, Coverage and Exclusions. The usual suspects are covered by well over 97% of employers, such as ER

The UAW and GM have been debating health care as Friday’s deadline for their national contract approaches. This round of negotiation is about survival. Yesterday, I covered the rising costs of employer-sponsored health insurance. Today, let’s visit the intimately-related topic of retiree health benefits. These are eroding even faster than health benefits for employed workers. Many employers have significantly scaled back health benefits for retirees. Currently, one in three large employers offers retire benefits, compared with two in three in the late 1980s. Consider the predicament of the company ranked #3 on the 2006 Fortune 500 list, General Motors. Retirees