A blog covering the health/care ecosystem and people.

Medical costs in America are still the top contributor to personal bankruptcy in the U.S., a risk factor in two-thirds of bankruptcies filed between 2013 and 2016. That’s a sad fiscal fact, especially as more Americans gained access to health insurance under the Affordable Care Act, according to a study published this month in the American Journal of Public Health (AJPA). Between 2013 and 2016, about 530,000 bankruptcies were filed among U.S. families each year associated with medical reasons, illustrated in Table 1 from the study. The report, Medical Bankruptcy: Still Common Despite the Affordable Care Act, updates research from 2007 which

“Patients as Consumers” is the theme of the Health Affairs issue for March 2019. Research published in this trustworthy health policy publication covers a wide range of perspectives, including the promise of patients’ engagement with data to drive health outcomes, citizen science and participatory research where patients crowdsource cures, the results of financial incentives in value-based plans to drive health care “shopping” and decision making, and ultimately, whether the concept of patients-as-consumers is useful or even appropriate. Health care consumerism is a central focus in my work, and so it’s no surprise that I’ve consumed every bit of this publication. [In

“Is it possible to take personalization too far for consumers?” asks a paper on Privacy and Personalization from SmarterHQ. The answer is, “it depends.” Consumers are sending mixed messages to marketers about their preferences for being forgotten versus being engaged and recognized. This tension has extreme relevance for personal health and healthcare, as AI and data analytics become quickly adopted by payors, insurance companies, providers, pharma, and consumer tech companies that lie outside of HIPAA privacy and security regulations. SmarterHQ polled over 1,000 consumers and found that: Most consumers are concerned about their data privacy, and believe that companies know too

As more of our “things” get digitally connected, there’s an unanswered question about how our connected lives impact human life and health. A new report from the OECD asks and answers: How’s Life in the Digital Age? Opportunities and Risks of the Digital Transformation for People’s Well-being. This research is part of OECD’s ongoing series asking the Big Question, “How’s Life?” A prevailing current mantra in work and daily living is “digital transformation.” The OECD broadly defined the phrase in their 2017 paper on the topic as follows: Mobility, cloud computing, the Internet of things (IoT), artificial intelligence (AI) and big

What industry compels its “consumers” to wait longer and travel further for services more than any other in a person’s daily life? That would be health care, a report from Altarum notes. People travel further and wait longer for medical services than for veterinary care (second in this line-up), auto repair, banking, and household services. The annual opportunity cost for travel and wait time in health care is $89 billion, Altarum estimated. For the average person, that translates to 34 minutes of travel time and 11 minutes waiting time at the provider’s office. In terms of personal opportunity costs, Altarum gauged the

National health spending in the U.S. is expected to grow by 5.7% every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth, published yesterday by Health Affairs. For context, note that general price inflation in the U.S. was 1.6% for the 12 months ending January 2019 according to the U.S. Bureau of Labor Statistics. This growth rate for health care costs exceeds every period measured since the high of 7.2% recorded in 1990-2007. The bar chart illustrates the

Seeking health information online along with researching other patients’ perspectives on doctors are now as common as booking dinner reservations and reading restaurant reviews, based on Rock Health’s latest health consumer survey, Beyond Wellness for the Healthy: Digital Health Consumer Adoption 2018. Rock Health has gauged consumes’ digital health adoption fo a few years, showing year-on-year growth for “Googling” health information, seeking peer patients’ physician and hospital reviews, tracking activity, donning wearable tech, and engaging in live telehealth consultations with providers, as the first chart shows. The growth of tracking and wearable tech is moving toward more medical applications beyond fitness

“The promise of AI is undeniable…could AI help clinicians deliver better and more humanistic care?” This question is asked and answered in a JAMA viewpoint published January 1/8 2019 titled, Humanizing Artificial Intelligence. This theme motivated a conversation held over a dinner convened by Philips hosted by Frans Van Houten this week at HIMSS19. To provide context Geoff Colvin, Fortune‘s Senior Editor, first talked about taking friction out of industries, as Lyft and Uber have done in the transport sector. “Taking friction out of industries challenges and changes business models,” Geoff noted. With Uber’s IPO valuation approaching $100 billion, I’d say that’s

Most patient visits to doctors result in a prescription written for a medicine that people retrieve from a pharmacy, whether retail in the local community or via mail order for a maintenance drug. This one transaction generates a lot of data points, which individually have a lot of importance for the individual patient. Mashed with other patients’, prescription drug utilization data can combine with more data to be used for population health, cost-effectiveness, and other constructive research pursuits. At HIMSS19, there’s an entire day devoted to a Pharma Forum on Tuesday 12 February, focusing on pharma-provider-payor collaborations. Allocating a full

Talk to me, patients are demanding in unison. Most health consumers expect providers to communicate about routine health care and prevention; this is especially true among those patients trying to manage chronic conditions we learn from 10 Ways to Fulfill Patients’ Communication Wish List, a report based on a consumer survey from West, the communications and network infrastructure company. Four in five patients say that talking to “me” means they want personalized recommendations to their unique needs – but only one-third of patients say they’re getting that level of service from their healthcare providers. Most health consumers expect providers to communicate about

Most consumers would be willing to try an FDA-approved app or online to treat a medical condition, as well as receiving hospital care at home if would be less costly. We’ve reached an inflection point on the demand side among consumers for digital health options, PwC suggests in their report on the New Health Economy coming of age. The report outlines health/care industry issues for 2019, with a strong focus on digital health. Whether a menu of care options including virtual health to access specialists across the U.S., post-hospital virtual visits, or hospital care at-home, a majority of Americans supports

Today, as Congress kicks off hearings about the cost of prescription drugs in the United States, IQVIA published its 2019 report on The Global Use of Medicine in 2019 and Outlook to 2023. The top-line of the research is the robust pharma market growth will be driven by two factors, and limited by two others: spending in the U.S. and emerging markets (coined “pharmerging” by IQVIA) will push up spending, while limiting factors on growth will be increasing generics and expiration of brand patents. The U.S. will continue to be the number 1 prescription drug spender in the world to

Have you read the life changing magic of tidying up, or Spark Joy, books by Marie Kondo? Her new Netflix series, Tidying Up with Marie Kondo debuted on January 1, and has enjoyed passionate early viewership by consumers in America who are among the world’s major hoarders. If you opened any pop culture magazine or newspaper in the past week, you probably saw the results of a PR blitz promoting KonMari, the trademarked name for Marie’s clean-out method. As an example, the Wall Street Journal discussed the phenomenon in Ben Zimmer’s profile, “A Guru of Organizing Becomes A Verb” published this weekend

I’m glad to be getting back to health economic issues after spending the last couple of weeks firmly focused on consumers, digital health technologies and CES 2019. There’s a lot for me to address concerning health care costs based on news and research published over the past couple of weeks. We’ll start with the centerpiece that will provide the overall context for this post: that’s the ongoing research of Gerard Anderson and colleagues under the title, It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt. It is bittersweet to

According to the Cambridge Dictionary, a “caveat” is, “a warning to consider something before doing anything more.” It is fitting that CES is held in Las Vegas, land of high risk and, with a lot of luck, reward. With that theme in mind, I depart LAS airport tonight on an aptly-named red-eye flight back home after spending an entire week here. I’m pondering not what I saw — some of which I covered daily over the past week — but what I didn’t see. Consider these the caveats for health/care at #CES2019. In no particular order… Where was the Chairman of

All health/care is retail now in America. I say this as most people in the U.S. who have health insurance must take on a deductible of some amount, which compels that insured individual to spend the first dollar on medical services up until they meet their financial commitment. At that point, health insurance kicks in, and then the insured may have to spend additional funds on co-payments for general medicines and services, and coinsurance for specialty drugs like injectables and high-cost new therapies. The patient is a consumer is a payor, I asserted today during my talk on the expanding

Self-care is the new health care as patients, now consumers at greater financial risk for medical spending, are learning. At #CES2019, I’m on the lookout for digital technologies that can help people adopt and sustain healthy behaviors that can help consumers save money on medical care and enhance quality of life-years. This week’s heart-and-food tech announcements at #CES2019 coincide with an FDA recall on a popular drug prescribed to treat hypertension (high blood pressure). Using food and tech as medicine can help people avoid going on medications like statins and others for heart health. An important example of this self-care

If I’m going to spend a week someplace, it usually has to be Italy. So next week in Las Vegas, I’ll deal with that bias by staying at the Venetian Hotel for the entire week to cover all-things-health at CES 2019, the annual convening of electronics retailers and enthusiasts. Most of the 180,000+ folks come to Vegas from over 150 countries to kick the proverbial tires on TVs, autos, games, virtual reality, 3-D printing, drones, and other shiny new things. For me, for the past eight years, CES means consumer-facing health in a person’s hands, on her phone, and increasingly

Today is Boxing Day and St. Stephens Day for people who celebrate Christmas, so I share this post as a holiday gift with well-wishes for you and those you love. The tea leaves have been brewing here at THINK-Health as we prepared our 2019 forecast at the convergence of consumers, health, and technology. Here’s our trend-weaving of 4 C’s for 2019: costs, consumerism, cyber and care, everywhere… Health care costs will continue to be a mainstream pocketbook issue for patients and caregivers, with consequences for payors, suppliers and ultimately, policymakers. Legislators inside the DC Beltway will be challenged by the

It would not be surprising to know that when the Great Recession hit the U.S. in 2008, one in three Americans delayed medical treatment due to costs. Ten years later, as media headlines and the President boast an improved American economy, the same proportion of people are self-rationing healthcare due to cost. That percentage of people who delay medical cost based on the expense has remained stable since 2006: between 29 and 31 percent of Americans have self-rationed care due to cost for over a decade. And, 19% of U.S. adults, roughly one-in-five people who are sick and dealing with

As the CVS + Aetna merger crosses its last regulatory hurdle at the close of 2018, we enter 2019 facing a fast-growing and -morphing retail health landscape. I brainstormed retail health yesterday with Patrick Freuler, CEO of Audicus (developer of hearing aids sold direct-to-consumer over-the-counter) and Shai Gozani, CEO of NeuroMetrix, maker of the Quell device for pain management. The three of us will be on a panel addressing retail health disruption at CES 2019 on 9th January 2019 at the Digital Health Summit. I explained to Shai what I’m going to say in my talk about retail health at

From culture to travel, food and drink to retail and beauty, health will be baked into consumer goods and experiences in 2019. Welcome to The Future 100: 2019 from The Innovation Group at JWT. In the 100 emerging trends across ten categories, the future is clearly health-driven, according to the tea-leaf readers at JWT.a Health is all over, Culture Tech and innovation Travel and hospitality Brands and marketing Food and drink Beauty Retail Luxury Health (as a category itself) Lifestyle. I’ve mined this report in previous years – you can review my findings from the 2017 report here in the Health

“Seeing is not believing” when it comes to people seeing health information on social networks. Four in five people seeking healthcare information online in social media are concerned about the accuracy of that information served up. Therefore, most consumers a very satisfied with the healthcare information they receive from nurses, eye doctors, pharmacists, dentists, nurse practitioners, doctors, and dietitians. But social media influencers. patient organizations, online patient forums, and pharmaceutical companies? Not so much. Only one-half of U.S. consumers believe that health-related information on the internet is as reliable as information from medical professionals. Welcome to The Great American Search for

Diabetes is a family issue, and its prevalence is growing in America. November 14, 2018, is World Diabetes Day, and the International Diabetes Federation reminds us that this condition impacts the whole household — not just the person diagnosed with diabetes. Why the family? Because diabetes is one disease that is largely preventable: through eating right, being physically active, and making healthy choices every day. The family is the primary ecosystem for daily living, and this environment can foster an individual’s healthy choices…or not. The IDF reminds us that family members can and should be aware of the signs and

…because it does. “Citizens scare politicians,” I heard Governor John Kasich say to Nicole Wallace on her show Deadline: White House yesterday, just hours from today’s U.S. 2018 midterm elections. Governor Kasich has led the Buckeye State since 2011, and his second and final term ends in January 2019. The Governor expanded Medicaid under the Affordable Care Act in the State of Ohio, discussed in this insightful Washington Post article. “I am my brothers’ and sisters’ keeper,” Kasich told Wallace. The Governor asserted this in the context of the role of protecting his fellow citizens for health and well-being, for

Among people who have health insurance, managing the costs of their medical care doesn’t rank as a top frustration. Instead, attending to health and wellbeing, staying true to an exercise regime, maintaining good nutrition, and managing stress top U.S. consumers’ frustrations — above managing the costs of care not covered by insurance. And maintaining good mental health and staying on-track with health goals come close to managing uncovered costs, Oliver Wyman’s 2018 consumer survey learned. These and other important health consumer insights are revealed in the firm’s latest report, Waiting for Consumers – The Oliver Wyman 2018 Consumer Survey of US

One in three working-age people in the U.S. have seen a doctor about something stress-related. Stress is a way of American life, based on the findings in The United States of Stress, a survey from Everyday Health. Everyday Health polled 6,700 U.S. adults between 18 and 64 years of age about their perspectives on stress, anxiety, panic, and mental and behavioral health. Among all sources of stress, personal finances rank as the top stressor in the U.S. Over one-half of consumers say financial issues regularly stress them out. Finances, followed by jobs and work issues, worries about the future, and relationships cause

There’s a shortage of medical providers in the United Kingdom, a nation where healthcare is guaranteed to all Britons via the most beloved institution in the nation: The National Health Service. The NHS celebrated its 70th anniversary in July this year. The NHS “supply shortage” is a result of financial cuts to both social care and public health. These have negatively impacted older people and care for people at home in Great Britain. This article in the BMJ published earlier this year called for increasing these investments to ensure further erosion of population and public health outcomes, and to prevent

Today, October 16, is World Food Day. At Health Populi and THINK-Health, we celebrate the birthday of the Food and Agriculture Organization (FAO), allied with the United Nations. FAO was founded to address malnutrition and bolster a sustainable, healthy food supply for people. World Food Day 2018 has four objectives: Don’t waste food Produce more food with fewer resources Advocate for #ZeroHunger by 2030, and, Adopt a healthier, more sustainable diet. All four of these pillars play a role in health, but I’ll focus today on the fourth: the role of food as a major social determinant of health. Hunger

    CVS Health’s acquisition of Aetna was approved this week by U.S. Federal regulators after months of scrutinizing the antitrust-size-market control implications of the deal. I wrote this post on the deal as an inflection point in American healthcare on 3rd December 2017 when CVS and Aetna announced their marriage intentions. This post updates my initial thoughts on the deal, given the morphing US healthcare market on both the traditional health services front and fast-evolving retail health environment. The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal

In American health economics, there’s a demand side and a supply side. On the demand side, we’ve done a poor job trying to nudge patients and consumers toward rational economic decision making, lacking transparency, information symmetry, and basic health literacy. On the supply side, we’ve engaged in a medical arms race allocating capital resources to shinier and shinier new things, often without cost-benefit rationale or clinical evidence. On that supply side, though, I met up with an innovation that can help to bend the capital cost curve of how we envision and build new hospitals and clinics. This week, I

California’s Governor Jerry Brown signed into law a net neutrality bill this weekend. Gov. Brown’s proverbial swipe of the pen accomplished two things: he went back to the Obama-era approach to ensure that internet service providers treat all users of the internet equally; and, he prompted the Department of Justice, representing the Trump Administration’s Federal Communications Commission (FCC), to launch a lawsuit. California, home to start-ups, mature tech platform companies (like Apple, Facebook and Google), and countless digital health developers, is in a particularly strategic place to fight the FCC and, now, the Department of Justice. Nearly two dozen other states

People dealing with chronic conditions are keener to share personally-generated data than people that don’t have a chronic disease, Deloitte’s 2018 Survey of U.S> Health Care Consumers learned. This and other insights about the patient journey are published in Inside the patient journey, a report from Deloitte that assesses three key touch points for consumer health engagement. These three patient journey milestones are searching for care, using new channels of care, and tracking and sharing health data, Deloitte maps. What drives people to engage on their patient journeys has a lot  more to do with practical matters of care like convenience,

The prices of medicines prescribed in outpatient settings rose, on average, 10.3% in 2018. Wages increased about 2.6%, and consumer prices, 1.3%, based on the 2019 Segal Health Plan Cost Trend Survey. Segal forecasts that medical cost trends will moderate for 2019, lower than 2018 rates. But to the patient, now feeling like a consumer dealing with high-deductibles and the growing sticker shock of specialty drug prices, a so-called “moderate” trend still feels like a big bite in the household budget. Specifically, specialty drug trend is expected to be 14.3% in 2019, compared with 17.7% in 2018 — still several

Consumers who have long purchased over-the-counter medicines, anti-dandruff shampoo, whitening toothpaste, and cosmetics-with-benefits at food, drug and mass merchant retailers are switching to other places to shop for health, new data from AT Kearney and GMDC have found. The two organizations have collaborated to launch a new  benchmarking study into health-beauty-wellness (HBW) sales, launched this weekend at the GMDC HBW Conference in Orlando. Overall, 2017 to 2018 year-on-year, HBW sales were flat-to-no growth, notwithstanding the consumer and influencer buzz around the categories.       This study uncovered some very important trends underneath the macro numbers that tell a story

Patients are the new healthcare payors, and as such, taking on the role of health consumers. In fact, health and wellness consumers have existed since a person purchased the first toothpaste, aspirin, heating pad, and moisturizing cream at retail. Or consulted with their neighborhood herbalista, homeopathic practitioner, therapeutic masseuse, or skin aesthetician. Today, the health and wellness consumer can DIY all of these things at home through a huge array of products available in pharmacies, supermarkets, Big Box stores, cosmetic superstores, convenience and dollar stores, and other retail channels – increasingly, online (THINK, of course, of Amazon — more on

Among industries that consumers frequent, one continues to delight people more than most: pharmacies. J.D. Power’s 2018 ratings on U.S. pharmacies finds that consumers do indeed still love their pharmacies after ten years of rating customer satisfaction with brick-and-mortar and mail order channels. “U.S. consumers love their pharmacies,” J.D. Power asserts in its first study finding. In terms of total points across all pharmacies, Wegmans pharmacy was the overall top-ranked Rx retail channel with a total ranking of 906 out of 1,000 points. J.D. Power evaluated four categories of pharmacy: Brick-and-mortar chain drug stores, ranking Good Neighbor Pharmacy number one.

Beyond the physical and emotional pain that people experience when they become a patient, in the U.S. that person becomes a consumer bearing expenses and financial pain, as well. 98% of Americans rank paying their medical bills is an important pain point in their patient journey, according to Embracing consumerism: Driving customer engagement in the healthcare financial journey, from Experian Health. Experian is best known as the consumer credit reporting agency; Experian Health works with healthcare providers on revenue cycle management, patient identity, and care management, so the company has experience with patient finance and medical expense sticker shock. In the

Looking for health information online is just part of being a normal, mainstream health consumer, according to the third Rock Health Digital Health Consumer Adoption Survey published this week. By 2017, 8 in 10 U.S. adults were online health information hunters. Six in 10 Americans looked for reviews of healthcare providers online, another new-normal consumer digital health activity. But only one in four people had used wearable technology for health, and one in five had participated in a live video telemedicine encounter. The Rock Health team observes that “the needle has not moved equally across every type of digital health solution.” Thus the

In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia. The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line)

Today’s financial news reports and the bullish stock market generate headlines saying that the U.S. economy is riding high. President Trump forecasted in late July, “we are now on track to hit an average GDP annual growth of over 3% and it could be substantially over 3%,” Trump said. “Each point, by the way, means approximately $3 trillion and 10 million jobs. Think of that.” Indeed, unemployment is at its lowest rate in decades at 4%. Today, NASDAQ reported that, “the U.S. economy stays strong as the Fed holds steady.” For mainstream working people, though, even with a job in a high employment

More U.S. employers are growing activist roles as stakeholders in the healthcare system, according to the 2019 Large Employers Health Care Strategy and Plan Design Survey from the National Business Group on Health (NBGH). Consider the Amazon-Berkshire Hathaway-JPMorgan Chase link up between Jeff Bezos, Warren Buffet, and Jamie Dimon, as the symbol of such employer-health activism. The NBGH report is based on survey results collected from 170 large employers representing 13 million workers and 19 million covered lives (families/dependents). This annual survey is one of the most influential such reports released each year, providing a current snapshot of large employers’ views

  There’s growing evidence that a majority of U.S. voters, across the three-party landscape, agree on two healthcare issues this year: coverage of pre-existing conditions, and lowering the consumer-facing costs of prescription drugs. A new poll jointly conducted by Politico and the Harvard Chan School of Public Health bolsters my read on the latter issue – prescription drug pricing, which has become a mass popular culture union. There may be no other issue on voters’ collective minds for the 2018 mid-term election that so unites American voters than the demand for lower-cost medicines. This is directly relates to consumers’ tri-party

While Amazon and Google get lots of positive PR and media attention as major healthcare industry disruptors, don’t forget about two big “W’s,” Walgreens and Walmart, in the healthcare innovator mix. I recently read The Four in which Scott Galloway explains the dominance of Amazon, Apple, Google and Facebook in consumers’ everyday lives. These four tech-behemoths each have their particular designs on healthcare innovation, or disruption in the eyes of, say, Epic and Cerner working on health IT systems, or GE and IBM if you’ve been pioneers in health data or big-iron information technology. Then in the past week, the

President Trump and his administrative have been trying to make the ACA fail, claim most U.S. adults. Thus, the public holds the POTUS and the Republican party responsible for moving the Affordable Care Act forward….or not, according to the July 2018 Kaiser Health Tracking Poll conducted by the Kaiser Family Foundation (KFF). Health care will be a key issue in the 2018 mid-term elections that will be held in November. Among U.S. voters’ key health care concerns in 2018, one ranks “most” or “very important” for two-thirds of Americans: that is continuing to protect people with pre-existing health conditions. Other issues

  Consumers are more bullish demanding virtual and digital health tools from their physicians than doctors are in providing it, based on the research findings in What can health systems do to encourage physicians to embrace virtual care? from Deloitte. One-third of physicians have concerns about using virtual care services, such as medical errors that may result, access to technology, and data security.               One in two U.S. consumers are now tracking health via digital tools, and one-half of these share the data generated by their apps. That sharing is limited by doctors’ ability to

In this moment post-Cambridge Analytica/Facebook, the launch of the GDPR, and the everyday-ness of data breaches, consumers most trust doctors for sharing personal information. I’ve mined, through my health economic lens, the U.S. data published in the insightful report, Data Privacy: What the Consumer Really Thinks, a global research study from Axciom and the Data & Marketing Association (recently acquired by the Association of National Advertisers) working with Foresight Factory. The report compares consumers’ personal views on privacy and trust in ten countries: Argentina, Australia, Canada, France, Germany, the Netherlands, Singapore, Spain, the UK, and the US. We learn that Americans

While the vast majority of Americans say that science has made life easier for most people, and especially for health care, people are split in questioning the financial cost and value of medical treatments, the Pew Research Center has found. The first chart illustrates the percent of Americans identifying various aspects of medical treatments as “big problems.” If you add in people who see these as “small problems,” 9 in 10 Americans say that all of these line items are “problems.” In the sample, two-thirds of respondents had seen a health care provider for an illness or medical condition in

In the USA, July 4th celebrates the adoption of the Declaration of Independence on that day in 1776. For people with diabetes, July 4th is also an inflection point when blood glucose spikes and kicks off a rise in blood sugar levels through autumn to New Year’s Eve. The team at Livongo observed this by mining 20 million blood glucose measures among its community of people with diabetes. This research debuted in the inaugural Insights Report, Diabetes Across America: Seasons, Regions & More. I appreciated the opportunity to discuss these findings with Dr. Jennifer Schneider, Chief Medical Officer at Livongo. I