A blog covering the health/care ecosystem and people.

Since the advent of the so-called consumer-directed health care era in the mid-2000s, there’s been a love-gap between health plan members of traditional plans, living in Health Plan World 1.0, and people enrolled in newer consumer-driven plans – high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs). That gap in plan satisfaction continues, according to the Employee Benefits Research Institute (EBRI)’s poll of Americans’ consumer engagement in health care. The survey was conducted with the Commonwealth Fund. As the bar chart illustrates, some 62% of members in traditional plans were satisfied (very or extremely) with their health insurance in 2012.

Most Americans don’t understand what a health savings account (HSA) is – including people who are enrolled in the plans. While health literacy is generally acknowledged to be a public health challenge in America, health insurance literacy is not well recognized. Yet in the emerging consumer-directed health plan era of U.S. health care, peoples’ lack of understanding of health financial accounts will get in the way of people who really need care seeking care at the right time. This leads to greater health spending later when the consumer-patient can develop a health condition that could have been prevented (say, pre-diabetes

More than 127,000 people die every year in America from cardiovascular disease, accruing $17 billion in medical spending. Heart disease is a “costly killer,” according to the Union of Concerned Scientists, who has calculated The $11 trillion reward: how simple dietary changes can save lives and money, and how we get there, published in August 2013. That $11 trillion opportunity is equal to the present value of lives saved. The solution to bolstering heart (and overall health) and saving money (medical spending and personal productivity) is in food. We’re not talking about genetically engineering anything special or out-of-the-ordinary. We are talking

Imagine walking into a storefront where you can shop for an arthroscopy procedure, mammogram, or appointment with a primary care doctor based on price, availability, quality, and other consumers’ opinions? Welcome to the “health care automat,” the online healthcare marketplace. This is a separate concept from the new Health Insurance Marketplace, or Exchange. This emerging way to shop for and access health care services is explored in my latest paper for the California HealthCare Foundation (CHCF), Help Yourself: The Rise of Online Healthcare Marketplaces. What’s driving this new wrinkle in retail health care are: U.S. health citizens morphing into consumers,

When it comes to who’s most responsible for reducing the cost of health care in America, most doctors put the onus on trial lawyers, health insurance companies, pharma and medical device manufacturers, hospitals, and even patients. But physicians themselves ? Not so much responsibility – only 36% of doctors polled said doctors should assume major responsibility in reducing health care costs. And, in particular, most U.S. physicians have no enthusiasm for reducing health care costs by changing payment models, like penalizing providers for hospital re-admissions or paying a group of doctors a fixed, bundled price for managing population health. Limiting

3 in 4 Americans say that out-of-pocket costs are the main reason they decide whether or not to seek preventive care, in A Call for Change: How Adopting a Preventive Lifestyle Can Ensure a Healthy Future for More Americans from TeleVox, the communications company, published in June 2013. TeleVox surveyed over 1,015 U.S. adults 18 and over. That’s the snapshot on seeking care externally: but U.S. health consumers aren’t that self-motivated to undertake preventive self-care separate from the health system, either, based on TeleVox’s finding that 49% of people say they routinely exercise, and 52% say they’ve attempted to improve eating habits.

It’s called “primary” care for a reason: it’s first and foremost important in the health care services a person can use. In its report, Primary care: our first line of defense, The Commonwealth Fund explains why primary care is crucial to one’s individual health, and how primary care is morphing into medical teams and patient-centered medical homes. And that’s a good thing for you and me, the Fund says. That’s because people in the U.S. who have a primary care doctor have 33% lower health costs and 19% lower risk of dying than people who see only a specialist (Source:

While there is big uncertainty about how health reform will roll out in 2014, and who will opt into the new (and improved?) system, health cost growth will slow to 6.5% signalling a trend of moderating medical costs in America. Even though more newly-insured people may seek care in 2014, the costs per “unit” (visit, pill, therapy encounter) should stay fairly level – at some of the lowest levels since the U.S. started to gauge national health spending in 1960. That’s due to “the imperative to do more with less has paved the way for a true transformation of the

Giving health consumers more skin in the game doesn’t always lead to them making sound health decisions. Over four years in consumer-directed health plans, enrollees used one-quarter fewer visits to doctors every year and filled one fewer prescription drugs. CDHP members also received fewer recommended cancer screenings, and visited the emergency room more often. These rational health consumer theory-busting findings were published in the June 2013 issue of the Health Affairs article, Consumer-Directed Health Plans Reduce The Long-Term Use of Outpatient Physician Visits And Prescription Drugs by Paul Fronstin of the Employee Benefit Research Institute and colleagues from IBM and RxEconomics,

One in three workers does not feel financially secure. The proportion of Americans who feel “not at all secure” grew to 16% from 12% between 2011 and 2012, based on the question, “When it comes to paying your bills and keeping up with living expenses, how financially secure do you feel these days?” Women are much more likely than men to feel financially insecure, representing a 33% growth rate in financial insecurity. These sobering financial statistics come to us from the UNUM study, 2012 Employee Education and Enrollment Survey: Employee Perspectives on Financial Security, published May 8, 2013. Based on the question asked – paying

The registered dietitian is an in-demand labor resource for grocery stores around the U.S. Advertising Age covered the phenomenon of the growing clout of dietitians in food chains (April 14, 2013). Let’s dig further into this phenomenon through the Health Populi lens on healthcareDIY and peoples’ ability to bend their personal health care cost curves. Stores such as Giant Eagle, Hy-Vee, Safeway and Wegmans are morphing into wellness destinations, with pharmacies and natural food aisles taking up valuable square footage to meet consumers’ growing demands for healthy choices. Some stores are formalizing their approach to food = health by formulating a

The Food & Drug Administration (FDA) launched its new website for and about patients, the Patient Network, with the tagline, “Bringing your voice to drug and device approval and safety.” With this move, the FDA moves toward social health, someplace where at least one-third of U.S. consumers already opine, shop, share personal info, crowdsource cures, and support each other on all-matters-health-and-illness. The objective of the Patient Network is, “to help FDA help patients have a bigger voice.” Dr. Margaret Hamburg, the Commissioner of the FDA, talks about the concept here. The rationale? “When patients better understand the intricacies of how

In this week’s BMJ (British Medical Journal), an American patient tells his story about being equipped, enabled, empowered and engaged — the many “e’s” making up the prefix of “ePatient.”  This definition comes out of the work of Dr. Tom Ferguson, who worked with the e-Patient Scholars Working Group in 2007, to publish the first white paper about the phenomenon, e-Patients: how they can help us heal health care. ePatient Dave is the patient-author of the BMJ piece, making the case for shared decision-making and patient involvement in health care decisions. He writes in the conclusion, “The value delivered by skilled

While health care cost growth has slowed nationally, most Americans feel they’re going up faster than usual. 1 in 3 people believe their own health costs have gone up faster than usual, and 1 in 4 feel they’re going out about “the same amount” as usual. For only one-third, health costs feel like they’re staying even. As the second quarter of 2013 begins and the implementation of the Affordable Care Act (ACA, aka “health reform” and “Obamacare”) looms nearer, most Americans still don’t understand how the ACA will impact them. Most Americans (57%) believe the law will create a government-run health plan,

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

The latest in SoLoMo (Social, Local, Mobile) Health is a gamified tool coupled with a hardware kiosk, known as higi. The brainchild of Michael Ferro, a successful dotcom entrepreneur who now owns the Chicago Sun-Times, higi’s mission is to help people – particularly younger peeps – to take better care of themselves by scoring points and, as a result, social connections. Higi’s an African word for origin, so the health tool has some aspects relating to being in a tribe — a kind of health tribe. It also has a fun sound to it, Ferro noted, which sets the vibe

Wearing his Walking Gallery jacket painted by (im)patient advocate, Regina Holliday, Dr. Eric Topol evangelized the benefits of digital medicine and consumer empowerment in health care, largely summarizing his epic (pun intended – wait for Hot Point, below) book, The Creative Destruction of Medicine. A founder of the West Wireless Health Institute (now known as West Health), Dr. Topol is a physician and researcher at Scripps and was recently named as editor at Medscape. A new piece of Topol Trivia for me is that GQ magazine called him a rock star of science. Dr. Topol is one of the more

A vast majority – 9 in 10 physicians – like mobile health (mHealth) apps, especially when tied to electronic health records (EHRs). eClinicalWorks surveyed physicians in January 2013, and found physicians bullish on mobile health apps for patient benefit – not just for their own office productivity and workflow. Specifically, – 93% of physicians say mobile health apps can improve patients’ health outcomes – 89% of physicians would recommend an mHealth app to a patient – 58% of doctors note a key mHealth benefit is providing patients with appointment alerts and reminders – 2 in 3 physicians say mHealth apps

The restaurant chain business employs 10% of U.S. workers and accounts for $660 bn worth of the national economy. Where restaurant chains are growing fastest is in serving up lower-calorie meals, and it’s been a boon to the bottom-line. The case for lower calories leading to better business is made in Lower-Calorie Foods: It’s Just Good Business from the Hudson Institute‘s Obesity Solutions Initiative, published February 2013. In the report, researchers analyzed nitty-gritty restaurant chain data on servings and traffic from 2006-2011 to sort out whether sales of so-called lower-calorie menu items in 21 chains led to improved business. The chains

Health care costs for workers lucky enough to receive health insurance at work nearly doubled since 2002. Wages in that decade grew by 33%. This growing affordability gap between health costs vs. wages is shown in the chart. Health consumers in America sharply perceive this gap, according to an analysis of eight focus groups, Consumer Attitudes on Health Care Costs: Insights from Focus Groups in Four U.S. Cities from the Robert Wood Johnson Foundation. To health-covered workers, though, health care “costs” are defined as out-of-pocket health spending for insurance premiums, co-payments and deductibles that come out of paychecks and pocketbooks — not

PwC has seen the future of health care for the next year, and the crystal ball expects to see the following: Affordable Care Act implementation, with states playing lead roles The role of dual eligibles Employer’s role in health care benefits Consumers’ role in coverage Consumers’ ratings impact on health care Transforming health delivery Population health management Bring your own device Pharma’s changing value proposition The medical device industry & tax impact. In their report, Top health industry issues of 2013: picking up the pace on health reform, PwC summarizes these expectations as a “future [that] includes full implementation of

1 in 3 U.S. adults have enough trust in online health resources that they’ve gone online to diagnose a condition for themselves or a friend. “For one-third of U.S. adults, the Internet is a diagnostic tool,” according to Health Online, the latest survey on online health from the Pew Internet & American Life Project. Nearly one-half of these people eventually sought medical attention. One-third did not. Women are more likely to do online medical diagnoses than men do, as do more affluent, college-educated people. When people perceive they’re ‘really’ sick, 70% get information and care from a health professional and

When it comes to taking on personal responsibility, the #1 New Year’s Resolution is to engage in fitness and exercise, cited by 43% of U.S. adults, followed by healthy eating, noted by 37% of people. Other resolutions involving personal responsibility are Family (26%) Spirituality and faith (22%) Managing personal finances (22%. This survey was undertaken as part of Liberty Mutual’s The Responsibility Project (RP), which is taglined: “Explore what it means to do the right thing.” Launched in 2008, Liberty Mutual’s RP has been diving into the many aspects of daily living for which we, each of us, could take responsibility…including

  41% of Americans are comfortable using websites that allow them to check health symptoms. Furthermore, 25% of people trust online symptom checkers, mobile apps and home-based vital sign monitors as much as they trust their doctor. In fact, roughly the same proportion uses these tools instead of going to see the doctor, according to a consumer survey from Royal Philips Electronics (Philips). The infographic illustrates some of Philip’s top-line findings from this poll, conducted among 1,003 U.S. adults 18 and over in November 2012. Over one-third of Americans also believe that technology allows them to monitor their health — a

Estimates on health spending in the U.S. are under-valued, according to The hidden costs of U.S. health care: Consumer discretionary health care spending, an analysis by Deloitte’s Center for Health Solutions. Health spending in the U.S. is aggregated in the National Health Expenditure Accounts (NHEA), assembled by the Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS). In 2010, the NHEA calculated that $2.6 trillion were spent on health care based on the categories they “count” for health spending. These line items include: Hospital care Professional services (doctors, ambulatory care, lab services) Dental services Residential

Reducing health care costs far outranks improving quality and safety, improving the public’s health, and upping the customer experience as Americans’ top priority for President Obama’s health care agenda, according to a post-election poll conducted by PwC’s Health Research Institute. In Warning signs for health industry, PwC’s analysis of the survey results, found that 7 in 10 Americans point to the high costs of health care as their top concern in President Obama’s second term for addressing health care issues. Where would cost savings come from if U.S. voters wielded the accountant’s scalpel? The voters have spoken, saying, Reduce payments

Health benefit costs grew a relatively low 4.1% in 2012 (5.4% for large employers), largely due to companies moving workers into lower-cost consumer-directed health plans. Last year, benefit costs grew at an annual rate of 6.1%, representing about a 30% fall in year-on-year cost growth for companies. And, coverage is up to 59% of employees having ticked down to 55% for the past couple of years. Employers expect about a 5% increase for 2013. Mercer’s National Survey of Employer-Sponsored Health Plans analysis finds that U.S. employers are looking toward 2014, when they’ll be covering more uninsured workers, and using this advance

It’s American Pharmacist Month, so let’s celebrate that key member of the health care team. Most Americans live quite close to a pharmacy, compared with peoples’ proximity to doctors, hospitals and emergency rooms. The pharmacist is not only a trusted health professional in the eyes of consumers: he/she is a key influencer on peoples’ health. And seeing as the #1 barrier to people taking prescription drugs is cost, the community-based pharmacist is in a prime position to educate, influence and motivate people to become more informed and activated health consumers. CVS Caremark’s survey of pharmacists is discussed in the company’s

U.S. health consumers continue their self-rationing behavior, forgoing prescription drug fills and doctor’s appointments due to cost. Consumer Reports annual prescription drug poll echoes the news, consistent with other surveys finding Americans skipping necessary care from Kaiser Family Foundation and the American Osteopathic Association. I’ve discussed the trend of health self-rationing identified in these polls in past Health Populi posts, here and here. Since 2011, nearly 1 in 2 health citizens younger than 65 — that is, those people without Medicare which carries the Part D prescription drug benefit — did not fill a prescription due to cost. This proportion

Among factors that contribute to patients’ positive experiences with health care providers, the doctor’s ability to access ‘my’ overall medical history is nearly as important to consumers as the doctor’s overall knowledge, training and expertise. This enlightening data point comes to us from a Harris Interactive poll conducted in July 2012 and published this week. This news is important because it’s National Health IT Week. I attended the kickoff meeting for #NHITWeek yesterday in Washington, DC, held in the Department of Health and Human Services headquarters building named for Hubert Humphrey – an early public health proponent (and trained pharmacist,

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

While 87% of U.S. adults are familiar with health providers converting paper medical records into digital records, only 26% — 1 in 4 — say they want their own medical records to go digital. This sobering statistic comes as hundreds of thousands of doctors and hospitals are migrating to electronic health records (EHRs), motivated by the U.S. government’s HITECH act which provides incentives for the adoption and so-called meaningful use of EHRs. To gauge U.S. consumers’ views on digital medical records, Xerox polled 2,147 U.S. adults ages 18 and via an online survey in May 2012. The chart illustrates several key

1 in 3 online consumers (36%) is interested in receiving customer service from the pharmaceutical industry. In particular, these engaged health consumers want contact, first and foremost, with a clinical expert associated with a pharmaceutical company: namely, a doctor or a nurse. In third place would be a patient advocate representing the pharmaceutical company. During the recording of a podcast this week hosted by Med Ad News‘s managing editor Josh Slatko, featuring Monique Levy, VP of Research at Manhattan Research, Adam Budish, SVP of Sales with Epocrates, and me, Monique mentioned this data point from the latest ePharma Consumer study conducted by

Calling Don Draper, Donny Deutsch, and the spirit of David Ogilvy: the President needs you. The President must sell the Affordable Care Act to the American people now that Justice Roberts wrote the Supreme Court’s historic 5-4 majority opinion supporting the Act, and especially the individual mandate. He argued for the majority that while the mandate is unconstitutional under the Commerce Clause which would “command people to buy insurance,” he said that the mandate is a de facto tax, as people who would choose to opt out of insurance would have an alternative of paying an IRS fine. Senator Eric

Since the advent of the Great Recession of 2008, more Americans have been splitting pills, postponing needed visits to doctors, skipping dental care, and avoiding recommended medical tests due to the cost of those health care services. Call it health care self-rationing: the Kaiser Family Foundation (KFF) has been tracking this trend for the past several years, and the proportion of American adults rationing health demand is up to 58%. This KFF Health Tracking Poll interviewed 1,218 U.S. adults age 18 and older via landline and cell phone in May 2012. As the chart illustrates, 38% of people are “DIYing” health care

What is a Mom, and especially, who is a “Digital Mom?” I’ve been asked to consider this question in a webinar today hosted by Enspektos, who published the report Digging Beneath the Surface: Understanding the Digital Health Mom in May 2012. I wrote my review of that study in Health Populi here on May 15. In today’s webinar, my remarks are couched as “Caveats About the Digital Mom: a multiple persona.” Look at the graphic. On the left, the first persona is a mother with children under 18. Most “mom segmentations” in market research focus on this segment. But what

  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,

“Knowing they may need to return at some later time, patients felt they were vulnerable and dependent on the good will of their physicians. Thus, deference to authority instead of genuine partnership appeared to be the participants’ mode of working,” asserts a study into physician-patient relationships published this week in Health Affairs. The study’s title captures the top-line research finding Authoritarian Physicians and Patients’ Fear of Being Labeled ‘Difficult’ Among Key Obstacles To Shared Decision Making.  Researchers at the Palo Alto Medical Foundation Research Institute analyzed data on patients participating in focus grooups, from the age of forty and over, from

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

Less is more when it comes to health care utilization and outcomes. The U.S. allocates too many resources to a huge line item of waste in the health system – administrative (in terms of too many paper processes and staff to deal with them) and clinically (especially involving duplicated tests and ineffective treatments that aren’t based on evidence based medicine). “Take less” is the tagline of the company called help which is found at the URL http://www.helpineedhelp.com/.  This is a consumer-facing over-the-counter drug supplier. Their product line counts 7 mature products each packaged with the health complaint they target: “Help,” I have

The Big Headline under the banner of Health Economics this week is the statistic that growth in U.S. national health spending slowed to an anemic 3.9%  in 2010 — the slowest rate of growth in the 51-year history of keeping the National Health Expenditure Accounts.   Before American policymakers, providers, plans and suppliers pat themselves on their collective back on a job well-done, the heavy-lifting behind this story was largely undertaken by health consumers themselves in the form of facing greater co-pays, premiums and prices for health services — and as a result, self-rationing off health care services and utilization, which

People enrolled in consumer-directed health plans (CDHPs) are more likely than enrollees in traditional health insurance products to be cost-conscious. In particular, CDHP members check prices before they receive health care services, ask for generic drugs versus branded Rx’s, talk to doctors about treatment options and their costs, and use online cost-tracking tools. Furthermore, CDHP members are also more likely to use wellness programs offered by their employers, and are offered “carrots” to participate in them in the forms of financial rewards and other incentives, as well as reduced health care insurance premiums. The 7th annual Employee Benefits Research Institute

The U.S. public’s views on health reform — the Affordable Care Act (ACT) – remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health

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 growth in prescription drug costs covered by employers and Rx plan sponsors are driving them to adopt a long list of utilization management and price-tiering strategies looking to 2012, according to the 2011-2012 Prescription Drug Benefit Cost and Plan Design Report, sponsored by Takeda Pharmaceuticals. The average drug trend for 2011 — that is, the average annual percentage increase in drug cost spending — was 5.5%, 1.5 percentage points greater than general price inflation of about 4%. The generic fill rate was 73% of prescription drugs purchased at retail. While drug price inflation is expected to increase in 2012, plan

A picture’s not only worth the proverbial thousand words, but can save a life. So can a t-shirt…er, TeachShirt. At the Unniched meeting held on 25 October 2011 in NYC, I spent a few minutes talking with two members of Zemoga‘s brain trust: Sven Larsen, Chief Marketing Office, and the firm’s Principal Design guru, Dan Licht. We discussed how design is so critical a factor in health, and in life — particularly, in DIY health, where we are all taking on more responsibility for our own health care — clinical, financial, mental, social. Among Zemoga’s colorful and uber-creative portfolio is its concept, the

The recessionary, sluggish U.S. economy has had an impact on Americans’ mental and physical health. The least healthy citizens have experienced a disproportionately hard hit on their health and health care. But necessity being the mother of invention, some people are re-inventing their personal workflows in health care — and many of these tactics may well benefit their health in the long run. The Economy and Health: 10 Observations is the analysis from Euro RSCG‘s survey of U.S. adults’ views on their personal health in light of the continued economic downturn. The first chart shows the economy’s impact on the overall mood of

Representatives from eight U.S. Federal government agencies, including the FDA and Veterans Administration, among others; health financiers (VCs, angels); health tech start-ups; providers, life science companies, and analysts, attended the Health Care Innovation Day DC sponsored by West Wireless Health Institute on April 28, 2011. The meeting had the tagline, A Discussion with the FDA, setting the stage for a day-long consideration of the role of regulation vis-a-vis health innovation. The $2.5+ trillion question (annual spending on health care in the U.S.) is: can innovation drive making health care “cheaper?” This was the underlying theme of the panel on which I sat

Today’s kickoff of the National eHealth Collaborative‘s Consumer Consortium on eHealth convened the most diverse workgroup of over 70 stakeholders with various lenses on consumers and health, rarely seen at similar meetings, as Lygeia Ricciardi (@lygeia) of the Office of the National Coordiantor for Health IT (ONC) in the Department of Health and Human Services, observed. However, although representing every conceivable segment of health consumer stakeholders, from seniors (AARP)  and physicians (MGMA) to people with disabilities (AAPD), women (National Partnership for Women and Families) and people who fall through the health safety net (the National Health IT Collaborative for the Underserved), there was concurrence