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Employers Changing Health Care Delivery – Health Reform At Work

Large employers are taking more control over health care costs and quality by pressuring changes to how care is actually delivered, based on the results from the 2017 Health Plan Design Survey sponsored by the National Business Group on Health (NBGH). Health care cost increases will average 5% in 2017 based on planned design changes, according to the top-line of the study. The major cost drivers, illustrated in the wordle, will be specialty pharmacy (discussed in yesterday’s Health Populi), high cost patient claims, specific conditions (such as musculoskeletal/back pain), medical inflation, and inpatient care. To temper these medical trend increases,

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The Connected Fitness Consumer

Personal fitness equipment is getting connected in the growing Internet of Things ecosystem (IoT), and fitness enthusiasts are getting more digitally connected well beyond their wristband tracking device. A survey conducted by ECRM and HellaWella, a healthy living portal, looked into fitness consumers’ digital habits and found a health-engaged cohort that’s online in the Web 1.0 world — sharing workout tips in social media communities but not so much product information. Product information is still learned Old School-wise, via product websites, traditional magazines, from peers and word-of-mouth (offline), and trying new gear out at the gym in real time. This

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The Average Monthly Health Plan Premium in the U.S. Hit $885 in 2016

  Three years after the launch of the Affordable Care Act (ACA), the big picture of employer-sponsored health benefits in the U.S. show stability, with modest changes in costs being kept in check by a growing younger workforce, according to the 2016 ADP Annual Health Benefits Report. Roughly 9 in 10 employees in large companies are eligible to participate in health insurance plans at the workplace, with two-thirds of people participating, shown in the chart. Younger people, under 26 years of age, have much lower participation rates than those over 26, with many staying on their parents’ plans (taking advantage of

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Samsung and Garmin Beat Fitbit in JD Power Fitness Band Match-Up

J.D. Power, the company best known for evaluating consumers’ experiences with automobiles, published its 2016 Fitness Band Device Satisfaction Report this week. The bar chart summarizes overall satisfaction with activity tracking wristbands, led by Samsung with the highest index score, followed by Garmin. Below the average index were LG, Fitbit, and Jawbone. Samsung’s top grade translates into J.D. Power’s methodology as “among the best” fitness bands, based on a 1,000 point scale. Samsung’s high ranking was earned based on particularly strong scores for customer satisfaction in comfort, reliability, and ease of use. Garmin’s customer service was also highly rated, along

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Workplace Wellness Goes Holistic, Virgin Pulse Finds

“Work is the second most common source of stress, just behind financial worries,” introduces The Business of Healthy Employees report from Virgin Pulse, the company’s 2016 survey of workplace health priorities published this week. Virgin Pulse collaborated with Workforce magazine, polling 908 employers and 1,818 employees about employer-sponsored health care, workers’ health habits, and wellness benefit trends. Workplace wellness programs are becoming more holistic, integrating a traditional physical wellness focus with mental, social, emotional and financial dimensions for 3 in 4 employers. Wearable technology is playing a growing role in the benefit package and companies’ cultures of health, as well

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The State of Health Benefits in 2016: Reallocating the Components

Virtually all employers who offer health coverage to workers extend health benefits to all full-time employees. 94% offer health care coverage to opposite-sex spouses, and 83% to same-sex spouses. One-half off health benefits to both opposite-sex and same-sex domestic partners (unmarried). Dental insurance, prescription drug coverage, vision insurance, mail order prescription programs, and mental health coverage are also offered by a vast majority (85% and over) of employers. Welcome to the detailed profile of workplace benefits for the year, published in 2016 Employee Benefits, Looking Back at 20 Years of Employee Benefits Offerings in the U.S., from the Society for Human

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One in Two People Use Wearable Tech in 2016

Nearly 1 in 2 people own at least one wearable device, up from 21% in 2014; one-third of people own more than one such device that tracks some aspect of everyday life, according to PwC’s latest research on the topic, The Wearable Life 2.0 – Connected living in a wearable world, from PwC. Wearable technology in this report is defined as accessories and clothing incorporating computer and advanced electronic technologies, such as fitness trackers, smart glasses (e.g., Google Glass), smartwatches, and smart clothing. Specifically, 45% of people own a fitness band, such as a Fitbit, the most popular device in this

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Financial Wellness Declines In US, Even As Economy Improves

American workers are feeling financial stress and uncertainty, struggling with health care costs, and seeking support for managing finances. 75% of employees feel financially insecure, with 60% feeling stressed about their financial situation, according to the 2016 Workplace Benefits Report, based on consumer research conducted by Bank of America Merrill Lynch. The overall feeling of financial wellness fell between 2013 and 2015. 75% of U.S. workers don’t feel secure (34% “not very secure” and 41% “not at all secure”), with the proportion of workers identifying as “not at all secure” growing from 31% to 41%. Financial wellness was defined for this

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Generation Gaps in Health Benefit Engagement

Older workers and retirees in the U.S. are most pleased with their healthcare experiences and have the fewest problems accessing  services and benefits. But, “younger workers [are] least comfortable navigating U.S. healthcare system,” which is the title of a press release summarizing results of a survey conducted among 1,536 U.S. adults by the Harris Poll for Accolade in September 2015. Results of this Accolade Consumer Healthcare Experience Index poll were published on April 12, 2016. Accolade, a healthcare concierge company serving employers, insurers and health systems, studied the experiences of people covered by health insurance to learn about the differences across age

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People Want Healthcare Sherpas

8 in 10 Americans would like one trusted person to help them figure out their health care, according to the Accolade Consumer Healthcare Experience Index Poll, conducted by The Harris Poll. The study gauged how Americans feel about their healthcare, especially focusing on employer-sponsored health insurance. One-third of people (32%) aren’t comfortable with navigating medical benefits and the healthcare system; a roughly percentage of people aren’t comfortable with their personal knowledge to make financial investments, either (35%). Buying a car, a home, technology and electronics? Consumers are much more comfortable shopping for these things. Consumers say that the most onerous

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Behavioral Economics in Motion: UnitedHealthcare and Qualcomm

What do you get when one of the largest health insurance companies supports the development of a medical-grade activity tracker, enables data to flow through a HIPAA-compliant cloud, and nudges consumers to use the app by baking behavioral economics into the program? You get Motion from UnitedHealthcare, working with Qualcomm Life’s 2net cloud platform, a program announced today during the 2016 HIMSS conference. What’s most salient about this announcement in the context of HIMSS — a technology convention — is that these partners recognize the critical reality that for consumers and their healthcare, it’s not about the technology. It’s about

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Retail Health Landscape Expanding Through Clinic Growth, Accenture Forecasts

The Old School retail clinic is going beyond checking your child’s ear infection and sore throat, giving immunizations and filling out back-to-school forms just-in-time over LaborDay  weekend. The new-new retail clinic is supporting patients’ chronic disease management, partnering with academic medical centers, and bolstering medication management. Accenture’s bullish forecast is titled “US Retail Health Clinics Expected to Surge by 2017,” making the case that these brick-and-mortar providers are shifting from a relatively limited retail scope to a broader and deeper clinical focus. The so-called surge in the number of retail clinics is projected to be nearly 50% growth between 2014 and 2017,

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Social Networking Is The New Normal, Pew Finds

Two-thirds of all internet users, and 65% of all adults over 18 years of age, use social networking sites. Social Media Usage: 2005-2015, the latest report from the Pew Research Center, finds social networking is the new normal for people up to 65 years of age. One-third of people over 65 use social networking sites. Peoples’ use of social media impacts every aspect of daily living beyond sharing social updates, from home keeping and political discussions to work, parenting, and managing stress, the Pew research found. Key findings in the report are that: Seniors’ use of social networks rose from

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Health consumers’ cost increases far outpace wage growth

American workers are working to pay for health care costs, having traded off wage increases for health premiums, out-of-pocket costs and growing high deductibles. Welcome to the 2015 Employer Health Benefits survey conducted annually by the Kaiser Family Foundation (KFF) and Health Research & Educational Trust (HRET). Premiums are growing seven times faster than wages.  The report calculates that high-deductibles for health insurance have grown 67% from 2010 to 2015. In the same period, wages grew a paltry 10%, while the Consumer Price Index rose 9%. The first chart illustrates that growing gap between relatively flat wages and spirally health

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Fitbit Means Business When It Comes To Privacy

Fitbit, the company that makes and markets the most popular activity tracker, is getting serious about its users’ personal data. The company  announced that it will enter into HIPAA business associate agreements with employers, health plans, and companies that offer workers the devices and the apps that organize and analyze consumers’ personal data. The Health Insurance Portability and Accountability Act (HIPAA) protects patients’ personal health information generated in a doctor’s office, a hospital, lab, and other healthcare entities covered under the law (as such, “covered entities”). However, data generated through activity tracking devices such as Fitbit’s many wearable technologies have

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A Company’s Healthy Bottom Line Requires Healthy Employees

“What is the meaning of health to our businesses?” asked Dr. Thomas Parry of the Integrated Benefits Institute (IBI) at a dinner last night, convened by the Pittsburgh Business Group on Health on the eve of the organization’s annual meeting being held today in Steel City. I was fortunate to attend the dinner and hear Dr. Parry speak; I will be addressing the meeting today on the topic, “Building a Better Health Consumer.” The IBI is researching the direct link between the top line of a healthy employee base and healthy workers’ impacts on the bottom line. A report will be

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Sports and the Internet of Things: the Scoop & Score podcast

From elite soccer and football fields to youth athletes in public school gyms, wearable technology has come to sports bringing two big benefits of gathering data at the point of exercise: to gauge performance and coach back to the athlete in real time, and to prevent injury. I discussed the advent of the Internet of Things in sports on the Scoop and Score podcast with Andrew Kahn, sports journalist and writer, and Stephen Kahn, sports enthusiast and business analyst. [In full disclosure these two Kahn’s are also my brilliant nephews.] We recorded the podcast on July 14, 2015, the day

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Telehealth goes retail

In the past couple of weeks, a grocery store launched a telemedicine pilot, a pharmacy chain expanded telehealth to patients in 25 states, and several new virtual healthcare entrants received $millions in investments. On a parallel track, the AMA postponed dealing with medical ethics issues regarding telemedicine, the Texas Medical Association got stopped in its tracks in a case versus Teladoc, and the Centers for Medicare and Medicaid Services (CMS) issued a final rule for the Medicare Shared Savings Program that falls short of allowing Accountable Care Organizations (ACOs) to take full advantage of telehealth services. These events beg the

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Employers go beyond physical health in 2015, adding financial and stress management

Workplace well-being programs are going beyond physical wellness, incorporating personal stress management and financial management. Nearly one-half of employers offer these programs in 2015. Another one-third will offer stress management in the next one to three years, and another one-fourth will offer financial management to workers, according to Virgin Pulse’s 2015 survey of workplace health priorities, The Busness of Healthy Employees. The survey was published June 1st 2015, kicking off Employee Wellbeing Month, which uses the Twitter hashtag #EWM15. It takes a village to bolster population health and wellness, so Virgin Pulse is collaborating with several partners in this effort

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Mental health at the workplace – US companies rank #1 for stress

People with anxiety, depression, interpersonal challenges, and substance abuse go to work every day. Together, these factors erode the mental health and wellbeing of workers, and this negatively impacts companies’ productivity, workplace morale, and profitability. Employers are increasingly taking notice of their role in promoting mental health on-the-job, a trend captured in the report Promoting Mental Well-being: Addressing Worker Stress and Psychosocial Risks, an international survey of employers published in May 2015 by Buck Consultants, part of Xerox. The survey polled 439 employers in 31 countries, and the report focuses on the results in four of those nations: Brazil, Singapore, the

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Health is where we live, work, and shop…at Walgreens

Alex Gourley, President of The Walgreen Company, addressed the capacity crowd at HIMSS15 in Chicago on 13th April 2015, saying his company’s goal is to “make good health easier.” Remember that HIMSS is the “Health Information and Management Systems Society” — in short, the mammoth health IT conference that this year has attracted over 41,000 health computerfolk from around the world. So what’s a nice pharmacy like you, Walgreens, doing in a Place like McCormick amidst 1,200+ health/tech vendors?  If you believe that health is a product of lifstyle behaviors at least as much as health “care” services (what our

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Workers at work for the health benefits but absent when it comes to talking costs

As much as the Affordable Care Act is bolstering health insurance rolls for the uninsured, people who have enjoyed health insurance at work continue to highly value that benefit, according to a survey from Benz Communications and Quantum Workplace published April 2015. Based on a national sample of over 2,000 employees surveyed in October 2014 about workplace benefits. The research re-confirms the long-term reality of workers working in America for the health benefit. Benz/Quantum note that 89% of workers say health benefits play a part in remaining on-the-job, and half say the health benefit is a “major” part of remaining

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Humana and Weight Watchers Partner in Weight Loss for Employers

More employers are recognizing the link between workers who may be overweight or obese on one hand, and health care costs, employee engagement and productivity on the other. As a result, some companies are adopting wellness programs that focus on weight loss as part of an overall culture of health at the workplace. Humana and Weight Watchers are the latest example of two health brands coming together to address what is one of the toughest behavior changes known to humans: losing weight. Humana will extend access to Weight Watchers for the health plan’s enrollees in an integrated wellness program. The program

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Employers grow wellness programs, and ramp up support for fitness tech

Offering wellness programs is universal among U.S. employers, who roughly divide in half regarding their rationale for doing so: about one-half offer wellness initiatives to invest in and increase worker health engagement, and one-half to control or reduce health care costs. Two-thirds of companies offering wellness will increase their budgets, according to the International Foundation of Employee Benefit Plans (IFEBP)  report, Workplace Wellness Trends, 2015 survey results. The IFEBP polled 479 employers in October 2014, covering corporate, public, and multi-employer funds in the U.S. and Canada. The statistics discussed in this post refer solely to U.S. organizations included in the study

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Hug your physician – chances are, s/he’s burned out

If you’re meeting with a physician in the next week or two, put on your empathy hat: chances are, they are feeling burned-out. Overall 46% of physicians report they were burned out in 2014, up from just under 40% last year. Medscape’s Physician Lifestyle Report 2015 finds that at least one-half of physicians are burned-out who work in critical care, emergency medicine, family medicine, internal medicine, general surgery, and infectious disease (including HIV). And, at least 37% of physicians are burned-out working in all other specialties, shown in the first chart. Medscape gauges doctors’ self-assessments of burnout with a lens

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Telehealth is in demand, driven by consumer convenience and cost – American Well speaks

Evidence of the rise of retail health grows, with the data point that on-demand health care is in-demand by 2 in 3 U.S. adults. American Well released the Telehealth Index: 2015 Consumer Survey, revealing an American health public keen on video visits with doctors as a viable alternative to visiting the emergency room. Virtual visits are especially attractive to people who have children living at home. [For context, this survey defines “telehealth” as a remote consultation between doctor and patient]. Convenience drives most peoples’ interest in telehealth: saving time and money, not leaving home if feeling unwell, and “avoiding germs

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People in consumer-directed health plans are — surprise! — getting more consumer-directed

People with more financial skin in the health care game are more likely to act more cost-consciously, according to the latest Employee Benefits Research Institute (EBRI) poll on health engagement, Findings from the 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey published in December 2014. Health benefit consultants introduced consumer-directed health plans, assuming that health plan members would instantly morph in to health care consumers, seeking out information about health services and self-advocating for right-priced and right-sized health services. However, this wasn’t the case in the early era of CDHPs. Information about the cost and quality of health care services was scant,

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Building the health ecosystem: new bedfellows coming together

2015 is already becoming a year where bedfellows of different stripes are joining together to build a health care ecosystem well beyond hospitals, doctors and health plans. Announcements launched last week at the 2015 Consumer Electronics Show in Las Vegas, and coming out this week at the J.P. Morgan Conference in San Francisco, the first two weeks of 2015 reveal that new entrants and legacy health stakeholders are crossing corporate and cultural chasms to (try and) solve challenges that prevent us from getting to that Holy Grail of The Triple Aim: improving health care outcomes, driving down per capita costs,

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Health IT Forecast for 2015 – Consumers Pushing for Healthcare Transformation

Doctors and hospitals live and work in a parallel universe than the consumers, patients and caregivers they serve, a prominent Chief Medical Information Officer told me last week. In one world, clinicians and health care providers continue to implement the electronic health records systems they’ve adopted over the past several years, respond to financial incentives for Meaningful Use, and re-engineering workflows to manage the business of healthcare under constrained reimbursement (read: lower payments from payors). In the other world, illustrated here by the graphic artist Sean Kane for the American Academy of Family Practice, people — patients, healthy consumers, newly insured folks,

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Women-centered design and mobile health: heads-up, 2014 mHealth Summit

This post is written as part of the Disruptive Women on Health’s blog-fest celebrating the 2014 mHealth Summit taking place 7-11 December 2014 in greater Washington, DC. Women and mobile health: let’s unpack the intersection. On the supply side of the equation, Good Housekeeping covered health tracking-meets-fashion bling in the magazine a few weeks ago in article tucked between how to cook healthy Thanksgiving side dishes and tips on getting red wine stains out of tablecloths. This ad appeared in a major sporting goods chain’s 2014 Black Friday pre-print in my city’s newspaper last week. And along with consumer electronics brand faves like

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Women worry about being bag-ladies – the health implications of financial un-wellness

My post, Even Rich Girls Worry About Being Bag Ladies, was published in the Huffington Post this week. In the analysis, I weave the results of several seminal surveys on women, money, and health that have been conducted in the past few months. The bottom-line: even the most affluent women are financially stressed, and that stress is leading women to re-define what it means to be personally successful. When it comes to personal health, financial wellness is part of overall well-being, as defined by women who place being healthy above having money. Avoiding debt is the nuance here, not amassing

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Live from the 11th annual Connected Health Symposium – Keeping Telehealth Real

Dr. Joseph Kvedar has led the Center for Connected Health for as long as I’ve used the word “telehealth” in my work – over 20 years. After two decades, the Center and other pioneers in connected health have evidence proving the benefits, ROI (“hard” in terms of dollars, and “soft” in terms of patient and physician satisfaction), and technology efficacy for connecting health. The 11th Annual Connected Health Symposium is taking place as I write this post at the Seaport Hotel in Boston, bringing health providers, payers, plans and researchers together to share best practices, learnings and evidence supporting the

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PwC on wearables – the health opportunity is huge, but who will pay?

“A wearable future is around the corner,” PwC says. So it’s appropriate the consulting firm’s new report is indeed titled The Wearable Future. Wearable technologies — smartwatches, sensor-laden workout gear, activity tracking wristbands, and Google Glass, among them — are more than individual tracking and information devices. They’re part of a larger ecosystem called The Internet of Things (IoT), which is made of lots of stuff, each ‘thing’ incorporating a sensor that measures something. Those measurements can track virtually everything that someone does throughout the day: beyond the obvious steps taken, hours slept, and GPS coordinates, sensors can sense movement

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Dialing Dr. Verizon – the telecomms company launches virtual house calls

Expanding its wireless footprint in health care, Verizon, the telecommunications company, announced the start of Verizon Virtual Visits today. The program will be marketed to employers and health plans to enable patients to see doctors at home or when traveling, via Verizon’s wireless network. I spoke with Christine Izui, Verizon’s quality officer, mobile health solution, earlier this week about Virtual Visits. We discussed the market forces that support the growth of telehealth and, in particular, physician visits “anywhere:” There is an under-supply and poor distribution of primary care doctors and certain specialties around the U.S. Employers and health plan sponsors are

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Apple and Google and Samsung, Oh My!

Three of the world’s biggest technology companies – Apple, Google and Samsung — have made big announcements in the world of connected health in the past few weeks. A fourth is positioned to enter the fray. These major announcements illustrate the convergence of consumer technology, health, and wearables, with the potential for Big Data and population health impacts. Among the three tech giants, Samsung announced its consumer health/tech story first, on May 28, 2014, at its Digital Health Initiative meeting. Samsung unveiled the Samsung Architecture Multimodal Interactions platform, SAMI, along with the Simband prototype wristband that would enable users to

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World No Tobacco Day v2014 – let’s raise (more) taxes on tobacco

Tomorrow is World No Tobacco Day. The use of tobacco is one of the most preventable public health issues on the planet. And the global tobacco epidemic contributed to 100 million deaths around the world in the 20th century. 6 million people die every year due to tobacco use — including 600,000 deaths due to exposure to secondhand smoke. About 500 million people living today will be dead from the use of tobacco products if current smoking habits continue, the World Health Organization (WHO) expects. WHO sponsors the World No Tobacco Day every year on May 31. For this year’s

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Wearable tech + the workplace: driving employee health

Employer wellness programs are growing in the U.S., bundled with consumer-directed plans and health savings accounts. A wellness company’s work with employee groups is demonstrating that workers who adopt mobile health technologies — especially “wearables” coupled with smartphone apps — helps change behavior and drive health outcomes. Results of one such program are summarized in Wearables at Work, a technical brief from Vitality, a joint venture of Humana and Discovery Ltd., published April 23, 2014. Vitality has been working in workplace wellness since 2005, first using pedometers to track workers’ workouts. In 2008, Vitality adopted the Polar heart rate monitor for

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The appification of health – a bullish outlook from Mobiquity

Over half of people using health and fitness apps began using them over six months ago, and one-half of these people who have downloaded health and fitness apps use them daily according to survey research summarized in the report, Get Mobile, Get Healthy: The Appification of Health and Fitness from Mobiquity. The company contracted a survey conducted among 1,000 U.S. adults in March 2014 who use or plan to use mobile apps to track health and fitness. Thus the “N” in this study was a group of people already interested in self-tracking health and not representative of the broader U.S. consumer

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Employers spending more on wellness in 2014, with growing focus on food

Employers continue to invest in wellness programs aimed at improving employees’ health. In 2014, 3 in 4 employers plan to offer incentives to employees who participate in health improvement programs compared = and the financial value of these incentives has grown to $500, up from $338 in 2010. In its fifth year, the National Business Group on Health (NBGH)/Fidelity Investments have conducted their benefit consulting survey, culminating in the report, Employer Investments in Improving Employee Health. In the past 5 years, employers have increased their investments in wellness: the chart illustrates the growth of programs addressing physical activity/weight management and health eating,

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The new retail health: Bertolini of Aetna connects dots between the economy and health consumers

3 in 4 people in America will buy health care at retail with a subsidy within just a few years, according to Mark Bertolini, CEO of Aetna. Bertolini was the first keynote speaker this week at the 2014 HIMSS conference convened in Orlando. Bertolini’s message was grounded in health economics 101 (about which frequent readers of Health Populi are accustomed to hearing). A healthy community drives a healthy local economy, and healthier people are more economically satisfied, Bertolini explained. The message: health care can move from being a cost driver to being an economic engine. But getting to a healthy

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Watson goes wellness

IBM’s data analytics engine Watson, having cut its teeth on complex health care conditions like cancer, is now entering an even more challenging space: wellness. Why is wellness more challenging? Because understanding a person’s wellness goes beyond mining data from health care claims silos in hospitals, pharmacies, and physicians’ electronic health records. Wellness happens where we live, work, play and pray. Wellness is nurtured through choices made every day at home, in the workplace, and at moments-of-truth in the grocery store and restaurant where slick marketing messages planted in our subconscious compete with our more rational minds that tell us to

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A CT for $300 or $2,781 – why health price transparency matters

  Charges for medical, pharmacy and dental services can vary by more than 300%. This means that in one place, a procedure that costs $100 can cost $300 for the same treatment in another location or practice, discovered by Change Healthcare in their latest Healthcare Transparency Index 2013 Q3 Report, published in January 2014. The 300% is the average overall across dozens of health services used by the 67,000 plan members Change Healthcare analyzed based on health plan enrollees’ health care utilization in the third quarter of 2013. These health care services include office visits (behavioral health, physical therapy and

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Schizo about smoking

There’s truly good news for public health about smoking: January 11th marked the 50th anniversary of the U.S. Surgeon General’s Report on Smoking and Health. That’s five decades’ worth of progress raising peoples’ awareness about the toxic impact of nicotine and chemicals embodied in cigarettes, and deleterious impacts on health and the economy. As a result, smoking rates have been cut in half since 1964, as the downward-sloping graph illustrates. With that happy news in my subconscious, I took a long walk, tracked by my digital device, through the Venetian Hotel in Las Vegas last week, bound for the 2014 Consumer Electronics

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Health Care Everywhere at the 2014 Consumer Electronics Show

When the head of the Consumer Electronics Association gives a shout-out to the growth of health products in his annual mega-show, attention must be paid. The #2014CES featured over 300 companies devoted to “digital health” as the CEA defines the term. But if you believe that health is where we live, work, play, and pray, then you can see health is almost everywhere at the CES, from connected home tech and smart refrigerators to autos that sense ‘sick’ air and headphones that amplify phone messages for people with hearing aids, along with pet activity tracking devices like the Petbit. If

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Wear It Well – Fashion Mashes Up With Health At #CES2014

Madame Onassis got nothing on you, Rod Stewart complimented in his hit You Wear It Well in 1972. Now we can all wear it well, based on the fashion-meets-health-mashups at the 2014 Consumer Electronics Show. Several events underline this observation at the CES this year: – Fitbit has signed up Tory Burch to put her mark accessorizing the company’s activity trackers – The CSR Bluetooth smart pendant was designed with the chic jeweler Cellini; the device can receive alerts from an iPhone (think: medication adherence, or a message from mom in Florida). This is featured in the first photo. –

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mHealth will join the health ecosystem – prelude to the 2014 Consumer Electronics Show

The rise of digital health at the 2014 Consumer Electronics Show signals the hockey-stick growth of consumer-facing health devices for fitness and, increasingly, more medical applications in the hands of people, patients, and caregivers. This year at #CES2014, while the 40% growth of the CES digital health footprint will get the headlines, the underlying story will go beyond wristbands and step-tracking generating data from an N of 1 to tools that generate data to bolster shared-decision making between people and the health system, and eventually support population health. For example: – Aetna is partnering with J&J to deploy their Care4Today

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3 Things I Know About Health Care in 2014

We who are charged with forecasting the future of health and health care live in a world of scenario planning, placing bets on certainties (what we know we know), uncertainties (what we know we don’t know), and wild cards — those phenomena that, if they happen in the real world, blow our forecasts to smithereens, forcing a tabula rasa for a new-and-improved forecast. There are many more uncertainties than certainties challenging the tea leaves for the new year, including the changing role of health insurance companies and how they will respond to the Affordable Care Act implementation and changing mandates

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Employers will strongly focus on costs in health benefit plans for 2014; so must consumers

Employers who sponsor health insurance in America are at a fork on a cloudy road: they know that they’re in the midst of changes happening in the U.S. health system. Except for one certainty: that health care costs too much. So employers’ plans for health benefits in 2014 strongly focus on getting a return-on-investment from health spending in an uncertain climate, according to Deloitte’s 2013 Survey of U.S. Employers. Key findings are that: Employers will grow their use of workers’ cost-sharing, continuing to shift more financial responsibility onto employees They will expand other tactics they believe will help address cost

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Color us stressed – how to deal

Coast-to-coast, stress is the modus vivendi for most Americans: 55% of people feel stressed in every day life, according to a study from Televox. A Stressful Nation: Americans Search for a Healthy Balance paints a picture of a nation of physically inactive people working too hard and playing too little. And far more women feel the stress than men do. 64% of people say they’re stressed during a typical workday. 52% of people see stress negatively impacting their lives. And nearly one-half of people believe they could better manage their stress. As a result, physicians say that Americans are experiencing negative

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Mobile health apps – opportunity for patients and doctors to co-create the evidence

There are thousands of downloadable apps that people can use that touch on health. But among the 40,000+ mobile health apps available in iTunes, which most effectively drive health and efficient care? To answer that question, the IMS Institute for Healthcare Informatics analyzed 43,689 health, fitness and medical apps in the Apple iTunes store as of June 2013. These split into what IMS categorized as 23,682 “genuine” health care apps, and 20,007 falling into miscellaneous categories such as product-specific apps, fashion and beauty, fertility, veterinary, and apps with “gimmicks” (IMS’s word) with no obvious health benefit. Among the 23,682 so-called

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Innovating and thriving in value-based health – collaboration required

In health care, when money is tight, labor inputs like nurses and doctors stretched, and patients wanting to be treated like beloved Amazon consumers, what do you do? Why, innovate and thrive. This audacious Holy Grail was the topic for a panel II moderated today at the Connected Health Symposium, sponsored by Partners Heathcare, the Boston health system that includes Harvard’s hospitals and other blue chip health providers around the region. My panelists were 3 health ecosystem players who were not your typical discussants at this sort of meeting: none wore bow ties, and all were very entrepreneurial: Jeremy Delinsky

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Economics of obesity and heart disease: We, the People, can bend the curves

The “O” word drives health costs in America ever-upward. Without bending the obesity curve downward toward healthy BMIs, America won’t be able to bend that stubborn cost curve, either. The Economic Impacts of Obesity report from Alere Wellbeing accounts for the costs of chronic diseases and how high obesity rates play out in the forms of absenteeism, presenteeism, and direct health care costs to employers, workers and society-at-large. Among the 10 costliest physical health conditions, the top 3 are angina, hypertension and diabetes — all related to obesity and amenable to lifestyle behavior change. The top-line numbers set the context:

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7 Women and 1 Man Talking About Life, Health and Sex – Health 2.0 keeping it real

Women and binge drinking…job and financial stress…sleeplessness…caregiving challenges…sex…these were the topics covered in Health 2.0 Conference’s session aptly called “The Unmentionables.” The panel on October 1, 2013, was a rich, sobering and authentic conversation among 7 women and 1 man who kept it very real on the main stage of this mega-meeting that convenes health technology developers, marketers, health providers, insurers, investors, patient advocates, and public sector representatives (who, sadly, had to depart for Washington, DC, much earlier than intended due to the government shutdown). The Unmentionables is the brainchild of Alexandra Drane and her brilliant team at the Eliza

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Working for health care in 2013: workers’ health insurance cost burden still grows faster than wages

Insurance premium costs grew 4% for families between 2012 and 2013, with workers now bearing 39% of health premiums in 2013 compared with only 26% ten years ago, in 2003. That’s a 50% increase in health plan premium “burden” for working families, by my calculation. This snapshot of health insurance in 2013 comes to us from the 2013 Employer Health Benefits Survey, provided by the Kaiser Family Foundation (KFF) and the Health Research & Educational Trust (HRET). This research is one of the most important annual reports to hit the health care industry every year, and this year’s analysis provides strategic context

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Healthways buys into Dr. Ornish’s approach: will “Ornish-inside” scale wellness in America?

People who live in U.S. cities with low levels of well-being have twice the rate of heart attacks as people who live in healthier America. That’s 5.5% of the population in sicker America versus 2.8% of the population living in healthy America. The first chart illustrates this disparity, taken from the Gallup-Healthways index that examined 190 metropolitan areas in 2012. Based on this study, it’s good to live in parts of Utah, Nebraska and Colorado, but not so healthy to be a resident in West Virginia, Alabama, and parts of Kentucky and Ohio. Heart disease and diabetes are killing a plurality

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Cost prevents people from seeking preventive health care

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.

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What to expect from health care between now and 2018

Employers who provide health insurance are getting much more aggressive in 2013 and beyond in terms of increasing employees’ responsibilities for staying well and taking our meds, shopping for services based on cost and value, and paying doctors based on their success with patients’ health outcomes and quality of care. Furthermore, nearly one-half expect that technologies like telemedicine, mobile health apps, and health kiosks in the back of grocery stores and pharmacies are expected to change the way people regularly receive health care. What’s behind this? Increasing health care costs, to be sure, explains the 18th annual survey from the National

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As health cost increases moderate, consumers will pay more: will they seek less expensive care?

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

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As Account-Based Health Plans Grow, Will Americans Save More in Health Accounts?

The only type of health plan whose membership grew in 2012 was the consumer-directed health plan (CDHP), according to a survey from Mercer, the benefits advisors. Two-thirds of large employers expect to offer CDHPs by 2018, five years from now. 40% of all employers (small and large) anticipate offering a CDHP in five years. The growth in CDHPs going forward will be increasingly motivated by the impending “Cadillac tax” that will be levied on companies that currently offer relatively rich health benefits. Furthermore, Mercer foresees that employers will also expand wellness and health management programs with the goal of reducing health

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The emerging economy for consumer health and wellness

The notion of consumers’ greater skin in the game of U.S. health care — and the underlying theory of rational economic men and women that would drive people to greater self-care — permeated the agenda of the 2nd annual Consumer Health & Wellness Innovation Summit, chaired by Lisa Suennen of Psilos Ventures. Lisa kicked off the meeting providing a wellness market landscape, describing the opportunity that is the ‘real’ consumer-driven health care: people getting and staying well, and increasing participation in self-management of chronic conditions. The U.S. health system is transforming, she explained, with payors beginning to look like computer

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Wellness at work – Virgin tells it all

Health, happiness and engagement among employees are closely-linked and drive productivity in the workplace. But there’s a gap between the kind of wellness services employers offer workers to bolster health, and the programs that people actually want. The current state of employer wellness programs is described in a survey conducted by Virgin HealthMiles and Workforce, The Business of Healthy Employees: A Survey of Workplace Health Priorities, published in June 2013. There’s a gap between what workers want for wellness and what employers are offering. Most-demanded by workers are health on-site food choices desired by 79% of employees; but, only 33%

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Un-directed Americans in a consumer-directed healthcare world

U.S. employers have been implementing various flavors of consumer-directed health plans for the better part of a decade. But consumers feel neither “directed” nor especially competent in managing their way through these plans. It appears that employers also have their own sort of health plan illiteracy when it comes to understanding health reform — the Affordable Care Act — according to the 2013 Aflac WorkForces Report (AWR) based on a survey of 1,900 benefits managers and over 5,200 U.S. workers conducted in January 2013. While you might know the Aflac Duck, you may not be aware that Aflac is the

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The Slow Economy Has Slowed Health Spending

Why has health cost growth in the U.S. slowed in the past few years? It’s mostly due to the economy, argues the Kaiser Family Foundation in Assessing the Effects of the Economy on the Recent Slowdown of Health Spending. The answer to this question is important because, as the American economy recovers, it begs the next question: will costs increase faster once again as they did in previous go-go U.S. economies, further exacerbating the budget deficit problems in the long-term? KFF worked with Altarum to develop an economic model to answer these questions. The chart illustrates the predicted vs. actual

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Health cost transparency comes to Cummins Engine

I can think of 3 reasons why workers at Cummins Engine are blessed: They are employed. They receive health insurance from their employer. They are about to be able to access a tool designed to help them become better health care consumers. Cummins, based in Columbus, Indiana (far from Silicon Valley), has 24,000 employees and dependents who will be covered by this plan. The company ranked 186 on the Fortune list and has 46,000 employees worldwide. So the firm’s health spending would be in the range of many millions of dollars. I found the company’s employee health plan HealthSpan offering

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Bending the cost-curve: a proposal from some Old School bipartisans

Strange political bedfellows have come together to draft a formula for dealing with spiraling health care costs in the U.S. iin A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment from the Bipartisan Policy Center (BPC). The BPC was founded by Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. This report also involved Bill Frist, Pete Domenici, and former White House and Congressional Budget Office Director Dr. Alice Rivlin who together work with the Health Care Cost Containment Initiative at the BPC. The essence of the 132-page report is that the U.S. health system is

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Food = Health for employers, hospitals, health plans and consumers

Food is inextricably bound up with health whether we are well or not. Several key area of the Food=Health ecosystem made the news this week which, together, will impact public and personal health. On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. Michelin, whose bulky advertising icon Bibendum has more than one “spare tire,” introduced a program to combat health issues, including but not limited to BMI and high blood pressure, according to the

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US Health Executives Predict the ACA Will Increase Health Insurance Premiums

As a result of implementing the Affordable Care Act (health reform), most U.S. health executives crystal balls foresee health care insurance premiums will increase over 10% in the next three years. 4 in 10 predict premiums will grow over 25% over the next 3 years. This sobering forecast comes out of a Munich RE Health survey conducted among 326 health industry executives in March 2013. Those polled included representatives from health plans, managed care, disease management firms, and health insurance brokers and agents. How do health execs expect employers would deal with such fast-rising health premium costs? Why shift more

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The Rationale for CVS “Sticking” (vs. “Carroting”) It To Employees for Wellness

The Boston Herald was one of the first newspapers talking about CVS requiring workers to disclose personal health information…”or pay a $600 a year fine,” as the LA Times succinctly put the situation. The story is that CVS Caremark, the pharmacy and Rx benefits management company, is implementing a health screening program to measure height, weight, body fat, and blood pressure. These metrics are commonly collected in the process known as health risk appraisals (HRAs), which most large employers have begun to implement to help employees prevent the onset of chronic disease (think: “metabolic syndrome,” diabetes combined with overweight, for

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The Sitting Disease: health is growing at SXSW

If it’s March, it must be time for South by Southwest (SXSW), the annual conference weaving music, film and interactive tracks of speakers and conferees that overcrowds and excites Austin, Texas, with a cool vibe and even cooler ideas. I’ll be participating on Sunday 10 March 2013 at 5 pm on a panel, Sitting Will Kill You: Can Mobile Save Us?, featuring Fran Melmed, developer of the HotSeat app that nudges us to all Get Up Offa Our Things when living our typical sedentary lives; Peter Katzmarzyk, public health researcher who knows all about the relationship between too much sitting

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The future of sensors in health care – passive, designed, integrated

Here’s Ann R., who is a patient in the not-too-distance-future, when passive sensors will be embedded in her everyday life. The infographic illustrates a disruption in health care for people, where data are collected on us (with our permission) that can help us improve our own self-care, and help our clinicians know more about us outside of their offices, exam rooms and institutions. In Making Sense of Sensors: How New Technologies Can Change Patient Care, my paper for the California HealthCare Foundation, I set out to organize the many types of sensors proliferating the health care landscape, and identify key

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The Accountable Care Community opportunity

“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

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Retail and work-site clinics – medical homes for younger adults?

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

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Cost-conscious health consumers are adopting personal health IT

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

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Employers slow health cost increases for 2013 by growing consumer-directed plans

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

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Small business says stress is the #1 wellness need for employees

Nearly 50% of business start-ups view health and wellness as crucial to employee recruitment and retention. 31% of start-ups under 10 years of age have adopted wellness programs. Furthermore, 3 in 4 small companies that offer wellness programs say they positively impact the businesses’ bottom-lines. Nonetheless, more than one-half of small business — companies with fewer than 100 employees — say that there isn’t enough information available that focuses squarely on wellness in small business. These findings come from Workplace Wellness Programs in Small Business: Impacting the Bottom Line, a report from the National Small Business Association (NSBA) and Humana, details findings

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Wired health: living by numbers – a review of the event

Wired magazine, longtime evangelist for all-things-tech, has played a growing role in serving up health-tech content over the past several years, especially through the work of Thomas Goetz. This month, Wired featured an informative section on living by numbers — the theme of a new Wired conference held 15-16 October 2012 in New York City. This feels like the week of digital health on the east coast of the U.S.: several major meetings have convened that highlight the role of technology — especially, the Internet, mobile platforms, and Big Data — on health. Among the meetings were the NYeC Digital Health conference, Digital

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U.S. health insurance updates from Kaiser, EBRI and the Census Bureau; uninsurance related to poor health

The average annual premiums for employer-sponsored health insurance in 2012 are double what they were a decade ago in terms of both total premium and worker contribution increases. The picture shows the story, according to the 2012 Employer Health Benefits Survey from the Kaiser Family Foundation (KFF). This annual survey polls small, mid-size and large employers to assess their updates for providing health insurance and prescription drug coverage to active and retired employees. The percentage growth of health costs in the past year were a “modest” 4%, according to KFF. Modest is a relative term: this single digit increase is indeed much

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Wellness takes hold among large employers – and more sticks nudge workers toward health

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

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The U.S. health consumer is health-finance illiterate, and resistant to linking wellness to health plan costs

Two in 3 employees (62%) can’t estimate how much their employers spend on health benefits. Of those who could estimate the number (which is, on average, about $12,000 according to the 2012 Milliman Medical Index), most weren’t very confident in their guess. Some 23% calculated the monthly spend by employers was less than $500 a month — less than 50% the actual contribution. Thus, most U.S. health consumers don’t fully value the amount of cash their employers spend on their health care, according to a poll from the National Business Group on Health, Perceptions of Health Benefits in a Recovering

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Employees will bear more health costs to 2017 – certainty in an uncertain future

Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in

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58% of Americans self-rationing health care due to cost

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

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Health costs will increase in 2013, and employees will bear more: can wellness programs help stem the rise?

Health spending will increase by 7.5% in 2013, with employees’ contributions rising for in-network deductibles, prescription drugs and emergency room visits. 3 in 4 employers, seeking to control rising health expenses, will offer wellness programs, even though a vast majority can’t yet measure an ROI on them. The Health and Well-Being: Touchstone Survey Results from PriceWaterhouseCoopers (PwC). PwC points out that the 7.5% medical cost increase is historically lower than in recent years, as a result of structural changes in the health care market including: A sluggish economy Growing focus on cost containment Lower utilization of health services by patients Employers’ efforts

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Fruits, financial incentives and remote coaching: evidence for behavior change

Increasing intake of fruits and vegetables, coupled with remote health coaching and financial incentives, together help people adopt and maintain healthy behavior changes. This is the conclusion of a randomized controlled trial using mobile technology, published in the May 28, 2012, issue of Archives of Internal Medicine. Dr. Bonnie Spring of Northwestern University’s Department of Preventive Medicine led the study. The researchers developed the trial, called Make Better Choices, to sort out which behavior changes would enable people to reduce major risk factors for cardiovascular disease, cancer and diabetes. Four combinations were assessed in the intervention among 204 people: Increasing fruit

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The pharmaceutical landscape for 2012 and beyond: balancing cost with care, and incentives for health behaviors

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

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Wellness Ignited! Edelman panel talks about how to build a health culture in the U.S.

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

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On the road to retail health: healthcareDIY and primary care, everywhere

At the ConvUrgent Care Symposium in Orlando, attendees from the worlds of clinics, ambulatory care, hospital beds, pharmacies, medical devices, life sciences, health information, health IT, health plans, academic medical centers and professional medical societies came together to share and learn about the morphing landscape of retail health. The topline message: primary care is everywhere, and based on the response to my keynote talk this morning, every stakeholder segment gets it. My mantra, courtesy of the U.S. Surgeon General Regina Benjamin: don’t look at health in isolation, that is, where the doctor and hospital are. Health happens wherever the person

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Consumers are at the center of the business of health and wellness

The market for health and wellness has traditionally included over-the-counter medicines, gym memberships, and vitamins/minerals/supplements. In 2012, the boundaries of health/wellness are blurring beyond these line items toward preventive medical services and consumer electronics. This morphing market is discussed by Cambridge Consultants in their report on the disruptions driving The Business of Health & Wellness: Engaging consumers and making money. Cambridge correctly introduces this analysis by saying that economics, the growing prevalence of chronic diseases, an aging population, and demand consumers are shaping health/wellness, “recharacterizing” the market as one driven by “life events.” Cambridge sees that health consumers are changing their spending

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Workplace wellness: the cost of unhealthy behaviors in the American workforce is $623 per worker

The health status of the American workforce is declining. Every year, unhealthy behaviors of the U.S. workforce cost employers $623 per employee annually, according to the Thomson Reuters Workforce Wellness Index. People point to smoking, obesity and stress as the 3 most important factors impacting health costs. Thomson Reuters and NPR polled over 3,000 Americans on their health behaviors, utilization and costs of health care, publishing their results in a summary, Paying for Unhealthy Behaviors in October 2011. 4 in 5 overall — and 9 in 10 of those with over $50,000 annual income — believe that people with healthy behaviors should receive a

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