HealthPopuli.com http://www.healthpopuli.com Health/Care is Everywhere Fri, 26 Aug 2016 12:07:53 +0000 en-EN hourly 1 14255750 What UPS Knows About Retail Shopping Applies to Health http://www.healthpopuli.com/2016/08/26/consumers-think-wearables-think-health-says-ups/ http://www.healthpopuli.com/2016/08/26/consumers-think-wearables-think-health-says-ups/#respond Fri, 26 Aug 2016 01:09:54 +0000 http://www.healthpopuli.com/?p=15680   Some 18% of U.S. consumers use a wearable device, according to the 2016 UPS Pulse of the Online Shopper survey. UPS researched tech-savvy shoppers with an eye to understanding where and how people buy stuff – and of course, how they ship it given the company’s core logistics business. (“Tech-savvy” in this study means consumers had purchased at least two items online in a typical 3-month period). Overall, Millennials adopt devices and do more tech-shopping compared with other generations, but UPS notes that other groups are indeed shopping for tech and shipping it, too. Millennials are leading the way, but even older generations can “look” Millennial in their shopping behaviors. The 2015-2016 comparison of wearable device adoption shows growth from 13% in 2015 to 18% in 2016, heavily driven by Millennials’ interest. 1 in 6 people who did not currently own a wearable device are interested in acquiring one in the next year, UPS found. Current wearable users do the following activities: 76% monitor fitness (with more Non-Millennials doing so at 82%, and more women than men) 60% use smartwatches, led by Millennials 38% use GPS functions 30% monitor “health” (as opposed to fitness), 2x the number of Millennials (39% vs. 20% Non-Millennials) 23% use eyewear, again double the number of Millennials (31%) vs. Non-Millennials (15%). The only other device categories showing growth were connected TVs, increasing from 28% in 2015 to 32%, and smartphones growing from 74% of adoption in 2015 to 77% of adoption in 2016, PC purchases and tablets showed flat adoption (95% and 57%, respectively). The most important factors consumers consider when purchasing a wearable device are led by health reasons: 62% say the goal is to establish better fitness and health habits, compared with 47% who are tech-loving (“I like to have the most up-to-date technology”) and convenience-appreciating (47% liking convenient access compared with other devices), with another 47% wanting to listen to music via the device. UPS surveyed 5,330 consumers in January and February 2016 who had purchased at least 2 items online in a typical 3-month period. Health Populi’s Hot Points: UPS has a vested interested in people shopping online, but they also benefit from people shopping in retail stores because they ship “everywhere.” Increasingly, the company finds that consumers want their stuff shipped “everywhere,” too — people in urban areas often find it difficult to receive their goods securely; people in rural areas can also have challenges in getting their stuff to their homes. So shoppers are asking UPS to deliver stuff to retailers’ stores, friends’ and families’ homes, a UPS location, to the workplace, or other location. Increasingly, shopping is being done via smartphones — 25% expecting to do so more frequently going forward; and, 24% of tablet-using shoppers expect to shop more via mobile tablet as well. The bottom-line: consumers shop and live omni-channel, multi-channel, 24×7, in “I-want-it-now” mode. (Thank Amazon Prime, in part, for priming consumers in this regard). 3 in 4 people are looking for a peer-review or recommendation. 70% of people are looking for easy access to information on a retailer’s site, including real-time inventory. And, 59% of shoppers would like product recommendations based on past browsing and buying behavior — that is, personalization. This is the new retail, and a challenge for incumbent retailers. That’s the prime (pardon the pun) reason Walmart purchased Jet.com earlier this month, for the behemoth retailer’s ability to grow omni-channel capabilities. Consumers’ expectation in their retail shopping lives are bleeding over into their health-lives, too. Health/care is expected everywhere, and should be as people take on more health financial responsibility….they’ll exercise more clout and vote with their out-of-pocket spending.

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UPS craving better health UPS Pulse of Online Shopper 2016 Aug 2016Some 18% of U.S. consumers use a wearable device, according to the 2016 UPS Pulse of the Online Shopper survey.

UPS researched tech-savvy shoppers with an eye to understanding where and how people buy stuff – and of course, how they ship it given the company’s core logistics business. (“Tech-savvy” in this study means consumers had purchased at least two items online in a typical 3-month period).

Overall, Millennials adopt devices and do more tech-shopping compared with other generations, but UPS notes that other groups are indeed shopping for tech and shipping it, too. Millennials are leading the way, but even older generations can “look” Millennial in their shopping behaviors.

The 2015-2016 comparison of wearable device adoption shows growth from 13% in 2015 to 18% in 2016, heavily driven by Millennials’ interest.

1 in 6 people who did not currently own a wearable device are interested in acquiring one in the next year, UPS found. Current wearable users do the following activities:

  • 76% monitor fitness (with more Non-Millennials doing so at 82%, and more women than men)
  • 60% use smartwatches, led by Millennials
  • 38% use GPS functions
  • 30% monitor “health” (as opposed to fitness), 2x the number of Millennials (39% vs. 20% Non-Millennials)
  • 23% use eyewear, again double the number of Millennials (31%) vs. Non-Millennials (15%).

The only other device categories showing growth were connected TVs, increasing from 28% in 2015 to 32%, and smartphones growing from 74% of adoption in 2015 to 77% of adoption in 2016, PC purchases and tablets showed flat adoption (95% and 57%, respectively).

The most important factors consumers consider when purchasing a wearable device are led by health reasons: 62% say the goal is to establish better fitness and health habits, compared with 47% who are tech-loving (“I like to have the most up-to-date technology”) and convenience-appreciating (47% liking convenient access compared with other devices), with another 47% wanting to listen to music via the device.

UPS surveyed 5,330 consumers in January and February 2016 who had purchased at least 2 items online in a typical 3-month period.

Health Populi’s Hot Points: UPS has a vested interested in people shopping online, but they also benefit from people shopping in retail stores because they ship “everywhere.” Increasingly, the company finds that consumers want their stuff shipped “everywhere,” too — people in urban areas often find it difficult to receive their goods securely; people in rural areas can also have challenges in getting their stuff to their homes. So shoppers are asking UPS to deliver stuff to retailers’ stores, friends’ and families’ homes, a UPS location, to the workplace, or other location.

Increasingly, shopping is being done via smartphones — 25% expecting to do so more frequently going forward; and, 24% of tablet-using shoppers expect to shop more via mobile tablet as well.

The bottom-line: consumers shop and live omni-channel, multi-channel, 24×7, in “I-want-it-now” mode. (Thank Amazon Prime, in part, for priming consumers in this regard). 3 in 4 people are looking for a peer-review or recommendation. 70% of people are looking for easy access to information on a retailer’s site, including real-time inventory. And, 59% of shoppers would like product recommendations based on past browsing and buying behavior — that is, personalization.

This is the new retail, and a challenge for incumbent retailers. That’s the prime (pardon the pun) reason Walmart purchased Jet.com earlier this month, for the behemoth retailer’s ability to grow omni-channel capabilities.

Consumers’ expectation in their retail shopping lives are bleeding over into their health-lives, too. Health/care is expected everywhere, and should be as people take on more health financial responsibility….they’ll exercise more clout and vote with their out-of-pocket spending.

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Consumers Show Low Demand For Connected Health, Parks Finds http://www.healthpopuli.com/2016/08/25/consumers-show-low-demand-connected-health-parks-finds/ http://www.healthpopuli.com/2016/08/25/consumers-show-low-demand-connected-health-parks-finds/#respond Thu, 25 Aug 2016 01:27:00 +0000 http://www.healthpopuli.com/?p=15668 People living in only 1 in 10 homes with broadband are “very interested” in connected health services, like a personal health coach, a remote health monitoring app that connects to and notifies a healthcare provider, or a clinician collecting vital signs virtually. This finding comes out of a survey from Parks Associates. This is a relatively low consumer demand statistic for digital health, compared with many other surveys we’ve mined here on Health Populi. While these are not apples-to-apples comparisons — note that Parks Associates focus on broadband households — a recent study to consider is Accenture’s consumer research published in March 2016, which found that the number of consumers using mobile health apps grew to 33% in 2016, and those using health wearables, 21%. Parks Associates gauges that only 13 to 14% of U.S. broadband holds “show interest” in remote health monitoring, personal health coaching, or wearable health tracking that connects back to clinicians. The company recommends that free trial periods with the products and services, and a pay-as-you-go approach (without requiring long term contracts) would help grow adoption of connected health services. Health Populi’s Hot Points:  The recently-launched wearables database from Vandrico found at least 434 wearable health devices on the market that are worn, literally, from head to toe (well, ankle). That’s a rich and crowded supply side, mostly aimed direct-to-consumer. And speaking of consumer, we expect to see even more product launches for health-focused wearables at the 2017 CES (the Consumer Electronics Show) in Las Vegas in January 2017. Many of these will be smartwatches with embedded health apps and sensors. The growth of adoption of connected health programs and technologies will be largely driven through the healthcare system “prescribing,” or recommending, the devices for use in chronic care management. Underlying this trend would be the migration from volume-based reimbursement to value-based payment and other incentive-based financial nudges for both providers and patients. Also, look to corporate wellness programs to be an engine for inducing demand for connected health, which will move Parks’ relatively low demand number up toward a tipping point by 2018.

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Parks-Associates--Consumers-Very-Interested-in-Health-Services (1)People living in only 1 in 10 homes with broadband are “very interested” in connected health services, like a personal health coach, a remote health monitoring app that connects to and notifies a healthcare provider, or a clinician collecting vital signs virtually. This finding comes out of a survey from Parks Associates.

This is a relatively low consumer demand statistic for digital health, compared with many other surveys we’ve mined here on Health Populi. While these are not apples-to-apples comparisons — note that Parks Associates focus on broadband households — a recent study to consider is Accenture’s consumer research published in March 2016, which found that the number of consumers using mobile health apps grew to 33% in 2016, and those using health wearables, 21%.

Parks Associates gauges that only 13 to 14% of U.S. broadband holds “show interest” in remote health monitoring, personal health coaching, or wearable health tracking that connects back to clinicians.

The company recommends that free trial periods with the products and services, and a pay-as-you-go approach (without requiring long term contracts) would help grow adoption of connected health services.

Health Populi’s Hot Points:  The recently-launched wearables database from Vandrico found at least 434 wearable health devices on the market that are worn, literally, from head to toe (well, ankle). That’s a rich and crowded supply side, mostly aimed direct-to-consumer. And speaking of consumer, we expect to see even more product launches for health-focused wearables at the 2017 CES (the Consumer Electronics Show) in Las Vegas in January 2017. Many of these will be smartwatches with embedded health apps and sensors.

The growth of adoption of connected health programs and technologies will be largely driven through the healthcare system “prescribing,” or recommending, the devices for use in chronic care management. Underlying this trend would be the migration from volume-based reimbursement to value-based payment and other incentive-based financial nudges for both providers and patients. Also, look to corporate wellness programs to be an engine for inducing demand for connected health, which will move Parks’ relatively low demand number up toward a tipping point by 2018.

The post Consumers Show Low Demand For Connected Health, Parks Finds appeared first on HealthPopuli.com.

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Aging America Is Driving Growth in Federal Healthcare Spending http://www.healthpopuli.com/2016/08/24/aging-america-driving-growth-federal-healthcare-spending/ http://www.healthpopuli.com/2016/08/24/aging-america-driving-growth-federal-healthcare-spending/#respond Wed, 24 Aug 2016 20:19:13 +0000 http://www.healthpopuli.com/?p=15654 Federal healthcare program costs are the largest component of mandatory spending in the U.S. budget, according to An Update to the Budget and Economic Outlook: 2016 to 2026 from the U.S. Congressional Budget Office (CBO). Federal spending for healthcare will increase $77 billion in 2016, about 8% over 2015, for a total of $1.1 trillion. The CBO believes that number overstates the growth in Medicare and Medicaid because of a one-time payment shift of $22 bn to Medicare (from 2017 back into 2016); adjusting for this, CBO sees Federal healthcare spending growing 6% (about $55 bn) this year. The driver of the growth in Medicare spending is greater costs per enrollee — largely due to prescription drugs, where spending for them is increasing 15% this year. The first chart illustrates the macro underlying driver of Federal healthcare cost growth in the longer-term CBO forecast: the aging of America. “The number of people age 65 or older is now more than twice what it was 50 years ago,” the CBO report explains. “Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries in these programs.” That will translate into projected spending for people age 65 and older in three big programs — Medicaid, Medicare and Social Security — to grow from one-third of federal noninterest spending in 2016 to 40% in 2026. Health Populi’s Hot Points:  Spending on prescription drugs in Medicare rose 17% in 2014, discussed in the Medicare Part D report published by the Center for Medicare and Medicaid Services (CMS) earlier this month.  (FYI, the data represents about 70% of all Medicare beneficiaries in the CMS methodology). At the same time, claims (utilization) for prescription drugs went up only about 3%. The 17% cost increase for 2014 was much higher than the 12.6% Rx price growth in 2013. By number of claims (prescriptions written and filled), the top 10 drugs prescribed for Medicare enrollees were all generics (led by Lisinopril, and ACE inhibitor for high blood pressure), Levothyroxine sodium (for thyroid), and Amlodipine Besylate (for blood pressure and angina). The top 10 drugs by spending were all branded medicines, led by Sovaldi (to treat Hepatitis C) with $3.1 bn in costs for 2014. The second largest spending for a prescription drug in 2014 was for Nexium (for acid reflux), closely followed by Crestor (for cholesterol management), Abilify (for mental health), and Advair (for COPD and respiratory conditions). There is a strong economic argument for prescription drugs when they help to prolong human life and quality of life, and keep patients out of expensive hospital inpatient beds. This is certainly the case for the bulk of the top ten generic drugs by claims, which help manage heart disease, gastrointestinal issues, and respiratory conditions. For the growing roster of high-cost specialty drugs, the return-on-investment — through health economic outcomes research — will become increasingly important to calculate for payors. As Americans age into Medicare, they become higher utilizers/consumers of prescription drugs, so will be looking through their own lens for an ROI on their out-of-pocket spending on drugs. This is true, as well, for younger people managing chronic conditions, or facing acute diagnoses like Hep C, various cancers, among other conditions for which specialty drug portfolios are growing. The current front-page story covered in mass media, not just trade press, involves the hockey-stick pricing of EpiPen, one of the most popular medicines on the market — especially for young people. The issue made the cover of USA Today this week, and the major broadcast networks. The five-fold price increase from 2009 to 2016 has enraged parents and patients, along with the White House. President Obama signed legislation in 2013 ensuring kids’ access to EpiPen in schools – the School Access to Emergency Epinephrine Act. I covered the latest Fidelity retirement projections for health costs in Health Populi earlier this month. The magic number is $260,000 for a couple retiring in 2016. Much of that number will go to specialty drugs. Transparency and patient-powered research will help consumers understand the value of expensive medicines in the context of overall healthcare spending. The pharma and life science industry have their work cut out for them. In the immediate term, this issue will be one of the very few on which Presidential hopefuls Hillary Clinton and Donald Trump will converge.

The post Aging America Is Driving Growth in Federal Healthcare Spending appeared first on HealthPopuli.com.

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Population by age group CBO Aug 2016Federal healthcare program costs are the largest component of mandatory spending in the U.S. budget, according to An Update to the Budget and Economic Outlook: 2016 to 2026 from the U.S. Congressional Budget Office (CBO).

Federal spending for healthcare will increase $77 billion in 2016, about 8% over 2015, for a total of $1.1 trillion. The CBO believes that number overstates the growth in Medicare and Medicaid because of a one-time payment shift of $22 bn to Medicare (from 2017 back into 2016); adjusting for this, CBO sees Federal healthcare spending growing 6% (about $55 bn) this year.

The driver of the growth in Medicare spending is greater costs per enrollee — largely due to prescription drugs, where spending for them is increasing 15% this year.

The first chart illustrates the macro underlying driver of Federal healthcare cost growth in the longer-term CBO forecast: the aging of America. “The number of people age 65 or older is now more than twice what it was 50 years ago,” the CBO report explains. “Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries in these programs.”

That will translate into projected spending for people age 65 and older in three big programs — Medicaid, Medicare and Social Security — to grow from one-third of federal noninterest spending in 2016 to 40% in 2026.

Medicare Part D Rx by Costs 2014 CMSHealth Populi’s Hot Points:  Spending on prescription drugs in Medicare rose 17% in 2014, discussed in the Medicare Part D report published by the Center for Medicare and Medicaid Services (CMS) earlier this month.  (FYI, the data represents about 70% of all Medicare beneficiaries in the CMS methodology). At the same time, claims (utilization) for prescription drugs went up only about 3%.

The 17% cost increase for 2014 was much higher than the 12.6% Rx price growth in 2013.

By number of claims (prescriptions written and filled), the top 10 drugs prescribed for Medicare enrollees were all generics (led by Lisinopril, and ACE inhibitor for high blood pressure), Levothyroxine sodium (for thyroid), and Amlodipine Besylate (for blood pressure and angina).

The top 10 drugs by spending were all branded medicines, led by Sovaldi (to treat Hepatitis C) with $3.1 bn in costs for 2014. The second largest spending for a prescription drug in 2014 was for Nexium (for acid reflux), closely followed by Crestor (for cholesterol management), Abilify (for mental health), and Advair (for COPD and respiratory conditions).

There is a strong economic argument for prescription drugs when they help to prolong human life and quality of life, and keep patients out of expensive hospital inpatient beds. This is certainly the case for the bulk of the top ten generic drugs by claims, which help manage heart disease, gastrointestinal issues, and respiratory conditions.

For the growing roster of high-cost specialty drugs, the return-on-investment — through health economic outcomes research — will become increasingly important to calculate for payors.

As Americans age into Medicare, they become higher utilizers/consumers of prescription drugs, so will be looking through their own lens for an ROI on their out-of-pocket spending on drugs. This is true, as well, for younger people managing chronic conditions, or facing acute diagnoses like Hep C, various cancers, among other conditions for which specialty drug portfolios are growing.

EpiPen pricesThe current front-page story covered in mass media, not just trade press, involves the hockey-stick pricing of EpiPen, one of the most popular medicines on the market — especially for young people. The issue made the cover of USA Today this week, and the major broadcast networks. The five-fold price increase from 2009 to 2016 has enraged parents and patients, along with the White House. President Obama signed legislation in 2013 ensuring kids’ access to EpiPen in schools – the School Access to Emergency Epinephrine Act.

I covered the latest Fidelity retirement projections for health costs in Health Populi earlier this month. The magic number is $260,000 for a couple retiring in 2016. Much of that number will go to specialty drugs. Transparency and patient-powered research will help consumers understand the value of expensive medicines in the context of overall healthcare spending. The pharma and life science industry have their work cut out for them. In the immediate term, this issue will be one of the very few on which Presidential hopefuls Hillary Clinton and Donald Trump will converge.

The post Aging America Is Driving Growth in Federal Healthcare Spending appeared first on HealthPopuli.com.

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Knowing And Acting On How Patients Think Will Improve Health and Healthcare http://www.healthpopuli.com/2016/08/22/knowing-acting-patients-think-will-improve-health-healthcare/ http://www.healthpopuli.com/2016/08/22/knowing-acting-patients-think-will-improve-health-healthcare/#comments Mon, 22 Aug 2016 15:35:50 +0000 http://www.healthpopuli.com/?p=15642 “In the developed world, patient disengagement has become the new killer disease — not the lack of diagnostic devices, trained physicians or efficacious treatment options,” argues Andrea LaFountain, PhD, in her book, How Patients Think. Disbanding prescription drugs in advance of doctors’ instructions, postponing lab and diagnostic tests, and avoiding daily blood glucose testing when managing diabetes are just some examples of “how patients think” about health care and the many tasks involved in caring for oneself and the health of loved ones. But better understanding how patients think — technically speaking, the cognitive neuropsychology underneath the thinking — can help health/care stakeholders better design care processes, programs, and products. It’s well-documented that health dis-engagement leads to poor health outcomes and higher costs. LaFountain quotes a price tag of $3 billion a year in unnecessary costs for diabetes when Medicare beneficiaries disengage from self-care and follow up with doctors, other healthcare providers, and self-care (taking prescribed drugs, blood sugar testing, exercise, and other DIY healthcare tasks). Of course, patient disengagement isn’t just a challenge in diabetes: patients diagnosed with all sorts of medical conditions can avoid necessary care, resulting in about $260 bn of annual costs that could be conserved with greater engagement. LaFountain begins her thesis by pointing to where a patient’s thinking is rooted — and where people can make what seem to be irrational decisions about their health and health care: the executive function system in the brain. This covers: planning and decision-making, error correction and trouble-shooting, situations where responses are not well-learned or require new-new actions for the person, dangerous or technically difficult situation, and scenarios that require overcoming strong habits or temptations. Health behaviors can fall into one or several of these areas. Complex healthcare situations, like trying to get smoking or deal with the many daily tasks to manage diabetes, can challenge the person trying to make a behavior change due to the health programs lack of understanding how patients think. Thus, the problem is not disengaged patients, LaFountain notes: the problem is the status quo, out-dated models of health care given what we know we know about how the brain works in complex health-decision situations. In the U.S., that status quo is driven by outmoded claim-based business models which can nudge people in the wrong direction.  LaFountain lays out the case and flow for developing a scientific platform that underpins sound programming for health behavior change, based on cognitive science and health psychology. Ultimately, cognition precedes behavior, which is “Course Correction #10” in the book. “Without a change in cognition, there is no change in behavior.” Health Populi’s Hot Points:  The status quo LaFountain points to (e.g., outmoded claims-based business models) can nudge people in the wrong direction. In my health economics world, I would point to the adverse impacts of high-deductible health plans, nudging some people to postpone necessary care, or not filling and taking a prescription as instructed. Our colleagues at Sloane-Kettering have termed this “financial toxicity,” another side-effect beyond clinical toxicity, discussed here in Health Populi. “Course Correction #8” in the book is for current programs to target the sickest patients to impact population health and costs. Currently, so many behavior change programs focus on wellness and healthy sectors, and affluent, more health-literate populations. As she asserts and understands through research, one size doesn’t fit all in health behave change. This calls for a more deliberate approach to patient engagement and resource allocation, LaFountain writes — sharing care with the right patient with the right intervention at the right time. Sounds straightforward, but that’s not how American healthcare functions in 2016. Patient engagement can be “the most mutable predictor of patient outcomes,” LaFountain quotes Katherine Kahn in her classic column, Moving Research From Bench to Bedside to Community: There Is Still More to Do in the Journal of Clinical Oncology, February 2008. Recognizing and acting on patients’ central role in driving population health is critical for realizing its full impacts for public health — and optimal individual impacts for personal, personalized health.

The post Knowing And Acting On How Patients Think Will Improve Health and Healthcare appeared first on HealthPopuli.com.

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How patients think Andrea LaFountain“In the developed world, patient disengagement has become the new killer disease — not the lack of diagnostic devices, trained physicians or efficacious treatment options,” argues Andrea LaFountain, PhD, in her book, How Patients Think.

Disbanding prescription drugs in advance of doctors’ instructions, postponing lab and diagnostic tests, and avoiding daily blood glucose testing when managing diabetes are just some examples of “how patients think” about health care and the many tasks involved in caring for oneself and the health of loved ones.

But better understanding how patients think — technically speaking, the cognitive neuropsychology underneath the thinking — can help health/care stakeholders better design care processes, programs, and products.

It’s well-documented that health dis-engagement leads to poor health outcomes and higher costs. LaFountain quotes a price tag of $3 billion a year in unnecessary costs for diabetes when Medicare beneficiaries disengage from self-care and follow up with doctors, other healthcare providers, and self-care (taking prescribed drugs, blood sugar testing, exercise, and other DIY healthcare tasks).

Of course, patient disengagement isn’t just a challenge in diabetes: patients diagnosed with all sorts of medical conditions can avoid necessary care, resulting in about $260 bn of annual costs that could be conserved with greater engagement.

LaFountain begins her thesis by pointing to where a patient’s thinking is rooted — and where people can make what seem to be irrational decisions about their health and health care: the executive function system in the brain. This covers: planning and decision-making, error correction and trouble-shooting, situations where responses are not well-learned or require new-new actions for the person, dangerous or technically difficult situation, and scenarios that require overcoming strong habits or temptations. Health behaviors can fall into one or several of these areas.

Complex healthcare situations, like trying to get smoking or deal with the many daily tasks to manage diabetes, can challenge the person trying to make a behavior change due to the health programs lack of understanding how patients think. Thus, the problem is not disengaged patients, LaFountain notes: the problem is the status quo, out-dated models of health care given what we know we know about how the brain works in complex health-decision situations.

In the U.S., that status quo is driven by outmoded claim-based business models which can nudge people in the wrong direction. 

LaFountain lays out the case and flow for developing a scientific platform that underpins sound programming for health behavior change, based on cognitive science and health psychology.

Ultimately, cognition precedes behavior, which is “Course Correction #10” in the book. “Without a change in cognition, there is no change in behavior.”

Health Populi’s Hot Points:  The status quo LaFountain points to (e.g., outmoded claims-based business models) can nudge people in the wrong direction. In my health economics world, I would point to the adverse impacts of high-deductible health plans, nudging some people to postpone necessary care, or not filling and taking a prescription as instructed. Our colleagues at Sloane-Kettering have termed this “financial toxicity,” another side-effect beyond clinical toxicity, discussed here in Health Populi.

“Course Correction #8” in the book is for current programs to target the sickest patients to impact population health and costs. Currently, so many behavior change programs focus on wellness and healthy sectors, and affluent, more health-literate populations.

As she asserts and understands through research, one size doesn’t fit all in health behave change. This calls for a more deliberate approach to patient engagement and resource allocation, LaFountain writes — sharing care with the right patient with the right intervention at the right time. Sounds straightforward, but that’s not how American healthcare functions in 2016.

Patient engagement can be “the most mutable predictor of patient outcomes,” LaFountain quotes Katherine Kahn in her classic column, Moving Research From Bench to Bedside to Community: There Is Still More to Do in the Journal of Clinical Oncology, February 2008. Recognizing and acting on patients’ central role in driving population health is critical for realizing its full impacts for public health — and optimal individual impacts for personal, personalized health.

The post Knowing And Acting On How Patients Think Will Improve Health and Healthcare appeared first on HealthPopuli.com.

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Naloxone in Retail Health – Helping The Opioid Epidemic at Pharmacies and Grocery Stores http://www.healthpopuli.com/2016/08/18/naloxone-retail-health-helping-opioid-epidemic-pharmacies-grocery-stores/ http://www.healthpopuli.com/2016/08/18/naloxone-retail-health-helping-opioid-epidemic-pharmacies-grocery-stores/#respond Thu, 18 Aug 2016 13:23:35 +0000 http://www.healthpopuli.com/?p=15621 The ranks of pharmacies making available the overdose reversal medication naloxone without a prescription or seeing a doctor, is fast-growing. These announcements from retail pharmacy chains and grocery stores is a collective retail health-response to the opioid epidemic, a mainstream public health challenge across America. Naloxone is used in the event of an overdose. It can reverse the impacts of opioids, administered by injection or nasal spray. The statistics on opioid overdoses in the U.S. are chilling. Mortality (death rate) from opioid overdose in the U.S. grew 200% since 2000. Deaths have been higher among people between 25 and 44 years of age, and in the southern U.S. Note the latest press releases from pharmacy chains and supermarkets offering “free naloxone” without prescription: Fred’s Pharmacy makes naloxone prescription-free in five states (Alabama, Kentucky, Mississippi, North Carolina and Tennessee) Kroger sells naloxone at all of the grocer’s pharmacies in Kentucky, which ranks in the top five states with the highest overdose death rate according to the CDC. Kroger worked with Dr. Jeremy Engel of Bellevue Primary Care to develop a protocol and processes for dispensing naloxone without a prescription in the state as well as Trish Freeman, RPh, PhD, President of Kentucky Pharmacists Association (KPhA) and clinical associate professor at the University of Kentucky College of Pharmacy, on staff training. CVS Health is offering naloxone without prescription in 31 states, “dedicated to helping the communities we serve address and prevent drug abuse…expanding access to naloxone to give more people a chance to get the help they need for recovery,” explained Tom Davis, VP pharmacy professional practices at CVS Pharmacy. Fruth Pharmacy, a regional chain in Ohio and West Virginia, provides naloxone without prescription. Fruth’s is family-owned company with 29 storefronts in Ohio, West Virginia, and Kentucky. In July, Walgreens expanded safe medication drop-off kiosks in 300 stores, where consumers can dispose of unwanted medications (including controlled substances) for free. Walgreens is looking to expand the free naloxone program to at least 7,000 of its 8,200 pharmacies, according to the company’s press release. Tonya Shackleford, Fred’s Pharmacy director of clinical and professional services, said that, “Research shows, if consumers are given access to life-saving countermeasures for known or suspected opioid overdoses, these events will decrease and lives will be saved.” Health Populi’s Hot Points:  One important way to stem the prescription of opioids is measuring the prescribing habits of clinicians through ePrescribing mandates. Surescripts latest report into ePrescribing found the number of providers who now can prescribe controlled substances digitally grew 359% in 2015, accompanied by a 600% rise in prescriptions for controlled substances like morphine and oxycodone, among others. In July 2016, Dr. Devon Herrick of the National Center for Policy Analysis argued to make ePrescribing mandatory to deal with the opioid epidemic. To fight opioid addiction, it will take a village, and there are many barriers to villagers coming together to stem this epidemic. They include community pharmacists having tough conversations with doctors and other prescribers, stigma around addiction, and state legislation where there isn’t yet a naloxone access law.

The post Naloxone in Retail Health – Helping The Opioid Epidemic at Pharmacies and Grocery Stores appeared first on HealthPopuli.com.

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Naloxone-Feb-2016-MAP Pharmacies Feb 2016The ranks of pharmacies making available the overdose reversal medication naloxone without a prescription or seeing a doctor, is fast-growing. These announcements from retail pharmacy chains and grocery stores is a collective retail health-response to the opioid epidemic, a mainstream public health challenge across America.

Naloxone is used in the event of an overdose. It can reverse the impacts of opioids, administered by injection or nasal spray.

The statistics on opioid overdoses in the U.S. are chilling. Mortality (death rate) from opioid overdose in the U.S. grew 200% since 2000. Deaths have been higher among people between 25 and 44 years of age, and in the southern U.S.

Note the latest press releases from pharmacy chains and supermarkets offering “free naloxone” without prescription:

  • Fred’s Pharmacy makes naloxone prescription-free in five states (Alabama, Kentucky, Mississippi, North Carolina and Tennessee)
  • Kroger sells naloxone at all of the grocer’s pharmacies in Kentucky, which ranks in the top five states with the highest overdose death rate according to the CDC. Kroger worked with Dr. Jeremy Engel of Bellevue Primary Care to develop a protocol and processes for dispensing naloxone without a prescription in the state as well as Trish Freeman, RPh, PhD, President of Kentucky Pharmacists Association (KPhA) and clinical associate professor at the University of Kentucky College of Pharmacy, on staff training.
  • CVS Health is offering naloxone without prescription in 31 states, “dedicated to helping the communities we serve address and prevent drug abuse…expanding access to naloxone to give more people a chance to get the help they need for recovery,” explained Tom Davis, VP pharmacy professional practices at CVS Pharmacy.
  • Fruth Pharmacy, a regional chain in Ohio and West Virginia, provides naloxone without prescription. Fruth’s is family-owned company with 29 storefronts in Ohio, West Virginia, and Kentucky.
  • Walgreens safe medication disposal kiosksIn July, Walgreens expanded safe medication drop-off kiosks in 300 stores, where consumers can dispose of unwanted medications (including controlled substances) for free. Walgreens is looking to expand the free naloxone program to at least 7,000 of its 8,200 pharmacies, according to the company’s press release.

Tonya Shackleford, Fred’s Pharmacy director of clinical and professional services, said that, “Research shows, if consumers are given access to life-saving countermeasures for known or suspected opioid overdoses, these events will decrease and lives will be saved.”

CDC opioid addiction prescriptionsHealth Populi’s Hot Points:  One important way to stem the prescription of opioids is measuring the prescribing habits of clinicians through ePrescribing mandates. Surescripts latest report into ePrescribing found the number of providers who now can prescribe controlled substances digitally grew 359% in 2015, accompanied by a 600% rise in prescriptions for controlled substances like morphine and oxycodone, among others. In July 2016, Dr. Devon Herrick of the National Center for Policy Analysis argued to make ePrescribing mandatory to deal with the opioid epidemic.
To fight opioid addiction, it will take a village, and there are many barriers to villagers coming together to stem this epidemic. They include community pharmacists having tough conversations with doctors and other prescribers, stigma around addiction, and state legislation where there isn’t yet a naloxone access law.

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Health Care Costs in Retirement Will Run $260K If You’re Retiring This Year http://www.healthpopuli.com/2016/08/17/health-care-costs-retirement-will-run-260k-youre-retiring-year/ http://www.healthpopuli.com/2016/08/17/health-care-costs-retirement-will-run-260k-youre-retiring-year/#respond Wed, 17 Aug 2016 14:46:04 +0000 http://www.healthpopuli.com/?p=15597 If you’re retiring in 2016, you’ll need $260,000 to cover your health care costs during your retirement years. In 2015, that number was $245,000, so retiree health care costs increased 6% in one year according to Fidelity’s Retirement Health Care Cost Estimator. The 6% annual cost increase is exactly what the National Business Group on Health found in their recently published 2017 Health Plan Design Survey polling large employers covering health care, discussed here in Health Populi. The 6% health care cost increases are driven primary by people using more health services and the higher costs for many medicines — specifically, specialty drugs whose costs are fast-increasing (covered here in Health Populi, The Rise and Rise of (Specialty) Prescription Drug Prices. The $260K covers people in the U.S. retiring with traditional Medicare coverage paying insurance premiums, health service copayments and deductibles, and out-of-pocket expenses for prescription drugs. Fidelity expects that health care spending costs will continue to increase more in the coming years — albeit more slowly than the double-digit increases of the mid-2000s. Health Populi’s Hot Points:  To save one-quarter of a million dollars as of mid-2016 would mean that a 21-year-old person starting in 1971 would have had to invest $136 a month, every month, for 45 years assuming a 5% return compounded annually. The fact is that a 5% return is well above any sort of savings accounts or FDIC-protected investments a U.S. investor might have garnered even if they religiously put away $136 monthly for 45 years. Medical inflation, even at a “low” 6% per annum, is still significantly over general consumer price inflation which is been very low in the past several years. Fidelity is in the investment business, and so tethered to this press release on retirement costs is a recommendation to save in Health Savings Accounts (HSAs) — with their triple-tax advantage. I am a fan of these and often discuss them in my work — recently here for the Intuit Tax and Financial Center. The new consumer-facing retail health world in the U.S. requires us to don financial wellness hats, as healthcare money savers. The good news is that more Americans are saving more for retirement, Bankrate learned in a consumer survey finding that Americans felt greater financial security in mid-2016. Health citizens of America will need to keep that sense of savings going over the long haul to be able to pay for health care services during retirement.    

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Fidelity retirement health costs 260K in 2016 Aug 2016If you’re retiring in 2016, you’ll need $260,000 to cover your health care costs during your retirement years. In 2015, that number was $245,000, so retiree health care costs increased 6% in one year according to Fidelity’s Retirement Health Care Cost Estimator.

The 6% annual cost increase is exactly what the National Business Group on Health found in their recently published 2017 Health Plan Design Survey polling large employers covering health care, discussed here in Health Populi.

The 6% health care cost increases are driven primary by people using more health services and the higher costs for many medicines — specifically, specialty drugs whose costs are fast-increasing (covered here in Health Populi, The Rise and Rise of (Specialty) Prescription Drug Prices.

The $260K covers people in the U.S. retiring with traditional Medicare coverage paying insurance premiums, health service copayments and deductibles, and out-of-pocket expenses for prescription drugs.

Fidelity expects that health care spending costs will continue to increase more in the coming years — albeit more slowly than the double-digit increases of the mid-2000s.

PwC health care costs increases to 2016 smallHealth Populi’s Hot Points:  To save one-quarter of a million dollars as of mid-2016 would mean that a 21-year-old person starting in 1971 would have had to invest $136 a month, every month, for 45 years assuming a 5% return compounded annually.

The fact is that a 5% return is well above any sort of savings accounts or FDIC-protected investments a U.S. investor might have garnered even if they religiously put away $136 monthly for 45 years. Medical inflation, even at a “low” 6% per annum, is still significantly over general consumer price inflation which is been very low in the past several years.

Fidelity is in the investment business, and so tethered to this press release on retirement costs is a recommendation to save in Health Savings Accounts (HSAs) — with their triple-tax advantage. I am a fan of these and often discuss them in my work — recently here for the Intuit Tax and Financial Center.

Americans financial security surges Bankrate 2016The new consumer-facing retail health world in the U.S. requires us to don financial wellness hats, as healthcare money savers. The good news is that more Americans are saving more for retirement, Bankrate learned in a consumer survey finding that Americans felt greater financial security in mid-2016. Health citizens of America will need to keep that sense of savings going over the long haul to be able to pay for health care services during retirement.

 

 

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400 Walking Gallery Jackets and Celebrating Jess Jacobs, the #FirstToFall http://www.healthpopuli.com/2016/08/15/400-walking-gallery-jackets-celebrating-jess-jacobs-firsttofall/ http://www.healthpopuli.com/2016/08/15/400-walking-gallery-jackets-celebrating-jess-jacobs-firsttofall/#respond Mon, 15 Aug 2016 12:50:19 +0000 http://www.healthpopuli.com/?p=15574 In the past week, the patient engagement/empowerment community marked two major events: the achievement of 400 painted patient stories in The Walking Gallery, and the loss of one of our tribe — Jess Jacobs. Jess passed away from complications of a complex condition called POTS (Postural Orthostatic Tachycardia Syndrome), made even more complicated by the fragmented, institution-focused (vs. patient-focused) healthcare she received. Jess documented many of her interactions with her health care providers, largely located in the Washington, DC, health care community, on social media–leaving a legacy and evidence on exactly how not to do patient care. You can experience her observations for yourself by searching under her Twitter handle @Jess_Jacobs. You will learn a lot. You will be disheartened and perhaps even enraged…appropriate responses. Her last tweet, on August 11, 2016, was, “Apparently ‘Vomiting so hard it comes out your nose’ is the motivator I needed to spend more hours trying to get my IV antiemetics refilled.”  So much for patient-centeredness from the U.S. healthcare system. Last night, many of her friends came together in a virtual wake via Twitter to celebrate Jess’s life, laughter, bravery, and huge contribution to the patient-health care conversation in America. Check out the sharing on Twitter via #UnicornJess. Regina Holliday, patient activist who created The Walking Gallery and is the project’s chief painter, organizer, and booster, wrote about Jess in her Medical Advocacy blog on Saturday – titled, The First to Fall. Hours before Jess died, I had asked Regina how she felt about reaching the 400-jacket threshold. Here is our Q&A exchange… Jane: What are your thoughts on growing the Walking Gallery to 400 members? Did you ever imagine you were creating a movement when you painted your first jacket? Regina: The first 5 jackets I painted were called art jackets. I created them for three friends. Those jackets told my family story combined with the mission focus of the person who wore them.   In Spring of 2011, I came up with the idea of an entire gallery of patients and providers wearing art jackets that would congregate at different medical conferences and public meetings.  I was inspired to do so while visiting the Kaiser Permanente Center for Total Health in Washington, DC.  The first gathering of the Walking Gallery occurred in June of 2011.  I and 12 other artists painted 56 jackets.  Now there are 45 artists in the gallery and we have painted 439 jackets.  I personally have painted 381. I thought from the inception of The Walking Gallery that we were creating a movement. Jane: So what was the theme of your first jacket? Regina: The first art jacket I painted was for Jen McCabe and it was called “Data Prison.”  That jacket focused on my demand that patients and family caregivers have rapid access to the digital health record. That jacket was painted prior to the concept of a gallery.  The first official jacket of The Walking Gallery was number 6. “Rosetta Stone” for Lygeia Ricciardi. Its primary focus was Lygeia’s ability to explain the complex worlds of government health policy and institutional care to the patient and consumer.  Its secondary focus was Lygeia’s role as a mother in advocating for her children through creating a birth plan and making sure breast feeding was supported. Jane: The Walking Gallery family is global by now.  We are walking throughout the US. Where else are we living in the world? Regina: We have walking members in France, UK, Australia, Canada, Greece, Netherlands, Switzerland, Kenya, Senegal, and South Africa. Jane: You mystically and artfully channel our personal stories, like my own “See Jane Think” story. They are all so special and moving, but which story have you channeled that was the most challenging? It must be hard to pick one of so many! Regina: That would be Sherry Reynold’s jacket “DEStiny.” Sherry is @cascadia on twitter and is an amazing thorn in the side of any institution that would like to look the other way when people are being harmed. She is an advocate for AIDS patients, the homeless, and those without a voice in healthcare.  For her jacket she wanted to focus on the disastrous effects of Diethylstilbestrol on multiple generations.  Sherry was only 12 years old when the medical community discovered the disastrous result of fetal exposure to DES (diethylstilbestrol).   This drug had been commonly prescribed to help maintain pregnancies.   Young girls were being diagnosed with a rare vaginal cancer that had never been described in youths.  Traditionally, onset of this rare disease occurred in women over the age of 60. In the early 1970’s studies began tracking the adverse effects of DES on the mothers and their children.  In 1971 the US government ordered doctors to stop prescribing DES.  The discontinue use recommendation occurred 20 years after DES was proven ineffective in clinical trials. I had to do a great deal of research to understand the ramifications of this disease so I could paint about it.  This jacket also depicts partial nudity, (as do several others in the gallery) referencing the biblical story of Eve and Lilith from Jewish folklore.  Channeling is a good term for what I do when I paint stories. I do my best to become one with the story and that is mentally exhausting.  Sometimes, when the painting is shown to the walker they inform me that I painted about parts of their story they did not tell me.  It is an honor to paint the story of a life and for a short moment become one with their soul. Jane: How do you think our WG community will morph and grow over the next 100 jackets as we grow to 500? Regina: I hope to have more artists help me create the next 100.  I have spent the last six months working on a building called Salt and Pepper Studios: Home of The Walking Gallery in Grantsville, MD.  We will have visiting artists stay there and hopefully finish a jacket or two.  To truly scale up we will need more folks painting as well as new members walking. *** And so…we will continue to grow our Gallery of patient-story walkers. You can be part of The Walking Gallery project and the growth of Salt and Pepper Studios by contributing at the GoFundMe site. here. Other friends of Jess Jacobs have been sharing stories about her. You will find posts getting published this week and beyond because Jess’s reach was substantial. Here’s one beautiful example from Dr. Ted Eytan — with a glorious Flickr photo gallery — Remembering Jess Jacobs. Jess’s website is online at http://jessjacobs.me/.  Health Populi’s Hot Points:   Every one of us has a patient story: more than one. Here’s the one Regina painted for me, capturing my father’s end-stage heart disease and fragmented end-of-life care: See Jane Think, Regina nailed it just about five years ago, channeling a Dick and Jane plotline. And here’s Regina’s storyline on my jacket. Jess’s legacy will be honored by those of us who know that the labyrinthine, Rube Goldbergian U.S. health care system lacks system-ness. More importantly, it lacks person-centeredness. As Jess’s pink Post-It note asks: “Why doesn’t love have a billing code?” Welcome to American healthcare.      

The post 400 Walking Gallery Jackets and Celebrating Jess Jacobs, the #FirstToFall appeared first on HealthPopuli.com.

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Walking Gallery at HIMSS2In the past week, the patient engagement/empowerment community marked two major events: the achievement of 400 painted patient stories in The Walking Gallery, and the loss of one of our tribe — Jess Jacobs.

Jess passed away from complications of a complex condition called POTS (Postural Orthostatic Tachycardia Syndrome), made even more complicated by the fragmented, institution-focused (vs. patient-focused) healthcare she received. Jess documented many of her interactions with her health care providers, largely located in the Washington, DC, health care community, on social media–leaving a legacy and evidence on exactly how not to do patient care. You can experience her observations for yourself by searching under her Twitter handle @Jess_Jacobs. You will learn a lot. You will be disheartened and perhaps even enraged…appropriate responses.

Her last tweet, on August 11, 2016, was, “Apparently ‘Vomiting so hard it comes out your nose’ is the motivator I needed to spend more hours trying to get my IV antiemetics refilled.” 

So much for patient-centeredness from the U.S. healthcare system.

Last night, many of her friends came together in a virtual wake via Twitter to celebrate Jess’s life, laughter, bravery, and huge contribution to the patient-health care conversation in America. Check out the sharing on Twitter via #UnicornJess.

Regina Holliday, patient activist who created The Walking Gallery and is the project’s chief painter, organizer, and booster, wrote about Jess in her Medical Advocacy blog on Saturday – titled, The First to Fall.

Jess222Hours before Jess died, I had asked Regina how she felt about reaching the 400-jacket threshold. Here is our Q&A exchange…

Jane: What are your thoughts on growing the Walking Gallery to 400 members? Did you ever imagine you were creating a movement when you painted your first jacket?

Regina: The first 5 jackets I painted were called art jackets. I created them for three friends. Those jackets told my family story combined with the mission focus of the person who wore them.   In Spring of 2011, I came up with the idea of an entire gallery of patients and providers wearing art jackets that would congregate at different medical conferences and public meetings.  I was inspired to do so while visiting the Kaiser Permanente Center for Total Health in Washington, DC.  The first gathering of the Walking Gallery occurred in June of 2011.  I and 12 other artists painted 56 jackets.  Now there are 45 artists in the gallery and we have painted 439 jackets.  I personally have painted 381.

I thought from the inception of The Walking Gallery that we were creating a movement.

jacobsj_headshot_edited_square-300x300Jane: So what was the theme of your first jacket?

Regina: The first art jacket I painted was for Jen McCabe and it was called “Data Prison.”  That jacket focused on my demand that patients and family caregivers have rapid access to the digital health record. That jacket was painted prior to the concept of a gallery.  The first official jacket of The Walking Gallery was number 6. “Rosetta Stone” for Lygeia Ricciardi. Its primary focus was Lygeia’s ability to explain the complex worlds of government health policy and institutional care to the patient and consumer.  Its secondary focus was Lygeia’s role as a mother in advocating for her children through creating a birth plan and making sure breast feeding was supported.

Jane: The Walking Gallery family is global by now.  We are walking throughout the US. Where else are we living in the world?

Regina: We have walking members in France, UK, Australia, Canada, Greece, Netherlands, Switzerland, Kenya, Senegal, and South Africa.

Jane: You mystically and artfully channel our personal stories, like my own “See Jane Think” story. They are all so special and moving, but which story have you channeled that was the most challenging? It must be hard to pick one of so many!

Regina: That would be Sherry Reynold’s jacket “DEStiny.” Sherry is @cascadia on twitter and is an amazing thorn in the side of any institution that would like to look the other way when people are being harmed. She is an advocate for AIDS patients, the homeless, and those without a voice in healthcare.  For her jacket she wanted to focus on the disastrous effects of Diethylstilbestrol on multiple generations.  Sherry was only 12 years old when the medical community discovered the disastrous result of fetal exposure to DES (diethylstilbestrol).   This drug had been commonly prescribed to help maintain pregnancies.   Young girls were being diagnosed with a rare vaginal cancer that had never been described in youths.  Traditionally, onset of this rare disease occurred in women over the age of 60. In the early 1970’s studies began tracking the adverse effects of DES on the mothers and their children.  In 1971 the US government ordered doctors to stop prescribing DES.  The discontinue use recommendation occurred 20 years after DES was proven ineffective in clinical trials.

I had to do a great deal of research to understand the ramifications of this disease so I could paint about it.  This jacket also depicts partial nudity, (as do several others in the gallery) referencing the biblical story of Eve and Lilith from Jewish folklore.  Channeling is a good term for what I do when I paint stories. I do my best to become one with the story and that is mentally exhausting.  Sometimes, when the painting is shown to the walker they inform me that I painted about parts of their story they did not tell me.  It is an honor to paint the story of a life and for a short moment become one with their soul.

Jane: How do you think our WG community will morph and grow over the next 100 jackets as we grow to 500?

Regina: I hope to have more artists help me create the next 100.  I have spent the last six months working on a building called Salt and Pepper Studios: Home of The Walking Gallery in Grantsville, MD.  We will have visiting artists stay there and hopefully finish a jacket or two.  To truly scale up we will need more folks painting as well as new members walking.

***

Why doesn't love have a billing code? Composition by @ChristineKraft

Why doesn’t love have a billing code? Composition by @ChristineKraft

And so…we will continue to grow our Gallery of patient-story walkers. You can be part of The Walking Gallery project and the growth of Salt and Pepper Studios by contributing at the GoFundMe site. here.

Other friends of Jess Jacobs have been sharing stories about her. You will find posts getting published this week and beyond because Jess’s reach was substantial. Here’s one beautiful example from Dr. Ted Eytan — with a glorious Flickr photo gallery — Remembering Jess Jacobs.

Jess’s website is online at http://jessjacobs.me/. 

See Jane ThinkHealth Populi’s Hot Points:   Every one of us has a patient story: more than one. Here’s the one Regina painted for me, capturing my father’s end-stage heart disease and fragmented end-of-life care: See Jane Think, Regina nailed it just about five years ago, channeling a Dick and Jane plotline. And here’s Regina’s storyline on my jacket.

Jess’s legacy will be honored by those of us who know that the labyrinthine, Rube Goldbergian U.S. health care system lacks system-ness. More importantly, it lacks person-centeredness. As Jess’s pink Post-It note asks: “Why doesn’t love have a billing code?” Welcome to American healthcare.

 

 

 

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Employers Changing Health Care Delivery – Health Reform At Work http://www.healthpopuli.com/2016/08/11/employers-changing-health-care-delivery-health-reform-work/ http://www.healthpopuli.com/2016/08/11/employers-changing-health-care-delivery-health-reform-work/#comments Thu, 11 Aug 2016 14:01:58 +0000 http://www.healthpopuli.com/?p=15561 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, large employers are looking to change the way health care is accessed and delivered through funding telehealth (for 90% of companies), providing price transparency tools (among 85% of companies), building and referring workers to Centers of Excellence (in 85% of firms, focused most on transplants, bariatric surgery, joint surgery, heart care, and cancers), and to a lesser extent, promoting accountable care organizations (among about one-fourth of employers). Consumer-directed health plans (CDHPs) will be a universal health insurance plan design by 2020, shown in the second chart. At least 84% of large employers will offer a CDHP option in 2017, and one-third will offer only a CDHP. Most high-deductible health plans in 2017 (92%) will be accompanied by a health savings account (HSA) The median employee cost-sharing amount this year was a $1,600 deductible for employee (single) coverage in a CDHP, and in-network out-of-pocket maximum payments were $4,000. For families, the out-of-pocket max was $7,200 with a $3,200 deductible. Telehealth is expected to be a universally-sponsored service among large employers by 2019, and most companies already use virtual care. One-third of large employers directly contract with telehealth vendors, according to NBGH’s survey. While most employers are offering telehealth services, in the first half of 2016, only 3% of employees had utilized this benefit. Looking to the future, employers are bolstering investments in mental and behavioral health, and in the financial wellbeing of their workforce. Influence physical well-being is a top-three priority among 85% of employers, followed by improvement employee engagement in healthcare decision making (that is, consumerism) for 65% of companies, emotional/mental wellbeing among 59%, and financial security and wellbeing for 58% of employers. Health Populi’s Hot Points:  Large employers are emboldened to drive changes in health care delivery — especially for virtual care via telehealth channels and narrowing networks for high-cost specialty care like transplantation and bariatric surgery via Centers of Excellence. Most employers are also deploying at least one cost transparency tool to support employees’ healthcare consumerism and decision-making chops. However, only 3% of employees have used telehealth services that have been available in the first half of 2016; this is an important proxy for understanding just how “consumerist” employees are with respect to saving money in deductible spending. The consumer-patient’s cost difference  between a virtual vs. in-person visit is significant: a telehealth visit with American Well is currently priced at a low of $49 compared with a face-to-face primary care visit for $95, urgent care for $140, or emergency department admission for $750. NBGH identifies employer tools and programs more companies are offering in 2017, including nurse coaching for care condition management, disease management, lifestyle management, self-service decision support tools, price transparency tools (fast-growing in 2017), and medical decision support/second opinion services. Large employers clearly understand the importance of these tools to support their mass adoption of high-deductible health plans. There’s no consumer-direction without such programs, and less optimal ROI on employers’ significant investments in health insurance without them. This week’s announcement of Accolade receiving a $70 million investment to further scale the company’s healthcare concierge services is an example of the market’s recognition of the importance of these employer-sponsored programs. This is health reform, playing out in the private sector.

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Top medical trend cost drivers NBGH specialty drugs no 1 Aug 2016Large 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, large employers are looking to change the way health care is accessed and delivered through funding telehealth (for 90% of companies), providing price transparency tools (among 85% of companies), building and referring workers to Centers of Excellence (in 85% of firms, focused most on transplants, bariatric surgery, joint surgery, heart care, and cancers), and to a lesser extent, promoting accountable care organizations (among about one-fourth of employers).

CDHPs becoming universal before 2020 NBGH Aug 2016

Consumer-directed health plans (CDHPs) will be a universal health insurance plan design by 2020, shown in the second chart. At least 84% of large employers will offer a CDHP option in 2017, and one-third will offer only a CDHP. Most high-deductible health plans in 2017 (92%) will be accompanied by a health savings account (HSA)

The median employee cost-sharing amount this year was a $1,600 deductible for employee (single) coverage in a CDHP, and in-network out-of-pocket maximum payments were $4,000. For families, the out-of-pocket max was $7,200 with a $3,200 deductible.

Large Employers Use of Telehealth NBGH Aug 2016Telehealth is expected to be a universally-sponsored service among large employers by 2019, and most companies already use virtual care. One-third of large employers directly contract with telehealth vendors, according to NBGH’s survey. While most employers are offering telehealth services, in the first half of 2016, only 3% of employees had utilized this benefit.

Looking to the future, employers are bolstering investments in mental and behavioral health, and in the financial wellbeing of their workforce. Influence physical well-being is a top-three priority among 85% of employers, followed by improvement employee engagement in healthcare decision making (that is, consumerism) for 65% of companies, emotional/mental wellbeing among 59%, and financial security and wellbeing for 58% of employers.

Cost-for-virtual-medical-visits-Am-Well-2015Health Populi’s Hot Points:  Large employers are emboldened to drive changes in health care delivery — especially for virtual care via telehealth channels and narrowing networks for high-cost specialty care like transplantation and bariatric surgery via Centers of Excellence.

Most employers are also deploying at least one cost transparency tool to support employees’ healthcare consumerism and decision-making chops. However, only 3% of employees have used telehealth services that have been available in the first half of 2016; this is an important proxy for understanding just how “consumerist” employees are with respect to saving money in deductible spending. The consumer-patient’s cost difference  between a virtual vs. in-person visit is significant: a telehealth visit with American Well is currently priced at a low of $49 compared with a face-to-face primary care visit for $95, urgent care for $140, or emergency department admission for $750.

NBGH identifies employer tools and programs more companies are offering in 2017, including nurse coaching for care condition management, disease management, lifestyle management, self-service decision support tools, price transparency tools (fast-growing in 2017), and medical decision support/second opinion services. Large employers clearly understand the importance of these tools to support their mass adoption of high-deductible health plans. There’s no consumer-direction without such programs, and less optimal ROI on employers’ significant investments in health insurance without them.

This week’s announcement of Accolade receiving a $70 million investment to further scale the company’s healthcare concierge services is an example of the market’s recognition of the importance of these employer-sponsored programs. This is health reform, playing out in the private sector.

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PhRMA vs. Employers: Healthcare Costs In the Eye of the Beholder http://www.healthpopuli.com/2016/08/10/phrma-vs-employers-healthcare-costs-eye-beholder/ http://www.healthpopuli.com/2016/08/10/phrma-vs-employers-healthcare-costs-eye-beholder/#comments Wed, 10 Aug 2016 14:18:24 +0000 http://www.healthpopuli.com/?p=15549 In the past week, the Pharmaceutical Research and Manufacturers of America (PhRMA), the advocacy organization for the branded prescription drug industry, published Medicines: Costs in Context,” the group’s lens on the value of prescription drugs in the larger healthcare economy. Their view: that prescription drug costs comprise a relatively low share of health care spending in America, and a high-value one at that. PhRMA contends that 10% of the health care dollar was allocated to prescription drugs in 2015, the same proportion as in 1960. “Even with new treatments for hepatitis C, high cholesterol and cancer, spending on retail prescription medicines is projected to remain approximately 10 percent of U.S. health care spending through 2025 – the same percentage as in 1960. This share of health care spending going toward medicines is providing tremendous value for patients and the health care system,” according to the PhRMA blog. In contrast, yesterday, the National Business Group on Health published their latest read on healthcare costs, citing specialty drug costs as the top driver of rising health care costs. “Fueling the overall growth in the cost of health benefits is the surge in spending on pharmaceuticals, and specialty drugs, in particular. For the first time in the survey, most employers now consider specialty pharmacy the highest driver of health costs and are taking steps to curb them” among 80% of employers in the NBGH survey. Who’s right? Health value is in the eye of the beholder according to where you play as an industry stakeholder. The ExpressScripts forecast of specialty drug costs, covered here in Health Populi in March 2016, expected the medicines line item to reach 20% of health care spending in 2020. Health Populi’s Hot Points:  Here at Health Populi, we focus on health care consumers, patients, and caregivers — the end-users of prescription drugs and life sciences products and services. Value-based payment means valuing what matters to patients, a recent JAMA post explained. Today’s Wall Street Journal features an article on taking in account patients’ perspectives before entering heart surgery, part of a growing program in Medicare to promote shared decision-making in health care. We have entered “a very different mindset than the era where the physician was the decision-maker,” Harlan Krumholz of Yale University is quoted. The article talks about a new cardiac device, the Watchman, designed to assist patients with atrial fibrillation (aFib, irregular heartbeat) to prevent strokes. Standard treatment for aFib is for patients to take blood thinners that preent clotting that can lead to strokes. But medications can have side effects like bruising and risks for excessive bleeding, which the Watchman avoids. As patients pay growing proportions of health costs, they must play the role of consumer — albeit a difficult mantle to bear at this painful stage of pioneering health care consumerism. PhRMA, employers that sponsor health insurance programs, the insurance industry itself, hospitals and health care providers, and all industry stakeholders must play a part in surrounding their products and services with programs that bolster consumers’ health literacy, health plan literacy, and health financial literacy so people can play their part in making sound healthcare decisions based on their own values. Too many health consumers don’t realize or have confidence that they actually can influence, and ultimately own, these decisions about their own health and the health of their loved ones.

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health_care_spending_pie_chart PhRMAIn the past week, the Pharmaceutical Research and Manufacturers of America (PhRMA), the advocacy organization for the branded prescription drug industry, published Medicines: Costs in Context,” the group’s lens on the value of prescription drugs in the larger healthcare economy. Their view: that prescription drug costs comprise a relatively low share of health care spending in America, and a high-value one at that.

PhRMA contends that 10% of the health care dollar was allocated to prescription drugs in 2015, the same proportion as in 1960. “Even with new treatments for hepatitis C, high cholesterol and cancer, spending on retail prescription medicines is projected to remain approximately 10 percent of U.S. health care spending through 2025 – the same percentage as in 1960. This share of health care spending going toward medicines is providing tremendous value for patients and the health care system,” according to the PhRMA blog.

Specialty pharma NBGH survey biggest cost driverIn contrast, yesterday, the National Business Group on Health published their latest read on healthcare costs, citing specialty drug costs as the top driver of rising health care costs. “Fueling the overall growth in the cost of health benefits is the surge in spending on pharmaceuticals, and specialty drugs, in particular. For the first time in the survey, most employers now consider specialty pharmacy the highest driver of health costs and are taking steps to curb them” among 80% of employers in the NBGH survey.

Who’s right? Health value is in the eye of the beholder according to where you play as an industry stakeholder.

The ExpressScripts forecast of specialty drug costs, covered here in Health Populi in March 2016, expected the medicines line item to reach 20% of health care spending in 2020.

Health Populi’s Hot Points:  Here at Health Populi, we focus on health care consumers, patients, and caregivers — the end-users of prescription drugs and life sciences products and services. Value-based payment means valuing what matters to patients, a recent JAMA post explained.

Today’s Wall Street Journal features an article on taking in account patients’ perspectives before entering heart surgery, part of a growing program in Medicare to promote shared decision-making in health care. We have entered “a very different mindset than the era where the physician was the decision-maker,” Harlan Krumholz of Yale University is quoted. The article talks about a new cardiac device, the Watchman, designed to assist patients with atrial fibrillation (aFib, irregular heartbeat) to prevent strokes. Standard treatment for aFib is for patients to take blood thinners that preent clotting that can lead to strokes. But medications can have side effects like bruising and risks for excessive bleeding, which the Watchman avoids.

As patients pay growing proportions of health costs, they must play the role of consumer — albeit a difficult mantle to bear at this painful stage of pioneering health care consumerism. PhRMA, employers that sponsor health insurance programs, the insurance industry itself, hospitals and health care providers, and all industry stakeholders must play a part in surrounding their products and services with programs that bolster consumers’ health literacy, health plan literacy, and health financial literacy so people can play their part in making sound healthcare decisions based on their own values.

Too many health consumers don’t realize or have confidence that they actually can influence, and ultimately own, these decisions about their own health and the health of their loved ones.

The post PhRMA vs. Employers: Healthcare Costs In the Eye of the Beholder appeared first on HealthPopuli.com.

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Most US Doctors Say They Ration Patients’ Healthcare http://www.healthpopuli.com/2016/08/08/us-doctors-say-ration-patients-healthcare/ http://www.healthpopuli.com/2016/08/08/us-doctors-say-ration-patients-healthcare/#respond Mon, 08 Aug 2016 16:01:40 +0000 http://www.healthpopuli.com/?p=15539 Rationing has long been seen as a common practice in national, single-payer health systems like the UK’s National Health Service and Canada’s national health insurance program (known as “Medicare”).  However, over half of U.S. physicians say they ration care to patients. In a peer-reviewed column in the Journal of General Internal Medicine published in July 2016, Dr. Robert Sheeler and colleagues at the Mayo Clinic, University of Iowa, and University of Michigan, found that 53% of physicians surveyed personally “refrained” in the past six months from using specific clinical services that would have provided the “best patient care” due to cost. This is one of the first studies looking at US physicians’ actual rationing behaviors, not just their attitudes. The survey instrument used with the physicians never used the actual word, “ration” or “rationing.” Instead, see the figure, which illustrates the actual language used in the study with the doctors. The most commonly withheld services included prescription drugs and MRI scans. Less rationed services were referrals to intensive care units, referrals for surgery, and admissions to hospital. Surgical specialists were less likely to ration services than non-surgeons. Prescription drugs were the most likely to be rationed, with 13.5% of physicians doing so on a daily basis. Services polled included lab tests, routine x-rays, MRI, screening tests, referral to specialist, referral to an ICU, prescription drugs, referral for surgery, referral for dialysis, and hospital admission. In order of most-frequent rationing were: Most common rationed services (40-50% of physicians) Prescription drugs (most likely to be rationed due to cost) MRI Intermediate-range rationed services (20-40% of physicians) Lab tests Screening test Routine x-ray Referral to specialist Referral for surgery Least rationed services (fewer than 20% of physicians) Hospital admission Referral to ICU Referral to dialysis (least likely to be rationed due to cost). The authors point out that the study, “highlights the challenging nature of being a physician in the United States with regard to resource utilization. Everyday clinical decisions involve complex issues, often requiring a series of subtle judgments b an individual physician for each patient (and the patient’s family), which collectively add up to tremendous costs or cost savings.” Health Populi’s Hot Points:  Physicians face resource allocation decisions several times during every patient encounter. Physicians’ collective decisions “can mean the difference between high-cost and low-cost health care,” the authors recognize. Doctors are the new practical health economists in the U.S. health system (and truly in every nation’s health system). I’ve called this out before here in Health Populi, in other contexts. The cost of treatment has been seen to influence doctors’ decisions about using certain medical products (drugs and medical devices), for example, discussed in this New York Times article from 2014. Doctors and patients need to communicate with each other, in shared decision-making mode, about the value of drugs, devices, procedures, and hospital stays, along with patients’ values about those medical goods and services, and views on their own lives in the context of themselves, their families, and their communities. This new study recognizes that doctors in America are already making these decisions in their own minds; in the spirit of participatory healthcare (the mission of the Society for Participatory Medicine, with whom I collaborate) and Making Health with patients, clinicians must open the conversation with patients in the spirit of transparency and joint responsibility for making healthcare better.

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Rationing among US physicians Aug 2016 Sheeler et al JGIM

Rationing has long been seen as a common practice in national, single-payer health systems like the UK’s National Health Service and Canada’s national health insurance program (known as “Medicare”).  However, over half of U.S. physicians say they ration care to patients.

In a peer-reviewed column in the Journal of General Internal Medicine published in July 2016, Dr. Robert Sheeler and colleagues at the Mayo Clinic, University of Iowa, and University of Michigan, found that 53% of physicians surveyed personally “refrained” in the past six months from using specific clinical services that would have provided the “best patient care” due to cost. This is one of the first studies looking at US physicians’ actual rationing behaviors, not just their attitudes. The survey instrument used with the physicians never used the actual word, “ration” or “rationing.” Instead, see the figure, which illustrates the actual language used in the study with the doctors.

The most commonly withheld services included prescription drugs and MRI scans. Less rationed services were referrals to intensive care units, referrals for surgery, and admissions to hospital. Surgical specialists were less likely to ration services than non-surgeons.

Prescription drugs were the most likely to be rationed, with 13.5% of physicians doing so on a daily basis.

Services polled included lab tests, routine x-rays, MRI, screening tests, referral to specialist, referral to an ICU, prescription drugs, referral for surgery, referral for dialysis, and hospital admission. In order of most-frequent rationing were:

Most common rationed services (40-50% of physicians)

  • Prescription drugs (most likely to be rationed due to cost)
  • MRI

Intermediate-range rationed services (20-40% of physicians)

  • Lab tests
  • Screening test
  • Routine x-ray
  • Referral to specialist
  • Referral for surgery

Least rationed services (fewer than 20% of physicians)

  • Hospital admission
  • Referral to ICU
  • Referral to dialysis (least likely to be rationed due to cost).

The authors point out that the study, “highlights the challenging nature of being a physician in the United States with regard to resource utilization. Everyday clinical decisions involve complex issues, often requiring a series of subtle judgments b an individual physician for each patient (and the patient’s family), which collectively add up to tremendous costs or cost savings.”

Health Populi’s Hot Points:  Physicians face resource allocation decisions several times during every patient encounter. Physicians’ collective decisions “can mean the difference between high-cost and low-cost health care,” the authors recognize.

Doctors are the new practical health economists in the U.S. health system (and truly in every nation’s health system). I’ve called this out before here in Health Populi, in other contexts. The cost of treatment has been seen to influence doctors’ decisions about using certain medical products (drugs and medical devices), for example, discussed in this New York Times article from 2014.

Doctors and patients need to communicate with each other, in shared decision-making mode, about the value of drugs, devices, procedures, and hospital stays, along with patients’ values about those medical goods and services, and views on their own lives in the context of themselves, their families, and their communities. This new study recognizes that doctors in America are already making these decisions in their own minds; in the spirit of participatory healthcare (the mission of the Society for Participatory Medicine, with whom I collaborate) and Making Health with patients, clinicians must open the conversation with patients in the spirit of transparency and joint responsibility for making healthcare better.

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