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Net Neutrality is Dead: What Happens to Connectivity as a Social Determinant of Health?

Today’s FCC’s repeal of the net neutrality rules for internet service providers will have an impact on healthcare — in particular, the channeling of telehealth services. “The Federal Communication Commission overturned a two-year-old set of rules passed during the Obama administration to protect consumers against bad behavior from their Internet service providers, overriding protests from consumer groups and Internet companies,” USA Today wrote just after the ruling. The concern from advocates to keep net neutrality is that the large ISPs — AT&T, Comcast, and Verizon, among them — could be so-called “bad actors” in favoring fast-lane communications for certain content versus

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Support for the Affordable Care Act the Highest Since Passage

Americans’ approval of the Affordable Care Act reached its apex in December 2017, the Pew Research Center found. The proportion of people approving the ACA has been growing since the middle of 2016, now at 56% of the public. The timing of this survey, conducted at the end of November and first few days of December 2017, coincides with Congress’s arm-wrestling a tax bill that would eliminate the individual mandate for health insurance which is an ACA building block for universal coverage in the United States. Most people in the U.S. also believe that the ACA has had a positive

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Will Getting Bigger Make Hospitals Get Better?

This month, two hospital mega-mergers were announced between Ascension and Providence, two of the nation’s largest hospital groups; and, between CHI and Dignity Health. In terms of size, the CHI and Dignity combination would create a larger company than McDonald’s or Macy’s in terms of projected $28 bn of revenue. (Use the chart of America’s top systems to do the math). For context, other hospital stories this week discuss layoffs at Virtua Health System in southern New Jersey. And this week, the New Jersey Hospital Association annual report called the hospital industry the “$23.4 billion economic bedrock” of the state.

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Patients Continue to Grow Healthcare Consumer Muscles, Alegeus’s 2017 Index Finds

Patients’ health consumer muscles continue to get a work out as more people enroll in high-deductible health plans and face sticker shock for health insurance premiums, prescription drug costs, and that thousand-dollar threshold. The 2017 Alegeus Healthcare Consumerism Index finds growth in patients’, now consumers’, interest and competence in becoming disciplined about planning, saving, and spending for healthcare. Overall, the healthcare spending index hit 60.1 in 2017, up from 54.4 in 2016. This is a macro benchmark that represents most consumers exhibiting greater healthcare spending engagement with eyes on cost as well as adopting purchasing behaviors for healthcare. Underneath that

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The Patient as Payor – Consumers and the Government Bear the Largest Share of Healthcare Spending in America

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

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Six Healthcare News Stories to Keep Hospital CFOs Up At Night

At this moment, the healthcare job I’d least like to have is that of a non-profit hospital Chief Financial Officer (CFO). Five news stories, published in the past 24 hours, tell the tale: First, Moody’s forecast for non-profit hospitals and healthcare in 2018 is negative due to reimbursement and expense pressures. The investors report cited an expected contraction in cash flow, lower reimbursement rates, and rising expense pressures in the midst of rising bad debt. Second, three-quarters of Federally Qualified Health Centers plan to lay off staff given lack of budget allocations resulting from Congressional inaction. Furthermore, if the $3.6

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CVS + Aetna: An Inflection Point for American Healthcare

The nation’s largest retail pharmacy chain signed a deal to combine with one of the top three health insurance companies. The deal is valued at $69 billion. I wrote about this inflection point for U.S. healthcare four weeks ago here in Health Populi. CVS is both the biggest pharmacy and pharmacy benefit manager in the U.S., as the first chart shows. In my previous post, I talked about the value of vertical integration bringing together the building blocks of retail pharmacy and pharmacist care, retail clinics, the PBM (Caremark), along with Aetna’s health plan member base and business. As Amazon and other

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Consumers Seek Health Engagement Everywhere: the Case for Alcohol and Breweries

More consumers are seeking health-making opportunities everywhere, both within and outside of traditional healthcare touch-points. That includes peoples’ consumption of beer. We learned from the Edelman Health Engagement Barometer that consumers seek to engage for health beyond healthcare organizations – namely, hospitals, providers, over-the-counter medicines, pharma and insurance. What was perhaps the most surprising industry segment consumers called on for personal health engagement was brewing and alcohol. Fully 8 in 10 consumers expect brewing and spirits companies to engage in health. The bar chart shows this finding, arraying beer and liquor producers on par with retail and consumer technology, along

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The State of Financial Wellness and Health in America – Suffering Across the Ages

Nearly one-half of Americans are challenged by low financial well-being. Compared to emotional/mental, job/career, social, physical, and financial, it’s this last lens on personal health that gets the lowest ratings for the largest number of Americans. The second most worrying factor diminishing well-being is a tie between physical health and social health. Welcome to The uncomfortable reality of financial wellbeing, a report on the 2017 Financial Mindset Study Highlights from Alight Solutions, an HR services company. The first chart arrays the well-being rankings across the five factors, showing that just over one-half of Americans have more positive views on their emotional

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High-Deductibles Do Not Automatically Inspire Healthcare Consumerism

It takes more than enrolling in a high-deductible health plan (HDHP) for someone to immediately morph into an effective health care “consumer.” Research from Dr. Jeffrey Kullgren and his team from the University of Michigan found that enrollees in HDHPs could garner more benefits from these plans were people better informed about how to use them, including how to save for them and spend money once enrolled in them. The team’s research letter was published in JAMA Internal Medicine on 27 November 2017. The discussion details results of a survey conducted among 1,637 people 18 to 64 years of age

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Engage With Grace and Your Family on Thanksgiving: Have an End-Of-Life Chat at the End-Of-the-Feast

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness. We each have our stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma. Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” bit unwanted, futile care. When you’re

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TIME Magazine’s Best Inventions – Health-y Things and Privacy Questions

Health permeates a plethora of TIME magazine’s 25 Best Inventions of 2017. From head to foot, health is the mother of invention, based on TIME’s curation of “the best” things launched to market in the past year. Starting with “the head,” the Oculus Go virtual reality (VR) headset from Facebook. While the first function with which VR is associated is fun and games, Dr. Brennan Spiegel at UCLA Geffen School of Medicine has been proving out VR‘s value in helping patients deal with pain and medical management. Keep your eye on his and others’ research into VR’s use in healthcare. The

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Don’t Touch My Entitlements to Pay For Tax Reform, Most Americans Say to Congress

To pay for tax cuts, take money from foreign aid if you must, 1 in 2 Americans say. But do not touch my Medicaid, Medicare, or Social Security, insist the majority of U.S. adults gauged by the November 2017 Kaiser Health Tracking Poll. This month’s survey looks at Americans’ priorities for President Trump and the Congress in light of the GOP tax reforms emerging from Capitol Hill. While reforming taxes is considered a top priority for the President and Congress by 3 in 10 people, two healthcare policy issues are more important to U.S. adults: first, 62% of U.S. adults

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Movin’ Out(patient) – The Future of the Hospital is Virtual at UPMC

In 2016, most consultations between patients and Kaiser-Permanente Health Plan were virtual — that is, between consumers and clinicians who were not in the same room when the exam or conversation took place. Virtual healthcare may be the new black for healthcare providers. Mercy Health System in St. Louis launched a virtual hospital in 2016, covered here in the Health Populi post, “Love, Mercy, and Virtual Healthcare.” Intermountain Healthcare announced plans to build a virtual hospital in 2018. And, earlier this month, UPMC’s CEO, Jeffrey Romoff, made healthcare headlines saying, “UPMC desires to be the Amazon of healthcare.” UPMC, aka University of Pittsburgh

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The Internet of Things via Medicines – FDA Approves Digital Pill

Yesterday, the FDA approved a “digital ingestion tracking system,” the first drug in the U.S. that has an ingestible (in other words, safely edible) sensor built into the pill. That sensor tracks that the medication was taken, which helps with adherence, meant to help ensure that patients who are prescribed the medicine do indeed take the regimen as prescribed. Once ingested, the sensor in the pill communicates to a wearable patch on the patient that then communicates information to a mobile health app that tracks the pill-taking via smartphone. Patients can allow their family and clinicians access to that information

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U.S. Healthcare Spending & Outcomes in Five Charts: #EpicFail in the 2017 OECD Statistics

“Spend more. Get less.” If a retailer advertised using these four words, how many consumers would buy that product or service? This is the American reality of healthcare spending in 2016, told in the OECD report, Health at a Glance 2017. I present five charts from the study in this post, which together take the current snapshot health-economic lesson for the U.S. First, look at health expenditures as a share of gross domestic product: the U.S. is number one above Switzerland, France, and the UK, and about two times the OECD average. Note, too, the proportion of out-of-pocket and so-called

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Stress is US: Health Care Is the #1 Stressor in America

Above the economy, trust in government, crime, war, terrorism, and taxes, health care is the top cause of stress in America. For ten years, the American Psychological Association has gauged Americans’ collective mood in their ongoing study, Stress in America. The latest report is The State of Our Nation, published this month, finding that we’re at the “lowest point in our nation’s history” according to 59% of Americans. The 2016 national election in the U.S. raised the stress-stakes, when APA released a stress study we discussed here in Health Populi. The election season was a source of stress for 52%

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Rx Delivery to the Patient’s Door: Home Is Where the Health/Care Is

Talk about the last mile in healthcare. CVS Pharmacy will deliver prescription drugs to patients’ homes, the company announced this week. “Same-day prescription delivery gives customers the easy option of having the pharmacy they trust deliver right to their front door at no cost,” Helen Foulkes, President of CVS Pharmacy, said in the press release. Rx home delivery may not be “the” last mile to conquer all healthcare access challenges, but it’s nonetheless a signal that healthcare industry suppliers are focusing on helping patients streamline their health-consumer lives. In this case, it’s also CVS morphing towards Amazon’s Prime delivery model. Amazon

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Evidence is Growing for Using Digital Health Apps, Says IQVIA

The evidence of the value of digital health tools is growing, based on research published in The Growing Value of Digital Health, from the IQVIA Institute for Human Data Science. With this report, the IMS Institute ushers in the organization’s new name, IQVIA Institute (THINK: “I” for “IMS,” and “Q” for “Quintiles). This is the organization’s third report on digital health, following the original analysis from 2013, updated in 2015. Here’s my take on the 2013 report, which found that 36 mobile health apps represented one-half of all downloads. On a conference call held last week, the company’s SVP and Executive

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Health Care Is 2.5 More Expensive Than Food for the Average U.S. Family

The math is straightforward. Assume “A” equals $59.039, the median household income in 2016. Assume “B” is $18,142, the mean employer-sponsored family insurance premium last year. B divided by A equals 30.7%, which is the percent of the average U.S. family’s income represented by the premium cost of health insurance. Compare that to what American households spent on food: just over $7,000, including groceries and eating out (which is garnering a larger share of U.S. eating opportunities, a topic for another post). Thus, health care represents, via the home’s health insurance premium, represents 2.5 times more than food for the

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