A blog covering the health/care ecosystem and people.

Two news stories this week highlight the fact that, even with a health reform bill signed and sealed by the President of the United States, and with $20 billion of ARRA stimulus funding on the books, electronic health records adoption will probably be slower than the go-go forecasts of one year ago. The head of Accenture’s clinical transformation practice was interviewed by Information Week this week. Dr. Kip Webb explained the results of an Accenture survey of small practices that found a “substantial number” of physicians in practices smaller than 10 doctors would not begin the process of EMR adoption. On the upside, Accenture

Inflation in the U.S. fell by 0.4% in 2009, the first such annual decline in the Consumer Price Index since 1955. At the same time, health care costs for American employers grew 7.3% per capita in 2009. As the chart health spending increased nearly 5%, with employers’ costs increasing even more quickly over the year. This was especially twice-as-onerous for small and mid-sized companies whose costs grew much faster than for larger companies, whose rate of increase actually fell in the year. These sobering statistics were calculated by Thomson Reuters and published in Helathcare Costs Rise More Than 7 Percent

Ted Kennedy spoke from the grave on Monday 22nd March, saying through the earthly voice of Nancy Pelosi that the passage of health reform was “the great unfinished business of our society.” Universal health coverage has been part of developed Europe for decades, and those countries spend a lot less overall and per capita on health care with arguably at least as good outcomes as the U.S. I’ve spent the past week in Europe, and while I was away, 219 Democrats voted in favor of health reform for America. I’ve had the opportunity to read various Euro-papers and listen to

The middle class in America is barely hanging on, and increasingly uninsured. the Robert Wood Johnson Foundation’s report on the continued erosion of health insurance in the U.S. talks of the recession’s toll on average Americans and employers’ ability to cover their health. Furthermore, two consecutive years of economic downturn in the U.S. have driven two years of downturn in consumer spending. This has led to consumers trading off a balance of price, brand and convenience which Strategy& (previously Booz & Company) calls The New Consumer Frugality. In their latest report detailing consumer spending trends in 2,000 random American adults, Booz

Cost and personal income are the key determinants of whether a Michigander seeks medical care. As the chart shows, cost is the #1 reason uninsured people in Michigan didn’t seek medical care for 55% of the uninsured. But for nearly 1 in 3 insured Michiganders, cost is also the key determinant in whether people go for medical care. These findings price elastic demand for health services were uncovered in the Cover Michigan survey, conducted by the Center for Healthcare Research and Transformation (CHRT), a partnership between the University of Michigan and Blue Cross Blue Shield of Michigan (BCBS MI). The

70,000 young Americans between 15 and 39 years of age are diagnosed with cancer every year. This population falls in a gap between pediatric and adult cancer. Newly-diagnosed young adults often find themselves in a no-patients’-land, confronting a lack of targeted clinical trials and knowledgeable clinicians in local health markets.The National Cancer Institute says that survival rates for this group of cancer patients haven’t improved in over 30 years.That’s definitely cause to flip cancer the bird, and that’s exactly what the young actor, Zac Efron, has done.Efron is photographed with a young cancer patient, Emily Hobson, to focus on Stupid

In the crush of crowds on the vendor floor at the HIMSS10 exhibition this week in Atlanta, booths are strategically designed with Pantone-matched colors and icons and clever taglines. Sales teams are festooned in corporate logo-emblazoned polo shirts (orange is popular this year). Colorful banners exclaim this year’s HIT mantras: lots of “HIE spoken here!” and “We are connectivity.” With all the thought and dollars allocated to health information technology sales and marketing, I wonder how much the line item known as “design” gets? As I spend a lot of time with pharmaceutical companies in the past two decades, I’m

Rest-in-peace, Hummer. Last week, GM announced that after 18 years, the gas-guzzling icon of car excess would be tossed to the proverbial scrap heap. The Tale of the Hummer provides a useful parable for American health care, especially for context this week as the annual HIMSS conference kicks off. (Please skip to the end-note to learn more about HIMSS, for those Health Populi readers unfamiliar with the acronym or organization). Why did GM send the Hummer to its resting place? There are several factors that eroded the demand for the Hummer: among them, First, the price of gas, generally trending

In the coming months and years, I anticipate that Monster.com and other online job services will grow their revenues from the health industry. Three important studies this month confirm that, while health care eats up nearly one-fifth of the U.S. economy, there are shortages of professionals to fill two important jobs that are growing: primary care physicians (PCPs), nurses, and health information technology (HIT) workers. Let’s talk about the doctors, first. The Journal of the American Medical Association (JAMA) reports this week that doctors cut back their working hours since 1998 to 2008. At the same time, the second chart

While the stock market and companies’ profitability improves, much of that has been done on the backs of employees: through reductions in force and job cuts, and re-working of benefits. Health benefits are a prime target for cost management as companies try to survive through the long recovery. Combined with insurance companies’ cost increases (most notably and recently Anthem’s announcement of up-to-39% increases in premium costs), employers who choose to continue to provide health insurance to employers are in a bind. According to the 15th annual survey from National Business Group on Health/Towers Watson, employers faced cost increases of 7%

Highly educated Americans support health reform; those with no college education don’t. 10% of Republicans support President Obama’s proposals for health changes; 77% of Democrats do. The schisms between groupings of Americans who support health reform in February 2010 versus those who don’t are wide, and many, depending how you slice the data. The Harris Poll conduced in late January 2010 starkly illustrates these gaps between supporters and detractors of health reform coming from the President’s pen. Most tellingly, The Poll finds that it doesn’t much matter what the details are: “support for, or opposition to, health care reform has

“‘Intent’ is the new demographic,” say the folks at Ruder Finn, the PR agency. What are people trying to achieve every moment of the digital day? According to the firm’s Mobile Internet Index, people are spending 2.7 hours a day on the mobile Internet. The Index survey studies what reasons people have for using their mobile phones. This isn’t about deep-dive education; instead, the mobile web is for connecting, quick transactions, life in-the-moment. Immediacy is the currency of the mobile web. The illustration shows Ruder Finn’s first iteration of the Intent Index, which analyzed peoples’ use of the Internet, broadly

There’s a new survey on EHRs out that most industry news outlets have headlined, “More doctors have gone digital.” This, directly from the survey’s title, Doctors Gone Digital, conducted by GfK Roper Public Affairs & Media for Practice Fusion, the EHR developer.Forty-eight percent, or nearly 1 in 2 patients in the U.S., has noticed that their doctors have their records stored digitally on a computer. This is, of course, good news indeed. But under the proverbial hood of the survey data, you find a subtext: that if you’re older or more affluent, your physician is more likely to have access

While coughs, colds and seasonal allergies have always been a retail health category, this recession has bolstered the workplace channel for messaging and products. BigResearch‘s Workplace Media group has found that 85% of working consumers are concerned about this year’s flue and cold season. Two-thirds of workers planned to get a flu shot. And, 9 in 10 workers would likely welcome and use an offer for flu/cold products delivered through the workplace. The H1N1 virus drives most working consumers to take extra precautions this cold/flu season. Other key findings are that: 3/4 of employers will offer flu prevention tips to

What are the implications for electronic health records in an era of consumers’ adoption of mobile phones and online social networks?That’s the question posed and pondered by Aviv Shachak and Alejandro Jadad of the University of Toronto, published in this weeks Journal of the American Medical Association (JAMA).The opportunity is to build a people-centered health system, they say, the kind envisioned in the IOM’s report, Crossing the Quality Chasm. Drs. Shachak and Jadad propose 7 building blocks to use when adopting EHRs that will help the U.S. get to the Holy Grail of people-centered health:1. Use tools to promote health,

With $20 billion worth of stimulus funding to help providers adopt electronic medical records, hospitals and doctors seem poised — finally! — to enter the digital information age that other vertical markets have already joined.The topline finding from HIMSS Analytics’ Healthcare Enterprise Survey found that 55% of small and mid-sized hospitals are poised to increase investments in point-of-care systems.However, the survey also finds this hospital segment is concerned about its ability to scale up data centers to manage the explosion of data they’re about to foster. Some of the challenges hospitals foresee include security, standards, and how to manage increasing

Being younger demographically doesn’t mean you’re younger, digitally-speaking. Your Real Age isn’t your Digital Age, according to Wells Fargo‘s survey into Americans’ use of advanced tools for daily tasks. The categories of peoples’ digital maturity include: – Digital teens, who are people who are online but don’t use all tools at a ‘high level’ – Digital novices are those people who manage basic tasks online but aren’t yet connecting with others online or managing more complex tasks – Digital adults have the highest digital age, as demonstrated by their using online tools for daily tasks, interacting with others online, and

If you have a blank check and could write it for whatever you wanted, what would it be? For Bill and Melinda Gates, life affords a rich opportunity to write a lot of blank checks. But for them, it’s not about the next Prada bag, Maserati or waterfront home: it’s about spending the next dollar on health, which they believe is also good for economic sustainability. Mr. Gates is concerned that after the signing of the Copenhagen accords, the global environmental pact, that developed countries’ funding of health projects will fall in favor of spending on new energy and other

1 in 2 Americans visits so-called quick service restaurants (QSR) twice a month, 29% visit 3-5 times a month, and 16% visit 6 or more times a month. Taco Bell sponsored the America’s Drive-Thru Survey and found that 7 in 10 Americans think having better choices in drive-thru’s would encourage them to eat better. Only 50% of Americans believe they can stick to a low-calorie diet while ordering through drive-thru’s. 9 in 10 would try better choices of their favorite menu items if they were offered. Taco Bell generates 70% of its business via drive-thru. This press release explains the

Employers aren’t happy with their health insurers. Satisfaction with health plans has eroded in the past year, according to a survey from PricewaterhouseCoopers (PwC). While 64% (about 2 in 3) of large employers were satisfied with their health plans in 2008, only 59% were in 2009. PwC says, “What employers want from health insurers in 2010: Better information, more value,” which is the name of the report covering the survey. As large employers morph to small ones, health benefits become much less important, the survey found. The smaller the company, the lower the satisfaction with health plans.The two key components

The chart shows that MinuteClinic retail health clinics have a better track record in following evidence-based guidelines than the average primary care practice in the U.S. (This chart replaces one I posted yesterday that did not start the origin point at ‘0.’ Thanks to reader Jason Rothstein at J-blawg for pointing this out – my apologies if I mislead anyone). The National Center for Policy Analysis (NCPA) pulled out this statistic in its Brief Analysis on Retail Clinics: Convenient and Affordable Care. The NCPA argues here that the solution to America’s lack of convenient, low-cost care is urgent care clinics.

Blue Shield of California is going where few health plans have: into the world of consumer ratings, a world beyond the plan’s control. The insurance company has worked with Bazaarvoice to develop a member ratings and review site. This is being rolled out to some members in a first phase, to be expanded over time. A press release on the plan’s website says, “Our members want to be heard and want to be able to interact with us and with each other in exciting new ways…we’re proud to be the first health plan in the country to be fully transparent.”

With the sobering headlines that “35 is the new 40” for Americans and a national erosion in optimism, Philips has published its 2010 Index on America’s Health and Well-being. The skin-deep, top-line finding is that 74% of Americans age 18-65 say their health is good or very good; however, there’s a disconnect and discontent that runs below this otherwise happy data point.I spent some time talking with Katy Hartley, Director of the Philips Center for Health and Well-being, about the study. She identified four key findings:1. People feel older, younger. That’s the “35 is the new 40” headline. When Americans

The health industry added 631,000 new jobs since the recession began, according to data from The Bureau of Labor Statistics released for January 2010. Critique the proportion of the GDP that the U.S. spends on health care if you must, but remember that the bioeconomy is a jobs engine for the nation and one of the few bright spots of innovation in the American economy.There’s another dynamic of jobs and health care that’s more good news: health reform would have a positive impact on job growth in the U.S. David Cutler (whom I talked about yesterday in Health Populi) and

Unemployment can quickly lead to uninsurance if a newly-laid-off worker doesn’t buy into COBRA. That’s the reality since the monthly cost of COBRA consumes, on average, about 84% of the average monthly unemployment payment for American workers. This calculation was made by Families USA in 2009, appropriately titled, Squeezed. When I wrote about COBRA here exactly one year ago, I posited that without significant subsidies, the newly-unemployed would quickly morph into the newly-uninsured. I can happily report that subsidies began to flow to laid off workers last spring and this led to a pick-up in COBRA enrollment throughout 2009. The

In the long run, it’s said, nothing is sure but death and taxes. In addition to those, there’s an increasingly sure thing: no retiree health benefits from employers. Once considered a “throw-away benefit” in the 1940s and 1950s when there were few retirees, retiree health benefits are an endangered species. In Implications of Health Reform for Retiree Health Benefits, the Employee Benefit Research Institute (EBRI) details the recent history and impacts of legislation on retiree benefits. Starting with FAS 106, the accounting rule change that passed in 1990, the financial treatment of employer-sponsored benefits negatively impacted access to health benefits

The long end-tail of the recession and the rising costs of health care — both medical trend/clinical and administrative — are creating uncertainty for employers who cover retiree health benefits. This picture is even more cloudy for pre-retirement benefit plan design.The bottom line: how do employers balance burdensome health costs with legacy promises?This question is addressed in Retiree Medical Challenges and Opportunities, December 2009, the fifth annual Towers Perrin–ISCEBS survey.Among this survey’s respondent employers, 80% have laid off workers in this recession, 32% have enacted voluntary staff reductions, and 26% have cut benefits. Nonetheless, 70% are continuing to provide retiree

The over-arching challenge facing health care in the U.S. for 2010 is managing costs, according to PricewaterhouseCoopers‘ forecast, titled appropriately, Squeezing the Juice Out of Healthcare. PwC says that health stakeholder organizations will have to redefine their roles given the ‘squeeze’ on incoming revenues, forcing focused management of operational costs. “Flat is the new growth for many industries outside of healthcare,” PwC asserts. Businesses in health will have to get used to that economic reality in 2010. 2009 saw big increases in costs which could result in pricing pressures in 2010.Value-based purchasing is taking hold in both the public and

29% of people in the U.S. have served as unpaid family caregivers in the past year. That’s 66 million people, mostly female (66%), middle age (on average 48 years old), usually taking care of a relative (86%).These sobering stats come out of Caregiving in the U.S. 2009, a study from the National Alliance for Caregiving in collaboration with AARP. The research, funded by the MetLife Foundation, follows up a similar study in 2004 and shows the proportion of Americans caregiving has substantially changed over the past five years.But both caregivers of adults and those for whom they provide care are

Nearly 8 million Americans 65 and over visited Facebook in November 2009. Nearly 8 million older Americans visited YouTube in November, too. After Google Search and Windows Media Player, the two big social networks are the most-visited websites among older Americans. So found The Nielsen Company, reported in the nielsenwire on December 10, 2009. One year ago, Facebook was the 45th most visited site by seniors. Today, it’s #3. 8.2% of social network visitors are over 65. That’s only 0.1 percentage points less than the proportion of teens visiting social network sites, according to Nielsen’s data based on November 2009

Health care delivered in today’s model can be thought of as a mass market product. There’s not much customization, even though to each of us, our health is extremely personal to us.   Welcome to the emerging era of personalized medicine: “the right treatment for the right person at the right time.” This is just-in-time, customized, measure-twice-cut-once care bespoke for the individual.   Read more about this transformational market in PricewaterhouseCoopers’ report, The new science of personalized medicine: Translating the promise into practice.   Personalized medicine includes several segments: Personalized medical care, such as telemedicine, health information technology and disease

Health care spending competes with other household spending, a fact we talk about a lot in Health Populi. For 2 in 5 Americans in this holiday season, the recession is forcing them to spend less on gifts. Only one in 5 Americans say their spending will be the same as in the last holiday season. For the majority of Americans, holiday spending declines are attributable to the cost of gas and household goods, recession fears, worries about job loss, and, yes, health care costs.This is especially true for women, those without health insurance and, not surprisingly, those with household incomes

The fifth annual survey on consumer engagement in health care from the Employee Benefit Research Institute (EBRI) finds that members of consumer-driven health plans (CDHPs) are more cost-conscious than enrollees in traditional health plans. These members also tend to be more engaged in wellness and health promotion programs. Health engagement happens among this group in a variety of behaviors; enrollees in CDHPs are more likely to, Check whether the plan would cover care Ask for generic drugs vs. brands Talk to doctors about drug and treatment options, and their respective costs Have a budget to manage health care expenses And

American health citizens are burned out on risk communication from pharmaceutical companies. They’d prefer simpler approaches through websites like WebMD and icons like the Consumer Reports‘ multishape “moons” to learn about health risks. ORC Guideline, an info GROUP company, identified a health risk information overload in their latest survey of American adults, conducted in late October 2009. The company presented data at the recent FDA meeting on promoting regulated medical products using the Internet and social media on November 13, 2009. The top-line finding is that there’s an increase in the percent of Americans who feel there’s too much emphasis

The health care market’s broken in the U.S., and it needs more help than Congress’s proposals are offering. What cost $10,743 for per-employee health care costs at large employers in 2009 will cost will nearly triple to $28,530 in 2019 if the status quo continues. If legislative proposals currently being discussed in Congress are implemented, that cost grow to $25,435. With greater restructuring for value, malpractice reform, and evidence-based medicine, the per-employee cost rises less, to $23,151 in 10 years. The menu of restructuring factors recommended by the Business Roundtable would soften per-employee cost growth to an annual rate of

8 in 10 Americans say making sure affordable health insurance plans are available is Job 1 for health reform. The November 2009 Kaiser Family Foundation Tracking Poll finds that affordability, insurance reform (especially coverage of pre-existing conditions), and managing the Federal deficit are top priorities for health reform across all Americans polled. Other reform elements favored by over 50% of Americans are subsidizing health insurance for uninsured who can’t afford it on their own (65%), and an individual mandate for health insurance (56%). Underneath these numbers are big differences between demographic groups–in particular, among those over 65 who seek to

In 1975, nearly one-half of American families had a sole wage-earner who was a husband. In 2008, those traditional families numbered only one in 5.Today, one-half of American workers are women, and one in five is a single working parent. 4 in 10 mothers is the primary bread-winner in her family.The Shriver Report, a study penned by Maria Shriver and The Center for American Progress, paints the picture of women in contemporary American society — New Breadwinners, Immigrants, Spiritual, Sharing the Load. At the end, the report finds that employers’ and government agencies’ policies don’t match up with what women

Employers across the world recognize the value of employee health and well-being, both to their organizations and to their individual workers. Buck Consultants surveyed over 1,000 organizations in 45 countries and found that, globally, health promotion that focuses on worker productivity is spreading.However, employers in the United States have different priorities and perceived risks than businesses in other regions of the world.The report on the survey, Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies, spells out the differences between the U.S. and the ROW.The chart details the top 3 priorities among employers by region; in the

One of few health reform topics all Americans agree on is the issue of prevention. The majority of Democrats, Independents and Republicans rank prevention ahead of most other health reform initiatives, according to a survey conducted for the Robert Wood Johnson Foundation.The top health reform priority among Americans is insurance reform: specifically, prohibiting insurance companies from denying coverage because of age, medical history, or pre-existing condition, scoring 7.9 out of 10 based on the survey methodology.In second place in the survey among Americans’ health reform priorities were to invest in more prevention to help people stay healthy, and to provide

Health care cost increases in the U.S. are unsustainable; there is universal agreement among U.S. health care stakeholders on this point. The uber-objective of “bending the cost curve” is a major sticking-point with the House-passed health reform bill.Some see cost-effectiveness analysis (CEA) as one viable approach to managing health cost growth in the U.S. CEA balances health benefits of different clinical interventions for a specific condition and compares each intervention to their costs. A report from the California HealthCare Foundation (CHCF), Value Proposition: The Role of Cost-Effectiveness in Coverage Decisions, clearly explains CEA and offers recommendations on how the method

Hospitals generally see the value of patient portals. In these projects, their highest-value goals are improving the quality of health care, enhancing patient experiences, empowering health consumers, and personalizing information. Geonetric conducted their eHealth Insight survey in August 2009 to learn more about hospitals goals and priorities for patient-facing Internet portals. Over 60% of hospitals and clinics who responded to the survey understood the value of a patient portal. One in 4 respondents had already built such a portal, and one-third looked to develop one in the next year. Ironically, while goals for portals were highly consumer-focused, future functional priorities

When it comes to the adoption of electronic health records, it’s good to be urban, large, and teach. According to the latest report on EHR adoption, Health Information Technology in the United States: On the Cusp of Change, 2009, fewer than 2% of American hospitals used a comprehensive electronic health record (EHR) in 2008, 7.6% had a “basic” EHR based on the definition generated by an expert panel conducted by the Robert Wood Johnson Foundation, the Massachusetts General Hospital, and the George Washington University — the team that developed this full report on the state of EHRs in U.S. hospitals.The

59% of Americans want to receive test results via email. 1 in 2 would like to use email to request prescription refills, confirming appointments, telling doctors about their conditions, and asking questions about new conditions. Email is now the preferred communications medium for consumers in health. Second to email, using doctors’ websites would also be welcomed by many health consumers, especially for prescriptions and appointments. Physicians’ websites are somewhat less desirable communications platforms for communicating about personal health conditions. It is still too early for consumers en masse to embrace text messaging in health. Women were more likely than men

As I nurse my flu symptoms, I’m struck in real-time by being a sick patient in a sick health system. Last Friday 30th October, I was suffering classic flu symptoms and after 2 days of trying to muddle through with home remedies, homeopathic products and OTCs, I contacted my doctor’s office first thing in the morning. I was told that my doctor was out for the day, and was referred to another physician in the practice. By noon, that doctor had phoned in a prescription for Tamiflu to my pharmacy. The office told me to follow up with my doctor

IBM is dropping the $20 co-payment for employees’ visits to primary care doctors. The Wall Street Journal covers this story today. The “no co-pay” scheme will cover employees enrolled in IBM’s self-insured health plan — excluding workers enrolled in HMOs. Overall, IBM has 115,000 employees and spends $1.3 billion on health care. The WSJ quotes SVP of IBM’s human resources Randy MacDonald, who said that emphasizing primary care is part of an overall “wellness” strategy that tries to keep costs low by preventing illness. Health Populi’s Hot Points: The data point of one U.S. company dropping a $20 payment for

New Yorkers who frequent Au Bon Pain, KFC, McDonald’s and Starbucks who noticed calorie counts on menu labels ordered 106 fewer calories at the point-of-purchase than people who didn’t pay attention to the information.   Here’s evidence that labeling in fast-food destinations works.   At the annual meeting of the Obesity Society in Washington DC this week, researchers are presenting results on how transparency of calorie information motivates many health citizens to change their choices based on nutritional knowledge.   Reuters reports some details from the study. Researchers in New York polled 10,000 diners at 275 locations of the most

Over one-quarter of a million jobs were lost in the U.S. in September 2009. Because unemployment quickly morphs into uninsurance, a question for the 263,000 workers and their families is: “Will Medicaid be able to cover me and my family if I cannot afford COBRA?” There are three pieces of arithmetic that can help us connect the dots to answer this question: 1. On average, the monthly cost of COBRA consumes 84% of the average monthly unemployment payment in the U.S. The ARRA stimulus package included a 65% subsidy to help newly-laid off people pay for COBRA if they elected

Today marks the launch of the Journal of Participatory Medicine. The inaugural issue coincides with the kickoff of the Connected Health symposium today in Boston. In the first issue of the Journal, Esther Dyson asks and answers the question, “Why Participatory Medicine?” She talks about the need for evidence that demonstrates what works in collaborative health care. “We are just at the beginning,” Esther says, “not of a brave new experiment that could end in disaster, but of multiple experiments, by thousands and ultimately millions of people, with variations in every parameter imaginable.” Thoughtful perspectives are offered through the lenses

Use of the Internet by older Americans leads to a reduction in the prevalence of depression, according to a study published by the Phoenix Center for Advanced Legal & Economic Public Policy Studies. This research highlights the macro-benefit of deploying broadband to all health citizens. Internet Use and Depression Among the Elderly analyzed a data sample of 7,000 Americans age 55 and older from the University of Michigan’s Health and Retirement Study household survey. This survey instrument polls over 22,000 older Americans every two years. The data used by Dr. George S. Ford and Dr. Sherry G. Ford in the