A blog covering the health/care ecosystem and people.

I was invited to attend a breakfast on Wednesday morning with Newt Gingrich, hosted by Allscripts. They’re an important innovator in health care connectivity, and work closely with Gingrich’s Center for Health Transformation (CHT). Gingrich has become an evangelist for the role that information technology can play in improving health care quality and efficiency. His organization’s CHT Press recently published Paper Kills, a book that highlights the impact of IT in health care. “We are in the early stage of how we’re going to deal with the health system” in the U.S., which Gingrich believes is in or nearing crisis-mode.

As I reflect on the marathon walk through the Orange County Convention Center at HIMSS in Orlando yesterday and my many conversations with vendors, analysts, financiers, and reporters, the results of the 19th Annual HIMSS survey of hospital CIOs ring like a bothersome case of tinnitus in my mind. This is in the context of reading the latest issue of Wired, featuring an important story by Chris Anderson on the impact of “free” on business. While CIOs say that quality, safety, and implementation of an electronic medical record at the 3 priorities for IT spending in 2008, it’s not clear

The Google–Cleveland Clinic health records venture has been announced. Cleveland Clinic is a leader among providers when it comes to health IT, so Google has chosen well.   This is a small, quick pilot between two mega-brands in their respective spaces. Word is that the project will last only a couple of months. While Cleveland Clinic has electronic health records for over 100,000 patients, this project will have an N of 10,000.   I will be exploring more about the project with Googlefolks at HIMSS next week. For now, I’m in research mode. I’ve already come across several useful posts

A proposal from health reform has been cobbled together by Jacob Hacker in concert with the Economic Policy Institute (EPI). The Lewin Group (part of Ingenix) has analyzed the costs of the proposal, and based on their assumptions, they find it’s a zero sum scenario. Lewin’s must-read cost impact analysis can be found here at the EPI’s website.The original Health Care For All plan was published in January 2007 as an EPI Briefing Paper by Jacob Hacker. Leave it to Hacker, the author of the terrific book The Great Risk Shift, to put together a more-than-modest proposal that Lewin calculates

I’m enjoying a weekend with London-based friends who travel the world and know what’s what. Today, we spent hours relishing (literally) the Borough Market in Southwark, located south of the Thames. This is London’s oldest food market, established when the Romans built the first London Bridge. The Market in its current state has been around for a quarter of a millenium.    The Market boasts and hosts a glorious array of green grocers, bread bakers, Spanish food purveyors, brownie makers, organic tofu purveyors, and parmigiano reggiano vendors in one spot I’ve seen, perhaps ever. It is foodie heaven and a

What do you stand on covering the uninsured in America? Do you support government mandates for health insurance or a market-based approach? Should the Federal government directly negotiate drug prices with pharma companies? Go visit Health Central’s Healthcare ’08 website to visually see where you stand on health issues compared to the Presidential candidates. Since the site’s inception early this year, many candidates have dropped out. As of today, there are two Democratic candidates (Clinton and Obama), and three Republicans (Huckabee, McCain, and Paul). The measurement tool which HealthCentral calls “the Poligraph” is a clever two-by-two matrix arrayed on six

Younger people are way more stressed out than people over 65, according to a poll sponsored by the American Psychological Association.   HarrisInteractive has published data in its latest Healthcare Newsletter titled, “Adults Over 65 Experience Far Less Stress Than Adults in All Other Age Groups.” These findings are part of a deeper dive into the APA’s report published in October 2007, Stress in America. The highest levels of stress in America are in the 35-49 age cohort, followed by people aged 25-34.   6 in 10 people aged 35-49 say they are concerned about the level of stress in their

Question: do women care more about their hair or their hearts?I wrote about companies marketing health through the lens of beauty last week in the context of promoting osteoporosis drugs. P&G gets this approach. This isn’t surprising to me because P&G also understands, psychographically, why I (an economist married to a banker) still buy expensive Tide when I know from Consumer Reports that Costco’s Kirkland brand works at least as well! Welcome to the “Heart of Beauty” campaign, promoting the heart-healthy benefits of Metamucil. Metamucil has been recommended by the American Heart Association as a useful product to help lower

It’s a case of “I’m falling but I can’t get up,” or knowing you’re sick but not knowing the cure. Consumer Reports‘ (CR’s) latest health poll shows that Americans know they have a sick health care system, but haven’t a clue about the antidote. Most Americans are pessimistic about health care costs across gender, income, political orientation, and age. This issue isn’t ‘just’ about seniors anymore. Looking ahead, 8 in 10 Americans are concerned about health care affordability in retirement, and 2/3 of peopel worry about both medical bankruptcy and losing employer-based health insurance. Americans say they want: To cover

For 40 years, health costs have grown faster than the general economy in the U.S. Technological advances in theory can reduce costs. However, a new study done for the Senate Budget Committee finds that, surprise surprise, the “increased capabilities of medicine” tend to raise spending. Technological Change and the Growth of Health Care Spending, the Congressional Budget Office (CBO)’s report issued last week, details the history of rising technology spending in health and offers a sobering warning about how health care costs are overtaking the American economy. In the report, “technological advances” cover the broad range of health technologies —

Or, The Lovely Bones (health care version).   I have an acquaintance whose bone density scan told her she is at high risk for osteoporosis. No surprise: the condition runs in her family. For several years, she has been paying a luxury-segment department store counter $300 every two months for her skin creme, which promises that she will be ageless as she ages into her fifties, sixties, and beyond.   But she has not yet filled her prescription for an osteoporosis-preventing drug.   She doesn’t have prescription drug coverage. She thinks the drug is too high-priced. It’s about $300 for

While fairly satisfied with their own health care, Washingtonians are frustrated about health care costs and the lack of access to care for their fellow Americans. These findings are similar to a similar poll of Iowans conducted by CodeBlueNow!, an advocacy organization focused on health reform. Health Populi blogged about the Iowa survey here. The most striking similarity between both polls is that people don’t trust the government to reform the health system. Instead, health professionals and the “common people” are seen as trusted health reformers. There is mass dissatisfaction with the costs of health care, about which 2/3 of

When the health care Oscars are announced in 2010 for top roles, the health care academy won’t know whether to cast Wal-Mart as the lead, supporting, director, or producer in health care. Wal-Mart is the third largest pharmacy chain in the U.S. As #1 on the Fortune 500 list, the retailer’s role as a jumbo employer means it has clout in health care negotiations and in the entire American health system. According to the company’s CEO, the company may enter the pharmacy benefits management business. During the company’s annual “Year Beginning Meeting” last week, Wal-Mart CEO Lee Scott talked about

For those employees fortunate enough to receive health insurance from work, there’s a bountiful array of health care services that are still covered by plans. The International Foundation of Employee Benefit Plans (IFEBP) polled its membership in late 2007 and found that employers are not only continuing to cover a broad range of services, but also new services the likes of which weren’t covered even two years ago…from medical tourism to biofeedback. These results are documented in IFEBP’s publication, Health Care Benefits: Eligibility, Coverage and Exclusions. The usual suspects are covered by well over 97% of employers, such as ER

In what is among the most up-close-and-personal incentives offered by an employer to motivate healthy behaviors, Safeway, the grocer, is implementing a program to reduce health insurance premiums for those employees who buy healthier foods at checkout. Among a group of employees who participated in the FoodFlex pilot last year, the program resulted in a 13% decline in medical costs per capita. FoodFlex is an online program linked to Safeway’s loyalty card program. Once someone enrolls in FoodFlex, the program tracks the nutritional quality of food that the consumer purchases at any Safeway store. Participants can provide various information about

In the most bullish forecast yet on the adoption of social media in health, iCrossing has found that 34% of Americans turn to social media for health research. iCrossing has been analyzing “How America Searches” for financial services, travel, and other vertical market information over the past two years. Now, they’ve researched Americans’ search for health and wellness information.It will be no surprise to Health Populi readers that health search is a normal part of most Americans’ online activities, based on previous research by the Pew Internet & American Life Project, California HealthCare Foundation, JupiterMedia, and other credible research teams.

A new report talks about the health risks of our demand for instant-everything. “Today, we expect all information to come fast and free,” writes the Center for Medicine in the Public Interest. That expectation can lead to disastrous consequences in the context of accessing health information without questioning its source. The “fast” expectation is proliferating every aspect of our lives. Here’s but one example I’ve been using lately with my clients: a few years ago, I noticed a proliferation of packaged foods to enable the busy householder to cook slow food, faster. One of these is pictured on the left

Getting access to physicians’ opinions is Big Business. Now, institutional investors will have access to the brains of doctors through a relationship between Goldman Sachs and Epocrates, the point-of-care health information company. Why is this so important? Because the health sector in the U.S. is now valued at over $2 trillion, according to a new estimate published by CMS this week. The prescription drug program, known as Medicare Part D, was responsible for driving health costs above the $2 trillion mark. This piece of the national economy can be an attractive place for investors to seek returns; however, not every

Break out the Bordeaux and eat those escargots: France ranks first in preventing deaths, according to a new study from The Commonwealth Fund. Compared to 19 industrialized countries, the US ranks dead (pardon the pun) last. The top three nations who do best at preventing death are France, Japan and Australia. The study in Health Affairs found that if the US health system performed as well as these three countries, we would see 101,000 fewer deaths each year. In Measuring the Health of Nations, Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine, the authors

Pharmaceutical companies spend twice as much money on marketing as they do on research and development, according to a new study published in PLoS Medicine, an online peer-reviewed journal. According to the study, U.S. drug companies spent $57.5 billion on marketing versus $31.5 billion on R&D, in 2004.The chart on the right details the researchers’ updated estimates on pharmaceutical companies’ promotion. The authors, Marc-André Gagnon and Joel Lexchin, are Canadian academics who built a new estimation model for pharma marketing expenditures. They begin their paper by critiquing data from IMS, which is the primary pharma marketing information source used by

The latest Associated Press-Yahoo News poll, published just days before the Iowa and New Hampshire presidential races, shows Americans more concerned about health care and the economy than the Iraq War. US presidential politics in 2008 may turn into a classic race between guns and butter. For the next president, addressing health care is Job 1: 53% of Americans say that health care is “extremely important,” a positive swing of the pendulum of 5 points since the question was asked the previous month in November 2007. On health care and the economy, Democrats are more trusted than Republicans: on health

Patients with at least one chronic condition spend more than five times of those with no chronic conditions. Increase the number of chronic conditions to five or more, and people have 25 times the inpatient hospital spending — the high-priced line item in the medical bill.Bottom line: “By the late 20th century and continuing into the 21st century, the major reason for mortality and morbidity in the United States and other industrialized countries has become chronic disease.”In Chronic Conditions: Making the Case for Ongoing Care, Dr. Gerard Anderson of Johns Hopkins quantifies the relationship between chronic disease and health spending.

IBM calls 2007, “The Year of the Omni Consumer.” In the area of health, IBM points to consumers’ eroding trust in food safety. However, in its press release on the Omni Consumer, health care is not a major feature. The IBM analysts are smart (or lucky). If this is an oversight, then it’s providence; if it’s an explicit omission, it’s spot-on. In my work and research, I remain unconvinced that Americans are truly behaving as health care consumers. Nor do I believe they want to embrace that role…yet. Notwithstanding the pronouncements of Ivy League professors in business bestsellers and human

Four out of ten physicians are e-mailing patients. In fact, most doctors are going online for way more than search. That’s what Jupiter Research found in their latest report, the US Online Physician Executive Survey, 2007. Doctors have turbocharged their use of web-based applications in just the past two years. What’s caused the increased adoption in so short a period? Well, doctors are Missourian in spirit; they are a “prove it to me” bunch. Physicians are finding richer content and tools online: 50% say that the Internet helps them be more efficient in their practices. Fully 3/4 of physicians are

Suze Orman, heads-up; there’s a new FICO score in town. Fair Isaac knows a lot about credit risk and data analytics, and they’re behind the development of the medFICO score that will help hospitals manage the financial risks they take on when they admit patients to hospitals.   The medFICO will represent a patient’s “medical credit” score. While consumer advocates are concerned that hospitals will use this data point pre-admission — thus giving the institution information about patients’ ability-to-pay their co-payments and coinsurance amounts — the project’s sponsors say the score will only be gleaned once the patient is discharged

EBRI’s latest report says we’re at the “tipping point” of employer-sponsored health insurance. But it’s not a tipping point for dropping insurance benefits; it’s a tipping point for changing the status quo of how these benefits are delivered. In The Future of Employment-Based Health Benefits, the Employee Benefits Research Institute asks whether employers have reached the point when they will stop providing health benefits. Data do not show that health benefits are disappearing from the workplace. Nonetheless, some employers believe that the current system of providing benefits is inefficient, lacks transparency, and is “not intelligent.” Employers concur that the current

The American College of Physicians has developed a position paper on universal access in health care — they’re for it. Why? Because as the good doctors point out, “The U.S. health care system is inefficient and inconsistent.”The ACP’s rationale for universal access is not driven by a moral imperative to cover all Americans; rather, they argue that by serving a strong central mission of primary care and implementing a robust IT infrastructure, we’ll achieve a high-performance health system. That is, we’ll deliver health care well and efficiently. In a far-reaching, richly-researched paper to be published in the January 1, 2008,

Not sufficient, that is, to guarantee access to health care. The latest release of that great publication of the Centers for Disease Control, Health 2007, has the theme of health care access at its core. Think of Health 2007 as the State of the States’ Health (all 50 collectively). This is the 31st annual version of this huge compendium. The book features updated data that paints a comprehensive picture about Americans’ health care, health status, financing, and resources (financial, labor, technological). Health 2007 is one of my health care “must-reads” each year; it makes me feel better about paying my

Families USA examined health care costs for families in four states, including Arkansas, Missouri, New Hampshire, and my home state of Pennsylvania. Nationally, one in four Americans under 65 will spend more than 10% of their income on health care next year. Take a look at the report on Pennsylvania. In the state reside over 2 million people who are under 65, 87% of them are insured, and more than 18% of these families will spend over 10% of pre-tax household income on health care costs in 2008. In addition, nearly 5% of Pennsylvania’s families will spend over 25% of

The concept of the Medical Home is emerging as an antidote to America’s fragmented health care landscape. Several large employers and physicians are pushing the concept, driven by different incentives but united in the effort. Medicaid plans have become early adopters of the Medical Home, too. The Medical Home is not a new concept; pediatricians have been lobbying for the concept since 1992, as this paper in Pediatrics defined the idea 15 years ago. It’s akin to a next-gen HMO gatekeeper, with a twist: the Medical Home features a primary care doctor at the center of care, but looks to

79% of Americans are interested in reading their medical records, according to a recent survey. That’s a good thing, because doctors can make mistakes recording notes in medical records that can lead to unintended health consequences based on faulty data. Doctors are chatting about finding mistakes in their own patient medical records. The chat is happening on the social networking site Sermo – a website that is accessible only by clinicians. The site is attracting thousands of physicians who want a place to talk about issues of concern in a safe environment…the way they might have done on the golf

Employer costs for health coverage are rising twice as fast as general price increases. This is leading to more employers dropping health coverage for employees. Mercer brings us this evidence in their new health cost survey, to be published in March 2008. The consultancy found that health costs increased 6.1%, equivalent to 2006 cost increases. This equated to $7,983 per employee. The forecast for 2008 is a 5.7% health cost price increase. These cost increases are outpacing wage increases. More small employers – where job growth is – are exiting health coverage, according to Mercer. The percentage of small employers

The National Business Group on Health (NBGH) has endorsed the retail health clinic concept in a new policy statement issued on November 15. The Physician Advisory Group of NBGH reviewed the available evidence on retail health clinics, also known as “convenience care,” to come to this policy decision. The bottom line: NBGH finds that retail clinics meet unmet needs for employees to use for selected, urgent, non-emergent medical problems. Helen Darling, NBGH Executive Director, said that the unique value proposition of retail clinics is that they are, “easily accessible, open to everyone, lower in cost than emergency rooms, and available

An iconic image from Matisse’s Jazz portfolio comes to my mind as I think about the chasm between social media and health on one side, and health plan data on the other. The image is shown on the left; I’m including him here to represent the health consumer engaged with social media, sharing opinions about his experience with health providers, payers, and other touchpoints in his health interactions. A new survey published by the National Business Coalition on Health (NBCH) finds that only 31% of health plans collect and publish patient experience data. And, like the readers of the National

The Mayo Clinic, one of the most prestigious names in health care, is planning to open several retail clinics in early 2008. Does this signal the beginning of an upper tier of retail clinic — where Nordstrom- or Neimans-meets-medicine? At this early stage, Mayo’s plans are to locate the branded “Mayo Express Care” centers around their immediate target market of Rochester, Minnesota, which includes part of Wisconsin. By implementing this plan, Mayo, known for its stellar inpatient services, expands its reach into community-based primary care role. Mayo was named one of America’s best hospitals by US News and World Report

Evidence-based medicine (EBM) can reduce health spending, according to two analysts at the Congressional Budget Office. Note that there’s a piece of legislation in Congress to fund EBM research.The very level-headed essay in the November 8th issue of the New England Journal of Medicine explains the positive role that EBM could play in preventing Medicare and Medicaid from consuming 20% of the GDP by 2050.Peter Orszag and Philip Ellis, the CBO’s Director and senior analyst, respectively, talk about the merits of marrying EBM — which generates information about the effectiveness of medical treatments — with rewarding clinicians when they adopt

Today, election day, is a day to watch the states closely for on-the-ground action on health. In particular, the outcome of the vote in Oregon which would raise the state’s cigarette tax to cover children’s health care could provide impetus to move the vote pro-kid’s health at the Federal level. Oregon has a history of being leading-edge in health care politics. A Health Affairs article from December 2006 discusses that history, and subsequent gap between Oregon’s health aspirations versus declining enrollment in its ambitious health plan. Today’s vote could fill that gap.If Oregonians reject Measure 50, those who diss SCHIP

In 2004, 20% of homicides were directly associated with intimate partner conflict (i.e., one in which an intimate partner killed another partner). Intimate partner violence resulting in death was most common among victims aged 40-44 years. Murder is the leading cause of death for pregnant women, according to the National Organization of Women. The National Center for Injury Prevention and Control, part of the Centers for Disease Control and Prevention, spends about $43 million a year on ways to reduce deaths and injuries from drowning, poisoning, suicide, industrial accidents, house fires and domestic violence. Of that sum, only $2.3 million

This week’s Forbes magazine features a story on Americas Most Sedentary Cities. Translation: which cities in America have the highest levels of obesity, and why? The answer to “why?” is a complex but understandable interaction between several factors: suburban sprawl, lifestyles of convenience, and some local factors that vary city-by-city.It turns out that transportation planning and the larger context of urban planning — or lack thereof — are contributing mightily to our lack of exercise and communities’ ‘walkability.’ Research is finding that the lack of greenspace and parkland in a community contributes to sedentary lifestyles and, thus, obesity. The Forbes

Iowa gained early-bird status for primary season as it set the date for its caucus as early in the new year as it could: January 3, 2008. A new survey indicates that Iowans are restless about health care. CodeBlueNow!, a consumer-led health advocacy group, sponsored the Iowa survey as part of its “Pulse” research program. Iowans believe that (1) health care services should stress disease prevention over high-technology cures, (2) more public accountability is needed in how health care dollars are spent, and, (3) “basic” health services should include access to any licensed health care professional. While the survey results

Health and wealth are intimately related. This week’s (October 24/31 2007) Journal of the American Medical Association (JAMA) is devoted to poverty and human development. Another important publication this week highlights the relationship between income and health: EBRI has just published its the 2007 Health Confidence Survey, the Institute’s tenth annual report on how Americans perceive the US health system. Together, these two documents shine a light on the health/wealth relationship. This relationship holds true whether we’re talking about rural India, Zambia, Beijing, east LA or Ames, Iowa. In JAMA, take a look at Dr. Steven Woolf’s commentary, Future Health

  There are many forms of plastic in health care. No, I’m not talking about new polymers used for medical implants. I’m talking about financial services. A new card from Humana and Republic Bank illustrates the continuing integration of consumer personal finance and health care. The new VISA card, private labelled as the HumanaAdvance card, will be offered to Humana’s employer groups for enrollees to use at hospitals, doctor and dentist offices, drugstores and other locations providing health-related products and services. Of course, as with all plastic, this card comes with its own fine print: 0% interest rate (APR) on

I’ve been looking at health care through a retail lens for some time. Perhaps it’s that I’m a rag trader’s daughter, or that I’ve been known to like shopping, that I have clients in consumer goods, or that I understand how tiered drug pricing impacts the consumption of medicines (answer: it’s all of the above). I’ve just reviewed the latest trend report from PricewaterhouseCoopers and TNS Retail Forward on the future of retailing. My mind is connecting the dots between the future of retail and the American health care consumer. Four future retail trends are already embedding in health care

Where you live, who you work for, and what color you were born are predictors of whether you have health insurance in America. New data from those hard-working, non-partisan researchers at the Employee Benefits Research Institute (EBRI) have published their latest portrait of insured, and uninsured, Americans. The report is based on data from the March 2007 Current Population Survey of the U.S. census. For the details, see EBRI Issue Brief No. 310, October 2007. Geography is destiny as a factor for being insured. The highest level of uninsurance is in the south central US, where about 20% of the

For 50 years, the oral health of Americans had been improving. By 2004, the trend reversed.The state of oral health in the US is on the decline, with 100 million people lacking dental insurance and cavities going unfilled. This, while so many millions are spending on tooth whitening and breath freshening.Oral health is an integral part of a person’s overall health. According to the Academy of General Dentistry, there is a relationship between gum (periodontal) disease and heart disease. A recent study on periodontal disease and atherosclerosis confirmed this finding. flossing showed evidence to support flossing to fight disease. Over

The annual financial burden of health illiteracy costs between $106 and $238 billion. This is enough money to cover the 47 million uninsured people in America.   That metric, and many other insights, were published this week in an important new report called, Low Health Literacy: Implications for National Health Policy. The report was written by Dr. John Vernon, a professor of finance at the University of Connecticut, and three colleagues from the University of Central Florida, George Washington University, and an executive from Pfizer. This research was sponsored by Pfizer, which has been promoting health literacy as part of

Consider, a definition of value: Worth in usefulness or importance to the possessor; utility or merit: as in, the value of an education.Hey Mr. Webster, how about, “the value of health?”This week, the ground beneath Philadelphia and Research Triangle Park moved as the announcement of Andrew Witty’s nomination to the post of CEO of GlaxoSmithKline shook the headquarter offices of the second biggest pharmaceutical company in the world. Among his American colleagues, Witty was generally not considered to be the front-runner in the triple-threat horse race launched by J-P Garnier, current honcho, to head the company. Among the 3 contenders

Covering the uninsured tops Americans’ health care priorities for presidential candidates. That’s the #1 health issue for Democrats and Independents; managing health care costs is the top health policy concern for Republicans. This, according to the latest Wall Street Journal Online/Harris Interactive poll published on October 4, 2007. Health care coverage is emerging as a front-burner for the American middle class. 61% of Americans said that health care ‘works’ better for the very poor and the rich versus the middle class. Furthermore, nearly 2/3 of Americans believe that health care in the U.S. works just fine if you are healthy

It is no surprise that chronic disease costs, but the burden of chronic disease is staggering: pegged at $1 trillion, according to the Milken Institute’s latest report, An Unhealthy America: the Economic Burden of Chronic Disease. This report highlights the sobering statistics about this critical cost driver in our system. The chronic diseases most burdensome to the economy including pulmonary conditions, hypertension, mental disorders, heart disease, diabetes, and cancer. What factors are contributing to America’s heavy chronic disease burden? The Milken team identifies them as: > Air quality > Alcohol > Cholesterol > Illicit drug use > Obesity (BMI ?