A blog covering the health/care ecosystem and people.

“I want what I want, when and how I want it.” If you think that sounds like a spoiled child, that’s not who I’m quoting. It’s you, if you are a mainstream consumer in the U.S., increasingly getting “primed” by Amazon which is setting a new bar for retail experience in terms of immediacy, customer service, and breadth of offerings. I talked about this phenomenon in my Health Populi post, How Amazon Has Primed Healthcare Consumers. The blog discussed my take on Accenture’s latest study into healthcare consumers based on the report’s press release. I appreciated the opportunity to sit

We are all Amazon Prime primed as consumers now. So it should not surprise healthcare providers, plans and suppliers that consumers expect just-in-time convenience for their healthcare, Accenture has found. Mind the gap: 8 in 10 U.S. patients would welcome some aspect of virtual healthcare, but only 1 in 5 providers is meeting that need. The consumer demand for virtual care is palpable for: Tracking biometrics, among 77% of consumers (say, for measuring blood pressure or blood glucose for people managing diabetes) Following up appointments, for 76% of people after seeing a doctor or being discharged from hospital Receiving reminders

Health care is the top concern of American families, according to a Monmouth University Poll conducted in the week prior to Donald Trump’s Presidential inauguration. Among U.S. consumers’ top ten worries, eight in ten directly point to financial concerns — with health care costs at the top of the worry-list for 25% of people. Health care financial worries led the second place concern, job security and unemployment, by a large margin (11 percentage points) In third place was “everyday bills,” the top concern for 12% of U.S. adults. Immigration was the top worry for only 3% of U.S. adults; terrorism and

Americans are more than five times more likely to skip medication doses or not fill prescriptions due to cost than peers in the United Kingdom or Switzerland. U.S. patients are twice as likely as Canadians to avoid medicines due to cost. And, compared with health citizens in France, U.S. consumers are ten-times more likely to be non-adherent to prescription medications due to cost. It’s very clear that more consumers tend to avoid filling and taking prescription drugs, due to cost barriers, when faced with higher direct charges for medicines. This evidence is presented in the research article, Cost-related non-adherence to prescribed

The top reason US consumers hear from a debt collector is due to medical bills, for 6 in 10 people in Americans contacted regarding a collection. This month, the Consumer Financial Protection Bureau (CFPB) published its report on Consumer Experiences with Debt Collection. Medical bill collections are the most common debt for which consumers are contacted by collectors, followed by phone bills, utility bills, and tax bills. The prevalence of past-due medical debt is unique compared with these other types because healthcare cost problems impact consumers at low, middle, and high incomes alike. Specifically: 62% of consumers earning $20,000 to

Among many health disparities which mar healthcare quality in the United States, there’s another one to add to the list: health and healthcare information access. Access to health care is underpinned in large part on a health consumer’s access to information about available health care services, their location, price, and if the patient is very fortunate to glean, quality. As people take on more responsibility for managing their health care utilization and financing in America, their access to information that is easy-to-find, clear, comprehensive and current is critical to personal and public health outcomes. But consumers are dissatisfied with the

1 in 5 U.S. adults used a retail clinic in 2016. Increasingly, health consumers seek care from retail clinics for more complex healthcare services beyond flu shots and pre-school exams, according to the Harris Poll’s survey, One in Five Adults Turn to Retail Health Clinics for Treatment, Prevention, and More, published January 5, 2017. Additional points the poll revealed are worth attention for public health policy purposes: Twice as many people who identify as LGBT turn to retail clinics than others (35% vs. 18%) Older people frequent retail clinics for flu vaccines more than younger people do More younger men

Why can’t the healthcare consumer experience be as easy as online banking? asks Tom Skelton, the CEO of Surescripts. That’s the expectation of most U.S. healthcare consumers, based on Surescripts latest survey results, summarized in the 2016 Connected Care and the Patient Experience report. The key findings are that U.S. consumers, Want their medical information delivered electronically, easily accessible and shareable; Are dissatisfied with the time and effort they spend on dealing with their medical information and waiting times in health care offices, both doctors and pharmacies; and, Prefer and expect innovative ways to get care and prescriptions. People are getting

“Because health is personal” is the tagline at the 2016 Connected Health Conference being held at the Gaylord Resort in National Harbor in metro Washington, DC. “Personal,” “Connected,” and “Health” are the three words that comprise the adjectives in the Personal Connected Health Alliance, the host of this conference. PCHA was formed through the merger of HIMSS, the health IT association, and Continua, the organization advocating for health technology “interoperability” — the ability for digital and communications technologies to communicate with each other, to remove friction from health data exchange. This week, PCHA announced that it will bring the Wireless-Life Sciences Alliance into

“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 have the stories of long and painful endings, in institutional settings and costly, futile care. When you’re already in the situation of making tough health

“The patient is the best sensor,” asserted Jamie Heywood, founder of Patients Like Me, during the perennial meeting sponsored by PwC, the 180° Health Forum. This event featured several panels of PwC’s curated group of so-called “provocateurs” in healthcare, and I was grateful to be one of nine selected for the event. Heywood joined Dr. Leanna Wen, Baltimore City Health Commissioner, and me in a panel called, “Strange Bedfellows or Soul Mates? The New Dating Game in Health.” The theme of our collective brainstorm was how collaborations across the ecosystem could help make health and healthcare better. The drawing is

The greater a person’s level of health engagement, the better their health outcome will be. Evidence is growing on the return-on-investment for peoples’ health activation and how healthy they are. That ROI is both in survival (mortality) and quality of life (morbidity), as well as hard-dollar savings — personally bending-the-healthcare-cost-curve. But people are more likely to engage in “health” than “healthcare.” We’d rather ingest food-as-medicine than a prescription drug, use walking in a lovely park for exercise, and laugh while we’re learning about how to manage our health insurance benefits. Thus, Campbell’s Soup Company and Hormel are expanding healthy offerings,

People feel like get-no-respect Rodney Dangerfield when they deal with health insurance, government agencies, or pharma companies. Consumers feel much more love from personal care and beauty companies, grocery and fitness, according to a brand equity study by a team from C Space, published in Harvard Businss Review. As consumer-directed health care (high deductibles, first-dollar payments out-of-pocket) continues to grow, bridging consumer trust and values will be a critical factor for building consumer market share in the expanding retail health landscape. Nine of the top 10 companies C Space identified with the greatest “customer quotient” are adjacent in some way to health:

Existing healthcare industry players – the stakeholders of hospitals, physicians, pharma/life sciences, medical device manufacturers, and health plans – are operating in a whirlwind of change. While there are many uncertainties in this period of transition, there’s one operational certainty: learn to do more with less payment. That’s due to the growing pursuit of payors paying for value, not on the basis of volume or what’s “done” to a patient in care delivery. At the same time, another force re-shaping healthcare is interest and focus on wellness and health management. Combined with the growing health economic value proposition, wellness and

More U.S. patients are faced with spending more out-of-pocket for health care services, to meet high-deductible health plans and rationally spend their health savings account investments. As rational economic men and women, some are seeking care outside of the United States where many find transparently priced, high-value, lower-cost healthcare. Check out the table from the Medical Tourism Association, and you can empathize with cash-paying patients looking for, say, gastric bypass surgery or a heart valve replacement. My latest column in the Huffington Post discussed this trend, which points first to the Cleveland Clinic — a top-tier American healthcare brand that’s

Consumers face increasing health insurance deductibles in 2016, faster-growing than earnings and well above general price inflation, featured in the Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2016. This report, updated annually, is the go-to source on the availability of, cost for, and trends in U.S. employer-based health plans. The average annual health insurance premium in 2016 reached $18,142, the survey found, about $600 more than in 2015. Over the past ten years since 2006, workers’ contributions to health insurance premiums increased 78%; employers’ contributions grew 58% over the decade.   To help stem costs, employers are adopting new services to

There are many signposts in the marketplace pointing the way toward the new retail health/care for consumers. They include: Food and exercise as the new medicine Loneliness as the new smoking as a health risk Prevention as the new sustainability Home as the new long-term care locus Balancing humanity and technology, the analog and the digital, and Retail as a center of the new healthcare ecosystem. Read more about the 7 Signs of the Retail Health Revolution,  published by Drug Store News. This graphic-rich publication was based on a speech I gave at a recent retail health summit convened with healthcare’s

“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

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.

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

Retail clinics are a growing source of primary care for more U.S. health consumers, discussed in a review of retail clinics published by Drug Store News in July 2016. There will be more than 2,800 retail clinics by 2018, according to Accenture’s tea leaves. Two key drivers will bolster retail clinics’ relevance and quality in local health delivery systems: Retail clinics’ ability to forge relationships with legacy health care providers (physicians, hospitals); and, Clinics’ adoption and effective use of information technology that enables data sharing (e.g., to the healthcare provider’s electronic health records system) and data liquidity (that is, securely moving

About two-thirds of health consumers would be open to virtual health care options for non-urgent situations, according to the 2016 Connected Patient Report from Salesforce Research. Salesforce conducted the survey with the Harris Poll online among 2,025 U.S. adults in June 2016. 1,736 of these health consumers had health insurance and a primary care physician. Among the many findings in the report, Salesforce found that: In terms of communications and relationship… The vast majority of consumers with primary care physicians are very satisfied with them (91% of people with PCPs) However, one-third of people with a PCP believe their physicians would

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

Virtual healthcare – call it telemedicine, remote monitoring, or the umbrella term, telehealth – is coming of age. And it’s a form of healthcare that a growing percentage of consumers in the U.S. want. I’m in Branson, Missouri, today, meeting with the State’s Hospital Association to talk about consumers in the growing DIY health/care economy. So “telehealth,” broadly defined, is part of my message. This week Xerox announced its survey results focused on consumers’ interests in telehealth. “Xerox helps healthcare providers serve patients anytime, anywhere,” the press release starts. Convenience, cost-savings, and the ability to consult physicians quickly and get e-refills are

6 in 10 people in the US would like to replace the Affordable Care Act with a national health insurance program for all Americans, according to a Gallup Poll conducted on the phone in May 2016 among 1,549 U.S. adults. By political party, RE: Launch a Federal/national health insurance plan (“healthcare a la Bernie Sanders”): Among Democrats, 73% favor the Federal/national health insurance plan, and only 22% oppose it; 41% of Republicans favor it and 55% oppose it. RE: Repeal the ACA (“healthcare a la Donald Trump”): Among Democrats, 25% say scrap the ACA, and 80% of Republicans say to do

“Health comes to your local store,” explains the recently-launched portal, GoHealthEvents. This site is a one-stop shop for health consumers who are seeking health screenings and consults in local retail channels like big box stores, club stores, drug stores, and grocery stores. Events covered include cholesterol, diabetes, heart health, nutrition, osteoporosis, senior health, vaccinations and immunizations. By simply submitting a zip code, a health consumer seeking these kinds of services can identify where and when a local retailer will provide it. I searched on my own zip code in suburban Philadelphia, and found the following opportunities taking place in the

At the start of 2016, the current installed base of wearable activity tracking devices was just over 33 million in the U.S. This consumer market penetration is expected to grow by 11% in 2016, according to the Consumer Technology Association (CTA) forecast published in the 18th Annual Consumer Technology Ownership and Market Potential Study. Wearable tech comprises a very small piece of the larger consumer technology market, led by TVs, smartphones, headphones (wired), DVD players, and notebook/laptop/netbook computers, the four largest rectangles in the graphic. However, there is growth momentum for emerging consumer tech segments such as portable wireless speakers,

Patient engagement is the new imperative in health care, writes Editor-in-chief Alan Weil in his introduction to the April 2016 issue of Health Affairs. It is appropriate and right that Judith Hibbard of the University of Oregon served as the theme adviser for the issue: she’s the innovator of the Patient Activation Measure and has frequently published her research in Health Affairs. Her own bottom-line: that the higher the patient activation, the less health care costs the health plan. (See a recent post on her research here on Health Populi). This issue of Health Affairs is a comprehensive primer on the

Consumers are extremely price-sensitive when it comes to shopping for health insurance. The cost of health insurance premiums, deductibles and copays, prescription drug coverage and out-of-pocket expenses rank higher in the minds of health insurance shoppers than the list of doctors and hospitals included in a health plan for health consumers in 2015. The Employee Benefit Research Institute (EBRI) surveyed 1,500 workers in the U.S. ages 21-64 for their views on workers’ satisfaction with health care in America. The results of this study are compiled in EBRI’s March 2016 issue of Notes, Views on Employment-based Health Benefits: Findings from the 2015 Health

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

“Banks and insurance companies that cannot keep pace will find their customers, busy pursuing flawless service models and smart solutions, have moved on without them and they are stranded on the wrong side of the digital divide — from which there will be no return,” according to a report on The Future of Retail Financial Services from Cognizant, Marketforce, and Pegasystems. You could substitute “healthcare providers” for “banks and insurance companies,” because traditional health industry stakeholders are equally behind the consumer demand for digital convenience. This report has important insights relevant to health providers, health plans and suppliers (especially for

9 in 10 people in the U.S. use some form of digital technology or electronic tools for health management, Accenture found in the company’s 2016 Consumer Survey on Patient Engagement. Younger people (18-34) tend to favor wearable technology, apps and social media for health. More older people (age 65-74) mine electronic health records (EHRs) for personal health data and more likely use tech for remote consultations with care providers. Overall, the percent of U.S. consumers accessing their EHR data grew by over 50% between 2014 and 2016, from 27% to 45% of people doing so, with older people indexing higher

Today is International Women’s Day. Being a woman is a social determinant of health (for the worse). To mark the occasion of the Day, The International Labour Organization (ILO) published a report on women and work yesterday, finding that in the 178 countries studied, inequality between women and men persists across labor markets. And while there’s been progress in women’s education over the past twenty years, this hasn’t resulted in women advancing career paths and wage equality. It struck me this morning, reading both (paper versions of) the Wall Street Journal and the Financial Times that the latter had two FT-sponsored ads marking

Patients are from Mars and Doctors from Venus when it comes to their views on whether consumers should have full access to their electronic health records (EHRs), according to a survey from Accenture released this week at the 2016 meeting of the HIMSS conference in Las Vegas. The vast majority of consumers are keen to access their full EHR, compared to a majority of doctors who advocate for limited access, as the circle diagram dramatically illustrates. The “old days” of patient information asymmetry — with a paper-based folder that got locked up in a health records cabinet — are gone.

As consumers’ growing financial skin in the health care game compels them to seek care in lower-cost settings, the pharmacy business recognizes the opportunity to provide healthcare services beyond the core business of filling prescriptions. This month, Drug Store News (DSN) published a special section called which profiles several pharmacy companies’ expanding reach into retail health – in particular, re-defining the concept of the “health fair.” A health fair is “an educational and interactive event designed for outreach to provide basic prevention and medical screening to people in the community,” according to the latest Wikipedia definition. But the health fairs described

All over the world, people define their health and wellness across many dimensions…physical, mental, financial, and appearance. In Florence, Italy, I happened upon a riff on this last component on “look good, feel good” at the Coin Department store located on Via Del Calzaiuoli in central Firenze. Welcome to Coin’s Health&Beauty Store. The two photos tell a story about health, where we live, work, play, and shop, the mantra for public health focused on the social determinants of health beyond healthcare. Here at Coin, adjacent to the holistic brands of Clarins and other luxury labels, is a pharmacy along with

People – patients, caregivers, health consumers all – have begun to use the digital tools they use in daily life for booking taxis, managing money, seeking information — for their health. This is the growing adoption of Personal Health IT (PHIT), and it’s a growing aspect of the annual HIMSS Conference that the planet’s health IT folk will attend from 29th February until 4th March in Las Vegas. I talk about the phenomenon of PHIT and #HIMSS16 in The State of Health IT to Engage the New Health Consumer, a summary of the driving forces of the trend and opportunities

9 in 10 adults in the U.S. have visited a doctor’s office in the past year, and over half of these patients have been very satisfied with the visit; 35% have been “somewhat” satisfied. Being a highly-satisfied patient depends on how old you are: if you’re 70 or older, two-thirds of people are the most satisfied. Millennial or Gen X? Less than half. What underlies patient satisfaction across generations is the fact that younger people tend to compare their health care experience to other retail experiences, like visiting a bank, staying at a hotel, or shopping in a department store.

About one-half of consumers want to partner with doctors instead of allowing their physicians to make treatment decisions for them, according to a report from the Deloitte Center for Health Solutions, Health care consumer engagement: No “one-size-fits-all” approach. 1 in 4 people (25%) want to make treatment decisions themselves. Call that clinical health engagement. But even more people, 6 in 10, want to be financially-health engaged: 58% believe doctors should explain treatment costs before decisions are made, shown in the first chart. Most consumers would be comfortable talking about health care costs with doctors, and believe doctors should provide and explain the

Retailers in the U.S. are morphing into health destinations in 2016. Members of Target’s management team attended the 2016 Consumer Electronics Show (CES) and shared their perspectives in the company blog. Among the Target teams observations came from the Chief Marketing Officer, Jeff Jones, who observed, “A tidal wave of newness is coming to fitness technology and many companies are on the cusp of changing the game. From nutrition and sleep to how you exercise, it’s all going to be measured, linked and tracked. Wearables are here to stay and getting smarter every year.” The Senior Vice President for Hardlines,

It’s time to get the tea leaves out and mash up trends in my world of health, health care, technology, policy and people for 2016. We’ll start with the central player: people, consumers, patients, caregivers all. Health consumerism on the rise.  People – call us patients, consumers, caregivers – will take on even more financial and clinical decision making risk in 2016. Growing penetration of high-deductible and consumer-driven health plans will push (not just nudge) people into the role of health care consumers, and the emerging businesses and programs serving the transparency market for price and quality will gain traction

“There’s no such thing as a healthcare consumer. No one really wants to consume healthcare,” naysayers tell me, critical of my all health-consmer-all-the-time bully pulpit. But, touché to my health consumer-critics! I’ve more evidence refuting the healthcare consumer detractors from McKinsey in their research report, Debunking common myths about healthcare consumerism, from the team working in McKinsey’s Healthcare Systems and Services Practice. Their survey research among over 11,000 U.S. adults uncovered 8 myths about the emerging American health consumer, including: Healthcare is different from other industries Consumers know what they want from healthcare and what drives their decisions Most consumers

The average price for a specialty drug was $53,384 in 2013; the average household income was $52,250. Thus, even allocating 100% of a family’s annual earnings to pay for a drug wouldn’t stretch far enough to cover it in 2013, nor would it do so today in 2015. This sober health economic artifact comes from the latest Rx Price Watch Report from the AARP, detailing cost trends for prescription drugs across all segments — generics, brands and specialty drugs.  Contrast, as well, the $53K for the average specialty drug with the median 2013 Social Security benefit payout of $15,526 and median Medicare

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

Reluctantly accepting the Affordable Care Act, health executives and their architects now see opportunities for re-imagining the hospital and health care services, according to Healthcare Industry Trends, a publication that’s part of the 2015 Building & Development Leadership Series provided by Mortenson, a construction services firm that’s active with healthcare organizations. Mortenson conducted a survey at the 2015 ASHE Planning, Design, and Construction Summit, the results of which were published in this report. The over 300 respondents included healthcare executives, facilities managers, and healthcare architects. Thus the lens on the data in this survey is through the eyes of physical

A growing desire for shared decision making with doctors. Increasing trust and consumption of health care information online, in social media, and report cards. Reliance on technology for monitoring health adn wellness, and medical conditions. Together, these three signals converge, illustrating a growing sense of consumer engagement among U.S. patients, found in the 2015 Deloitte Center for Health Solutions Survey of US Health Care Consumers. In Deloitte’s research summary, the title states that “No ‘one-size-fits-all’ approach” will work, given diversity among American health consumers. The sickest health consumers, Deloitte notes, have higher levels of health engagement and index higher on

The fastest-growing category of products and services at Health 2.0 is consumer-facing digital health, and a panel of companies demonstrated various flavors of the New Retail Health. One of the most prominent companies featured in Health 2.0’s conferences from the inception has been MyFitnessPal (MFP), a long-time helpful tool I’ve used to manage my own health-life. Under Armour acquired MFP earlier this year, which I covered here in Health Populi. Under Armour’s original mission was to make all athletes better. With the company’s acquisition of MyFitnessPal, Under Armour continued its morphing from a textile and sports gear company to a

8 in 10 people in the U.S. say that Medicare as well as private health insurance plans should pay for discussions held between patients and doctors about hatlhcare at the end-of-life. The September 2015 Kaiser Family Foundation Health Tracking Poll asks people their opinions about talking end-of-life with their doctors. The vast majority of people support the concept and physicians being paid for holding such conversations in doctor-patient relationship. The question is germane because the Obama Administration has announced plans to pay doctors for office visits to discuss end-of-life (EOL) issues with Medicare patients. There isn’t a huge variation across

Health is where we live, work, play, pray, learn, and increasingly, shop. The new Retail Health goes well beyond the pure-play pharmacy. Part of Target’s re-imagined market positioning is in this expanding sweet-spot as healthcare morphs from institutional providers like hospitals and doctors’ offices to the community. Don’t think pharmacy’s not important: it will remain a core business and revenue center in retail health. But that business is fast-changing, as the role of pharmacy benefits management companies change, more (expensive) specialty drug benefits come out of pipeline and into the market, and health insurance continues to shift financial risk to