A blog covering the health/care ecosystem and people.

As Big Payors continue to shift more costs onto health consumers in the U.S., the importance of and need for transparency grows. 39% of large employers offered consumer-directed health plans (CDHPs) in 2013, and by 2016, 64% of large employers plan to offer CDHPs.  These plans require members to pay first-dollar, out-of-pocket, to reach the agreed deductible, and at the same time manage a health savings account (HSA). In the past several weeks, many reports have published on the subject and several tools to promote consumer engagement in health finance have made announcements. This week of posts provides an update on

U.S. consumer spending on health care is boosting the nation’s economy, based on some new data points. First, health care spending grew at an annual rate of 5.6% at the end of 2013, USA Today reported. This was the fastest-growth seen in ten years, reversing the fall of health spending experienced in the wake of America’s Great Recession of 2008. Furthermore the Centers for Medicare and Medicaid Services (CMS) anticipates health spending to grow by 6.1% in 2014 with the influx of newly-insured health plan members. Healthcare was responsible for one-fourth of America’s GDP growth rate of 2.6%, which is

Employers continue to invest in wellness programs aimed at improving employees’ health. In 2014, 3 in 4 employers plan to offer incentives to employees who participate in health improvement programs compared = and the financial value of these incentives has grown to $500, up from $338 in 2010. In its fifth year, the National Business Group on Health (NBGH)/Fidelity Investments have conducted their benefit consulting survey, culminating in the report, Employer Investments in Improving Employee Health. In the past 5 years, employers have increased their investments in wellness: the chart illustrates the growth of programs addressing physical activity/weight management and health eating,

Thinking about personal health information technology – the wearable devices, remote health monitors, digital weight scales, and Bluetooth-enabled medical equipment scaled for the home – there are two glasses. One is half-full and the other, half-empty. The half-full glass is the proliferation of consumer-facing devices like Fitbit, Jawbone and Nike, which comprise the lion’s market share in the health wearables segment; the mass adoption of mobile phones and tablets; consumers’ multi-screen media behavior (as tracked by Nielsen); and consumers’ growing share of medical spending, now about 40% of annual spending (or something north of $8,000 for a family of four

As more U.S. health citizens enroll in high-deductible health plans – now representing about 30% of health-insured people in America – health plan members are being called on to play the role of consumer. Among the most important choices the health consumer makes is for a physician. Ratings sites and health care report cards ranking doctors by various characteristics have been in the market for over a decade. However, little has been known on the public’s knowledge about the availability of these information sources, nor of peoples’ use of physician rating sites. This question is addressed in Public Awareness, Perception, and

  Charges for medical, pharmacy and dental services can vary by more than 300%. This means that in one place, a procedure that costs $100 can cost $300 for the same treatment in another location or practice, discovered by Change Healthcare in their latest Healthcare Transparency Index 2013 Q3 Report, published in January 2014. The 300% is the average overall across dozens of health services used by the 67,000 plan members Change Healthcare analyzed based on health plan enrollees’ health care utilization in the third quarter of 2013. These health care services include office visits (behavioral health, physical therapy and

Employers who sponsor health insurance in America are at a fork on a cloudy road: they know that they’re in the midst of changes happening in the U.S. health system. Except for one certainty: that health care costs too much. So employers’ plans for health benefits in 2014 strongly focus on getting a return-on-investment from health spending in an uncertain climate, according to Deloitte’s 2013 Survey of U.S. Employers. Key findings are that: Employers will grow their use of workers’ cost-sharing, continuing to shift more financial responsibility onto employees They will expand other tactics they believe will help address cost

Ordering up and financing health care in the U.S. looks like the proverbial Chinese food menu, picking and paying for “one from column A, and one from column C.” But that’s no way to operate a well-oiled machine for delivering quality health care, according to Healthcare Shifts from á la Carte to Prix Fixe from Strategy&, an analysis of the fragmented, high-cost and only fair quality American health system. One solution to this challenge is bundled payment. “No one has an overarching view of the entire process,” the report opines, “with an eye toward improving customer service, quality, or costs.” Further exacerbating the sub-optimal

The Affordable Care Act (ACA) was signed in March 2010; that month, 57% of U.S. adults did something to self-ration health care, such as splitting prescription pills, postponing necessary health care, and putting off recommended medical tests, according to the Kaiser Family Foundation (KFF) Health Tracking Poll of March 2010. 57% of U.S. adults are still self-rationing health care in September 2013, according to KFF’s latest Health Tracking Poll, completed among 1,503 U.S. adults just two weeks before the launch of the Health Insurance Marketplaces on October 1, 2013. As of September 2013, only 19% of U.S. adults said they had heard

Over 1 in 5 people in the U.S. have not had enough money to buy food for themselves or their families in the past year, according to the August 2013 Gallup Healthways Index. This is as many consumers as those who couldn’t afford food during the deepest months of the last recession. Lack of access to food is a challenge for a cadre of Americans who lack access to other basic needs such as shelter and health care. Gallup’s Basic Access Index looks at this market basket, and has found that Americans’ access to basic needs at 81.4 in August

You might see potato and I might see po-tah-to when looking at the Affordable Care Act – health reform — but it’s clear we don’t want to call the whole thing off. (Go to 1:44 seconds in this video to get my drift, thanks to the Gershwin’s). I’m talking about the latest August 2013 Kaiser Health Tracking Poll from Kaiser Family Foundation finds a health citizenry suffering ennui or a form of split personality about health reform: while many Americans don’t believe the Affordable Care Act (ACA) will help them, most don’t want Congress to de-fund it, either. Several graphs from

Consumers misunderstand health insurance, according to new research published in the Journal of Health Economics this week. The study was done by a multidisciplinary, diverse team of researchers led by one of my favorite health economists, George Loewenstein from Carnegie Mellon, complemented by colleagues from Humana, University of Pennsylvania, Stanford, and Yale, among other research institutions. Most people do not understand how traditional health plans work: the kind that have been available on the market for over a decade. See the chart, which summarizes top-line findings: nearly all consumers believe they understand what maximum out-of-pocket costs are, but only one-half do.

When Secretary Sebelius calls, I listen. It’s a sort of “Help Wanted” ad from the Secretary of Health and Human Services Kathleen Sebelius that prompted me to write this post. The Secretary called for female bloggers to talk about the benefits of The Affordable Care Act last week when she spoke in Chicago at the BlogHer conference. Secretary Sebelius’s request was discussed in this story from the Associated Press published July 25, 2013. “I bet you more people could tell you the name of the new prince of England than could tell you that the health market opens October 1st,” the

Urgent care centers are growing across the United States in response to emergency rooms that are standing-room-only for many patients trying to access them. But can urgent care centers play a cost-effective, high quality part in stemming health care costs and inappropriate use of ERs for primary care. That’s a question asked and answered by The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? from the Center for Studying Health System Change by Tracy Yee  et. al. The Research Brief defines urgent care centers (UCCs) as sites that provide care on a walk-in basis, typically during regular

In June 2013, even though news about the economy and jobs is more positive and ObamaCare’s promise of health insurance for the uninsured will soon kick in, most Americans are concerned about (1) money and (2) the costs of health care. The Kaiser Health Tracking poll of June 2013 paints an America worried about personal finances and health, and pretty clueless about health reform – in particular, the advent of health insurance exchanges. Among the 25% of people who have seen media coverage about the Affordable Care Act (alternatively referred to broadly as “health reform” or specifically as “ObamaCare”), 3

While there is big uncertainty about how health reform will roll out in 2014, and who will opt into the new (and improved?) system, health cost growth will slow to 6.5% signalling a trend of moderating medical costs in America. Even though more newly-insured people may seek care in 2014, the costs per “unit” (visit, pill, therapy encounter) should stay fairly level – at some of the lowest levels since the U.S. started to gauge national health spending in 1960. That’s due to “the imperative to do more with less has paved the way for a true transformation of the

The number of retail health clinics will double between 2012 and 2015, according to a research brief from Accenture, Retail medical clinics: From Foe to Friend? published in June 2013. What are the driving market forces promoting the growth of retail clinics? Accenture points to a few key factors: Hospitals’ need to rationalize use of their emergency departments, which are often over-crowded and incorrectly utilized in cases of less-than-acute care. In addition, hospitals are now financially motivated under the Affordable Care Act (ACA, health reform) to reduce readmissions of patients into beds (particularly Medicare patients with acute myocardial infarction [heart attacks],

If you have health insurance, chances are you take several actions to bolster your health such as take vitamins and supplements (which 2 in 3 American adults do), take medications as prescribed (done by 58% of insured people), and tried to improve your eating habits in the past two years (56%). Most people with insurance also say they exercise at least 3 times a week. Fewer people who are uninsured undertake these kinds of health behaviors: across-the-board, uninsured people tend toward healthy behaviors less than those with insurance. This is The Prevention Problem, gleaned from a survey conducted by TeleVox

Two in 3 Americans are uncomfortable with their financial situation. And most are totally oblivious to how much money they will need to spend on health care in the future. Seven in 10 people expect to spend less than 10% of their monthly retirement income on medical and dental expenses; but the real number is 30% of income needed for health care in retirement, according to The Urban Institute. The Wellness for Life survey, conducted for Aviva, the life and disability company, collaborating with the Mayo Clinic, finds an American health citizen out of touch with their personal health economics.

U.S. employers have been implementing various flavors of consumer-directed health plans for the better part of a decade. But consumers feel neither “directed” nor especially competent in managing their way through these plans. It appears that employers also have their own sort of health plan illiteracy when it comes to understanding health reform — the Affordable Care Act — according to the 2013 Aflac WorkForces Report (AWR) based on a survey of 1,900 benefits managers and over 5,200 U.S. workers conducted in January 2013. While you might know the Aflac Duck, you may not be aware that Aflac is the

Strange political bedfellows have come together to draft a formula for dealing with spiraling health care costs in the U.S. iin A Bipartisan Rx for Patient-Centered Care and System-Wide Cost Containment from the Bipartisan Policy Center (BPC). The BPC was founded by Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. This report also involved Bill Frist, Pete Domenici, and former White House and Congressional Budget Office Director Dr. Alice Rivlin who together work with the Health Care Cost Containment Initiative at the BPC. The essence of the 132-page report is that the U.S. health system is

As a result of implementing the Affordable Care Act (health reform), most U.S. health executives crystal balls foresee health care insurance premiums will increase over 10% in the next three years. 4 in 10 predict premiums will grow over 25% over the next 3 years. This sobering forecast comes out of a Munich RE Health survey conducted among 326 health industry executives in March 2013. Those polled included representatives from health plans, managed care, disease management firms, and health insurance brokers and agents. How do health execs expect employers would deal with such fast-rising health premium costs? Why shift more

Comparing health care prices in the U.S. with those in other developed countries is an exercise in sticker shock. The cost of a hospital day in the U.S. was, on average, $4,287 in 2012. It was $853 in France, a nation often lauded for its excellent health system and patient outcomes but with a health system that’s financially strapped. A routine office visit to a doctor cost an average of $95 in the U.S. in 2012. The same visit was priced at $30 in Canada and $30 in France, as well. A hip replacement cost $40,364 on average in the

The Boston Herald was one of the first newspapers talking about CVS requiring workers to disclose personal health information…”or pay a $600 a year fine,” as the LA Times succinctly put the situation. The story is that CVS Caremark, the pharmacy and Rx benefits management company, is implementing a health screening program to measure height, weight, body fat, and blood pressure. These metrics are commonly collected in the process known as health risk appraisals (HRAs), which most large employers have begun to implement to help employees prevent the onset of chronic disease (think: “metabolic syndrome,” diabetes combined with overweight, for

Digital health is attracting the likes of Bill Clinton, Lupe Fiasco, Deepak Chopra, Dr. Sanjay Gupta, Arianna Huffington, and numerous famous athletes who rep a growing array of activity trackers, wearable sensors, and mobile health apps. Will this diverse cadre of popular celebs drive consumer adoption of mobile health? Can a “cool factor” motivate people to try out mobile health tools that, over time, help people sustain healthy behaviors? Mobile and digital health is a fast-growing, good-news segment in the U.S. macroeconomy. The industry attracted more venture capital in 2012 than other health sectors, based on Rock Health’s analysis of the year-in-review. Digital health

Here’s Ann R., who is a patient in the not-too-distance-future, when passive sensors will be embedded in her everyday life. The infographic illustrates a disruption in health care for people, where data are collected on us (with our permission) that can help us improve our own self-care, and help our clinicians know more about us outside of their offices, exam rooms and institutions. In Making Sense of Sensors: How New Technologies Can Change Patient Care, my paper for the California HealthCare Foundation, I set out to organize the many types of sensors proliferating the health care landscape, and identify key

The wealthiest Americans’ top financial concern is being able to afford healthcare and support they’ll need in old age. The #2 financial concern among wealthy investors is worrying about the financial situation of their children and grandchildren, closely followed by a major family health problem occurring and someone to care for them in their old age. These health-financial worries come out of a survey among 2,056 U.S. investors age 25 and over who have at least $250,000 in investable assets conducted by UBS in January 2013. UBS found that staying health and fit is investors’ top objective, with 73% of wealthy

On a recent Whole Living segment on Martha Stewart’s Sirius XM radio channel, I learned of the artisan chocolatier, Gnosis. The company, whose name is Greek for “knowledge,” grew out of the kitchen of a holistic health counselor, Vanessa Berg, who began to make nutritionally-infused sweets for her private clientele. Word-of-mouth made its way to a buyer from Whole Foods, who subsequently did a deal with Berg to sell Gnosis goods in some of the company’s stores in New Jersey and New York. Here’s a link to the radio interview. Chocolate is a health food for this company, and for

Costco and Aetna announced that the Big Box retailer would expand its marketing of Aetna health insurance policies to card-carrying members in California. Costco has already been selling health insurance through stores in Arizona, Connecticut, Georgia, Illinois, Michigan, Nevada, Pennsylvania, Texas and Virginia. Later in 2013, Aetna plans will be available in Costco stores in other state markets. BTW, Costco operates stores in 42 U.S. states (as well as Canada, the UK, Taiwan, Korea, Japan, Australia, and Mexico). All together, the company serves 37 million households. The Costco Personal Health Insurance Program offers five plans, a network of health providers, and

People enrolled in consumer-directed health plans (CDHPs) and high-deductible health plans (HDHPs) are more cost-conscious than those enrolled in more traditional plans, according to Findings from the 2012 EBRI/MGA Consumer Engagement in Health Care Survey from the Employee Benefit Research Institute (EBRI), published in December 2012. The logic behind CDHPs and HDHPs is that if health plan enrollees have more “skin in the game” — that is, personal financial exposure — they’ll behave more like health “consumers.” By 2012, 36% of employers with over 500 employees offered either HRA- or HSA-eligible plans. About 15% of working age adults are enrolled

Wired magazine, longtime evangelist for all-things-tech, has played a growing role in serving up health-tech content over the past several years, especially through the work of Thomas Goetz. This month, Wired featured an informative section on living by numbers — the theme of a new Wired conference held 15-16 October 2012 in New York City. This feels like the week of digital health on the east coast of the U.S.: several major meetings have convened that highlight the role of technology — especially, the Internet, mobile platforms, and Big Data — on health. Among the meetings were the NYeC Digital Health conference, Digital

With “Zero” large employers expecting to drop health insurance, as reported in the Washington Post, companies are getting creative and innovative about how to manage workers’ health and wellness, while addressing ever-growing costs. One strategy that’s getting more traction is the re-invention of the onsite health center. Towers Watson‘s 2012 Onsite Health Center survey report, finds that one-half of employers view establishing an onsite health center as a linchpin to enhancing productivity and health in the workplace. Following close behind productivity is the onsite health center’s promise of reducing medical costs, improving access to care, and the traditional reason for providing onsite

Amidst uncertainties and wild cards about health care’s future in the U.S., there’s one certainty forecasters and marketers should incorporate into their scenarios: consumers will bear more costs and more responsibility for decision making. The 2012 Deloitte Survey of U.S. Employers finds them, mostly, planning to subsidize health benefits for workers over the next few years, while placing greater financial and clinical burdens on the insured and moving more quickly toward high-deductible health plans and consumer-directed plans. In addition, wellness, prevention and targeted population health programs will be adopted by most employers staying in the health care game, shown in

Skype and videoconferencing have surpassed the tipping point of consumer adoption. Grandparents Skype with grandchildren living far, far away. Soldiers converse daily with families from Afghanistan and Iraq war theatres. Workers streamline telecommuting by videoconferencing with colleagues in geographically distributed offices. In the era of DIY’ing all aspects of life, more health citizens are taking to DIY’ing health — and, increasingly, looking beyond physical health for convenient access to mental and behavioral health services. The Online Couch: Mental Health Care on the Web is my latest paper for the California HealthCare Foundation. Among a range of emerging tech-enabled mental health

Without trust, health consumers won’t engage with organizations who want to cure them, sell to them, promote to them, help them. Here’s what I told a group of  pharmaceutical marketers at The DTC Annual Conference in Washington , DC, on April 9, 2010. Let’s start with the World Health Organization’s definition of health: that is, the state of complete physical, mental and social wellbeing, and not just the absence of disease. This definition is being embraced by health citizens long before the silos in the health industry – including pharma – get it. That’s an important mindset to take on as

Nearly 1 in 2 women put off seeking health care because the cost was too high. The kinds of services delayed included visits to the doctor, medical procedures, and filling prescription medications. The fourth annual T.A.L.K. Survey was released this week by the National Women’s Health Resource Center (NWHRC), focusing on the declining economy and its impact on women and three dimensions of their health — physical, emotional, and fiscal. 40% of women say that their health has worsened in the past five years due to increasing stress and gaining weight, according to the survey. One of the most interesting

The UAW and GM have been debating health care as Friday’s deadline for their national contract approaches. This round of negotiation is about survival. Yesterday, I covered the rising costs of employer-sponsored health insurance. Today, let’s visit the intimately-related topic of retiree health benefits. These are eroding even faster than health benefits for employed workers. Many employers have significantly scaled back health benefits for retirees. Currently, one in three large employers offers retire benefits, compared with two in three in the late 1980s. Consider the predicament of the company ranked #3 on the 2006 Fortune 500 list, General Motors. Retirees