A blog covering the health/care ecosystem and people.

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,

The phone continues to be the platform technology used in this digital age of health care, according to Better Together: High Tech and High Touch, a survey report sponsored by the Bipartisan Policy Center and the Council of Accountable Physician Practices. Nielsen’s Strategy Health Perspectives project polled 5,014 U.S. adults in June and July 2015 for this study. According to the study sponsors, this is the largest consumer population studied conducted to-date on the topic of digital health use and demand. The first chart illustrates the reality of digital health in the U.S. 2015: that notwithstanding the availability of telehealth,

A Congressional hearing on the Internet of Things was held on July 29, 2015. “As we talk about your home, your lighting, your messaging, your voice, and, of course, your health and your actual biological function, issues like privacy and data security for these interoperable technologies become not just something to talk about but an area in which we in Congress play a large and potentially destructive — if we’re not careful — role in the development of these technologies,” cautioned the Honorable Bob Goodlatte, Chairman of the Judiciary Committee, U.S. House of Representatives. Pictured with Chairman Goodlatte are the other witnesses

In the growing shared economy, one centerpiece is people-powered health – co-creating, shared decision-making, and a greater appreciation for the impact of social on health. As we approach the mid-point of 2015, there are several signposts pointing to people-powered health/care. FasterCures launched the Science of Patient Input Project, with the objective of getting the patient’s voice into clinical discovery and decision-making. This video describes the intent of the program and its potential for people-powered health and user/patient-centered drug design, beyond the pure clinical efficacy of therapies. Another example of people-powered health comes from The Wall Street Journal dated 29 June 2015, which

Patients in the U.S. are transforming into health care consumers, and in 2015 there are 3 underlying forces shaping that new consumer. This week kicks off the annual BIO conference in Philadelphia, and today Klick Health, the digital communications firm, convenes a group of thought leaders in healthcare to brainstorm markets, financing, and the state of pharmaceutical and life science innovation. An underlying theme throughout this meet-up is patient’s role in health/care. Patients are people, consumers, caregivers, mothers, fathers, sisters, brothers, friends, neighbors, community members, taxpayers, all. We’re old, we’re young, we’re mobile and not-so-much, we’re amputees, we’re migraneurs, we’re cancer

Retail health v1.0 encompassed the pharmacy, then embraced urgent care and retail health clinics co-located in brick-and-mortar pharmacy chain stores. In v2.0, retail health encompasses all health/care, really, because people, patients and consumers are essentially self-insured up to the point when their health plan kicks in some cash. The high-deductible health plan era is ushering in the retail health era, broadly writ. Hospitals & Health Networks magazine (HHN) ran a story titled Think Like a Retailer to Engage Patients, covering founder of WEGO Health Jack Barrette‘s and my panel presentation at the 2015 HIMSS conference in Chicago last week. Writer

Alex Gourley, President of The Walgreen Company, addressed the capacity crowd at HIMSS15 in Chicago on 13th April 2015, saying his company’s goal is to “make good health easier.” Remember that HIMSS is the “Health Information and Management Systems Society” — in short, the mammoth health IT conference that this year has attracted over 41,000 health computerfolk from around the world. So what’s a nice pharmacy like you, Walgreens, doing in a Place like McCormick amidst 1,200+ health/tech vendors?  If you believe that health is a product of lifstyle behaviors at least as much as health “care” services (what our

40% of U.S. consumers trust Big Retail to manage their health; 39% of U.S. consumers trust healthcare providers to manage their health. What’s wrong with this picture? The first chart shows the neck-and-neck tie in the horse race for consumer trust in personal health management. The Walmart primary care clinic vs. your doctor. The grocery pharmacy vis-a-vis the hospital or chain pharmacy. Costco compared to the chiropractor. Or Apple, Google, Microsoft, Samsung or UnderArmour, because “digitally-enabled companies” are virtually tied with health providers and large retailers as responsible health care managers. Welcome to The Birth of the Healthcare Consumer according

While there’s little evidence that the short-term impact of the Affordable Care Act has limited job growth or driven most employers to drop health insurance plans, the ACA has spawned a “cottage industry” of health companies since 2010, according to PwC. As the ACA turned five years of age, the PwC Health Research Institute led by Ceci Connolly identified at least 90 newcos addressing opportunities inspired by the ACA: Supporting telehealth platforms between patients and providers, such as Vivre Health Educating consumers, such as the transparency provider HealthSparq does Streamlining operations to enhance efficiency, the business of Cureate among others

As sensors begin to proliferate our “Things,” from refrigerators to cars, toasters to t-shirt, our health could benefit mightily. Approaching this weekend’s South-by-Southwest Interactive meet-up in Austin, several authors have crowdsourced views on using technology for good in ImpactX, a special section in the Huffington Post sponsored by Cisco. I was asked to develop a view on using technology for good — for health and health care. Here’s my offering: How the Internet of Things Can Bolster Health. The promise of sensor-laden stuff in our lives can work for personal and public health in myriad ways — from perceiving impending epidemics

As people take on self-service across all aspects of daily living, self-care in health is growing beyond the use of vitamins/minerals/supplements, over-the-counter meds, and trying out the blood-pressure cuff in the pharmacy waiting for a prescription to be filled. Today, health consumers the world over have begun to engage in self-care using digital technologies. And this isn’t just a phenomenon among people in the Millennial generation. Most seniors who regularly use technology (e.g., using computers and mobile phones) are also active in digitally tracking their weight, for example, learned in a survey by Accenture. Older people who use technology in daily

Three laws that shape the digital world have kicked into high gear, changing our lives in ways we cannot yet imagine. Those three forces are Metcalfe’s Law (in brief, the increasing value of networks), Moore’s Law (that processing power doubles every 18 months, or even faster), and the Law of Accelerating Returns (the fast pace of technological change). The guy who told me about that at the 2015 Consumer Electronics Show (#CES2015) was Shelly Palmer, something of a Renaissance Man in the evolving digital world, advising communications companies, composing music, patenting TV technology, investing in ventures, hosting shows on digital living,

Doctors and hospitals live and work in a parallel universe than the consumers, patients and caregivers they serve, a prominent Chief Medical Information Officer told me last week. In one world, clinicians and health care providers continue to implement the electronic health records systems they’ve adopted over the past several years, respond to financial incentives for Meaningful Use, and re-engineering workflows to manage the business of healthcare under constrained reimbursement (read: lower payments from payors). In the other world, illustrated here by the graphic artist Sean Kane for the American Academy of Family Practice, people — patients, healthy consumers, newly insured folks,

Dr. Joseph Kvedar has led the Center for Connected Health for as long as I’ve used the word “telehealth” in my work – over 20 years. After two decades, the Center and other pioneers in connected health have evidence proving the benefits, ROI (“hard” in terms of dollars, and “soft” in terms of patient and physician satisfaction), and technology efficacy for connecting health. The 11th Annual Connected Health Symposium is taking place as I write this post at the Seaport Hotel in Boston, bringing health providers, payers, plans and researchers together to share best practices, learnings and evidence supporting the

There’s a health information disconnect among U.S. adults: most people believe online access to their personal health information is important, but three-quarters of people who were offered access to their health data and didn’t do so didn’t perceive the need to. The first two graphs illustrate each of these points. When people do access their online health records, they use their information for a variety of reasons, including monitoring their health (73%), sharing their information with family or care providers (44%), or downloading the data to a mobile device or computer (39%). In this context, note that 1 in 3

In the post-Recession American economy, people shop for value in all things. And that includes health care services like MRIs — when patients are informed of pricing differences among imaging facilities and given free rein to pick-and-choose among them. In addition to lowering imaging costs in a community, price transparency also generated competition between providers. Health Affairs published this research detailed in Price Transparency for MRIs Increased Use of Less Costly Providers And Triggered Provider Competition in August 2014. An Economics 101 course teaches us that a well-oiled (perfect) market depends on lots of sellers of a product and lots of

The growth of data, small and Big, in health care motivates the industry’s stakeholders to adopt technologies that help store, manage and analyze data to drive knowledge and, ultimately, individual and public health. Healthcare is embracing cloud technology, mobile platforms, social networks, e-commerce, robotics, and the Internet of Things (IoT), among a growing list of tech innovations. Each of these innovations, which enable productivity and economic growth, also present cybersecurity risks. The value of these risks is estimated to be as much as $3 trillion to the global economy, according to McKinsey’s calculations in the report Risk and Responsibility in

Consumers around the world are feeling more knowledgeable, self-confident and realistic, enabled by mobile platforms, the democratic power of social “choruses,” and a more sharing economy featuring collaborative consumption. As peoples’ phones get smarter and smarter, they carry more powerful multichannel information devices in their hands which empower Homo Informaticus – the new global digital consumer, described in EY’s report, How to copilot the multichannel journal. EY polled 29,943 consumers in the Consumers on Board survey living in 34 countries: across the Americas, Asia-Pacific, the Middle East, India and Africa. Homo informaticus is the rational consumer smartly using technology to filter information.

Open data is a growing trend in health care. Analyzing data sets across lots and lots of people can help researchers identify medical cures, anticipate epidemics, and solve knotty problems where social and behavioral issues complicate clinical questions and solutions. Joining the open health data community is the health IT company Practice Fusion, which is sharing with the public aggregated data on some 81 million patients collected through over 100,000 active users every month recording patient data in the company’s cloud-based electronic health records system. Insight, the searchable database, is freely available to people, researchers, policymakers, and anyone who wants to look at top line

When Mary Meeker talks, the digerati listen. Meeker is the digital industry analyst who’s a partner at KPCB, a venture capital company, in Silicon Valley. Each year she publishes a report on the state of the digital marketplace. Her 2014 paper, Internet Trends 2014 – Code Conference (dated May 28 2014)  is online, and as usual, it’s full of data points on both digital technology segments along with some vertical industry findings – in education, financial services, and health, among other segments. I’ve combed through the 164 pages of the PDF to trend-weave the health implications. When it comes to health, the

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

Over one dozen scores assessing our personal health are being mashed up, many using our digital data exhaust left on conversations scraped from Facebook and Twitter, via our digital tracking devices from Fitbit and Jawbone, retail shopping receipts, geo-location data created by our mobile phones, and publicly available data bases, along with any number of bits and pieces about ‘us’ we (passively) generate going about our days. Welcome to The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future. Pam Dixon and Robert Gellman wrote this well-documented report, published April 2, 2014 by The World Privacy Forum.

In our increasingly-DIY society, most consumers expect high levels of access and customer service from the organizations with whom we engage. With more consumers reaching into their pockets to pay for health services and products, the health industry is increasingly a retail-facing environment. So expect quality service levels from their healthcare touch points. The pharmaceutical and prescription drug touch point is not exempt from this expectation, as learned by an Accenture survey analyzed in Great Expectations: Why Pharma Companies Can’t Ignore Patient Services. As the first picture shows, 70% of patients think pharma companies are responsible for bundling information and services

In the not-too-distant future, will our health care be universally available to all, standardized with limited choices? Or, will we be in self-care mode, able to “buy up” if we can afford it like luxury goods? Will health care delivery be totally tech- and information-driven? Or, will care be driven by insurers’ health plans with artful designs that (almost) predetermine our choices? Welcome to four futures of health care, brought to us by PA Consulting whose report, How Can We Stop Healthcare From Bankrupting Our Children? speaks to scenarios based on 2 uncertainties, whether: Health care will be a personal

That’s a useful and timely question, given the news that Castlight Health will launch its IPO with valuations north of $1 billion. Yes, “billions,” and according to a  MarketWatch analysis, “it’s a bargain at $1 billion.” So then – do we anticipate a bubble? asked Marc Monseau of the Mint Collective, the convener of our panel who brought together Robert Stern, a successful health-tech entrepreneur whose latest venture, @PointofCare, focuses on patient engagement; Marco Smit of Next Innovation Health Partners (parting from the Health 2.0 Conference family where he led Health 2.0 Advisors for several years); and me. Some key

With health costs increase increasing at 4.4% in 2014, a slightly higher rate of growth than the 4.1% seen in 2013. While this is lower than the double-digit increases U.S. employers faced in 2001-2004, it’s still twice the rate of general consumer price inflation. That’s what the first graph shows, based on the The 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care.  Employers generally want to continue to provide health insurance…for the time being. 92% of companies expect to make changes in health plan provisions in 2014, with 1 in 2 anticipating “significant

  At last year’s annual HIMSS conference, I had the pleasure of experiencing Bill Clinton’s keynote speech in New Orleans, which I wrote about here. As a long-time member of HIMSS, this was a great moment in my many years attending HIMSS conferences. Another special moment in HIMSS conference history happened today, as, I had the honor of attending Hillary Clinton’s keynote speech at HIMSS 2014 in Orlando today. I am blessed with fast-typing fingers thanks to my mother’s genes, and took constant notes during Hillary’s talk. My favorite paragraphs are quoted below, indicating “Applause” pauses where Hillary was lauded.

Even before stepping into the Orlando Convention Center on Sunday 23 February 2014, my clairvoyant powers know the forecast of the Best in Show: the growing role of patients in health care, reflected in both the education session at the annual 2014 meeting of HIMSS as well as the product/service mix being proffered on the convention show floor. As a member of HIMSS Connected Patient Committee, I know first-hand the conscious effort and energy that the organization has committed to getting real about patients’-peoples’-caregivers’ central role in health care. The organization was built on providers and technology. When I first

This is my second post for the #HIMSS14 Blog Carnival, written to coincide with the annual 2014 HIMSS Conference convening health IT leaders in Orlando, FL, 23-28 February 2014. I am gratified to be one of a dozen+ Social Media Ambassadors to the Conference. The first post, on why health IT ‘should’ matter to consumers, can be found here.  Investments in the digital health space reached nearly $2 billion in 2013, based on Rock Health’s look back at venture funding in the market. These financings covered $245 mm that went toward electronic health records and clinical workflow; $161 toward analytics

This is the first of four posts that are written for the HIMSS 2014 Blog Carnival. The theme, provided by HIMSS (the Healthcare Information and Management Systems Society): “Why Health IT Matters to Consumers.” You’ll note the title here has been purposefully changed. Health IT “should” matter to consumers. Since George Bush declared in 2004 that within 10 years’ time, U.S. health citizens would each have an electronic medical record, there’s been as more bipartisan support inside the Beltway for EHRs than possibly for any other issue in Congress. The American Recovery & Reinvestment Act of 2009 (ARRA), aka the

The number of physicians using electronic health record systems (EHRs) rose by 50% since 2010, from 51% to 78% of office-based doctors. That equates to about 4 in 5 U.S. physicians now using any EHR system. This growing adoption of EHRs is evident in the first chart, published in Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001-2013. This survey was published by the National Center for Health Statistics in the NCHS Data Brief Series in January 2014. (The NCHS is part of the Centers for Disease Control, aka the CDC). This growth rate hasn’t

The 2013 Mobile Health Summit was hosted by HIMSS at The Gaylord Resort in suburban Washington DC, taking place over 4 days during the mid-atlantic region’s iciest conditions in years. But inside the cocoon of this convention space, 5,000 conveners took in demonstrations of innovations using mobile platforms and standards that extend health services, knowledge and self-help tools to people and providers. Several themes emerged out of the meeting… Lots of apps, too few business models.  There are too many apps and not enough companies, Esther Dyson noted in a keynote session during which she dialogued with two Steve’s: Steven

At the Venture+ Forum at the 2013 Mobile Health Summit yesterday, Lisa Suennen, Managing Director of Psilos Ventures was asked what she and her venture capital fund look for in choosing new investments for their health care portfolio. She succinctly said, “technologies that lower costs.” With nearly $1 in $5 of the U.S. economy attributable to health spending, Lisa’s got a point. Technology in U.S. health care has been mostly additive and expense-inducing, not reducing: fax machines and printers, for example, continue to proliferate in health care settings as part of “networking,” and once you add a new clinical technology

There are thousands of downloadable apps that people can use that touch on health. But among the 40,000+ mobile health apps available in iTunes, which most effectively drive health and efficient care? To answer that question, the IMS Institute for Healthcare Informatics analyzed 43,689 health, fitness and medical apps in the Apple iTunes store as of June 2013. These split into what IMS categorized as 23,682 “genuine” health care apps, and 20,007 falling into miscellaneous categories such as product-specific apps, fashion and beauty, fertility, veterinary, and apps with “gimmicks” (IMS’s word) with no obvious health benefit. Among the 23,682 so-called

Where can you shop the health and beauty aisles, pick up some groceries and a prescription, get a flu vaccine, and weigh in on Obamacare and what digital health tools you like? Why, at one of several thousand retail stores where you can find a SoloHealth kiosk. As of yesterday afternoon, over 32 million encounters were recorded on SoloHealth kiosks, based on an app I saw on the company CEO Bart Foster’s smartphone. Kiosks are locatted around the United States in retailers including Walmart and Sam’s Clubs, along with major grocery chains like Schnuck’s and Publix, and the CVS pharmacy

A cadre of pioneering Americans has been meaningfully using personal health information technology (PHIT), largely outside of the U.S. health care system. These applications include self-tracking and wearable health technologies, mobile health apps, and digital medical tracking devices like glucometers that streamline tracking and recording blood glucose levels. In the meantime, only 21% of doctors surveyed by Accenture currently allow patients to have online access to their medical summary or patient chart – very basic components of the electronic health record. We know what’s primarily driving health providers’ adoption of health IT: namely, the HITECH Act’s provisions for incentives. But

In game-scoring unit terms, 52 is the number of hours an average American spends seeking health information online each year. The 1 (hour) is roughly equivalent to the approximate total time a patient spends with a physician (an average of 3 visits, with an average time per vision of 20 minutes). Thus, 52:1. This means that the average U.S. health consumer spends much more time DIYing her health using digital information resources than speaking face-to-face with their physician in the doctor’s office. Still, the physician continues to be a go-to source for health information, according to Makovsky, a health communications

The news this week that Fitbit attracted $42 million investment capital follows Withings’ announcement of $30 million (including Euro11 million from BPIFrance, the French national investment fund), Jawbone’s recent acquisition of Bodymedia for $100 million in April 2013, and MyFitnessPal raising $13 million earlier this month. The quick arithmetic for these four companies alone adds to roughly $200 mm in a few months going to these brands, which are feverishly competing for the heartbeats and footsteps of people who are keen to track their steps and stay healthy. Can you keep up? You need a new kind of activity tracker to track

In the $3 trillion economy that is American health care, the role of information technology is central to transforming this huge piece of U.S. fiscal activity. This week convened the fourth annual Health Datapalooza (HDP) in Washington DC, with the underlying theme, “health engagement is the blockbuster drug of the 21st century” (quoting Leonard Kish). This meeting of over 2,000 registrants – huge growth from the first year’s 400 attendees — is organized by the Health Data Consortium (HDC) , whose CEO Dwayne Spradlin kicked off remarks on Day 2 of HDP4. He described the HDC, a public-private collaboration led

In the long-run, health information technology (HIT) will improve the quality of health care, according to 73% of U.S. physicians. However, about the same number (7 in 10 physicians) believe that the ROI on health IT is inflated and that implementing EHRs will cost more, not less. Still, market forces from health insurance plans, payers and consumers are driving health IT adoption, according to Deloitte’s survey report, Physician adoption of health information technology: implications for medical practice leaders and business partners. Electronic health records (EHR) adoption and meeting meaningful use (MU) Stage 1 criteria appears strongly related to the size

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

Only one-third of U.S. physicians believe that patients should have “full access” to their electronic health records, according to Patient Access to Electronic Health Records What Does the Doctor Order?, a survey conducted by Accenture, released at HIMSS13 in March 2013. Two-thirds of doctors in the U.S. are open to patients having “limited access” to their EHRs. However, the extent to which doctors believe in full EHR access for patients depends on the type of health information contained in the record. Accenture surveyed 3,700 physicians in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States, and found the doctors’

In 2010, the folks who supported health care reform were massacred by the polls, Bill Clinton told a rapt audience of thousands at HIMSS13 yesterday. In 2012, the folks who were against health care reform were similarly rejected. President Clinton gave the keynote speech at the annual HIMSS conference on March 6, 2013, and by the spillover, standing-room-only crowd in the largest hall at the New Orleans Convention Center, Clinton was a rock star. Proof: with still nearly an hour to go before his 1 pm speech, the auditorium was already full with only a few seats left in the

At HIMSS13 there are the equivalent of rock stars. Some of these are health system CIOs and health IT gurus who are driving significant and positive changes in their organizations, like Blackford Middleton, Keith Boone, Brian Ahier, and John Halamka. Others are C-level execs at health IT companies. In this latter group, many avoid the paparazzi (read: health trade reporters) and stay cocooned behind closed doors in two-story pieces of posh real estate on the exhibition floor. A few walk the floor, shake hands with folks, and take in the vibe of the event. We’ll call them open-source personalities. The

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

“ACOs most assuredly will not…deliver the disruptive innovation that the U.S. health-care system urgently needs,” wrote Clay Christensen, godfather of disruptive innovation, et. al., in an op-ed in the Wall Street Journal of February18, 2013. In the opinion piece, Christensen and colleagues make the argument that Accountable Care Organizations (ACOs) as initially conceived won’t address several key underlying forces that keep the U.S. health care industry in stasis: Physicians’ behavior will have to change to drive cost-reduction. Clinicians will need “re-education,” the authors say, adopting evidence-based medicine and operating in lower-cost milieus. Patients’ behavior will have to change. This requires

This week, I had a conversation with a physician whom I consider quite patient-engaged, who uses an EHR, and who works with one of the most wired health organizations in the United States. I complained to her that my user-generated data from my Bodymedia armband, Fitbit, Withings scale, among other #QuantifiedSelf devices, can’t find their way through the cloud to my doctors’ electronic health records or my patient portal. Her reaction was surprising to me. She was not so keen on the idea, saying, “It’s the physician workflow” that’s the problem. The wordle on workflow comes from Dr. Chuck Webster

The proliferation of mobile health (mHealth) apps appears to be an abundant cornucopia of “lite” tools that look simple to access and easy to use. But this growing menu of a la carte choices that promise to keep us healthy, track our numbers, and access useful health information can also, in the words of three Dutch health researchers, “drive us crazy.” Why mobile health app overload drives us crazy, and how to restore the sanity, by Lex van Velsen and colleagues, makes the case that the plethora of mHealth apps available in online app stores is a fragmented, disorganized marketplace

U.S. consumers’ desire to take an active role in their health decisions is growing, according to the Altarum Institute Survey of Consumer Health Care Opinions. 61% of people want to make health decisions either on their own (26%) or with input from their doctor (38%). The proportion of people wanting to be “completely in charge of my decisions” rose 4 percentage points in one year, from 2011. This statistic skews younger, with 33% of people 25-34 and 31% of those 35-44 wanting to be “completely in charge.” Only 17% of those 55-64 felt like being totally in charge of their