A blog covering the health/care ecosystem and people.

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

With the stunning Supreme Court 5-4 majority decision to uphold the Patient Protection and Affordable Care Act (ACA), there’s a Roberts’ Rules of (Health Reform) Order that calls for liberating primary care beyond the doctors’ office. That’s because a strategic underpinning of the ACA is akin to President Herbert Hoover’s proverbial “chicken in every pot:” for President Obama, the pronouncement is something like, “a medical home for every American.” But insurance for all doesn’t equate to access: because 32-some million U.S. health citizens buy into health insurance plans doesn’t guarantee every one of them access to a doctor. There’s a

The idea of value-based purchasing in health care has been around since the 1990s, when 3 researchers named Meyer, Rybowski and Eichler wrote, “The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. This strategy can be

There’s a long-held belief among us long-time health industry analysts that Americans spend more time shopping around for cars and washing machines than for health plans and doctors. Consumer Reports is betting that’s going to change, now that Consumers Union has decided to lend its valuable, trusted brand to developing report cards on physicians, having already rated hospitals and heart surgeons. CR will call their version of the doctor’s report card Patient Experience Ratings. CR has first entered the competitive medical market of Massachusetts, and has unveiled reports on 500 primary care physicians in the state. CR worked with  physician survey

Trust is a precursor to health engagement. Trust impacts health outcomes such as a patient’s willingness to follow a doctor’s or health plan’s instructions. Two new studies point out that U.S. consumers don’t trust every touchpoint in the health system. Online medical information has become a trusted channel. Health plans? Not so much. Wolters Kluwer’s Health Q1 Poll on Self-Diagnosis found that consumers trust online health information to inform themselves — even for self-diagnosis. 57% of U.S. adults turn to the Internet to find answers to medical information; 25% “never” do, and 18% rarely do. Two-thirds of people say they trust

Some 500 data analytics gurus representing the health care ecosystem including hospitals, physician practices, life science companies, academia and consulting came together on the lush campus of SAS in Cary, North Carolina, this week to discuss how Big Data could solve health care’s Triple Aim, as coined by keynote speaker Dr. Donald Berwick: improve the care experience, improve health outcomes, and reduce costs. Before Dr. Berwick, appointed as President Obama’s first head of the Centers for Medicare & Medicaid Services, Clayton Christensen of the Harvard Business School, godfather of the theory of disruptive innovation in business, spokee about his journey

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA. In enabling mobile physician visits, American Well and Consult A Doctor join Myca, which has offered mobile phone-based visits for clients for at least two years to employer clinic customers. In April 2010, my report, How Smartphones Are Changing Healthcare for Consumers and Providers, talked about Myca’s work with Qualcomm: the telecomms company armed traveling employees with mobile phones that could connect

One in 3 Americans uses social media for health discussions. Health is increasingly social, and PwC has published the latest data on the phenomenon in their report, Social media ‘likes’ healthcare: from marketing to social business, published this week. PwC polled 1,060 U.S. adults in February 2012 to learn their social media habits tied to health. Among all health consumers, the most common use of social media in health is to access health-related consumer reviews of medications or treatments, hospitals, providers, and insurance plans, as shown in the graph. Social media enables people to be better health “consumers” by giving them peers’

Dr. Andrew Weil, the iconic guru of all-things-health, was joined by a panel of health stakeholders at this morning’s Edelman salon discussing Wellness Ignited – Now and Next. Representatives from the American Heart Association, Columbia University, Walgreens, Google, Harvard Business School, and urban media mavens Quincy Jones III and Shawn Ullman, who lead Feel Rich, a health media organization, were joined by Nancy Turett, Edelman’s Chief Strategist of Health & Society, in the mix. Each participant offered a statement about what they do related to health and wellness, encapsulating a trend identified by Jennifer Pfahler, EVP of Edelman. Trend 1: Integrative

Highmark is the next health plan to launch mobile health programs, signalling a tipping point in health insurance companies getting up-close-and-personal with members’ wellness. Encouraging Words of Wisdom is a personal nutrition coaching program for plan enrollees who meet with dieticians. Members can opt-in to receive motivational text messages and support ongoing commitments to healthy eating. One such message reads, “The best food comes in its own package.” Another app enables members to find a doctor using GPS or to calculate their co-pay amount for a service. Highmark’s head of health services strategy said in the company’s press release, “We understand

comScore has issued its annual report on the state of the American digital consumer in U.S. Digital Future in Focus 2012 and the topline is that mobile and Facebook are redefining communication in both the digital and physical worlds. This disruptive phenomenon has transformational implications for health and health care. comScore’s macro observations are that: – Social networking, and especially Facebook, is capturing a growing proportion of online users’ time, thus redefining how brands and organizations must interact with customers offline and on-. – Google remains the search leader but Bing has grown, surpassing Yahoo! as #2 in 2011. –

Over 20% of U.S. families had problems paying medical bills in 2010 — about the same proportion as in 2007. The Center for Studying Health System Change found this datapoint “surprising,” given the Great Recession of 2008 that lingers into 2012. However, HSC points out that the leveling of medical bill problems may be a “byproduct” of reduced medical care utilization; in Health Populi-speak, self-rationing of health care. In the Tracking Report, Medical Bill Problems Steady for U.S. Families, 2007-2010, HSC analyzed data from the 2010 Health Tracking Household Survey and discovered that since 2003, the proportion of families facing problems with medical debt

The Great American Recession of 2008 will reawaken in 2012, Goldman Sachs expects. In the current economic climate of a jobless recovery and dropping home values, the definition of The American Dream has changed. It’s more about personal fulfillment than financial gain, according to the 2011 MetLife Study of The American Dream: The Do-It-Yourself Dream. This is the rise of the “do-it-yourself” American Dream, MetLife found in its survey of 2,420 online adults conducted in September-October 2011. Across the generations — from Silent (born between 1920 and 1945) to Gen Y (born between 1978 and 1993), this redefining concept is relatively consistent.

Walmart issued a Request for Information to expand its retail health footprint in the communities in which the world’s largest company operates. That was a strong sign that retail health has surpassed a tipping point. Now, there are hard data to support this observation from a RAND Corporation research team. Trends in Retail Clinic Use Among the Commercially Insured, published in the November 25, 2011, issue of The American Journal of Managed Care, quantifies retail clinic utilization among a group of Aetna health plan enrollees between 2007 and 2009. In those two years, use of retail clinics grew 10-fold. RAND looked

The health status of the American workforce is declining. Every year, unhealthy behaviors of the U.S. workforce cost employers $623 per employee annually, according to the Thomson Reuters Workforce Wellness Index. People point to smoking, obesity and stress as the 3 most important factors impacting health costs. Thomson Reuters and NPR polled over 3,000 Americans on their health behaviors, utilization and costs of health care, publishing their results in a summary, Paying for Unhealthy Behaviors in October 2011. 4 in 5 overall — and 9 in 10 of those with over $50,000 annual income — believe that people with healthy behaviors should receive a

U.S. employers’ health insurance-response to the nation’s economic downturn has been to shift health costs to employees. This has been especially true in smaller companies that pay lower wages. As employers look to the implementation of health reform in 2014, their responses will be based on local labor market and economic conditions. Thus, it’s important to understand the nuances of the paradigm, “all health care is local,” taking a page from Tip O’Neill’s old saw, “all politics is local.” The Center for Studying Health System Change (HSC) visited 12 communities to learn more about their local health systems and economies, publishing their

Doctors won’t be celebrating Independence Day on July 4th — at least when it comes to their professional practices. The days of the cottage industry physician are dwindling as more doctors are losing their independence, instead opting for employment. There are several reasons for physicians’ exodus from private practice: these include increasing administrative burdens, economies of scale for adopting information and communications technology, security in uncertain futures around reimbursement, and that all-important work-life balance. Accenture points out these trends in a summary report, Clinical Transformation: Dramatic Changes as Physician Employment Grows.  Accenture sees benefits accruing to health systems acquiring physician

With health reform uncertainties, growing health regulations, and ever-increasing costs, employers who sponsor health plans for their workforce will continue to cover active employees. That is, at least until 2017, according to the crystal ball used by Mercer, explained in the Health & Benefits Perspective called Emerging challenges…and opportunities…in the new health care world, published in May 2011. Note that it’s “active” employees who Mercer expects will retain access to health benefits. For retirees, however, it’s another story. They need to be ready to take on more responsibility, financially and perhaps going-to-market to select coverage, while employers may continue some level

Health care costs have doubled in less than nine years for the typical American family of four covered by a preferred provider health plan (PPO). In 2011, that health cost is nearly $20,000; in 2002, it was $9,235, as measured by the 2011 Milliman Medical Index (MMI). To put this in context, The 2011 poverty level for a family of 4 in the 48 contiguous U.S. states is $22,350 The car buyer could purchase a Mini-Cooper with $20,000 The investor could invest $20K to yield $265,353 at a 9% return-on-investment. The MMI increased 7.3% between 2010 and 2011, about the same

Wellness and disease prevention were the meta-themes at Health 2.0’s Spring Fling held earlier this week in San Diego. where the discussions, technology demonstrations, and keynote speakers were all-health (as opposed to health care), all-the-time. Dr. Dean Ornish told the attendees in the standing-room-only ballroom space that the joy of living is a greater motivator than the fear of death. And the 1.0 version of managing health risks has been more the latter than the former. As a result, Ornish’s two decades of research have shown that health is more a function of lifestyle choices than it is drugs and surgery. In fact, people have

“If nothing else, the health reform bill has signaled the beginning of the end of the health plan as we know and love it,” David Brailer, once health IT czar under President GW Bush and now venture capitalist, is quoted in Reuters on Hot Healthcare Investing Trends for 2011. One health plan Brailer called out that could be relevant in the post-reform, post-recessionary US health world is Humana. I had the opportunity to spend time with Paul Kusserow, Chief Strategy Officer for Humana, during the HIMSS11 meeting. Our conversation began with me asking why the chief strategist for Humana would

1 in 5 among all U.S. employers (22%) would likely drop health insurance coverage and let workers buy a plan through a health insurance exchange. However, most employers would expand wellness programs driven by incentives in health reform. Employers’ perspectives on the Affordable Care Act/health reform are mixed, according to a survey conducted by the Midwest Business Group on Health, co-sponsored by the National Business Coalition on Health, Business Insurance and Workforce Management. Not surprisingly, these views vary by whether the firm is large (>500 employees) or small. More large employers support the creation of Health Insurance Exchanges and would expand wellness services;

Americans trust their supermarkets and local hospitals more than other industries they deal with. while tobacco and oil companies remain at the bottom of the trust-list for U.S. consumers, health insurance and managed care aren’t much ahead of them. Pharmaceutical companies rank fairly low, with only 11% of U.S. adults seeing them as “honest and trustworthy.” As a result, nearly one-half of Americans would like to see increased regulation on pharma. Over 1 in 3 Americans would like to see managed care and health insurance companies more regulated. The latest Harris Poll has found that oil, pharmaceutical, health insurance and tobacco are

3 in 4 American workers who receive health insurance at the workplace have been impacted by increasing health care costs. As a result, more are self-rationing health care; this is taking many forms, including delaying visits to the doctor, skipping a recommended visit, and not filling prescriptions written by the doctor. Most concerning is that the 14% drop in the percent of employees trying to take better care of themselves in the past year, according to Employee Perspectives on Health Care: The Affordability Gap, from Towers Watson. As health costs rise, employee satisfaction is falling — this is particularly true

Americans feel pretty helpless about their individual ability to lower health care costs. Most people look to health insurance companies and the pharmaceutical industry to be responsible for lowering health costs in the U.S. A survey from Chadwick Martin Bailey and South Street Strategy looks at Americans’ views on health reform and health care costs in late summer 2010 and finds people still confused about how health reform will impact them, and impotent in their ability to lower their costs. American Consumers Uncertain About Health Reform summarizes the survey results, with the top line finding that 74% of people expect that

Since 2000, American workers’ contributions to health insurance premiums more than doubled, to nearly $4,000 a year from $1,619 ten years earlier. The total premium going to health insurance per worker for family coverage is $13,770 in 2010, with nearly $10,000 being borne by the employer. Workers’ share of premium increased 147%, and employers’ grew 114%. The Kaiser Family Foundation/Health Research & Educational Trust’s (KFF/HRET) annual 2010 Employer Health Benefits survey tells the story of health insurance costs that continue to grow, the rates of which depend on the type of health insurance purchased. For example, workers in high-deductible health plans saw

Now showing in a 60-second spot during the 6 o’clock news: Andy Griffith’s got the starring role in promoting the peoples’ use of the Patient Protection and Affordable Care Act of 2010 (PPACA). Here is the announcement of the ad in The White House blog of July 30 2010. In the ad, Andy, now 84, recalls the signing of Medicare by President Johnson and moves into some details about the good things PPACA brings to seniors in the U.S. The Christian Science Monitor covers the story and shows the video here. This has caused quite a stir among Republicans who say

As the recession continues to negatively impact U.S. business, employers are tightly managing benefits across-the-line, from health to housing and travel categories. Benefits overall are experiencing a downward trend versus 5 years ago. In the health arena, benefits that show staying power include wellness resources (covered by 75% of employers), on-site flu vaccinations (68%), wellness programs (59%), and 24-hour nurse lines (59%). On the downside, benefit programs that are expected to erode in the next 12 months are prescription drug coverage, dental insurance mail-order drug programs, and chiropractic coverage, among others shown in the chart. The Society for Human Resource

J.D. Power, an expert in understanding satisfaction across industries, has looked under the hood of employers and their satisfaction with health plans. In summary: it’s not only about the benefits and costs when it comes to health plan satisfaction. For employers, satisfaction is also based on near-equal parts of “service” in 3 guises: account servicing from the employer’s point of view (where more communication from the plan is seen as better than less); employee plan service experiences; and problem resolution. For the 4 in 5 employers who have had problems with health plans (that’s 79% of employers), it’s less about costs and

61% of American health citizens have difficulty paying for health insurance when they go out on the open market to purchase it as individual customers.  A survey from the Kaiser Family Foundation (KFF) finds that most people in the U.S. who go for health insurance on their own have trouble paying for it. 14 million people in the U.S. aren’t covered by employers and seek so-called non-group or individual health insurance policies. Premium increases for these policies averaged 20% in early 2010. Nearly 1/2 of these people are self-employed or work in small business. The average out-of-pocket health spending for

Today, $18,074 could cover… A new 2010 Honda Civic A year of college at Hampton University in Virginia The per capita income in Waterloo, NY. Or, you could cover health insurance for a typical family of four in America. In the past year, the average cost of health care for a family of four in the U.S. has increased by $1,303, the large single dollar increase seen in the past 10 years since the start of the Milliman Medical Index (MMI). The total medical cost for a family of four is $18,074 in 2010. Employers will pay, on average, 59% of the

  When it comes to health plans sponsored by U.S. employers, there are two realities facing benefits managers: on one side of the coin, most U.S. employers held the line on employee benefits in the recession. The other reality: controlling costs is the most important objective for employee benefits, according to most U.S. employers polled in MetLife’s 8th Annual Study of Employee Benefits Trends. Under the cost-control priority, though, is a novel finding in the MetLife study. That is that employers see a link between benefits and employee productivity and loyalty. Thus, when productivity is viewed as a benefits objective, employers can connect the dots

So much for America’s ability to manage health care costs without health reform: health costs will increase in the double-digits this year, according to Buck Consultants‘ 21st National Health Care Trend Survey. This annual survey monitors medical trend — the factors that drive cost increases. These include inflation, service utilization, technology, adding new programs, changes in service mix, and benefit mandates. The chart illustrates that medical trend varies across plans — but not my much. High-deductible consumer-driven health plans expect growth of 10.4%: hardly a significantly lower rate of growth than for the most open, rich plans (PPO, POS). Buck

Rosie the Riveter reminds us to Honor Labor. In that vein, with the Labor Day holiday upon us, this post assembles data to paint the latest picture of health insurance and the American worker in 2009…  Workscape’s Annual Benefits Study for 2009 found that employees have a heightened appreciation of benefits. The declining economy clearly has increased awareness and appreciation of workplace benefits.  Trends In Underinsurance And The Affordability Of Employer Coverage, 2004-2007, in Health Affairs online, found eroding health insurance coverage among employers who continued to provide insurance, and further moves for employees to have more financial “skin in

Because of high premiums, only 9 percent of unemployed workers have COBRA coverage. Maintaining Health Insurance During a Recession: Likely COBRA Eligibility, a study from The Commonwealth Fund (CMWF), clarifies how COBRA is actually used by unemployed people in the U.S. CMWF calculates that: – Two of three working adults are eligible to buy into COBRA under the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) if they became unemployed. – Under COBRA, workers pay 4 to 6 times their current premium for health benefits. – Thus, only 9 percent of unemployed workers have COBRA coverage due to the high price

Call it the health insurance Blue-tique. Highmark Blue Cross Blue Shield is opening storefronts in shopping malls to talk health insurance.   Highmark Direct will be the name on the front of this store, whose mission it will be to meet with sales staff from the insurance company to learn more about health insurance options and, before leaving the store, sign up for insurance the way a consumer might by a bed from a SelectComfort shop or a stereo component from Bose. The first Highmark Direct shop will be in Pittsburgh, PA. Highmark isn’t the first Blues plan to go

The cost of health insurance is the #1 problem cited by small business owners. Health costs beat gas prices, the #2 most severe problem cited by small business, as of March 2008 (when the survey was conducted). This week, small business leaders convened at the annual National Small Business Summit conference of the National Federation of Independent Business (NFIB). The report notes the downturn in the economy during the second half of 2007 when the NFIB Small Business Optimism Index dropped to 94.6 in December, the lowest since 2001. Health care costs rank first in small business problems regardless of

$15,609 could cover a lot of household needs for the average American family in the course of a year: utilities, mortgage, gas tank fills.   It’s also the cost of health care to cover a family of four in 2008.   Milliman notes that the average annual medical cost for a family of four increased by 7.6% from 2007 to 2008. This rate of increase is lower than the 8.4% average annual increase between 2003-2007; however, the burden of overall expense is “steadily shifting to employees,” Milliman attests.   Health spending splits into five components, as the Milliman Medical Index

  The traditional health behavioralists haven’t succeeded too well in changing our un-healthy behaviors. It may take an economist and a lawyer to sort this out.   In the new book, Nudge, Richard Thaler (the economist) and Cass Sunstein (the lawyer) present a useful approach to motivating people toward better health behaviors.   One of the scenarios that particularly resonated with me was the empirical evidence that, if you put healthy food at the front of the school cafeteria, kids will eat it.   Thaler and Sunstein term this moving of the healthy stuff to the front of the line

I “leave” you for the year with some great, good, and less-than-sanguine expectations for health care in 2008. These are views filtered through my lens on the health care world: the new consumer, health information technology, globalization, politics, and health economics.  Health politics shares the stage with Iraq. Health care is second only to Iraq as the issue that Americans most want the 2008 presidential candidates to talk about, according to the latest Kaiser Health Tracking Poll. Several candidates have responded to the public’s interest with significant health care reform proposals. But major health reform – such as universal access

There is more money spent on health care for each citizen of Massachusetts and Pennsylvania than for a citizen in Utah, Arizona or Nevada. In fact, per capita health spending was 59% lower in Utah than Massachusetts in 2004. The latest state-by-state spending variations are highlighted in Health Affairs’ web-exclusive feature. Welcome to the statistical phenomenon in health care known as “regional variation.” The guru-researcher of regional variation is John Wennberg, who has detailed these trends in fhe Dartmouth Atlas.   New regional health spending data were published in Health Affairs, which we health economists and policy wonks eagerly anticipate