A blog covering the health/care ecosystem and people.

Health is where we live, work, play, pray and have fun. And if you’re Penn Jillette, the magician who collaborates with Teller, it took more than sleight of hand or a magic trick to lose 100 pounds — one-third of his body weight. He did it, according to this video, with the help of hard work, and using activity tracking tools from Withings. [youtube https://www.youtube.com/watch?v=EQWCVLvuBzI?rel=0] Unlike many people who quantify themselves for wellness and fitness, Penn did so to avoid having a medical procedure (i.e., the implantation of a stomach sleeve for weight loss) and also to reduce the six

By 2020, according to the World Economic Forum, more than 5 billion people and 30 billion “things” will be connected to the Internet — cars, refrigerators, TVs, washing machines and coffeemakers, among those 5 bn folks’ electronic stuff. But so will medical devices, activity trackers, and a host of sensor-enabled “things” to help people and clinicians optimize health and manage illness. The Internet of Things (IoT) phenomenon, which is already penetrating households with energy management and security applications, is reaching health care. One of the pioneers in this connected health market is Dr. Joseph Kvedar, who leads the Center for

“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

Most Americans support price controls on drug and medical device manufacturers, hospitals, and payments to doctors, along with allowing Medicare to negotiate drug prices. U.S. health citizens, now consumers, have been experiencing sticker-shock when it comes to prices on medical bills upon hospital discharge, leaving the doctor’s office, filling a prescription at a pharmacy or receiving a specialty drug recommended for a serious medical condition. The HealthDay/Harris Poll of 5 November 2015 quantifies their observation that Americans Want Bold Steps to Keep Health Care Costs in Check. The topline of the Poll shows that: 73 percent support price controls on

Consumers are most concerned about health care costs among their kitchen table issues, above their ability to afford the utility bill, housing, food, or gas and transportation costs. The October 2015 Kaiser Family Foundation Health Tracking Poll finds 4 in 10 Americans finding it difficult to afford health care, including 16% of people earning $90,000 a year or more. Underneath that worrying healthcare cost umbrella are the price of prescription drugs, which the majority of Democrats, Independents, and Republicans all agree need to be “limited” by government regulation. Ensuring that the public have affordable access to high-cost drugs for chronic conditions

I lost a best friend last week. His memorial service, held this past weekend, was a celebration of his life. And part of that well-lived life was a very conscious planning of his last days. The Economist published its 2015 Quality of Death Index, a data-driven treatise on palliative care, the very week my dear friend Rick died. This gives me the opportunity to discuss palliative care issues with Health Populi readers through The Economist’s lens, and then in the Hot Points below through my personal context of this remarkable man’s end-of-life choices. The Economist ranks 80 countries on several

Two-thirds of all internet users, and 65% of all adults over 18 years of age, use social networking sites. Social Media Usage: 2005-2015, the latest report from the Pew Research Center, finds social networking is the new normal for people up to 65 years of age. One-third of people over 65 use social networking sites. Peoples’ use of social media impacts every aspect of daily living beyond sharing social updates, from home keeping and political discussions to work, parenting, and managing stress, the Pew research found. Key findings in the report are that: Seniors’ use of social networks rose from

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

Noncommunicable diseases (NCDs) are the #1 cause of death in the world. NCDs are the yin to the yang of infectious diseases. Mortality from infectious disease has fallen as national economies have developed, while NCDs such as heart disease, respiratory disease, cancer, diabetes, and other NCDs are a growing burden. Health Affairs devotes its September 2015 issue to The Growing Burden of Noncommunicable Diseases, featuring research focusing both on global trends and U.S.-specific challenges. In their look into the relationships between NCDs, unhealthy lifestyles and country wealth, Thomas Bollyky et. al. note that NCDs aren’t only the “diseases of affluence,”

“Tomorrow [drug makers] may not get paid for the molecule, they may only get paid for the outcome,” expects Brian Niznik of Qualcomm Life. He’s quoted in a report from PwC’s Health Research Institute, 21st Century Pharmaceutical Collaboration: The Value Convergence. What Brian’s comment recognizes is the growing value-based environment for healthcare, which couples purchasers driving down drug costs via discounts and stringent formulary (approved drug list) contracts, and growing patient responsibility for paying for prescription drugs — especially financially costly for specialty drugs that are new-new molecules. But as Brian points out, if the high-cost molecule doesn’t perform as

When I clipped you to my underwear for the first time in 2011, I’d no idea that you were about to change my life, health and mindfulness. You were my first digital activity tracker and since then, I’ve purchased three versions of you…as well as others. Fitbit, you really did change my life and help me become more mindful of my activity, my calorie burn, ultimately supporting me in losing weight and keeping it off. Since its launch in 2009, the brand name “Fitbit” has become synonymous with digital activity tracking, the most popular digital pedometer on the market —

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

People in the U.S. spend over five-and-a-half hours a day with digital media in 2015, with time on mobile devices exceeding use of laptop and desktop computers. The growth of mobile means people are using and seeking more just-in-time services in daily living, and this has big implications for health/care, based on the annual mega-report on Internet Trends from Mary Meeker, KPCB’s internet analyst. “People” in health/care are patients, consumers and caregivers; people in health/care are also health plan administrators, employer benefits managers, doctors, nurses, allied health professionals, financial managers in hospitals, pharmacists, and the entire range of humans who

The spiritual and emotional top the physical in women’s definition of “health,” based on a multi-country survey conducted in Brazil, Germany, Japan, the UK and the U.S. The Power of the Purse, a research project sponsored by the Center for Talent Innovation, underscores women’s primary role as Chief Medical Officers in their families and social networks. The research was sponsored by health industry leaders including Aetna, Bristol-Myers Squibb, Cardinal Health, Eli Lilly and Company, Johnson & Johnson, Merck & Co., Merck KGaA, MetLife, Pfizer, PwC, Strategy&, Teva, and WPP. The study’s summary infographic is titled How the Healthcare Industry Fails

Headphones and smartphones are the top two electronics products U.S. consumers intend to purchase in 2015. But the emerging consumer electronics categories of wearable fitness trackers, smart watches, and smarthome devices (especially “smart” thermostats) are positioned to grow, too, in 2015, according to the 17th Annual CE Ownership and Market Potential Study from the Consumer Electronics Association (CEA). Wearable trackers have an installed base of about 17 million devices in the U.S., with 11% of U.S. households intending to purchase a tracker in 2015 — 6 percentage points up from 2014 (about a 50% increase over 2014). There are about 6 million smart

It’s Mother’s Day 2015, so it’s time to praise moms and their role in making health: in their families, in their communities, and long-overlooked, for themselves. Mothers play a defining role in driving health in the world. Moms may be the most important social determinant of health. The National Partnership for Women & Families advocates for the role of women in building a healthy society, broadly defined. From the womb via the Childbirth Connection and Reproductive Health through economic security (such as fair wages and paid maternity leave) and women’s ability to access health information on behalf of their families and themselves,

The two most trusted health professionals in the eyes of U.S. consumers are nurses and pharmacists, and both of these health workers will be key partners for people wanting to engage in health/care. That was my introductory message kicking off the annual conference of ANIA, the American Nursing Informatics Association, in Philadelphia on April 24, 2015. Meeting in the City of Brotherly Love gave ANIA the opportunity to theme the meeting a “Declaration of Nursing Informatics,” carrying that theme through the exhibition hall with a Benjamin Franklin lookalike walking the floor availing himself of attendees’ requests for selfie-taking with the

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

When you think about life insurance, images of actuaries churning numbers to construct mortality tables may come to mind. Mortality tables show peoples’ life expectancy based on various demographic characteristics. John Hancock is flipping the idea life insurance to shift it a bit in favor of “life” itself. The company is teaming with Vitality, a long-time provider of wellness tools programs, to create insurance products that incorporate discounts for healthy living. The programs also require people to share their data with the companies to quality for the discounts, which the project’s press release says could amount to $25,000 over the

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

Financial wellness is integral to overall health. And the proliferation of high-deductible health plans for people covered by both public insurance exchanges as well as employer-sponsored commercial (private sector) plans, personal financial angst is a growing fact-of-life, -health, and -healthcare. Ask any hospital Chief Financial Officer or physician practice manager, and s/he will tell you that “revenue cycle management” and patient financial medical literacy are top challenges to the business. For pharma and biotech companies launching new-new specialty drugs (read: “high-cost”), communicating the value of those products to users — clinician prescribers and patients — is Job #1 (or #2,

Health is the hot topic at SXSW. While edgy new movies and hot music are the foundational elements of the annual South-by-Southwest festival, health and health care are the fast-growing themes at the meet-up, where the new-new, month-old beautiful JW Marriott Hotel by the Convention Center hosted most of the digital health track sessions. Digital health today goes well beyond mobile apps and genomic futures. Philips was a major presence this year at SXSW with its vision, shared by me, THINK-Health, and the HeathcareDIY team, of connected health where we live, work, play, pray and learn. In the case of

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

People in the U.S. are spending over 20.6% of their income on health care, according to data published by the U.S. Department of Commerce on March 2, 2015. This is up from 15% of personal income in 1990. Note the slope of this curve, moving up the X-Y axes from southwest to northwest. Now note the slope of the curves in the second chart, which illustrates consumer spending on other household goods and services: cars, housing, clothing, education, groceries, and eating outside of the home. Spending on these home budget line items remained relatively flat over the 25 year period 1990-2015,

More employers are recognizing the link between workers who may be overweight or obese on one hand, and health care costs, employee engagement and productivity on the other. As a result, some companies are adopting wellness programs that focus on weight loss as part of an overall culture of health at the workplace. Humana and Weight Watchers are the latest example of two health brands coming together to address what is one of the toughest behavior changes known to humans: losing weight. Humana will extend access to Weight Watchers for the health plan’s enrollees in an integrated wellness program. The program

The 87th annual 2015 Oscars show (#Oscars15) feted more than the movie industry: the event celebrated health in both explicit and subtle ways. Julianne Moore took the golden statuette for Best Actress, playing the title role in Still Alice, the story a woman diagnosed with early-onset Alzheimer’s Disease. In accepting her award, Moore spoke of the need to recognize and “see” people with Alzheimer’s – so many people feel isolated and marginalized, Moore explained. Movies help us feel seen and not alone – and people with Alzheimer’s need to be seen so we can find a cure, she asserted. See Moore’s lovely

February may be American Heart Month, African-American History Month, and Marfan Syndrome Awareness Month. But based on the volume of studies and reports published in the past two weeks, ’tis also the season for talking mobile health and doctors. This Health Populi post trend-weaves the findings. The big picture for mobile in health is captured by Citrix in its Mobile Analytics Report, dated February 2015. Everyday people are using mobile in work and daily living, blurring the distinctions between the various hats people wear. These roles, whether business or pleasure or life, happen 24×7, enabling through mobile platforms, Citrix found.

In our ADHD-addled, over-messaged and noisy world, it’s hard to break through the media clutter and binge-watching to get a health message out. Here’s the way it’s done: an engaging, humorous, impactful and crisp campaign focusing on making smoking so un-sexy and un-cool, you swipe the prospective date off of your Tinder app. Watch and learn, from The Truth. You can follow the campaign on Twitter using the hashtag #LeftSwipeDat. Kudos to the truth® anti-smoking campaign and the creative team who got this blend of message and medium so right. truth® is part of the Legacy project which is funded by the

If you’re meeting with a physician in the next week or two, put on your empathy hat: chances are, they are feeling burned-out. Overall 46% of physicians report they were burned out in 2014, up from just under 40% last year. Medscape’s Physician Lifestyle Report 2015 finds that at least one-half of physicians are burned-out who work in critical care, emergency medicine, family medicine, internal medicine, general surgery, and infectious disease (including HIV). And, at least 37% of physicians are burned-out working in all other specialties, shown in the first chart. Medscape gauges doctors’ self-assessments of burnout with a lens

People with more financial skin in the health care game are more likely to act more cost-consciously, according to the latest Employee Benefits Research Institute (EBRI) poll on health engagement, Findings from the 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey published in December 2014. Health benefit consultants introduced consumer-directed health plans, assuming that health plan members would instantly morph in to health care consumers, seeking out information about health services and self-advocating for right-priced and right-sized health services. However, this wasn’t the case in the early era of CDHPs. Information about the cost and quality of health care services was scant,

2015 is already becoming a year where bedfellows of different stripes are joining together to build a health care ecosystem well beyond hospitals, doctors and health plans. Announcements launched last week at the 2015 Consumer Electronics Show in Las Vegas, and coming out this week at the J.P. Morgan Conference in San Francisco, the first two weeks of 2015 reveal that new entrants and legacy health stakeholders are crossing corporate and cultural chasms to (try and) solve challenges that prevent us from getting to that Holy Grail of The Triple Aim: improving health care outcomes, driving down per capita costs,

Are you Feelin’ Groovy about wearables? Well slow down, you move too fast… …at least, according to Accenture’s latest survey into consumers’ perspectives on new technologies, published this week in conjunction with the 2015 Consumer Electronics Show in Las Vegas, the largest annual convention in the U.S. featuring technology for people. At #CES2015, we’re seeing a rich trove of blinged-out, multi-sensor, shiny new wearable things at the 2015 Consumer Electronics Show. Swarovski crystals are paired with Misfit Wearables, called the Swarovski Shine, shown here as a shiny new thing, indeed. Withings launched its Activite fitness tracking watch in new colors.

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,

Consumers’ growing health care cost burden is competing with other household spending: basic costs for Americans are eroding what’s left of the traditionally-defined Middle Class. At the front end of health costs is the health insurance premium, the largest single line item for a family. It looks like a big number because it is: Milliman gauged the cost for an employer to cover a family of four in a PPO in the U.S. at around $23K, with the employee bearing an increasing percent of the premium, copays, coinsurance, and a larger deductible this year than last, on average. There are

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

The health care industry is undergoing a retail transformation, according to Retail Reigns in Health Care: The rise of consumer power and its organization & workforce implications from Deloitte. Deloitte’s report published in October 2014 focuses on the health insurance business, which is newly-dealing with uninsured people largely unfamiliar with how to evaluate health plan options. This by any definition requires new muscles for both buyers and sellers on a health insurance exchange: new product access + uninformed consumer = retail challenge. Deloitte notes another supply and demand challenge, and that’s with the health insurance company workforce: while 93% of health

Wearables met health and medicine at the 8th annual Health 2.0 Conference in Santa Clara, CA, last week. I had the real pleasure of shepherding a wearables panel of five innovators during the conference, in a well-attended session followed by an energetic Q&A. The organizations who demonstrated their tools and brainstormed the wearables market included, in alphabetical order, Atlas Wearables, Heartmath, MySugr, SunSprite and Withings. I hasten to add that among the five presenters, two were women: that 2 in 5 = 40% gender representation is, happily to my way of thinking about women’s roles in health-making, a very good

National health spending will comprise 19.3% of U.S. gross domestic product in 2023, nearly $1 in $5 of all American spending. This statistic includes the expenditure categories for health spending as defined by the Centers for Medicare and Medicaid Services (CMS), Office of the Actuary. The number includes hospital care, personal health care, professional services (physicians and other professionals), home health, long term care, retail sales of prescription drugs and durable medical equipment, and investment in capital equipment, among other line items. The forecast was published in Health Affairs article, National Health Expenditure Projections, 2013-23: Faster Growth Expected With Expanded

It’s de rigueur for any organization marketing a product or service in health care to be “patient-centered” these days. “Patient engagement” and “health engagement” are phrases found on health conference agendas, whether pitching to attendees in pharma and life sciences, health IT, health insurance, or healthcare (to hospitals and physicians, alike). One paradigm for patient-centricity that’s more mature than most is IMS Health’s Patient Journey construct, which the data-driven company has been talking about since 2012. While the concept focused mainly on pharmaceutical marketing and medication adherence, it’s useful for all industry segments looking to motivate behavior change in health

Nations throughout the world are challenged by the cost of health care: from Brazil to China, India to the Philippines, and especially in the U.S., people are morphing into health care consumers. Three categories of health spending in the bulls-eye of countries’ Departments of Health are prescription drugs, and the costs of care in hospitals and doctors’ offices. In the U.S., one tactic for cost containment in health is “switching” certain prescription drugs to over-the-counter products – those deemed to be efficacious and safe for patients to take without seeking treatment from a doctor. Over-the-counter drugs (OTCs) are available every

As Americans become health care shoppers, learning to spend “their” money to meet high deductibles and manage expenses in health savings accounts, they seek information — made transparent through trusted, sometimes branded, sources. One of these is U.S. News & World Reports, which has published the U.S. News & World Reports Best Hospitals list since 1990, and as such, has become a popular go-to source for engaged patients looking for information on hospitals before receiving surgery, seeking second opinions for a medical condition, or moving to a new town looking to affiliate with a health system. But in February 2014, a

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

“Reality is the leading cause of stress among those in touch with it,” Lily Tomlin once quipped. Perhaps in 2014, America is the land of stress because we’re all so in touch with reality. THINK: reality TV, social networks as the new confessional, news channeling 24×7, and a world of too much TMI. So no surprise, then, that one-half of the people in the U.S. have had a major stressful event or experience in the last year. And health tops the list of stressful events in This American Life in the forms of illness and disease (among 27% of people)

There’s a growing number of wearable digital health devices on the market, and more will appear at the 2015 Consumer Electronics Show in Las Vegas. Four new such products competed live today at CE Week’s Battle of the Bands, an event launched by Living in Digital Times. The competitors included GoQii, Healbe, Skulpt, and Wellograph, Wellograph calls itself “the world’s first wellness watch.” Made of sapphire crystal, the watch has a sleek design, targeting a working professional audience who wants a view on health throughout the day. The watch has an Integrated heart rate sensor, taking readings from the wrist for pulse,

What do you get when you pair Meredith Wilson, the writer-composer of The Music Man, with Robert Preston (who acted the starring role of Harold Hill, the traveling music-band instrument salesman) with a President committed to reversing the “softness” he saw in American health citizens? You get “Go, You Chicken Fat, Go,” a rousing band-and-choir backed anthem to promote people to engage in more exercise and shed their “chicken fat.” President Kennedy was the public health Prez who, in 1960, asked Meredith Wilson to pen a national anthem to motivate Americans who he considered were growing “soft.” Back in the

A vast majority of people shopping for a health plan on a Health Insurance Exchange for coverage in 2014 obtained information online via websites. One-half of these shoppers used only online information, and 29% combined both websites and other sources like direct assistance, informal assistance, and via (offline) media. In the Health Reform Monitoring Survey from the Urban Institute Health Policy Center, a research team, funded by the Robert Wood Johnson Foundation and the Ford Foundation, looked into data collected from the Health Reform Monitoring Survey in March 2014 at the end of the 2014 open enrollment period for the

8 in 10 people in the U.S. believe that total privacy in the digital world is history, based on a survey from Accenture conducted online in March and April 2014 and published in the succinctly-titled report, Eighty Percent of Consumers Believe Total Data Privacy No Longer Exists. 84% of U.S. consumers say they’re aware what tracking personal behavior can enable – receiving customized offers and content that match one’s interests. At the same time, 63% of people in the U.S. also say they have a concern over tracking behavior. Only 14% of people in the U.S. believe there are adequate safeguards

During my conversation with a prominent pharma industry analyst yesterday, he observed, “As a consumer, you are self-insured until you get sick.” My brain then flashed back to a graph from the 2013 Employer Health Benefits Survey conducted annually by the Kaiser Family Foundation (KFF). The chart is shown here. It illustrates the upward line indicating that in 2013, 4 in 5 workers were enrolled in a health plan that included an annual deductible. That’s the “self-insurance” part of the observation my astute conversationalist noted. Simply put, when you are enrolled in a high-deductible health plan, You, The Consumer, are responsible for

“The surge in HDHP enrollment is causing patients to become consumers of healthcare,” begins a report documenting the rise of patients making more payments to health providers. Patients’ payments to providers have increased 72% since 2011. And, 78% of providers mail paper statements to patients to collect what they’re owed. “HDHPs” are high-deductible health plans, the growing thing in health insurance for consumers now faced with paying for health care first out-of-pocket before their health plan coverage kicks in. And those health consumers’ expectations for convenience in payment methods is causing dissatisfaction, negatively affecting these individuals and their health providers’