3 Things I Know About Health Care in 2014

We who are charged with forecasting the future of health and health care live in a world of scenario planning, placing bets on certainties (what we know we know), uncertainties (what we know we don’t know), and wild cards — those phenomena that, if they happen in the real world, blow our forecasts to smithereens, forcing a tabula rasa for a new-and-improved forecast. There are many more uncertainties than certainties challenging the tea leaves for the new year, including the changing role of health insurance companies and how they will respond to the Affordable Care Act implementation and changing mandates


Bending the cost-curve: a proposal from some Old School bipartisans

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


A health economics lesson from Jonathan Bush, at the helm of athenahealth

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


Said the EHR to the doctor, “you like me, you really like me!”

Over one-half of office-based physicians in the U.S. had adopted an electronic health record (EHR) in 2011. Among theese adopters, 85% were satisfied: 38% “very,” and 47% “somewhat.” Those are pretty good reviews considering so many came to EHRs based on the government’s HITECH incentive and not motivated purely out of intrinsic personal passion to adopt digital medical records systems. This update comes from the July 2012 Data Brief from the National Center for Health Statistic, Physician Adoption of Electronic Health Records Systems: United States. 2011. The report details survey findings from 5,232 office-based physicians who completed the mailed questionnaire in


The Online Couch: how the Internet and mobile are changing mental and behavioral health care

Therapy is now a click away, whether on a computer, a smartphone or a tablet. Drs. Freud, Ellis and Beck, heads-up: the Internet is the new couch of psychiatry. That is, at least for people with mild to moderate depression and those with anxiety, as I report in my latest paper for the California HealthCare Foundation, The Online Couch: Mental Health Care on the Web. Many factors are aligning that make therapy online an effective extension of face-to-face therapy for the right patients at the right time in the U.S.: An undersupply of psychologists, psychiatrists, and other therapists, especially in rural and


Wellness Ignited! Edelman panel talks about how to build a health culture in the U.S.

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


Consumer engagement in health: greater cost-consciousness and demand for cost/quality information

People enrolled in consumer-directed health plans (CDHPs) are more likely than enrollees in traditional health insurance products to be cost-conscious. In particular, CDHP members check prices before they receive health care services, ask for generic drugs versus branded Rx’s, talk to doctors about treatment options and their costs, and use online cost-tracking tools. Furthermore, CDHP members are also more likely to use wellness programs offered by their employers, and are offered “carrots” to participate in them in the forms of financial rewards and other incentives, as well as reduced health care insurance premiums. The 7th annual Employee Benefits Research Institute


Employers’ health plans look to behavior change, while accelerating the premium cost shift to employees

The new mantra for employers who sponsor health benefits is: “a healthy workplace leads to a healthy workforce.” Employers that sponsor health plans are now in the behavior change business, according to Aon’s 2011 Health Care Survey. Health plans are tightly focusing on wellness, motivating and sustaining positive personal health changes, with carefully designed incentives (carrots and sticks) informed by behavioral economics. The paradigm is value-based insurance design (VBID) that removes barriers to essential, high-value health services to bolster treatment adherence, improve productivity, and reduce overall medical costs. The top five priority tactics for employers in health are: To offer incentives


No relief: medical costs will increase by double-digits again in 2011

Medical costs will grow between 10% and 11% in 2011, depending on whether an enrollee is opting for a PPO (11%), a POS (11.2%) or an HMO plan (10.2%). These growth rates are similar to 2010 increases, with the largest percentage growth projected for point-of-service plans from 10.6% in 2010 to 11.2% next year. These cost increases are roughly eight-times inflation in the consumer price index (CPI), gauged at 1.2% in July 2010 for urban consumers. The 2011 Segal Health Plan Cost Trend Survey reflects additional costs the benefits consultants that plan sponsors will incur to comply with the Affordable Care


Benefits and costs: the growing burden of health insurance on American families

By Jane Sarasohn-Kahn on 3 September 2010 in Employers, Health Economics, Health Plans, Managed care

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


Health consumers don’t understand their patient-power…yet

Most health consumers define the value of drugs in terms of safety and efficacy first, then quality of life and cost second. These priorities are similarly shared by both biopharma executives and managed care management. Where consumers diverge with the two health industry stakeholders, though, is with respect to their power: while about 1 in 3 biopharma and managed care execs believe that patients will be influential in the success or failure of new therapies over the next five years, only 11% of patients say that “people like me” will be influential over what new drugs will be available in the


More out-of-pocket, more wellness in 2011? A look into PwC's Behind the numbers

By Jane Sarasohn-Kahn on 14 June 2010 in Employers, Health Consumers, Health Economics, Managed care

Medical costs will increase by 9% in 2011, a mere 0.5% less than 2010 cost growth. The fastest-growing components will be inpatient and outpatient costs, shown in the pie chart. 81% of premium costs are bound up in provider costs for hospitals and physicians — the two most significant factors of medical inflation. And Americans will bear even more medical costs, out-of-pocket (OOP), in 2011 in the form of greater coinsurance and deductibles. Behind the numbers: Medical cost trends to 2011 looks into employers’ crystal balls on health benefits for 2011. PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to


Employers are worried about health reform


Half of employers will offer consumer-directed health plans in 2015

The growth of consumer-directed health plans (CDHPs) continues as employers look for ways to rationalize their health spending in the midst of annual double-digit health cost increases. By 2015, 61% of large employers will off CDHPs. Overall, 45% of employers think they’ll be offering CDHPs in five years. These data were found through the Mercer National Survey of Employer-Sponsored Health Plans, sponsored by the American Association of Preferred Provider Organizations (AAPPO), published in April 2010. In 2009, 15% of all employers offered a CDHP: this grew from 10% in 2008. 18% of employers are likely to offer a CDHP this


Employers seek to maintain benefits while reducing costs, in MetLife survey

  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


Affordable care and better information: what Americans want from a new-and-improved US health system

Anxiety about health care costs tops American citizens’ concerns about health care in the U.S. Rich, poor, insured or un-, 2 in 3 Americans worry about the affordability of health care in America.   So it follows, then, that among those without health insurance, 57% blame their uninsured state on the fact that they simply cannot afford it, as shown in the table on the right. Beyond this group, 30% of the uninsured cite the employer’s role in health insurance: 14% aren’t employed, 9% have employers who don’t offer coverage, and 7% are “between jobs.”   These findings come from


Wal-Mart’s leading role in health care — now, as PBM

When the health care Oscars are announced in 2010 for top roles, the health care academy won’t know whether to cast Wal-Mart as the lead, supporting, director, or producer in health care. Wal-Mart is the third largest pharmacy chain in the U.S. As #1 on the Fortune 500 list, the retailer’s role as a jumbo employer means it has clout in health care negotiations and in the entire American health system. According to the company’s CEO, the company may enter the pharmacy benefits management business. During the company’s annual “Year Beginning Meeting” last week, Wal-Mart CEO Lee Scott talked about