A blog covering the health/care ecosystem and people.

Most patient visits to doctors result in a prescription written for a medicine that people retrieve from a pharmacy, whether retail in the local community or via mail order for a maintenance drug. This one transaction generates a lot of data points, which individually have a lot of importance for the individual patient. Mashed with other patients’, prescription drug utilization data can combine with more data to be used for population health, cost-effectiveness, and other constructive research pursuits. At HIMSS19, there’s an entire day devoted to a Pharma Forum on Tuesday 12 February, focusing on pharma-provider-payor collaborations. Allocating a full

As #CES2019 kicks off in Las Vegas with today’s first Media Day, the Consumer Technology Association presented its forecast on the 5 Technology Trends to Watch in 2019 — and they all play into health, wellness, and medical care. The five trends are: Artificial Intelligence on the Rise Envisioning the Smart Home of the Future Digital Health Tech Empowers Patients Esports and Sports Technology, and Smart Cities Promote Resilience. Here are how these five mega-trends can bolster our health and healthcare products and services over the next decade. AI is indeed on-the-rise in healthcare: as I have begun planning my agenda for

Diabetes is a family issue, and its prevalence is growing in America. November 14, 2018, is World Diabetes Day, and the International Diabetes Federation reminds us that this condition impacts the whole household — not just the person diagnosed with diabetes. Why the family? Because diabetes is one disease that is largely preventable: through eating right, being physically active, and making healthy choices every day. The family is the primary ecosystem for daily living, and this environment can foster an individual’s healthy choices…or not. The IDF reminds us that family members can and should be aware of the signs and

“Happiness is within, but not within you alone as it is among us. If we can create happiness in a community, then we will be able to attain happiness as individuals,” observed Saamdu Chetri speaking at the International Psychological Congress last week. Chetri is head of Bhutan’s Gross National Happiness Centre, which developed the Gross National Happiness Index. The phrase “Gross National Happiness” was first mentioned in 1972 by the 4th King of Bhutan, King Jigme Singye Wangchuck in an interview with the Financial Times. King Wangchuck said that, “Gross National Happiness is more important than Gross Domestic Product.” The GNH

There’s a shortage of medical providers in the United Kingdom, a nation where healthcare is guaranteed to all Britons via the most beloved institution in the nation: The National Health Service. The NHS celebrated its 70th anniversary in July this year. The NHS “supply shortage” is a result of financial cuts to both social care and public health. These have negatively impacted older people and care for people at home in Great Britain. This article in the BMJ published earlier this year called for increasing these investments to ensure further erosion of population and public health outcomes, and to prevent

California’s Governor Jerry Brown signed into law a net neutrality bill this weekend. Gov. Brown’s proverbial swipe of the pen accomplished two things: he went back to the Obama-era approach to ensure that internet service providers treat all users of the internet equally; and, he prompted the Department of Justice, representing the Trump Administration’s Federal Communications Commission (FCC), to launch a lawsuit. California, home to start-ups, mature tech platform companies (like Apple, Facebook and Google), and countless digital health developers, is in a particularly strategic place to fight the FCC and, now, the Department of Justice. Nearly two dozen other states

In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia. The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine. The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line)

The Search for Value is the prevailing journey to a Holy Grail in healthcare these days. On that, most stakeholders working on the ground, globally. can agree. But whose value is it, anyway? Three reports published in the past few weeks give us some useful perspective on that question, woven together in today’s Health Populi blog. Let’s start with the Philips Future Health Index, which assesses value to 16 national health systems through three lenses: access, satisfaction, and efficiency. The results are shown in the map. “Value-based healthcare is contextual, geared towards providing the right care in the right place, at

          The U.S. gets relatively low ROI for its relatively exorbitant spending on healthcare, noted once again in the latest Health at a Glance, the annual OECD report on member nations’ healthcare systems. The report includes U.S. country data asking, “How does the United States compare?” with its sister OECD countries. The answer is, “not well across most population health, access, and mortality measures.” For the Cliff’s Notes/Where’s Waldo top-line of the research, find the two long bars in this chart heading “south” of the OECD average, and one long blue bar going “north.” The northern climbing bar

Social mobility in America has a lot of friction: children of wealthier people tend to grow into affluence, and children of low-income parents tend to struggle to move up the income and education ladder, according to A Broken Social Elevator: How to Promote Social Mobility, a new report from the OECD. The Organization for Economic Cooperation and Development studied member nations’ economies, demographics, income and opportunities to gauge each country’s social mobility. Social mobility, the OECD explains, is multi-faceted. It can refer to inter-generational mobility between parents, children, and grandchildren. Alternatively, social mobility can look at intra-generational mobility, over the course

The U.S. Department of Commerce Bureau of Economic Analysis (BEA) released, for the first time, data that quantifies Americans’ spending to treat 261 medical conditions, from “A” diseases like acute myocardial infarction, acute renal failure, ADHD, allergic reactions, anxiety disorders, appendicitis and asthma, to dozens of other conditions from the rest of the alphabet. High Spending Growth Rates For Key Diseases In 2000-14 Were Driven By Technology And Demographic Factors, a June 2018 Health Affairs article, analyzed this data. This granular information comes from the BEA’s satellite account, using data from the Medical Expenditure Panel Survey which nationally examines expenditures by disease;

Be the change you wish to see in the world, Gandhi has been attributed as saying. This sentiment was echoed by Lauren Singer as we brainstormed the social determinants of health and the factors that underpin healthy communities. Our Facebook Live session was convened by the Aetna Foundation, which sponsored research on the Healthiest Communities in 2018.  In addition to Lauren, founder of Trash Is For Tossers, Dr. Garth Graham, President of the Aetna Foundation, Dr. Pedro Noguera, Distinguished Professor of Education at UCLA, and I joined the quartet, moderated with panache and sensitivity by Mark J. Ellwood, journalist. Each

  Disparities in Americans’ health vary among people living in each of the 50 states. These differences in health status generally fall into two regions: north and south, found in the Commonwealth Fund’s 2018 Scorecard on State Health System Performance. The map shows this stark geography-is-health-destiny reality: the worse-than-average states, the Fund found, run from Nevada southeast to Arizona, through New Mexico and Texas all the way to Atlantic Ocean and the Carolinas, then north west all the way up through the industrial Midwest states through Michigan to the north. Wyoming is the only non-contiguous state in the worse-performing U.S. state

This is the second post of three written to summarize what I learned participating in Medecision’s annual meeting with the company’s partners, held March 27-29, 2018 at the Ritz-Carlton in Dallas, TX.  I concluded the first of this three-part series with Dr. Don Rucker’s belief that, “Patients are the massive use-case for interoperability.” This second post focuses on the key role of designing for healthcare – for patients, caregivers, providers, all industry sector workers indeed. And designing information to make it beautiful, useable, meaningful. You’ll read about Renaissance Man/Doctor Andrew Chacko MD, a board-certified physician, French and Physics student at the Naval

In the US, when it comes to life and death, it’s good to live in Hawaii, Utah, Minnesota, North Dakota, and Iowa — the top five states with the greatest life expectancy and healthy life expectancy at birth in 2016. For health and longevity, sorry to see the lowest five ranked states are Washington DC which ranks last, along with Mississippi, Louisiana, South Carolina, and Alabama. This sober geography-is-health-destiny update was published this week in JAMA, The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. The first chart illustrates states down the left

If it’s true that “your ZIP code is more important than your genetic code,” you’d look for a job in 22046, buy a house there, and plant your roots. You’d find yourself in Falls Church, Virginia, named number one in the Healthiest Communities rankings of 500 U.S. towns. You can see a list of all of the communities here. The project is a collaboration between the Aetna Foundation and U.S. News & World Report, with help from the University of Missouri Center for Applied Research and Engagement Systems (CARES) and a team from the National Committee on Vital and Health

The United States don’t feel very united these days on a whole range of issues. But today, I’m struck by a 180-degree-apart chasm between Idaho and Oregon. While the centers of these two states only lie 290 miles from each other, they are worlds apart when it comes to their views on their residents as health citizens. Idaho. First, let’s travel to Idaho, aka the Gem State due to its rich endowment of natural resources. Health insurers in the state are now allowed to offer plans with limited benefits, escaping the rules for plans in the Affordable Care Act that

Let’s change the conversation and put healthcare over  politics.  Sounds just right, doesn’t it? If you’re reading Health Populi, then you’re keen on health policy, health economics, most of all, patients: now playing starring roles as consumers, caregivers, and payors in their own care. Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), has assembled a diverse group of health care leaders who care about those patients/people, too, appropriately named the United States of Care. Founders include Dr. Bill Frist, former Republican U.S. Senator from Tennessee, Dave Durenberger, former Republican U.S. Senator from Minnesota, and

For this end-of-year post leading into 2018, I choose to address the big topic of how long we live in America, and what underpins the sobering fact that life expectancy is falling. Life expectancy in the United States declined to 78.6 years in 2016, placing America at number 37 on the list of 137 countries the World Economic Forum (WEF) has ranked in their annual Global Competitiveness Report 2017-2018. The first chart shows the declining years for Americans compared with health citizens of Australia, France, Canada, Finland, and the UK. While Australians’ and Britons’ life expectancies declined from 2015-16, their

Americans’ approval of the Affordable Care Act reached its apex in December 2017, the Pew Research Center found. The proportion of people approving the ACA has been growing since the middle of 2016, now at 56% of the public. The timing of this survey, conducted at the end of November and first few days of December 2017, coincides with Congress’s arm-wrestling a tax bill that would eliminate the individual mandate for health insurance which is an ACA building block for universal coverage in the United States. Most people in the U.S. also believe that the ACA has had a positive

More consumers are seeking health-making opportunities everywhere, both within and outside of traditional healthcare touch-points. That includes peoples’ consumption of beer. We learned from the Edelman Health Engagement Barometer that consumers seek to engage for health beyond healthcare organizations – namely, hospitals, providers, over-the-counter medicines, pharma and insurance. What was perhaps the most surprising industry segment consumers called on for personal health engagement was brewing and alcohol. Fully 8 in 10 consumers expect brewing and spirits companies to engage in health. The bar chart shows this finding, arraying beer and liquor producers on par with retail and consumer technology, along

“Spend more. Get less.” If a retailer advertised using these four words, how many consumers would buy that product or service? This is the American reality of healthcare spending in 2016, told in the OECD report, Health at a Glance 2017. I present five charts from the study in this post, which together take the current snapshot health-economic lesson for the U.S. First, look at health expenditures as a share of gross domestic product: the U.S. is number one above Switzerland, France, and the UK, and about two times the OECD average. Note, too, the proportion of out-of-pocket and so-called

Obesity, conflict, and mental illness contribute most to the ill health and mortality of the world’s population – especially in the U.S., according to the annual Global Burden of Disease study published this month in The Lancet and funded by The Bill & Melinda Gates Foundation. There’s good news and bad news in this research: on the upside, people are living longer. On the downside, there’s a lot of morbidity – that is, sub-optimal health – in those years. The study examines both YLLs (years of life lost) and YLDs (years lived with disability). “Death is a powerful motivator, both

    The Affordable Care Act (ACT) was implemented in 2010. Since the inception of the ACA, the proportion of uninsured women in the U.S. fell by nearly one-half, from 19 million in 2010 to 11 million in 2016. The Commonwealth Fund has documented the healthcare gains that American women made since the ACA launch in their issue brief, How the Affordable Care Act Has Helped Women Gain Insurance and Improved Their Ability to Get Health Care, published earlier this month. The first chart talks about insurance: health care plan coverage, which is the prime raison d’être of the ACA. It’s

  In 2015, poor and low-income people in America had worse health care than high-income households; care for nearly half of the middle-class was also worse than for wealthier families.   Welcome to the 2016 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality (AHRQ). The report assesses many measures quantifying peoples’ access to health care, such as uninsurance rates (which improved between 2010 and 2016), and quality of health care — including person-centered care, patient safety, healthy living, effective treatment, care coordination, and care affordability. While some disparities lessened between 2000 and 2015, disparities

On July 23, 1967, I was a little girl wearing a pretty dress, attending my cousin’s wedding at a swanky hotel in mid-town Detroit. Driving home with my parents and sisters after the wedding, the radio news channel warned us of the blazing fires that were burning in a part of the city not far from where we were on a highway leading out to the suburbs. Fifty years and five days later, I am addressing the subject of health equity at a speech over breakfast at the American Hospital Association 25th Annual Health Leadership Summit today. In my talk,

“Helping people on their path to better health” is the mission-mantra of CVS Health. Re-branded from its previous identity as CVS/pharmacy, the organization convened a Health Innovation Summit with its vendor partners whose products fill the front-of-store shelves to empower, inspire and support consumers to manage health and wellness for themselves and their families. I was grateful for the opportunity to provide the first talk for the day, setting the context for the evolving retail health/care landscape with the consumer at the center. The consumer is, at any point in a 24-hour day: a person wearing many hats (a worker,

Former Surgeon General Dr. Regina Benjamin was the first person who quoted to me, “Health isn’t in the doctor’s office. It’s where people live, work, play and pray,” imparting that transformational mantra to me in her 2011 interview with the Los Angeles Times. I wrote about that lightbulb moment here in Health Populi. Dr. Benjamin was the 18th Surgeon General, appointed by President Obama in 2009. As “America’s Doctor,” she served a four-year term, her mission focused on health disparities, prevention, rual health, and children’s health. Today, Dr. Benjamin wears many hats: she’s the Times Picayune/NOLA.com professor of medicine at

This week I celebrate two spring holy holidays in one city that embraces spirituality, civility, and culture: Florence, Italy. Today, I had the special opportunity to tour Ospedale degli Innocenti: the Hospital of the Innocents. The hospital is now an institute for studying the culture and economics of children, and a museum telling a unique story of Florentine babies born in the early 15th century, spanning our contemporary era. The founding and root history of this beautiful place has lessons to teach us even today. It is key to realize, first, that Florentine humanism exalted the ideal virtues of the

U.S. counties with better health have better performing economies. There’s a direct link between healthy people and a healthy economy, where healthier regions enjoy lower unemployment and higher incomes, according to the Blue Cross Blue Shield Health Index. When compared to counties with a median BCBS Health Index score, counties within the top 10 percent had: A per capita income that’s $3,700 higher than the median 10-year economic growth that’s 3.5% higher An unemployment rate half a point lower. The Blue Cross Blue Shield Association (BCBSA) worked with Moody’s Analytics (part of the Moody’s financial services company) on this second edition of this

States that expanded Medicaid since the start of the Affordable Care Act made greater health system access improvements than those States that did not expand Medicaid, according to Aiming Higher: Results from the Commonwealth Fund Scorecard on State Health System Performance. There’s good news and bad news in this report: on the upside, nearly all states saw health improvements between 2013 and 2015, and in particular, for treatment quality and patient safety. Patient re-admissions to hospitals also fell in many states. But on the downside, premature deaths increased in nearly two-thirds of states, a reversal in the (improving) national mortality

Geography is destiny, Napoleon is thought to have first said. More recently, the brilliant physician Dr. Abraham Verghese has spoken about “geography as destiny” in his speeches, such as “Two Souls Intertwined,” The Tanner Lecture he delivered at the University of Utah in 2012. Geography is destiny for all of us when it comes to our health and well-being, once again proven by Gallup-Healthways in The State of American Well-Being 2016 Community Well-Being Rankings. The darkest blue circles in the U.S. map indicate the metro areas in the highest-quintile of well-being. The index of well-being is based on five metrics, of consumer self-ranking

Results of two polls published in the past week, from the Kaiser Family Foundation and Pew Research Center, demonstrate growing support for the Affordable Care Act, aka Obamacare. The Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid was published 24 February 2017. The first line chart illustrates the results, with the blue line for consumers’ “favorable view” on the ACA crossing several points above the “unfavorable” orange line for the first time since the law was signed in 2010. The margins in February 2017 were 48% favorable, 42% unfavorable. While the majority of Republicans continue to be solidly

The autonomous car is a metaphor for healthcare: that’s how my first interview kicking off the  HIMSS marathon began. The annual 2017 HIMSS conference isn’t your father’s or mother’s HIMSS of ten years ago, or even the HIMSS of 2010 — the year that financial incentives for EHR adoption began to stream from the HITECH Act of 2009, motivating thousands of healthcare providers to acquire and meaningfully use digital health records systems. Then, the HIMSS conference floor was abuzz with EHR frenzy. This week, over 43,000 people working at the intersection of healthcare and technology have converged in Orlando, Florida, for

Health care is the top concern of American families, according to a Monmouth University Poll conducted in the week prior to Donald Trump’s Presidential inauguration. Among U.S. consumers’ top ten worries, eight in ten directly point to financial concerns — with health care costs at the top of the worry-list for 25% of people. Health care financial worries led the second place concern, job security and unemployment, by a large margin (11 percentage points) In third place was “everyday bills,” the top concern for 12% of U.S. adults. Immigration was the top worry for only 3% of U.S. adults; terrorism and

Consumers spend one in five dollars of their household budgets on healthcare in America. This fiscal reality is motivating more U.S. health citizens to seek information and control for their and loved ones’ health care. Personal health technologies will play a growing part in peoples’ self-care outside of the healthcare system and, increasingly, as part of their care prescribed by clinicians and (to some extent, for the short-term) paid-for by payors – namely, employers and government sponsors of health plans. This week is the Disneyland event for the personal tech aficionados known as CES (once called the Consumer Electronics Show).

I’ve missed my friend Tony for the past 19 years. He was in the first generation of white gay men who died of AIDS, back in 1997. When Tony was diagnosed within months of this photo being taken, he was with full-blown AIDS. At that time, Tony had no access to the portfolio of drug therapies available to an HIV+ patient today. Those were the days of denial, experimentation, toxicity, and really, really tough side effects. If you want to know what it was like in that era under President Reagan and his politicized regime that was blind to the public

It’s the 9th of November, 2016, and Donald Trump has been elected the 45th President of the United States of America. On this morning after #2016Election, Health Populi looks at what we know we know about President Elect-Trump’s health policy priorities. Repeal-and-replace has been Mantra #1 for Mr. Trump’s health policy. With all three branches of the U.S. government under Republican control in 2018, this policy prescription may have a strong shot. The complication is that the Affordable Care Act (aka ObamaCare in Mr. Trump’s tweet) includes several provisions that the newly-insured and American health citizens really value, including: Extending health

60% of Americans are currently trying to lose weight. So it shouldn’t be a surprise that when asked, “what’s the most serious health problem in the United States?” Americans say it’s obesity, tied with cancer, and ahead of heart disease and diabetes. Overweight and obesity are top-of-mind for most Americans, according to research conducted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and NORC at the University of Chicago. This research has created two reports which can be accessed at the link. The survey, conducted among 1,509 consumers in August and September 2016, found that Americans’ understanding of

When it comes to health care, more American voters trust Hillary Clinton to deal with health issues than Donald Trump, according to the Kaiser Health Tracking Poll: August 2016 from the Kaiser Family Foundation (KFF). The poll covered the Presidential election, the Zika virus, and consumers’ views on the value of and access to personal health information via electronic health records. Today’s Health Populi post will cover the political dimensions of the August 2016 KFF poll; in tomorrow’s post, I will address the health information issues. First, let’s address the political lens of the poll. More voters trust Hillary Clinton to do

More than 40 Americans die every day from prescribed opiate overdoses, Dr. Tom Frieden of the CDC has recognized. The harms of pain-killing drugs have been substantial: Dr. Frieden observed, “the prevalence of opioid dependence may be as high as 26% among patients in primary care receiving opioids for chronic non-cancer-related pain.” There were more deaths due to drug overdoses in 2014 than in any previous year, 61% of which involved opioid pain relieving medications such as oxycodone and hydrocodine, and heroin which has grown in use over the past few years. The CDC has recommended that healthcare providers do

The bad news: mortality rates haven’t improved much and obesity rates rose in one-third of communities. The good news: public health gains can be made in resource-poor communities with the right health policies, based on research from The Commonwealth Fund, Rising to the Challenge, the Fund’s Scorecard on local health system performance for 2016. The top-line of this benchmark report is that health care in the U.S. has, overall, improved more than it’s declined. Among the big levers driving health care improvement in the past year have been the further expansion of health citizens covered with insurance through the Affordable

#PrayForOrlando The club Pulse, site of the biggest mass gun shooting in U.S. history, was named to honor one of the co-owner’s brothers, who succumbed to AIDS in 1991. In today’s Health Populi, I soberly ponder the lost lives in the Orlando massacre of people who joyfully convened in a safe haven to celebrate life, liberty, and their pursuits of happiness. Over fifty people ended up dead, and there will be more mortalities as the health workers at Orlando Regional Medical Center continue to fight the post-trauma battle to save gunned-down lives. We define “health” broadly in Health Populi and

  “Our goal is to create an aware and engaged, irritating set of patients who create a dialogue with health care providers once they’ve had a [blood] clot,” explained Randy Fenninger, CEO of the National Blood Clot Alliance (NBCA). NBCA’s tagline and hashtag is “Stop the Clot.” Welcome to the multi-stakeholder community involved with deep vein thrombosis (DVT) and, clinically speaking, Venous Thromboembolism (VTE). We’re talking blood clots, and the public health burden of this condition is big: it’s a leading cause of death and disability. One in 4 people in the world die of conditions caused by thrombosis. I had

April 7 is World Health Day, and the World Health Organization (WHO) has named #diabetes the big public health challenge for 2016. What’s striking about this year’s World Health Day is the “Stay Super” public health ad campaign that WHO has developed featuring figures of super-people. THINK: Superman and Wonderwoman meet Doctors Welby, Kildare, and McDreamy. I’ve included several of the posters in the blog today to show how engaging health messaging works well when it works. The materials can be downloaded at this link. This week also saw the publication of America’s Health Rankings, spotlighting the impact of unhealthy behaviors.

As consumers’ growing financial skin in the health care game compels them to seek care in lower-cost settings, the pharmacy business recognizes the opportunity to provide healthcare services beyond the core business of filling prescriptions. This month, Drug Store News (DSN) published a special section called which profiles several pharmacy companies’ expanding reach into retail health – in particular, re-defining the concept of the “health fair.” A health fair is “an educational and interactive event designed for outreach to provide basic prevention and medical screening to people in the community,” according to the latest Wikipedia definition. But the health fairs described

Rural hospitals operating in the U.S. have a higher risk of mortality — closure — than other hospitals in America. The U.S. health care landscape is littered with examples of health disparities among the nation’s health citizens – for example, women’s lower access to heart-health care, Latinos’ higher rates of Type 2 Diabetes, and African-Americans’ greater risks of stroke, many cancers, maternal mortality, and many other causes of mortality and diminished health. A report from iVantage, Rural Relevance – Vulnerability to Value, documents the fiscally challenging environment for rural hospitals in America. There are at least 673 facilities at-risk of closure

Where you live in the U.S. is a risk factor for your health. Hawaii, Alaska, Montana, Colorado and Wyoming rank highest on the State of American Well-Being 2015 State Well-Being Rankings, the Gallup-Healthways Well-Being Index. Well-Being is based on an index of five components that people self-assess: purpose, social, financial, community, and physical. See the map: the darker blue the state, the healthier the population perceives itself to be. Note more light blue to the northeast and south, and dark blue in the mountain states, Alaska and Hawaii. Some states have stayed in the top-tier of wellness since 2012: Hawaii

It’s time to get the tea leaves out and mash up trends in my world of health, health care, technology, policy and people for 2016. We’ll start with the central player: people, consumers, patients, caregivers all. Health consumerism on the rise.  People – call us patients, consumers, caregivers – will take on even more financial and clinical decision making risk in 2016. Growing penetration of high-deductible and consumer-driven health plans will push (not just nudge) people into the role of health care consumers, and the emerging businesses and programs serving the transparency market for price and quality will gain traction