The Patient As Payor: From Rationing Visits Due to Co-Pays to Facing $370K for Healthcare in Retirement

Health care in America is such a scary experience that more people are afraid of paying for care than the actually getting sick part of the scenario.

The patient is the payor, and she is afraid…more afraid of the paying than of the illness, according to a survey conducted among U.S. health consumers from WestHealth Institute and NORC, Americans’ Views of Healthcare Costs, Coverage, and Policy from WestHealth and NORC.

 

 

See the orange bar on the left: 40% of Americans are “extremely or very afraid” about paying for care if they get seriously ill, and 33% are that afraid if they get very sick.

Shifting to the middle of the graph, 24% of consumers are “moderately” afraid of the paying versus 30% about getting sick.

If you add the “afraid” proportions together, it’s a tie between roughly two-thirds of consumers afraid of getting seriously ill or having to pay for that care in view of being ill.

Consumers come to that ethos through experience with health care costs: the second chart from the report illustrates the reality of patient self-rationing due to cost: 44% didn’t go to the doctor when they were sick because of cost, and 40% went without a routine physical or preventive care due to cost as well as skipping a recommended test or treatment.

 

 

 

 

 

 

 

 

While one-third of U.S. consumers didn’t fill a prescription or stick to a medication as directed due to cost, one-third shopped around for lower-cost care for that recommended treatment.

Health Populi’s Hot Points:  Health care cost sticker shock gets worse with age. The latest data on health care costs in retirement was published by EBRI earlier this year in their report, Savings Medicare Beneficiaries Need for Health Expenses: Some Couples Could Need as Much as $370,000, Up from $350,000 in 2016.

It’s a good thing that report has a long title, because when I got to the “$370,000,” I was taken aback and needed to catch my breath a bit. In one year, EBRI’s forecast for needed monies for medical care in retirement rose by $20K, which equates to a 5.7% increase in one year. That’s the top-line number for a couple in retirement, including Medigap premiums, Medicare Part B Premiums, Medicare Park D Premiums, and out-of-pocket drug expenses at age 65 in 2017.

Here’s EBRI’s big table with the big number.

 

 

With that sober number in mind, the next chart, from the Insured Retirement Institute report on Boomers’ expectations for retirement, illustrates that American workers have gotten the 9-1-1 emergency news about health care costs: that most U.S. consumers say health care expenses are their top concern late in retirement. #1 is changes to Social Security, which Americans realize is their first go-to source for income in retirement years. If Social Security is threatened, so goes the older American’s ability to pay for health care as she ages.

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The Whacky Uses For Toothpaste You’ll Love…

If you’re anything like us, you love products that have multiple uses. Baking soda can be used in cakes and as a household cleaning agent; left over tea bags can remove lingering bad odors; and toothpaste can be repurposed for a variety of household uses from cleaning shoes to removing lipstick stains! 

 

While we always prefer you use your toothpaste first and foremost for brushing your teeth, it is helpful to have it around in a pinch when you’re faced with unexpected water rings or even dirty piano keys. Below are some of our favorite alternative use of toothpaste. 

 

Stain removal 

 

While your little Renoir might have been making memories by coloring on the walls with crayons, you prefer their canvas to be a little more disposable. Instead of heading to the hardware store to buy more paint (which is both expensive and time consuming), try using toothpaste first. The original white paste can be applied to a rag and used to remove any stains—or artwork—from the wall. You will have to vigorously scrub the wall; however, with a little elbow grease, the abrasives in the toothpaste will rub away the crayon over time. Wash the wall with water after you are done.  

 

Using toothpaste to get rid of stains on clothing is another alternative use of toothpaste. The efficacy of this hack really depends on the fabric. For finer fabrics like silk or cashmere, you are better off taking it to a dry cleaner. However, if you’re in a pinch at work or out on the town, putting toothpaste on the stain and rubbing the fabric together can lessen the impact. 

 

Finally, for water rings left on wooden furniture when a guest forgets to use a coaster, a non-gel toothpaste can be gently rubbed on the wood. Once it dries, use a damp cloth to remove the toothpaste. Finish off with a fresh coating of furniture polish.  

 

Hygiene  

 

The same cleaning power that makes your teeth white and shiny is also can help disinfect your hands. If you have been working on your car or dealing with chemicals that leave a lingering and potent smell, wash your hands with toothpaste to rid yourself of the odor. This is one use where we suggest using a mint flavored paste! 

 

And how much money have we all spent on pimple creams over the years? Instead of breaking the bank to clear up problem spots, dab non-gel, non-whitening toothpaste on the pimple. The chemicals will dry up the pimple and absorb the oils in the surrounding skin. This could result in mild irritation for those with very sensitive skin, so we would suggest going slowly and using a small amount at first.  

 

Other creative uses 

 

What do piano keys and leather boots have in common? Toothpaste can be used to buff out scuffs and stains on both! Squirt toothpaste onto a damp cloth and gently rub the scuff off. Use a damp cloth to remove any additional residue thereafter. 

 

In addition to ridding your hands of foul smelling odors, toothpaste can rid baby bottles of that spoiled milk smell. When cleaning the bottle, put toothpaste on the end of the bottle brush, scrub with water, then rinse thoroughly. The toothpaste will breakdown the bad smell and leave the bottles smelling fresh.  

 

Finally, toothpaste can be used to prevent goggles and scuba masks from fogging while you are swimming. Fogged goggles can be dangerous, especially if you’re deep scuba diving. Many times, goggles fog due to the protective coating used on the glass. By dabbing toothpaste on the lens and rubbing vigorously, you will remove some of the film and decrease the likelihood of fogging.  

 

Toothpaste can be a valuable and cost-effective tool to removing onerous stains. Leave a comment if you find any other creative uses!

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Sounds Like A John Denver Song: Virginia and Colorado Towns Rank High As Healthy Communities

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 Statistics.

Healthiest Communities is part of U.S. News’ portfolio of healthcare information projects, the best-known of which is Best Hospitals, most recently rated for 2017-18. Eric Gertler, U.S. News’ Chairman, believes that this project will give, “citizens, community leaders and policy-makers the tools to assess health in their communities and develop a blueprint for positive change” with learnings that can translate to less-healthy communities. Key health service factors among the town leaders are lower rates of chronic disease and hospitalizations, and greater access to primary care.

The Healthiest Communities for 2018 are:

• Falls Church, VA
• Douglas County, CO
• Broomfield County, CO
• Los Alamos County, NM
• Dukes County, MA
• Fairfax, VA
• Hamilton County, IN
• Routt County, CO
• Ouray County, CO
• Loudon County, VA

A tally among these top ten clues us into trends in the pack: there are three towns in Virginia, four in Colorado, and one each in Indiana, Massachusetts, and New Mexico.

So what is it about Virginia and Colorado when it comes to the social determinants of health (SDOHs)? A handful of social determinants translate into big positive impacts for public health: education, a resilient local economy, commitment to public safety, and a strong primary care backbone.

Here’s some of the evidence on population health related to these four factors:

Education: Perhaps the most impactful social determinant on health is education. From early childhood education through college, evidence abounds supporting investment in education across a health citizen’s lifespan,.

Economy: Related to education, a good job and sufficient income is key to health outcomes and healthy communities. Being employed, versus unemployed, and earning a fair salary (especially with health benefits for U.S. workers, where low wages have been called an “occupational health hazard”), boost individual and community health. In addition, lower stress in the workplace also improves health status.

Primary care: Throughout the world, people who live in countries that have strong primary care workforces enjoy better health outcomes, which I discussed in my paper, Primary Care, Everywhere, written for the California Healthcare Foundation. In the rich evidence base for primary care improving community health, we can look to the seminal 2005 work of Barbara Starfield .

Several other factors also play out in the top ten:

• Physical activity, especially related to health baked into town/urban planning for walkability, safe neighborhoods, and green spaces. There is a lot of learning about this throughout Europe, where city planners have proven out the direct relationship between planning green and active transportation strategies and health outcomes.
• Public transportation which helps people get to doctor’s appointments and workplaces which, then, bolsters personal income. Recent programs extending Lyft and Uber into healthcare services are working to address this unmet need across the U.S.
• Healthy eating, with local food access through farmer’s markets (such as the award-winning one in top-ranked Falls Church), a strong agricultural sector, and nutrition programs in schools. Note the new program announced by Amazon to offer discounted Prime membership to members of SNAP and Medicaid programs, to help people order healthy food (and other products) if they live in USDA-designated food deserts. Mora, NM, one of the up-and-coming towns, is part of a sustainable food program that’s also bolstering the local economy.

Consider Falls Church across these dimensions: the town has an award-winning farmer’s market and good food access, a public transportation network, a solid economy with relatively good commute to jobs in Washington, DC, walkable streets, and a relatively high primary care: health citizen ratio.

The Healthy Communities rankings evaluated nearly 3,000 American towns, considering ten categories across ten key social determinants of health:

The categories and subcategories considered included:
1. Community vitality, which covers social capital and community stability
2. Equity, addressing equity across social, health, education, and income lenses
3. Economy, dealing with income, employment, and opportunity
4. Education, in terms of infrastructure, achievement, and participation
5. Environment, looking at the natural environment, air and water (THINK: Flint), and natural hazards
6. Food and nutrition, focusing on food availability (versus food deserts) and nutrition
7. Population health, a broad segment including access to health care services, health behaviors, health conditions, mental health, and outcome
8. Housing, with an eye on affordability, capacity and quality
9. Public safety, relative to capacity, crime, and injury
10. Infrastructure, for the community layout and transportation.

There are many versions of SDOHs; this methodology was informed by that developed by the National Center for Vital and Health Statistics, described in its report on The Community as a Learning System. NCVHS has identified the first nine of these ten SDOHs. The Healthiest Communities team added in Equity, to recognize its importance in people’s personal lives and community health.

This was written in collaboration with the Aetna Foundation, which is a paid sponsor for this post.

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How Scott Gottlieb is transforming the FDA

The Economist has an article on the evolution of FDA regulation of pharmaceutical treatments.  Brining a drug to market costs billions of dollars.  FDA commissioner Scott Gottlieb aims to cut this cost by expediting the drug approval process in three key ways.

First, he wants the agency to rethink how much information the FDA demands at an early stage. For example, with better models of a drug’s toxicity, it could be tested in animals later in the process rather than at the outset.

Lowering development cost is not just a give-away to big Pharma; lowering drug development cost would incentivize more investment in R&D and likely help bring new drugs to market.

The second area where FDA is changing is considering allowing for adaptive trial designs. This approach has already been used to test some oncology treatments. Adaptive trial designs…

…may involve doing away with the traditional hard boundaries of the drug-testing process (known as phases 1, 2 and 3). Instead, trials constantly adapt by expanding and shrinking cohorts of patients depending on their response to treatment. This makes the process more efficient. The agency is also open to the inclusion of non-trial data (from wearables or patient records, say).

The FDA’s third area of reform is considering the use of surrogate trial endpoints. Treatments for oncology already use these surrogate endpoints. For instance, rather than measuring a drug’s effect on overall survival, many clinical trials for cancer treatment use surrogate endpoints like progression-free survival (PFS) or time-to-progression (TTP). My own research has shown the relationship between these surrogate endpoints and overall survival in the real-world for multiple tumor types. The FDA is considering more use of surrogate and biomarker endpoints for clinical trials in other diseases, such as Alzheimer’s.

Interesting developments and we will see how these play out in practice.

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Early Alzheimer’s Diagnosis could save U.S. $7.9 billion

That is the conclusion from a Bloomberg article highlighting some research done by some of my colleagues at Precision Health Economics in conjunction with the Alzheimer’s Association.  An excerpt is below.

The Alzheimer’s Association commissioned researchers at Precision Health Economics to study the potential savings of obtaining an earlier diagnosis. It used data from the Health and Retirement Study, a “nationally representative sample of adults age 50 and older” run by the University of Michigan and supported by the National Institute on Aging and the Social Security Administration.

The $7.9 trillion in savings was derived from a scenario in which all adults who develop Alzheimer’s receive an early diagnosis in the MCI stage. The cumulative cost in such a circumstance is projected at $39.2 trillion—far below the $47.1 trillion that would be spent under current diagnostic patterns.

“We know that there’s a spike in medical spending around the time of diagnosis,” said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association. “It’s actually quite expensive to do things that way.”

“You can save a significant amount of money just through better early diagnosis,” he said.

For example, managed dementia is less expensive to treat because it reduces the chances of missing medication or incurring avoidable costs, Fargo said. It’s more costly to be diagnosed in the later stages because that’s likely to occur only after an expensive trip to the hospital

Currently, Alzheimer’s disease is the sixth leading cause of death in the U.S.  Alzheimer’s death rose by 123% between 2000 and 2015.   The articles conclusion–with which I whole-heartedly agree–is that more scientific research is needed to address this disease that will become increasingly deadly as Americans life spans continue to grow.

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The New Toxicity in Health Care: The Cost of Hospitalization

In healthcare, we use the word “toxicity” when it comes to taking a new medicine, especially a strong therapy to cure cancer. That prescription is toxic as a side effect to helping us get better. This concept of financial toxicity for cancer patients was first raised by concerned clinicians at Sloane-Kettering Medical Center, who discussed the topic on 60 Minutes in 2014 and have published papers on the issue.

Beyond strong medicines, a new toxicity has emerged for patients due to hospital inpatient admissions. A new article in the New England Journal of Medicine studies Myth and Measurement – The Case of Medical Bankruptcies written by four economists from UC Santa Cruz, MIT, and Northwestern University.

The “measurement” named in the title is graphed here as the proportion of people who filed for bankruptcy relative to years before or after hospitalization. The data points come from one-half million people who were hospitalized in California between 2002 and 2011 and tracked in credit reports which included information on whether and when the patients filed for bankruptcy.

The graph illustrates the effect of hospital admission on bankruptcy, with the rate of bankruptcies increase in the years after hospital admission, both one and four years after the admission.

The authors recognize that this study doesn’t cover all potential medical bankruptcies, like hospitalizations for children or elderly, and cover just patients in California. The data also don’t include people who are ill and injured but not admitted to hospital who may have high medical expenses. This is probably a smaller group of patients filing for bankruptcy, the authors believe based on other research they and others have conducted.

The study also leaves out data on the financial costs of hospital admissions among patients who did not file for bankruptcy. “We have found that hospitalizations cause increased out-of-pocket spending on medical care, increased medical debt, and decreased employment and income,” they write. “These costs may have considerable adverse consequences,” calling out the Oregon Health Insurance Experiment which saw that these adverse impacts can be helped by health insurance coverage.

The “myth” part of this study, the authors conclude, is that focusing on “medical bankruptcies” per se may obscure the larger issue impacting more U.S. health citizens of the economic hardship of high-cost health problems.

Health Populi’s Hot Points:  The Oregon Health Insurance Experiment found that having health insurance

Sommers, Gawande and Baicker write in the NEJM article on the Oregon experiment linked above, “Are the benefits of publicly subsidized coverage worth the cost?…expanding health insurance is a more cost-effective investment than many others we currently make in areas such as workplace safety and environmental protections. Factoring in enhanced well-being, mental health, and other outcomes would only further improve the cost–benefit ratio. But ultimately, policymakers and other stakeholders must decide how much they value these improvements in health, relative to other uses of public resources — from spending them on education and other social services to reducing taxes.”

Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence, the three researchers conclude.

The Myth and Measurement essay is published this week at the same time as an important piece by Margot Sanger-Katz was published yesterday in the New York Times called Getting Sick Can Be Really Expensive, Even for the Insured.

The line chart illustrates data from an NBER study published in 2017 in the American Economic Journal, The Economic Consequences of Hospital Admissions, which shows that for working age adults with health insurance, hospital admission increase out-of-pocket medical spending unpaid medical bills and bankruptcy, and reduce income. Uninsured working age people bear an even bigger burden of unpaid medical bills and bankruptcy risk.

So health insurance, while imperfect, continues to be an important financial risk management tool for Americans. We can expect that the erosion of the Affordable Care Act and peoples’ access to insurance, in the short-to medium-term, will adversely impact some American families in light of the research discussed here.

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How the Latest on Facebook and the “Deep State” Could Undermine Patient Data Sharing and AI

There’s a potential large obstacle that could prevent the full benefits of the current go-go, bullish forecasts for artificial intelligence (AI) to help make healthcare better: a decline in consumers’ willingness to share their personal data.

Along with the overall erosion of peoples’ trust in government and other institutions comes this week’s revelations about Facebook, Cambridge Analytica, and the so-called Deep State.

Three-fourths of Americans believe that some type of “Deep State” in the federal government exists, a new poll from Monmouth University published yesterday. I clipped the responses to three of the survey’s most relevant questions here. Not only do 74% of U.S. health citizens think a Deep State exists, but over 50% of people are worried that the U.S. government is monitoring them or invading their privacy.

Add this data point to a new report from EY on health consumers noting that while most people would be glad to use some form of technology to interact with their clinicians, only 26% of them would be interested in sharing their lifestyle data. That is, unless consumers received incentives: 61% of people would seek reduced wait times, 55% would share personal data if it reduced their health care costs, and 26% of patients would look for a more comprehensive health plan in exchange for disclosing lifestyle data.

My third data point comes from a conversation I observed at HIMSS between Dr. Kyu Rhee, Chief Medical Officer of IBM Watson Health, Dr. Cris Ross, Mayo Clinic CIO, and Dr. James Madara, President of the American Medical Association. Jonah Comstock covered this meet-up here, and I refer to his quotes of the conversation.

“Fundamentally, health and healthcare are about trust,” Dr. Rhee said. “Data is such a natural resource and sharing data across multiple stakeholders requires trust…from the patient…from the provider and the payers, and all these different stakeholders that need to connect this data together to bring these insights out.”

Those insights come out of machine learning and AI — which need data to inform insights that help realize the promise of truly, deeply personalized medicine.

Without a robust data mine, which goes beyond the healthcare claims and medical system and reaches into peoples’ everyday lives – from the kitchen to the bathroom, the bedroom to the bar — the algorithms underpinning AI in healthcare won’t be informed by our 360-degree lives.

But trust comes before sharing, and Americans’ trust in institutions is eroding even more quickly in 2018. I observed eroding trust in healthcare earlier this year in the 2018 the Edelman Trust Barometer.

Health Populi’s Hot Points:  This week’s revelations about Facebook, Cambridge Analytica, and the U.S. political system will contribute to Americans’ continued cynicism and concern for privacy. People, and especially wearing the hat of a patient, need to feel that their personal data are held by trusted stewards. Doctors have long played that singular trusted role for holding data in the patient relationship.

In the era of big data and machine learning in health care, “It is no surprise that medicine is awash with claims of revolution from the application of machine learning to big healthcare data,” a spot-on essay by Andrew Beam and Isaac Kohane asserted in JAMA last week.

“Deep learning algorithms require enormous amounts of data to capture the full complexity, variety, and nuance inherent to real-world images,” they recognized. But these systems aren’t magic devices that can “spin data into gold,” they wrote. They were addressing the fairness of algorithms, raising the clichéd but still-true notion of “garbage in, garbage out.”

That “garbage” morphs into pearls when patients share lifestyle and very-personal data. But without trust, that sharing erodes and chills. And with it, the Holy Grail that techno-optimists expect AI will bring to healthcare.

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What A Sore Jaw REALLY Means

Jaw pain can be both severe and come out of the blue. The pain can be debilitating and lead you to have trouble eating, sleeping, and carrying on with normal daily activities.

 

While you may assume that jaw pain is directly caused by your teeth, the truth is that the pain can originate from a variety of issues that range from sinus infections to bad bites.

 

Jaw pain that comes on suddenly can be alarming and causes many people to automatically assume the worst. While in rare circumstances the jaw pain can be a result of something catastrophic like cancer, the most common causes are easily fixable if you seek care. Follow along as we outline common causes of jaw pain and how urgently you should seek care!
 

 

Jaw injury

 

A jaw injury is one of the most frequent emergency calls we receive. Just like an arm or a leg, your jaw is a set of bones that can become fractured or broken due to blunt trauma. If a fracture or break occurs, there can be significant bruising and swelling combined with pain and difficulty opening the mouth. If a break is suspected, it’s important to seek care immediately. An x-ray will be taken and an assessment of the of your teeth will also take place. Doctors may be able to set the jaw right away—normally under anesthesia to control pain. However, in some circumstances surgery may be required to repair the damage.

 

Jaw joint pain

 

Another common cause of pain is when the temporomandibular joint, a joint that hinges your jaw to your skull, has developed an irregularity. Sometimes referred to as TMJ disorders, the exact cause of this pain is not always known. Some believe that the pain can be linked to genetic predispositions, while other experts think the pain is linked to a higher propensity to arthritis or other joint diseases.

 

Those who suffer from TMJ disorders identify pain under the jaw, or aching facial pain, and difficulty chewing. If symptoms persist it’s important to seek care to discuss your treatment options.

 

Other causes of jaw pain

 

There are numerous other causes of jaw pain that result from small issues like bad bites to more severe issues like teeth grinding. When you sleep, for example, you put a significant amount of pressure on your jaws. If your teeth are not aligned properly then the muscles surrounding the jaw can become inflamed and nonalignment can cause teeth to wear unevenly.

 

Bad alignment is also sometimes the result of teeth grinding. While teeth grinding is common in children, it can be bad for your teeth as an adult. Many patients grind their teeth in sleep unconsciously. High stress situations or when lifting heavy objects, patients also grind or over-clench their teeth. These things commonly lead to jaw pain, but the good news is they can be easily addressed by your dentist.

 

Another common cause of jaw pain is the result of an infection in your sinus cavity. The cause of the pain is due to the pressure from your sinuses being blocked, the swelling, or the infection moving to different areas. Ear infections can also cause jaw pain. The fluid from the ears can cause the inner ear to swell, which results in pressure being placed on the jaw.

 

Finally, an abscessed tooth can also lead to significant jaw pain. No matter where the tooth is located along the jaw line, it can cause a lot of pain. If you suspect this is the cause of your discomfort, it’s important to call us to have the situation addressed.

 

Jaw pain can be jarring and disruptive of your daily life, not to mention nerve wracking if you don’t know what’s causing it. If you are concerned about acute or lingering pain, it’s important to seek treatment and call Dr. Ku as soon as possible.

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Healthcare Economist on Vacation (+ Links)

The Healthcare Economist will be on vacation with blog posts resuming March 26.  I will be in Peru.  To learn more about the Peruvian health care system, read this post.

For those of you in Healthcare Economist withdrawal, below are some end of the week links to tide you over until I get back.

• 3D printing and rheumatoid arthritis evaluation.
• ‘Pharma bro’ jailed.
• Gottlieb to AHIP: Why aren’t there more biosimilars?
• Medicare spending falls?
• The future of telemedicine?
• HWR.

Healthcare Economist on Vacation (+ Links) posted first on http://dentistfortworth.blogspot.com

Open-Source Publishing

An interesting new approach to academic article publishing as described by Josh Cohen from Tufts University:

Open-peer review journals preserve scientific review by conducting reviews after the article’s initial release. Review takes place in the open, with comments and the peer reviewer’s name published online, along with the article authors’ responses and revised manuscript, and the reviewers’ final decision to “approve” the article, or not. Gates Open Research gathers three reviews for each article and reports how many of the reviewers ultimately approve of the science in the revised article. Pubmed indexes Gates Open Research articles after a majority of the three reviewers ultimately approve.

This approach makes a lot of sense.  By publishing before peer review, research findings get out faster.  On the other hand, by requiring 2 of 3 reviewers to approve the article before PubMed indexing, quality review is maintained.  Further, because peer review comments are public and unblended, one would expect peer reviewers to provide higher quality comments since their reputations are on the line.

F1000Research, uses a similar approach as Gates Open Research and it has published nearly 2,000 articles.

Dr. Cohen also describes the publication experience with Gates Open Research here.

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How We Spend Versus What We Get: America’s Healthcare Spending Makes for Poor Health

The U.S. spent nearly twice as much as other wealthy countries on healthcare, mostly due to higher prices for both labor and products (especially prescription drugs). And, America spends more on administrative costs compared to other high-income countries. What do U.S. taxpayers get in return for that spending?

Lower life spans, higher maternal and infant mortality, and the highest level of obesity and overweight among our OECD peer nations.

These sobering statistics were published in Health Care Spending in the Untied States and Other High-Income Countries this week in JAMA, the Journal of the American Medical Association.

The study analyzes healthcare spending and outcomes across eleven countries in the Organization for Economic Cooperation and Development (OECD), the world’s wealthiest nations.

The first chart shows the data on “inputs:” spending on healthcare overall, and split into categories of inpatient care, outpatient care, long-term care, and other categories. U.S. data are shown in yellow.

Some important line items stand out. Note the last line of that matrix, population with health care coverage: the U.S. ranks lowest on that, at 90%. [It’s important to realize that this statistic is based on data from 2016 at a historic high, when the Affordable Care Act was in full implementation].

“Relative to comparison countries, US performance varied on quality and access measures. Of the other countries examined, the United States was the only one in which a sizeable minority (approximately 10%) of individuals lacked coverage for basic health care services,” the report calls out.

Also see the poverty rate, percent of the population below poverty, is highest in the U.S. across the OECD nation-peers.

Now turn your eyes to the second chart, which is titled “Population Health” in the report. This matrix ranks the wealthy nations on determinants of health, such as smoking, alcohol consumption, and obesity; life expectancy; and maternal and infant health.

Some of the key findings on America’s higher costs/poorer outcomes are that:

• The U.S. spends more than double the average costs on administration at 8% of GDP compared with 3% of GDP across the OECD nations.

The U.S. had the highest pharmaceutical spending per capita of $1,443 versus $749 for the other nations, roughly double.

Access and quality of care in the U.S. varied, with that 10% of health citizens lacking coverage for basic health care. On quality, the U.S. had a higher avoidable hospitalization rate for diabetes and asthma compared with other countries.

Finally, people in the U.S. rated the lowest satisfaction with their health system, where only 19% said the health system orks well.

Health Populi’s Hot Points:  One of the first books I read as a young economics student, before diving into the microeconomics of healthcare, was Victor Fuchs’ book, Who Shall Live? Health, Economics, and Social Choice. The tagline of the book explains the plot: how we allocate resources is a conscious choice that impacts individual and collective health.

That the U.S. spends roughly the inverse on social care versus health care compared with peer wealthy nations is a key reason for America’s poor outcomes on so many metrics: life expectancy, maternal mortality, infant mortality, and obesity which drives greater utilization of health care services and prescription drugs.

It’s all about prices, this study concludes, where the cost of our inputs — hospital beds and labor rates, and administrative cost/waste — drive up spending as well as ration peoples’ access to those services when they need them…often causing greater spending downstream when a condition can worsen or get more complicated.

The study points to salaries of generalist and specialty physicians in the U.S. being “markedly higher” than in other countries, with specialists paid twice as much in the U.S. as in the U.K. and Germany. Overall, it’s a greater than $200,000 difference between U.S. and other nations’ doctors — who may be underpaid overseas, the study points out.

The report hints at the different (read: lesser) emphasis on primary care in the U.S. compared with most other OECD countries which have stronger and more accessible primary care backbones than America’s. While data in this study didn’t connect social care spending to lower performance on social determinants, the primary care on-ramp may be where America’s health care rubber should hit the road with greater spending there — on accessible primary care in the community, in retail settings, in schools, in pharmacies, and at home by bolstering self-care. Move care to the home via telehealth, enabled through net-neutral broadband, can help if we treat connectivity as a social determinant/public utility the way public health looks at clean air and clean water.

Consumers who use more primary care can lower healthcare costs, as this blog in Health Affairs pointed out this week. This phenomenon has been known for many years through the seminal work of Dr. Barbara Starfield.

I return to Fuchs as I often do, asking the question: “Who Shall Live” in America? If healthcare in the U.S. continues on its unaffordable pathway, then it will be those who can afford care and services who will be more likely to live.

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FemTech is Hot, and Fitbit Knows It

Girls Rule the World, Beyoncé has told us. But not when it comes to digital health…at least until 2018, as Fitbit has announced a woman-focused smartwatch called the Versa which is expected to hit the market in April 2018.

The waterproof Versa will measure heart rate, do the usual fitness tracking metrics, and enable women to track their menstrual cycle. Fitbit has been quite clear that the device isn’t for conception or contraception.

The watch will be priced at $199 at retail, a much lower price-point than the Apple Watch at $329. So here Fitbit also has an argument for financial wellness, along with health and fitness.

I’ve witnessed the growing presence of femtech at CES since I started attending the mega-meeting over the past six years. “Femtech” is the abbreviation for “female technology,” which covers digital tools that track, manage or and/or enhance reproduction, maternity, fertility, nursing, and sexual health.

Let me share some market history through my own experience at CES, which provides some useful context for Fitbit’s announcement.

First, femtech was about pink: specifically, pink bands for wrist-worn activity trackers, like the ones shown here on a Fitbit “pink timeline.”

In the first years of activity tracking, when it came to female-focused devices, it was about fashion-meeting-sensors. Tori Burch designed jewelry that fit a Fitbit tracker (shown in the third picture). Swarovski crystals surrounded a Misfit Shine. In 2016, after Fossil acquired Misfit, the Kate Spade brand (part of the Fossil Group) created whimsical watch faces that housed sensors to track steps.

But honestly, all I’ve wanted these years since beginning of quantifying myself with the Fitbit “Classic” in 2009 was a way to organize the many facets of my health-life in one app. There are dozens of niche apps which target one or two women’s health issues, but getting the continuum of female wellness and healthy living in one dashboard has been a long time coming.

So I welcome Fitbit to the streamlining of femtech, a personal Holy Grail.

That streamlining is important as period-tracking data can mash up with other data in the very large Fitbit database. “Female health tracking will empower women with a greater understanding of their menstrual cycles in conjunction with their physical and mental health, as they start to recognize what are normal trends over time versus what could be an issue to share with their doctor,” Dr. Katharine White, MD MPH, assistant professor of obstetrics and gynecology at Boston University School of Medicine and Fitbit Advisor, said in the Versa press release. “The nuances of the menstrual cycle have not been as widely studied across populations as have other areas in healthcare. This exciting development by Fitbit could help potentially create one of the largest databases of menstrual health metrics in the world, providing healthcare and research professionals with an unprecedented ability to study menstrual cycles and women’s health with real world data.”

Fitbit’s announcement is getting a lot of media attention. This morning’s UK Financial Times featured an article in the Technology box titled, “Fitbit launches fitness tracker for children,” within which the “female-focused Versa smartwatch” is featured. When it comes to femtech, the world is flat.

As Lauren Goode wrote in The Verge, Fitbit’s design is, “more thoughtful than just pinking and shrinking a smartwatch.”

Health Populi’s Hot Points:  We are all patients and consumers at some point, and a plurality of us who have self-tracked activity have done so on a Fitbit. The brand has, until recently, led in market share among activity trackers. IDC reported earlier this month that Apple became #1 in wearable tech volume ahead of Fitbit and Xiaomi.

Mainstream women are not all 18 to 34 years of age who shop at Lululemon or run marathons. We work, we live faith-based lives, we volunteer in communities, we mate, we parent, we caregive to those parents and/or to our kids, we work in the home, we work outside the home, and we are usually the Chief Health and Houeshold Officers in those homes. Life is good, life is complicated, life is difficult, sometimes all at the same time.

There are dozens of apps in the femtech digital health landscape across the continuum of women’s health: for fertility, period tracking, making babies, sexual health, and nursing, as CB Insights’ picture illustrates.

You’ve seen one app, and you’ve seen one, and adding more complication to our lives takes time away from living. This is why women seek streamlining in daily life, and consolidating clicks and apps is one of these demands. If Fitbit can add value to daily living by doing this at an accessible price point for those mainstream women, Beyoncé and we might feel Crazy in Love about it.

 

 

 

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Why does the U.S. spend more on health care than other countries?

A paper in JAMA by Papanicolas, Woskie and Jha (2018) try to answer the question.  One reason could be that Americans are less healthy than people in other countries.  On the one hand, Americans do have the highest rate of obesity in the world; on the other hand, smoking rates are among the lowest.

Another explanation could be that we use more medical goods and services.  This turns out not to be the case.

The US did not differ substantially from the other countries in physician workforce (2.6 physicians per 1000; 43% primary care physicians), or nursing workforce (11.1 nurses per 1000). The US had comparable numbers of hospital beds (2.8 per 1000) but higher utilization of magnetic resonance imaging (118 per 1000) and computed tomography (245 per 1000) vs other countries. The US had similar rates of utilization (US discharges per 100 000 were 192 for acute myocardial infarction, 365 for pneumonia, 230 for chronic obstructive pulmonary disease; procedures per 100 000 were 204 for hip replacement, 226 for knee replacement, and 79 for coronary artery bypass graft surgery).

A third option is for that the prices of the health care goods and services we use may be higher than those of other countries.  This does indeed turn out to be the case.  In particular, administrative costs in the U.S. are 8% of health care spending whereas most other countries have administrative costs of 1%-3%.  Administrative costs could represent waste, but they also could be a symptom of more competition across health plans and potentially more effective treatment targeting.  In addition, costs for providers and pharmaceuticals are higher in the U.S. than elsewhere.

For pharmaceutical costs, spending per capita was $1443 in the US vs a range of $466 to $939 in other countries. Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.

One solution to this ‘problem’ would be to cut prices of pharmaceuticals as well as physician salaries.  However, higher pharmaceutical prices have incentivized more innovation.  As the Council of Economic Advisors writes, in fact other countries may be free-riding on American generosity and the solution may be a mix of (i) faster approval of generics after patent expiration and (ii) making other developed countries pay their fair share of pharmaceutical prices.  Additionally, lowering physician wages would save cost, but physician quality would also fall as the most highly intelligent individuals may leave for careers in technology, finance, or other areas.  In addition to potentially lowering quality, reducing physician compensation could lead to a physician shortage if physicians exit the market.

While the results of this study ultimately depend on the reliability of the cross-country data used, it is interesting to decompose how health care spending differs across countries.

 

Source:

• Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024–1039. doi:10.1001/jama.2018.1150

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A New Era of Specialty Drugs, Telehealth, Mobile Apps and Value, IQVIA Reports

In 2018, spending on branded prescription drugs will fall in wealthy countries, while spending on specialty drugs will increase, resulting in flat medicines spending.

In the U.S., net spending on medicines will fall in 2018 and remain flat at about $800 per person, according to forecasts in 2018 and Beyond: Outlook and Turning Points, from the IQVIA Institute for Human Data Science.

“Concerns about existing medicine costs have captured significant attention,” the introduction warns, setting the stage for slowing growth. Key factors for slow growth include payor concerns about budgets and the consideration of value when deciding on access for new specialty drugs – which are typically high-cost products compared with traditional pharma medicines.

87% of the $69 billion of net growth in medicines spending came from the U.S. over the past five years. This, in contrast with other developed countries who tend to manage prescription drug costs more aggressively and/or directly through single-payer financing systems or reference pricing regimes.

Spending will moderate in part due to the loss of exclusivity for some major Rx products — that is, the loss of patent protection, with entrants of generics and biosimilar competition.

Specifically, $19 billion worth of biotech spending will find biosimilar competition starting in 2018 for the first time. This year is the largest single-year change to-date, IQVIA points out, and is the beginning of a wave of biosimilars like ones we’ve seen for generic drugs going off-patent in the past fifteen years.

Some of the biosimilars expected include big-names like Humira for autoimmune diseases like arthritis, plaque psoriasis, and Crohn’s disease (worth about $18 bn); Lantus for diabetes (about $11 bn); Enbrel, used similarly to Humira  ($10 bn); and, Remicade which, like Humira and Enbrel, is prescribed to deal with arthritis and inflammation (accounting for about $8 bn).

IQVIA sees the U.S. as an outlier with brand net spending growth of 1% to 4% compared with other developed markets remaining flat or declining due to their aggressive management of access to new products.

In the context of this flat-growth scenario, medicines makers are adopting some innovative approaches to development including incorporating the use of real-world evidence which is being fostered by the FDA; bundling the use of digital health tools with medicines in the growing era of digital therapeutics; and, recognizing the growth of telehealth which could enhance patient engagement and result in improved outcomes, such as medication adherence support.

Health Populi’s Hot Points: The big wild card in forecasting what prescription drug spending will look like in the U.S. is just how aggressive Dr. Alex Azar at the Department of Health and Human Services, and Dr. Scott Gottlieb at FDA, want to be regarding drug pricing. In the past year, it’s been pricing, not volume, that’s drive medicines price growth in America, as I explained here in Health Populi.  While we note, “It’s the prices, stupid” applying to inpatient hospital costs, it’s also true that price, not utilization, has underpinned the recent growth in prescription drug spending in the U.S.

However, IQVIA expects that short-term drug spending in America will moderate based on patent expirations and the arrival of some very popular therapies for auto-immune conditions.

President Trump made clear on the campaign trail and in his interview with TIME magazine as Person of the Year that pharmaceutical companies’ pricing needed to be reined in using government pressure. We don’t know yet what form that will take, but there is some indication that Dr. Azar is has his sights on some form of prescription drug pricing program, perhaps beginning with Medicare Part B. As we know from the Trump Administration in power for the past fourteen months, we must keep our collective eye on this ball on a daily basis. For now, IQVIA’s forecast must be heeded by pharma along with the rest of the healthcare ecosystem: we all need to learn to do more with less.

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Do You Know The Causes of Losing Teeth?

Have you ever had the dream that all of your teeth are falling out one by one? The feeling that you no longer have teeth can be frightening and lead you to wonder what actually causes toothlessness, and if you could be at risk. For those curious sorts, the recurrent dream of losing your teeth is believed to be caused by anxiety over upcoming changes. Many times, you have the dream before a change in job or before welcoming a new baby into your family. While the dreams may be disconcerting in the moment, you still wake up in the morning with the teeth you had the night before. 

 

For those who do deal with toothlessness, their daily oral care can be more complicated than the average patient. We’re going to walk you through the basic forms of tooth loss, oral care and your high-tech dental options to restore that smile no matter the case. 

 

What causes tooth loss and who is affected? 

 

Tooth loss is most prevalent in older patients, however young people can be affected as well. Poor oral hygiene is the most common cause of tooth loss. But why? 

 

As a result of poor daily oral care, cavities and gum disease are more likely to develop. Cavities occur when tooth decay begins and when plaque isn’t properly removed from the surface of teeth. The plaque eventually begins to weaken the tooth and eat away at the enamel. Once the enamel is gone, a hole can develop that eventually grows down to the root. And when the root is impacted, it can cause the tooth to loosen and eventually fall out. 

 

Gum disease is another leading cause of tooth loss as well. Just like with cavities, gum disease begins with plaque that is not cleaned away. Everyone’s mouth contains bacteria. While some is normal (and, in fact, necessary), there are some strains of bacteria that are bad. If these bad bacteria infiltrate your gum line (that has already been weakened by plaque), it can affect your jaw or other bones in the mouth. Unlike a cavity that can be painful, many times gum disease can go unnoticed. By the time it is identified it could be too late to save the tooth. Since gum disease can sneak up on you, it is important to look out for symptoms that include: swollen gums, soreness, gum recession or abscessed gums.  

 

In addition to cavities and gum disease, smoking increases the risk of tooth loss due to a spike in gum disease. And how’s that happen? A combination of decreased oxygen levels in the blood and more-than-average bad bacteria increase the risk of infection and makes gums take longer to heal. 

 

Poor nutrition and certain medication or drugs are also causes for tooth loss. But eating too much sugar is the number-one cause of tooth decay. Also, medications (and illegal substances) trigger tooth loss since side effects of medication can cause a decrease in saliva, which spurs bad bacteria growth.  

 

Finally, tooth loss can also be caused by injuries. From getting knocked in the mouth by a foul ball to biting into something hard the wrong way, teeth can easily become chipped or loosened.  

 

Options after tooth loss 

 

If you are experiencing tooth loss then you’re probably thinking about how a dental implant could help. Dental implants are natural looking and as stable as natural teeth, so you can be confident when eating and talking. Technological advancements have moved this 1960s technology far into the future. Titanium dental implants are now used because the metal has been proven to be compatible with tissues in the body, and will actually help the bones to heal around the new implant. Dental implants are a safe and easy way to replace missing teeth, and almost everyone is a candidate. 

 

Tooth loss can be devastating since your smile is what helps boost your confidence and get you through the day. If you have experienced tooth loss and are hoping to restore your smile, then call us at Dr. Ku’s office to discuss options for dental implants. These implants are sure to transform your smile, increase confidence, and boost your morale.

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The costs of quality reporting

Provider pay-for-performance initiatives aim to increase reimbursement to physicians and others who provide high-quality, low-cost care to patients. Medicare has two main programs for physicians to ahcieve these goals: (i) the Merit-Based Incentive Payment System (MIPS) and (ii) the Alternative Payment Models (APM).  MIPS measures cost and quality for smaller physicians groups whereas APM requires physicians to participate in accountable care organizations, bundled payment, or other alternatives to traditional fee-for-service payment.

In his Health Affairs blog post, however, Matt Fielder argue that MIPS is not likely to improve quality.  Physicians are able to choose their own quality measures which leads to (i) physicians choosing ‘easier’ measures–often screening measures, or (ii) physicians choosing measures they already know they are good at.   The article mentions that a number of observers–including MedPAC–have argued that MIPS is unlikely to improve quality while the administrative burden on physicians is likely to be large.

How large?

Notably, CMS estimates that providers will spend $694 million complying with MIPS reporting requirements for the 2018 performance year. External estimates of the administrative costs of prior quality reporting programs suggest that burdens could be even larger.

The authors also report a number of strategies to improve quality.  They are bullish on the benefits of APMs and ACOs–whereas I am a bit more skeptical that these approaches will truly improve quality of care.  I do agree with the authors that it is a good ideas to have clinician reporting to clinical data registries as it “…can generate benefits for the health care system as a whole by creating a knowledge base that can be used to identify strategies to improve patient care and that allows clinicians to compare themselves to their peers.”

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Cigna-Express Scripts merger

Today, Cigna purchased Express Scripts for $52 billion.  This follows another mega-deal where CVS bought Aetna.  The integration of pharmacy benefit managers (PBMs) and insurers is nothing new.  Previously, many insurers managed their own pharmacy benefit.  However, as PBMs grew in size and were able to get larger discounts and rebates, in-house PBMs became less competitive.

The key question on everyone’s mind is, is this deal a good thing?  On the one hand, it could be a good thing.  Many pharmaceuticals improve patients health and reduce the risk of hospitalizations.  By bringing Express Scripts in house, Cigna may be able to better internalize these cost savings.  In addition, this deal will help with value-based contracts.  Under value-based or performance-based contracts, life sciences firms must provide discounts if their products do not show the health benefits or savings expected.  By better integrating pharmacy and medical benefits, these contracts are much more feasible.  Further, the Cigna-Express Scripts deal may increase the purchasing power of this entity, which could drive down prices.

However, there are also reasons to be pessimistic.  Driving down prices may be good in the short-run, but–as I mention in my interview with NBC News–oftentimes these discounts are not passed on to consumers.  This could be changing, however, after UnitedHealth Group announced a few days ago that it would be passing drug rebates on to consumers.  Although value-based contracting could is a promising area for PBMs to ensure that new treatment’s value is worth the cost, there is some worry that the contracts would largely be structured to control cost and access to new medications would be restricted.  For instance, CVS’s new Transform Rheumatoid Arthritis Care program appears to have some cost and outcomes guarantees it would provide to employers.  Cost guaranttes are only possible, however, if PBMs can restrict access to innovative–but perhaps more expensive–new therapies that come on the market.  Further, if access to new medicines becomes more restrictive, life sciences firms may reduce their R&D investments in response, leading to the development of fewer innovative medications.  Finally, with increasing consolidation, there is a risk for price increases to consumers.  With fewer insurer and PBM choices, there is less competition and health insurance premiums could rise.

They key question is, how will patients and consumers be affected by this deal in the short, medium and long-runs.  That question, is still yet to be answered.

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Will People Enrolled in Medicaid Want to Be Amazon Prime’d?

Amazon is planning to extend Prime subscriptions to people enrolled in Medicaid for the discount price of $5.99 a month instead of the recent price increase to $12.99/month or $99 a year.

The $5.99 a month calculates to a 27% break on the annual Prime membership cost.

Medicaid enrollees who want to take advantage of the deal must provide Amazon with a scan or image of the card they use for their benefit (either Medicaid or EBT). These consumers can enroll annually, for a maximum of four years.

Here’s what the Seattle Times, Amazon’s hometown newspaper, said about the program. And, here’s a link to coverage of the story in Mundo Hispanico, targeted to a Latino audience.

Health Populi’s Hot Points:  I’ve talked and written about this concept in the past couple of years as one way to extend healthy eating and living opportunities to people residing in food and commercial deserts — a way to overcome a key social determinant of health which is healthy food access. Amazon began to extend Prime delivery for people with SNAP (food stamp) benefits in June 2017, which the Los  Angeles Times discussed in this article.

If a family with low-income deems $5.99 a month a value to access Amazon Prime’s benefits, it’s a good thing for them especially to bolster aspects of living that bring health, wellness (physical and financial) and happiness to them.

As Amazon continues to evolve its health and healthcare strategies — from employee benefits to pharmacy and “front-of-store” private labelled over-the-counter products, along with Alexa’s growing user base, having a larger community of potential consumer purchasers benefits the company. As Amazon grows its consumer base or those purchasers, the company also gathers more information about these consumers and learns more about all of us, in and beyond Prime. That data can be used for good use, particularly if it’s mashed up for health and wellness purposes that directly, positively and transparently benefit the very people whose data informs the company’s commercial goals.

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Pharmacy Spending Trends in Workers Comp

According the Centers for Medicare and Medicaid Services’ Office of the Actuary (OACT), in 2016 the U.S. spent $328.6 billion on prescription drugs, or 10% of all health care spending.   We also see that prescription drug spending increased 1.3% to $328.6 billion in 2016, slower than the 8.9% growth in 2015.

These trends towards more spending on prescription drugs, however, is not homogenous throughout the economy.  Take a look at the graph below looking at pharmacy spending growth among workers compensation plans.  As detailed in a report by Joe Paduda of CompPharma, we see that prescription drug spending is actually falling among those covered by workers compensation plans.

Joe gives some highlights in his Managed Care Matters blog as well:

2017 drug spend dropped 13.4 percent from 2016 – the biggest decrease in the 15 years we’ve been doing the survey

Opioid spend decreased twice as much – over 26 percent.

Note that the huge drop in opioid spend occurred BEFORE adoption of formularies and other controls in big states like Pennsylvania, New York and California.Note also that this is the sixth drop in drug spend since 2010.

In short, while drug spending is increasing, but perhaps decelerating in the economy as a whole, workers comp actually has seen a large drop in prescription drug spending, particularly for opioids.

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Wearable, Shareable, Virtual: The Demands of the Digital Health Consumer in 2018

As I wrote here in April 2017, telehealth and virtual healthcare are mainstreaming.

This week at the 2018 annual HIMSS conference, telehealth is playing a mainstream role in discussions about right-sizing and right-placing healthcare.

 

 

The evidence for telehealth’s tipping point is rooted in new research published today by Accenture on Patients + Doctors + Machines, Accentures’ 2018 Consumer Survey on Digital Health.

I sat down today with Dr. Kaveh Safavi who leads Accenture’s healthcare practice to discuss the results of this study into peoples’ atttudes toward healthcare technology and innovation.

Three in four consumers in America say technology is important to managing their health. Consumers most commonly use the following  technologies to help them manage health in 2018:

• 56% use websites
• 48% mobile app
• 38% electronic health records
• 35% social media
• 33% wearables
• 27% smart scales
• 25% online communities, and
• 14% remote monitoring.

 

The most important advantages of virtual care have to do with cost and convenience, shown in the second chart. Half of Americans believe virtual care services can reduce medical costs to patients and accommodate patients’ schedules, and another 43% of consumers say that virtual care can provide timely services to patients. FYIm Accenture defines virtual services as video or voice transmitted by a provider either synchronously (in real-time) or asynchronously.

Patients’ views on the advantages of virtual are de-valued through consumers’ lenses on quality, engagement, and the speed of diagnoses.

There are two axes to consider when it comes to consumers’ current views on virtual healthcare options vs. in-person F2F with a clinician: those axes are trust and risk.

“When trust is high and risk is low,” Kaveh explained, “People can have asynchronous email” with their providers. “When trust is low and risk is high, we need to be in the same room. Health hasn’t offered us many options” before the emergence of the telehealth/virtual health continuum of choices, Kaveh pointed out.

We discussed other research demonstrating that the proportion of consumers who use alternatives to seeing “their” primary care provider, like telemedicine and retail clinics, is growing. A key reason these patients seek alternatives to F2F visits with their personal physicians is that they want to “get something done.” Convenience and the “Amazon Prime’ing” of consumers has come to health care underpinning consumerism.

Trust underpins health engagement, and that directly relates to the sharing of personal health information. Accenture found that 90% of consumers are willing to share health data from wearable devices with physicians and nurses, and 75% with their family. Surprisingly (to me), 72% of consumers said they’d share their health data with a health insurance plan. But only 38% would share wearable health data with an employer, and 41% with a government agency.

Here, instead of trust vs. risk, the factors to consider are trust vs. benefit, Kaveh counsels.

Accenture surveyed 2,301 U.S. adults 18 years of age and over between October 2017 and January 2018 for this survey.

Health Populi’s Hot Points:  This morning, I had the honor of participating as a judge in Microsoft’s annual Health Innovation Forum. Dr. Judd Hollander of Thomas Jefferson University Health System shared his experience launching JeffConnect, which is the organization’s telehealth platform. The program provides a full continuum of healthcare access to patients both within and outside of the TJU network. “A little sick” patients can access care at the 6 o’clock point of the diagram, all the way across the patient spectrum to post-discharge and remote monitoring at home.

Dr. Hollander provided hard evidence for consumers’ embrace of telehealth based on his experience with both clinicians and patients who are using JeffConnect. My favorite of his many quotable insights was the following:

“When a patient is doing a telemedicine call for 10 minutes with a patient, she’s not hell-bent to get antibiotics. But if she waits four hours in the ER and doesn’t get antibiotics, she’ll have something to say about it.”

Thus, virtual health can drive efficiency, right-sized healthcare, and greater patient satisfaction. These are key ingredients into migrating to the Quadruple Aim.

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