A number of studies have suggested that we are spending too much on end of life care. Consider this Kwok et al. (2011) study published in Lancet.
Many elderly people in the USA undergo surgery in the year before their death. The rate at which they undergo surgery varies substantially with age and region and might suggest discretion in health-care providers’ decisions to intervene surgically at the end of life.
And the Modern et al. (2012) study in Health Affairs makes a similar arguement:
Our study revealed a relatively high intensity of care in the last weeks of life. At the same time, there was more than a twofold variation within hospital groups with common features, such as cancer center designation and for-profit status…These findings raise questions about what factors may be contributing to this variation. They also suggest that best practices in end-of-life cancer care can be found in many settings and that efforts to improve the quality of end-of-life care should include every hospital category.
These analyses, however, are only useful if you can predict who will die. If you know someone will die almost certainly, then you will want to limit the among of intensive medical interventions they receive not only to save money but also to allow the patient to avoid the pain and suffering of the operation. If, however, some patients with similar symptoms could be saved by an expensive interventions and some not and if you cannot tell the difference between them, then it is more difficult to determine if spending is wasteful.
In fact, this is what a recent study in Science by Einav et al. (2018) find.
That one-quarter of Medicare spending in the United States occurs in the last year of life is commonly interpreted as waste. But this interpretation presumes knowledge of who will die and when. Here we analyze how spending is distributed by predicted mortality, based on a machine-learning model of annual mortality risk built using Medicare claims. Death is highly unpredictable. Less than 5% of spending is accounted for by individuals with predicted mortality above 50%. The simple fact that we spend more on the sick—both on those who recover and those who die—accounts for 30 to 50% of the concentration of spending on the dead. Our results suggest that spending on the ex post dead does not necessarily mean that we spend on the ex ante “hopeless.”
In addition, people do value additional life gained at the end of life. As I wrote back in 2010 citing Philipson, Becker, Goldman and Murphy (2010):
Individuals at the end of their life place very high value on terminal medical care for the following reasons: (1) if resources have no value when dead, a self-interested individual would be willing to forego his entire wealth to extend his life, (2) the preservation of hope raises the value of life…(3) the social value of terminal care is often greater than the private value…[as] adult children (hopefully) places a high value on extending the life of their elderly parents, [and] (4) the value of terminal care may be the same regardless of a patient’s quality of life…QALY estimates of the value of life underestimate the utility the elderly receive from being alive, even in a very frail state.
In short, the assumption saying that end-of-life care is too high may not be right after all.
An interesting article by Charles Silver and David A. Hyman argues that we should do away with patents for pharmaceuticals and move to a prize based system. They write in Vox:
A well-designed prize regime would lower drug prices by eliminating drug monopolies, yet it would also create the necessary incentives for innovation, including incentives to develop so-called “orphan” drugs (for diseases that afflict relatively few people).
The prize system could also be tailored to encourage drug companies to test the efficacy of old drugs for new uses. Finally, a prize regime would place the costs of drug innovation on budget, where they would be borne by all taxpayers rather than just by consumers who happen to need drugs (and their insurers).
Prizes are attractive on a theoretical since they can drive drug costs down to marginal costs (which increases demand and short-run social surplus) while still compensating innovators for the risk taken (making these dynamically efficient).
Implementing a prize-based reimbursement system in practice, however, is much more challenging. As I wrote way back in 2006 in my “Prizes or patents” post:
Prizes work only if we know exactly which innovation society needs; this limits their scope. For instance, it would have been impossible ex ante to have had a prize for the inventor of the cell phone, since no one had conceived of the concept before it was actually developed.
Also, using prizes has large informational demands. How large should the prize be? It must be high enough to induce researchers to search for cures, but setting a prize too high would use up valuable funds which could be used in other arenas. How does one determine if a drug is a me-too drug or not? If a vaccine provides immunity to AIDS for 50% of cases, would this development merit the full prize? If not, how large should the prize be? What if the vaccine was only 10%, or 1% or 0.1% effective?
Further, the value of any particular treatment is likely not known at drug launch. For instance, let us say that a clinical trial for a cancer drug shows that it reduces mortality by half over an 1 year period. However, we don’t know how well the drug will work in the long run. If we continue to see mortality falling by half many years out, the drug clearly is more valuable than another one where mortality differences narrow over time. Prizes would need to be structured in such a way that evidence on treatment value evolved, the prize payment would need to evolve over time as well.
Prizes are also problematic as they may add uncertainty, decrease investment and limit choice. Consider the case where 3 pharmaceutical firms are in a race to develop a new treatment. Currently, if all three companies discover effective treatments around the same time, they can all can compete to get some sales and it may even be the case that some drugs are better for certain subgroups and others are better for other subgroups. Under prizes, if the first one is the one to get the prize, then the investment risk becomes very high. Investors required return on investment may need to be much higher than is currently the case to justify this added risk. Further, the advent of ‘me too’ drugs which may have some beneficial effect for certain patient populations, would be unlikely to occur if the prize were no longer available to them.
In short, prizes may be an attractive way to stimulate R&D where little is occurring, but it is unlikely that prizes could ever effectively replace the current patent system.
Toothlessness is a common occurrence as we age, much though no one wants to hear that. And as a result, many patients ask their dentists to help guide them in deciding which type of tooth replacement option is best for them. Dr. Ku has been a leader in this field in the Fort Worth area, leveraging his decades of dental implant training to counsel patients in what type of implant can fit their needs best.
By age 50, the average American has lost an average of 8 teeth (including wisdom teeth). And among adults 65 to 74, 26% have lost all their teeth.
Severe tooth loss can lead to a host of issues that impact self-esteem, nutrition and oral health. And so, many of our patients are curious about dental implants, but all too many worry about the cost or pain associated with the procedure.
The American Academy of Implant Dentistry reports that 3 million people in the U.S. currently have dental implants—a number that is rapidly growing every year. If you want to be part of the growing population that is regaining their confidence and smiles, keep reading to see what our office has to offer!
History of implants
While the idea of dental implants are not new—in fact, they date back to 600 A.D.—innovation over the last few decades has brought this idea well into the future. Implants that date back to ancient times relied on naturally-occurring elements like seashells or ivory. Thankfully, by 1965 these elements had been phased out and replaced with the first titanium implants.
Over the last 50 years, dentists and researchers have learned more about how implants integrate and actually bind with the jawbone. Today, many experts point to the discovery that titanium can physically bond with living bone tissue as the catalyst to the modernization of dental implants.
Modern implants use titanium to form an artificial root of the tooth. Once surgically implanted into the jawbone, the titanium bonds with the jawbone and also heals much quicker than previous iterations. This dental implant technology brings comfort, aid in eating, and confidence to millions of Americans every year.
Impact of technology
Technology has impacted dental implants hugely by removing much of the manual work and replacing it with advanced software that minimize error and can give your dentist a complete digital rendering of your mouth prior to the treatment. This increased precision ensures that your dentist knows exactly where they’re drilling and guarantees that they know how sturdy the underlying bone is—and any abnormalities that need to be taken into consideration. Technology today makes dental implant surgery predictable, precise and—most important to our patients—affordable.
Continuing education
One of the most important things Dr. Ku does is to stay up-to-date on his dental implant training. While these skills are learned in almost every dental school today, they are perfected and modernized through additional training courses and continuing education.
Due to the speed that the technology is changing, it would be difficulty to stay on the cutting-edge without attending specialized classes or seminars. Dr. Ku’s dedication to continuing education shows his patients that he is committed to be a leader in his field.
If you are considering dental implants, it’s important to consider your provider’s training since it has a direct impact on patient experience and the longevity of your dental implant.
Dental implants can change the trajectory of your life if you suffer from tooth loss. Thanks to new technologies, the process is faster, cheaper and more comfortable than ever before. If you are considering dental implant surgery, call Dr. Ku today to discuss how his credentials in the field can give you a smile that will last a lifetime.
The post Cutting-Edge Dental Implant Technology at Dr. Ku’s appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
Hospital and healthcare providers are getting real about improving patient and health consumer experience, the latest Kaufman Hall research finds.
The company’s 2018 State of Consumerism in Healthcare report is out, subtitled, “Activity in Search of Strategy.”
Kaufman Hall has developed a Healthcare Consumerism Index for healthcare providers based on four pillars: access to care, consumer experience, pricing, and a strong foundation of consumer insights. Based on their assessment of providers on these components, Kaufman Hall found identified four tiers of performance:
The top-performing group, Tier 1, includes only 8% of providers. These are the early adopters who allocate resources to build and implement a strong consumer focus in their healthcare operations.
Tier 2, 23% of providers, are evolving to become more consumer-centric, in pilot modes.
Tier 3, with just over one-half of providers, have focused on a specific need in their market versus adopting an overall culture of healthcare consumerism.
Tier 4 represents 17% of providers, who are following others to learn from earlier adopters of consumerism in healthcare.
On the first pillar of access, some tactics are better utilized than others to expand accessible touchpoints: urgent care centers and freestanding imaging sites are more widely available to consumers compared with video and e-visits (telehealth) services. Roughly one-in-five providers is planning or developing virtual care services.
Convenience is an integral component to consumer experience, and for healthcare that means same-day appointments, messaging between patients and clinicians, hours of operation, and on-line scheduling. A majority of providers offer these initiatives or are rolling them out.
Providers’ addressing friction points for consumers trying to access healthcare services is key to garnering patients’ loyalty and trust. The most-used tactics for enhancing customer experience friction are providing easy-to-find phone numbers and customer service training for staff. Plans and roll-outs are in progress for facility way finding support, reducing office wait times, and real-time patient feedback loops.
Health care costs are a key issue for patients and healthcare consumers in 2018, for both personal households and as a mid-term election hot-button. This study examines consumers and healthcare costs across several dimensions. First, providers’ addressing consumer-friendly billing statements is a work-in-progress: while 28% of providers have fully implemented “easy-bills,” 20% have them in pilot or roll out stage, and 24% in planning/development.
Pricing methods is another aspect of consumers’ healthcare costs. The most common tools that providers use to set pricing are benchmarking negotiated rates to the market and analyzing price/volume trade-off impacts on revenue and margin. Less-common tactics to address pricing are cost-to-serve analysis based on costs of patient/clinical services, determining relative price risk by service, and consumer research to understand patient demand-elasticity or willingness-to-pay for a service.
Finally, Kaufman Hall analyzed price transparency efforts among providers. The most common approach to transparency is reactive, not proactive: it’s responding to price quote requests by consumers. Only 23% of providers offer an online tool providing estimated patient out-of-pocket costs. Fewer than one-in-five providers offer clinicians and staff with tools to answer patient questions about price. Note that the Aetna Health Ambitions Study, which I wrote about here, found that the majority of consumers wants to ask doctors about the patient-facing cost of services, so the demand side is quite clear (and substantial) on this point-of-friction and -service.
Kaufman Hall interviewed 200 organizations for this study, including health systems, stand-alone hospitals, children’s hospitals, and specialty hospitals.
Health Populi’s Hot Points: There’s a hard return-on-investment for garnering patients’ satisfaction and HCAHPS scores. First, in terms of experience, customer experience guru Bruce Temkin connected the dots between patients’ emotions during hospital visits and the organization’s net promoter scores based on different feelings: relief, confidence, happiness, versus disappointment, confusion and anger. The bar chart illustrates the impact on NPS by emotion factor: confidence and excitement inspire high scores; disappointment drives the NPS way down, followed by anger.
Deloitte calculated another way to measure the ROI of patient delight by looking at hospitals’ financial performance, finding that those providers who scored more highly on patient experience yielded better financial outcomes — highly correlated to patient-nurse engagement. On the nurse-connection, note that Americans rank nursing the most honest and ethical profession in the nation, the Gallup Poll found in its 2017 annual study on the topic. In fact, nurses have placed at the top of this poll for many years ongoing.
Accenture, too, calculated that the higher the HCAHPS scores a hospital garnered, the better fiscal margin the provider realized.
So the moral of this story is if you delight the patient, you do good and do well. If you highly value and compensate your nursing staff — all the better.
The post Hospitals Work to Address Customer Experience Gap With Consumers, Kaufman Hall Finds appeared first on HealthPopuli.com.
Consumers have health goals across many dimensions, topped with eating well, getting fit, reducing stress, sleeping better, feeling mentally well, and improving personal finances.
That’s an ambitious health-and-wellness list, identified in the Health Ambitions Study, the first such research Aetna has published.
Six in ten people are looking to food and nutrition for health, whether as “medicine” to deal with chronic conditions, for weight loss or general wellness, which is a frequent theme here on Health Populi. Consumers embrace their food habits as a key self-care determinant of health.
Fitness, cited by most consumers, is also a can-do, self-powered activity that can cost a consumer zero to little money when we consider the power of walking in a neighborhood, at the mall or the “Y,” taking stairs at work, and parking a car far from a building entry.
Reducing stress? That’s key for 40% of consumers in this study. Knowing from the American Psychological Association Stress in America study that over 50% of Americans now feel stress, this finding in the Aetna research resonates.
Sleep, too, or lack thereof, is top-of-mind for so many consumers: there was a growing category of sleep-assisting digital health tools featured at the 2018 CES, which I covered here in the Huffington Post. One-third of people cite mental health as a goal, closely followed by improving finances. Financial health relates to the previous five goals as money-stress can lead to poor eating habits, lack of energy to exercise, interrupted sleep, and of course, anxiety.
While the consumer spirit is willing and goal-oriented when it comes to health, most people understand that making behavior change initially then making it stick is difficult. So the vast majority of consumers look to doctors to help them achieve their health goals, the second chart illustrates. Beyond health, lifestyle and stress, note that 3 in four people want physicians to help them achieve overall happiness and life satisfaction.
The annual checkup is the top-ranked opportunity consumers identify to communicate with their physician: I repeat, “annual” check up. This is followed by feeling sick, prompting people to schedule time to see the doctor for more urgent (non-preventive) issues.
The cost of care is a big issue for most consumers: one-half of consumers want doctors to help them understand the cost of their care. Two in three consumers have made a health care goal to reduce their healthcare costs.
There’s a Mars/Venus chasm between women and men when it comes to healthcare navigation: fewer women than men feel their physicians are familiar with their health values — lifestyle habits, health goals, and personal relationships. But two-thirds of women are keen to spend an extra hour a day on well-being.
Aetna worked with Market Measurement to conduct 1,000 interviews among people 18 years of age and older in December 2017. An additional survey of 400 physicians was conducted, split between 200 primary care providers and 200 specialty physicians.
Health Populi’s Hot Points: The good news conclusion of the Health Ambitions Study is that consumers, indeed, have ambitious goals for their personal health. The opportunity-gap that physicians can fill is to help people address their health goals based on their health values. In my client work and speech-giving, I often point these days to a JAMA article, Value-Based Payments Require Valuing What Matters to Patients. Women, especially, articulate the need and wish for their physicians to help them deal with real-life flows — even to help them achieve happiness and life satisfaction.
It’s encouraging, then, that Aetna found physicians involved in value-based payments to identify community-based resources like social workers, in-home visitors, mental health counselors, and nutritionists to help people deal with wellness goals — that they themselves value.
Remember that doctors, still, rank quite highly on consumers’ list of trusted and ethical professions in the annual Gallup Poll. The doctor-patient relationship continues to have goodwill that can feed consumer engagement to help people achieve their personal health ambitions.
The post Patients have ambitious health goals, and look to doctors for help appeared first on HealthPopuli.com.
As I walked by windows with Marvel-inspired superhero characters, I stopped to read their talk-bubbles: “strengthen your savings, power your financial quest, be the hero of your money, be one with your budget.”
The top-line message here is that you can be your own fiscal superhero.
The sign read, Capital One Cafe with Peet’s Coffee. But was it a bank branch or a cafe? I asked myself, passing by this sign yesterday morning at the corner of Walnut and 18th Streets in center city Philadelphia.
It’s both, as it turned out, and when I entered I found a welcoming, beautifully designed space that was a new-new thing. And really good coffee. In this storefront, the bank allies with Peet’s Coffee to create a space meant for banking, recharging, learning and hanging out.
There are nearly thirty such cafes around the US, in California, Colorado, Florida, Illinois, Massachusetts, Minnesota, Pennsylvania, Texas, Virginia, and Washington State.
You can meet the Cafe Ambassador, who is akin to the Genius Bar concierge that provides an on-ramp to financial services you might need or want: a new savings or checking account, a home or auto loan, or perhaps a credit card.
Then there’s a sign inviting you to book an appointment for money coaching, a free one-on-one meet-up where a consumer can learn about their personal financial personality and get tips to achieve financial goals.
That financial wellness theme extends to the cafe itself, where Capital One cardholders can buy their brew for 50% off retail price. On special event days, Cap One “members” can get free coffee and snacks, too; some of the events coming up at the Philadelphia branch included “Spend Smarter, How to Get More for Your Money;” “Building Your Savings;” and, “Navigating Life’s Twists and Turns.”
Here’s the video of the Capital One Cafe experience:
Health Populi’s Hot Points: Financial health is part of peoples’ overall definition of health and well-being. Healthcare costs are now the top pocketbook issue for American families, as higher health care costs bring stress and, with it, health risks for gut, heart, and mental health.
Traditional healthcare stakeholders have begun to recognize the importance of design for health, from the hospital waiting and inpatient rooms to the enchantment of health apps and tools and beautifully designed “hearables” to aid people with hearing deficits, and an easy to understand the explanation of benefits like that shown here from a recent Mad*Pow’s project on re-imagining the patient’s medical bill journey with Geisinger.
Capital One’s messaging in the Cafe inspires empowerment, conversation, education, community, and fun. Finance and fun? You bed.
These are elements that healthcare can learn from and emulate.
The post Good Coffee + Engaging Design + Banking = Financial Health appeared first on HealthPopuli.com.
Everyone on staff here at Dr. Ku’s office is dedicated to making your visit stress-free and hassle-free. We understand that many of our patients suffer from dental anxiety or dental phobias, whether from traumatizing experiences in the past or without any explanation at all. We also understand that these are real fears!
That said, the health of your mouth is important, and we don’t want you to forgo necessary treatments. That’s why we love it when we have patients return to us for over a decade, because that means we’re getting at the problem. We believe in establishing the relationships with patients that side-step phobias, stress and other hassles. We believe it’s important that ALL our patients form a long-term relationship with their dentist. Through decades of work, we’ve proven that forming this relationship leads to better health outcomes for patients.
If you are feeling anxious about a visit, we would love to welcome you to the Ku Dentistry Family where we treat you like one of the family and put all your anxieties to ease.
Why does a relationship matter?
Dental care is based on a good dentist-patient relationship. Since the vast majority of patients are not practicing clinicians themselves, it is required they put their trust in their dentist and know that the recommended treatment plan is necessary and not offered solely as a way to ensure a higher bill at the end. We are all skeptical beings. If you do not explicitly trust us, then we will never have a true and transparent relationship.
That’s why it’s our mission to build that trust!
Communication is key
You’ve heard this before from friends or family, but we can’t read your mind. If you are anxious, in pain or worried about the cost of a procedure, bring it up to us. Having these conversations will held deepen our relationship and build a trust between both of us.
There is no question too dumb and no request too steep. If you’d like to set up a conversation before you’re locked and loaded in the chair, that’s fine, too! Comfortable dentistry is a term we like to use at our office, and it means that we’re willing to “meet people where they are” emotionally and physically.
Some of our favorite patients have special needs or require special accommodations. We are happy to work with you on ensuring that your visit is pleasant and quick! Please call our office to schedule a time to talk to Dr. Ku. Patients are his number-one priority, and we want everyone to feel valued and respected!
Reliability
Finally, having a long-term relationship with your dentist means that in the event of a dental emergency you know exactly who to call. We have all your records and know right off the bat about any allergies or medications that we need to take into consideration. This also goes for our office staff. If you have a long relationship with our staff, they can easily work with you on scheduling future appointments and know the quirks of insurance that might have caused you issues in the past.
We want all of our patients—past, present and future—to know that they are welcome in the Ku Family. We work hard to build relationships with each of our patients. We hope that our approach to comfortable dentistry invites in those who have previously been fearful of the dentist. All of that means that we ultimately want everyone to have the benefit of a healthy smile, and we are dedicated to getting everyone North Texas there!
The post Why Dr. Ku’s Office Cares appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
In econ-speak, we are looking to measure the elasticity of plan switching with respect to premium increases. This elasticity is in essence how much would a 10% change in premium affect the likelihood of plan choice change. If the answer is 10%, the elasticity is -1. If the answer is a 5% increase in plan switching, the elasticity would be -0.5; on the other hand, if the increase in plan switching rates was 20%, the elasticity would be -2.
An interesting paper by Bischof and Schmid (2018) provides this estimate in Switzerland using a novel estimation technique.
We exploit that individuals born before the turn of the year (“treatment group”) face a larger increase in premiums than individuals born after the turn of the year (“control group”). We find that the treatment group is 1.5 times more likely to switch their health plan than the control group. Overall, individuals respond to premium increases by choosing more frequently health plans with managed care features, increasing the deductible, and by switching the insurer. Regarding health plan choice, we find an average elasticity of −0.56 with regard to the relative premium difference of any plan to the status quo contract. The elasticity is up to 5 times larger for the treated (−1.03) than for the controls (−0.19).
You can an ungated earlier version of the paper here.
Source:
In econ-speak, we are looking to measure the elasticity of plan switching with respect to premium increases. This elasticity is in essence how much would a 10% change in premium affect the likelihood of plan choice change. If the answer is 10%, the elasticity is -1. If the answer is a 5% increase in plan switching, the elasticity would be -0.5; on the other hand, if the increase in plan switching rates was 20%, the elasticity would be -2.
An interesting paper by Bischof and Schmid (2018) provides this estimate in Switzerland using a novel estimation technique.
We exploit that individuals born before the turn of the year (“treatment group”) face a larger increase in premiums than individuals born after the turn of the year (“control group”). We find that the treatment group is 1.5 times more likely to switch their health plan than the control group. Overall, individuals respond to premium increases by choosing more frequently health plans with managed care features, increasing the deductible, and by switching the insurer. Regarding health plan choice, we find an average elasticity of −0.56 with regard to the relative premium difference of any plan to the status quo contract. The elasticity is up to 5 times larger for the treated (−1.03) than for the controls (−0.19).
You can an ungated earlier version of the paper here.
Source:
Hank Stern has posted A Midsummer Night’s Health Wonk Review at InsureBlog.
The HWR reviews the latest and greats posts from the health wonk-o-sphere. In this edition, you can learn about Association Health Plans, the pros and cons of a number of mega-mergers in the health sector, and the effect of GOP plans to end Obamacare, among others. Check it out.
Taking a page out of Hippocrates, “let food by thy medicine and medicine be thy food,” consumers are increasingly shopping for groceries with an appetite for health, found in research published this week by the International Food Information Center cleverly titled, An Appetite for Health.
The top line: over two-thirds of older adults are managing more than one chronic condition and looking to nutrition to help manage disease.
Most consumers have that “appetite for health” across a wide range of conditions, with two rising to the top as “extremely important:” heart health and brain function. Other top-ranked issues are emotional/mental health, energy, and maintaining a healthy weight, along with other conditions and health aspirations shown in the chart.
A quick glance at the chart underscores the point that a majority of older consumers see food playing a role in virtually every condition polled, ranking them all very important or somewhat important.
Older adults are changing their health by changing their eating habits, with:
While the spirit and the flesh are willing, there are barriers to older people actually making these dietary changes. First, there’s the barrier of nutrition literacy: IFIC found that consumers don’t really know what foods can help achieve desired health outcomes. One in three older adults could not identify a specific food to either consume or eliminate that would help them achieve a desired health outcome. This speaks to the need for much more education about what healthy food looks like, and which nutrients tie to specific personal health goals.
The most frequently identified food-for-health was vegetables (cited by 28% of people), followed by protein (18%) and fruit (17%).
Older people were smart enough to identify that knowledge was the top issue standing in their way, followed by accessibility and physical ability as factors enabling a healthy diet. Additional barriers cited were cost and time, preventing people from eating healthier, people said.
The survey was conducted online among 1,005 Americans age 50 and older between January and February 2018. The research was supported by Abbott.
Health Populi’s Hot Points: As patients morph into health consumers, seeking food options that make health, they’re also savvy buyers, who clip coupons, shop private labels, and look for value-priced products in their lives. This applies to health and food, too.
Dr. Carolyn Scrafford and her research team presented compelling research this week in Boston at the annual Nutrition 2018 conference convened by the American Society for Nutrition on the subject of healthcare costs and savings accruing based on U.S. adults adopting healthy eating patterns.
The research methodology modeled cost savings based on two behavior change assumptions: that consumers’ adopted healthy dietary patterns, achieving a 20% or 80% score based on the Healthy Eating Index (HEI) and the Mediterranean-style diet (MED) regimes. Under the 20% scenario, the U.S. could save an average of $25.7 billion (HEI) to $38.1 billion (MED) in indirect and direct costs, resulting from reductions in cardiovascular disease, cancer, Type 2 diabetes, Alzheimer’s disease and hip fractures. With the 80% scenario, cost-savings increases to a range of $66.9 billion (HEI) to $135 billion (MED).
Nearly one-half of the cost reductions would connect to heart disease because it is so directly influenced by diet quality.
These large macroeconomic national numbers would translate to individuals and their households in terms of patients direct and indirect costs for healthcare and disability, along with improved quality of life for U.S. health citizens.
IFIC’s research recognizes that consumers are connecting the dots between food, food-as-medicine, and health. If people can sustain healthy foodstyles, like the Mediterranean (or DASH) diet, or the Healthy Eating Index, we well find that the U.S. healthcare cost curve is bending based on the actions of American patients eating more healthfully.
For more information about these eating paradigms, check out these websites:
Mediterranean Diet from the Mayo Clinic website
DASH Diet from the Mayo Clinic website
Healthy Eating Index from the USDA portal
The post Consumers Grow to View Food as the Prescription appeared first on HealthPopuli.com.
When it comes to healthcare costs, lines that decline over time are generally seen as good news. That’s how media outlets will cover the top-line of PwC’s report Medical cost trend: Behind the numbers 2019.
However, there are other forces underneath the stable-looking 6.0% medical trend growth projected for 2019 that will impact healthcare providers, insurers, and suppliers to the industry. There’s this macro-health economic story, and then there’s the micro-economics of healthcare for the household.
Simply put: the impact of growing financial risk for healthcare costs will be felt by patients/consumers themselves.
I’ve curated the four charts from the study to explain this story. Here is the first “good news” line chart, showing declining medical trend from 2007 to next year in 2019. The 6% trend is equal to that of 2018, illustrating a flat scenario, roughly the same trend seen in 2016 at 6.2%. That’s one-half the high point at nearly 12% in 2007. That’s good news indeed, from a healthcare cost bird’s-eye view.
The second graphic, labeled Figure 3, compares national health spending as a share of U.S. gross domestic product (GDP) versus what employers spend as a share of workers’ wages. See the growing line-item of employer health spending as a share of employee earnings grow decade by decade.
The point here is that the share of employee earnings devoted to healthcare has grown: workers have traded off wage increases for healthcare benefits, a central theme over the ten+ years that I’ve written this blog. In 2007, the year I launched Health Populi, the inaugural post focused on just this issue; the post was titled, “Health care is the #1 line item in our national economy…and taking more out of your pocket.” That was written in the 2001-2010 period of healthcare spending, so an old story giving me feelings of déjà vu.
“Employer health spending has grown from 6 percent of total wages in 1988 to more than 12 percent in 2018,” driven by healthcare prices growing faster than the general economy, and the adoption of new technologies, procedures, and increasingly expensive new prescription drugs, PwC observes.
Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. economy by 2026.
Now, to Figure 4 (the third graphic). This shows growth in consumer personal income adjusted for inflation. That’s the issue of flat wages mentioned in the previous paragraphs. PwC notes that consumer income had a “dramatic drop” in 2015 and 2016, which will lead to a dampening impact on healthcare spending in 2019. Wage growth in 2017-18 will then drive healthcare spending up again in 2020, which has been demonstrated by a two-to-three-year lag that CMS’s actuaries have observed over many years.
With employers’ goal of bending their cost curve (and in turn, that for workers), more employers are offering different “front doors” to services. These include health risk appraisals, biometric screenings, weight management, and health coaches: at least one-half of employers are offering these four services, PwC’s research found.
The fourth graphic (labeled Figure 8) illustrates the percent of consumers likely to access new care options outside of bricks-and-mortar doctors’ offices if these services were lower cost:
56% of people would use telehealth via smartphone for a dermatologist to examine a skin problemEmployers are also enlisting the services of third-party health advocate services to help patients, now consumers, navigate the complex and expensive health system. Advocacy services include price transparency, identifying appropriate clinical trials for participation, identifying mental/behavioral health providers in a local market or virtual telehealth program, or finding a specialist for a rare condition. These organizations collect data on consumers which can be used to better coordinate care, as well as, if married to practical artificial intelligence, predict health needs in advance of disease onset.
To stay relevant in this future scenario of more virtual and retail health channels, a plurality of health providers would consider aligning with various non-hospital healthcare providers such as skilled nursing facilities, outpatient centers, retail clinics, home health agencies, acute rehabilitation, and hospice agencies.
Health Populi’s Hot Points: Financial wellness is a benefit in companies building a culture of health and an integrated employee benefits strategy embedding wellness across all components of the compensation package. Smart companies realize that financial stress contributes to absenteeism and challenges with presenteeism, along with being a risk for various health conditions — both physical and emotional/behavioral.
The final chart shows the growth curve for U.S. consumers’ healthcare spending as a percent of their disposable income. The Bureau of Labor Statistics tells us that currently, consumers spend $1 in every $5 of household spending on healthcare — and that’s just the stuff included in healthcare claims.
In previous research, PwC has calculated consumer spending on other health-related services and products that people gladly pay for out-of-pocket, outside of the health insurance premium copayments, coinsurance, insurance premiums and deductibles.
It’s no surprise, then, that healthcare spending continues to be the top pocketbook issue among Americans.
As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S. consumers’ ability to spend on other household line items, like college education, automobiles, hard goods, entertainment, and vacations.
Americans’ credit health has eroded over the past few years, with 15 consecutive quarters of increasing debt, according to the Federal Reserve Bank of New York. The NY Fed found that household debt increased to $13.21 trillion in the first quarter of 2018, the 15th consecutive quarter with an increase that ranks the level higher than the previous peak of $12.68 trillion from the third quarter of 2008 — as the Great Recession hit the U.S.
Current political polling shows that voters, across the political spectrum, continue to rank healthcare costs as high priorities for the 2018 mid-term elections. Watch this space, and this blog, for continued focus on financial wellness, healthcare costs, and consumer sentiment.
The post As Medical Cost Trend Remains Flat, Patients Face Growing Health Consumer Financial Stress appeared first on HealthPopuli.com.
Medicare provides health insurance for 58.4 million Americans. To provide health care to largely elderly Americans, it spent $710 billion in 2017. One key question is, does the federal government have the funds to continue to support this program as the baby boomers retire?
According to the 2018 Medicare Trustees report, the answer is increasingly pessimistic. The Medicare Trust Fund will run out of money by 2026, three years earlier than previously anticipated.
Kaiser Health News interviewed a senior government official who said that:
…the trustees projected lower wages for several years, which will mean lower payroll taxes, which help fund the program. The recent tax cut passed by Congress would also result in fewer Social Security taxes paid into the hospital trust fund, as some higher-income seniors pay taxes on their Social Security benefits. The aging population is also putting pressure on the program’s finances.
Some other interesting points:
Source:
Whether in our own bodies or in someone we love, cancer has affected nearly all of us. Whether personally or a friend or family member, it is a cruel disease. When you go to the dentist, did you know that we’re looking for more than just your adherence to a good flossing regime? On top of traditional dental issues, Dr. Ku is also screening you for oral cancer.
Oral cancer includes all cancers in the mouth and at the back of the throat, and account for nearly 3% of all cancer diagnoses each year. Knowing what to look out for and catching it early are crucial to help better your chances of beating it. If you have any concerns or are exhibiting symptoms, please call your general practitioner or Dr. Ku today.
Causes
Men are twice as likely as women to be diagnosed with oral cancer. And most diagnoses occur in those over 40 years old. While cancer can affect anyone at any time, there are certain lifestyle choices that lead to a higher incidence rate. For example, tobacco users of any kind are at a higher risk of developing oral cancer. In combination with alcohol, the prevalence rate increases exponentially. Individuals exposed to the human papillomavirus (HPV), specifically HPV type 16, also have a higher chance or being diagnosed with oral cancer. And finally, excessive sun exposure can cause cancer of the lips, which is another form of oral cancer.
Symptoms and diagnosis
The signs of oral cancer can imitate those of a variety of different illnesses, which is how it’s often ignored or confused for other things. From a sore throat to an ear infection, oral cancer can feel like other ailments you’ve experienced a thousand times before. Due to this, some people delay in seeking treatment since they think it will get better on its own. In other cases, the signs can be seen but have no physical pain or discomfort accompanying them. Most commonly, the cancer causes sores or thick patches in our mouth, lips or throat that are red and white in color. Patients don’t know what to think.
Since catching oral cancer can be difficult, it’s important that you visit your dentist regularly so that an oral cancer screening can occur. These screening are quick and painless—so much so that patients didn’t even realize it’s part of their standard check-up. And ultimately, a visit to the dentist could save your life.
Treatment options
If cancer is suspected, your dentist will refer you to doctors who specialize in the treatment of oral cancer. This includes ENTs, head and neck surgeons and oncologists. When oral cancer is caught early, radiation or chemotherapy in combination with surgery is the most common treatment plan. If the cancer is detected later, radiation in combination with chemotherapy is commonly prescribed. Like many other types of cancers, the treatment is dependent on your overall health and the progression of the disease.
Throughout the course of treatment, it’s important your cancer team stay in contact with your dentist. Treatments can cause lateral damage to the teeth, so continuing your bi-annual visits is extremely important.
Oral cancer left unchecked can quickly spread. If diagnosed in late stages, the disease can be life-threatening. Oral cancer that is found late has normally metastasized, which means cancerous cells have entered into other regions of the body. One in four individuals who suffer from oral cancer will die due to delayed diagnosis and treatment.
These alarming statistics should encourage you to make an appointment with Dr. Ku today for your regular check-up and oral cancer screening.
The post Stop Oral Cancer appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.
Yesterday at 1 pm, we learned that the incidence of suicide is up in America in a report from the Centers for Disease Control (CDC), an agency in the U.S. Department of Health and Human Services.
This morning, we awake to news that Anthony Bourdain, the witty and prolific travel and food expert, took his own life. Earlier this week, Kate Spade, fashion designer and creative force, took her own life.
These two creative forces, gone from our lives to suicide within a few days of each other, gives me the sad compulsion to say something, again, about the state of mental health and behavioral health services in America.
In a larger context, it’s about life and social connections in America right here, right now.
What do we know we know?
Two of the 45,000 deaths by suicide that will be counted in CDC’s 2018 mortality census will be those of Kate Spade and Anthony Bourdain.
Countless celebratory articles and memorials have been published this week, from Advertising Age to Women’s Wear Daily, on the life and legacy of Kate Spade. My own fashion life has been blessed with Kate’s accessories and office supplies; I carry her iconic black nylon backpack regularly to business meetings, and love her cleverly-designed work. A postcard from a recent purchase in her store hangs on my inspiration board and reads, “She is quick and curious and playful and strong.” This is pinned next to images of Botticelli’s Venus, Andy Warhol’s Campbell’s Soup dress, and a journaling card from Studio Calico that reads, “You’re as happy right now as you’ll ever be.” (pictured here)
Health Populi’s Hot Points: Why now, in the U.S., do we see the rate of suicides growing? As CDC notes in the new report, there is no one cause for each person’s decision to take their own life. The list of underlying dark forces is long….and pervasive in America. Some of the evidence-known factors contributing to suicide are:
The lack of civil discourse in America is at fever pitch, and certainly contributes to health citizens’ stress. The American Psychological Association’s Stress in America survey identified “political stress” as a thing that emerged during the 2016 Presidential election cycle, and has contributed to ill health, sleeplessness, depression and anxiety.
One thing is clear: the CDC researchers found that more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. This speaks to the need for mental and behavioral health services to be moved into primary care settings as an integral part of a medical exam and intake, to benchmark and track a person’s mood and screen for anxiety and depression.
Mental health service parity and access continue to plague Americans’ wellbeing. There are fast-growing digital channels to tele-mental health, and accessing these services at a distance can help people get the services they need while reducing the feeling of taboo they may have to getting care in-person.
That taboo was apparently some of the challenge that Spade faced in worrying that her brand might be tarnished if people found out she reached for mental health services. That’s such a huge shame on American society and the U.S. healthcare system.
One heartbreaking quote, something that rang true to me, I heard this morning: “Suicide is the ultimate self-medication for pain.”
Take note of the resources available to all of us to prevent this ultimate self-medication: 1-800-273-TALK (8255).
I mourn for Kate and Anthony, for their families and friends, and for those of us touched by their gifts. Their stories weren’t over yet. But we can continue to learn from them, revel in their wit and knowledge that they both left in their wake.
This Op-Ed in today’s Wall Street Journal was a lovely tribute to “Kate Spade, Entrepreneur,” reminding us of her contribution to making our lives more joyful and colorful. The last two paragraphs will resonate:
Spade’s success is a reminder that the wonder that is the U.S. economy rewards—and needs—creativity of all kinds…Mental illness is a scourge that afflicts millions, but the world’s good fortune is that it didn’t afflict Kate Spade before she could leave such a large legacy.
As for Bourdain’s legacy, as he said in this bittersweet quote, “I’m not going anywhere…it’s been an adventure…But I wouldn’t have missed it for the world.”
Rest in peace, Kate and Anthony.
The post Thinking About Kate and Anthony – Suicide and Depression Is US appeared first on HealthPopuli.com.
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; and, a “blended account,” which mines claims databases of information for millions of insured Americans and billions of their claims.
The Bureau is working to better understanding health care spending at this detailed level, by condition.
The first illustration shows how medical conditions were divided into the 261 so-called “detail conditions.” The typology starts with aggregate conditions, including Circulatory, Musculoskeletal, Respiratory, Endocrinological, Nervous system, Neoplasms, Injury/poisoning, Genitourinary, Digestive, Mental illness, Infectious disease, Skin, Pregnancy/birth complications, Blood organs, Perinatal, Congenital anomalies, and Symptoms, check-ups, and ill-defined conditions.
Six conditions made up 51.4% of total medical spending: Circulatory (12% of total healthcare spending), Musculoskeletal (9.9%), Respiratory (7.9%), Endocrinological (7.7%), Nervous system (7.2%), and Neoplasms (6.7%). In addition, symptoms, checkups, and ill-defined conditions accounted for 13% of spending.
The second chart indicates healthcare spending by category in billions of dollars and annual rate of growth. Some key findings from this study were that:
The fastest-growing spending conditions between 2013 and 2014 were infectious disease, mental illness, and diabetes.
The key drivers of spending growth were the adoption of new technologies, shifting to more preventive services, obesity and population aging.
The highest per capita (per person) spending on the top 30 conditions were for medical exams (checkups), diabetes without complications, rehabilitation care, immunizations/screening, chronic kidney disease, septicemia, osteoarthritis, and maintenance chemotherapy.
Among the top thirty conditions were diseases for which new specialty drugs are available to cure or chronically manage – among them, rheumatoid arthritis, hepatitis, HIV infection, and multiple sclerosis. For these diseases, the high drug cost is largely behind the cost growth. Even with that high cost, the authors note, many are seen to be cost-effective and “worth” their cost in terms of value and patient outcomes. There’s good news here in that some conditions once thought to result in mortality are now evolving to chronic conditions, like HIV and many cancers, for which treatments are lower in toxicity and helpful for extending life with quality.
Aging contributes to healthcare spending for age-related diseases like osteoarthritis; retinal detachments, defects, and vascular occlusion; and delirium, dementia, and other cognitive disorders. The researchers note that aging combines with higher obesity rates among older people that further drive healthcare costs for conditions such as diabetes, with higher risk for kidney disease and renal failure. The study found “rapid growth” (the authors’ words) for the treated prevalence for these three conditions.
Health Populi’s Hot Points: The third chart shows consumers’ top-line for healthcare spending: that healthcare makes up 20.6% of U.S. consumer spending versus spending on other commodities. That’s just over $1 in every $5 for each U.S. health citizen.
The BEA researchers recognize that technology has improved health outcomes for a great many of the 261 conditions that make up the study. Still, the American healthcare system continues to be wasteful in terms of duplication, paper-intensive process, and inefficient workflow, which deflates the value and return on healthcare spending. In addition, healthcare prices in the U.S. hover much higher than in other developed countries, especially relative to the value of incremental innovations, the BEA team found.
One of the key goals of the satellite account study is to identify areas to improve efficiency in U.S. healthcare spending.
With health consumers allocating 20% of household spending on healthcare, making healthcare more efficient will also benefit peoples’ household budgets.
The post Technology, Aging and Obesity Drive Healthcare Spending, BEA Finds appeared first on HealthPopuli.com.
Doctors have a complicated relationship with electronic health records (EHRs): two-thirds of primary care providers (PCPs) see value in digital records (EHRs), but at the same time believe the technology has weakened relationships with patients, detracted from clinical effectiveness, and lack streamlined user experience. That deficiency is, in three words, lack of interoperability; that challenge has required one-half of physician-users to use work-around’s to make their EHR investments more useful.
These insights come out of a survey conducted among primary care providers by The Harris Poll for Stanford Medicine, published to coincide with the medical school’s convening of the EHR National Symposium held on June 4, 2018.
The poll was conducted among 521 PCPs in March 2018.
The infographic summaries some of the points emerging from the study. Among the major findings:
The top value of the EHR is digital storage, according to nearly one-half of PCPs.
The second chart illustrates the gap between doctors’ EHR wants versus EHR abilities. Physicians’ top-ranked importance factor for EHRs is to maintain a high-quality record of patient data in the EHR over time, with virtually 100% agreement among doctors (99%). This importance factor is closely followed by providing an intuitive user experience (97%), sharing information with providers across the care continuum (95%), coordinating care for patients with complex conditions (94%), change or adapt in response to user feedback (91%) and facilitating better patient-provider interaction (91%).
Each of these issues has a reality gap in terms of EHR performance: the chart orders those issues from the largest to smallest gaps.
Health Populi’s Hot Points: The latest 2018 Medscape survey into physician wellness was titled the National Physician Burnout & Depression Report. Doctors pointed to administrative task burdens, largely to do with their EHR systems, contributing to burnout among 56% of physicians.
Medscape’s research has consistently found that 42% of doctors feel burned out in 2018. Primary care physicians in internal medicine, OBGYN, and family medicine have even higher rates of burnout.
Most physicians want more time to spend with patients. Most physicians rarely have time to address all patients’ questions and concerns, the third chart from the Stanford/Harris survey shows.
Most physicians blame EHRs for taking valuable time away from patients.
These are the unintended consequences of the HITECH Act, which funded healthcare provider investments in electronic health records. In historical context, HITECH was part of the ARRA Stimulus Bill, legislation meant to bring the Great Recession Economy back to life. Digitizing records underpinned this with the long-term goal of helping reduce health care costs in the American macroeconomy, especially to help make Medicare and Medicaid more sustainable over time.
The costs of implementing EHRs go well beyond direct expenses of the computer systems and staff time devoted to making systems “work.” Interoperability wasn’t baked into the original legislation. Neither was an objective to enchant users with streamlined experience.
This is where we are now in American healthcare: physicians want more time with patients. Patients want more effective relationships with physicians, sharing decisions, better understanding therapeutic options and of course, what personal costs will be for various healthcare decisions. Some healthcare systems are innovating to improve care at the nexus of patient and provider: the growth of Open Notes and Our Notes is bolstering the patient-physician relationship. See the latest announcement from UPMC about expanding Open Notes access to patients via the patient portal.
Voice technology (THINK: Alexa-meets-the-EHR) and the adoption of APIs (application programming interfaces) can “appify” the EHR from the inside out, to enable greater interoperability and sharing of information across the care continuum and between providers. It’s encouraging to see the Stanford/Harris survey find that among physicians using voice recognition technology, 62% are at least somewhat satisfied with it.
Adopting these new digital tools, when they can positively impact the doctor’s workflow and patient life-flow, will help to improve the EHR experience for both doctors and patients. How quickly these will be adopted into mainstream practice remains to be seen: sooner, better. If not, EHRs are a very expensive data storage option.
And there’s always the “overhaul” of aligning with Apple via the just-announced API for EHRs…
The post Doctors Say EHRs Are Good for Storage, But Risky for Patient Relationships and Burnout appeared first on HealthPopuli.com.
