Friday, 30 November 2018

The Ultimate Health Outcome, Mortality, Is Rising in America

How long can people living in the U.S. expect to live? 78.6 years of age, if you were born in 2017.

That’s a decline of 0.1 year from 2016.

This decline especially impacted baby boys: their life expectancy fell to 76.1 years, while baby girls’ life expectancy stayed even at 81.1 years.

That’s the latest data on Mortality in the United States, 2017, soberly brought to you by the Centers for Disease Control and Prevention, part of the U.S. Department of Health and Human Services.

Underneath these stark numbers are the specific causes of death: in 2017, more Americans died due to unintentional injuries, lower respiratory diseases, stroke, Alzheimer Disease, diabetes, influenza and pneumonia, and suicide, increasing in prevalence among the top ten causes of death in the U.S. On the upside, deaths fell due to cancer, and rates for heart and kidney disease stayed relatively even.

There are three underlying stats that are particularly concerning in this report:

1. The rates of death for younger ages significantly grew between 2016 and 2017 in the age cohorts 25-34 and 35-44.

2. For infant deaths, unintentional injuries significantly rose over the year. There was also a marked increase in maternal complications.

3. Drug overdoses were the cause of over 70,000 U.S. deaths — related to the growing use of synthetic opioids.

That’s due to the fact that the age-adjusted rate of drug overdose deaths with synthetic opioids (not methadone) increased by 45% between 2016 and 2017. This is shown in the third graphic, the line chart showing the hockey-stick growth of synthetic opioids since 2013.

While there is obvious and important attention being paid to drug overdoses and the opioid crisis, and suicides among younger people, Americans should be mindful too of lack of significant progress dealing with mortality due to respiratory disease, stroke, Alzheimer’s, and the flu, along with infant deaths due to maternal complications and unintentional injuries.

Health Populi’s Hot Points: It’s a stark, sad reality that Americans are losing years of life that could be conserved. The nation spends more resources on healthcare than any country on Planet Earth, and the ultimate ROI should be life-years, and quality of those life-years.

If you look at the map, you’re seeing states by the rate of drug overdoses in 2017. The higher-than-national-average rates are in dark blue. This is not to say there aren’t deaths due to overdose in the green-hued states. But this is one lens on one’s ZIP code being a risk factor for health, and in this case, death from overdosing.

This challenge is but one of many that are, partly, addressable by getting real about social determinants. For these deaths of despair, job security and unemployment, social connections and loneliness, access to healthcare services (THINK: mental health, anxiety, depression, pain), and education are all pathways to socioeconomic status and social security (meant in the phrase as written, not as the U.S. Federal program of “Social Security”).

Three years ago here on Health Populi, I wrote about the deaths of despair, a phrase coined by Angus Deaton and Ann Case of Princeton. Then, I said,

“The authors note that the increase in midlife mortality is only partly understood. Increased availability of opioid prescription drugs, chronic pain (for which opioids are often prescribed), and the economic crisis which began in 2008 may all have contributed to an increase in overdoses, suicide, and increased liver disease associated with alcohol abuse.”

Three years later, there’s little national/Federal progress on resourcing the social determinants and personal/household economies that could help turnaround this public health challenge. (Most Americans didn’t feel a short-term sustained benefit from the recent tax reform legislation). While Congress and the President do chat about the opioid crisis, look for more action from the private sector and State Governors than Congress in 2019.

The post The Ultimate Health Outcome, Mortality, Is Rising in America appeared first on HealthPopuli.com.


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Friday Links


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Wednesday, 28 November 2018

Innovation and Value Initiative in the news

The Innovation and Value Initiative (IVI) where I serve as the Director of Research was recently in the news with a Journal of Clinical Pathways interview with Executive Director Jennifer Bright and Director of Scientific Communications Mark Linthicum.  Some excerpts:

Can you tell us about the Innovation and Value Initiative?

Bright: We are working in three primary areas. The first is methods development – how do we apply better methods and create better models for assessing value of health care therapies? The second is transparency; we are putting all of our models and research in an open-source environment, much like open-source software development, which is a very novel and forward-thinking approach to what has traditionally been done behind the walls of an academic or research institute. The third core element is incorporating the experience of patients. In the health policy world and in the health care marketplace, there is a lot of discussion regarding patient-centered health care. We believe that this philosophy needs to also be applied to the assessment of therapies’ value. We have to start with understanding the patient experience in disease and their approximation of value – in their choice of treatment options and how they define the value of various outcomes of a treatment.

Let’s talk about CVS Caremark’s new program to use ICER’s version of value assessment. What are the concerns with this program and what do you see as the potential impact that the program may have on patients?

Linthicum: I think one of the main concerns that is raised by the CVS decision is that it uses an estimate of value as a black-and-white justification for coverage decisions, which in our view is an inappropriate way to use estimates of value. There are a couple of reasons for our belief on this. The estimates produced by ICER are one approach, but they are broad population-level estimates that reflect averages across the entire population of clinical trials and do not reflect the heterogeneity and differences in response that are associated with different types of patients, demographics, and genetic markers. One of the most vocal critiques from the patient community has been that ICER also does not adequately incorporate the patient perspective. ICER has made some efforts to correct this by meeting with patient groups and conducting patient surveys prior to releasing reports, but this information is generally included as a brief section providing contextual information, with no discernible impact on actual value estimates.

Read the full interview here.  You can also visit the IVI website to learn more as well.

 


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JWT’s Future 100 Tells Us Tomorrow Is All About Health

From culture to travel, food and drink to retail and beauty, health will be baked into consumer goods and experiences in 2019.

Welcome to The Future 100: 2019 from The Innovation Group at JWT. In the 100 emerging trends across ten categories, the future is clearly health-driven, according to the tea-leaf readers at JWT.a

  • Health is all over,
  • Culture
  • Tech and innovation
  • Travel and hospitality
  • Brands and marketing
  • Food and drink
  • Beauty
  • Retail
  • Luxury
  • Health (as a category itself)
  • Lifestyle.

I’ve mined this report in previous years – you can review my findings from the 2017 report here in the Health Populi post, Health is Everywhere in 2016.

Among the ten trend-examples in the Health section, I pulled out Healing Cafés here. This speaks to an increased awareness of mental health, recognizing the mass experience/prevalence, the under-supply of professional therapists, and the opportunity to leverage the available supply of public spaces for “recharging and rebalancing in hectic cities,” JWT observes. I’ve experienced an example of this in London at the Frazzled Café which is sponsored by Marks & Spencer, the retailer, and inspired and founded by Ruby Wax. Ruby is a British performer, writer, and all-around lovely human. The Frazzled Café convenes bi-weekly meet-ups in Marks & Spencer Cafés for people throughout the UK, conceived as places where “it’s OK to no be OK.”

In the U.S., HealHaus in Brooklyn offers such a respite. “At HealHaus, we question how we work through the harder topics, not just the easy ones,” the studio’s founder told JWT.

The concept of Healing Cafés is most popular in Asia, where living in very crowded cities is a norm for many people. 

Health Homekits Upgraded is another Health trend to note in the JWT report. This addresses the growing DIY healthcare/self-care concept powered by personalized medicine and technology that helps to scale it. As an example of the trend, JWT talks about tech-enabled fertility programs in the hands of consumers. People order tests online, complete their “homework,” and return samples back to labs. After data are crunched through AI systems and reviewed by medical professionals, the companies develop personalized treatment plans and recommendations. The write-up mentions Thorne Research and Modern Fertility, along with Biem further expanding the market for sexual health testing. “We want to empower people, make them proud of getting tested, and make that become the norm,” Beam founder Bryan Stacy explained to JWT.

JWT also recognizes consumers’ growing embrace of food-as-medicine in the trend Nutritional Snapping. “These apps illustrate the potential for tech to simplify consumers’ paths to optimal well-being,” JWT summarizes. The barrier to food tracking has been lack of simple ways to do it. Increasingly, photographing food and scanning labels is getting easier and more effective to do. JWT features the Pinto app: this tool is built on about 100,000 food products that represent 85% of the top-sellers in the U.S. The platform enables users to identify their preferred eating style (or “food tribe”) — say vegan, paleo, diabetic — and scan products’ nutrition labels to generate a personalized version based on eating style and preferences. For example, a person managing heart disease can identify whether a particular product is high in fat or salt.

The remaining seven Health trends are:

  • Empowering adolescence
  • Rebooting men’s wellness
  • Circadian rhythms
  • Community spas
  • Silence
  • Asia wellbeing wave
  • China health tech.

And you’ll find even more health-related trends blurred throughout the report, such as energy-positive hospitality (part of medical tourism), fitness interfaces, vegan luxury, diagnostic travel, and elemental health experiences, among others. Review the report and you’ll be sure to have some lightbulb moments through your own work and life lenses.

Health Populi’s Hot Points:  In the Tech & Innovation list of ten trends, you’ll find Humanizing Tech. JWT describes this trend as tech brands, “trying to blend in, carving out space in our homes and on our bodies to integrate into everyday life.”

Ultimately, nearly every trend on the JWT Future 100 has a technology-underpinning. Tech can scale services, knowledge, and empowerment, especially for health — the most humanizing sector of all industries (or should be, anyway).

Kudos and thanks to the JWT Innovation Group for giving me another great year of thinker-toys to inspire my own work and world.

The post JWT’s Future 100 Tells Us Tomorrow Is All About Health appeared first on HealthPopuli.com.


JWT’s Future 100 Tells Us Tomorrow Is All About Health posted first on http://dentistfortworth.blogspot.com

Tuesday, 27 November 2018

Medicare, adverse selection and cancer

Conventional wisdom holds that Medicare Advantage provides better service and lower cost sharing than traditional Medicare fee-for-service, and thus is attractive for many people.  However, Medicare Advantage may restrict access to providers and may be less attractive to patients with more severe illnesses.  Healthcare economists, however, do not rely on rumors and stories to make conclusions, we rely on data!

And the results from data analysis is exactly what we have from Lissenden (2018), who looks at Medicare beneficiaries recently diagnosed with cancer:

I estimate that a cancer diagnosis increases the probability a patient will leave a private Medicare plan, for the public plan, by 0.8% points (41%). Similarly, a cancer diagnosis decreases the probability a patient will leave the public Medicare plan, for a private plan, by 0.5% points (16%). The implication is that private Medicare plans are relatively less attractive to cancer patients than they are to noncancer patients.

This study does not look at all serious illnesses, but is one data point that suggests that conventional wisdom may not be totally incorrect.

 


Medicare, adverse selection and cancer posted first on http://dentistfortworth.blogspot.com

Monday, 26 November 2018

Come work with me at PHE

If you are interested in working with me at Precision Health Economics, please apple here.  A job description is below.

Associate Research Scientist – Health Policy

Location: Los Angeles, California US

Job Id: 1357
Los Angeles, California US
Work From Home Available:No
Exempt,Regular Full-time
Division:Precision Value & Health
Business Unit:Precision Health Economics

 

Who we are:
Precision Health Economics has a global reputation for delivering results that have strategic and practical applications, generating academic publications in the world’s top research journals, and leading public debates in prestigious, closely watched forums.

With offices in Austin, Boston, Los Angeles and Oakland, we continue to experience rapid growth and have assembled a team of professionals from around the globe with expertise across multiple disciplines; academics, economists, epidemiologists, medical anthropologists, public health and public policy experts and more—all passionate about producing high quality research for the latest health care medicines and technologies.

We are excited to invite bright, motivated Research Scientists to consider a career with us. Dedicated team members who enjoy a challenge, thrive in the details and flourish in dynamic environments are highly likely to be successful.

Join us to deliver research that focuses on attributes of value that is meaningful to all healthcare constituencies, which leads policymakers and pharmaceutical, biologic and healthcare technology companies worldwide turn to PHE to shape strategy, inform key healthcare decisions, and produce effective changes in public policy through insightful research.

Do you consider yourself a highly organized, self-starter with a real passion for projects involving innovative health economic concepts? Are you passionate about conducting high quality research and are willing to put in the hard work? Do you love to work with real-world data to answer pivotal research questions in the health care industry? Are you a clear and confident communicator among teammates and in front of clients? If you’re a born problem-solver and enjoy when no day is the same – keep reading. Your dream job is waiting.

What you can expect day-to-day:

  • Collaborating across a broad portfolio of sophisticated health economic and health policy research projects.
  • Performing a wide range of activities including: literature reviews; regression analysis; preparing content for reports and manuscripts, slide decks and meeting notes; quality assurance/review; and other activities.

Qualifications:
Minimum required:

  • Master’s degree
  • 1-year experience conducing health economic research

Preferred:

  • Degree concentration in economics, health services research, epidemiology, biostatistics, public policy, health policy, or public health or related
  • Experience with R, Stata or SAS
  • Experience conducting data analysis, especially analysis to identify causal inference

 

Precision Medicine Group is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status or other characteristics protected by law. © 2018 Precision Medicine Group, LLC


Come work with me at PHE posted first on http://dentistfortworth.blogspot.com

When To Be Your Own Dentist

To some, the instruments in a dentist’s office look foreign and obscure. while other people think that, if needed, they could figure out how just about anything works. 

 

However, with most things in density it’s important to leave certain aspects of the practice to the professionals. This clip is a comical parody that follows Mr. Bean’s trip to the dentist. While we hope this series of misfortunate events would never happen in an actual appointment (especially the patient taking the cleaning into their own hands), we do think that this video gives us the perfect opportunity to discuss what dental issues can be handled by the patient and which ones require a professional. So, enjoy this hilarious clip of Mr. Bean and then keep reading for our list of dental issues that you should know what to do about! 

 

Toothache and radiating pain—what’s it mean? 

 

A toothache often comes at the worst time: in the middle of the night, on a holiday or while you’re out of town. For severe toothaches, especially those that that are accompanied by radiating pain through your jaw, it’s important that you seek professional care. 

 

Severe tooth pain could mean you need a root canal before more damage is done to your mouth. However, if you are faced with middle-of-the-night pain and want instant relief, there are home remedies that should help take the edge off. 

 

  • First, try over-the-counter pain relievers if you’re in a pinch. This should provide some instant relief. 
  • In addition to pain relievers, put peppermint leaves in boiling water and let them steep for 20 minutes. After allowing the liquid to cool, swish the peppermint tea around your mouth several times a day. If you have peppermint tea in a bag, the bag can be placed on the effected area to provide similar medicinal benefits. 
  • And finally, if you aren’t opposed to strong flavors (and maybe won’t be breathing on anyone anytime soon), try using garlic, which has been used widely throughout history remedy toothaches. Garlic contains a compound called allicin, which accounts for its powerful antibacterial properties. Crush a fresh glove of garlic and mix with salt, then apply to the affected tooth. 

 

What about swelling? 

 

Any swelling in the mouth is an indicator that you should call your dentist immediately. And while they try to slot you in as soon as possible, there are a couple things you can do at home to try to help relieve the pain in the meantime.  

 

  • First, try a salt water rinse. A good mix is 1/2 teaspoon table salt to 8 ounces of water. Make sure to use warm water and spit the solution out—don’t swallow it. 
  • Also, place a cool compress or a bag of ice on the affected area. This will help numb it as well as receive swelling.  

 

Bleeding or lost tooth and what to do 

 

If you’re suffering severe bleeding from the mouth or have knocked out a tooth, it is important to seek care immediately. If you can’t get the bleeding under control, then it’s time to visit urgent care or an emergency room. In the event you knocked out a tooth, first find the tooth. It is important to try to seek care within the first 30 minutes if you want to be able to save the tooth. And remember, keep it moist in a baggie with saliva or milk. 

 

Don’t try to be your own dentist 

 

Dr. Ku has once again been voted Fort Worth’s #1 dentist by the Star-Tribune, so it’s important to use his skills and expertise instead of relying on what you can research on the internet. Give our office a call today if you are experiencing pain and we will ensure you will have a great visit—unlike that of Mr. Bean!  

The post When To Be Your Own Dentist appeared first on Fort Worth Dentist | 7th Street District | H. Peter Ku, D.D.S. PA.




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Sunday, 25 November 2018

Discrete choice experiments

How have discrete choice experiments changed over time? This is the question Soekhai et al. (2018) try to answer.  They conduct a systematic literature review covering 27 years of data.  Below I summarize some of their findings graphically.

First, you see a trend of an increasing number of DCEs.

We also see that whereas DCEs were previously concentrated in the UK, now DCEs are done all over the world.

The vast majority of DCEs (82%) have between 4-7 attributes, with 39% having 4-5 attributes.

Whereas only 9% of DCE were done online between 1990 and 2000, now 57% of all DCEs are administered through an online approach. Further, the vast majority of studies (83%) present individuals with two choices to consider for each question.

When we examine the type of people who are surveyed, patients are the most likely.

The mean sample size was 728, but the median was 401. Most studies (89%) used a fractional factorial design. Mixed logit (39%) and multinomial logit (39%) were the most common econometric approaches.

For more details, do read the whole article (it is open access!)


Discrete choice experiments posted first on http://dentistfortworth.blogspot.com

Wednesday, 21 November 2018

Be Thankful by Engaging With Grace and Talking About Your End-of-Life Wishes With Loved Ones

thanksgiving-definition-merriam-webster-ppt-png

“Thanksgiving.” Merriam-Webster’s dictionary defines the word, first, as “the act of giving thanks.” Second, it’s “a prayer of expressing gratitude.” And, third, the word means a public acknowledgment or celebration of divine goodness.

We each have our own stories about how a loved one’s life has ended. If we’re lucky, that beloved person had a good death: in sleep, perhaps, or simply of old age with no hospital events or trauma.

Then there are the Rest-of-Us who share family stories and experience of long and painful endings, in institutional settings often coupled with costly, so-called “heroic” but unwanted, futile care.

When you’re already in the situation of making tough health decisions toward the end-of-life, it’s tough, it’s emotional, it’s irrational, it’s energy-draining…and, it’s the wrong time.

Futile care is not a new-new thing. 2400 years ago, Hippocrates counseled clinicians to, “refuse to treat those who are overmastered b y their disease, realizing that in such cases medicine is powerless.”

But love is not.

engage-with-grace-the-one-slideThe right time to have that sensitive, considered, intimate dialogue is now, before that inevitable time comes for decision-making.

The questions at Engage in Grace dot org, shown in the chart of five queries, are a helpful roadmap for inspiring that conversation. Alexandra Drane, Founder of Archangels, Cashier at Walmart, and Co-Founder of the Eliza Corporation, knows all about how to have conversations in health: she’s leveraged technology to innovate such conversations. Engage with Grace is Alex’s long-time mission to inspire these conversations within extended families and tight social networks.

The Thanksgiving meal in America is a time where we are surrounded by the people we love most: family, friends, our close-in communities and social networks. Check out these five simple questions; if you haven’t yet covered these with your tribe, Thanksgiving is a wonderful time to do so.

Remember Merriam-Webster’s definition of the noun and holiday we celebrate in America ever fourth Thursday of November, every year.

If you can’t have this conversation during Thanksgiving week, anytime is the right time to Engage with Grace. Designing your end-of-life strategy, and putting it in a digital form that your caregivers, Powers-of-Attorney, and physicians can access, is the ultimate in consumer-directed health and empowerment.

Health Populi’s Hot Points:  Every year, the day before Thanksgiving, I write this post on the Engage With Grace project and the opportunity to inspire an end-of-life conversation.

The American Thanksgiving occurs on the last Thursday of November each year. This year, the Eve of Thanksgiving coincides with the 55th anniversary of the assassination of President John F. Kennedy. As I think about JFK, whom my parents held in very high esteem, I ponder his words shown in the photo: that, “As we express our gratitude, we must never forget that the highest appreciation, is not to utter words, but to live by them.”

Heeding JFK’s wisdom and recommendation, let us be grateful on this great American holiday. And let us endeavor to be the best community members we can be, mindful of and helpful to our national and global community of brothers and sisters in life….and in death.

We, each of us, has the power to help to make each others’ health.

The post Be Thankful by Engaging With Grace and Talking About Your End-of-Life Wishes With Loved Ones appeared first on HealthPopuli.com.


Be Thankful by Engaging With Grace and Talking About Your End-of-Life Wishes With Loved Ones posted first on http://dentistfortworth.blogspot.com

Tuesday, 20 November 2018

Your reading list


Your reading list posted first on http://dentistfortworth.blogspot.com

Monday, 19 November 2018

Data Privacy and Healthcare Access: Top Issues Shaping Consumers’ Societal ROI

Organizations that address consumers’ data privacy and access to healthcare create greater social brand equity, inspiring people to say nice things about the companies, recommend them as good employers, and be welcomed as businesses operating in peoples’ community.

In The Societal ROI Index: A Measure for The Times We Find Ourselves In, Finn Partners and The Harris Poll measure U.S. companies’ reputations for social good, the project’s press release explains. “Our new data shows that the public has a definite opinion about what issues they feel companies should address and the social impact bar has been set high,” according to Amy Terpeluk, senior partner at Finn Partners.

The Index is based on a survey of 25,800 U.S. adults conducted in December 2017 into January 2018. The Index score runs from a low of 0 to a high of 100.

The Index rests of three pillars: visible values, civic mindedness, and ethical stewardship. Underneath these three factors are attributes including:

  • Exhibiting excellent leadership
  • Maintaining high ethical standards
  • Fairly rewarding employees
  • Behaving responsible toward people in communities where the organization operates
  • Speaking out on societal issues that are important to me
  • Being accountable for actions.

Consumers’ ranking an organization with a high societal ROI sounds like a “nice-to-have” rating. However, there’s a hard return-on-investment for companies that are top performers versus those who rank low. The second graphic shows that top performers compel a consumer to more likely say something positive about the organization; recommend the company as a good place to work; and, welcome the company expanding in the consumer’s community.

The top performing companies fell into grocery, technology, and consumer packaged goods segments. Food retailers fetched particularly high scores on the Index: among the top 20  performers were six grocery chains, plus Amazon for ecommerce. The top grocers included Wegmans, which ranked first on the entire poll for SROI score, followed by Aldi, Publix, HEB, Publix, Whole Foods, and Kroger. The top tech company was Microsoft, and Patagonia the top consumer goods retailer.

Health Populi’s Hot Points:  This poll was released a few days before I was interviewed by Greg Matthews (@Chimoose) for his DataPoint podcast. In planning for our conversation, our intention was to discuss the data elements of the social determinants of health, and challenges in (1) collecting particularly useful and elusive data points from peoples’ everyday lives; and, (2) challenging issues of data privacy.

The week before our dialogue happened was also really bad news for Facebook (hearkening back to the Cambridge Analytica revelation and implications for healthcare), along with the Google/DeepMind story concerning the AI company’s planned “absorption” into Google. Tech stocks were taking a hit on the stock market, and data privacy was once again above-the-fold in newspapers, broadcast media, and social networks.

As we who work at the intersection of health and tech increasingly have to do, based on the pace of change in this converging world, Greg and I pivoted a bit to first contextualize our discussion with the Finn Partners/Harris data: specifically, U.S. consumers’ top priorities of data privacy and healthcare access for valuing societal return-on-investment.

For most of the past decade, I’ve evangelized the evolving role of the patient-as-payor, and the central role of financial wellness in Americans’ everyday lives and household budgets. Healthcare costs have become Americans’ top pocketbook issue.

Now we add data privacy to this mix — call it, “data well-being.” Because people are getting stressed about how their digital data — from retail receipts to gene and lab tests and wearable tech metrics — are being stored, stewarded and secured, and shared with third parties.

The “Trust in platforms” graphic comes from KPMG’s new report, Me, My Life, My Wallet, which examines how consumers around the world make decisions. This snippet focuses in on U.S. consumer data, finding 4 in 5 people use platforms, but only one-fifth of them completely trust the platforms. “In the healthcare sector, patient privacy has always been sacrosanct, but that notion was formed in a world where sensitive information was largely confined to conversations in a doctor’s surgery or behind drawn curtains on a hospital ward,” Mark Britnell KPMG Global Chairman for Healthcare is quoted. Today, “our health is played out across an amalgam of devices, apps, platforms, and companies,” he explains in the report.

Consumers want to control their personal information, and potentially monetize it. After all, if companies are already using personal data-for-profit in their business models, then why shouldn’t “I” financially benefit from that? more people ask.

Furthermore, “If [your insurance company is] offering you two or three times the amount of money that every other insurance company’s offering you, there’s something else they value in the data that they’re giving you that cash for,” NPR quoted Andrew Boyd, the associate chief health information officer at the University of Illinois Hospital. “If Congress ever repeals the Affordable Care Act, insurers could use the fitness data they’re collecting today to deny you coverage based on a medical condition that your tracker picks up,” Boyd warns in NPR’s Shots blog.

So consumers are connecting dots in this Brave New World of health data mashing up with other personal information. And those organizations who respect the consumers’ privacy, and value healthcare as a social right, are garnering more favor with most Americans Finn Partners and Harris Poll folks inform us.

You can link to my conversation with Greg on his DataPoint podcast site here. Please let me know, via comment below, what you think once you’ve listened in on our discussion. The convergence of data privacy, healthcare, and consumers’ rights will only get thornier.

The post Data Privacy and Healthcare Access: Top Issues Shaping Consumers’ Societal ROI appeared first on HealthPopuli.com.


Data Privacy and Healthcare Access: Top Issues Shaping Consumers’ Societal ROI posted first on http://dentistfortworth.blogspot.com

Can single payer systems work?

Much of the discussions of the pros and cons of single payer systems are ideological.  Single payer advocates will say they are fair, potentially can leverage economies of scale, and more equitable.  Single payer opponents will argue that they are inefficient, and restrict choice.

An interesting paper from Tomoki Fuji (2018), shows that the answer isn’t so simple:

We find that private health spending has on average a higher health‐promoting effect than public health spending. This result is robust with respect to the choice of outcome measure and covariates in the regression and driven primarily by the countries with ineffective governments. Once we restrict our sample to countries with effective governments, private health spending is found to be no better than public health spending in improving the health outcome.

In short, on average, government spending is less efficient than private spending.  This should give single payer opponents ammunition that a single payer system is likely to be wasteful.  Single payer advocates will cite that this difference is not found in countries with efficient governments.  Thus, your interpretation of these findings for the U.S. context likely has to do whether your prior belief of whether you think U.S. government is efficient or not.


Can single payer systems work? posted first on http://dentistfortworth.blogspot.com

Thankful In Fort Worth, Texas

With Thanksgiving just hours away, we want to take the time to count our blessings and tell you what we are thankful for this year. Living and working in Fort Worth allows us to be in a community full of loving families, hard-working folks, and people dedicated to the betterment of our home town. We are thrilled Dr. Ku’s office has grown roots here in North Texas and even more humbled that his office was once again voted as the #1 dentist is Fort Worth by the Star Telegram. Read our list of what we are thankful for and make sure to add your own as well! 

 What we’re thankful for this Thanksgiving 2018

Living within local history 

 

Fort Worth, TX commonly calls itself “the city of cowboys and culture.” While those two things seem to contradict each other on the surface, in reality that’s one of the ways Fort Worth exudes a deep-rooted sense of home and welcoming, even for people who are first-time visitors.  

 

We are so thankful to live in a city that is teeming with history and adventure around every corner! Below are some of our favorite places to visit year-round, each of which we’re truly thankful for. 

 

  • Sundance Square is famous for its retail and dining. Grab some hot chocolate this fall and watch as the Square is transformed into a winter wonderland! 
  • Stockyards Museum and Station is located in the historic Livestock Exchange Building and documents the history of the cattle trade and its role in the growth of Fort Worth, from a mere stop along the Chisholm Trail to the center of the ranching, cattle-shipping and meatpacking industries. 
  • Vintage Flying Museum is located at the south end of Meacham International Airport, always open to tour nearly two dozen rare and historic aircraft. Also on display are a dedicated reciprocal and jet engine room, an FAA aviation education resource center, WWII memorabilia and artifacts, and a unique aircraft model exhibit. 

 

Easy escapes to outdoor adventures  

 

This is the perfect time of year to soak in mild temperatures and escape to the outdoors to take in the natural beauty of North Texas. Here are some of our favorite places to get out to in nature: 

 

  • Everyone is a child again at the Fort Worth zoo. With over 540 species represented, there’s always something new to see! 
  • Trinity Park boasts over 40 miles of hiking and biking paths along the river. You’ll also find a duck pond, large playgrounds and a miniature train that’s been running since 1959! 
  • Fort Worth Nature Center is a remarkable park and education center located in Fort Worth, just north of the city limits. The park includes a small herd of bison, a prairie dog city, and alligator residents in the lake. 
  • Did you know you don’t have to head out west to fly-fish? Avid fisherman attest that some of the best fly-fishing is right here in Trinity River! 

 

What we’re most thankful for: each one of you 

 

One of the best things about working, living, and having our practice in Fort Worth is getting to interact with each of you, our patients! We understand that going to the dentist is not the appointment everyone looks forward to. However, we appreciate the joy, positivity, and smiles each of you bring to our office. We are also thankful for the staff at our practice. We work with some of the most professional, talented, and kind people in the area. Their dedication to great service and hospitality are directly related to the success of our office. 

 

We wish each of our patients and their family a Happy Thanksgiving from the team at Dr. Ku’s office! Be sure to connect with us on social media this holiday season! 

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Sunday, 18 November 2018

Positive externalities of Medicaid expansion

From Sen and DeLeire (2018):

…premiums of Marketplace plans are 11% lower in Medicaid expansion states, controlling for demographic and health characteristics as well as measures of health care access. These results are consistent with evidence on the composition of the private insurance risk pool in expansion versus nonexpansion states and associated differences in expected health spending.

Medicaid expansion may make private health insurance more affordable for non-Medicaid eligible middle class individuals, but those same individuals may be paying higher taxes to finance the Medicaid expansion. It would be interesting to predict the net effect of Medicaid expansion on middle class take-home pay after insurance premiums and taxes and how that varies across states. Free study idea for anyone interested.


Positive externalities of Medicaid expansion posted first on http://dentistfortworth.blogspot.com

Friday, 16 November 2018

What is the difference between rate, risk and odds?

Oftentimes, you will ready a study that says, treatment A reduces the rate of something by X%, or the treatment reduces the risk by Y%, or reduces the odds by Z%.  These are basically the same thing, right?

That is not entirely correct.  While all these concepts summarize the frequency or likelihood of something occuring in some way, their exact definition varies.  Below, I provide a list of commonly use measures and what their official definition is.

  • Probability: (# events that occured in a period)/(number of entities eligible).  This number ranges between 0 and 1.  For instance, if I want to know the probability or risk that I get a cold this winter, I will want to count the number of people who lived in my city over that winter and got a cold during the winter and divide that by the total number of people living in my city that winter.
  • Rate(# events that occurred in a period)/(total time period experience by all subjects).  Now consider the case where different people live in my cite different amounts of time.  I could measure the total number of flu cases divided by the total number of days the eligilbe people lived in my city.  Another example would be a health plan that measures the rate at which people are hospitalized.  People often enroll and disenroll in health plans so for a given year, the health plan would count up all the hospitalizations in the year and divide by the total months enrolled of all these people.
  • Relative risk. (probability of outcome in the exposed)/(probability of the outcome in the unexposed).  Let’s go back to my flu example.  Let’s say that kids spread the flu easily.  Assume one did a study where 40% of adults with young children got the flu, but only 20% of adults without young children got the flu.  In this case, the relative risk is 2 (i.e., 40%/20% =2).  A relative risk number can vary between 0 and infinity.
  • Odds: (probability of an outcome)/(1-probability of an outcome). In my flue example, the odds of getting the flue for parents are 40%/(1-40%) = 40%/60% = 2/3, or 0.67:1.  For, adults without young children, the odds are 20%/(1-20%) = 20%/80% = 1/4 or 0.25:1.
  • Odds ratio(Odds of exposed group)/(odds in unexposed group). Back to the flu example, the odds ratio would be (2/3)/(1/4) = (8/12)/(3/12) = 8/3 = 2.67.
  • Risk difference. Risk in exposed group – risk in unexposed group.   For the flu example, this would be 40% – 20% = 20%.  The parents with young kids have a 20 percentage point higher chance of getting the flu.
  • MeanNumber of events/number of observations.

In short, these measures aim to capture similar but not identical concepts.  Relative risk and odds ratios are comparative of two groups, whereas probability, rate, odds and measure the frequency of occurrence within a specific group.


What is the difference between rate, risk and odds? posted first on http://dentistfortworth.blogspot.com

Thursday, 15 November 2018

“Seeing Is Not Believing:” Consumers Concerned About the Accuracy of Online Health Information

“Seeing is not believing” when it comes to people seeing health information on social networks. Four in five people seeking healthcare information online in social media are concerned about the accuracy of that information served up.

Therefore, most consumers a very satisfied with the healthcare information they receive from nurses, eye doctors, pharmacists, dentists, nurse practitioners, doctors, and dietitians.

But social media influencers. patient organizations, online patient forums, and pharmaceutical companies? Not so much. Only one-half of U.S. consumers believe that health-related information on the internet is as reliable as information from medical professionals.

Welcome to The Great American Search for Healthcare Information from Weber Shandwick, a report analyzing consumer survey research into U.S. adults’ use of online search for health information, along with perspectives on the U.S. healthcare system and use of connected health technologies. KRC Research polled 1,700 U.S. adults 18 and over in May-June 2018.

The two sources most-used for seeking health-related information are medical information websites (THINK: WebMD and Sharecare, for example, used by 53% of U.S. adults), and the doctor, used by 48% of people.

Yesterday, I concluded my Health Populi post on a Deloitte study into consumers’ adoption of telecomms and computer technology discussing a crucial health M.O.: that trust underpins peoples’ health engagement, and more people trust health professionals than advertising execs, pharma CEOs, or members of Congress. This insight was brought to you by the annual Gallup Poll on honesty and ethics in U.S. professions, the latest of which is discussed here in Health Populi.

Weber Shandwick’s survey on The Great American Search found that a plurality of U.S. consumers question the integrity and accuracy of healthcare information found online. This is true across generations — not just Boomers or Silent Generation folks who may interact less often in social networks, nor substantially more acute among younger people who are more active on social media.

Health Populi’s Hot Points:  For every action there’s an equal, opposite reaction, it’s said – in this case, that reaction is family physicians’ response to, “patients reading online then getting in line,” quips a Merck Manuals’ survey on what family docs think about online information’s impact on patients. Here’s what they think:

  • 60% of doctors said patients are coming into the office more frequently based on what they read about symptoms online
  • 79% of doctors believe patients are more likely to question doctors’ diagnoses
  • 97% of doctors say patients are coming into the office with mis-information.

This latter point is in line with the Weber Shandwick finding that a plethora of patients believe there’s a lot of inaccurate health information online.

The solution? One physician interviewed in the survey said this: “We run into problems when patients go to online sources that aren’t evidence-based medicine. But patients aren’t going to stop looking up their symptoms on the Internet, so it’s up to physicians to direct them to trusted sources.”

This (intelligent) insight prompts the opportunity for organizations to crowdsource apps, tools, and websites based on the channels and sources they’ve vetted for their own patients, and sharing these with colleagues within health systems. Another tack is to create an “app-script” store, akin to iTunes, to which clinicians can refer patients for uploading trusted and evidence-based apps to track, say, nutrition, mood, medication adherence, and other applications. Here’s a link to the UK National Health Service NHS Apps Library which serves that purpose. Finally, physicians can, literally, prescribe a portal to patient as a sort of information therapy script. This concept goes back to the mid-1990s (when I was still a student). Then, the info-therapy might have taken the form of a Xerox’ed article from a medical journal. Today, that e-script could be communicated by doctor, pharmacist, nurse, or other health care professional via a text message sent with a Medscape or JAMA article, or a recipe emailed (via HIPAA-compliant secure portal, of course) from a dietitian’s website.

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November Health Wonk Review

Lisa Lines of The Medical Care Blog hosts this month’s edition of the Health Wonk Review.  Lisa blogs from San Diego as she is attending the American Public Health Association annual meeting.  The HWR edition talks about HRRP, income eligibility for the health insurance exchanges, pharmacists as providers, Medicaid expansion and many other topics.

Check it out!


November Health Wonk Review posted first on http://dentistfortworth.blogspot.com

The Smartphone Is the Consumer’s Personal Health Platform – Implications from Deloitte’s 2018 Survey

  American consumers are now viewing their phones an average of 52 times daily, with 39 percent of consumers believing they use their smartphones too much. In fact, 60 percent of 18 to 34-year-olds admit to smartphone overuse, the highest level of any age group. However, 63 percent of the respondents reported trying to limit their smartphone usage, roughly half succeeding in cutting back. Smartphones also are helping blur the lines between work and leisure with 70 percent of respondents using personal smartphones at least occasionally for after-hours work.

Furthermore, voice technologies are “making noise,” according to Deloitte in A New Era in Mobile Continues, the 2018 Global Mobile Consumer Survey: US Edition.

I’ve mined the US data of this global survey to divine insights for health/care. First and foremost among these is the growth of smartphone adoption across all age groups. Quite recently, health-tech app developers were frustrated by lack of smartphone penetration among older people — lots of the very folks who could benefit from self-tracking data that can be useful for managing chronic conditions. Eight in 10 people 65 and older have multiple chronic conditions, and 50% of people 45-64 do, as well.  which 1 in 2 U.S. adults over 55 manage. [I discussed that important public health/economic challenge here in Health Populi from a RAND report.].

Note in the first bar chart that in 2018, 89% of those 45-54 and 74% of people 55 and over have “ready access” to a smartphone. That’s one barrier overcome to get smartphone health apps into the hands of people dealing with the many tasks involved with managing chronic disease. It’s not the only barrier, and not a panacea; but it’s an important one in terms of a potential on-ramp to self-health tools.

Now look at the second chart: this inventories consumers’ interests in using different technology devices for various online activities. You’ll see a lot of blue fill signifying peoples’ preference for using a phone for these various tasks — from checking social networks to reading the news and watching short videos. Only people over 65 prefer desktop computers for a few of these tasks, otherwise the phone dominates the task-map.

A third data point Deloitte raises that are germane to healthcare deals with privacy and consumers’ concerns about how companies treat personal data. This study found that most Americans are fairly or very concerned about sharing their data with companies, as well as how companies use and store consumers’ personal data. This gets to transparency, regarding how these companies communicate privacy policies to users; and, for health care, this speaks to patients’ concerns about their healthcare privacy. Many personal information flows don’t fall under the HIPAA umbrella if the company isn’t a business associate.

Furthermore, this week Google made news about how it will absorb the DeepMind AI business into the larger Google Health unit. Some analysts and privacy lawyers question how Google will handle patients’ (assumed private) health data, a volatile question for the UK’s National Health Service as I draft this post.

The growth of wearable devices, a fourth data point in the Deloitte report, relates to consumer-generated data that can be very useful for health (privacy aside for now).

In 2018, one in five U.S. consumers used a fitness band, 14% a smartwatch, and 8% a virtual reality (VR) headset, shown in the third chart. Note the ten percent decline in use of fitness bands. This may be due to marginally more consumers using phones for tracking activities as the phones get better equipped with smarter sensors with more utility. Mic Locker, managing director in Deloitte’s  Technology, Media & Telecommunications practice, noted a bright spot for wearables: that daily usage is growing for owners of fitness bands and smartwatches. So those who continue to use these devices are doing so more regularly.

The uptick in smartwatches may be due to their tighter integration with smartphones, boosting utility and value, Locker wrote me. On the other hand, fitness band adoption may be slipping due to consumers’ greater use of both smartwatches integrating fitness features and greater use of phones for health applications.

Health Populi’s Hot Points:  A new study from Weber Shandwick and KRC asked a question that speaks to consumers’ trust and willingness to engage with different sources of health information. The bottom-line, no surprise to those of us who annually follow the Gallup Poll on Americans’ perceptions of the most honest and ethical professions: that most U.S. adults are most satisfied with healthcare information they receive through nurses and physician’s assistants, as well as eye doctors, pharmacists, dentists, nurse practitioners, doctors, and dietitians/nutritionists.

These are the clinical professionals who spend the most time with patients. They are licensed, trained, and tested for service. They are, in my evolving concept of the health/care ecosystem, retail health’s front-line workers.

As digital health tools continue to be developed to go direct-to-consumer/patient, people will still look to the trusted human touchpoints in their personal health ecosystems for counsel and support. Some people will want or need a quick session on how to use a mobile app. Some patients will rely on videos, Khan Academy-style, for their DIYhealth tutoring. Other patients will look to clinicians to “prescribe” or otherwise recommend specific applications, some of which will be covered or subsidized by payors or health plans.

I’ll dive more deeply into the Weber Shandwick data tomorrow. In the meantime, Deloitte reminds us that the smartphone is most peoples’ personal health platform. This is something that Dr. John Mattison, Kaiser Permanente’s Chief Health Information Officer, taught me many years ago. Now, his forecast is mainstream.

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Wednesday, 14 November 2018

The Placebo Effect

The placebo effect is well-known in medicine.

Give people a sugar pill, they have shown, and those patients — especially if they have one of the chronic, stress-related conditions that register the strongest placebo effects and if the treatment is delivered by someone in whom they have confidence — will improve. Tell someone a normal milkshake is a diet beverage, and his gut will respond as if the drink were low fat. Take athletes to the top of the Alps, put them on exercise machines and hook them to an oxygen tank, and they will perform better than when they are breathing room air — even if room air is all that’s in the tank. Wake a patient from surgery and tell him you’ve done an arthroscopic repair, and his knee gets better even if all you did was knock him out and put a couple of incisions in his skin. Give a drug a fancy name, and it works better than if you don’t.

Placebos are frequently used in randomized controlled trials to assure that new drugs work better than these sham medicines.  But are these placebos really shams?  They do after all work.  The point of doing these trials is to show that new drugs work better than placebos.

But should physicians be actively prescribing placebos?  The N.Y. Times has an interesting article on the topic of placebos. Although physicians would like to claim placebos are never used, having fancy hospitals, physician betside manner, and other ritualistic events do improve a treatment’s efficacy than say buying it at the local 99 cents store. The N.Y. Times writes of Ted Kaptchuk who believes that:

…rituals embedded in the doctor-patient encounter…are fundamental to the placebo effect, and…embody an aspect of medicine that has disappeared as scientists and doctors pursue the course laid by Franklin’s commission.

Kaptchuk also writes:

Rituals trigger specific neurobiological pathways that specifically modulate bodily sensations, symptoms and emotions,” he wrote. “It seems that if the mind can be persuaded, the body can sometimes act accordingly.

For instance, there are numerous stories of patient health improvements after acupuncture, many of which may be due to a very strong placebo effect.

If placebos work, however, should physicians prescribe them?  The problem is, that placebos are more likely to work if physicians believe in them and convince the patient that they are effective therapy.  If physicians do not disclose this information, however, the patient-physician trust relationship may be suffer. Short-run gains in the placebo effect may result in long-run smaller placebo effects if patients are less likely to trust their physician.

I am not a physician but clearly the interaction between, medicine and ritual does play an important role in treatment effectiveness.  Quantifying the importance of ritual, however, is often difficult.


The Placebo Effect posted first on http://dentistfortworth.blogspot.com

Tuesday, 13 November 2018

The Venture Valkyrie’s Next AdVenture

Investor, advisor, operator, podcaster, blogger, speaker, Board member, mentor, mother, wife, volunteer. Take inventory of the many hats of Lisa Suennen, aka the Venture Valkyrie, and you understand why I see her as the Renaissance Woman of Healthcare. Ron Popeil couldn’t incorporate this many features into a contraption – yes, she slices and dices healthcare and technology, places bets on the best of them, and she deploys a whole lot more tools in her Mary Poppins-rich toolbox.

Two months ago, Lisa announced she was leaving GE Ventures, where she was Senior Managing Director, to do something new. This week, she announced that she was putting on her “big boots,” under the umbrella of Manatt Health.

First, let’s talk about those many hats that Lisa wears. Lisa comes by her technology savvy through DNA, I believe: her father developed and held many patents and was a serial entrepreneur. Lisa was born not far from the homes of inventors Albert Einstein and Thomas Edison, in Princeton, NJ. The family moved to California where Dad launched his invention of the first real-time ultrasound machine and  expanded his technology research and innovation work. So the apple didn’t fall too far from the paternal tree.

While she’s best-known for being a very visible woman in health-technology investing and building venture funds, Lisa is social media savvy well beyond the profiles of those in her tech-investing peer group. Lisa started the Venture Valkyrie blog in 2010. The Tech-Tonics podcast, co-hosted with David Shaywitz, was an early entrant into that medium, launching in 2015 (today, podcasts in healthcare are multiplying like rabbits). You would get smarter by mining the archive of TechTonics: so many hours of insightful (and funny!) conversations from which to learn. These co-hosts are pictured here, donning their jerseys of personal sports passion.

Lisa is a mentor, both out-and-proudly and quietly, too. Long understanding and experiencing life as a woman in tech in Silicon Valley, well before media covered stories and #MeToo emerged, Lisa co-founded CSweetener. The organization matches women healthcare leaders to mentors, a supportive clearinghouse to help grow and empower women in tech. CSweetener also curates a Speakers Bureau to help alleviate the ongoing challenge of “manels” (men on panels) at technology meetings.

Lisa’s also a frequent public speaker, in both the U.S. and globally. In the past few months, she’s traveled to Australia and Ireland, for example, to spread her knowledge about digital health and technology to healthcare providers, investors, and innovators. A few weeks ago, I met with the Dublin-based team of HealthXL, where Lisa sits on the Board. The group waxed lyrically about Lisa’s involvement and important voice and energy supporting their important efforts to bolster innovation in health, globally.

I spent time with Lisa on the phone this week, she from her home base of Silicon Valley and me at mine on the east coast. In full transparency, I was aware that Lisa had the option of selecting from a broad range of opportunities for this next professional step. I asked her, among this rich trove of possible futures, “Why Manatt?”

She synthesized the many reasons into one over-arching response: joining Manatt would afford her, she said, “the opportunity to combine the familiar with the new, and do it in a setting that provides many degrees of freedom.”

Manatt has offices around the U.S., and so gives Lisa the geographic bandwidth to explore and inform healthcare from coast-to-coast. Manatt has operations in Albany (NY), Chicago, Los Angeles, New York, Orange County (CA), Palo Alto, Sacramento, San Francisco, and Washington, DC. And now, Mill Valley, CA.

A recent article in the American Lawyer discussed Manatt’s evolving business model and portfolio of services, moving from a law firm to an integrated health advisory organization. Lisa will be part of this ongoing evolution of Manatt as a professional services firm across many industries from healthcare to financial services, music and media — with a venture fund in the mix, as well, an important aspect of Lisa’s job description in the firm.

In my own work forecasting healthcare, I do 1:3:5 year snapshots, with the 5 years more of a scenario planning exercise than a straight line projection given tech, social, political and wild card uncertainties across our health/care ecosystem.

For the many year’s I’ve known Lisa, one of my personal asks has been to help inform my own advisory work — especially, in forecasting the future of healthcare. Lisa’s eyes see business plans for health/care innovations that are often pre-minimum viable product stage. So I asked Lisa, given that I’ll be writing the 2019 Health Populi Trendcast in a matter of weeks. What does she see achieving serious growth on the health care and technology front over the next 3 to 5 years? Four key areas are in her radar:

  • Voice as user interface, as a tool to free doctors from computer screens, provide older people access to things they don’t have, and enable simple queries for parents. “Voice is a big democratizer,” Lisa believes. “Alexa et. al. can speak in multiple languages.”
  • IoT (Internet of Things), Lisa foresees, will feature sensors in “everything:” medical devices, products, medications, among them. We’ll also see more and more connected health data in the IoT ecosystem for different applications.
  • AI will have more health-evidence supporting its adoption, perhaps, she expects, the first AI-developed FDA approved drug, Lisa expects.
  • Another key development to watch: the massive vertical integration going on among the various stakeholders in healthcare across providers, payors, tech, medtech and pharma. (THINK: CVS + Aetna, Apple aligning with LabCorp and Quest, and Walmart potentially purchasing a health plan).

Finally, we discussed the next phase of her career — what’s most exciting?

“Reconnecting with my love of growing and building things,” Lisa confessed. “I haven’t been doing that for a while. While I’ve been helping other organizations build and grow from the sidelines. I can now enjoy being back to owning something. It’s energizing!”

For more on the Renaissance of the Renaissance Woman in health care, you can read Lisa’s personal announcement on her must-read Venture Valkyrie blog. Here’s also a terrific profile in STAT on Lisa, titled, “The gatekeeper: If you want to make it big in health care, it’ll help to get past Lisa Suennen first.”

Health Populi’s Hot Points: Kudos to Mannatt for recognizing that Lisa Suennen wears many hats in and beyond healthcare. She’s forged a role with the firm that incorporates and leverages so many of her skills, interests, and experiences. The company demonstrates a lot of savvy and prescience for doing so. And, if any one person can help make healthcare better, it’s the great Venture Valkyrie.

Yes, she’s my friend. But she’s a brilliant colleague and valued healthcare-whisperer, which is how I got to learn about and value, first-hand, her many professional gifts.

I am all health/care, all the time in my work and in daily living. ‘Tis the season of forecasts and wishes in my world. My forecast and wish for Lisa and the Manatt family: Be well, Prosper, and Keep Building Health. I believe you will.

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Monday, 12 November 2018

The Growing State of Diabetes in America on World Diabetes Day 2018

Diabetes is a family issue, and its prevalence is growing in America. November 14, 2018, is World Diabetes Day, and the International Diabetes Federation reminds us that this condition impacts the whole household — not just the person diagnosed with diabetes.

Why the family? Because diabetes is one disease that is largely preventable: through eating right, being physically active, and making healthy choices every day. The family is the primary ecosystem for daily living, and this environment can foster an individual’s healthy choices…or not.

The IDF reminds us that family members can and should be aware of the signs and symptoms of diabetes that can help detect the condition sooner rather than later.

Diabetes is also a family issue because the condition can significantly impact household finance. Nearly one-half of U.S. patients have skipped insulin doses or monitoring due to costs, an Upwell Health survey found. The rising cost of insulin has garnered a lot of media coverage: this JAMA article pointed out that insulin prices skyrocketed over ten years. Here’s a sobering example of the ultimate cost of self-rationing insulin due to cost: the death of a young man who did exactly that, featured in this STAT story about the role of financial health contributing to this patient’s ultimate mortality. The Endocrine Society has made recommendations for legislation that would ensure greater transparency over insulin pricing.

The rising costs of caring for diabetes haven’t yet significantly changed personal behavior relative to the key risks for Type 2 diabetes amenable to change: food intake and exercise.

The prevalence of diabetes in the U.S. increased in 18 states over ten years, and didn’t decrease in any, the map illustrates. The state of diabetes in America is gauged in the latest Gallup-Sharecare Wellbeing Index, which found that five of these states had at least two percentage point increases: West Virginia, Louisiana, Hawaii, Rhode Island, and South Carolina. West Virginia had a 17.9% prevalence rate, South Carolina 15.1%, Mississippi 14.8%, and Kentucky and Louisiana 14.4%. States with the lowest rates of diabetes include Alaska, Colorado, Montana, New Hampshire, Utah, and Vermont, all under 9% prevalence rate.

Obesity rates rose in 34 of the 50 states over the past decade, shown in the second map from the Gallup-Sharecare study. Obesity underpins these rates of diabetes: obesity can quadruple the odds of a person being diagnosed with Type 2 diabetes. Last year, Gallup-Sharecare said that, “Obese adults between the ages of 25 and 64 are at least four times more likely to have been diagnosed with diabetes than those who are normal weight.”

Gallup noted, in its companion report on the rise of diabetes in America, that communities, businesses and schools can play important roles in helping to reduce the risk factors of Type 2 diabetes. Since inactivity is a major risk factor, towns can plan and implement bike paths and safe places for walking in “active transportation” modes. Parks and green spaces also encourage movement, and have “strong inverse relationships” to both diabetes and obesity.

Business cross-industry is a key stakeholder in bending the diabetes prevalence curve. Grocery stores that offer healthy cooking classes and store tours that teach how to read food labels can help in the effort to drive healthy communities. The restaurant industry is also heeding the better-for-you wellness consumer trend: Panera recently announced its Food Interrupted campaign seeking to, “change food systems from the inside out.” Thus far, Panera has developed videos on sugar, eggs, and meat quality and provenance for food system sustainability and human health outcomes.

Businesses as employers, too, can better equip on-site cafeterias with healthier food options, and nudge people toward more active lifestyles through artful health benefit design.

 

Health Populi’s Hot Points:  Remember that, “Food has become the main driver of human health costs,” the Food Tank editor writes this week commemorating World Diabetes Day 2018.

One of the largest U.S. exports is America’s food-eating ethos. “If we start with global dietary patterns, we know they are shifting towards the U.S. model of high meat and high calorie consumption, coupled with low fruit and vegetable consumption,” Dr. Michael Hamm, Founding Director of the Michigan State University Center for Regional Food Systems told Food Tank.

As the U.S. continues to wrestle with the high costs of healthcare, preventing and managing Type 2 diabetes has a high DIY component: people who feel empowered and activated in health can do better to manage the condition once-diagnosed, or be mindful to prevent the onset of T2D if diagnosed with pre-diabetes.

Hearkening back to the IDF’s 2018 theme of the role of the family, it’s important to realize that families who eat together are healthier, as this TIME magazine article spelled out based on research evidence. A team of Rutgers researchers did a meta-analysis of 68 studies, connecting dots between family meals and weight gain. They learned that,

  • Children who has more meals together with their families tended to eat more fruits, vegetables, fiber, calcium-rich foods, and vitamins, and ate less junk food
  • Teens who ate with families were less likely to have signs of depression and feel families were more supportive compared with teens who dined less at home
  • Children in families who frequently shared meals had lower BMIs than young people who did not.

Tune into the Food Tank Inaugural San Diego Summit on Wednesday 14 November to hear about the true cost of food, connecting to sustainability and holistic health – from farm to fork to disposal to the circular economy. your work towards a more sustainable food system for all? Please share your thoughts, concerns, or questions in the comments. You can attend the live stream here on FoodTank.com and Food Tank’s Facebook Live page.

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