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The Promise of Digital Health and the Privacy Perils – HealthConsuming Explains, Part 4

The supply side of digital health tools and tech is growing at a hockey-stick pace. There are mobile apps and remote health monitors, digital therapeutics and wearable tech from head-to-toe. Today in America, electronic health records (EHRs) are implemented in most physician offices and virtually all hospitals. Chapter 5 of my book, HealthConsuming: From Health Consumer to Health Citizen, details the promise of digital health: wearable, shareable and virtual.

Today, we can also call on Alexa to remind us to take medications, play nostalgic music when we are lonely, check our physical activity status with Fitbit, and query WebMD about a symptom. Just last month, Amazon announced HIPAA-compliant privacy bundled into Alexa skills with Atrium Health, Boston Children’s Hospital, CIGNA, ExpressScripts, Livongo, and Swedish Health Connect.

Broadband connectivity, cloud computing, data analytics and well-conceived artificial intelligence (AI) enable the use of data generated from digital health tools to benefit our health. Increasingly, as connectivity gets to each of us wherever we live, work, play, and learn, and sensors shrink and lower in cost, we can do more self-care at home and in lower-cost venues to help bend that stubborn medical cost curve. This is a health economist’s Holy Grail, and my vision for the home-as-health-hub which is my end-image in HealthConsuming.

As I walk the miles of aisles at the annual CES, I track ten technology categories that can support this paradigm, covering more mature digital health tech like WiFi weight scales and personal emergency response systems to the growing Internet of Things ecosystem for smart and connected homes and cars, an emerging third space for health that Honda, Mercedes, Toyota, et. al., are concepting, which I wrote about back in 2007 focusing on Toyota’s wellness car concept.

Promising, promising.

With every one of these digital health encounters, from Alexa to Zipongo, a bit of data is created. It’s personal stuff, and it’s a tiny little bit about “you.”

All that digital dust can be collected, mashed up and built into a personal profile for your benefit, or for other reasons. The graphic is based on work done by Juhan Sonin of GoInvo, a group that does brilliant work on health data design that’s vigilantly people-focused. GoInvo has been working for a long time on how to communicate health and healthcare data in enchanting ways.

Juhan and another person first shaped my views converging the promise of digital health data through enchanting design, and the perils of Big Data algorithms. Juhan for the former lightbulb moment; and for the latter, Fred Trotter. I interviewed Fred for research I was conducted on behalf of the California HealthCare Foundation (CHCF) in 2014.

For CHCF that year, I wrote Here’s Looking at You: How Personal Health Information is Being Tracked and Used, I took cues from a 60 Minutes‘ profile of third-party data brokers and Latanya Sweeney’s groundbreaking research at the Harvard Privacy Lab. Latanya found that just a few data points — which fell out of HIPAA-privacy protected flows — could re-identify a person with, say, HIV positive status, a mental health DSM-code, or degenerative disease.

Five years later, patients still share their personal health information on Facebook groups, with the promise of crowdsourcing cures, accessing support and advice, and finding community.

As a WEGO Health poll of patient activists found in April 2019, patients continue to share this very intimate data, even in the wake of the Facebook/Cambridge Analytica story, growing cybersecurity breaches of medical data, and a challenging environment for trust and “fake news” for health care.

In researching the thorny privacy issues for HealthConsuming,. I learned the phrase “a concerned embrace of technology” from Deloitte’s 2017 survey of U.S. mobile consumers. Deloitte found that 80% of consumers believed that companies were using their personal data and that their data wsa being shaerd with third parties. But people were williong to share “some” online data (like name or email address), less willing to share health metrics using a phone or wearable device — only 7% of people willing to do that in 2017 based on this poll.

So “concerned embrace” for health means that trust is the enabling bridge between digital health connections and peoples’ willingness to share data — underpinned by stronger privacy protections and true data ownership for each person. Through that ownership and control, people could monetize their own data and treat it as the personal asset it truly is.

This is the plotline between HealthConsuming‘s Chapter 5 on the promise of “Digital Health: Wearable, Shareable, Virtual” and Chapter 6 on “Privacy and Health Data In-Security.”

Tomorrow will be my fifth and final post in this week’s series outlining HeatlhConsuming: From Health Consumer to Health Citizen, focusing on the last two words in the title. Can and will Americans take on the role of health citizens, with health care access as a civil right and full privacy protections, coupled with the responsibilities for self-care and health engagement, and the civic responsibility to vote and engage in civil discourse? We’ll round out this journey in tomorrow’s Health Populi.

That’s the argument for health citizenship, our topic for tomorrow’s #5 of five posts plotlining HealthConsuming: From Health Consumer to Health Citizen, all this week in the Health Populi blog.

The post The Promise of Digital Health and the Privacy Perils – HealthConsuming Explains, Part 4 appeared first on HealthPopuli.com.

Article source:Health Populi

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Why Are We Complicit? A Narrative for Our Era

Why are seemingly good people complicit with bad things?  In health care, we have seen seemingly good health care professionals and academics silent in the face of manipulation and suppression of clinical research; deception, attacks on free speech and the press, silencing of whistleblowers;  conflicts of interest; ill-informed, incompetent, self-interested leadership; and outright corruption and Article source:Health Care Renewal

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What We Know We Know About ZIP Codes, Food, and Deaths of Despair – HealthConsuming Explains, Part 3

“There’s a 15-year difference in the life expectancy between the richest and poorest Americans.” That’s the first sentence of Chapter 7 in my book, HealthConsuming: From Health Consumer to Health Citizen.

This data point comes from research published in JAMA in April 2016 on the association between income and life expectancy in the U.S. (That’s endnote #399 in the back of the book, one of 519 notes I use to support the plotline).

Today, the Brookings Institution convened a meeting on the funding for social determinants of health to address disparities, costs, and quality of healthcare in America. The overall theme is about building healthy neighborhoods through cultures of health with touchpoints of housing, nursing and local health workers, public libraries, grocery stores, schools, “third places” (beyond home and work, like a retail store for mental health meet-ups or online social networks) and, indeed, hospitals that bolster community health.

Chapter 7 of my book, HealthConsuming: From Health Consumer to Health Citizen, is titled, “ZIP Codes, Genetic Codes, Food and Health.” The plot begins with the importance of “place,” our personal physical geographies and what they portend for our individual health — beyond our genetic code and inherited health risks. As the JAMA article notes, “The differences in life expectancy were correlated with health behaviors and local area characteristics.”

This graphic on SDoH comes out of the book, illustrating the many external factors that influence personal and community health: among them, food, job security, education, environment (think: clean air if you live in ___, clean water if you live in Flint, Michigan), job and income security, and safe and green spaces among them. While not traditionally called out as a social determinant, I’ve added in broadband connectivity (with net neutrality baked in) as an influence on health and wellness, as well.

To introduce the ideas in each chapter of the book, I ask big hairy “What If?” questions that I endeavor to answer. Here, I wonder, “What if… America reduced health disparities, increased health equity, and our ZIP codes didn’t determine our health outcomes and life expectancy?”

The shocking reversal of life expectancy in the U.S. has been termed the “deaths of despair” by the brilliant researchers Anne Case and Sir Angus Deaton who are based at Princeton University. Their latest work on the phenomenon has revealed the role that (less) education plays as a risk factor for shorter lifespans, which I discuss in HealthConsuming as a tragic feature in U.S. public  health — uniquely American versus the rest of the developed world. Opioids and social isolation (read the book Bowling Alone for more insights) contribute to this reversal-of-longevity.

“There is mounting evidence that some of these [SDoH] initiatives are associated with improved health outcomes and reduced health care utilization,” a report from Deloitte asserted in a new report on social determinants of health published this week. The growth of public sector incentives in Medicare for social supports, and growth of value-based payment in commercial plans, are forces nudging health care providers  toward bundling SDoH services into targeted programs. The graphic from the Deloitte study illustrates a few of those strategies, including multi-tasking social needs, referring people to services with high-touch, partnering in the community with service providers, and monitoring and tweaking the SDoH interventions in a continuous-improvement mode.

This seventh of eight chapters of HealthConsuming concludes: “Our communities are our local health ecosystems. Centuries’ worth of evidence, from Hippocrates in Athens, Greece to Geisinger Medical Center in Danville, PA, shows us that how we live, the daily choices we make or are constrained from making, and the built and natural environments we live in shape our health well beyond the local doctor and hospital do.”

As U.S. policymakers are in the throes of designing an infrastructure bill allocating $trillions of taxpayer dollars, they should be mindful of “baking” social determinants of health into the plans. This concept is recommended in the last chapter of HealthConsuming as the plot moves to the question of whether health consumers will emerge as health citizens in America.

Tomorrow, we’ll focus on the promise of digital health and the perils of privacy. Digital platforms and tools can help scale social determinants to people who need services. But without privacy protections that address our current reality of how we live and share online, the best-designed technology won’t be effective, or worse…could exacerbate already-challenged health outcomes and disparities.

The post What We Know We Know About ZIP Codes, Food, and Deaths of Despair – HealthConsuming Explains, Part 3 appeared first on HealthPopuli.com.

Article source:Health Populi

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Health Consumers Are Now Amazon-Primed for Healthcare – HealthConsuming Explains, Part 2

As patients now assume the role of health consumer, they rationally expect retail-level experiences with greater first-dollar payment for health insurance, health care services and medical products like prescription drugs.

Consumers know what good retail looks and feels like, and are focusing that experiential lens on health care, Aflac found when their Workforces Survey polled Americans on what they’d like their health insurance shopping process to feel like. One in two people said, “like Amazon,” and another 20% of folks said, “like retail.”

Chapter 3 of HealthConsuming is titled, “How Amazon Has Primed Health Consumers,” and explains this re-shaping of patient expectations. Here’s one of my paragraphs from the chapter, noting that, “Health consumers are hungry for Amazon’s brand of transparency, convenience, and streamlined interactions for medical care. The Amazon Prime-ing of the U.S. consumer has raised peoples’ expectations of what health care services could be: personalized, customized, anticipatory, immediate or on-schedule, and convenient – where we live, work, play, pray, learn and even drive.”

People trust Amazon for daily retail experiences. The bar chart from research by Market Strategies shows that a plurality of consumers also trusts Amazon to try on for healthcare products and services. The company has been multi-tasking a broad range of tactics throughout the health care ecosystem. Every publicly traded market segment Amazon has touched has had moments of shattering stock prices.

In the past couple of months, Amazon announced many health-related plans and developments, including:

Accepting medical and health savings accounts (HSAs) to pay for consumer health products like over-the-counter drugs.

Developing Alexa-skills that are HIPAA-compliant to bolster users’ personal health information privacy collaborating with Atrium Health, Boston Children’s Hospital, CIGNA, Express Scripts, Livongo Health, and Providence St. Joseph Health. In each instance, the developer organizations see voice as the next frontier for conveniently accessing health care services.

Marketing PillPack, the subscription prescription drug service, to consumers, with the subtext that this may be Amazon Prime-eligible.

Naming the Amazon-JPM-Berkshire Hathaway venture in health care organization “Haven,” and announcing plans to hire staff in New York City.

Expanding Alexa skills to join the growing tele-mental health supply side.

Launching a private label skin care line, Belei, covered in Allure magazine here. (The name is a combo of “believe” and “beauty,” and the disruptive ingredient with this beauty brand is that no product exceeds $40.

Jim Cramer of CNBC’s Mad Money has been studying up on digital health, recently recommending that Apple buy Epic, the health IT behemoth. (See more on that recommendation, and subsequent social media frenzy, here on Health Populi). This month, he recommended that companies and investors need to study Amazon as a sort of “Death Star” in how the company re-defines industries — whether movies or music, retail or….health care.

For health consumers, Amazon’s multi-tasking efforts are re-shaping health care service delivery and channeling.

Most importantly, in this immediate moment, Amazon has re-shaped patients as health consumers — our expectations for what is possible in health care delivery, price transparency, peer-to-peer advice, and convenience.

In tomorrow’s Health Populi, we’ll dive into a third key theme in HealthConsuming: that’s what we know-we-know about ZIP codes, food, deaths of despair, and the social determinants of health. Where we live portends how healthy we are…and why spending on social care is key to addressing health and longer life spans…the personal health version of surviving a death star.

On Thursday, my post will raise Amazon’s role in health/care again, looking more deeply into the promise of digital health and the perils of privacy for health, retail, and other personal data. Amazon isn’t just about convenient delivery of health care “things.” It’s about the data generated by those transactions, which help to construct profiles on you and me. Using such profiles can be very helpful for health, if that’s the intent of the data-miner. But as the Financial Times pointed out today in an op-ed written by its editorial board, “Platform companies from Amazon to Google to Apple are getting deep into the healthcare field, allowing us to do everything from communicate with doctors to check on prescriptions. The privacy implications are troubling….they are [also] surveilling consumers at the same time — gathering, analysing and, in many cases, selling sensitive data. In many countries, personal healthcare data are subject to strict regulation. In the US, the Health Insurance Portability and Accountability Act (HIPAA) imposes criminal and civil penalties for breaching confidentiality of healthcare data. But the rules apply only to entities covered by HIPAA such as healthcare plans and providers, or clearing houses that process healthcare claims.”

Stay tuned to tomorrow’s post, on social determinants of health and social spending. By Friday, the dots will converge on the topic of morphing from health consumers to health citizens.

The post Health Consumers Are Now Amazon-Primed for Healthcare – HealthConsuming Explains, Part 2 appeared first on HealthPopuli.com.

Article source:Health Populi

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Remedy Partners founder Steve Wiggins explains why he’s high on bundled payments (podcast)

https://healthbusinessgroup.com/wp-content/uploads/2019/04/Wiggins-4_22_19-9.36-PM-4.mp3

Remedy Partners founder Steve Wiggins

Steve Wiggins has seen a thing or two in his more than three decades as a healthcare entrepreneur. His Oxford Health Plans introduced “pods,” a precursor of the Accountable Care Organization and he led HealthMarket, an early player in the consumer directed health plan space. He’s carried the same themes into his current  role as founder and Chairman of Remedy Partners, the leader in Medicare’s Bundled Payments for Care Initiative (BPCI).

As you’ll hear in this podcast, Steve’s a big believer in bundles, offering them as a proven solution for a large portion of the healthcare dollar, within almost any healthcare financing framework from traditional commercial coverage to Medicare for All.

Here’s what we discussed:

(0:18) What is a bundled payment? How does it relate to other new approaches like ACOs?

(3:05) Did bundled payments start in Medicare rather than the private sector? If so, why?

(6:52) How well has BPCI worked? What does the future look like?

(11:01) How do episodes and bundles tie in more broadly? I often hear that chronic care or end of life care are the big cost drivers, not episodic care. Can those statements be reconciled?

(15:10) How should we think about bundled payments and related topics playing into the campaign, or should we just give up on that?

(19:14) You’ve founded quite a few healthcare companies over your career. How does this Remedy compare?

(21:41) How do you expect the company to evolve in the next few years?

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By healthcare business consultant David E. Williams, president of Health Business Group.

The post Remedy Partners founder Steve Wiggins explains why he’s high on bundled payments (podcast) appeared first on Health Business Group.

Article source:Health Business Blog

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Patients Become Healthcare Payors, Now Consumers – HealthConsuming Explains, Part 1

We Are All Health Consumers Now. That’s the title of the first chapter of my new book, HealthConsuming: From Health Consumer to Health Citizen. I start this chapter quoting President Ronald Reagan in 1983, who recognized that health care costs were growing at three times the rate of inflation during the first term of his Presidency.

It’s déjà vu in health care all over again, but 35 years later, it’s the patient now facing sticker-shock with first dollar payments in high-deductible health plans, six-figure prices on specialty drugs to treat cancers, and a poor return-on-investment for personal health spending.

Thus begins my journey, with you the reader, explaining how patients-as-payors, now nudged into the role of consumer, could morph into health citizens: with rights to health care, bolstered privacy protections; more care in the community and at home to boost quality and safety and reduce costs, and, more opportunity and responsibility for self-care.

In the Health Populi blog this week, I’ll take each weekday to explain one part of this story: the patient-as-payor, now consumer; how Amazon has primed health consumers, with informed retail service expectations; what we know about ZIP codes, food, deaths of despair and the social determinants for health; the promise of digital health and perils of privacy; and finally, whether health consumers in the U.S. can/will emerge as health citizens. All of these themes are backed up by 519 endnotes in the back of the book, as I connect the dots of the rich evidence base for telling this story.

First, let’s explore the scenario-reality of the patient-as-payor, now consumer. This is a contentious issue, debated from my admired economist-guru Paul Krugman in the New York Times in 2011 when he contended that patients weren’t consumers; to last week in Medscape, when bioethicist, and another admired thinker, Dr. Art Caplan, echoed the same.

Health Affairs covered this topic, too, last month, which I discussed here in Health Populi.

The data, though, demonstrate the growing adoption of high-deductible health plans, co-payments and coinsurance for health plan members. When people face first-dollar out-of-pocket spending, they are assigned the role of consumer in choosing to spend that money out of household budgets. The latest research from the Bureau of Labor statistics is that on a median household basis, 20% of spending goes to healthcare.

That’s the immediate situation for real people facing real diagnoses, today and tomorrow, in 2019.

“Today’s high deductibles are tomorrow’s bad debt,” a Moody’s analyst recently wrote. This starts the theme of the second chapter — The Patient is the Payor.

Health care costs stress out people at all income levels in the U.S., according to the American Psychological Association‘s annual study on Stress in America. And this goes, too, for people both uninsured and insured. This isn’t a new-new finding: even families earning over $90,000 a year cited health care costs as their #1 pocketbook issue, a Kaiser Family Foundation study learned in 2015.

This sets the stage for understanding how patients, now consumers, paying more directly for health care in deductibles and OOP expenses are, justifiably, expecting greater service, experiences, value and return-on-investment from th ehealth care industry. Welcome to the next section of HealthConsuming, the Amazon-Prime-ing of health consumers, in tomorrow’s Health Populi blog,

The post Patients Become Healthcare Payors, Now Consumers – HealthConsuming Explains, Part 1 appeared first on HealthPopuli.com.

Article source:Health Populi

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April, 2019, Update: How to Challenge Health Care Corruption Under a Corrupt Regime?

In these last few weeks, the US news has been dominated by the release of a redacted verion of the Mueller report which included extensive evidence of questionable behavior by President Trump, his campaign, and various Trump associates.  This week, an editorial in Mother Jones suggested: The Russia scandal was never, in the main, about whether the president would be prosecuted for a crime. It Article source:Health Care Renewal

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Across All Political Parties, Likely Voters Over 50 Favor Cutting Prescription Drug Prices

People over 50 in the U.S. that are likely to vote in the 2020 Presidential election are keenly interested in lowering the cost of prescription drugs, according to a survey conducted by AARP in February and March 2019.

Most people over 50 take prescription drugs daily; one-third take two or three Rx’s regularly, and one in five older people take six or more prescription medicines regularly.

Thus, prescription drugs are part of most older Americans’ daily life-flows and household spending considerations.

About two-thirds of older people who are likely to vote say that Rx prices are “unreasonable,” including 67% of Democrats, 70% of Independents, and 53% of Republicans. Strikingly, 71% of likely older voters told the AARP that cost was a reason for not filling a prescription drug. This medicine self-rationing behavior due to cost is common among a majority of older voters across party-identification: 74% of Democrats, 67% of Republicans and 72% of Independents.

Older voters are making trade-offs to be able to buy Rx medicines: currently, one in four older people has delayed getting a prescription filled as they didn’t have enough cash to do so; and, one in four older people took less medicine than prescription to make it last longer.

Looking to the future, 4 in ten older voters told AARP they may have to cut back on necessities like food, fuel and utilities to afford an Rx drug, or delay filling the prescription due to lack of available funds to pay for it. Four in ten older voters would look to purchase an over-the-counter medicine to treat a condition.

It’s a rational response, then, that 9 in 10 older voters agree that pharmaceutical companies “make too much profits,” once again consistent — equally felt — by older voters across all three political parties, shown in the second bar chart.

Furthermore, 8 in 10 older U.S. voters contend that Rx companies spend too much on advertising, and that they are “too concerned about making profits, not concerned enough about helping people.”

85% of older voters also believe that U.S. consumers pay more for prescription drugs compared with peers in other wealthy countries.

Health Populi’s Hot Points:  The third chart illustrates that pharma pricing is a unifying force across older voters across the three political parties. Fully 9 in 10 people over 50 who intend to vote favor a wide range of prescription drug price lowering strategies such as faster generic approvals, allowing Federal Medicare and State governments to negotiate for lower prices as Americans’ fellow patients in other countries benefit from, and allowing U.S. consumers to import cheaper prescription drugs from other countries.

While deep understanding of how U.S. health care “works” eludes so many Americans, one common area of health system literacy is older patients’ comprehension of prescription drug pricing at the point of person-and-purchase. The AARP study findings confirm the premise in my book, HealthConsuming: From Health Consumer to Health Citizens — that the patient is now a consumer and payor, looking for value at the N of 1 — for themselves and their families. There’s an opportunity for pharma companies, health plans, and Payors (employers, unions, and government plans) to surround health consumers with the mantra of “value around the pill.” Collaborations can be struck to help people help themselves when it comes to self-care and engaging in making health. Yes, there’s the issue of price which the President and Secretary of HHS continue to discuss. But there is much the private sector can do to address costs, transparency, and value-added services to re-gain patient trust and health engagement.

Between “now” and the 2020 Presidential election, it’s clear this issue will be top-of-mind for likely voters over 50 years of age: the biggest health consumers of prescription drugs.

The post Across All Political Parties, Likely Voters Over 50 Favor Cutting Prescription Drug Prices appeared first on HealthPopuli.com.

Article source:Health Populi

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Lifespan tries to keep Partners out of RI. I’m quoted in the Boston Globe

Big bad Partners HealthCare plans to take over Rhode Island’s number two player, Care New England. Lifespan, the market leader is trying to keep Partners out by appealing to Rhode Islanders’ resentment of out-of-state players and claiming to have the public interest at heart.

“This is not about Lifespan,” [Lifespan’s CEO Dr. Timothy] Babineau said in an interview. “This is about the future of health care in Rhode Island.”

Actually, Lifespan seems to want to go from being the big fish in a small pond to the only fish, by merging with Care New England and Brown, in a so-called “unified” health system, which is just another word for monopoly.

I call them out in the Boston Globe (Lifespan says Partners takeover of Care New England would cost R.I.)

“Lifespan has correctly identified the threat to themselves — but the idea that that is a threat to the public interest is another matter,” said Williams, president of Health Business Group.

“It’s kind of an obvious move to attack a big company for being from out of state, and [saying] they’re going to hurt our local economy and drive up costs,” Williams said. “Really what’s happening is [Lifespan] would like to dominate Rhode Island and not have to worry about somebody else.”

The post Lifespan tries to keep Partners out of RI. I’m quoted in the Boston Globe appeared first on Health Business Group.

Article source:Health Business Blog

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You’ve come a long way baby! And thanks to this app, your mom’s employer knows all about it

There’s an app for that

The Denver Post (Tracking your pregnancy on an app may be more public than you think) has published an interesting and disturbing article about the rise of Ovia, an app that collects detailed and personal data from pregnant women and those hoping to conceive. I’m not surprised that the business model is to provide data to employers about their workforce in order to save on medical costs and reduce time away from work. But I am a little surprised at how much data employees are willing to enter on topics like their sex life, color of cervical fluid, miscarriages and so on, while the app also track things like what medical conditions they looked up.

“Maybe I’m naive, but I thought of it as positive reinforcement: They’re trying to help me take care of myself,” said [Diana] Diller, 39, an event planner in Los Angeles for the video-game company Activision Blizzard. The decision to track her pregnancy had been made easier by the $1 a day in gift cards the company paid her to use the app: That’s “diaper and formula money,” she said.

As I remind people using “free” apps –or ones they are paid to use– you’re not the customer, you’re the product. There’s plenty written on this topic so I won’t bother to rehash it here, but it’s worth remembering that the data provided by Diller and others can be combined with tons of other data from their use of Google, Facebook, Waze, exercise trackers, and more to create incredibly detailed and personal profiles.

In 2008 I wrote a brief blog post called Baby formula in the mailbox. “Honey, is there something I should know?” I was puzzled to see that it still gets a lot of hits in 2019 and that readers are still commenting about their own experiences. Back then, an au pair who worked for us had received baby formula from Abbott Nutrition. Somehow, some marketer thought she was pregnant. It was kind of embarrassing and of course could be problematic for a family relationship or if the pregnancy had ended prematurely.

Online data gathering has come a long way in the past decade. If Abbott once guessed you were pregnant, imagine how much more they –or many others– knows about you now. Maybe the users of these apps aren’t naive, just fatalistic about the idea that everyone knows everything anyway, so why not just take the formula and diaper money and run?

In a few years, Diller’s child will probably find the Denver Post article or maybe even this blog post. If that person is you, I’d be interested to know how you feel about it.

—

By healthcare business consultant David E. Williams, president of Health Business Group.

  The post You’ve come a long way baby! And thanks to this app, your mom’s employer knows all about it appeared first on Health Business Group.

Article source:Health Business Blog

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A Dose of Optimism Is a Prescription for Financial Health, Says Frost Bank

People define their personal health and well-being broadly, well beyond physical health. Mental wellness, physical appearance, social connections, and financial wellness all add into our self-health definitions.

Mind Over Money is a consumer study conducted by Frost Bank, working with FleischmanHillard, connecting the dots between optimism and financial health.

The top-line of the study is that people who are optimists have roughly two-thirds fewer days of financial stress per year than pessimists. Put another way, pessimists stress about finances 62% of the year, shown in the first chart from the study.

This translates into 62% of optimists having better financial health, seven times greater than pessimists at 9%.

In a regression analysis, the study showed a significant relationship between optimism and better financial health: a 1-point increase in optimism was associated with a 0.1-point increase in financial well-being. Optimism was associated with an increase in financial well-being of up to 10 points. This straight-line relationship is illustrated in the second graph showing that greater optimism, controlling for wealth and other demographics, is related to greater financial well-being.

The study identified several other data points that paint the financially unwell profile of Americans:

Six in ten people say finances control their lives at least sometimes

On average, Americans have five months of financial stress annually

Nearly 9 in 10 Americans have experience at least one financial setback.

The survey polled 2,002 U.S. adults 18 and over in September 2018 in English and Spanish.

Health Populi’s Hot Points:  “By believing that life’s challenges are temporary rather than permanent, people can feel inspired to take meaningful steps to improvement,” Michelle Gielan, a psychologist with whom Frost collaborated for the study, asserts in the report. Optimism can be a catalyst for better physical and emotional health, Michelle adds, noting that Americans want more optimism in their lives.

Let me call out the front half of the first sentence here:

“By believing that life’s challenges are temporary rather than permanent…”

Millions of Americans feel health in-secure, both those with insurance who perceive they are under-insured and cannot afford their premiums or co-payments, and those who are uninsured.

That perception of healthcare insecurity has a negative impact on financial wellness and health status.

I discuss this phenomenon in my new book, HealthConsuming: From Health Consumer to Health Citizen. In Chapter 2, titled “The Patient Is the Payor,” you’ll read the introductory quote from a Moody’s analyst observing that, “Today’s high deductibles are tomorrow’s bad debt.”

This week, Health Affairs published an essay on The Challenges of High-Deductible Plans For Chronically Ill People. The authors note that, “There is a significant number of Americans who cannot simply elect to limit their use of health services or can do so only by risking severe consequences. For the 60 percent of Americans living with at least one chronic condition, high deductibles present precarious financial conditions that recur every January 1. As the National Center for Health Statistics has reported, people with HDHPs are far more likely than those with traditional health plans to forgo or delay medical care or to be in a household that is having difficulty paying medical bills.” The piece presents scenarios for patients dealing with cancer, auto-immune disease, and epilepsy.

For people enrolled in high deductible health plans dealing with chronic conditions, one-half felt financial stress due to health care costs versus 21% of people enrolled in conventional health plans.

High deductible health plan designs continue to grow and mainstream in both commercially-insured populations for people receiving employer-sponsored plans, as well as for folks enrolling in public sector and marketplace plans. In thinking through health care reform futures and how people live daily lives, in health and illness, we should be mindful of bundling in financial wellness into our visions for making healthcare better in America.

The post A Dose of Optimism Is a Prescription for Financial Health, Says Frost Bank appeared first on HealthPopuli.com.

Article source:Health Populi

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Americans’ Trust in U.S. Healthcare Lags Tech — and Women Are Particularly Cynical

The 2019 Edelman Trust Barometer measured the biggest gap in trust for the healthcare industry between the U.S. “informed public” and the mass population.

Fewer American women, too, trust the healthcare industry than men do.

“This inequality of trust may be reflective of the mass population continuing to feel left behind as compared to others, even as they recognize the advances that are being made that could benefit them. Given tone and tenor of the day, and particularly among mass population, healthcare may continue to see increasing demands for change and regulation,” Susan Isenberg, Edelman’s head of healthcare, notes in her observations of the 2019 Edelman Trust Barometer.

This week, Edelman released more granular healthcare insights from the annual omnibus survey that was published during the World Economic Forum in Davos in January. I analyzed those general results with health/care implications here in Health Populi.

In this study, the healthcare industry is comprised of five segments: hospitals and clinics; pharma; biotech (separate from pharma); consumer health (e.g., over-the-counter medicines); and, health insurance.

Trust in the overall healthcare industry grew by 4 percentage points on a global basis, with a net trust score of 67 points in the Edelman Trust index. This falls behind the top-trusted industry, tech, garnering 78 points, followed by manufacturing, education and automotive at 70, and retail at 69. Healthcare’s score is marginally greater than fashion, energy, consumer packaged goods, and financial services at the bottom at 57 points.

It’s important to note differences in trust across the five healthcare industry segments — and there are big differences. Pharmaceuticals garner the lowest score at 57, compared with biotech and life sciences at 64. While hospitals and clinics have the highest index across the five sectors, there was a decline in trust for providers — whereas the other four segments enjoyed trust increases.

What might account for this drop in trust for healthcare providers? My hypothesis would include the growing high-deductible world where patients facing high-cost hospital bills, sometimes surprise bills due to lack of transparency of costs and/or out-of-network “gotchas.” In addition, there is a growing risk of cybersecurity hacks of patients’ personal health information, with stories reaching local news media on a regular basis.

Compared with other countries, Americans’ trust in hospitals/clinics is on the lower end of the spectrum, just ahead of South Africa, Germany, Turkey, Colombia and Russia. The high index marks for hospitals were found in China at the top end (at 88), Indonesia, UAE, The Netherlands, and Malaysia.

The trust-gap between women and men is striking in the U.S. Not only do fewer women trust American healthcare, but that trust gap is the largest in the world across all countries Edelman polled, shown in the second graph.

As we have noted for several years here on Health Populi, roughly equal proportions of Americans would trust digital companies and large retailers to help them manage personal health as trust health care providers.

Edelman’s Trust Barometer measured consumers’ health tech sentiment, shown in the third graphic which captures peoples’ forecast on how tech will impact healthcare in the next five years. Leading to better outcomes, and empowering clinicians with useful information, could positively shape healthcare in the near term. However, tech could also make healthcare more expensive and create unforeseen issues we’re not prepared to address, consumers also expect.

Health consumers in America in the post Facebook/Cambridge Analytica era are much more attuned to privacy and cybersecurity risks of personal health data. Edelman identified three practices that would help U.S. health citizens in feeling more comfortable sharing their personal data:

The company would place data in the most secure data protection system available

The privacy of personal data would be guaranteed by the government, and

The government or company or provider would guarantee that no one would ever link personal data back to “me.”

Ultimately, to earn and sustain trust with people, healthcare organizations — the five segments — should be transparent about the costs of products and services, provide balanced information about both benefits and side effects, and provide tools and support to help people manage their health.

Health Populi’s Hot Points: There is much to mine for health/care industry stakeholders in Edelman’s 2019 Trust poll at this particular moment-in-time for U.S. health consumers. The first layer concerns how trust between what Edelman segments as the “informed public” versus the mass population. There is a 10 percentage point gap between the informed public’s trust in U.S. healthcare compared with trust among the mass population.

Edelman defines the informed public as U.S. adults ages 25-64, college educated, in the top 25% of household income, who are avid, engaged consumers of media for business and public policy news.

By that definition, the informed public represents a higher socioeconomic stratum than the mass population, are more news-informed, and would likely be employed with access to employer-sponsored health insurance.

It’s no surprise, then, that trust among this U.S. population segment would run substantially higher than that among mainstream Americans.

Secondly, we see a significant gap in healthcare trust among U.S. women compared with men — the highest chasm in the world across all nations Edelman studied.

Susan Isenberg rightly pointed out in her analysis that women tend to be the “Chief Medical Officers” of their households.

I would expand that to be the “Chief Household Officers,” beyond medical and health/care issues. Women determine most health/care spending in their homes. At the same time, women have borne a “pink tax” for household goods and, indeed, healthcare prices, a topic I covered here in the Huffington Post a while ago in an essay I titled, “The Gender Disparity of Taxes: Toys, Tech and Tampons.”

Cost continues to be top-of-mind for healthcare consumers, who largely blame pharma first in the Edelman research. This data point gives further impetus to prescription drug price hearings in Congress and various proposals promulgated on Capitol Hill to address the cost of medicines.

I write this as I received an announcement that Amazon has begun to more visibly market PillPack, the subscription mail service for prescription drugs in convenient medication-adherence packaging.

Amazon is also piloting selling health insurance in India. As health consumers in the U.S. continue to embrace new options for sourcing, consuming and paying for health care services, from “care” to supplies like prescription drugs and food-as-medicine, we can expect people to seek trusted channels for health engagement beyond the legacy system of hospitals, traditional health plans, and pharma.

  The post Americans’ Trust in U.S. Healthcare Lags Tech — and Women Are Particularly Cynical appeared first on HealthPopuli.com.

Article source:Health Populi

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LinkedIn scam a.k.a. Revenge of the self-employed research associate

In late 2015 I received a lot of spam LinkedIn invitations, many from people who listed their positions as “Research Associate at Self-Employed.” It’s a weird title for a self-employed person.  As I wrote at the time (How many self-employed research associates does it take to change a light bulb?) I think it was some kind of phishing attempt. In particular, the aim seemed to be to build an impressive network and gain access to contact info and credentials. Maybe it was related to the 2016 election. The profiles were pretty bare and obviously not of real people, if you bothered to look. But I noticed that quite a few of my contacts were connected with these accounts.

I haven’t heard from any self-employed research associates in a while, but I got a message recently that reminded me of those days.

This one was a little more clever. It said, “We have done some truly path-breaking work in Healthcare using AI and Machine Learning which has resulted in significant savings and benefits for Healthcare Institutions. Would love to share more with you. Please let me know when we can talk.” The invitation came from Sonu Gandhi, listed as a “Manager” in Albany, NY.

Screenshot 2019 04 18 07.31.07

This message is similar to legit ones I received, usually pitching story ideas for my blog. But something seemed a bit off.

LinkedIn gives two options in the email: View profile or Accept. I clicked “view profile” and saw that this is a nothing person –no photo, no current or former employer, no education, but a member of several healthcare related groups and someone with 237 connections, including with 8 of my connections.

Screenshot 2019 04 18 07.31.23

Sonu, if you’re out there for real I’d love to talk. And in any case I have access to several self-employed Research Associates in search of a Manager.

—

By healthcare business consultant David E. Williams, president of Health Business Group.

Article source:Health Business Blog

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The Rise of Ideologically or Theologically Based Medicine, Public Health, and Health Policy - Recent Examples

I have long been a proponent of evidence-based medicine (EBM), and evidence-based health care, public health, and health policy.  EBM, for example, is about medical-decision making based on critical review of the best applicable evidence from clinical research informed by knowledge og biology and medicine, of the patient's biopsychosocial circumstances, the patient's values, and of ethics and Article source:Health Care Renewal

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You’ve come a long way baby! And thanks to this app, your mom’s employer knows all about it

The Denver Post (Tracking your pregnancy on an app may be more public than you think) has published an interesting and disturbing article about the rise of Ovia, an app that collects detailed and personal data from pregnant women and those hoping to conceive. I’m not surprised that the business model is to provide data to employers about their workforce in order to save on medical costs and reduce time away from work. But I am a little surprised at how much data employees are willing to enter on topics like their sex life, color of cervical fluid, miscarriages and so on, while the app also track things like what medical conditions they looked up.

“Maybe I’m naive, but I thought of it as positive reinforcement: They’re trying to help me take care of myself,” said [Diana] Diller, 39, an event planner in Los Angeles for the video-game company Activision Blizzard. The decision to track her pregnancy had been made easier by the $1 a day in gift cards the company paid her to use the app: That’s “diaper and formula money,” she said.

As I remind people using “free” apps –or ones they are paid to use– you’re not the customer, you’re the product. There’s plenty written on this topic so I won’t bother to rehash it here, but it’s worth remembering that the data provided by Diller and others can be combined with tons of other data from their use of Google, Facebook, Waze, exercise trackers, and more to create incredibly detailed and personal profiles.

In 2008 I wrote a brief blog post called Baby formula in the mailbox. “Honey, is there something I should know?” I was puzzled to see that it still gets a lot of hits in 2019 and that readers are still commenting about their own experiences. Back then, an au pair who worked for us had received baby formula from Abbott Nutrition. Somehow, some marketer thought she was pregnant. It was kind of embarrassing and of course could be problematic for a family relationship or if the pregnancy had ended prematurely.

Online data gathering has come a long way in the past decade. If Abbott once guessed you were pregnant, imagine how much more they –or many others– knows about you now. Maybe the users of these apps aren’t naive, just fatalistic about the idea that everyone knows everything anyway, so why not just take the formula and diaper money and run?

In a few years, Diller’s child will probably find the Denver Post article or maybe even this blog post. If that person is you, I’d be interested to know how you feel about it.

Article source:Health Business Blog

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Telehealth In 2030 – Notes From the Future At #ATA19 with Safavi, Holt, Bathina and Swafford

What will telemedicine look like in 2030?  imagined Kaveh Safavi, Accenture’s Senior Managing Director and Health of Global Healthcare Practice. Kaveh was brainstorming the future of telehealth a decade from “now,” with three innovators attending #ATA19: Deepthi Bathina of Humana, Matthew Holt of Catalyst Health (and Co-Founder of Health 2.0), and Kim Swafford of Providence St. Joseph. This week convened the ATA annual conference where healthcare industry stakeholders met up to deal with the current telehealth environment and imagine what the future prospects would/could be.

As Kaveh invoked the futuristic theme, I couldn’t help thinking about Elroy Jetson, pictured here in a kind of FaceTime/Skype-type visit with a clinician sometime in the future that Hanna-Barbera produced in my childhood.

”Telemedicine used to be about solving access to no care,” Kaveh introduced the conversation. “Now, it’s about serving people who already have care through different mechanisms.”

This quartet of innovative digital health thinkers discussed the pace of adoption for telehealth, moving from the current state to 2030 and working backward from there, asking what conditions would have to change to get us from “here” to telehealth as, well, a healthcare delivery channel norm.

Today, fewer than 1% of Medicare beneficiaries have had any telehealth encounter, Kaveh explained, and fewer than one in eight doctors are aware of offering telehealth in their practice.

Deepthi from Humana offered three considerations concerning how care will transform. First, connected care: one in five U.S. households have a smart device, Deepthi noted. In 2018, after Amazon acquired PillPack, the company filed a patent for Alexa that would observe a consumer’s cough or sneeze and predict the onset of depression or disease. By 2030, she imagined, Alexa would recognize this before we do and a drone might drop something off at our doorstep before we even know we have a problem.

Deepthi added two more elements: individualized care, personalized to each of us; and, standardized care, perhaps using a digital twin, in a system that cares for me employing established standards based on the latest knowledge culled through machine learning/AI.

Kim Swafford of Providence St Joe’s knows a lot about telehealth “today” because her organization is on the forefront of leveraging digital and virtual health modes. Providence St. Joe’s deploys telehealth in eight states. She asserts that leveraging AI and machine learning for low acuity issues can automate as much as 80% of care, for both physical and behavioral/mental health.

Matthew talked about the “Flip the Stack” concept that he and Indu Subaiya, his partner in Health 2.0, developed for the World Congress on Health and Medical Sociology in December 2018. They imagined a scenario where, say, Alexa version 5 was the home platform enabling daily living, including health care delivery at home. From their talk’s abstract: “Starting with technology, the sensors, trackers, AI systems and processes are soon going to be in place monitoring, measuring and suggesting next steps to both providers and patients.” That sounds very 2030, but also do-able with the eleven-year time horizon.

The quartet discussed whether the demand (consumer/patient/caregiver) side would push telehealth adoption, or whether the supply side would. On the consumer side, younger people — namely, Millennials and Gen Z cohorts — are behaving today as if they do not value a primary care medical home, instead, favoring an on-demand, just-in-time-on-my-timeline mode. This would conform with other services in daily life flow, from shared rides to GrubHub food delivery, as health behavior morphs into more general consumer behavior patterns. Matthew pointed to latent demand for Lyft and Uber supplying that demand, which brought cheaper transport into peoples’ hands. “But how to get cheaper care into the hands of consumers?” he asked. We have this for some aspects of health and wellness services, choosing to deliver children in different settings, the supplement industry market, and chiropractic, Matthew commented.

Health Populi’s Hot Points:  In full disclosure, I worked with Kaveh and the Accenture team on a recent study modeling the economic value of shifting a portion of ambulatory care visits to virtual care settings. The report’s title summarized what we calculated: Virtual Health: The Untapped Opportunity to Get the Most out of Healthcare. We modeled three scenarios: a typical primary care office visit, ongoing patient management dealing with a chronic condition, and patient self-management at home. Our scenarios combined virtual health and traditional in-person patient care to reflect a hybrid model of care, reflecting how life really works in an omni-channel world for healthcare and other daily life-flows. By saving even five minutes’ time per patient, our model calculated that a health system could conserve 320 primary care providers (PCPs) and save about $63 million for these three use cases taken together.

This small study is but one data point and insight into how telehealth can help bend the cost curve to help remake a sustainable U.S. healthcare system. Any designs on healthcare reform, whether broad public/private universal healthcare or tightly defined Medicare4All, must move care outside of ultra-expensive care settings. Let’s be mindful that in espousing whatever flavor of healthcare reform we debate in the coming months, we ensure affordability, good design, and consumer engagement in places convenient to people — especially, in the home as Indu and Matthew imagine in their Flip the Stack future world.

The post Telehealth In 2030 – Notes From the Future At #ATA19 with Safavi, Holt, Bathina and Swafford appeared first on HealthPopuli.com.

Article source:Health Populi

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Listen Up, Healthcare: Hear The Patient’s Voice!

Consider the voice of a patient before the advent of the Internet in the digital 1.0 world, and then the proliferation of social networks in v 2.0. One patient could talk with another over their proverbial neighborhood fence, or in a room with other parents dealing with a children’s health issue (say, a PTA meeting discussing nut allergies and birthday treats at school, or a recovering alcoholic testifying in person at an AA meeting).

Today, the voice of the patient is magnified one-to-many, omnichannel and multi-platform — via video, blogs, podcasts, social networks, listservs….and, yes, still in live forums like AA meet-ups, church basements, Y-spaces, and the Frazzled Cafe meet-ups in Marks & Spencer retail cafes across the UK.

WEGO Health’s new report on the state of patient social networks found that patients are indeed socially-sharing personal heatlh information with each other — but getting savvier about it with respect to managing privacy.

Nine in ten patient influencers told WEGO Health that online communities play an important role in their health care decisions.

More granularity, nine in ten patient activists have shared personal details about a prescription drug they have used, and most of these people have had a positive experience doing so.

WEGO Health polled 412 patient activists on their use of social media for health. The top line is quite clear: among all social media platforms, most patients use Facebook to engage with people-like-them for health and social support. If Facebook disappeared, a plurality of these patients would turn to Instagram, then Twitter.

This, within a year of the Facebook/Cambridge Analytica revelations about the in-security of personal data and lack of transparency when it comes to a platform’s sharing of that data with third parties. I wrote about that moment here in Health Populi just over one year ago, saying that, “This week’s revelations about Facebook, Cambridge Analytica, and the U.S. political system will contribute to Americans’ continued cynicism and concern for privacy. People, and especially wearing the hat of a patient, need to feel that their personal data are held by trusted stewards. Doctors have long played that singular trusted role for holding data in the patient relationship.”

Fifty-five percent of patient influencers said that privacy concerns have not changed their use of Facebook. But that means that 45% of patients have adopted a more guarded approach using social media for personal health. One of the big shifts in patients’ social sharing of health information is that half are sharing on closed patient networks.

After trusting patient networks, the most-trusted sites are health-focused portals like WebMD and healthcare provider sites like Mayo Clinic, and patient/disease advocacy sites (e.g., American Heart Association, Susan G. Komen, et al.).

One of the key findings in this study is that patients’ trust of pharma sites is low.

Health Populi’s Hot Points: As patients’ trust of pharma websites remains low, the personal cost of prescription and specialty drugs for people managing challenging chronic conditions is growing. Media may report that the annual change in drug pricing has been more modest in the past year; however, the patient-facing cost can be onerous based on people enrolled in high-deductible health plans, co-payments and co-insurance.

The patient is the payor, I argue in my newly-published book, HealthConsuming: From Health Consumer to Health Citizen. In the book, I cite a survey which was a collaboration with the WEGO Health patient community on the cost of healthcare. Once we analyzed the results, we titled the poll, “The Empowered Patient and the Endangered Wallet.” That’s because one-half didn’t have enough money to cover their out-of-pocket costs; one-third had OOP spending over $5,000 in one year.

                      Increasingly, patient conversations cover costs as much as they do clinical-medical and social components. Financial health is part of the patient’s experience now. And pharma, already not-trusted for engaging with patients online, are in the sights of hospitals, health plans, and physicians in the current healthcare cost blame-game on Main Street in mass media and in Congressional Capitol Hill hearings.

Moving Americans from health consumers to health citizens will require dealing with health care access for all, addressing the negative fiscal and physical impacts of self-rationing care and drugs due to cost; and securing privacy in the era of the data cloud, AI and machine learning, and peoples’ desire to share data with people-like-me.

Healthcare industry, pharma and beyond: listen to patients. Social networks as trusted patient-empowered platforms can help patient/consumer health engagement and, as a positive side effect, build trust.

The post Listen Up, Healthcare: Hear The Patient’s Voice! appeared first on HealthPopuli.com.

Article source:Health Populi