Food = Health for employers, hospitals, health plans and consumers

Jane Sarasohn-Kahn

Food is inextricably bound up with health whether we are well or not. Several key areas of the Food = Health ecosystem made the news this week which, together, will impact public and personal health.

On the employer health benefits front, more media are covering the story on CVS strongly incentivizing employees to drop body mass index (BMI) through behavioral economics-inspired health plan design of a $50 peer month penalty. (more…)

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Health at SXSW13 vs. HIMSS13: the yin, the yang, and the blur

Jane Sarasohn-Kahn

I endured what very few people could (or would) do in the past ten days: I traveled to New Orleans to the annual conference of HIMSS, the Health Information Management Systems Society, which features hundreds of suppliers to the health care information technology industry. I returned home to kiss my family hello and goodbye, and a day later flew to Austin for the annual South-by-Southwest conference for music, movie and digital folks. The health track at SXSW has grown over the past five years, and provides a start contrast to “health care” as embodied at HIMSS, and “health” translated through SXSW’s lens.

That contrast represents the confounding nature of the chaos and creative destruction, as Eric Topol has coined it, that the health/tech industry is undergoing. (more…)

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The Internet as self-diagnostic tool, and the role of insurance in online health

Jane Sarasohn-Kahn

1 in 3 U.S. adults have enough trust in online health resources that they’ve gone online to diagnose a condition for themselves or a friend. “For one-third of U.S. adults, the Internet is a diagnostic tool,” according to Health Online, the latest survey on online health from the Pew Internet & American Life Project.

Nearly one-half of these people eventually sought medical attention. One-third did not. Women are more likely to do online medical diagnoses than men do, as do more affluent, college-educated people. (more…)

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Social media in health help (more) people take on the role of health consumer

Jane Sarasohn-Kahn

By Jane Sarasohn Kahn. One in 3 Americans uses social media for health discussions. Health is increasingly social, and PwC has published the latest data on the phenomenon in their report, Social media ‘likes’ healthcare: from marketing to social business, published this week.

PwC polled 1,060 U.S. adults in February 2012 to learn their social media habits tied to health. Among all health consumers, the most common use of social media in health is to access health-related consumer reviews of medications or treatments, hospitals, providers, and insurance plans, as shown in the graph.

Social media enables people to be better health “consumers” by giving them peers’ views on health products and services. Notably, PwC found that 45% of consumers said information found via social media affects their decision to seek a second opinion from another doctor — this, above the 42% of people who use social media to help them cope with chronic conditions, diet, exercise or stress management. Furthermore, 41% of people said information they find via social media helps them choose a specific hospital or physician. And — listen up, pharma and medical device companies, along with health insurance plans – one-third of people said social media influence their decisions about taking certain medications or undergoing specific procedures, or selecting a health plan.

Social media also helps people manage personal health administration, such as making appointments, getting appointment reminders, referrals, and discounts for services (think: Groupon for dermatology), customer service, and determining wait times at emergency rooms.

The report features examples of health industry segment leaders who are successfully engaging in social health, such as Aetna. The health plan offers Life Game, an online social game that engages people in setting and working toward personal wellness goals. What’s notable about this is that health plans haven’t historically been trusted by consumers to get up-close-and-personal with their health. But as health consumers look for useful and well-designed online tools, the health industry can build bridges for both health and trust. (more…)

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The economics of mHealth – incentives align more easily outside of U.S., but times (and incentives) are a’changing

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. A global analysis of mobile health (mHealth) by the Boston Consulting Group (BCG) for Telenor, the telecomms company, illustrates many forms of return-on-investment using mobile platforms in health:

  • Improved quality of life for individuals and families
  • A more educated society
  • Lower absenteeism for employers, and
  • Greater incomes for people.

Together, these micro-benefits yield macro societal benefits such as freeing up (acute) health systems due to a lower burden of chronic care; positive impacts on people, labor participation, and productivity; and, long-term economic growth.

BCG believes that, “the smartphone is the most popular technology among doctors since the stethoscope.” That phone can play multiple roles, from promoting patient adherence to therapeutic regimens and remote diagnostics to allowing doctors to access data on-the-go.

The World Health Organization has calculated that mHealth adoption could reduce costs for elderly care by 25%, reduce maternal and perinatal mortality by 30%, and improve TB treatment compliance between 30% and 70%.

For nations with aging populations, BCG presents a compelling case for remote diagnostic treatment and support, drawing on data from pilots in Denmark and Norway. In these countries, about 4% of people have COPD, and using remote monitoring technology reduced inpatient hospitalizations and days by over one-half. This finding is important for these nations as their governments are well-aware that the current welfare model is not sustainable as society is aging and birthrates not replacing older retiring workers with younger (tax-paying) ones to support care for the elderly in the expected numbers. (more…)

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US doctors less sanguine about the benefits of health IT

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow.

However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.

As the subtitle of the report recognizes, there is an age chasm at the age of 50: physicians under 50 years of age more likely believe in the benefits of health IT; fewer older doctors do, on a global basis. Accenture points out that younger doctors are comfortable using computers during patient interactions in the exam room, compared with older physicians who prefer face-to-face conversations without what they may perceive as a disruptive interruption of looking at a keyboard or computer screen. (more…)

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Make 2012 the year of living health-fully

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. When I would meet up with clients and friends during the latter half of 2011, people whom I hadn’t seen for months would do a double-take when they saw me. “What have you done?” they have asked. In this first post of 2012, I will share with Health Populireaders my story of 2011 – a year of living health-fully for me.

One of the blessings of my work-life is that I have access to some of the great minds in health and health care. But not until I began to personally harness their wisdom, intentionally incorporating what they’ve learned into my own life-flow and personal health ecosystem, did I impact my health.

You can see from the then-and-now photo what the physical transformation has been. This journey, though, went way beyond weight loss: my changed behaviors have to do with, yes, food intake, but also exercise, relaxation and balance, attitude, social connections, creativity, and intentional living.

2011 marked a major milestone in my life: my 25th wedding anniversary. This was a key health activation point: my husband and I discussed what we could give each other for the occasion. The idea of getting on another plane for a ‘special trip,’ when we both regularly travel for work and want to stay off planes in our spare time, did not appeal. Instead, we threw each other a wonderful party with special friends…and we gave each other the gift of health.

I disrupted my routine in many ways:

  • How I eat (lean protein at every meal, including and especially breakfast, low fat, low-to-no white carb and sugar, lots of water and decaffeinated beverages – my choice, Tazo Calm Tea); listening to Michael Pollan’s Food Rules; and, continuing my allegiance to Slow Food. (more…)


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Value and values will drive the adoption of mobile health

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. This week’s mHealth Summitin Washington, DC, features scores of presentations, posters, and corporate announcements demonstrating the typical chaos of emerging technology markets: the Big Question at this stage on S-curves for new tech is always, “what’s the timing of the pace of change,” or for you mathematically-inclined readers, “what’s the slope of the mHealth adoption curve?”

Before we address that question, let’s be transparent about the fact that there are several definitions of just what ‘mHealth’ is: purists may conceive it as covering only those health tools and applications that ‘go’ mobile–that is, that are deployed via mobile phones and devices like tablet computers. Then there’s the other end of the spectrum (pardon the tech-pun) embodied by the West Wireless Health Institute‘s concept of infrastructure-independent health care. My friend and long-time colleague Matthew Holt, co-founder of the Health 2.0 Conference, addresses this idea with his paradigm of “un-platforms.”

Wherever your own idea about “mhealth” sits on this continuum, it’s crucial to recognize that mHealth does not equal only mobile phone apps. There is a lot of hype around health apps for smartphones, but the traction is already with text messaging on simple phones in developing countries, doctors accessing prescription drug information on their beloved iPhones, and a growing number of people quantifying themselves through wearable devices that provide health-promoting nudges throughout the day.

What’s driving the adoption behind these programs? First, it’s about the value that the program offers the health system, health provider, and individual health consumer. Cash-strapped developing countries have leapfrogged over developed nations’ health systems– where health capital is sunk into hospital beds, legacy IT systems, and incentives that aren’t well-aligned with providers to deliver health care at the most appropriate, efficient site. In the developed world, providers deliver care based on how to maximize reimbursement — often in higher-cost-than-necessary settings — but paid-for by both public and private payers. In poorer countries, necessity is indeed the mother of invention — read “adoption” — of mobile health. (more…)

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More U.S. health citizens embrace digital personal health information: the topline of Manhattan Research’s Cybercitizen Health survey

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. “56 million U.S. Consumers Access Medical Information from Electronic Health Records,” asserted Manhattan Research’s press release of October 12, 2011. This statistic, fresh out of the firm’s 2011 Cybercitizen Health survey, is among several stunning numbers that demonstrate a growing trend: U.S. health citizens’ embrace of their personal health information in digital formats, via electronic channels.

To kick the tires on the survey a bit, I spent time on the phone with the “3 M’s” of Manhattan Research — Meredith Ressi, President; Monique Levy, VP of Research; and, Maureen Malloy, Senior Healthcare Analyst who can recite the survey data backwards and forwards. Together, they guided me through the topline on digital health information use among U.S. adults in 2011.

The 56 million US adults who access data via electronic health records (EHRs) was a surprise to me, and to this trio, as well — so much so that they revisited the study methodology and samples to ensure that this was not a statistical anomaly. It’s not. But as with all numbers, it’s insightful to know what lies beneath the raw stat.

The big number to consider here is 24% of U.S. adults who are accessing their personal health information (PHI) from their physicians’ EHRs. In this case, the 56 million tend to be younger, better educated (more with college education), higher internet adoption, and more likely to own smartphones and tablet computers. They are also more likely to observe a physician doing digital activities during the consult – such as seeing the doctor entering information into the EHR.

What’s common among those consumers interacting with their EHR-borne health information is that they are more frequent online health information seekers than people who are non-users of their EHR data: three times more likely. (more…)

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Americans’ new normal in health: paying attention and responding to costs

Jane Sarasohn-Kahn

By Jane Sarasohn Kahn. The passage of health reform in the U.S. has not enhanced peoples’ confidence in the American health system. In fact, U.S. health consumers’ high confidence level in the future of employer-sponsored health benefits has eroded over the past ten years, according to the Employee Benefit Research Institute‘s (EBRI) 2011 Health Confidence Survey: Most Americans Unfamiliar with Key Aspect of Health Reform.

Most people are dissatisfied with the U.S. health system overall, with 27% of U.S. adults rating the system as “poor” and 29% giving a rating of “fair.”

High costs may be at the root of peoples’ dissatisfaction with the U.S. health system. Only 18% of people are satisfied with the cost of health insurance; only 15% satisfied with the cost of health services not covered by insurance.

EBRI looked into peoples’ health-consumer behaviors, detailed in the chart. Most people who have visited doctors ask them to explain why a test is needed, as well as inquire about risks of treatments and medications and their success rates. Nearly one-half of people ask about less costly treatment options often or always.

Consumers also adjust their health care utilization when facing higher health care costs:

  • 74% of U.S. adults try to take better care of themselves
  • 69% choose generic drugs when available
  • 64% talk to the doctor more carefully about treatment options and costs
  • 59% go to the doctor only for more serious conditions or symptoms
  • 44% delay going to the doctor
  • 36% switch to over-the-counter (OTC) drugs
  • 34% look for cheaper health insurance
  • 31% look for cheaper health providers
  • 25% skip medication doses or don’t fill prescriptions.

Health care costs are eating into peoples’ savings contributions: 56% of people say they have decreased contributions to other savings due to health cost increases, and 33% have difficulty paying for other bills beyond health care.

The Health Confidence Survey interviewed 1,001 U.S. adults over age 21 in May and June 2011 via telephone. (more…)

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More health consumers look to pharmacists and pharmacy staff for health-related services

Jane Sarasohn-Kahn

Health consumers prefer supermarket-based pharmacies to chain or mass merchandiser drugstores, according to the J.D. Power and Associates 2011 U.S. National Pharmacy Study.  Mass merchants, however, often beat out both supermarket and chain drugstores when it comes to price.

In the study, J.D. Power segments brick-and-mortar pharmacies from mail-order. Brick-and-mortar pharmacies cover chain drug stores, supermarkets and mass merchandisers/Big Box stores.

What drives top performance for consumers shopping brick-and-mortar pharmacies are the ordering and pick-up process, the store itself, cost, the non-pharmacist staff, and the pharmacist.

In mail-order, quality translates into cost competitiveness, prescription delivery, ordering, and customer service. Consumer satisfaction with the mail-order Rx channel declined between 2010 and 2011, primarily due to ordering and delivery problems. But due to price and challenges in switching back to the brick/mortar option, mail-order customers are largely expectedly to remain in the channel and not switch to a store. One-third of consumers are required by their insurance provider to use mail-order for maintenance and repeat scripts – these customers are even less satisfied with their pharmacy than those who freely choose to go the mail-order route for prescriptions.

J.D. Power, analysts on consumer satisfaction, notes that Amazon has set a high bar for speed and convenience in the online shopping world. Mail-order pharmacy has a ways to go to catch up to those standards.

High customer satisfaction ties to those consumers who have an ability to have a private conversation with the pharmacist or staff in a private area of the pharmacy. Furthermore, added services such as immunizations and wellness services are driving higher consumer satisfaction with those pharmacies who offer them.

The highest rankings by segment were:

Chain drug stores: Good Neighbor Pharmacy, Health Mart, The Medicine Shoppe (all well above competitors in the segment)

Mass merchandisers: Target, Sam’s Club, Costco (with Walmart at the bottom)

Supermarkets: Publix, Wegmans, Winn-Dixie, Jewel-Osco, Vons (all above the segment average)

Mail-order: Kaiser Permanente Pharmacy, Humana RightSourceRx (both well above competitors).

This is the fifth year J.D. Power has conducted the national pharmacy survey. The poll, fielded in May and June 2011, was conducted among 12,300 consumers who filled a new prescription or a refill in early 2011.

Health Populi’s Hot Points: The pharmacy has always been a touchpoint in consumers’ health, but its importance is growing as a primary care site for wellness, prevention, immunization and a growing menu of consumer-driven primary health care services. The supermarket channel, in particular, has begun to marry messages about nutrition and healthy food with chronic health condition messaging. For example, Wegmans (ranked #2 after Publix stores, features a food/health related display adjacent to the pharmacy: this month, my local Wegmans has been promoting quinoa’s nutritional contributions to healthy eating at a “pharmacy teaching table.’ In the winter, the pharmacy promoted the purchase of frozen blueberries to enhance shoppers’ intake of the fruit’s health benefits in the cold season.

This is another example of health being where our Surgeon General says it is – not in isolation in the doctor’s office, but where we live, work, play and pray. Let’s add the word “shop” to that mantra.

On a personal note, I have a comment to make on J.D. Power’s mail-order pharmacy results. In the past six months, we have been forced to switch to the mail-order channel to acquire a repeat prescription for a member of our family. The company, whom I will not name, is one of the poorer performers on the table – and no surprise to me. The company has a cumbersome, un-helpful, poorly designed website which it claims streamlines the process. For the first three months of the fulfillment process, I’ve had to dial into the company’s call center – which has no hours on the weekend, when I, and most working people, usually run household errands. Suffice it to say, after speaking with the doctor-prescriber’s insurance associate, our experience with this mail-order company was not atypical.

Would that this company, whose services I am compelled to use, could demonstrate the efficiency, accessibility, and friendly quality of my favorite shoe purveyor – Zappos. This is a case where I cannot, if you’ll excuse the pun, vote with my feet.

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Peoples’ home economics are driving DIY Healthcare

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. I shared this perspective yesterday at the Social Health Unconference in Philadelphia.

In the post-recession economy, consumers are living in an era of the new sustainability, looking for products and services from organizations that help them conserve resources, save me money, nurture creativity, and keep me healthy. In their report, Eyes Wide Open, Wallet Half Shut, Ogilvy surveyed consumers’ perceptions of their new lives shell-shocked by an economy that changed everything for them and their families.

The new household economics are driving a DIY economy. From DIY’ing home improvement and photo developing and sharing to self-booking travel with Expedia and trading shares via Schwab online, consumers have adopted, en masse, a self-service ethos.

As people do more DIY in life, they’re doing the same in health for themselves and those for whom they care — aging parents, sick mates, ailing kids. Both healthy and chronically ill people self-track their steps, their food intake, their clinical numbers like glucose and blood pressure. Some download mhealth apps to their smartphones to DIY health. Some people pay for personal emergency response systems for their parents to ensure their wellbeing at home. Others seek health information via online search and in social networks, on- and offline. Further up the social networking curve, Very Empowered Patients share their health data online in communities to CureTogether. (more…)

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Connecting the dots between personal fiscal health and physical health

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. Home foreclosures negatively influence health in several dimensions: they cause stress on the lives of the home’s residents, including children, driving mental and physical illness; they impact neighbors who worry that home values will fall in their community; and, they can motivate unhealthy behaviors, such as drinking and foregoing medical treatment such as seeing the doctor and filling needed prescriptions for drugs treating chronic conditions.

In Is the Foreclosure Crisis Making Us Sick? published by the National Bureau of Economic Research in August 2011, Janet Currie and Erdal Tekin find that the number of foreclosures in a community is associated with increases in medical visits for mental health (anxiety and suicide attempts), preventable conditions such as hypertension, and a long list of stress-related diseases.

Furthermore, more foreclosures in an area are most harmful on people age 20 to 64, and disproportionately impact African-Americans and Hispanics compared to whites.

The map shows the “heat index” for areas with the most home foreclosures: the redder, the higher the foreclosure rates in the state. Currie and Tekin focused on four of the hardest-hit foreclosure states: Arizona, California, Florida and New Jersey. They combined foreclosure data from 2005 to 2009 with data on ER visits and hospital discharges at the zip code level. (more…)

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Why nuns are important to hospitals and health care

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. Nuns and priests were CEOs at 770 of 796 Catholic hospitals in the U.S. in 1968. This year, there are only 8 of them leading 636 hospitals. Sister Mary Jean Ryan, who retired as CEO of SSM Healthcare, says, “We’re a dying breed.”

Why has this happened, and why should we care — whether or not we’re Catholic?

The New York Times covered this story on August 22, 2011, titled, Nuns, a ‘Dying Breed,’ Fade from Leadership Roles at Catholic Hospitals. NY Times editors smartly placed this story in the “U.S.” section and not under the “Religion” corner of the paper.

At the crux of this historical transition at religious hospitals is whether the values that drove the heart and soul of these institutions — caring for the needy, the safety net population, and the larger community — will translate when MBAs and MHAs take over leadership of these organizations. The Times wrote, “Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.”

This is not a marginal issue in American health care: in 2009, 1 in 6 hospital admissions was in a Catholic hospital.

Health Populi’s Hot Points: With the U.S. economy in decline or stasis in most of the nation, and health benefits for covered workers lucky enough to be covered by a health plan, moving more financial burden onto employees, more health citizens in the U.S. have been moving into safety-net, under-insured, or un-insured status. As such, more people seek care in emergency rooms and outpatient care in the community, and more have a difficult time paying for health care (my blog posts have featured this issue over the past 4 years; search on the topics of safety net, Medicaid, self-rationing, and medical home in Health Populi‘s search box). (more…)

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Patient centered care lowers cost

Jane Sarasohn-Kahn

By Jane Sarasohn-Kahn. Patients who perceive their visit to the doctor was patient-centered, with more communication, receive fewer diagnostic tests and referrals, and yield lower expenses for diagnostic testing. A new study finds that patient-centered care leads to lower spending on health care over one year of care due to fewer specialty care referrals. A contributing factor to lower costs is increased patient participation during the visit, which reduces patients’ anxiety and perceived need for further investigations and referrals. In the milieu of more effective patient-physician communication, physician gets more knowledge about the patient. This brings greater trust between patient and doctor, as described in Patient-Centered Care is Associated with Decreased Health Care Utilization, published in the Journal of the American Board of Family Medicine published in July 2011, and penned by Dr. Klea Bertaks and Dr. Rahman Azari.

This is not a new concept: ten years ago, the IOM’s seminal report, Crossing the Quality Chasm: A New Health System for the 21st Century, called for “patient-centeredness.”

What is patient-centered care? Bertakis and Azari call out four communication behaviors:

  1. Eliciting understanding and validating the patients’ perspective
  2. Understanding the patient within his or her psychosocial context
  3. Reaching a shared understanding with the patient of the problem and its treatment
  4. Creating a partnership in which “activated” patients share in decision making, power and responsibility.

These four precepts were codified in a 2007 publication from the National Cancer Institute, Patient-centered communication in cancer care: promoting healing and reducing suffering.

Health Populi’s Hot Points: Adopting a patient-centered approach isn’t solely about reducing health care costs: it’s about patient empowerment, effective communication between doctor and patient, and participatory medicine. The secret in this sauce is in the communication between the partners: greater sharing of information from each side of the conversation, building greater trust, and leading to a decreased use of unnecessary diagnostic testing, hospital care, and specialty referrals. While long-term outcomes haven’t yet been quantified in the patient-centric approach, this study adds to the growing evidence base that participatory medicine is a win for the patient, a win for the physician, and a win for the larger health system and health economics.

Originally posted on Health Populi on July 19th.


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