By Jane Sarasohn-Kahn. Over 85% of the world’s population is covered by wireless phone signals. The global proliferation of wireless phones provides a technology platform to move health services to people — broadly referred to as ”mobile health” or “mhealth.” mHealth: New Horizons for health through mobile technologies, the World Health Organization’s (WHO’s) second report on mobile health, summarizes a survey of mobile health developments around the world, published in June 2011 based on survey data from 2009 collected in 114 nations.

WHO learned that mHealth is most easily deployed into health applications where voice communication via traditional phone networks has been used. Thus, in important applications like surveillance and decision support, mHealth is less likely to be established because these functions require more advanced capabilities and technology infrastructure.

The survey evaluated mHealth services in 14 categories, as shown in the chart. These include health call centres, emergency toll-free phone services, emergencies and disasters, mobile telemedicine, appointment reminders, community mobilization and health promotion, treatment compliance, mobile patient records, information access, patient monitoring, health surveys and data collection, surveillance, health awareness raising, and decision support.

The most prevalent of these services are toll-free emergency applications, mobile health call centres and emergency services, and mobile telemedicine, all available in over 50% of WHO member states. In addition, mHealth-based appointment reminders are available in a plurality of nations.

The most popularly piloted mHealth programs include patient monitoring, treatment compliance, mobile telemedicine, and patient records.

Health Populi’s Hot Points:  Most of the mHealth deployments around the world tend to be small-scale pilots that deal with single issues. The largest scale mHealth programs are usually supported via public/private partnerships. (more…)

By Jane Sarasohn-Kahn. By 2050, the demand for long-term care (LTC) workers will more than double in the developed world, from Norway and New Zealand to Japan and the U.S. Aging populations with growing incidence of disabilities, looser family ties, and more women in the labor force are driving this reality. This is a multi-dimensional problem which requires looking beyond the issue of the simple aging demographic.

Help Wanted? is an apt title for the report from The Organization of Economic Cooperation and Development (OECD), subtitled, “providing and paying for long-term care.” The report details the complex forces exacerbating the LTC carer shortage, focusing on the fact that current policies to address this future are fragmented and piecemeal. Instead, OECD argues, policymakers must smartly weave together a comprehensive approach that addresses the many facets of the problem.

Statistically, in today’s world, 1 in 5 LTC users is under 65 years of age; one-half are over 80. Most of the LTC services paid-for are based in institutions: 62% of total LTC expenditures occur in institutional settings, not at home.

That simple aging demographic is the first aspect to consider: in 1950 under 1% of the global population was over 80. By 2050, that share will increase from 4% in 2010 to 10% in the OECD countries.

Today, it is informal, unpaid caregivers — usually family carers — who bear the brunt of long-term care.

Health Populi’s Hot Points:  The report states, “Family carers are the backbone of any LTC system.” That backbone is breaking in developed countries. More than 10% of adults over 50 living in an OECD country provides help with personal care to people who have limited ability to care for themselves. Without support, OECD says that caregiving is associated with a reduced labor supply for unpaid work, higher risk of poverty, and a 20% greater prevalence of mental health problems. (more…)

By Jane Sarasohn-Kahn. Americans are opting for Botox and cosmetic procedures more than colonoscopies and cancer tests, according to a story in Reuters.

This trend makes companies like Allergan, makers of Botox and the Lap-Band for gastric surgery, very happy indeed. Plastics and gastric bypass surgeries are back up to pre-recession levels as of 2Q11.

However, for companies and providers in other segments of the health care and surgery value-chain, prospects for bounceback in 2011 aren’t as promising. Various indices on consumers’ health care sentiment — such as the Thomson-Reuters Consumer Healthcare Sentiment Index and the EBRI Health Confidence Survey, show U.S. consumers’ perceptions of their ability to pay for needed health care falling.

Health Populi’s Hot Points:  The Reuters story shows the chasm in U.S. health consumers’ mindsets between their “health” and “health care.” In the past 50 years, health ‘care’ has been an entitlement largely covered by health insurance, at or close to 100% with minimal co-payments, coinsurance, and premium sharing. In the past decade, however, enrollee out-of-pocket costs have skyrocketed, with the average employee covered for a family of 4 now paying about 40% of health costs, according to the 2011 Milliman Medical Index, explained here in Health Populi.

Furthermore, Kaiser Family Foundation continues to track peoples’ self-rationing due to health costs. In their April 2011, tracking survey, 1 in 2 U.S. adults was seen to still cut pills in half, postpone recommended medical tests, delay dental care, and health “mis-behave” in other ways. Note that these are all self-rationing behaviors for health “care” issues.

So as we may skinny down our waistlines and de-wrinkle, our cancer diagnoses get delayed, costing us as patients precious time; our bank accounts, HSAs and health plan sponsors higher costs; and, diminishing public health. This scenario needs a good nudge toward value-based health plan design and positive consumer health behavior. Furthermore, health citizens need to connect-the-dots between prevention and outcomes, as well as whole health — that today’s health micro-choices bolster outcomes and quality of life for the long-term.

Originially posted on Health Populi on May 16th.

By Jane Sarasohn-Kahn. “Ward and June Cleaver have left the building,” observe analysts at Nielsen. “The white, two-parent, ‘Leave it to Beaver’ family unit of the 1950s has evolved into a multi-layered, multi-cultural construct dominated by older, childless households,” starts a report from The Nielsen Company, The New Digital American Family.

Whatever ethnic flavor this Digital Family may represent, there’s one equalizer across all of them: the smartphone, which is owned by households across cultures and income levels.

First, the socio-demographics paint a picture of increasingly multi-cultural households. Recent immigrants to the U.S. accounted for 90% of population growth from 2000-2010, over-indexing for Hispanic and Asian communities. Hispanics are the fastest-growing segment of the multi-cultural nation, now numbering 50 million people in the U.S. Marriage seems to be going out of fashion, with only 52% of adults being married in 2008 compared with 72% in 1960. In the next decade, households with young children will grow more slowly than in the past; the greatest growth will be among multi-cultural, lower/middle income families. Nielsen forecasts that most families with kids in the U.S. will be multi-cultural before the end of this decade. (more…)

By Jane Sarasohn-Kahn. Wellness and disease prevention were the meta-themes at Health 2.0′s Spring Fling held earlier this week in San Diego. where the discussions, technology demonstrations, and keynote speakers were all-health (as opposed to health care), all-the-time. Dr. Dean Ornish told the attendees in the standing-room-only ballroom space that the joy of living is a greater motivator than the fear of death. And the 1.0 version of managing health risks has been more the latter than the former. As a result, Ornish’s two decades of research have shown that health is more a function of lifestyle choices than it is drugs and surgery. In fact, people have a “spectrum” of choices to make based on their personal preferences — not a one-size-fits-all “diet,” Dr. Ornish has learned.

While genes are our predisposition, they are not our Fate: good news for every human being. Furthermore, he said that, “healthcare needs more connection and community. It’s as important as food and water.” He and other researchers have learned that a person’s greater social connectedness (friends, family, community) contributes to better health. People who are lonely and depressed have 3 to 7 times greater mortality, Ornish told us. The largest unmet need is for intimacy and connection.

While Dr. Ornish’s research continues to demonstrate the power of lifestyle changes on health and longer, more joyful living, sponsors of health plans are now getting into a next generation of wellness and prevention in the context of value-based benefit design. With health premium increases that now have a family of four’s coverage indexed at nearly $20,000 per year based on the Milliman Medical Index, fewer employers are confident they’ll be able to cover employee health benefits a decade from now as the chart’s declining red line illustrates.

Thus, employers in 2011 are looking to link benefits with health and productivity, based on the Towers Watson and National Business Group on Health’s survey  into employer-based benefits in the post-reform era. While companies will continue to offset increasing health costs to employees (with a 45% increase in employees’ share of health costs since 2006), they’re also using incentives more aggressively to motivate lifestyle behavior changes in a new-and-improved approach to wellness and prevention. (more…)

By Jane Sarasohn-Kahn. In February 2011, 1 in 10 jobs in the U.S. is in health care employment; nearly 14 million people in the U.S. work in health care employment, with health care representing 10.7% of all jobs in America. The growth rate of health care jobs rose 1.2 percentage points since the recession kicked in late 2007. Since the start of the recession, health employment grew 6.3%; the number of non-health jobs fell by 6.8%. The chart starkly illustrates this story (click the chart to enlarge for easier reading).

Altarum Institute has crunched the health job numbers from the Bureau of Labor Statistics (BLS) and published their analysis in Health Sector Economic Indicators, published February 9, 2011. Altarum’s top-line: health care employment has reached an “all-time high” in the U.S.

Outpatient care settings accounted for the fastest-growth in jobs with a 12-month rate of increase of 5.3%. The hospital segment grew the slowest, at a mere 0.7% — basically flat-lining (though still representing, by far, the largest segment in terms of jobs). Home health jobs grew by 4.3%.

Health Populi’s Hot Points:  It is impossible to separate the U.S. health microeconomy from the nation’s macroeconomy. With only 39,000 new jobs added to the U.S. economy in January 2011, we economists look for bright signs wherever we can find them. One-third of this increase in total new employment was in health care.

The number of jobs in the health sector will continue to grow. This will continue to be the case for the next decade, at least. Among many drivers for health job growth, two are at the top of the list in 2011: health information technology and the aging of the population. There will be intense demand for workers skilled in health information technology, based on the adoption of electronic health records by providers (both doctors and hospitals), along with growing digitization of all health information generated by digital imaging, point-of-care diagnostics, smart infusion pumps, and other medical devices. Dr. Blackford Middleton of Partners HealthCare projects a need for an additional 40,000 to 160,000 workers in health IT in the coming years.

As for aging, the chart shows already-growing demand for more home care workers. Boomers won’t age quietly into that good night, wishing to avoid institutional care in nursing homes. So home care work will be re-defined back in the person’s home — requiring even more digitally savvy workers to re-imagine and re-design what home care is. This will mean more jobs for new kinds of design and ideation, applying the disciplines of anthropology and sociology, and of course, more IT developers who can marry, say, miniature accelerometers to milk bottles and sensors to scales.

How we define health care jobs today will morph into a new definition for jobs in health tomorrow.

Originally posted on Health Populi on February 10th.

By Jane Sarasohn-Kahn. While 8 in 10 U.S. adults want a physician to have primary responsibility for the diagnosis and management of their health care, many people are not sure who’s a medical doctor. Surprisingly numbers of health consumers don’t think that orthopaedic surgeons, family practitioners, dermatologists, psychiatrists, and ophthalmologists are MDs.

The American Medical Association‘s survey, Truth in Advertising, published in January 2011, follows up the AMA’s 2008 survey which had similar results.  Data based on consumers answering the question, “Is this person a medical doctor,” are organized in the chart.

90% of people say that a physician’s additional years of medical education and training are ‘vital’ to optimal patient care. At the same time, only 51% of people say it’s easy to identify who is a licensed medical doctor and who is not by reading what services they offer, their title and other licensing credentials in ads and marketing materials.

In a related story, my colleague and friend Michael Millenson wrote in Kaiser Health News today about “Fixing the Failure at Physician Compare.” Physician Compare is the Centers for Medicare and Medicaid Service’s (CMS’s) portal meant to assist the health citizens (whether enrolled in Medicare or not) in finding doctors in their local communities. Millenson writes,

“In reality, the site is confusing and unfriendly to consumers, painfully slow and, worst of all, factually unreliable. Put bluntly, the agency, whose leader famously called himself a ‘patient-centered … extremist’ in a 2009 Health Affairs article, has produced a consumer tool that practically shouts, ‘We couldn’t care less whether any consumer ever uses this.’”

The AMA survey was conducted in November 2010 among 850 adults.

Health Populi’s Hot Points: The AMA poll and Millenson’s analysis point to the desperate need for greater health literacy, transparency and useful, usable tools for health citizens for becoming more engaged and empowered in their health and health care choices. Most health citizens don’t aspire to be couch potatoes when it comes to tapping into health information: in fact a majority of U.S. adults who have a primary care doctor would like more comprehensive information about their doctors online, learned in a survey conducted in November 2010.

AHRQ is soliciting comments for the Agency’s project, Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT.  This project will focus on consumer health information search and storage, and health monitoring. Health Populi readers involved in consumer-facing health IT innovation and design should tap into this site and get involved. As the Physician Compare early experiences point out, AHRQ — which is a ‘sister’ organization to CMS under the umbrella of the Department of Health and Human Services — can benefit from your input.

Originally posted by Jane Sarasohn-Kahn on January 27th on Health Populi.

By Jane Sarasohn-Kahn. For every $1 spent on health care in the U.S., 10 cents goes to prescription drugs, 31 cents goes to hospital care, and 27 cents goes to professionals (doctors, dentists, and other services), based on 2009 health spending reported to the Centers for Medicare and Medicaid Services (CMS).

There’s evidence that by spending a bit more on medication and bolstering prescription drug adherence among patients, total health spending can be lowered for vascular medical conditions. The study and data which leads to this conclusion is published in Medication Adherence Leads to Lower Health Care Use And Costs Despite Increased Drug Spending appears in the January 2011 issue of Health Affairs.

The study cites the World Health Organization’s report from 2003 that stated medication compliance rates globally averaged about 50%. This number may be high compared with other newer studies on adherence, such as reports from

Peoples’ lack of adherence to medication treatment regimes costs: diabetes patients who do not take their medications have a 58% increased risk for hospitalization and an 81% increased risk of mortality. The New England Healthcare Institute (NEHI) calculated that more than half of all Americans currently suffer from at least one chronic disease such as diabetes, heart disease and asthma at a cost to the economy of $1 trillion annually.

The Health Affairs study, sponsored by CVS (the retail pharmacy chain), established a causal link between medication adherence and outcomes: specifically, hospitalizations and total health costs. The researchers examined four conditions under the umbrella of vascular disease: congestive heart failure (CHF), hypertension, diabetes, and dyslipidemia (high cholesterol). Among these four conditions, bolstering adherence had positive impact (i.e., lowered) health costs across all categories, most markedly for CHF, as shown in the chart.

The average benefit-cost ratios from adherence for the four conditions were 8:4:1 for CHF, 10:1:1 for hypertension, 6:7:1 for diabetes, and 3:1:1 for dyslipidemia.

Health Populi’s Hot Points:  Focusing just on CHF, the average cost-savings per patient was $7,893. About 5.7 million Americans have CHF, and there are 400,000 new cases of CHF in the U.S. each year, according to the National Heart, Lung and Blood Institute (NHLBI). Do the math: bolstering medication adherence among CHF patients could save $billions to the U.S., which would positively and directly impact Medicare — the nation’s largest threat to financial security in the not-so-long-term.

Furthermore, improving medication adherence as described in this study would avert hospital admissions for patients with vascular conditions, which would enhance millions of Americans’ quality of life and productivity. This is one example of how to bend the cost curve in health, and it doesn’t require a lot of new technology – just strong doses of sound communication between patients and doctors, access to prescription drugs and medication adherence programs, and a culture of participatory health where patients feel vested in their own care in partnering with their physicians.

Posted originally on Health Populi by Jane Sarasohn-Kahn on January 10th.

By Jane Sarasohn-Kahn. In a ballroom at the Hilton Union Square in San Francisco on October 6, 2010, several hundred people shared ideas, debated, and painted a multi-faceted picture of the NewPatient: the networked patient.

The meeting was convened, in “unconference” style, in conjunction between the Health 2.0 Conference and Gilles Frydman, founding father of ACOR, the Association of Cancer Online Resources. Gilles knows a lot about the NewPatient: he’s organized people focused on cancer for over 15 years through his organization, which has helped tens of thousands of health citizens connect to clinical trials, researchers, information, and each other – all seeking to cure virtually every form of known cancer, and identifying forms unknown.

As Jeremy Shane of Health Central kicked off the meeting, he set the theme: this session was, “Not Meet the Parents, but Meet the Patients.” As Health Central sees 14 million visitors to its sites on a monthly basis, Jeremy has some knowledge about the NewPatient, too.

What makes an engaged patient, he has learned, isn’t based on a demographic such as age or gender or socioeconomic status, per se; what makes an engaged patient is a desire to understand her situation and a driving curiosity – in sum, a “need for cognition and understanding,” Jeremy contends.

Jeremy notes that the average search on health has grown from 4 words just a couple of years ago to 6.5 words today — a longer tail – because people are describing their unique situation and they want an answer to their own needs.

Nine people – patients, experts – shared their perspectives with specific communities and personal histories. The goal of the sharing was to seek commonalities, shared principles, and learnings. Dr. Alan Greene, both a patient and provider, shared the vision of participatory medicine, recommending that every clinician convene a Patient Advisory Council to inform and shape their practice.

Regina Holliday, of the Medical Advocacy Blog and 73 cents/21 days fame, passionately talked about the NewPatient’s need for accessing their own information.

Ian Eslick of the MIT Media Lab told the group about a fast-track approach for clinical research enabled through linking an online community of patients with researchers around the globe.

James O’Leary of the Genetic Alliance works with 1,000 genetics organizations, inspired early by his mother’s diagnosis with lung cancer when he was a teen. His passion is driven by the objective of how to get information out of the doctor’s office to patients and their families – “we need to mix services, support, and advocacy together – we’re getting the care model wrong,” he recognizes. “It should be a continuous process of care.”

(more…)

By Jane Sarashon-Kahn. The following, originally posted on Health Populi on September 30th summarizes the ePatient Connections Conference that took place last week.

The ePatient Connections (ePC) conference convened this week in the City of Brotherly Love, my town, Philadelphia. And indeed, the eHealth love did flow between health citizens and organizations that seek to serve them: technology developers and health providers, alike. My flying fingers recorded nearly fifty pages of notes, and these don’t even include two tracks’ worth of presentations — social networks in health and health games — because I was the emcee for mobile health track. However, this gave me the opportunity to get to know the 11 mHealth presenters and their organizations up-close-and-personal and to brainstorm with track attendees the many issues shaping the mHealth landscape.

The over-arching themes of the conference were (1) a growing cadre of patients-people are empowering themselves and (2) we are all patients. It’s not about the technology, either, although vendors presented many gadgets and tools to help people stay well and manage illnesses. Instead, as David Reim, founder of SimStar and shepherder of Claritin.com, the first branded Rx website, coined the zeitgeist, it’s about the Architecture of Participation. In his discussion on the mHealth track, he said mobile health means that “health care comes to the patient.”

The theme of technology-enabled care meeting up with patient echoed through the 2 days at ePC. FitBit, the wellness-nudging wearable micro device, brings together smart monitoring, deep analytics, and motivational tools that help people wanting to get or stay well to make good micro-decisions through the day. The big lesson that FitBit’s crew has learned is that you need to (1) give people a reason to care, and (2) give them a reason to share.

Text4Baby, of which I have waxed lyrically in Health Populi, was built by Paul Meyer and his team at Voxiva, who have built texting/health projects in the developing world and have brought their expertise to the lucky health citizens of America. Starting in Peru in 2001 creating the first system for health workers to use cellphones, Voxiva now operates in 13 countries in the developing world — which he unabashedly asserts are well ahead of the U.S. when it comes to using phones for health. So now the U.S., with among the highest infant mortality rates in the developed world at 6.3 per 1,000 live births, may be able to catch up with, say, Cuba at 5.1 and Slovenia at 4.8. Text4Baby is leveraging the fact that cellphones are ubiquitous in the U.S. among young women who may not know how or where to access pre-natal care. Furthermore, you don’t need an expensive smartphone to receive SMS text messages — and Text4Baby’s are free, thanks to the universe of mobile carriers who provide the texts for free. This is a public-private partnership that works to benefit all, and is a model for public health programs to study. (more…)

By Jane Sarasohn-Kahn. Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system.

Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act and estimates that 80% of existing hospital IT applications will be affected by the regulation. Hospitals will be spending about $120 billion to meet the adoption and meaningful use provisions of the Act. This equates to $80,000 to $100,000 per hospital bed. ARRA incentive payments will cover roughly 20% of this cash outlay, meaning that $60-80K won’t to covered.

But McKinsey says, “Hold on!” There are ways to recoup the spending gap between HITECH incentives and cash-out-of-the-hospitals-budget. McKinsey’s research calculates that optimizing labor, reducing adverse drug events and duplicate tests, and adopting revenue cycle management can help the average hospital save $25,000 to $44,000 per bed each year. That gets to the $40 billion in annual savings when multiplied across all hospital beds in the U.S.

In operational terms, the savings accrue through:

• Managing inpatient beds more efficiently using equipment-scheduling software
• Optimizing the use of clinical equipment
• Determining optimal staffing
• Reducing administrative waste
• Reducing adverse drug reactions through computerized-physician-order-entry (CPOE) which cost $8,000 to $15,000 per bed each year (up to $3 million for a 200 bed hospital)
• Managing the revenue cycle by billing unbilled services, equivalent to 0.4% of hospital services, or $4,000 per bed.

Jane’s Hot Points: The McKinsey team rightly points to three critical success factors for maximzing health IT investments that the most wired, effective hospital-adopters have learned: get critical buy-in among clinicians and hospital execs early in the HIT adoption process; ‘radically’ simplify health IT architecture; and, elegantly plan and execute.

It’s the implementation phase in health IT adoption that so often gets short-shrift. McKinsey notes that Canada’s hospital system devoted 30% of its entire budget to change management. That’s a big number, but it’s also where rubber meets road: a capital outlay of $N million is the easy part of HIT adoption. The follow-on implementation resources, both in terms of sheer dollar volume and labor/staffing, along with disruption of clinical workflow, is the hard part. But getting to meaningful use will require no small amount of implementation effort in the form of evangelism, education and training, and ongoing assistance and support.

Originally posted on The Health Care Blog on August 18th.