Health Populi

Retail clinics, stalled in 2010, will grow to 2014

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 19 Nov 2009 11:37:00 +0000

Reports on the demise of the retail health clinic aren't reading the tea leaves right, says Deloitte's Center for Health Solutions.

While total retail clinics in operation numbered just over 1,000 in 2009, with modest growth since 2007, Deloitte forecasts growth exceeding 3,000 clinics by 2014.

MinuteClinic and Take Care make up 72% of clinic market share in the U.S. The remainder of the clinic market is quite fragmented, with Wal-Mart taking on a hybrid model (both operating and sharing operations with local health systems). The majority of clinics are co-located in pharmacies.

What's going to drive accelerating growth of retail clinics after 2010 to 2014?

Health plans' reimbursement of clinic visits. It helps to follow the money. Health plans have begun to cover retail clinic visits as they see cost savings, evidence-based practices, and enrollee satisfaction.

Consumer awareness and adoption. HarrisInteractive's surveys have shown an uptick in Americans' acceptance of the retail clinic concept in terms of staff and service quality.

New channels beyond the pharmacy. As clinics locate to even more convenient locales, such as worksites and big-box discounters, more consumers will utilize them.

Health care is local. Health citizens may have a preference for locally branded and operated retail clinics. Mayo, Intermountain Healthcare, and The Cleveland Clinic have piloted retail sites and health consumers like the fact that these operators can provide back-up in case of emergency or the need for ancillary referral services.

Health Populi's Hot Points: Deloitte says we're entering the second wave of retail clinic expansion toward 2014. What could be obstacles to getting to the 3,000+ clinics are the limited supply of primary care health workers and pressures from pricing and regulation.

Ultimately, retail health is heavily driven by consumer demand. As Americans take on more out-of-pocket cost and fiscal responsibility for their health care decisions, the more they will look to convenient, quality health sites and providers. Those retail clinics that can be locally branded (or branded by a quality health imprimatur like Mayo) and deliver on a consumer-friendly value proposition, from the parking lot through the health outcome, will make it in Wave 2 of the retail clinic evolution.

Global wellness strategies: the U.S. is unique, but all regions' businesses disconnect strategies from priorities

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 17 Nov 2009 15:39:00 +0000

Employers across the world recognize the value of employee health and well-being, both to their organizations and to their individual workers.

Buck Consultants surveyed over 1,000 organizations in 45 countries and found that, globally, health promotion that focuses on worker productivity is spreading.

However, employers in the United States have different priorities and perceived risks than businesses in other regions of the world.

The report on the survey, Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies, spells out the differences between the U.S. and the ROW.

The chart details the top 3 priorities among employers by region; in the U.S., it's physical activity above all priorities. In the rest of the world, the top risk factor is stress, stress, stress. Physical activity is a challenge in second place in Asia, Australia, and Europe. Food, too, takes second place in the U.S. and Latin America -- the two regions of the world where obesity is growing fastest.

The top strategic objective in the U.S. is to reduce health care and insurance costs -- the only region of the world where this shows up as a first-order priority. In every other region of the world, the top business wellness priority is to improve productivity and reduce presenteeism.

Health Populi's Hot Points: Two key observations come out of this study for me:

1. There's a disconnect between the companies' priorities (stress, nutrition) and the top wellness program elements that Buck identified: biometric health screening, flu shots and immunizations, executive screening programs, health fairs, and gym memberships. Targeting, really targeting, stress, obesity and chronic disease requires more focused programs than these fragmented tactics.

2. The U.S. employer-sponsored health system is an anomaly in the world. While Buck says this isn't surprising, it's a drain on American companies' profitability and erodes global competitiveness.

And that's why health system costs is the #1 stress factor for U.S. business.

Technology can help providers deal with cuts in Medicare, but many still waiting-and-seeing

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 17 Nov 2009 12:39:00 +0000

Health providers believe they'll need to make better use of technology to offset proposed cuts in Medicare reimbursement, according to a survey by IVANS.

IVANS, the IT solutions provider, conducted this survey to gauge health providers' perspectives on health reform and the impact of proposed Medicare cuts on operations.

About 1 in 3 health providers views technology as a way to deal with downward trends in Medicare reimbursement, as the chart illustrates. Thus, providers are connecting the dots between the role of health care IT to reduce operating expenses, especially administrative costs.

In the conclusion of its survey summary report, IVANS, which competes in the health IT implementation space, argues for the role of technology in reducing operating costs such as high-speed networks' role in replacing dial-up telephone systems.

Health Populi's Hot Points: As providers plan to manage their health care operations in a scenario of proposed cuts from Medicare, and potentially private payers as well, technology can indeed play a role in streamlining manual processes and in replacing expensive labor. A conservative estimate is that 30% of health costs in the U.S. go to administrative waste. The U.S. Healthcare Efficiency Index (a project with which I am affiliated) calculates that the U.S. health system is only at 43% efficiency.

There are several administrative simplification provisions that would move the needle on health care paper-based administrative waste in the Senate Finance Bill, including:

A timeline for accelerating existing HIPAA transactions
Adding electronic funds transfer (EFT) as a required transaction
A requirement that by 2014, no Medicare payment under Part A or Part B be made other than EFT or an electronic remittance, among others.

While a growing cadre of providers sees the merits in going electronic, IVANS research reveals a chasm between that belief and movement toward adopting these systems, pointing to a "wait-and-see" attitude among many health providers. Other providers, if adopting, may be doing so in a piecemeal fashion.

In the meantime, potential technology benefits notwithstanding, a plurality of health providers are worried that Medicare cuts will lead to layoffs and lower salaries in the practice, and reduced quality of care for patients.

Americans Want Prevention in Health Reform

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 16 Nov 2009 14:23:00 +0000

One of few health reform topics all Americans agree on is the issue of prevention. The majority of Democrats, Independents and Republicans rank prevention ahead of most other health reform initiatives, according to a survey conducted for the Robert Wood Johnson Foundation.

The top health reform priority among Americans is insurance reform: specifically, prohibiting insurance companies from denying coverage because of age, medical history, or pre-existing condition, scoring 7.9 out of 10 based on the survey methodology.

In second place in the survey among Americans' health reform priorities were to invest in more prevention to help people stay healthy, and to provide tax credits to small businesses to buy health insurance for employees. Each of the #2 priorities scored 7.7 out of 10 in the survey.

Specific prevention issues are shown in the chart. Most important in Americans' minds are to have a state-of-the-art public health system, loan forgiveness for public health professionals to shore up the supply of this labor force, and creating a Public Health Investment Fund targeting nutrition and exercise in schools and communities. Another function of this Fund would be to "test new approaches to staying healthy so people would have the information they need to make their own best decisions about how to be healthy and prevent disease."

Health Populi's Hot Points: Listen up, Congressfolk and others who make health policy in the U.S.: 2 in 3 Americans said they'd be more likely to support a member of Congress who votes for prevention or it would make no difference in their vote, versus 32% who said they'd be less likely to vote for this politician.

Most Americans are pro-prevention in health reform. When it comes to public health and personal participation in health and health care, we're passed the tipping point of convincing people the merits of health promotion. Time to get on with this strategy that Americans, across-the-political-spectrum, favor.

Will the FDA support or inhibit participatory health care when it comes to social media?

jane@think-health.com (Jane Sarasohn-Kahn) — Fri, 13 Nov 2009 12:50:00 +0000

Yesterday and today, the FDA is listening to stakeholders at the nexus of social media and health relate their perspectives on the benefits of social media in health. The topic in its full title is "Promotion of FDA-Regulated Medical Products Using the Internet and Social Media Tools." This is a long-anticipated meeting that's discussing the benefits, drawbacks and true stories about the Internet in health -- in particular, related to pharmaceuticals and medical devices.

Full coverage online has been provided by igniteHealth, a health marketing agency, that's tracking all tweets and presentations from the event.

Representatives testified from a range of stakeholder organizations including pharmaceutical manufacturers, health infomediaries, marketing companies, social networks, patient advocates, industry associations. A full list of those who testified can be found here.

This morning, a health citizen, representing herself -- not an organization or company -- provided testimony that was most persuasive and at the same time truly moving; Kim Witczak talked about her husband, Woody, who had hung himself while following doctor's instructions to take a prescription of anti-depressants. This was six years ago, in the era before black-box warnings were implemented.

Kim has been part of the movement toward drug safety and patient participation. Her website, Woody Matters, is dedicated both to the memory of her husband and to providing helpful resources and support to people managing decisions around prescription drugs -- especially anti-depressants.

Kim's message is that health citizens need full access to information about health products and services. The Internet is the logical, practical locus for that information.

One particularly crisp and informative presentation was offered by WEGO Health, a health portal founded by Jack Barrette who had previously nurtured Yahoo!'s health strategy. He co-presented with his colleague, Bob Brooks, who directs product development at the company.

WEGO conducted a social media survey among 162 health activist panelists that participate on the site. Consider this group ultra-engaged health citizens who 'get' the role that social media play in health and health care. Jack calls these "power users online." Bob told the FDA panel that WEGO's activists are the 10% of health citizens who create content for 90% of all health citizens.

The graph above shows a key question in WEGO's survey, which was: "Does the use of social media by Health Care Companies help people to understand important health issues?" Most engaged health citizens say, "Yes," especially for four key aspects of health communication: to provide product updates, to bring accurate information into conversations, to address FAQs, and to add professional expertise. All of these, in the context of conversations.

To be credible and trustworthy in these conversations, product and service companies have an obligation to the community to correct misinformation about the products, and to follow regulations, WEGO found. Overall, health activists believe that the FDA should work to tailor regulations to the "practical realities of social media."

Health Populi's Hot Points: Aaron Krinsky of VeoMed, which provides technical platforms for social media in and beyond the health vertical, testified that, "we are moving from monological to a dialogical, participatory model in health."

The story of Woody and Kim, and the activists in WEGO Health, all understand the practical realities of social media. 74% of the WEGO activists agree that regulation of health care companies' participation in Internet and social media needs to be tailored to the unique attributes of these channels. Furthermore, 2 in 3 health citizens agree that open Internet and social media conversation between health companies and people online is valuable, and regulations should not prevent those open conversations.

In putting together recommendations based on these two days of testimony, the FDA would be wise to listen to the voices of patients-health citizens, who are already regularly using social media in their lives. Participatory health is the way forward, and the Internet is the bridge that's bringing stakeholders and patients together.

Cost-effectiveness is not a harbinger of rationing health care

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 12 Nov 2009 14:43:00 +0000

Health care cost increases in the U.S. are unsustainable; there is universal agreement among U.S. health care stakeholders on this point. The uber-objective of "bending the cost curve" is a major sticking-point with the House-passed health reform bill.

Some see cost-effectiveness analysis (CEA) as one viable approach to managing health cost growth in the U.S. CEA balances health benefits of different clinical interventions for a specific condition and compares each intervention to their costs.

A report from the California HealthCare Foundation (CHCF), Value Proposition: The Role of Cost-Effectiveness in Coverage Decisions, clearly explains CEA and offers recommendations on how the method can be fairly implemented in the U.S.

CEA is used the world over to compared health therapies' and procedures' cost, impacts and patient outcomes. The United Kingdom's NICE, the National Institute for Health and Clinical Excellence organization, for example, delivers guidelines based on the latest clinical evidence; their findings guide funding decisions for the National Health Service that directly impact patient care.

In the U.S., land of open-ended health choices and "free" clinical decision making, CEA is seen as an inhibitor of innovation for pharmaceuticals, medical devices, and surgical procedures.

CEA is used in many managed care organizations in the U.S. along with the VA and the DoD health systems, although is not widely deployed in Medicare. 90% of health plans have adopted CEA in making coverage decisions.

Health Populi's Hot Points: Medicare is the single largest contributor to the long-term fiscal instability in the U.S. budget. Thus, adopting CEA in Medicare would make sense. To do so would require a major dose of transparency in CEA methodologies for each clinical area studied. There are assumptions underneath each CEA study which must be made explicit for this to work in Medicare, a publicly-funded program.

The CHCF report talks about NICE's Citizen Council, comprised of 30 British health citizens broadly representing the demographics of England and Wales.

"Americans in their dual roles as tax-payers and users of health care have key roles to play in contributing to the discussion of priority setting," the report concludes. By bringing American health citizens into the CEA process as true participants in health care and health coverage decision making, greater transparency and empowerment would be enhanced. CEA doesn't have to mean rationing.

Thank you, Dad, on this Veterans Day, for your bravery and good patient modeling

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 11 Nov 2009 15:44:00 +0000

The best patient I ever knew was also one of The Greatest Generation in World War II. Charles Sarasohn, my father, fought in the frontlines of the Pacific theatre in the Philippines and beyond, as part of the scrappy team known as the Jungleers. They made their way on foot through the jungle terrain with machete in hand and determination in their heart.

They fought for freedom. They fought for Us.

When we get caught up in the day-to-day stresses of life in 2009, we need to more often remember the warriors who fought for our right to live the lives we live so freely.

His bravery and fortitude extended to his lifelong self-management of Type 2 diabetes and high blood pressure, which he combated in an uber-disciplined way through diet and exercise. Insulin wasn't part of his health regimen until he was 84 when his aging body hit the wall: congestive heart failure and an old heart. Over 12 years before, that beautiful big heart had been made stronger after quintuple bypass and a pacemaker implant that helped buoy him in his later years as he continued to work full-time, travel and enjoy friends, family and a daily martini.

I'm thinking about him more today...in the midst of global unrest, the erosion of civil liberties, and general malaise in the world and in our collective mood. He would have been so happy to see last weekend's passage of the House health reform (although he would have wanted to see more comprehensive change).

His model gives me strength and fortitude to keep fighting the good fight. As he told me time and again, "It's not that 'the show must go on.' Life does go on, and you have to decide to move along with it."

Hospitals focus on quality, experience, and empowerment in patient portals

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 11 Nov 2009 13:08:00 +0000

Hospitals generally see the value of patient portals. In these projects, their highest-value goals are improving the quality of health care, enhancing patient experiences, empowering health consumers, and personalizing information.

Geonetric conducted their eHealth Insight survey in August 2009 to learn more about hospitals goals and priorities for patient-facing Internet portals. Over 60% of hospitals and clinics who responded to the survey understood the value of a patient portal. One in 4 respondents had already built such a portal, and one-third looked to develop one in the next year.

Ironically, while goals for portals were highly consumer-focused, future functional priorities for portal applications were more tactical in nature. The highest priorities among hospitals for patient portals were to provide medical news and health information (55%), finding a doctor (55%), and patient education and content publishing (45%). In addition, transaction-oriented apps such as bill payment, appointment requests and reminders were of interest for at least 1 in 4 hospitals.

Health Populi's Hot Points: The partial disconnect between goals and functional priorities in hospitals' Internet portal planning may get in the way of institutions fully reaching their objectives to more closely bond with health citizens in their communities. Consumers who want to engage in health care see their health care as being "all about me," and health and wellbeing are local, according to the Edelman Health Engagement Barometer.

The greater the level of personalization and customized service orientation, the more current patients, and patient-prospects, will bond with their local hospital provider.

Americans dying in hospitals cost more than those who are discharged, says AHRQ

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 11 Nov 2009 03:20:00 +0000

Some people believe they're worth more dead than alive. When it comes to patient deaths in hospitals, that may indeed be the case. At least patients who die in hospitals cost more than inpatients who survive their stays.

According to the Agency for Healthcare Research and Quality (AHRQ), patient deaths in hospitals cost about $20 billion, based on AHRQ's analysis of 765,651 hospital patient deaths in 2007.

The average cost of a patient death in hospital was $26,035 over the course of 8.8 days. The average cost of an inpatient stay in 2007 was $9,447 generated over the course of 4.5 days.

Thus, people dying in hospital had twice the length-of-stay of those who were discharged. But the money spent on Americans who died in hospital was more than twice the amount of inpatients, signalling that the intensity of care and resources deployed for the dying were greater.

The inpatient death rate declined with income; the poorest Americans are more likely to die in hospital than at home.

Health Populi's Hot Points: As the U.S. works to bend the nation's health care cost curve, a rational re-think about end-of-life care is long overdue. One in 3 patients who died in 2006 did so in the hospital.

While it is understandable that most deaths in hospital occur among Medicare enrollees -- that is, among the oldest cohort of Americans -- it is important to note that among Medicaid patients, the costs per hospital stay ending in death were $38,939 -- over 5x the cost of inpatients discharged alive.

What's wrong with this picture? Plenty. The AHRQ report dramatically illustrates several facets of health disparities in America: between the rich and the poor; between the insured and the uninsured.

Finally, technologies are available now and more emerging to help keep people at home where care can be delivered at a lower cost and higher quality (say, avoiding hospital infections among several quality indicators). Medicare payment reform must reallocate resources toward this other "medical home" -- that is, the patient's residence -- and take advantage of remote monitoring and other telehealth applications that will ultimately conserve spending, bend that cost curve, and eliminate health disparities.

Still a long road to EHR implementation:in U.S. hospitals

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 09 Nov 2009 22:34:00 +0000

When it comes to the adoption of electronic health records, it's good to be urban, large, and teach.

According to the latest report on EHR adoption, Health Information Technology in the United States: On the Cusp of Change, 2009, fewer than 2% of American hospitals used a comprehensive electronic health record (EHR) in 2008, 7.6% had a "basic" EHR based on the definition generated by an expert panel conducted by the Robert Wood Johnson Foundation, the Massachusetts General Hospital, and the George Washington University -- the team that developed this full report on the state of EHRs in U.S. hospitals.

The most common applications instituted in hospital EHRs included laboratory results (77%), radiology reports (78%) and images (78%). About 1 in 5 U.S. hospitals used computerized order entry and clinical decision support.

The most significant barrier to EHR adoption was found to be financial -- 70% of hospitals reported that inadequate capital kept them from acquiring and implementing EHRs. Other barriers cited by about 1 in 3 hospitals included physician resistance, unclear ROI, maintenance costs, and access to IT staff.

One of hte most intriguing findings in this survey was found among hospitals serving the poor, known as "disproportionate share hospitals" (abbreviated "DSH"). These are the safety-net hospitals in the U.S. that serve more people funded by Medicaid. Among DSH hospitals that used EHRs, there was not obvious difference in the quality of care delivered. The researchers conclude, based on this statistics, that the presence of an EHR mitigated that expected negative effect of a high DSH index.

Health Populi's Hot Points: Since the overwhelming barrier to implementing EHRs is financial, based on this survey of American hospitals, the EHR funding included in the ARRA stimulus package holds tremendous promise -- and inspires great expectations. This survey found that a minority of U.S. hospitals has implemented comprehensive EHRs. It is in the implementation of all aspects of EHRs where real impacts on clinical quality are made. Adopting a few modules that make up bits of EHRs doesn't result in greatly different outcomes overall.

The subtitle of this report is, "On the Cusp of Change." That cusp will have a pretty long tail given the low-penetration of fully implemented EHRs in American hospitals. The stimulus funding was a must-do to get EHR adoption rolling based on what RWJF et. al. have found in this important work.

America's primary health care backbone needs reinvestment and re-imagining

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 05 Nov 2009 16:58:00 +0000

59% of U.S. physicians say their patients have difficulty paying for health care and medicines.

The foot soldiers of American health care are front-line primary care physicians (PCPs). Compared to their colleagues in ten other developed countries, American PCPs say their nation is far behind other countries' health systems in at least three ways:

Patients' access to health care
The use of financial incentives to improve quality
The use of health information technology, where U.S. physicians say 46% of doctors use EMRs versus over 90% of doctors in Australia, Italy, the Netherlands, New Zealand, Norway, Sweden, and the U.K.

The Commonwealth Fund has published A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences, published on November 5 2009 in Health Affairs. The survey sampled 10,000 PCPs in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the U.K., and the U.S. The data was collected between February and July 2009.

Health Populi's Hot Points: The main difference between the U.S. health system and the comparison systems surveyed in this report is America's lack of a primary care backbone. The health systems globally with the best health outcomes have resilient, strong primary care infrastructures. The primary care backbone in the U.S. is suffering from a lack of reinvestment and re imagination. The promise of a patient-centered medical home for every American is one vision for re-energized primary care in the U.S. Aligning incentives toward primary care would at once attract talent to the PCP pool which is needed based on projected deficits for primary care professionals in the U.S.; and, the access problems that American doctors point out in the survey would abate.

As the population in the U.S. ages and more health citizens live longer with more complex chronic conditions, the demand for more primary care access and new models for delivering the care will only increase.

Americans want to use email for all sorts of health apps

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 05 Nov 2009 12:09:00 +0000

59% of Americans want to receive test results via email. 1 in 2 would like to use email to request prescription refills, confirming appointments, telling doctors about their conditions, and asking questions about new conditions.

Email is now the preferred communications medium for consumers in health.

Second to email, using doctors' websites would also be welcomed by many health consumers, especially for prescriptions and appointments. Physicians' websites are somewhat less desirable communications platforms for communicating about personal health conditions. It is still too early for consumers en masse to embrace text messaging in health.

Women were more likely than men to embrace these new media platforms for communicating with physicians.

Lightspeed Research conducted a survey on Americans' attitudes on communicating with physicians to save time and money in August 2009 among 1,000 respondents.

Health Populi's Hot Points: As much as Americans say they'd embrace email communication with their doctors, there are two impediments in the current market: first, most physicians aren't 'there' yet, according to the surveyed consumers; and second, at least one-half of consumers aren't willing to pay for this service. 49% of consumers polled said they were unwilling to pay for an email consult; 31% said they'd be willing to pay if it were covered by insurance.

In addition to many convenience factors, a key benefit cited by 49% of consumers was that they would have a written set of instructions from the doctor to which she can refer. Such written instructions can get to the major challenge of health literacy and "patient ADD" that addles physician-patient communications in today's harried/hurried world.

The emergence of the patient-centered medical home, bundled payments, and paying physicians to manage conditions should break down these two key impediments. In the meantime, physicians and payers can tap into services already available that connect patients such as those from Medem, Medfusion, and RelayHealth.

CDHP and HDHP Plan Enrollment Still Tiny in 2009

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 04 Nov 2009 10:14:00 +0000

On one hand, it can be said that enrollment in consumer-directed and high-deductible health plans in 2009 grew by 33% in the past year. On the other hand, the total proportion of Americans enrolled in private plans who was in a CDHP or HDHP was 4%.

While this represents growth by definition, it's instructive to look at the chart and note that 34% of employers did not offer employees an HDHP or CDHP in 2009 -- up from 28%. That is, substantially fewer employers offered a consumer-directed plan this year compared to the previous 3 years this survey has been conducted.

The Employee Benefits Research Institute (EBRI) takes a detailed dive into the state of account-based health plans in the November 2009 issue of EBRI Notes.

Health Populi's Hot Points: A growing proportion of Americans with access to private health insurance through work is eligible for account-based health plans like CDHPs and HDHPs. However, most of these workers choose to stay in more traditional health plan types. People are slow to change to new plan types when they know the devil they know.

EBRI notes that for those employees who have opted into CDHPs and HDHPs (the 4%), their account fund balances continue to grow. EBRI believes that's due in part to these workers increasing their contributions to the health plan accounts in the case of workers with family-coverage. Contributions for employee-only (single) coverage actually fell in 2009.

EBRI notes that it's in the larger employer groups where there is growth in CDHP enrollment, and in fund balances where employers make greater contributions.

Still, the fund balances aren't big money: overall, 50% of the covered population has at least $1,000 in an account, and slightly less than one-half has less than $1,000 in their account. 9% of people don't even know how much they have sitting in their health account.

These findings from EBRI demonstrate another aspect of health care in the U.S. where there is substantial lack of consumer activation and engagement. When offered an innovation like a CDHP or HDHP, most Americans who access health insurance through private employers are still loathe to change.

How do less empowered American health citizens get through the flu season?

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 03 Nov 2009 14:08:00 +0000

As I nurse my flu symptoms, I'm struck in real-time by being a sick patient in a sick health system.

Last Friday 30th October, I was suffering classic flu symptoms and after 2 days of trying to muddle through with home remedies, homeopathic products and OTCs, I contacted my doctor's office first thing in the morning. I was told that my doctor was out for the day, and was referred to another physician in the practice.

By noon, that doctor had phoned in a prescription for Tamiflu to my pharmacy. The office told me to follow up with my doctor via phone after the weekend on Monday. I then drove to the pharmacy and picked up the oseltamivir phosphate capsules and swallowed the first of ten pills prescribed for a five-day period.

A compliant patient, I followed up yesterday by phoning my doctor's office. My call was given to the medical secretary responsible for my doctor's patients. Let's call her Mary. Mary asked me why I was calling -- was this 'just an FYI' for my doctor? I said, no, I was instructed by the doctor who prescribed the Tamiflu on Friday to report back to my own doctor on Monday when he would be back in the office and be able to directly consult with me.

My doctor's practice still doesn't use electronic health records; thus, Mary grabbed a piece of paper and scratched out notes based on what I was telling her about my condition and health status. It was a hurried conversation -- well, less of a conversation than a data dump by me -- with no assurance on my end that the information was getting transcribed completely or correctly.

Mary did not pull my paper file to catch up with my situation. She didn't access any notes in my file from last Friday's telephone encounter telling her that I was prescribed Tamiflu. She did not know I had trouble sleeping and so was bumming Ambien off of my husband's personal supply. When I told her I was doing just that, she berated me and told me what a terrible thing I was doing.
I had to laugh.

Mary told me to phone the office back at 4:45 pm if I hadn't heard from her before then. Presumably, she would put her scribbled note in front of my doctor, who could then follow up with me directly.

Of course, there was no phone call back to me by 4:45 pm, so I phoned the office again and asked for Mary. When she took the call, she didn't remember who I was, what my symptoms were, or even what doctor I was calling for. After a few seconds I said to her, "I'm the one you yelled at for taking the Ambien," she vaguely recalled my identity. Vaguely.

My patience lost, Mary finally 'heard' that in my voice and said she'd "rotate" my file to the front of the doctor's pile of records he was reviewing.

Around 7 pm, the doctor phoned me: he quickly got down to business with the question, "what's up? and once he learned my fever had abated on Saturday, he was glad I had been fever-free for over 48 hours. His business was done, and he said he'd phone in a script for Tussinex to help me sleep.

30 minutes later, my local CVS pharmacy phoned me to say they would be out of Tussinex until 1 pm today.

So much for a good night's sleep, at least from my doctor's point of view. For me, an Ambien did the trick once again, albeit that sleepy little pill was not what the doctor ordered.

Health Populi's Hot Points: I have a friend who is a senior executive with a pharmaceutical company who cannot find a swine flu vaccine for her young daughter in suburban Philadelphia. She is among the savviest health citizens I know and works for a company that makes vaccines.

I am a health economist and consultant who meets with and counsels some of the country's largest health plans, suppliers to the industry on the Fortune 100, provider groups, and government agencies. I live in a community with five medical schools and more MRIs per capita than in most of the nation.

I cannot imagine how health citizens less empowered than me make it in this chaotic, flu-ridden, vaccine-deficited world that is U.S. health care in November 2009.

Not much in the 1,900-page health reform bill will get to reforming overwhelmed, under-servicing medical practices any time soon. Certainly not in this devastating flu season.

In 14 states, over 1 in 5 women is uninsured

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 02 Nov 2009 13:34:00 +0000

Between 2007 and 2008, 18% of American women between 18 and 64 years of age were uninsured. 1 in 10 women in this age group were enrolled in Medicaid.

Two-thirds of women were covered by either employer-sponsored plans or public insurance such as Medicare and military-related plans, or ESI (employer-sponsored insurance).

Kaiser Family Foundation has published the latest data from the Urban Institute which pooled 2008 and 2009 iterations of the Current Population Surveys, based on the March 2009 Survey from the Bureau of the Census.

The proportion of women covered by employer-sponsored insurance varies substantially across the 50 United States. The highest percentage of working-aged women covered through employer plans were in the States of Hawaii and New Hampshire, where nearly 8 in 10 women are covered by employers (78%). The lowest penetration of employer-sponsored insurance was found for women living in New Mexico with 55% of women covered by ESI, and Mississippi and Texas where 58% of women receive.

In 14 states, at least 1 in 5 women was uninsured. The table turns to this other side of the coin: the level of uninsurance among women by state. The table presents data for the states where at least 1 in 5 women was uninsured in 2007-2008. These states include Texas (closer to between 1 in 3 or 4 women who lack health insurance), New Mexico, Louisiana, Florida, and Alaska, along with nine others.

Health Populi's Hot Points: The latest and best health plan legislation includes a provision for states to opt out of providing a public option. Since there is high variability, state-by-state, on the proportion of women who lack health insurance, it is easy to forecast that such variability will continue where patchwork health reform allows people (in this case, women) to slip through the cracks left by the over-compromise of certain basic health reform principles: namely, the principle of universal coverage.

Read more about what the opt-out could mean here in The Gov Monitor.

Opening access to primary care, IBM drops copays

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 29 Oct 2009 12:23:00 +0000

IBM is dropping the $20 co-payment for employees' visits to primary care doctors.

The Wall Street Journal covers this story today.

The "no co-pay" scheme will cover employees enrolled in IBM's self-insured health plan -- excluding workers enrolled in HMOs. Overall, IBM has 115,000 employees and spends $1.3 billion on health care.

The WSJ quotes SVP of IBM's human resources Randy MacDonald, who said that emphasizing primary care is part of an overall "wellness" strategy that tries to keep costs low by preventing illness.

Health Populi's Hot Points: The data point of one U.S. company dropping a $20 payment for employees visiting a physician may seem trivial. But in fact the implications of this are huge:

1. Here you have company #14 in the 2009 Fortune 500 list designing a health benefit to nudge people to seek primary care by eliminating one of the main barriers (that is, money) to scheduling that appointment.

2. In the past 12 months, 1 in 3 Americans has postponed getting necessary health care due to cost, according to the latest Kaiser Family Foundation Health Tracking Poll.

3. Employers are "getting" wellness and the crucial role of primary care in keeping employees healthy and productive.

In 1996, the Asheville Project measured the impact of dropping a co-pay for a prescription drug targeting maintenance meds for chronic conditions like diabetes and asthma. By dropping co-pays for drugs in a strategic way, patients' compliance and adherence to prescribed drug regimens improved, thus improving outcomes and increasing peoples' productivity in their daily lives.

David Hom also evangelizes on the top of value-based benefit design where he honed his skills on the topic at Pitney Bowes. His approach is codified in the book, Total Value Total Return which is required reading for new-and-improved health benefit design.

IBM's strategy to drop primary care co-pays is the New Asheville -- watch for primary care visits among IBM's employees to increase and for the company's medical trend to be better managed. This approach also promotes a medical home for every employee, a positive move toward improving access and health management for employees.

Web-based health programs can save money and improve outcomes

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 28 Oct 2009 13:12:00 +0000

There's more evidence that linking patients online to targeted programs that help them manage chronic conditions not only results in better patient outcomes -- the process results in lowering costs for care.

The DASH for Health program is an online tool that helps health consumers change nutrition and exercise behaviors.

A pilot program to test the cost-effectiveness of DASH was offered by EMC Corporation, an employer based in Massachusetts, to its employees as a free, opt-in benefit. Data generated through employees' use of the program was gathered and analyzed by researchers from Boston University's Schools of Medicine and Public Health.

Among employees diagnosed with heart disease -- including hyperlipidemia, hypertension and diabetes -- use of the Internet-based tool resulted in lower health care costs for those who visited the site at least nine times over the course of a year. Note that visiting the site more than 9x yielded even more impressive results -- representing a possible direct dose-response relationship. The research is published in the Oct/Dec issue of the Journal of Medical Internet Research.

In terms of outcomes, employees who opted into the program lost weight, lowered blood pressure, and improved healthy eating habits.

In terms of money, for people managing cardiovascular conditions, health care costs were $827 lower than for people who did not use the program.

Health Populi's Hot Points: There remains some skepticism among employers who instituted disease management programs during their first generation. Many of these programs didn't demonstrate clear return-on-investment. In the reincarnation of health management, innovators are building on lessons learned from previous failures and are focusing more on patient engagement, usability, and meeting people-patients where they 'live.' This is one building block toward Participatory Health based on greater employee engagement in managing chronic conditions.

Several surveys published from employee benefits firms expect that employers who sponsor health insurance at the workplace are complementing these plans with wellness and population health management programs. Taking a page out of the DASH for Health study at EMC will help health plan sponsor organizations yield positive results for both employee-patients and for the company's bottom line.

This program is another example of how to bend the cost curve of U.S. health finance over the long term. For more on this topic, see my column in the Washington Post's Healthcare Rx panel responding to the question: "Has Congress done enough to constrain long-term health spending growth?"

Health and fast food: calorie labels work

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 27 Oct 2009 10:53:00 +0000

New Yorkers who frequent Au Bon Pain, KFC, McDonald's and Starbucks who noticed calorie counts on menu labels ordered 106 fewer calories at the point-of-purchase than people who didn't pay attention to the information.

Here's evidence that labeling in fast-food destinations works.

At the annual meeting of the Obesity Society in Washington DC this week, researchers are presenting results on how transparency of calorie information motivates many health citizens to change their choices based on nutritional knowledge.

Reuters reports some details from the study. Researchers in New York polled 10,000 diners at 275 locations of the most popular fast food and coffee chains in the spring of 2007. They repeated the survey in the spring of 2009 among 12,000 consumers, who shared register receipts and survey responses.

New York implemented menu-labeling laws in March 2008. Data on the New York City fast food consumers was delivered at the meeting by Lynn Silver, MD, MPH, assistant commissioner for New York's Bureau of Chronic Disease Prevention and Control. Dr. Silver believes this information will change consumers' food choices over time. She looks to the industry to change portion sizes and offer healthy choices on menus.

Food and health marketers must respond, too, in helping people move toward healthier decisions, several presenters at the conference pointed out. A fifth fast food retailer, Subway, actually had consumers doubling their calories ordered during the study period. This is attributed to the company promoting 12-inch sub sandwiches in a consumer advertising campaign at the time the study was conducted.

Follow the Obesity Society on Twitter at @Obesity2009.

Health Populi's Hot Points: Transparency is the new black in health care. Well, it's not as much 'new' as it is 'standard operating procedure' for building trust and empowerment on the part of health citizens vis-a-vis the health industry. It will take the whole village in health to move Americans toward healthy food and lifestyle choices, akin to a strategic War on Healthy Living. We did it with Brooke Shields, tight jeans, and cigarettes; it can be done for healthy food, too, with engaging and innovative approaches to social marketing.

It's astounding how many calories are consumed in fast food outlets at lunch -- even with transparent labeling information. New Yorkers who heeded the labels purchased on average 754 calories' worth of food for lunch in 2009. Consumers who did not pay attention to the menu labels purchased 860 calories' worth of food.

So portion control, along with more healthy choices, plays a huge role in managing calories. Emerging technologies, such as iPhone apps and proprietary systems like Keas and Sensei, empower consumers on a 24x7 basis to bolster healthy choices.

For the food industry, this means bringing consumers into the information-fold the way health providers, plans, and life science companies have begun to do. It's early days for all stakeholders who touch health citizens with products and services -- including the food industry -- but if all touchpoints provide useful, usable and design-friendly information, then we'll achieve real health reform at the citizen level well beyond whatever comes out of Capitol Hill.

Thanks to Dr. Ted Eytan for his ongoing collegiality and knowledge-sharing. He is the model of a Participatory Provider in this era of Participatory Medicine and Health.

Small business is the working poor in U.S. industry

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 26 Oct 2009 10:06:00 +0000

Small business is the working poor of American industry when it comes to health insurance access: they simply cannot afford to pay for it.

This means that workers in small businesses -- which is where most new jobs are created -- probably won't have access to health insurance at work.

Workers who don't receive health coverage from employers are unlikely to get coverage on the individual market or from any other source, according to Insurance at Risk: Small Business Employees Risk Losing Coverage.

This report was compiled by a team from the Department of Health and Human Services (DHHS), synthesizing statistics on small business and health insurance coverage between 2000 and 2009.

Three in 4 small businesses that do not offer benefits point to the high cost of premiums as the #1 cause for not offering health insurance at the workplace. The percentage of small businesses offering health insurance dropped from 57% to 46%. Thus, fewer than 1 in 2 small businesses offer health care to employees.

If it's the costs that prevent small businesses from getting into health coverage, why do small businesses face higher health insurance costs than larger companies? First, their relative burden of health plan costs is greater: small biz pays as much as 18% more than big firms for the same policy due to higher broker fees and administrative costs. Administrative costs can be as much as 3 to 4 times greater for small groups than for large groups.

Health Populi's Hot Points: While geography is destiny in health care when it comes to variability in the quality of clinical services, employer size is a determining variable for worker's health coverage. The larger the firm, the more likely health insurance is offered, and offered at a cost that is more manageable than in a small business.

Employees of small business are 50% more likely to lose coverage as a worker in a large business, this report found.

If employers are to continue to be the cornerstone of health insurance financing in the U.S., then health reform must provide small businesses the wherewithal to play this role in a meaningful way. Tax credits and enhanced local competition to keep plan premiums competitive and increase options for businesses of all sizes will translate into a stronger foundation for health coverage nationally.

Can Medicaid absorb the newly-uninsured?

jane@think-health.com (Jane Sarasohn-Kahn) — Fri, 23 Oct 2009 11:04:00 +0000

Over one-quarter of a million jobs were lost in the U.S. in September 2009. Because unemployment quickly morphs into uninsurance, a question for the 263,000 workers and their families is: "Will Medicaid be able to cover me and my family if I cannot afford COBRA?"

There are three pieces of arithmetic that can help us connect the dots to answer this question:

1. On average, the monthly cost of COBRA consumes 84% of the average monthly unemployment payment in the U.S. The ARRA stimulus package included a 65% subsidy to help newly-laid off people pay for COBRA if they elected to do so and earned less than $125,000. This programs covers people laid off to 12/31/09, and covers those who are eligible and opt-in for a period of nine months.

2. For every 1% increase in unemployment, there is a 1.1 million person increase in the uninsured and a 1 million person increase in Medicaid and SCHIP. This metric was calculated by the Kaiser Commission on Medicaid and the Uninsured in April 2008, shown in the graphic.

3. Governors have to balance their state budgets under the law and cannot run deficits. The recession has decimated most state budgets due to lower tax receipts accompanied by increasing demand for services -- like health, education, and social services as citizens lose jobs. The Washington Post discussed the painful burdens of governors earlier this month, noting that the National Governors Association is lobbying hard against any additional unfunded mandates for health and other programs.

Health Populi's Hot Points: Time for the Kaiser team to update their metric on 1% = 1.1 + 1. The "1 million people" expected to be absorbed by Medicaid is now unsustainable given the depth and length of the recession. The U.S. has lost about 6,582,000 jobs since January 2008. The rate of job losses in the past six months hasn't dramatically slowed -- we lost 467,000 jobs in July, 466,000 jobs in August, and 263,000 jobs in September -- so over 1 million jobs lost in just the past 3 months.

One job that's dealing with this intensely is the Governor's -- having to dial down services when more are being demanded. Expect Medicaid to foist off prospective enrollees to the uninsured rolls in this so-called "jobless recovery."

The state of U.S. health care quality is flat - and varies across America

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 22 Oct 2009 11:39:00 +0000

Managing health care costs and achieving a high quality health system aren't parallel goals - they're inter-related and two sides of one coin. Adding more enrollees to existing poorly integrated health delivery organizations will simply increase costs while delivering sub-optimal outcomes to patients.

In its 13th annual report card on the U.S. health system, the National Committee for Quality Assurance (NCQA)'s The State of Health Care Quality 2009 adds more statistical evidence to the argument for health reform in America. 2009 has seen "meager progress" according to the President of NCQA, Margaret O'Kane. In her introduction to the report, O'Kane argues for five key elements in health reform that will directly improve quality:

1. Hold all health plans accountable, through accreditation, data reporting of HEDIS and CAHPS measures, and demonstrating quality improvement.

2. Reform payment and delivery systems, by paying for performance.

3. Create a framework for quality measurement, setting priorities for measurement, and aligning public and private markets by using similar measures for comparison.

4. Focus on Medicare and Medicaid quality, which NCQA has found slipping in the past 3 years.

The report analyzes quality of care data for 116 million Americans enrolled in health plans.

NCQA found that there is high variability in quality of care for a broad range of conditions. A key example is diabetes, which has reached epidemic proportions in the U.S. When well-managed,

diabetics can gain five or more years of life. NCQA found that the highest quality of care for diabetics is achieved in New England; the lowest, in the South Central region including Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, and Texas).

There is some good news in the report:

Improvement in the use of beta-blockers administered to Medicare patients who had a heart attack within the previous 6 months.

Near universal high-quality care for Americans with asthma.

Gains in helping Medicaid beneficiaries to stop smoking (important because 1 in 3 Medicaid beneficiaries smokes).

The back of the report contains a plethora of quality measures on health conditions and lifestyle behaviors that provide the backstory to NCQA's conclusions and recommendations. One of the best parts of this report is the 13-page appendix containing a long list of reference articles on health care quality, organized by theme. This will be useful for anyone looking for vetted evidence on various aspects of health quality.

Health Populi's Hot Points: If all health plans performed at the 90th percentile level demonstrated by the top 10% of plans in the U.S., between 49,400 adn 115,300 deaths could be prevented every year in the U.S. Furthermore, billions of dollars would be saved in the U.S. health system that could be deployed elsewhere -- say, to cover the uninsured in better-performing plans.

"The status quo is dangerous and costly," NCQA concludes. NCQA data prove that by spending more, you don't get more. We learned this from Shannon Brownlee's important book, Overtreated, we've learned it from the Dartmouth Health Atlas, and now we have the 13th annual NCQA State of Health Care Quality report to further bolster that fact.

We must reform payment to reform clinical workflow and nudge all players to do right by patients. Paying wrong can kill in health care.

The New Era of Participatory Medicine and Connected Health: building the evidence base

jane@think-health.com (Jane Sarasohn-Kahn) — Wed, 21 Oct 2009 10:15:00 +0000

Today marks the launch of the Journal of Participatory Medicine. The inaugural issue coincides with the kickoff of the Connected Health symposium today in Boston.

In the first issue of the Journal, Esther Dyson asks and answers the question, "Why Participatory Medicine?" She talks about the need for evidence that demonstrates what works in collaborative health care. "We are just at the beginning," Esther says, "not of a brave new experiment that could end in disaster, but of multiple experiments, by thousands and ultimately millions of people, with variations in every parameter imaginable."

Thoughtful perspectives are offered through the lenses of patients, providers, purchasers, nurses, technology developers and clinical researchers.

Finally, a bold research agenda is offered by Dr. David Kibbe and Dr. Joseph Kvedar focused on how to build the evidence base for participatory medicine:

1. What does participation in health mean?
2. How does a patient's participation in medicine challenge the traditional role(s) of physicians?
3. How can technology be strategically, appropriate deployed in participatory medicine?
4. How can participatory medicine play a role in quality and new payment systems based on outcomes and performance?
5. What are the personal and societal "rules of the game" in the context of participatory medicine? Just how much responsibility should individuals bear? What's the role of genes vs. individual responsibility for lifestyle choices? How much can we nudge people toward participation?

The Journal welcomes participation from all comers -- which is what participatory health is all about. They're collecting via crowdsourcing research papers from that demonstrate or reflect participatory medicine. See this link for instructions on how to be part of this growing crowd.

Health Populi's Hot Points: What's driving this emerging era of collaborative and participatory health? Kibbe and Kvedar see, "A confluence of factors...including an overburdened health care system and inexpensive, fast consumer access to targeted information, technologies, and peer support."

Today, pioneering physicians, providers and patients are meeting in Boston at Connected Health to continue to gain insights and learnings into how participatory health can work to benefit patients, providers, and the public's health. The most effective way to bend the cost curve in health is to get health citizens more engaged in their own health to manage the $1.7 trillion component of health spending that's spent on chronic disease. We'll need to realign incentives for both providers and patients to change the workflow in health care delivery and get the participants on the same page.

Participatory medicine is an integral part of spending smart in health care.

Poverty is a major health risk

jane@think-health.com (Jane Sarasohn-Kahn) — Tue, 20 Oct 2009 09:21:00 +0000

Poverty is a problem for all of us…and it reaches across the generations.

The health effects of poverty begin in early childhood and persist through a person’s lifetime. Poor children have a higher rate of asthma and lower rates of cognitive development. By middle age, diabetes and heart disease hit the poor harder than more affluent Americans. Among older Americans, those living below the poverty line are far more likely to have three or more chronic conditions than those whose incomes are four times greater than the poverty line.

Poverty costs not only the poor, but the overall U.S. economy as well. Based on a subset of the potential quantifiable consequences of poverty, the economic costs of sustained childhood poverty alone amount to $500 billion per year -- nearly 4% of the U.S. GDP of the U.S.

A new study from the Robert Wood Johnson Foundation, The Poor Pay More: Poverty’s High Cost to Health, by Dr. George Kaplan of the University of Michigan School of Public Health (my alma mater).

Poor environments in childhood set the stage for ill health later in life. Environmental factors that negatively impact kids' health include exposure to hazardous waste and bad air, as well as crime and disorder. Furthermore, lack of access to healthy foods – fresh fruit and vegetables – leads to higher incidence of obesity and heart un-healthy food habits. The report cites the impactful statistic that within walking distance of schools in lower income neighborhoods there are one-third more fast food restaurants and 50% percent more convenience stores than near schools in higher income neighborhoods. Citing a 2008 study by Zenk and Powell, curbing the obesity epidemic among adolescents requires addressing the food environment surrounding schools.

Because poorer Americans often lack health insurance benefits from employers, many poor and near-poor families don't have adequate access to health care. This translates into less access to preventive care, diagnostic services and treatment. Of over 53 million people without health insurance some time in 2007, nearly two-thirds of 18 to 64 year old almost two-thirds of poor 18 to 64 year olds had no health insurance.38

Health Populi’s Hot Points: How to break the cycle of poverty and ill health in the United States? The diagram illustrates five strategic pillars that, together, would ameliorate the underlying negative forces that shape poor health among the poor. These challenges are:

To raise the economic status of the poor
To reinforce the safety net
To provide affordable health care
To improve where the poor live
To invest in early childhood and in education.

All five of these areas are, in fact, investments in the future health of Americans. Beyond the health of the individuals who would directly benefit in this investment strategy is the larger nation and its citizens. If we break the poverty cycle in early childhood, the lifelong benefits of healthy, hard-working taxpayers would accrue to the macroeconomy. And, wouldn't it be nice for the health status of America to be raised from the position at #37 in the World Health Organization's rankings of health systems.

Internet use among the elderly reduces depression

jane@think-health.com (Jane Sarasohn-Kahn) — Mon, 19 Oct 2009 12:09:00 +0000

Use of the Internet by older Americans leads to a reduction in the prevalence of depression, according to a study published by the Phoenix Center for Advanced Legal & Economic Public Policy Studies. This research highlights the macro-benefit of deploying broadband to all health citizens.

Internet Use and Depression Among the Elderly analyzed a data sample of 7,000 Americans age 55 and older from the University of Michigan's Health and Retirement Study household survey. This survey instrument polls over 22,000 older Americans every two years. The data used by Dr. George S. Ford and Dr. Sherry G. Ford in the study was from the latest available data from 2006.

The researchers conclude that expanding Internet use among the elderly may have "significant economic payoffs."

The study methodology analyzed two variables: Internet use and the measure of depression. Internet use is based on the question of whether the respondent uses the Internet for the purpose of "sending or receiving e-mail or for any other purpose" (yes or no). The depression variable was based on the eight-item depression scale developed by the Center for Epidemiologic Studies (known as the CES-D scale). This is a common screening test for people to use in assessing the state of their personal mental health. The scale synthesizes eight response to questions that ask the person to reflect on their mental wellbeing.

The sample was limited to non-working people over 55.

Health Populi's Hot Points: Getting broadband connections to the homes of older health citizens has a direct positive impact on the mental health of seniors, based on the data analyzed by the Phoenix Center team. Dr. George Ford intuits that, "Increased Internet access and use by senior citizens enables them to connect with sources of social support when face-to-face interaction becomes more difficult."

The latest findings from The Pew Internet & American Life Project estimated that 45% of people over 65 use the Internet. The largest percentage increase in Internet use since 2005 has been in the 70 to 75 age group.

However, broadband penetration to households among the oldest age cohort severely lags younger homes; only 16% of people 76 years of age and older have broadband.

Public health policy would argue for broadband to be part of the prescription for senior health and wellness.

From Here to Maternity: How to Effectively Market Health Services Online

jane@think-health.com (Jane Sarasohn-Kahn) — Thu, 15 Oct 2009 21:41:00 +0000

The proliferation of health care report cards has not seen an uptake by the majority of health citizens in the U.S. In fact, there are more than 200 health quality ratings programs accounted for by the Agency for Healthcare Research and Quality (AHRQ), yet few consumers use them to make choices about providers or health services.

Since maternity services are among the most consumer-facing health services that people might use in the course of their lifetime, the California HealthCare Foundation (CHCF) wondered how to "nudge" people to use quality ratings to inform their choices. The Issue Brief, From Here to Maternity: Birth of an Online Marketing Campaign, describes how CHCF increased California health consumers use of the online quality website, CalHospitalCompare.org, and what the team learned in the course of implementing a promotional campaign to educate consumers about the website.

To put the project in context, we should first ask: what makes an effective health care "consumer?"

For purposes of this brief, a workable definition of "consumer" is someone who can make the decision whether or not to purchase an item at the store, and someone who can be influenced by marketing and advertisements.

This definition comes from Investorwords.com and I especially like the second half of the definition that speaks to the reality of shopping in the 21st century: that consumers can be influenced by marketing and ads.

CHCF undertook a multi-pronged marketing campaign to promote CalHospitalCompare.org's maternity service ratings. Promotional channels included display and text ads online, search words, branded emails, and finally an 'offline" event in the form of the San Francisco Birth & Baby Fair.

CHCF quickly learned that the online ad campaign had an immediate impact and drove up visits to CalHospitalCompare.org by eleven-fold in seven months.

As in any good pilot, the team measured progress and took away several key learnings:

Match the medium and the message to the audience.
Target group diversity.
Pay attention to placement of online investments and measure ROI.
Cost-effectiveness varies by strategy and audience, so pay attention to these details.
Be flexible throughout a campaign and adjust as needed.
Words matter: ads should have a call to action and be meaningful to the consumer.

Health Populi's Hot Points: Questions remain which CHCF's study raised: for example, Yahoo and Google yielded positive results, but would AOL and/or MSN do the same? Is maternity unique compared to other health conditions; would an online campaign to drive traffic for mental health services, for example, fare as well? This campaign was for health services; would a similar campaign for physicians produce the same cost-effective outcomes?

Manhattan Research published its 9th Cybercitizen Health survey this month, finding that most Americans are now ePatients: the number of Americans seeking health information online reached 157.5 million people in 2009, 1.6 times the number of online health seekers found in 2005. As more health citizens come online to seek health information, they'll be looking for quality data to inform health decisions. Among those 200 quality health info sites AHRQ has inventoried will be a few trusted brands that health citizens will come to trust. The trick will be to meet health consumers using the language, channels, and other qualitative factors they'll demand that are highly relevant and meaningful to their own lives.