Entries in Consumers (68)

Wednesday
Jul252018

The Sounds of Silence

By Kim Bellard, July 25, 2018

Listen closely, healthcare organizations and professionals: those sounds you are not hearing are the voices of people not speaking up, including patients. And that’s a problem.

Let’s start with the elephant in the room: a new study found that even when physicians actually asked patients why they were there, on average they only listened to the patient’s explanation for eleven — that’s 11 — seconds before interrupting them.

Think about that, and then think back to a doctor’s visit you had about something that was worrying you: could you have explained it in eleven seconds?

Believe it or not, that’s not the worst of it. Only 36% of the time did patients even get a chance to explain why they were there. Even then, two-thirds of them were interrupted before they had finished.

Primary care doctors did better, allowing 49% of patients to explain their agenda for being there, versus only 20% for specialists. Hurray for the primary care physicians…

The researchers say there are many reasons why physicians aren’t listening better, including time constraints, burnout, and lack of communications training. But still…11 seconds? For the minority that even get the chance to talk?

As Bruce Y. Lee said in Forbes, “A doctor’s visit shouldn’t feel like a Shark Tank pitch.”

As bad as this is, it is not the only area where not feeling able to speak up is a problem in healthcare. For example, a study in BMJ Quality and Safety found that 50% to 70% of family members with a loved one in the ICU were hesitant to speak about common care situations with safety implications.

It’s not just patients who are silenced. One study found that 90% of nurses don’t speak up to a physician even when they know a patient’s safety is at risk. Another survey, of medical students in their final year of school, found that 42% had experienced harassment and 84% had experienced belittlement.

A couple of years ago ProPublicalooked at why physicians stay silent about other physicians they know commit medical errors, including ones who do so repeatedly. One physician, speaking about his hospital, told them:

There’s not a culture where people care about feedback. You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.

It’s about power: who has it, or at least who we think has it. We trust our doctors (although not as much as our nurses!). We assume that more experienced doctors have more knowledge than newer doctors, that doctors know more than nurses, and that healthcare professionals know more than we do. We’re at the bottom of the knowledge tree.

But that may not be true. Dave deBronkart — e-patient Dave — likes to cite Warner Slack’s great quote: “Patients are the most underused resource.”

But healthcare professionals must be willing to listen, and they must ensure that they ask. And we must take the initiative to speak up.

Our values are wrong if we allow reimbursement considerations to squeeze our time with physicians to the point we’re not talking and they’re not listening. Our values are wrong if we’re conditioned to think our opinions and concerns do not matter. Our values are wrong if everyone is not only empowered but also expected to speak up, especially when we see or experience something we think is a problem.

Anybody listening?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Wednesday
May232018

Too Many Poor Excuses

Too Many Poor Excuses
 

By Kim Bellard, May 23, 2018

 

I am so tired of reading yet another story about how we — Americans — cannot afford things. Not luxury item. Increasingly, it seems like too many of us can’t afford what most people would consider basics — food, housing, child care, transportation.

 

And health care, of course.

 

new study by the United Way ALICE Project found that 51 million households can’t afford a basic monthly budget that includes food, housing, health care, child care, and a cell phone. That is 43% of all U.S. households.

 

ALICE stands for Assets Limited, Income Constrained, Employed. Of the 51 million households, two-thirds are ALICE ones. These are working households that, in a prior era, might have been thought of as middle class.

 

Now they are living paycheck to paycheck, and fearing sudden expenses — like an unexpected health care bills. Maybe they can’t afford their insulin, their inhalers, or their epipens anymore. And, of course, God forbid they end up in the emergency room or get out-of-network care.

 

Indeed, a hospital stay may result in a permanent reduction in income, even if you have insurance, according to a study released earlier this year. We shouldn’t be surprised that the Commonwealth Fund recently found that the percentage of Americans who feel confident they can afford the health care they need continues to fall. Only 62% re very or somewhat confident, down from 69% just three years ago. Twenty-four percent reported health care has become harder to afford over the last year.

 

Another new study found that 40% of us skipped a recommended test or treatment due to cost, and 44% skipped seeing a doctor when sick or injured due to concerns about costs. More feared the cost of a serious illness than they did the serious illness itself.

 

That is seriously wrong.

 

And there are no signs of anything improving. The number of uninsured is rising again. Actions by the Trump Administration to undermine the ACA exchange markets are estimated to have drastic increases on health insurance premiums — potentially jumping by 35% to 94% over the next three years. Plus, HHS has proposed rules for so-called short-term health insurance policies that the CMS

 

Actuary says will simply increase costs for everyone else, not to mention that those “covered” under those policies will find that coverage to be skimpy if/when they need it.

 

This all adds up. Kaiser Health News reports that, in addition to bankruptcies due to health care bills, nearly 40% of adults under 65 have had their credit scores lowered due to medical debts. A 2014 Consumer Financial Protection Bureau report found that almost 20% of credit reports had at least one medical collection account listed.

 

The sad truth is that only 39% of Americans say they could handle an unexpected expense of even $1,000 — and 34% had had a major unexpected expense over the past year. Not surprisingly, we are doing a terrible job saving for retirement. Increasingly, we’re both saying we’ll have to rely on Social Security for our retirement income, while lamenting that we’re not very confident it will be there when we need it.

 

These problems are not about our having enough money. We do. They are not just problems for “poor people.” They are problems for the majority of us. These are problems of priorities, and somewhere along the way our have gotten screwed up.

 

We’re making too many poor excuses for not doing more and for not doing better. It’s time to stop.
 
This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

 
Friday
May112018

The Disconnect with Consumers and Health Plan Costs

The Disconnect with Consumers and Health Plan Costs
 

By Clive Riddle, May 11, 2018

 

eHealth this week released a new eleven page report: Costs and Consequences in the ACA Market: A Survey of Individual and Family Health Insurance Consumers, presenting findings from more than 1,700 consumers who purchased their ACA-compliant plans via eHealth that included:  (1) “Consumers’ idea of a fair price is hard to find in today’s market;” (2) Policyholders aren’t willing to pay extra for key ACA benefits;” and (3) “Voters are bringing health care frustrations to the mid-term elections this fall,” (66% said it was one of their top three issues.)

 

Consistent with a number of previous studies, there is a significant disconnect between consumers sense of where healthcare prices should be in the market, and what they actually are. Health reports that the average individual monthly premium cost during the last open enrollment was $400,  Only 3% surveyed felt $400+ was a fair price. Only 9% felt $300+ was fair. Only 25% felt $200+ was fair. So what is fair? 38% felt premiums should be $100 or less. Another 36% felt $200 or less was fair.

 

The disconnect carries over consumer sense of the value of specific benefits. 61% want mental health benefits, 60% want maternity care and 55% want birth control coverage (which are all ACA required), but only 25%, 24% and 16% respectively, want to pay for them. Even emergency room benefits experience this disconnect: 80% want the benefit and 54% are willing to pay for it.

 

ACA compliant HDHPs are prevalent in the ACA marketplace, and continue to gain the large group environment as well. Benefitfocus this week released a new eleven page survey report: The State of Employee Benefits 2018 - Industry Edition that examined benefit trends for four sectors: education, health care, manufacturing and retail, with an emphasis on examining the impact of HDHPs in each sector.

 

Benefitfocus found that regarding HDHP prevalence by sector:

·         Education: 50% of employers offer HDHPs compared to 23% in 2016.

·         Healthcare: 73%% of employers offer HDHPs compared to 56% in 2016.

·         Manufacturing: 88%% of employers offer HDHPs compared to 54% in 2016.

·         Retail: 76%% of employers offer HDHPs compared to 55% in 2016.

·         All Industries: Healthcare: 70%% of employers offer HDHPs compared to 58% in 2016.

 

When large employers offer other type plans and HDHPs side by side (many employers do not offer both), the HDHP employee enrollment rates by sector were: Education: 34% (30% in 2016); Healthcare: 27% (23% in 2016); Manufacturing: 29% (46% in 2016); Retail: 40% (27% in 2016) and All Industries: 35% (40% in 2016).

 

What would drive such different results by sector? Employee premium HDHP contributions compared to last year decreased 27% in Education, increased 4% in healthcare, increased 46% in manufacturing, increased 20% in retail, and increased 4% overall for all industries.

 

So just as in the individual marketplace, much comes down to price, even though there is a disconnect in the value that price reflects.

 
Friday
Feb092018

Employees Feel Their Own Health Plan is Better Than Most Others

Employees Feel Their Own Health Plan is Better Than Most Others
 

By Clive Riddle, February 9, 2018

Surveys have consistently shown over the years that the public generally ranks Congress low in esteem, but their personal Congressman is held in higher regard. Health Plans, like Congress, have been a favorite target as well, but similarly – people tend to like their personal coverage more than how they view health plans overall.

AHIP has just released a 42-page report of findings from their national survey “The Value of Employer Provided Coverage” that not only reinforces this phenomenon – in which respondents rank their own plan higher than their overall view how health care is covered, but also makes the case that consumers place employer provided coverage in higher regard than the nation’s health coverage system as a whole. On top of that, there is perhaps less angst about the nation’s health insurance system overall than one might have thought.

63% were satisfied with the nation's current health insurance system, and 31% were dissatisfied. 71% were satisfied with their own health plan, and 19% were dissatisfied. 60% felt their personal cost was reasonable and 29% felt the cost was unreasonable, while 66% felt the cost was unreasonable for Americans as a whole. 52% described their deductible as reasonable, while 36% said it was unreasonable. However, for those dissatisfied with their plans, 82% cited costs as the main reason.

72% say they are adequately informed about health insurance benefits under their plan, yet only 20% understand that employers average paying above 75% of the total costs.

In other findings from the survey:

·         71% remain concerned the cost of health care will continue to rise

·         56% prioritize comprehensive benefits while 41% prioritize affordability of plans.

·         46%said health insurance was a deciding factor in choosing their current job

·         56% support keeping employer provided coverage tax free, and 13% oppose

·         58% prefer increased market competition while 42% support increased government involvement to address costs

·         Prescription drug coverage (51%), preventive care (47%), and emergency care (47%) rank among the benefits that matter most.

 
Friday
Jan122018

Accenture’s Advice to Pharma: It’s The Evidence, Stupid.

Accenture’s Advice to Pharma: It’s The Evidence, Stupid.
 

By Clive Riddle, January 12, 2018

 

Remember when Bill Clinton’s first presidential campaign mantra was “it’s the economy, stupid”?  Accenture advises the pharmaceutical industry to substitute evidence for economy in that equation and focus more on evidence-based solutions than products or brand.

 

Accenture has just released 16-page report: Product Launch: The Patient Has Spoken in which they conclude “brands are not major influencing factors when patients consider new pharmaceutical products. More than two-thirds (69 percent) of patients surveyed said the product’s benefits – i.e., treatment outcomes – are more important than the brand itself, with less than one-third (31 percent) citing a strong affinity to brands in a healthcare setting.”

 

Accenture tells us that for the report, they commissioned a survey of 8,000 patients in France, Germany, the U.K. and the U.S across eight therapeutic areas – immunology, cardiology, pulmonology, neurology, oncology, rheumatology, endocrinology and eye disease. Respondents represented three main age demographics: baby boomers, Gen Xers and millennials.

 

Accenture shared the following findings:

 

When patients were asked which factors influence their healthcare product and treatment decisions:

·         66% cited the doctor/physician relationship

·         55% indicated the ability to maintain their current lifestyle

·         53% said ease of access to the care they’ll need

·         But just 31% listed brand loyalty or popularity, and this ranked twelfth out of 14 influencing factors

 

The report notes that patient perspectives include:

·         38 % said they feel very knowledgeable about new or existing products coming to market for their condition

·         25 % reported having either very limited or no knowledge of new products that might be suitable for them

·         48 % believe that their doctors discuss the full range of product options with them

·         44 % feel that they have significant input into their treatment selection

·         63 % said they want to be involved in such decisions

·         47% said they’ve thought about switching their treatment at some point

·         62%of those who think about switching end up doing so

 

So if it isn’t product and brand, what does drive patient treatment choice decisions? Accenture says “despite survey results showing that many patients look online for information about new treatments, physicians remain the primary influencer of their treatment choices. In fact, the reason patients cited most often for switching treatments was a recommendation from their physician (cited by 81 percent of patients who switched treatments), followed by proven benefits compared to current treatment (79 percent) and fewer side-effects than their current treatment (78 percent).”

 

Regarding demographics, the survey “findings also identified differences in attitude and behavior by age group, with younger patients more likely than older ones to understand which treatments are available—and switch treatments when they believe there’s something better. For instance, while physician recommendation was the most-cited reason across all age groups for switching treatment, Millennials are almost twice as likely as Baby Boomers to be influenced by people posting alternative treatment options on social media.”

 

Of course what the report doesn’t focus on regarding treatment decisions is the role of insurance coverage, cost-sharing and formularies. But Accenture’s message in this value based era should still resonate. Accenture’s Jim Cleffi, a co-author of the report, tells us “given the significant budgets pharmaceutical companies devote to driving brand equity in the marketplace, our report findings should be a strong signal to the industry that launch strategies need to change. Patients in our study made it clear that outcomes matter most which means that pharma companies should focus their launch strategies and communications more on patient value and impact versus the brand—and do so in a much more precise and personalized way. Reallocating parts of launch budgets to programs that resonate the most with different patient segments would not only better meet patients’ needs and deliver better outcomes, but likely provide the companies with better ROI.”

 

Accenture provides pharma two recommendations in the report:

1)    Bring an outcome – not just a product – to market. Patients value outcomes over brands, so instead of launching just products, pharmaceutical companies should start launching evidence-based solutions, or products with services as a secondary offering. This will require collaborative data-sharing – between patients, providers and payers – along with advanced analytics to generate robust insights and delivery via digital channels. This mindset should begin at the clinical trial-stage so it informs new launch strategies and full commercialization.

2)    Make it personal and precise. One size no longer fits all; pharmaceutical companies need to understand patient sub-segments and develop value-driven launch strategies tailored to each segment. Harnessing advanced analytics and other new technologies that leverage the proliferation of health data will help enable companies to modify launch strategies that make new treatments more relevant to patients while also driving better-informed resource and investment allocations.