Archive for the ‘Jane Sarasohn-Kahn’ Category

Guest Blog: Less Than 10% of People Manage Health via Mobile: A Reality Check on Remote Health Monitoring

Jane Sarasohn-Kahn
Thursday, March 1st, 2012

Jane Sarasohn-Kahn is a health economist and management consultant serving clients at the intersection of health and technology. Her clients are stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs.  She blogs on HEALTHPopuli  and you can follow her on twitter at @healthpopuli.

 

With mobile health consumer market projections ranging from $7 billion to $43 billion, according to PricewaterhouseCoopers, a casual reader might think that a plethora of health citizens are tracking their health, weight, food intake, exercise, and other observations of daily living by smartphones and tablets.

But as the chart shows, health self-trackers number around 1 in 20 U.S. adults, according to a survey conducted for HIMSS Analytics and sponsored by Qualcomm Life.

HIMSS Analytics’ report, A New Prescription for Chronic Disease: remote monitoring devices, was published in conjunction with the annual HIMSS conference which highlights the latest health information technology products and education. Last week’s meeting, held in Las Vegas, also included an exhibit with Qualcomm and several dozen health monitoring application companies.

HIMSS Analytics conducted 125 interviews with consumers in January 2012 to ascertain their views on mobile communications, health care and concerns about remote health monitoring via mobile. The concept of remote health monitoring was defined in this poll as, “a device worn by a person that transmits data into a database. An example might include a device you wear on your arm or wrist that measures your blood pressure and heart rate while running.”

90% of the people said they have a smartphone and/or tablet computer. As the chart shows, the most popular uses of these devices are communication, e-mail, and map functions (think: personal GPS). Even though only 7% of people use the devices to “manage health” and 5% to monitor health, most people appear to be comfortable with the idea of using mobile devices for health-related purposes. Based on a scale of “1″ to “7,” with 1 being not at all comfortable and 7 being very comfortable, HIMSS Analytics constructed indices for the following functions:

  • Looking up health information, 4.89;
  • E-mailing physicians, 4.61;
  • Entering health information for personal use, 4.06; and,
  • Entering health information for a physician, 4.02.

While these are half-way comfort indices, the survey learned that consumers have several concerns about using technology for remote health monitoring — most notably, concerns about privacy and security, cited by 59% of people. The second-most significant concern is one’s ability to remember tracking data, followed by doubts about using the device correctly.

Network concerns, whereby the device could communicate back to the clinical “mothership” and send data successfully through the cloud or other connection were noted by 14% of consumers. This connectivity concern was the most important barrier cited by health IT executives with whom HIMSS Analytics spoke.

Health Populi’s Hot Points: HIMSS Analytics is right to point out that, “for remote monitoring devices to be successful, patients need to be compliant and enter data/take measurements as prescribed by their caregiver.”

About one-half of doctors (65% of PCPs and 54% of specialists) would be interested in monitoring patients outside of the hospital, found by PwC in their 2010 physician survey. Thus, at least one-half of health providers are teed up, theoretically, to add remote health monitoring to their workflow.

What about consumers? While they tend to have seen monitoring technology for “jocks” (athletes), most people are still unfamiliar with quantified-self devices for the consumer market. One-half told PwC in 2010 they would not buy mobile health technology. 20% said they’d buy mobile tech to monitor fitness and wellbeing, and 18% of people would have their doctor monitor their condition remotely.

There’s a gap of knowledge among consumers, about half of whom could probably be persuaded to self-monitor, or allow their physician to monitor a health condition.

There’s also a health plan literacy gap, where American have been slow to connect the dots between the “nudges” their health plans are signaling to them through increasing co-pays and wellness incentives, and essentially owning their health status and outcomes.

When we can get to aligned incentives between patient-consumers and providers in accountable care, there will be greater teamwork both within the clinical care team and between that team and the patient – call it participatory health, participatory medicine, collaborative care.

Accountable care, whether write in capital letters or small, is on the way. That’s when payment will put providers and patients on the same page, fanning the adoption of remote health monitoring. This won’t happen overnight, but more patient-consumers will be nudged to use remote monitoring devices — and some will also have them prescribed by their physicians.

 

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Guest Blog: We Are All Health Illiterates: Navigating the Health System in a Sea of Paper and Financial Haze

Jane Sarasohn-Kahn
Thursday, February 2nd, 2012

Jane Sarasohn-Kahn is a health economist and management consultant serving clients at the intersection of health and technology. Her clients are stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs.  She blogs on HEALTHPopuli  and you can follow her on twitter at @healthpopuli. 

“Older patients, caregivers, and family members face growing challenges in understanding and navigating the nation’s increasingly complex healthcare system,” begins a well-articulated column called Why Consumers Struggle to Understand Health Care, in U.S. News & World Report dated January 27, 2012.

Health literacy isn’t just about understanding clinical directions for self-care, such as how to take medications prescribed by a doctor, or how to change a bandage and clean an infected area. Health literacy is also about how to effectively navigate one’s health system. The first graphic is a schematic published in the New Republic in 2009 which illustrates the arcane Trip-Tik that is the U.S. health system. I often use this drawing in presentations when I’m addressing the topic of health literacy in America.

And that skill is in short-supply in the U.S., U.S. News reports. Donald Berwick, recent head of the Centers for Medicare and Medicaid Services, wrote with colleagues in Health Affairs that, “Despite its importance, health literacy has until recently been relegated to the sidelines of healthcare improvement efforts.”

Lack of health literacy results in medical errors, patients presenting themselves to emergency rooms due to prescription drug dosing errors, asthmatic children through the ER revolving door when not regularly inhaling their medications, and overall sub-optimal health outcomes.

Health Populi’s Hot Points: One of my dearest friends is bravely battling multiple myeloma and, so far, so good. His clinical journey with the labyrinthine health system began in early December 2011 – about seven weeks ago.

He is on 23 medications now, administered at home. He was discharged from his inpatient stay without a system to help manage those meds at home. Home care workers get easily confused between names on bottles, some of which are called by their generic names, and some by their esoteric brands. He’s just completed many rounds of radiation, rang the bell in the facility to mark the end of that phase, and will continue a long phase of chemotherapy to be followed by stem cell transplant in a few months.

I spent an hour yesterday, January 29, 2012, at his home, helping his wife (another best friend) reconcile a four-inch-thick pile of paper explanations of benefit forms (EOBs) and bills from various health providers: two hospitals, two imaging centers, two clinical laboratory companies, an orthopedic surgeon, a nephrologist, and other providers whose specialties are hazy to me 24 hours later.

Ironically, the front of each of the few dozen envelopes from the health plan containing the EOBs included the pre-printed phrase, “Be green with Blue,” shown in the graphic. Even if the EOBs came through email, that wouldn’t solve the very un-green challenge of health literacy, and lack of health data integration where all of this should be populating a digital worksheet to help consumers and caregivers manage the countless transactions that get billed in the U.S. health system.

My friend is a hospital administrator with a clinical undergraduate degree and an MBA in health administration. I am a health economist who has consulted with hospitals, physicians, and every kind of stakeholder organization in the health industry for over 20 years. Together, we have at least 50 years of health care system experience.

We morphed the four-inch-pile of bills and EOBs into six bulldog-clipped folders of health financial categories and questions:

  1. EOBs correctly reconciled to patient bills from health providers
  2. EOBs without provider bills
  3. Provider bills without EOBs
  4. EOBs with denials from the health plan
  5. A survey form from a third party administrator for the health plan asking to clarify the context of an inpatient procedure that may or may not be denied
  6. A sixth category of “need more information.”

I won’t even go into the “patient’s responsibility” financial bottom-line (thus far – it’s only 7 weeks into what will be many months of health services from dozens of billing providers).

We are all health illiterates, my girlfriend and I remarked to each other over tea, exhaling over our six piles of prideful organizing. This is just the beginning. Now, to get the data into a Quicken Health spreadsheet…

 

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Guest Blog: Connections between Fiscal and Physical Health

Jane Sarasohn-Kahn
Tuesday, September 20th, 2011

Jane Sarasohn-Kahn is a health economist and management consultant serving clients at the intersection of health and technology. Her clients are stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs.  She blogs on HEALTHPopuli  and you can follow her on twitter at @healthpopuli. 

horizontalline

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

In Is the Foreclosure Crisis Making Us Sick?, published by the National Bureau of Economic Research in August 2011, Janet Currie and Erdal Tekin find that the number of foreclosures in a community is associated with increases in medical visits for mental health (anxiety and suicide attempts), preventable conditions such as hypertension, and a long list of stress-related diseases.  Furthermore, more foreclosures in an area are most harmful on people age 20 to 64, and disproportionately impact African-Americans and Hispanics compared to whites.

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

Health Populi’s Hot Points: Previous research has looked at the link between health and the house mortgage crisis, finding that unhealthful behaviors are often used to cope with stressful life events. Such negative coping behaviors include tobacco use, alcohol consumption, sleep dysregulation, and weight gain perhaps via decreased physical activity. For more on these impacts, see the 2009 essay in PLOS Medicine by Gary Bennett et. al. called, Will the Public’s Health Fall Victim to the Home Foreclosure Epidemic?

The health of a nation’s macroeconomy clearly impacts the health of the household’s microeconomy – not just of a parent but on children’s health, as well, according to Currie and Tekin.

This study connects the dots between personal finances and health, which is a connection that people make for themselves. The first Edelman Health Engagement Barometer identified that people define their health and wellness across several dimensions: physical health, mental health, appearance, and financial health.

This study raises many points for both health and economic policy which are inextricably linked. First is the rationale for universal health insurance coverage provides a health safety net for all health citizens, can help stem the negative impacts of unemployment in a community and the longer term downstream health costs that increase when conditions aren’t prevented and managed. Second is the importance of COBRA and unemployment insurance payments, the latter of which often can’t cover the former (see this post describing that financial disequilibrium).

Finally, the relationship between economic development and population health has been long documented. As the U.S. economy continues to lag — and the “recovery-less recovery” continues to continue — the public’s health will be in jeopardy, particularly in minority communities.

This scenario also reminds us of the connections between people that Christakis talks about…Health is Contagious, and vice versa.

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Guest Blog: Mayo Finds Heart Patients Skip Meds Due to Costs; Self-rationing in Health Continues

Jane Sarasohn-Kahn
Monday, April 25th, 2011

Jane Sarasohn-Kahn is a health economist and management consultant that serves clients at the intersection of health and technology. Her clients include all stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs. Jane’s lens on health is best-defined by the World Health Organization: health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. She blogs on HEALTHPopuli.

If you are a person with heart disease and you have received treatment at the Mayo Clinic, you’re certainly a fortunate health citizen. The hospital was just ranked #2 best hospital in the U.S. by US News & World Report.

However, if that’s you and the costs of post-op treatment — namely prescription drugs — are out of your financial reach, then you might skip them; thus, undoing your top-notch acute care.

This scenario is discussed in the April 2011 issue of Mayo Clinic Proceedings, which describes a study by Mayo researchers among 209 patients with heart failure who were prescribed statins – three-quarters of whom were on Medicare which has the Part D program that covers outpatient prescription drugs.

One-half of these patients stopped taking the statins due to cost, they told the researchers. Furthermore, one-quarter of patients in the study said they had also skipped prescribed medicines in the past due to cost.

Health Populi’s Hot Points: Welcome to the world of self-rationing in health, where even the lucky health citizen receiving the best acute care money (and third-party health insurance) can buy doesn’t follow through with recommended self-care at home.

The phenomenon of self-rationing health care due to cost is a particularly American invention, as more health citizens are asked to pay more out-of-pocket in a culture of medical entitlement. As additional health care costs are levied onto health consumers in the form of co-pays, higher coinsurance, and greater premium sharing with employers, more consumers are opting out in a variety of ways: from not filling prescriptions and skipping doses to not following up receiving recommended diagnostic tests and other self-care regimens at home.

In the recession, this pattern of health behavior has been tracked by the Kaiser Family Foundation’s Health Tracking Poll, which in December 2010 found that over 1 in 2 U.S. adults did something to self-ration care due to costs.

The challenge of medication adherence is complicated and thorny: there are many reasons why people don’t fill or take prescribed medications, such as unpleasant side effects, inconvenience, and some peoples’ unwillingness to ingest pills by mouth who might prefer another method — say, via dermal patch, inhaler, or even via medication-enhanced food (think: early polio vaccines on sugar cubes).

But poor medication adherence due to cost is another matter. This is where value-based insurance design and creative nudging comes into play. The Mayo researchers point to “better communication” between doctors and patients as a solution to help guide patients to cheaper drugs and treatments. This is necessary, but not sufficient. When it comes to drugs like statins, which treat a condition that for many people is virtually invisible (or perceived to be so), the solution to medication adherence will require several tactics combined to crack this problem.

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