Cost is the major reason why Medicare Advantage plan beneficiaries switch plans, but people who switch also tend to have lower satisfaction scores based on non-cost factors. Those ratings have a lot to do with information and communication, according to J.D. Power’s 2019 Medicare Advantage Plan Study.
The Study explores MA beneficiaries’ views on six factors:
Coverage and benefits
Information and communication, and
Billing and payment.
Kaiser Foundation Health Plan garnered the top spot for the fifth year in-a-row.
By feature, Kaiser achieved 5 “Power Circles” for all factors except for cost and provider choice, each of which earned only 3 Circles out of 5. The Power Circle detailed ratings are shown in the second chart from the J.D. Power study.
Highmark and Humana led the second tier of MA Plan satisfaction with four Power Circles. Each of these plans scored higher than Kaiser on cost, with Highmark the only plan studied earning five Circles, the maximum, for provider choice.
The plans studied in this 2019 report included Aetna, Anthem, BlueCross BlueShield of Michigan, BlueCross BlueShield of Minnesota, Centene, Cigna HealthSpring, Highmark, Humana, Kaiser Foundation Health Plan, UnitedHealthcare, and WellCare.
For the research, J.D. Power surveyed 3,233 members of Medicare Advantage plans in January through March 2019.
Health Populi’s Hot Points: “Even though health plans have been delivering a remarkably consistent customer experience, there is still room for improvement in the form of lower costs for seniors, proactive communication around explanation of benefits and helping members coordinate healthcare,” James Beem, J.D. Power’s Managing Director of Global Healthcare Intelligence, opined in the study’s press release.
J.D. Power defines the “information and communication” component as, “the usefulness of information, ease of understanding plan benefits and services, frequency of communications, and variety of communications.”
Fewer than one in 10 Medicare Advantage beneficiaries told J.D. Power they have experienced the three sub-components that make up “information and communication.”
A quote from Ghita Worcester, SVP Public Affairs and Chief Marketing Officer of UCare, points to the importance of and opportunity for personalization in health benefits to actually benefit an individual:
“At UCare, we know the health of our members is directly impacted by conditions where they are born, grow, work, play and age…We also recognize the need to tailor health improvement programs to meet the needs of all our members. Partnering with individuals and their diverse communities on solutions is fundamental to our mission of improving the health of our members through innovative services and partnerships across communities.”
Addressing the information and communications pillar, one of J.D. Power’s health plan satisfaction factors, is key to not only bolstering satisfaction but to that need to tailor health improvement programs that truly improve a beneficiary’s health. This isn’t just a matter of deploying information technology for technology’s sake, like a portal that isn’t based on how older people access, use and appreciate “information” or data. These platforms and programs have to be design-ful, inspired and built on peoples’ values, capabilities, natural life flows and goals.
Through AHIP’s Project Link, health plans may have another resource to inform and support efforts to improve communication that educates, informs and inspires older peoples’ health activation and sustained engagement, drives up satisfaction and — most importantly — improve the health of Americans as they age.
In the U.S. each year between 2006 and 2016, employees’ healthcare cost sharing grew 4.5%. In that decade, Americans’ median wages rose 1.8% a year, PwC notes in their annual report, Medical cost trend: Behind the numbers 2020 from the firm’s Health Research Institute.
Medical cost trend is the projected percent growth in healthcare costs over a year based on an equivalent benefit package from one year to the next. As the first chart shows, trend will grow 6% from 2019 to 2020. This is an increase of 0.3 percentage points up from 5.7% for 2019, which was flat from the previous year. That costs are inching up are concerning to employers providing health benefits, who have become dissatisfied with efforts to contain health spending, PwC learned from its survey research.
This has led to what HRI coins an emergence of “employer activists.” Among this vanguard of companies PwC HRI cites are Haven, the trifecta-alliance of Amazon-Berkshire Hathaway-JPMorgan, and the Health Transformation Alliance of 50 companies among them 3M, Pitney Bowes, and Verizon — along with many healthcare organizations including but not limited to Kaiser Permanente, Advocate Health Care, Amgen, Medtronic, OhioHealth, Quest Diagnostics, Sharp HealthCare, and Walgreens.
One of employers’ key challenges in moderating healthcare costs is the burden of chronic disease among workers. Employers’ healthcare spending on individuals with chronic diseases is nearly four-times that for healthy workers, shown in the second graphic from the report.
Average annual spending for a healthy worker ran $1,320 between 2013 and 2015. A person with a chronic condition cost 3.5 times that, nearly $5,000. And, for an employee with complex conditions, spending was over eight times greater than for a healthy employee.
A key co-morbidity that the report calls out is mental illness. HRIs research found an inflection growth point among employers offering health benefit programs addressing mental health and depression between 2016 and 2017 — growing from 44% of companies offering in 2016 to 66% in 2017 — that’s 50% growth year-on-year between 2016-17. Not that in 2018, 75% of employers offered these programs.
But on the supply side, just because employers may have offered mental health services, and with good intentions, the majority of employees did not take advantage of these services. Eight in ten employees did not seek mental health treatment; HRI’s employee survey found that 8% of those who did not seek treatment felt they should have done so.
Among people who didn’t take advantage of mental health care, one-half thought they could “handle it on their own,” 35% couldn’t afford paying for the services, and 29% didn’t know where to go.
The cost of a co-morbidity of mental illness coupled with a complex chronic illness is sticker-shocking for a company. Consider that healthy employee per capita annual cost of $1,320:
An employee with a mental illness and no chronic condition cost $3,063
An employee with chronic illness coupled with mental illness cost $7,104
An employee with a complex chronic illness and mental illness cost $14,885.
To help bend their corporate healthcare cost curves, employers are nudging covered workers to lower-cost settings, both onsite and away from the workplace. At worksite clinics, 43% of employers offer physical exams and urgent care, 36% do annual preventive exams, and 11% offer chronic care management.
For employer insights, HRI’s research included interviews with health industry executives representing 95 million insured employees and dependents, along with PwC’s 2019 Health and Well-being Touchstone Survey of 550 employers. On the consumer side, HRI conducted a national survey among 2,500 U.S. adults.
Health Populi’s Hot Points: Patients have become major payors as they enroll in high-deductible health plans, and this was the other lens on HRI’s survey findings. The third graphic from the report summarizes results from PwC’s consumer poll, finding that at least one-third of covered employees could not cover their deductible with savings.
Consumers’ ability to cover a deductible varied with the level of a deductible: one-half of individuals with a deductible over $3,000 could not cover it with savings. Neither could one-half of families cover a deductible at all from savings, even at the lowest level deductible polled of $0 to $2,699.
This scenario has led to HRI’s observation that, “Deductibles dampen utilization and spending as employees feel the pain.” In my own words, this is self-rationing health care due to cost. “Employees often don’t understand their financial exposure with high deductible plans….[patients] may be surprised to return for a sick visit to the same doctor who provides their preventive care only to walk away with a bill,” the report explains.
Four in ten consumers enrolled in a high-deductible plan that HRI polled said they were dissatisfied with their deductible.
Americans spend too much, save too little, and take on too much debt — which is the title of this last chart which comes out of HealthConsuming, featuring recent data from the Center for Financial Services Innovation. Nearly one-half of Americans spend more than they earn — thus living on credit. At the same time, savings wouldn’t cover three months of living expenses for one in two people in the U.S. And one-third of Americans say they have more debt than they can manage.
No wonder, then, that a plurality of PwC HRI’s consumers polled were “dissatisfied” with their deductible.
Note that stress is compounded by financial worries, which I also note in HealthConsuming as the new normal for Americans with respect to health care costs and mental health. Whether one is of higher or lower income, dealing with health care costs is a stressor for people in America.
The PwC HRI report concludes with a summary of universal healthcare as a “thing to watch.” The paragraph asserts, “It is no surprise that there are a number of universal healthcare proposals on the table…universal healthcare is gaining traction and is something to watch as we approach the 2020 presidential election.”
I couldn’t agree more as I expect both employers and mainstream Americans to become more activist with respect to health care reform.
In reading the July/August issue of Eating Well magazine this week, I came across this ad which I scanned for you to see yourself: “We believe in food as medicine.” Signed, Kroger Health.
Here’s the introductory text in the full-page ad: “As Kroger Health, our vision is to help people live healthier lives. And now, more than ever, through our experts, innovation, and technology, we’re uniquely positioned to bring that vision to life,” the copy read.
“We know food,” the text continued, as part of The Kroger Co. which is the largest grocery chain in the U.S. celebrating 135 years in business. Kroger also employees 23,000 health care professionals employed in about 3,000 pharmacies in the chain.
In fact, Kroger Health is the umbrella under which all of the food chain’s health and wellness assets fit:
Frequent Health Populi readers know this kind of ad would reel me in: I devoted many pages in my book, HealthConsuming: From Health Consumer to Health Citizen, in the chapter on “The New Retail Health,” and wax lyrically about Kroger in many ways such as allying with Walgreens on fresh food in a small footprint (retail pharmacy); the Wellness Your Way platform bundled with The Little Clinic, Kroger’s urgent care offering; and, Kroger’s alliances with health care systems and hospitals.
This ad inspired a call-to-action by the time I got to the last sentence pointing me to the Krogerhealth.com website, which I immediately visited. The landing page features a video with the following phrase overlaid: “Kroger Health. America’s trusted destination for health, wellness and nutrition.”
The video is a virtual tour of a Kroger grocery store featuring a dozen of the company’s 23,000 healthcare employees: a pharmacist, a pharmacy tech, a nutritionist, a nurse practitioner, and even a produce representative advising a shopper on the health benefits of fruit.
The first bar chart illustrates “the meaning of eating well” based on FMI’s consumer survey of U.S. adults. Note that the findings on how people know they are eating well fall into four categories: health, enjoyment, mindfulness, and their budget.
Health factors address nutritious food and beverages, closely followed by quality of food and eating in moderation. Health benefits are sought by 6 in 10 people.
Taste rises above all factors, agreed by 84% of U.S. consumers. Enjoyment involves taste, then the sense of feeling full and satiated, and in third place, sociability — eating with family and/or friends.
Mindfulness covers ethics and sustainability, important for 4 in 10 consumers.
And finally, eating within one’s budget is important to 7 in 10 people — roughly the same as the top factors of nutrition, quality, moderation, and feeling full.
This second bar chart is also very important for the evolving health care consumer seeking food-as-medicine and using retail health channels. This question asked people what organizations and people help them stay healthy and are “on my side” to help me make health. These are the aqua blue bars on the right side of the graph.
Tied in first place are my family and doctors (in general — not “my doctor,” per se). These two personae, valued by 7 in 10 consumers, are followed by my friends, farmers, fitness/health clubs, and my primary food store (that is, the grocery channel the consumer most frequents during the week).
Now cast your eyes to the left — the grey/black bars. These are the folks we believe are working against our health. At the bottom are fast food restaurants (49% agreeing), the entertainment industry (among 32%), food processors and manufacturers (for 29% of people), and the news media (for 25% of people).
Intriguingly, government agencies tie at one in five people for both being on my side and working against me. Yet in a previous data point, one-half of Americans say that the USDA and FDA are responsible for nutrition. So while this is a mainstream opinion, this chart illustrates that most Americans don’t believe the government is pulling its weight for supporting nutrition for the nation.
Health Populi’s Hot Points: Americans are tying eating well to shopping well — where the food-as-medicine relates to overall financial wellness, too.
Grocery shopping is fragmenting beyond the traditional grocery store: people are going to small format stores, “C-stores” (convenience stores, also covered in my book in their search of reducing dependence selling “cokes and smokes” to healthier fare and living products), natural specialty stores, Big Box and club stores and of course, online via ecommerce.
As we consider the role of social determinants and long-term social supports extended by insurance plans, e-commerce food delivery and subscription meal kits could be useful “prescriptions” for people who live with food insecurity and chronic conditions.
Note that drug stores are also on FMI’s map here where, “shoppers need a compass to help them eat and shop.”
Patients as payors and consumers want to live their lives based on their personal values — but they also seek value (for money) and support in helping choose healthier fare. This is a big opportunity for these community touchpoints to collaborate with health care providers, health plans, and fitness places (like the Y) to help people make health in ways that are engaging, impactful, value-priced and, the top-line for mainstream people — tasty.
“Health is now everyone’s business,” Shaheed Peera, Executive Creative Director of Publicis LifeBrands, said this week at the 2019 Cannes Lions awards. Shaheed also led the Health & Wellness jury at Cannes Lions 2019, the mission of which is to, in the words of the award’s portal, “celebrate creativity for personal wellbeing.”
The Grand Prix Lions award for Health & Wellness went to IKEA for the company’s ThisAbles campaign.
ThisAbles is a project pioneered by IKEA’s team in Israel, looking to improve everyday living for people with special needs through well-designed IKEA products.
IKEA collaborated with non-profit organizations to develop this line of products that help people live and thrive independently at home.
Part of IKEA’s mission statement is to, “create a better everyday life for the many people.” Operational values that flow out of this vision are democratic design, sustainability, form, function, and low prices so “the many” can benefit from IKEA products.
So back to the Grand Prix award for Health & Wellness. There are three-pages of short-listed entries in very fine print on the Cannes Lions 2019 website in just the Health & Wellness category.
These applicants by category included over-the-counter medicines, devices, nutraceuticals, technology, branded education and awareness, foundation-led education and awareness, fundraising and advocacy, corporate image and communications, health services, and animal health.
Among the diverse range 120 products and services short-listed were campaigns from Huawei (Storysign), Nestle (Pinch-water), ESPN (Legs to Fly), Monica Lewinsky (on anti-bullying), GSK (for over the counter pain meds), P&G (“Yarmulke Switch” for Head & Shoulders shampoo), Dwight & Church (for Trojan branded condoms), Medmen (for cannabis – a fast growing category), Neurogen Brain and Spine Institute (on One Mindful Mind), Movember (on suicide prevention for Be a Man of More Words), and the UN (“The Bridal Uniform” to raise awareness on anti-child marriage), among many other worthy and impactful projects. This is also a global competition, this year with entries from Argentina, Brazil, Canada, Chile, China, Colombia, Denmark, Ecuador, France, Germany, India, Ireland, Israel, New Zealand, Norway, Peru, Poland, Spain, Switzerland, UAE, the UK, and the U.S.
But it was Israel’s IKEA entry that garnered the top prize, the Grand Prix, for ThisAbles — creative communication not for a drug or device or technology or service or education campaign, but for product innovation.
Health Populi’s Hot Points: This quote of Shaheed’s from AdAge strikes at the heart of what IKEA’s ThisAbles program really means: “Did the technology bring a level of humanity? The ideas that broke through were very scalable.”
Bravo! to the Cannes Lions jury for choosing ThisAbles as the top Health & Wellness innovation for 2019. There was stiff competition from all kinds of worthy programs and products that can help support peoples’ self-care, mental health, physical health outcomes, and community well-being. But ThisAbles speaks to EveryMan and EveryWoman, all of us at-risk one day for needing extra help, EveryDay.
I’m encouraged with traction I perceive, globally, for attending to health in the community and health, broadly-defined, for individual health citizens. If my colleagues working in the U.S. look outside of American borders for evidence of this, you will find lots of it abroad.
And you will also find green shoots of evidence throughout the U.S. if you are mindful and open to seeing them. A week ago today, Providence-St. Joseph’s Health System announced an investment of $1.6 billion (with a “b”) to focus on community benefit for mental health and homelessness. In their community benefit report, PSJH listed the key health and social areas the system has targeted, calling out social determinants of health like housing instability, food insecurity, and social isolation. The system is partnering with local organizations to sustain community support for health citizens, especially people who are vulnerable and dealing with chronic illness.
IKEA’s ThisAbles stakeholders make the case for resilience, creativity, humanity, and pragmatically-inspired design. In 2016, I quoted my colleague Aman Bhandari in a report I wrote for California Healthcare Foundation on technology and the safety net; Aman told me that, “scaling is the new sexy” when it comes to health and technology. The 2019 Cannes Lions awards for Health & Wellness demonstrate this across much of the category. It’s getting (appropriately) hot in here!
Here’s a wonderful video on ThisAbles from IKEA’s YouTube channel:
The health care section of Mary Meeker’s 334-page annual report, Internet Trends 2019, comprises 24 of those pages (270 through 293). These two dozen exhibits detail growing adoption of digital tech in health care, the growth of genomics and EHR adoption, examples of these tools from “A” (Apple) to “Z” (Zocdoc), and on the last page of that chapter, medical spending in the U.S., the highest in raw and per capita numbers versus the rest of the world.
But the most important implications for American health care aren’t found in those pages: they’re in other parts of the report addressing consumers’ digital time spent, growth of voice tech adoption, the growing use of customer data to drive insights and nudge behavior that’s highly personalized,
The first chart, from page 152 in the general discussion on “Data Growth,” illustrates the proliferation of data expanding from core applications out to edges. In health care, this is an underlying tectonic trend with implications for research, translation to therapies, individual treatment plans, population and public health. The outer grey circle details many of the emerging tools and sources for personal and clinical data that can be mashed up and analyzed to benefit care, drive better health outcomes and, our Health Populi Holy Grail, optimize spending. APIs, Internet of (Healthy) Things, and AR/VR among the others are getting deployed in retail channels and at home to support peoples’ health in the real world, in real time outside of the clinical setting. For health care, the application of FHIR standards helps mobilize data for better health, turbocharging this trend.
This quote from Frank Bien, CEO & President of Looker, succinctly summarizes these trends:
Data is now fundamental to how people work & the most successful companies have intelligently integrated it into everyone’s daily workflow…Data is the new application.
There are other data points in the report that strongly impact and shape healthcare — among them, the percent of foreign-born people as a percentage of total U.S. population. This chart, on page 262, is important for healthcare delivery because a large proportion of the healthcare labor force is indeed foreign-born — at all levels of the system, from hyper-specialists in the operating room and research labs to home health aides helping elders with activities of daily living. One in four physicians practicing in the U.S. in 2016 was foreign-born, this JAMA article published in December 2018 attested.
For another big impact for health, outside of the healthcare chapter, turn to the section, “Internet Usage = There Are Concerns…There is Goodness.” Consumers’ concerns about privacy of personal data are “moderating,” one chart illustrates. But then there’s the formidable challenge of medical privacy and the regulation of Big Tech companies’ use of personal data, covered in general terms on page 167 shown here. For health care privacy, Americans’ HIPAA provisions surely don’t cover personal information that informs health beyond the healthcare claim the way Europeans’ GDPR or the soon-to-be-implemented California Consumer Privacy Act of 2020 do.
The blurring of mobile and digital into overall business process is a meta-trend for the global economy, and certainly for the health care ecosystem. Increasingly, “mobile health,” “mHealth,” “telehealth” and “eHealth” are just part of normal health/care workflows and personal life flows that complement face-to-face, synchronous health care delivery. While we read a broad range of industry analysts’ reports using these nouns, their definitions vary so broadly as to be, by 2019, fairly meaningless in terms of how they quantify these markets.
I’ve covered this influential document here in Health Populi through my health economics/consumer tech lens for most years since 2011 (skipping 2012 and 2016). For some perspective on the Internet Trends reports’ implications for health/care over time, my previous posts assessing the report are linked here:
Health Populi’s Hot Points: The fourth chart, on preventable deaths, represents the poor ROI on high U.S. healthcare spending. The chart is succinctly and accurately titled, “USA Worse vs. Peers.” The U.S. spends more and gets far less a return-on-that-investment than other countries do.
In my book HealthConsuming: From Health Consumer to Health Citizen, I detail the health microeconomics which explain that low return. Much of this is due to the fact that U.S. prices are greater than in fellow OECD nations: wages are higher for specialist physicians, prices for digital imaging greater, and of course prescription drug prices the highest in the world. We wait for President Trump’s administration to address this last issue with a comprehensive policy he promised in his President campaign stump speeches along with this compelling TIME magazine article he granted when he was named Person of the Year for 2017, covered here in Health Populi.
Another important contributor to higher medical spending in America is the nation’s lower proportion spend on social care — education, nutritious food supply, public transportation systems, safety baked into neighborhoods and housing, environmental standards like clean air and water (think Newark and Flint, for example). This last chart, from HealthConsuming, quantifies those relative differences in social versus healthcare spending by OECD country, with results for life expectancy for each.
While technology and data can help us improve therapies and individualized healthcare, spending more upstream on infrastructure and health baked into public policies can prevent so many of these deaths per 100,000 in the U.S. The good news is that more attention and resources are flowing to these social determinants of health, largely from private sector interests like health plans, providers, and retail health touchpoints such as grocers and pharmacies.
Food insecurity ranks high on Americans’ greatest social health risks. In local communities, grocery stores are playing key roles in bolstering neighborhood wellness. Publix and other food chains, collaborating with the Produce for Kids program, are walking the talk on nutrition for local health citizens.
Produce for Kids is associated with Feeding America, which works with local food banks and non-profits to help channel healthy food to children and families. Feeding America is a national network of over 200 food banks fighting hunger in America, serving over 46 million people and 60,000 food pantries, and advocating for legislation that addresses peoples’ hunger. “Individuals, charities, businesses and government all have a role in ending hunger,” the organization believes.
Publix has worked with the Produce for Kids program for 17 years. This year, the grocery chain is collaborating with a dozen food suppliers to promote the produce section of the market that features fresh and healthy food options; these companies include CMI Orchards (apples, pears and cherries), Coast Tropical (with a full range of produce), Del Monte Foods (canned fruits and vegetables), Driscoll’s (berries), Fresh Express (salads), Lakeside Produce (tomatoes, cucumbers and peppers, Marie’s (salad dressings), Mastronardi Produce (greenhouses), Mission Produce (avocados), RealSweet (onions), Wonderful (citrus) and Acosta (a sales and marketing services organization).
Doubling down on this investment in nutrition as a social determinant of health, Publix stores also baked in a literacy riff that speaks to the education SDoH. The Produce for Kids program brought in the children’s author Eric Carle’s iconic character, The Very Hungry Caterpillar, to promote both food and education/literacy. The project even shared a kid-friendly recipe for constructing a hungry (and tasty-healthy) caterpillar in live store cooking sessions and also featured on the Produce for Kids website here.
Health Populi’s Hot Points:The USDA Report on Household Food Security in the U.S. in 2017, published in September 2018, found that 12% of U.S. households were food insecure — with difficult some time during the year providing enough food for their family members due to a lack of resources. The prevalence of food insecurity for children in 2017 was equal to that of the 2007 pre-recession level of 8.3%.
There are higher risks of being food-insecure if you have an income near or below the Federal poverty level. are in a household with children headed by a single parent (male or female), people living alone, and Black and Hispanic-headed households. Food insecurity also varies by state, from a low of 7.4% in Hawaii versus a high of 17.9% in New Mexico.
Addressing social determinants of health is a team sport, a collaborative effort in local communities bolstered with health baked into public policy at the national, state and local levels. Social determinant risks are inter-dependent, largely rooted in socioeconomic status – at the center, income inequality.
That isn’t to say that more affluent people don’t have SDoH risks — they do. But the nature of these can be different. Food security is less a risk factor among wealthier households; however, loneliness and social isolation can be a significant challenge particularly among higher-income, aging people.
Businesses, like grocery stores, can and should play their part to bolster social determinants that relate or are adjacent to their businesses. In addition to doing good in a local community and for employees’ families, these efforts can also build on the loyalty and “love factor” for the companies that commit to efforts that support health inside and outside their organizations. The latest 2019 BrandZ survey conducted by Kantar and WPP found that among the top 100 most valuable U.S. brands, “love sustains success.” According to the study, “love in a brand context is the emotional affinity a consumer has for a brand, and it can’t be bought or manufactured. However, brands can create the conditions in which love can flourish, if they invest in innovation, promote a higher purpose, and deliver a consistently great experience.” Love isn’t a nice-to-have factor, Kantar advises: some of the most loved brands are the most resilient over time. And love sustains success, the bubble chart shows, over the study of twelve years of brand value growth.
Publix Produce for Kids campaign has the love-flavor to which Kantar and WPP refer. The food-brands involved in the program, along with Publix and the other grocery chains that participate in the program, are sharing and growing the love — and healthy families and communities along the journey.
DARQ Power, the acronym for Distributed ledger technology, Artificial intelligence (AI), extended Reality, and Quantum computing. Adopting these applications can help health care reduce costs, drive labor efficiency and support people-centered design and experience.
Get to Know Me is the use of technology to develop and deepen relationships with people. As an example of this trend, Accenture points to Mindstrong which leverages AI and machine learning to divine digital phenotypes of consumers-patients that inform mental health support. (For good background on the promise of digital phenotyping for mental health, see this article by Mindstrong’s co-founder Dr. Thomas Insel in World Psychiatry).
Human +Worker recognizes that workers in organizations are more digitally advanced than the organizations themselves, playing “catch-up” with people. In health care, two-thirds of management told Accenture that in the next three years, staff will have access to a “team of bots” to accomplish their work.
Secure US to Secure ME calls out the risk of cybersecurity across healthcare organizations’ entire ecosystem of inter-connected payers, providers, technology vendors and, to be sure, patients whose data are a personal precious asset at increasing risk of hacking.
My Markets is about “meeting consumers’ needs at the speed of now,” in Accenture’s words, because healthcare is more connected in the post-digital age. We live on-demand lives in daily life-flows and tasks, so people expect that experience and service level in health care. The AI part of “SMAQ” is one of the tools the health care industry will increasingly use to personalize, customize, and “immediate-ize” health care across the continuum, from wellness and fitness to acute care and rehabilitation. Underlying technology like the emerging 5G networks, drones, and autonomous vehicles will enable some of the My Markets’ scenario.
The report points out that the health care industry hasn’t felt the level of disruption that other sectors, shown at the bottom right corner of the company’s “Where Are You Now?” bubble chart of industry positions. The diagram illustrates Accenture’s “Disruptability Index” study published last year. Industries that have already experienced a high degree of disruptions that have been volatile (versus viable) are energy, infrastructure and transportation services, and natural resources. Industries with low current disruption levels that have been durable include consumer goods, industrial equipment, and chemicals.
Health care sits in the higher vulnerability with low current level of disruption — highly susceptible to future disruption.
Accenture believes that, “Those most vulnerable to disruption are under pressure to scale new technologies….[some] experimenting to learn how these technologies can deliver new sources of value.”
Now return to the first chart to re-visit the five trends, the first four all about the human in health care.
Health Populi’s Hot Points: “Me,” “US,” My,” pronounces repeated throughout the Accenture 2019 Health Tech Vision report. As I re-read the findings, I kept hearkening back to the George Harrison song, “I Me Mine,” recorded on the Let It Be album — and also the title of Harrison’s (semi-auto) biography. The first stanza of lyrics of “I Me Mine” go:
“All thru the day, I Me Mine I Me Mine I Me Mine
All thru the night, I Me Mine I Me Mine I Me Mine
Now they’re frightened of leaving it
Everyone’s weaving it
Coming on strong all the time
All through the day I Me Mine I Me Mine I Me Mine….”
George could have been writing about the vulnerability of health care organizations late to the digital health era, let alone the post–digital health era. It’s a time for the legacy healthcare system to leap-frog, to turbocharge that scaling of new technologies and experiment, as Accenture recommends at the start of the report. We see such leap-frogging in parts of the world that were indeed late to the Health Care v1.0 era, and now have the opportunity through SMAQ to scale and not be too concerned about sunk investments into slow tech.
“Now they’re frightened of leaving it,” George observed on the third line of the song. Indeed, many healthcare players have been slow to change and pilot, but Accenture’s survey research of health execs demonstrates that most of these folks believe it’s time to get off the dime and embrace that post-digital era.
I’m particularly keen on the I-Me-Mine analogy as it speaks to the central player in health care I’ve been focusing on for many years: the patient, morphing into the consumer and now, the payor. As I wax on about in my book, HealthConsuming: From Health Consumer to Health Citizen, the new retail health landscape, coupled with digital health platforms (baked into the SMAQ acronym), enables people to take on more self-care, and also connects providers (doctors in traditional settings and new entrants in retail clinics, telehealth channels, and grocery stores, among them) to consumers to inform and support that care.
I’m an omnivore of Accenture’s research, and this year’s Digital Health Tech Vision 2019 tells the big top-line truth that, “digital is no longer a differentiator.” There’s no more eHealth or mHealth — it’s all health, it’s all digital.
The great irony in all this — which I, not Accenture, term as ironic — is that “together, humans + machines produce better results.” This is the subtext and subtitle of Dr. Eric Topol’s latest book, Deep Medicine — that AI can and should be artfully deployed to “humanize healthcare.”
Some folks in healthcare may well need that explicit, big “smack” in the head (speaking metaphorically, not literally).
There are many forms of magic inspired by Disney, the company. There’s the obvious attraction, the Magic Kingdom, that was Walt’s original destination vision, “imagineered” in 1932.
Then there are other kinds of magic. The one I’m deep into in the moment is inspiration, ideation, and “reimagineering” my own thinking about work, legacy, and social justice.
I’m grateful to have had the opportunity to spend much of this week at the inaugural Disney Institute Women’s Leadership Summit. The Institute convened about 300 women (and a handful of brave “He-for-She” men keen on diversity) in Orlando to learn about and brainstorm Disney’s corporate approach to intentional listening, storytelling, and inclusion – and how these values can benefit us for both our business and personal lives.
Between keynotes in large plenary sessions and breakouts focusing in on specific values, we attendees came away brimming with new ideas, challenging biases, and making dozens of new friends.
In this post, I aim to share the key lessons that resonated with me, many of them through my broad lens on health.
Catherine Powell, President of Disney Parks, Western Region, kicked off the Summit with her keynote talk during which she detailed her work history and personal life, offering key insights along her journey. In her early career, Catherine made documentary films in Somalia and worked with the BBC. She fell in love, married, and had 3 sons. She also traveled and worked in the UK, Australia, in Europe, and in the U.S.
There is no work-life balance, she quickly shared, based on her experience. So we must not seek perfection. We should make our choices with open eyes and good information, and then have no regrets: we must be mindful and know our values. Catherine advised taking time off remembering that, “you are the same person: just because you took time off doesn’t mean you are not the same amazing person you are when you re-enter the workplace.” We (women) can be so hard on ourselves – but we must remember that, Catherine believes, “there is no perfect solution.”
Disney challenged her, in that move to Australia, to manage the entire portfolio of businesses well beyond her “vertical expertise.” How to run a horizontal team with seven businesses she didn’t know as well as the folks on the ground who ran them? How to add value in that scenario, Catherine wondered? She learned the lesson and value of vulnerability, which she believes is “a super-hero strength.” Risk-taking, fast failure, acknowledgement, and learning “together” is a valuable work-flow and M.O.
Catherine learned to don many hats building the team and businesses in Australia, and was then recruited to go to EuroDisney outside Paris. Here, you see her wearing a very-Disney hat, fashionably sequined mouse ears, migrating from Australia to France.
Disney Institute’s Julianna Alley followed up with a discussion about Disney’s values and success factors. “We’re not Disney because we’re different from other organizations,” Julianna noted; there’s “no secret sauce or bullet. We are Disney because we are doing the same things other organizations do (but) differently and often to a different degree.”
A central tenet of this, I came to learn this week, was the following mantra: “We have learned to be intentional where others may be unintentional.”
That “intent” is a strategic commitment and operational verb at Disney.
There’s another verb that Julianna called out: “Leadership,” is not a noun, she asserted. It’s a verb. It’s not who you are – it is all about what you do, reinforce, role model.”
Another Julianna pearl: “When you know what your values are, decisions become easy.”
In closing, Julianna quoted Bob Iger, CEO of Disney: “We want to be the most admired company in the world, admired for quality of product, integrity of people, and the way in which we behave as citizens of the world.”
My next lightbulb moments came during a breakout session on “legacy.” This is a huge part of the Disney phenomenon, an outgrowth of Walt Disney’s corporate DNA.
Diana Ballard from the Institute led this impactful session, starting off by asking us what “legacy” is. Various attendees in our session offered up responses such as, “what you leave behind,” “what people say about you,” “a memory.”
Every leader leaves a legacy, Diana explained, as an “aggregate of the story he or she told over time.. the more we can be intentional and purposeful about that legacy, that’s the one you want people to read….Great leaders intentionally write their legacy,” Diana recognized.
Diana then introduced us to three Disney “cast members” (Disney-speak for employees-colleagues): Kartika Rodriguez, RK Kelley, and Sarah Tedrow-Azizi.
I listened with intent to each of these three women’s stories and took copious notes. Each embodies different backgrounds, career pathways, ethnicities – but they’ve all embraced the Disney way of intention, mindfulness, positive attitude, can-do spirit, and very important to me, a larger embrace of life beyond the workplace and self-defined holistic health. Each is committed to various community and family roles, and all open to evolving and growing over many years and many seasons of career and life.
At the end of Day 1, Dr. Steve Robbins keynoted a discussion about neuroscience and human behavior, inclusion as an intentional process, and the power of caring.
Steve’s sixty minutes were chock full of lightbulb moments for me, and I was silently thanking my mother for teaching me to be a fast typist on my iPad keyboard. (For more on her powerful woman’s influence and my learning on the IBM Selectric machine, see my Huffington Post essay on “Mom and the Selectric”).
Steve’s key lesson #1: “In our encounters with difference we need to give ourselves a chance.” Steve gave me a huge insight on “diversity,” which as I write this down, is so obvious, and yet….not. We’ve approached diversity in business like a checklist, focusing on demographics like gender, or sexual preference, or ethnic/culture differences.
That approach hasn’t been so productive, has it?
At any given moment we are the other person – the Outsider, not the Insider.
Steve told us that the brain is optimally operative based on two conditions: our own brain…
1. Wants to be around other people or be part of a tribe, and,
2. With people who care about us
This is basic, survival instinct stuff. For safety reasons, we want to be part of a tribe. We need others to survive, both in the womb and outside the womb.
You can also feel lonely around other people, Steve knows. We want others to value us, to hold us as significant. “If people like you in the tribe, you are more valued and won’t be sacrificed….The brain is hard wired to belong,” he has learned.
If you do inclusion right (in business), you get more value and productivity from a worker.
From a brain science perspective (Steve’s expertise), this is why people surround themselves with people like themselves. In Steve’s words, “Fox people [link up] with Fox, and CNN’s with CNN’s.”
Lightbulb shining brightly once again.
“It is easier to hang out with people like us because our brains prefer the familiar,” he explained. Energy is currency in the brain, which operates on an ROI mentality. That energy-currency is glucose, which the brain wants to conserve. Stepping outside of our comfort zone uses more of that energy source; but, the brain tends to want to be lazy, Steve’s research has gleaned.
Next lightbulb: “Diversity is not our problem. It’s close-mindedness.”
When you feel like an outsider, research has shown that manifests in physical pain in two parts of the brain. The social pain of exclusion or rejection is real pain to the person.
Ultimately, this costs business a lot of money, and Steve worked out a quick financial model to demonstrate that cost for a theoretical organization. Based on a few reasonable assumptions, we calculated that lack of inclusion can run in the millions of dollars for an organization with 1,000 employees.
This is a hidden cost, but a real cost, nonetheless.
Steve then pivoted his talk from engaging and informative data to his very personal story.
I won’t go into the details here – you can experience these from one of Steve’s TED-style talks here. Just know that I ended the day standing with several hundred people in a circle around the ballroom, singing Bill Withers’ “Lean on Me,” tears streaming down my eyes, hugging the woman next to me – a person I had never met before.
The uplifting bottom-line, à la Steve: “The more you care for strangers and outsiders, the more friends and homies you get!”
Robin delivered an authentic and uplifting message about resilience, full-on life-engagement, and love. You know Robin’s presence through her many decades as a positive force in sports and news media. You may not know that Roberts has faced two devastating medical diagnoses, and miraculously emerged (twice) on this side of the acute healthcare system with grace, through grit, excellent medical care and a whole lot of social network and familial love beneath her wings.
Robin offered some great advice baked into her personal storytelling. A major message was delivered through this poem by Robert Browning Hamilton, which Robin quoted to a woman in our group who asked about resilience in the face of dark and challenging times.
Robin grew up the youngest of four children raised by two loving parents who were graduates of Howard University where they met and fell in love.
Robin and her three sibs grew up with the “3 D’s:” discipline (her Dad, after all, was in the military), determination, and her mama’s ‘D’ — “Da Lord.”
What may have resonated most with us in the audience was this: that “Mama said, ‘Make your mess your message.’”
If you’re going through something tough, others are too, Robin assured us. “Share it with others,” she advised, telling us that she and Diane Sawyer, her colleague at ABC News, used to call themselves, “Thelma and Louise” — that fictional movie duo who shared adventure and doom with gusto.
One of those “adventures” Robin had to share was her patient journey with MDS, myelodysplastic syndrome, which turned out to be a toxic side-effect of the chemotherapy that saved her life after her cancer diagnosis.
The sharing part came when Robin needed a bone marrow donor. That sharer turned out to be Sally-Ann, Robin’s sister, who emerged a perfect match. When Robin told her that, indeed, Sally Ann had the magic marrow, Robin gave her sister permission to back out of the transaction. Sally-Ann was insistent: “I feel I was born to do this,” Sally-Ann told her baby sister.
Subsequently, Sally-Ann started up the Be the Match donor registry, especially important for people of color and, most importantly, for people of mixed race.
“Don’t compare despair,” Robin finally recommended. “Know that everybody’s got something and everybody has a resource to help them through something…(so) enjoy the freakin’ ride!” she optimistically insisted.
As we were ready to applaud and let Robin get to the plane to her next destination, she waxed lyrically about seeing a blue bird that morning….and then a soaring voice began singing from back stage, “Somewhere Over the Rainbow” — Ms. Patti Labelle, Robin’s BFF!
Patti, proudly letting us know she had celebrated her 75th birthday, sang to the depths of her soul and heights of her range. We in the audience were beyond thrilled and, once again, so inspired.
I left the Summit humming, “If happy little bluebirds fly beyond the rainbow why, oh why, can’t I?” buoyed by rockin’ Robin’s and Patti’s positive loving spirits and shared wisdom.
Health Populi’s Hot Points: While attending the Disney Institute Summit in the Happiest Place on Earth, as Disneyworld is called, I’ve not been able to escape my work-life 24×7. The pace of the evolving nature of health and healthcare these days is such that going totally off-the-grid is not possible until I decide to go all-in on making cheese in Italy and leading tours at the Uffizi Gallery in Florence. That day may come, but not quite yet.
On the work-front this week, I was faced with the fact that measles cases in the U.S. reached 1,000 based on the CDC’s latest data. This is a tragic and avoidable public health fail in my work-world, and something that’s part of a larger context of trust, information flow, and human tribal culture — ironically, the subject of one of my breakout sessions this week that was highly relevant to my own career space and clients’ challenges. That session, titled “The Relationship Between Information and Trust,” was based on the principle that, in the words of Disney Institute, “When you build relationships based on trust, information flows to you. If you do not have trust, information does not flow at all.” That resonated with everyone in my team exercise, which brought out some very normal human and frail behavior which, after the process, yielded important learning to apply to both professional and personal lives.
While in Orlando this week, the world kept spinning, and my thoughts turned to Normandy, France. This week marked the 75-year anniversary of D-Day, thinking about our hard-won freedom fought by my Greatest Generation Dad, who believed in all-men-and-women-are-created-equal kind of justice and fairness for America and the world. D-Day was coined FDR and Churchill’s “Mighty Endeavor” conducted on June 6, 1944, to finally put down Hitler’s fascistic Nazi regime.
This week, I also recalled the 50-year anniversary of Stonewall: another brave fight fought this side of the Pond on U.S. soil in New York City. The Stonewell rebellion was truly another battle for equity and justice for Everyday People. In my work whether helping to ideate new medical products to address infectious diseases, designing services to meet future demands of patients with emerging or under-served conditions, or developing patient access programs that enable people to get needed care, calling out bias against people is one element of our public health toolkit.
Note this Stonewall protestor banner speaks to “fascism.”
With the D-Day and Stonewall events in my heart and mind, I hearken back to this week’s teachings of Dr. Steve Robbins — tearing up in that Circle of Love and Life, and reminding myself with intentional thinking not to draw lines between Insiders and Outsiders.
I connect the dots between this wisdom and FDR, who collaborated with Churchill on the D-Day strategy.
FDR initially funded the fight against polio through the March of Dimes in 1938. With his vision and leadership, we eradicated polio (through the Salk vaccine) and the Nazis, too.
We must be mindful of the nature of viruses, which come in many forms.
We must speak up on behalf of love for social (and public) health, Steve’s wisdom reinforced.
What a week of insights, laughter, tears, and love. Thank you, Disney Institute, for the inspiration and experience in this Magic Kingdom that inspired fresh thinking and spawned so many new friendships.
In the U.S., rural residents’ access to broadband at home continues to lag behind urban and suburban dwellers, the Pew Research Group noted in a May 2019 research note on Americans’ use of technology.
The Pew survey explored Americans’ adoption of technology and found that rural dwellers are also less likely to have multiple devices than non-rural consumers. Across the four types of tech studied, it’s smartphones that top the list of penetration in rural areas (at 71%), closely followed by computers (desktop or laptop, with 69% adoption), broadband (at 63%) and tablets in fourth/last place (49%).
The chart illustrates that rural residents’ adoption of broadband and computers has remained flat over the past couple of years, with faster-paced growth for smartphones and tablets.
Without access to broadband, an individual can’t seek a job online, get banked, apply for health insurance, or access a health information portal, among many other daily tasks EveryWoman and EveryMan do to streamline life.
The lack of broadband to rural health citizens exacerbates disparities by preventing people from digital engagement in their health and caring for loved ones.
Consider the importance of national infrastructure investment for broadband to the last person, not just to the “last mile.” Furthermore, net neutrality is also an important underpinning for fast health care connections that deliver access to telehealth and virtual health channels that can scale care to under-served people, patients, and caregivers.
Most U.S. healthcare providers are spending more time, effort and capital with an eye to engaging with patients-as-consumers, a trend quantified in the report, the 2019 State of Consumerism in Healthcare: The Bar is Rising from Kaufman Hall, summarizing results from this year’s healthcare consumerism index survey conducted among about 200 healthcare providers.
“Legacy organizations will need premier-level consumer capabilities to compete in today’s increasingly consumer-centric environment,” Kaufman Hall recommends. Providers identified the key capability gaps for consumer-centric care as improving the consumer experience, offering a variety of facility-based access points, utilizing digital tools for health engagement, providing price transparency, and offering more virtual access points.
Those highest-threat “premier-level” consumer health service organizations would be UnitedHealth Group/Optum. CVS Health/Aetna, Amazon, Google/Alphabet, and Apple, in the Kaufman Hall poll.
The most prevalent convenient access points providers offer are walk-in clinic hours, “save-a-spot” urgent care, and same-day appointments, with online schedule, evening and weekend clinic hours, and online-self scheduling for new patients falling behind.
As consumers go digital to project manage many daily activities, they look to do more personal health work flows this way, too, especially via mobile platforms. The second chart illustrates that most providers offer a patient portal — that’s largely owing to the near-universal adoption of electronic health records and the Meaningful Use access point of a portal. A distant second digital tool for health consumer engagement is smartphone apps, available by one in three providers. In-home monitoring and wearable devices are offered by about one in ten healthcare providers. And voice, while currently hyped in trade and mass media, has virtually nil availability yet in real-world healthcare delivery.
A key on-ramp to providers building capabilities to meet consumers’ service demands is by working with third parties who have the competence, experience, and oftentimes brand recognition that can turbocharge tech or new service adoption.
The most popular consumer-facing health service where providers are collaborating with third parties are virtual health services (think telehealth vendors like American Well or Teladoc), digital experience tools (like Welltok or Salesforce), outpatient lab (e.g., Quest or LabCorp), and retail or urgent care (such as CVS/Minute Clinic or Walmart).
Ultimately, building capacity for delivering on the promise of consumer experiences will compel providers to adopt a hospital mindset to “delight,” not just satisfy, Kaufman Hall urges. This means addressing the entire continuum of the patient/consumer journey across all touchpoints, leveraging platforms that consumers already use to live, work, play and learn.
Health Populi’s Hot Points: Speaking of learning, Kaufman Hall’s 2019 report is well-timed to coincide with my attendance at the Disney Institute’s Women’s Leadership Summit this week in Orlando — that happiest place on earth. I’ll be trend-weaving the learnings of the best practices in hospitality for health/care, and I’m in good company here sharing perspectives with many health/care industry leaders.
We’re brainstorming the consumer experience in health care for three days, and I’ll be sharing with Health Populi readers the best thinking coming out of this experience. Stay tuned for a post on Friday 7th June for those insights…