LIFE EXPERIENCES AND INCOME INEQUALITY IN THE UNITED STATES

Over the past five decades, income inequality has sharply increased between the highest income earners and middle- and lower-income earners in the U.S. This poll examines the implications of this growing inequality for the lives of U.S. adults across different income levels. This report, Life Experiences and Income Inequality in the United States, is based on a survey conducted for NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health. It explores how adults’ personal experiences, values, and views on income inequality, opportunity, and health in the U.S., differ among adults by household income. Surveyed adults are split into four income categories: those in the top 1% highest income households in the U.S. (earning at least $500,000/year), those in higher-income households (earning $100,000-$499,999/year), those in middle-income households (earning $35,000-$99,999/year), and those in lower-income households (earning less than $35,000/year). Due to the heterogeneity of incomes in the higher-income category, analyses in this report focus on differences between the top 1% highest income adults compared to middle- and lower-income adults, though results are included for all four income groups. It was conducted July 17 – August 18, 2019, among a nationally representative, probability-based telephone (cell and landline) sample of 1,885 adults ages 18 or older living in the United States.

The full report can be downloaded below.  

The Real Epidemic: Not Burnout But 'Moral Injury' Of Doctors Unable To Do Right By Patients

During the course of my husband’s two months of outpatient care, and four days in the local ICU, I realized that the physicians were shockingly absent, and the nurses only a little less so. They had withdrawn into the recesses of the system, remote from patients and families, working at the top of their billing capacity, but walled off from those they were caring for by phone trees and receptionists playing a potentially deadly game of “operator.”

Blaming the medical staff in this situation would be easy, but misplaced. It is the system, designed and overseen largely by non-clinicians, that is to blame.

The full WBUR article can be viewed at this link.  

Why Pharmacies Are About To Be Hit Hard By Disruption

Pharmaceutical distribution vary from country to country, but all of them are subject factors that make genuine competition in the sale of prescription drugs a complex matter. The need to verify that the patient requesting a given medicine has obtained the corresponding prescription from a doctor, as well as other aspects related to how the medicine is acquired (totally or partially subsidized, by public or private bodies, etc.), along with other issues reflect a business fabric that can vary enormously from the large US drugstore chains to the traditional pharmacies in many European countries, owned by a qualified pharmacist, with their regulated margins, and which until a few years ago, sold only pharmaceutical or related products.

Recent moves by Amazon seem to presage disruption in the pharmaceutical sector. In June 2018, the e-commerce giant acquired PillPack for just under $1 billion, precipitating sharp falls in the share value of companies such as CVS, Walgreens, Boots or Rite Aid: PillPack, which also traded with Walmart and was simply a little-known startup as far as the general public was concerned, had obtained a license to sell prescription drugs in all US states, and furthermore, was a service designed from scratch to be digital, a situation very few of its competitors could contemplate.

The full Forbes article can be viewed at this link.  

Patients can’t afford for doctors to misunderstand the healthcare business

Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation.  As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.

By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”

We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.

The full Quartz article can be viewed at this link.  

The Complexities Of Emergency Medicine And Prolonged ER Wait Times

Some communities have already issued warnings of increased emergency room (ER) wait times in the upcoming months, a routine phenomenon during the height of the winter season. Congruently, one among many complaints that patients have nationally about the state of modern healthcare is ER wait-times. With nearly a 50% increase in the number of ER visits in the last 20 years, this is likely a plausible public perception. However, what may not be well known to the public are the complex algorithms and protocols that drive patient flow and care in the emergency room. It is these intricacies that ultimately determine the entire patient care experience, including wait times.

The full Forbes article can be viewed at this link.  

Nine Experts On The Trends That Changed Healthtech In The Last Decade, And The Innovations To Expect By 2030

As we enter 2020, it seems like a good moment to reflect on how technology has reshaped the way we think about, and deliver, healthcare in the last 10 years, and to look forward to the innovations that might transform our sector in the decade ahead. 

I asked some of my peers to share their views on the biggest developments in digital health during the 2010s, and their predictions for what the 2020s will bring.

The full Forbes article can be viewed at this link.  

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

What matters most to people who use healthcare?  What matters to their caregivers?  How do we use this information to support ongoing quality improvement in the healthcare system?  In this paper, we explore three concepts from the current healthcare discourse, intended to drive health system improvements: person-centred care, value-based healthcare and learning health systems.  We propose that key tenets from each of these concepts should be combined to create a person-centred learning health system (PC-LHS).  We highlight two key points: First, in achieving a PC-LHS, the experiences, priorities and values of patients and their caregivers should be continually collected and fed into data systems to monitor ongoing quality improvement and performance benchmarking.  Second, the information collected in determining value must include important contextual factors-- including the social determinants of health-- as patient health and well-being outcomes will ultimately be shaped by these factors, in addition to health system and disease factors.  In summary, improving value for patients and caregivers, by capturing the things that matter most to them, within their life contexts, needs to be part of the continuous quality improvement cycle that lies at the heart of a learning health system.  

The full article can be downloaded below.  

CVS: Low Cost Care Coming For Aetna Members In 2020

CVS Health’s top executive said its stores are focused on offering “80% of what a primary care physician can treat” as it rolls out its new HealthHub format and “zero” and “low copays” for certain Aetna health plan members using CVS services.

Speaking at the JPMorgan Chase Healthcare conference Tuesday, CVS chief executive Larry Merlo said the company remains on track to have 1,500 HealthHUBs operating by the end of 2021. This comes after the first 50 HealthHubs opened last year in four markets: Houston, Atlanta, Tampa and the market that includes Philadelphia and southern New Jersey.

The full Forbes article can be viewed at this link.  

The economy of connecting

Right now, patients don’t know their own strength. But as they wake up to their emerging role as keepers of their own healthcare data, the economic clout that comes with ownership will hand them a controlling stake in the new business models that are set to disrupt traditional financing across the sector.

Forecasts give a strong indication of the potential scale of that role – and the reasons why technology startups, insurers, providers and researchers are gearing up for the age of value-based health, in which patients will trade their data as currency, investing in their own care outcomes and the tools that will help to identify and realise them.

The full Healthcare IT News article can be viewed at this link.  

The Boldest Healthcare Prediction For 2020: Business As Usual

As the decade turned and the 2020s began, news headlines made it seem as though the healthcare revolution was already underway. One banner boasted “2020: Another Year of Radical Change in Healthcare,” mirroring similar stories claiming that innovations and technologies will continue to transform medicine in the year ahead.  

Just one problem with these predictions: There’s no empirical or statistical evidence that American healthcare has undergone (or will soon undergo) any kind of radical change, or even meaningful improvement. 

In healthcare, the past is a reliable predictor of the future. And when you look at key performance measures—such as cost, quality and satisfaction—it’s clear that U.S. healthcare underperformed over the last decade.

So, why should we expect anything different in 2020 or in years to come? In short, we shouldn’t. Here’s why: 

1. Costs Keep Rising
2. U.S. Still Lags Far Behind Global Peers In Quality
3. Physician Burnout Up, Patient Satisfaction Down

The full Forbes article can be viewed at this link.