A Health Future with Lyft and Uber as Patient Data Stewards: Rock Health’s 2019 Consumer Survey

Patients searching online for health information and health care provider reviews is mainstream in 2019.  Digital health tracking is now adopted by 4 in 10 U.S. consumers.

Rock Health’s Digital Health Consumer Adoption Report for 2019 was developed in collaboration with the Stanford Medicine Center for Digital Health. Rock Health’s research has tracked peoples’ use of telemedicine, wearable technology, digital health tracking, and online health information since 2015, and the results this round show relative flattening of adoption across these various tools.

Rock Health’s top-line findings were that:

1. Patient-generated health data creates opportunity, and potential challenges
2. Online health information is re-shaping the relationship between patients and clinicians
3. U.S. consumers’ willingness to share their data depends on whom they are sharing it with.

Start with tracking: nearly 80% of people tracked at least one health metric in 2019, but nearly one-half of that tracking was done in an analog, not digital way. This was a deja vu data point for me, thinking back to Susannah Fox’s study at the Pew Research Group back in 2013 which learned that most people tracked health data “in their heads.”

How not-so-far we have come, right?

What do health trackers track, then? The second chart (Figure 3 in Rock Health’s report) illustrates the most popular consumer-tracked health metrics by health conditions of obesity, diabetes, heart disease and hypertension.

Note that the darkest green tone identifies the data for tracking via digital methods. Overall, the most common digitally-tracked metric is blood pressure, followed by weight.

The most digitized tracking was for blood sugar among people managing diabetes, at 29% of patients, followed by 24% of people tracking blood pressure digitally among people with hypertension as well as heart disease, and 23% of people dealing with obesity tracking weight digitally.

Only about 20% of people who tracked a health metric shared that data with a health care provider, Rock Health learned.

Among consumers willing to share health information, the most trusted touch point is “my physician,” with whom 86% of people said they’d share in 2017 but dropping to 73% in 2019. Second in sharing-line were “my health insurance company” and “my pharmacy” for just over one-half of consumers, a percentage which stayed fairly flat between 2017 and 2019.

The proportion of people willing to share data with research institutions fell by 44% to 34% in the two years, and with health tech companies, flat at 23% between 2018-2019.

Only one in five consumers would be willing to share their data directly with pharma companies, to Rock Health’s third point about willingness-to-share-with-whom.

 

Health Populi’s Hot Points:  The third chart shown here, Figure 9 from the Rock Health report, presents data on the tech companies with whom U.S. consumers would be most willing to share their health data.

This information compelled me to return to the previous responses to this question in Rock Health’s surveys starting back in the 2015 study into digital health consumer adoption.

In 2015, Google was still the top company with whom people would share data — at a percent of 10.2% of total consumers, followed by:

• 9.6% willing to share with Microsoft
• 9.2% with Apple
• 8.3% with Samsung, and
• 5.4% with Facebook.

You will quickly say, “ah! The proportion of consumers willing to share personal health information with pure-play tech companies has grown exponentially!”

True — yet the proportions have dropped between 2018 and 2019 as follows:

• Google is down 4 percentage points over the past year
• Microsoft down 4 percentage points
• Amazon down 8 points
• Apple down 7 points
• Samsung down 4 points
• Facebook down 4 points.

And this year, Rock Health added in Uber and Lyft, with whom 22% and 16% of consumers would share health data, respectively.

We see the continued evolution of health-data ecosystems, as well as the re-definitions of what a “tech company” is vis-a-vis a “health-tech company.” Clearly, with the rumors this week that Google may be looking to acquire Fitbit, Google Health would continue to grow its data mine massively through that transaction. And, as Cerner announced its collaboration with Uber Health this week, we see a health IT company expanding beyond what an EHR could be.

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Quotation of the Day: On Work and Mortality

“It is not your duty to finish the work, but neither are you at liberty to neglect it.”

Rabbi Tarphon

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While Costs Are A Top Concern Among Most U.S. Patients, So Are Challenges of Poverty, Food, and Housing

Rising health care costs continue to concern most Americans, with one in two people believing they’re one sickness away from getting into financial trouble, according to the 2019 Survey of America’s Patients conducted for The Physicians Foundation.

In addition to paying for “my” medical bills, most people in the U.S. also say that income inequality and inadequate social services significantly contribute to high medical spending for every health citizen in the nation.

The Physicians Foundation conducts this study into Americans’ views on the U.S. health care system every other year. This year’s poll was conducted in September 2019 and included input from 2,001 U.S. adults ages 27-75 who had seen the same doctor at least once in the past year.

Digging into the health care cost concerns, the Foundation asked people about their health care affordability cost thresholds — that is, their ability to pay medical bills for an unexpected illness before they hit a personal financial crisis. 42% of Americans could afford a bill of $500 or less before they would have financial issues; 22% could afford between $501 and $2,500; and, 37% could afford more than $2,500 to pay for an unexpected health issue.

Cost was ranked as the top issue negatively impacting patient care in this survey, identified by 86% of U.S. health care consumers, followed by waiting for insurance pre-approvals (cited by 72%), using pre-determined treatments based on scientific evidence of similar cases (aka protocols or clinical guidelines (noted by 50% of consumers), and electronic health records (among 30% of people).

Related to costs, consumers were asked about factors they believe drive up health care spending. Three-quarters of Americans believe that hospitals, clinics and physicians should look beyond patients medical/clinical needs into root causes like access to healthy food, transportation, and safe/clean housing — the social determinants of health.

The study also addressed the politics of health care leading up to the 2020 Presidential election. Cost concerns are playing into peoples’ perspectives on health care reform proposals, with a majority of survey respondents saying they’d be more likely to vote for a candidate that would support expanding private health insurance reforms versus scrapping commercial insurance for a Medicare for All proposal. While a “single payer health care system” was favored by 41% in terms of a candidate’s position, 77% of people could not agree on a definition for what “single payer” means in a U.S. health care system model.

Health Populi’s Hot Points:  Americans’ mentions of “government” as a top U.S. problem are near a record high, a Gallup poll published this month found. Americans’ satisfaction with “the way things are going in the U.S.,” as Gallup puts it, has fallen down to 28% in this study conducted in the first two weeks of October 2019. Americans pointed to government as the top problem in the U.S., followed by immigration (at 13%, falling 3 points in the month since September), race relations (at 6%), health care and insurance (at 5%), unifying the country (5%), and climate change (4%).

“Average mentions of government have been on the rise since 2017,” Gallup noted in a growing polarized political climate in the U.S.

So whose job is it anyway to bolster social, economic and environmental health for a nation’s health citizens?

There’s a trend in 2019 which will continue through 2020 where private sector health care providers, Foundations and other non-public sector entities have begun to address social determinants of health. Kaiser Permanente is building a data platform with Unite US to manage and address the challenge, as well as investing in housing for residents in its communities, part of the organization’s $200 mm Thriving Communities Fund.

Microsoft recently launched a program to build housing for people around its Seattle headquarters. Microsoft is working with Humana on how to leverage data to help people age in place safely and health-fully. Humana connects with consumers on issues of loneliness and mental health through its campaign with spokespeople Nick Jonas, Queen Latifah and Ted Danson. Humana also launched a “Bold Goal” initiative to boost healthy food access for people enrolled in the plan’s Medicare Advantage programs.

I laud these programs initiated by private sector businesses and health care stakeholders. Health consumers absolutely want to engage across all industry segments for health, we learned from the Edelman Health Engagement Barometer back in 2010 (shown in the bar chart here taken from my book HealthConsuming).

But as we consider our larger personal health ecosystem’s beyond healthcare system touch points, the public sector plays an over-arching role in fundamental public health pillars like infrastructure (think: clean air, clean water), education and food policy.

A new study from a global research team published in the Proceedings of the National Academy of Science (PNAS) looked into social, demographic, and economic correlates of food and chemical consumption finding a direct statistical relationship between wastewater and socioeconomic factors: that is, people in lower socioeconomic strata had greater exposure to environmental hazards. These are social determinants of health that lie well beyond the prescription pads of doctors, nurses, pharmacists and disease managers.

In tomorrow’s Health Populi blog, I’ll cover specific aspects in the Physicians Foundation 2019 survey addressing prescription drug costs.

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Friday Links

• Gene therapies on the rise.  
• No rebate drug markets?
• California health hazards.
• Exercise and dementia.
• BC/BS: Single payer = salad bar?

…and the NBA season has started!

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Making Health Care Better, from the N of 1 to the Public’s Health – Trend-Weaving Medecision Liberation 2019

Health and our health information are deeply personal. Changing health care and inspiring positive health behaviors is hard to do.

But we must and we will, a group of inspiring and inspired people who work across the health/care ecosystem affirmed this week in Dallas at the conference of Medecision Liberation 2019.

I was engaged at this conference to wear several hats — as a keynote speaker, a sort of “emcee,” and, finally, to trend-weave the many talks and discussions happening throughout the meeting. This post is my synthesis of the summary I delivered live at the end of the conference, which one of the attendees described as “poetry slam-meets-healthcare.”

I quite like that new-and-improved Cliff’s Notes metaphor.

Deb Gage, Medecision CEO, kicked off the meeting. The inspiration started within minutes as Deb shared several personal stories involving the health care system and its flaws. Think of Deb as the proverbial shoe-maker’s child with no shoes: she leads a company helping drive digital transformation in health care, but two people she loved, and she herself, had all been failed by some aspect of fragmented health care delivery in America.

Deb shared the experiences of Sam, her friend of 25 years, who had the quite-typical co-morbidity of multiple chronic physical conditions baked with mental health issues. Deb’s Dad, Ray, having lost his wife (Deb’s mom), was living alone, aging with some common conditions that come with living long and well, and wanting to stay independent in a health-and-social environment that doesn’t make this so easy to do. And Deb herself, surviving a tough condition, found that her own medical records were located in four disparate health systems based on the fragmented nature of her care delivered through different provider organizations.

Her learning, and ours: “We don’t need new tech….we need a single person view.”

Furthermore, Deb pointed to this quote from Dr. Atul Gawande — that our job is not to ensure health and survival…it’s to enable well-being.

This ethos echoed throughout the 36 hours of Liberation 2019, culminating with the mantra of Nick Adkins, Co-Founder of the #PinkSocks Life community, who challenged us to look each other in the eye in close personal space to a new acquaintance and say (and mean), “I see you.”

Another riff on “I see you,” that N of 1 person-patient-consumer, was Dr. Eric Topol’s explicit mission for Deep Medicine: that is, to personalize treatment based on evidence, not on the long-accepted
“sclerotic” medical thinking and prescriptions (as in “athero-sclerosis” blocked arteries) that aren’t based on the latest sound science. Dr. T’s “omes” slide, included in his book Deep Medicine, illustrates the many layers of a human being on multiple levels. I found this to be an apt metaphor once again for thinking about the individual human with many layers and lenses…the complexity of the individual with whom we must “go deep”

My own talk on the acronym I coined for this event, “TiSH,” spoke to each of our challenges with Trust, Stress, and Health Literacy. Taken together, these can be a toxic cocktail when not aligned for positive health behavior. Stress in America today crosses socioeconomic strata when it comes to health care costs several research studies have found that I cited, including surveys from the American Psychological Association and the Kaiser Family Foundation.

The call-to-action Rx for this is to get to know a patient’s values in terms of the life-flows and personal goals, as well as their “value” for health care — the ability and willingness to pay, their personal definition of affordability, and how that plays into their potential or actual self-rationing behavior due to cost. As many as 1 in 2 Americans has avoided some aspect of health care due to cost in the past year, such as postponing a needed visit to a doctor or not filling a prescription drug.

So we’ve spoken to the N of 1 patient-person and the N of 1 physician-clinician. But if we want to change health care for the better, we must look into the eyes, Nick Adkins-style, of workers in health care. Chris Mahai, who runs Aveus, Medecision’s consulting division, wrote the book BOLD on leadership. The acronym stands for, “Believe, be Open, Learn, and Do.” Bold leadership, Chris and her panel who represented three different roles and health industry segments all believe that leadership can and should be fostered, embraced and rewarded at all levels of an organization. I was particularly struck and resonant with one of the panelists’ personal approach to change-agency at work: she said she tries to disrupt her work and workflows every day. That takes bravery, risk-management, and vision. And her organization’s top leadership supports her bold approach.

During Liberation 2019, there were many moments of inspiration, but none more visceral or personal than the family history shared by Gary Mendell, founder of Shatterproof. Gary’s son was addicted to opioids and ultimately, after many months of being clean, took his own life. Gary’s mission with Shatterproof has four pillars, none more important than de-stigmatizing mental health and especially addiction by recognizing that it’s a legitimate healthcare condition worthy of parity of treatment priority and payment just like physical conditions such as cancer or heart disease.

Gary talked of a vision, “that our society would look this straight in the eye, prevent, treat with love and empathy and with programs based on science.” This vision weaves together elements shared in the conference by all of the speakers, with Gary’s family’s learning this in the most personal, devastating way.

From Gary and the challenge of addiction, we moved and were moved by Dr. Shoshana Ungerleider’s leadership of Endwell, an organization devoted to expanding the concept of a good death. The U.S. fails in this end-of-life patient and family experience, and so many of us in the room where Shoshana shared her mission-driven message nodded, teased up, shook our heads, and stared this truth in its face. In Shoshana’s introductory video, a doctor from Stanford said, “Coming here (to the Endwell meet-up) and dealing with end of life makes me proud to be part of health care.”

There’s nothing more personal than one’s own death, and Shoshana challenges the siloed health care system to break down the siloed of home care, hospice, inpatient care, physician care, faith-based organizations, and disease advocacy groups to come together for the benefit of streamlining and humanizing death to make it just as enlightened a patient experience as other aspects of health care on life’s continuum.

Patients and families who have felt betrayed by the health care system, as Gary and many of Shoshana’s communities, may have reacted, must feel trust again with those segments of the health/care ecosystem from whom they are alienated. Trust is a precursor for health engagement, and Lynn Hanessian and Cydney Roach of Edelman did a deep dive into the 2019 Edelman Trust Barometer. This year’s study, released as usual at the World Economic Forum in January, found that while overall trust in health care grew over the past year, there was a significant decline in trust in the hospital sector. Hospitals have traditionally been valued members in patients’ communities, with hospital beds notoriously difficult to close due to these institutions being so prominent in their towns and among the largest employers — economic engines — in their local geographies. But how the mighty have fallen in trust — even these pillars of local Chambers of Commerce and economies.

Julie Murchinson, CEO of Health Evolution, concluded the meeting with her insights into “tribes.” She noted that each of us, within and outside of health care, but each of us people is a member of a tribe that’s unique to us, riffing on the work of Dave Logan. Some of us are in tribes where we feel we’re great (and “you’re not”). Some of us are in tribes where we feel marginalized by society and hang with other people in our tribes who feel the same way. Some of us feel communal in our tribe in that our operating system is inclusive for the whole versus the individual in and of ourselves. Recognizing that we are all in tribes, sometimes quite different than the ones with which we identify.

Julie’s call-to-action asked each and all of us: “How do we drive change in health care as a tribe to make a movement?”

She pointed to Greta Thunberg, who at 16 has indeed inspired a movement to popularize climate change across borders, age groups, social strata, and political persuasions.

Greta is as good an inspirational role model as any we can channel in these cynical days.

That’s liberating. That’s Liberation 2019.

Thank you, Medecision team, for convening this exciting, inspiring, informative meeting. This isn’t my job at moments like this; it’s a mission.

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Fear of Falling

As people age, falls become not only more common, but more problematic. Every year 300,000 elderly Americans are hospitalized for a hip fracture, and 95% of these fractures are due to falls. Falls are the leading cause of fatal and non-fatal injuries among the U.S. elderly. What are people doing about it? Kaiser Health News has two interesting stories on the topic.

First, younger elderly individuals are moving to more “Age-proofed” housing:

For those 65 and older, it said, “the number of households with housing cost burdens has reached an all-time high. By 2050, almost one-quarter of Americans will be 65 or older, according to the Census. Surveys conducted over the past decade show that older adults overwhelmingly want to age in their homes.

Yet many houses aren’t suited to “aging in place,” said Abbe Will, associate project director of the Remodeling Futures Program at Harvard…

In a recent survey of 1,000 people age 65 and older by the California-based nonprofit SCAN (formerly the Senior Care Action Network), 80% of respondents were concerned about their ability to age in place. The driver appears to be financial: About 60% said they have less than $10,000 in savings (including investments and retirement plans).

Baby boomers want a safe place for them to live as they age. While this caution is well-placed, another KHN article argues that hospitals may be too cautious. In an effort to prevent falls, hospitals may be keeping the elderly on bedrest for too long. Kaiser Health News reports:

Hospitals face financial penalties when…[falls]…occur. Nurses and aides get blamed or reprimanded if a patient under their supervision hits the ground.
But hospitals have become so overzealous in fall prevention that they are producing an “epidemic of immobility,” experts say. To ensure that patients will never fall, hospitalized patients who could benefit from activity are told not to get up on their own — their bedbound state reinforced by bed alarms and a lack of staff to help them move.

That’s especially dangerous for older patients, often weak to begin with. After just a few days of bed rest, their muscles can deteriorate enough to bring severe long-term consequences.

Part of the reason hospitals are overly cautious is that starting in 2008, the Centers for Medicare and Medicaid Services imposed financial penalties on hospitals whenever patients fell. The penalties increased when the Affordable Care Act was passed. This created a culture where hospital staff were perhaps overly fearful of falls, as CMS only tracks fall rates, not patient mobility at discharge.

Preventing falls is important. But physicians and nurses need to be able to use their discretion to help determine to balance the risk from falls against a lack of mobility.

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Learning from Dr. Eric Topol, Live from Medecision Liberation 2019

“Bold thinking is great. Bold doing is better,” Dr. Eric Topol introduced his talk yesterday at Medecision’s Liberation 2019 conference.

I have the opportunity, for which I’m so grateful, of not only attending this meeting but playing a role as a speaker, a sometimes stage “emcee,” and a keynote speaker. And as an attendee, I learn so much from other speakers, fellow attendees, and Medecision staff all sharing perspectives during breakouts and networking breaks.

In mode of attendee (and self-confessed collegial-groupie of Dr. Topol’s), I took in his remarks taking notes as fast as I could thanks to Mom teaching me how to type on an IBM Selectric (the significance of which I wrote about here in the Huffington Post).

Riffing on his great book, Deep Medicine: How AI Can Humanize Health Care, Eric started his talk donning my own professional hat as a heath economist, sharing data about America’s high health care spending with low ROI yield. “The U.S. is a distinct negative outlier,” the doctor noted, pointing to the detailed data from the OECD published in The Economist.

More people going into health care jobs, he continued, with the latest data from the Bureau of Labor Statistics illustrating that we’re adding more human capital to a broken health care system. “This isn’t the answer to our problem,” Eric asserted.

He showed new evidence from Nature (journal) Volume 574 dated 24th October 2019 — Eric is never guilty of showing old data unless it’s making a new-new insight. The article in Nature was “Quantum Supremacy Using a Programmable Superconducting Processor,” demonstrating that instead of 10,000 years to analyze data, the new analytics capability enables a calculation in a matter of seconds.

Then Eric quoted Thomas Friedman’s January 2019 op-ed from the New York Times, titled, “Warning: everything is going deep.” Friedman, author of one of my go-to tomes, The World is Flat, called out that in 2019, “The word for the year is ‘deep,'” as in “deep learning, deep insights, deep artificial minds.”

For Dr. T, it’s all about “Deep Medicine.”

What can going deep in medicine do for health systems, health care, doctors and patients?

Eric offered several prescriptions, #1 being to use evidence to underpin workflows, diagnoses and prescribed therapies and procedures.

Here, he described the evidence demonstrating that statins work in only 18 of 1,000 patients, but of course statins are prescribed the world over in millions of patients, making the drug category one of the top prescription medicines on the Planet. This is the illusion of treatment that doesn’t do anything.” Instead, we need to do polygenic risk scores instead of taking statins, Eric argued based on the evidence for doing so published in JAMA and New England Journal of Medicine. “Polygenic risk scores are going to be the future.”

So why aren’t these risk scores used by cardiologists, internists and PCPs today?

Because of  “sclerosis of the medical community,” Eric called it.

He continued his prescriptions for making health care more human, humane, and evidence-based with other bold ideas including getting rid of keyboards in the physician-patient encounter, ensuring patients own/control their personal health data, and increasing the time shared between doctors and patients during the encounter.

Finally — my most re-tweeted tweet during the session — Dr. T asserted that, “There is no room for hospitals in the future. It’s all about the patient’s bedroom.” Eric’s point wasn’t that we don’t need emergency and trauma services, ICUs and other brick-and-mortar health care sites for people who need care in complex settings. But for so many conditions that can be managed remotely and via self-care technologies enabled by broadband connectivity…we’re getting there.

I quite concur: this is the last section of my book, HealthConsuming: From Health Consumers to Health Citizens. That paragraph imagines how our homes can and should be our health hubs, enabled by connectivity (ensuring net neutrality and fast lines for all), privacy and data security, and universal health care access.

That, too, was a prime Dr. Topol moment, wearing his health policy hat: his belief that the U.S. as a “negative outlier” in the developed world is that way because the nation does not guarantee universal health care as a civil and human right.

It’s not only AI that can help humanize health care. It’s people like Dr. Eric Topol living out bold thinking and bold doing.

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