Jane Sarasohn-Kahn

Recent research points to dissatisfaction and erosion of trust between American citizens and government.

She believes prevention is the key to building a more sustainable healthcare system.

The $8 billion allocations proposed with the AHCA would have to cover the 17.5 million people who could lose coverage with Medicaid cuts.

Whether the doctor or patient is a Democrat, Independent, or Republican, the numbers are clear that people think healthcare coverage is important for all.

The remedy is in better design.

It’s generally thought that healthy people are more health-engaged than people diagnosed with medical issues. But that’s old health school thinking: most health consumers managing chronic conditions say they’ve become more engaged with healthcare over the past two years, according to CDW’s 2017 Patient Engagement Perspectives Study.

Results of two polls published in the past week, from the Kaiser Family Foundation and Pew Research Center, demonstrate growing support for the Affordable Care Act, aka Obamacare. The Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid was published February 23, 2017. The margins in February 2017 were 48 percent favorable, 42 percent  unfavorable. While the majority of Republicans continue to be solidly against the ACA, a larger share of voters who identify as Independent have shifted to a favorable position on Obamacare. Furthermore, the KFF survey found that more than one-half of Americans overall say Medicaid is important for their families, with fewer Republicans saying so. Fifty-six  percent of Americans said they had some connection to Medicaid, either currently or in the past. The KFF survey was conducted February 13-19, 2017 by telephone among 1,160 U.S. adults ages 18 and older. The Pew poll asked people if they approved or disapproved of the healthcare law passed by Barack Obama and Congress in 2010. The difference between pro- and con- in the Pew poll was wider than in the KFF survey, with 54 percent approving and 43 percent disapproving. Among people who disapprove of the law, more want to see Republican Congressional leaders modify the law versus repealing it, now with 44 percent of Republicans seeking repeal and 42 percent looking for a “repair.” There’s also a big difference in how younger Americans view the ACA compared with older people by a 2:1 ratio: 65 percent of younger adults approve of the law vs. 31 percent who disapprove. Support for Obamacare has also grown among Americans between 50 and 64 years of age. Note that the divergence in positive/negative responses in both polls reversed in 2017, lines crossing in the opposite directions as the 2017 new year set in with the eventual confirmation of Secretary Tom Price to lead the Department of Health and Human Services, and the reality of prospects for an ACA repeal. Finally, college graduates are more likely to support the Affordable Care Act than people with no college. The Pew poll was conducted among 1,503 U.S. adults the week before the KFF study, February 7-12, 2017. Health Populi’s Hot Points:  Media outlets repeated the Democratic Party leadership’s mantra that “Republicans could make America sick again.” The UK’s Financial Times reported that, “Trump warns party on speed of health reform as lawmakers push alternative visions.” The column pointed out: “The day after Republicans took a first step towards repealing the Obama reforms, the president and Mr. Pence separately met lawmakers who are pushing alternative visions for improving healthcare while trying to insulate themselves from future public ire.” The issue “spans household budgets, government spending and the profitability of the health industry,” the FT called out. Indeed: the U.S. healthcare economy is $1 in $5 of the national economy: As such, the healthcare economy is the national economy. At last week’s annual HIMSS conference, which attracted more than 40,000 healthcare information technology users and developers to Orlando, there was a growing number of vendors focused on patient payment systems – to deliver greater transparency, medical banking, and so-called “revenue cycle management.” Healthcare providers, hospitals and physicians alike, are confronted by patients who are now payers: paying first-dollar coverage out-of-pocket whether in high deductible health plans, working through health savings accounts, or paying @retail without insurance or under-insured. These patients are Democrats, Independents, and Republicans alike, all seeing $1 in every $5 bill in their pocketbook going to healthcare costs. Over one-half of respondents to the February 2017 KFF poll reported some connection Medicaid: a fact that Congress, President Trump, and Secretary Price should note. I’ll put a real-life, fine point on this: I spent last Friday morning, February 24, with the Kansas Hospital Association brainstorming the growing role of patients as consumers in U.S. healthcare. Kansas Governor Brownback had not expanded Medicaid to-date, and neither had the State House been keen to do so. The night before my speech to the Association, the State House had voted in favor of expanding Medicaid. That issue will now be considered by the Kansas State Senate. This is a state that has been very conservative about Medicaid expansion. Now, in February 2017, we see a sign that state representatives seek a change. Kansas could be a bellwether. Watch this space: “ad astra per aspera” means, “through hardship to the stars.” There are few greater hardships than a very sick person facing a choice between paying for healthcare services and life-saving drugs, and paying for food, shelter, and heat in the winter.

Eight in 10 U.S. patients would welcome some aspect of virtual healthcare, but only 1 in 5 providers is meeting that need.

Access to healthcare is underpinned in large part on a health consumer’s access to information about available health care services, their location, price, and if the patient is very fortunate to glean, quality. As people take on more responsibility for managing their health care utilization and financing in America, their access to information that is easy-to-find, clear, comprehensive and current is critical to personal and public health outcomes. But consumers are dissatisfied with the state of health care information in their lives, discovered through a survey supported by Robert Wood Johnson Foundation and Oliver Wyman, and conducted by the Altarum Institute. Results of this study were published in the report, Right Place, Right Time: Health Information and Vulnerable Populations. Oliver Wyman featured these findings in a conversation held at the World Economic Forum in Davos week titled, Vulnerable Populations and the Great Health Divide. The study’s top-line insight was that vulnerable US health citizens are health information-compromised. This group of people tends to be uninsured, Spanish-speaking, caregiving, and enrolled in Medicaid. The lack of health/care information access jeopardizes care access and quality, putting people at-risk for worse health outcomes, eventual higher costs, and greater burden of disease compared with people who enjoy health information access. Health consumers want financial transparency; simpler, direct language; mobile-friendly formats; and, respect. This is a lightbulb moment finding in the survey; see the Hot Points, below. The study’s key findings were that: Consumers demand cost information and mobile-friendly websites Consumers seek improvements to information about cost of care, accessibility, and comparisons Caregivers use the most health care information but struggle to find resources to help themselves Uninsured people have greater difficulty accessing health care information Spanish speaking people struggle with language barriers, and rely on friends and family to offer advice and remedies Patients who feel disrespected by providers are less likely to trust health care information or follow medical advice. For the poll, Altarum Institute interviewed 4,068 consumers via a mail and web survey, and conducted interviews and focus groups with 65 consumers. Research was fielded between June and August 2016. Health Populi’s Hot Points:  The role of respect in the relationship between patient-consumer and provider cannot be underestimated, based on the clinical evidence found in this study. Specifically: feeling disrespected was linked to medication non-adherence. Thirty-two percent of people without health insurance feel disrespected, this study found. People who are sicker tend to feel less respected, as well as those with lower incomes. The Rodney Dangerfield feeling of “can’t get respect” leads to health consumers being three times less likely to trust information provided by their doctors. Furthermore, patients who feel disrespected by providers are twice as likely to be non-adherent to medication regimens. For example, people with diabetes (PWD) who do not feel respected are one-third more likely to have poorly-controlled diabetes compared with PWDs who feel respect from their providers.  User-centered design is mandatory for the health information economy. Health information portals are poorly utilized because they lack good design informed by patients’ values, digital literacy, and life-flows. Empathy is part of this ethos. The report notes that, “Good patient-provider relationships are not just part of good bedside manner…positive patient-provider relationships should be considered a medical priority, and should be encouraged through training, education and, potentially, compensation changes.” Throughout the health/care ecosystem, as we work to incorporate health in all policies and cultures of health, we must be mindful that empathy, caring, and respect are key ingredients in user-centered design. Check out the approach of Dignity Health’s #hellohumankindness as an example of branding and delivering on empathy in healthcare. This post originally appeared on Health Populi.

Most medical things exhibited at CES 2017 are connected devices with apps that collect, analyze, and feedback data and information to users (patients, consumers, caregivers) and health/care providers (physicians, nurses, care coaches, and others who support people in self-care). While the Internet of Things is generally thought to cover more generic stuff for smart and connected homes, network-connected health and medical technologies are also part of the larger IoT phenomenon. And like health and medical “things” exhibited at #CES2017, other consumer electronics that people will purchase this year ongoing will be connected to the Internet, from refrigerators to cars, to TVs and hearing aids. Among the most popular connected devices during the 2016 holiday season was Amazon’s Alexa, providing voice-assistant technology in the home: Amazon shoppers bought more Alexa devices than ever in the 2016 holiday season. Alexa’s base technology can be used for healthcare at home, which was demonstrated by Orbita at the recent Connected Health Conference in December 2016. The company showed voice-activated home health capabilities such as medication adherence, pain management, patient monitoring, and caregiver coordination. This is an early example of home health through home tech assistants, of which Amazon’s Jeff Bezos waxed, “I think health care is going to be one of those industries that is elevated and made better by machine learning and artificial intelligence. And I actually think Echo and Elena do have a role to play in that.” Boston Children’s Hospital is a pioneering healthcare provider, implementing Alexa in KidsMD, which uses the device to support parents caregiving for their kids’ healthcare. As the Internet of Things takes hold in all aspects of consumer technology adoption, another phenomenon may also simultaneously occur: the Insecurity of Things, coined by Accenture in advance of #CES2017. The Insecurity of Things, Accenture’s John Curran explained to VentureBeat last week, is the challenge that consumers won’t universally trust IoT connected devices until the ongoing security issues around them are resolved. Health Populi’s Hot Points: I addressed the privacy and security issues of connected health data in my recent paper published by the California HealthCare Foundation, Here’s Looking At You: How Personal Health Information Is Being Tracked And Used. Most consumers are unaware of what’s in the fine print in mobile health opt-in notices, but if people buy a new wearable tech or download an app they’re keen to use, most click through the privacy policy without really knowing what’s gonig to happen to their data. That information can end up in third party data brokers’ data mines that can be mashed up into consumer profiles and sold to any number of organizations who might benefit from getting up-close-and-personal (albeit, in the dark shadows) with consumers; say, mortgage brokers evaluating loans for home buyers, or employers considering job applications for prospective employees. That’s the privacy aspect of data shared, unwittingly, by health consumers whose diagnosis of, perhaps, depression, or active use of a food-tracking app that documents one’s personal obsession with Twinkies. From privacy in IoT for health and medicine, we can then consider security. The US Department of Homeland Security published the report, Strategic Principles for Securing the Internet of Things (IoT), in November 2016. The report talked about the growing ubiquity of network-connected devices, from fitness trackers and pacemakers to cars and home thermostats. Cybersecurity has gained more attention in the age of connected health and the Internet of Healthy Things, the phenomenon discussed by Dr. Joseph Kvedar in his book of the same name. The Homeland Security report mentions the Food and Drug Administration draft guidance on Postmarket Management of Cybersecurity in Medical Devices discussed in a recent blog on the FDA website here. A Healthcare IT News survey out this week found that the No.1 health IT challenge hospital IT execs cite for 2017 is data security (52 percent), followed by analytics; patient engagement and population health tied for third place. Electronic health records took the fourth position, indicating that now that most healthcare providers have patients’ records digitized, they’re now ready to mash them up and analyze them to manage  population health, prevent readmissions, and personalize services for increasingly demanding consumers. But that data, first, must be secured to prevent cyber-attacks, malware, and personal health data theft. Trust is a precursor to health engagement: patients engage with healthcare stakeholders who earn that trust and authenticity which drives patient satisfaction. Data security in health care is now a patient engagement issue in the growing telehealth and health IoT era. I’ll be asking digital health companies about privacy and security issues all week here at #CES2017.