Jane Sarasohn

Many health citizens in the U.S. would likely skip receiving preventive health care services if the Affordable Care Act’s (ACA) coverage for them goes away, a Morning Consult survey found.                   The first chart illustrates the top-line of this research: that most U.S. adults would not pay out of pocket for several preventive services including tobacco cessation, drug use screening, weight loss measures to prevent obesity-related illnesses, as well as screening for depression or HIV. One of the key benefits embedded in the ACA was “free” without co-pay shares for  preventive care. These addressed four broad categories of services for adults and children covering screening and counseling (e.g.,  depression, diabetes, obesity, various cancers, and sexually transmitted infections) as well as prenatal tests, medications that can help prevent HIV, breast cancer, and heart disease, as well as counseling for drug and tobacco use, healthy eating, and other common health concerns. Routine immunizations have also been covered (updated for COVID-19). In addition, preventive services for women are part of ACA prevention list such as well-woman visits, all FDA-approved, -granted, or -cleared contraceptives and related services, and other female-focused care. It’s a lot — and has made a huge difference in public health access for those enrolled in ACA plans. Morning Consult polled 2,199 U.S. adults in late January 2023 to understand how American health consumers felt about paying for health care — in particular, the preventive care services that were embedded in the original Affordable Care Act (ACA), currently on the Texas Supreme Court docket of Judge Reed O’Connor. (If you want to learn more details on the case, it’s formally filed as Braidwood Management Inc. v. Becerra). Judge O’Connor had ruled that the ACA was unconstitutional over four years ago — overturned by the Supreme Court. In September 2022, Judge O’Connor ruled it unconstitutional for the ACA to require health plans to cover preventive services.                 Health Populi’s Hot Points: By late January, one-in-two U.S. adults said they had delayed or skipped medical care due to cost — including preventive services. This included 54% of those earning under $50,000 a year, 50% of people earning between $50K and $100,000, and 38% of those earning over $100,000 a year. People value preventive care, but if they have to cover these services out of their own pockets, the services compete with other household spending that, in the current economic climate, crowds out preventive care for many households.                   Check out the health care services Americans say are the most important for commercial health insurance plans to cover. First comes emergency services, followed by prescription drugs, hospital inpatient care, and then preventive services and chronic disease management followed by mental health and substance use disorder services. Celebrating International Women’s Day today for 2023, we are joining the theme #EmbraceEquity.                   Women’s health care and health rights around the world have been eroded, especially in the wake of the pandemic as well as structural blocks to care (say, in the U.S. Post-Dobbs era of women’s health access challenges). “A woman’s health is her capital and her body hears everything her mind says.” This is one of the mantras for #IWD2023. Health care access and equity cannot be separated from women’s overall well-being – mind, body, spirit, financial. We still have such a long way to go to achieving equity for women across all of these pillars. Let’s continue to collaborate together to advance and #EmbraceEquity this year and ongoing.        

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The challenging financial climate at the start of 2023 is impacting how people, globally, are perceiving, managing, and spending money on health and well-being, based on the latest (Wave 21) Global Consumer Barometer survey conducted by Toluna, a sister company of Harris Interactive.               Globally, one-third of health citizens the world over are confronting greater stress levels due to the higher cost of living in their daily lives. One in two people say that rising cost of living is negatively impacting their health and well-being. On the positive side, one in three people believe they will be more satisfied with their personal health and well-being by the end of the year — and as health consumers, expect to spend more money on healthcare, vitamins and supplements, and personal care and hygiene. I asked Lucia Juliano, who discussed the global findings in a webinar in February, if she could share U.S.-specific data with me for the Health Populi blog and my upcoming talks about health consumers at SXSW and the Virgin Pulse Summit happening in the next month. Lucia with her team including Esther Ward, and Ian Smith generously put together a special data cut for us to consider, key points of which I share with you here in this Health Populi post.             The green-bar chart shows us the U.S. data responding to the question of how the financial climate is re-shaping Americans’ health across physical and behavioral aspects. Stress is the most common impact shared by U.S. health consumers, followed by eating less healthfully and buying less health-supportive products such as vitamins and supplements. Looking forward to the next few months, 27% of U.S. consumers expect to spend more on health care as well as personal care and hygiene, 24% of folks more on vitamins and minerals to support health as well as 24% on medications and health insurance coverage.             Roughly one-half of U.S. consumers will spend about the same on personal care and hygiene, VMS, meds, and health plans. Several other granular points to note about U.S. consumers in light of the current fiscal challenges households face: 1 in 2 Americans say the rising cost of living is impacting their health and wellbeing 21% expect to spend more on fitness, sports and exercise 25% expect to spend more on vitamins, minerals and other items to support personal health 25% expect to spend more on health care services 23% expect to spend more on medications 24% expect to spend more on personal care, toiletries and hygiene products 22% expect to spend more on health insurance, and, 30% of U.S. health citizens are looking for more cost-effective solutions for health, wellness and fitness. The Barometer’s findings bolster our ongoing appreciation for consumers linking their financial fiscal lives and livelihoods to their physical lives and well-being, continuing to morph people into health consumers.                         Health Populi’s Hot Points:  “In 2023, inflation will influence most consumers’ purchasing decisions — and purchases of food, fuel utilities, healthcare services, and more will undergo greater scrutiny,” the 2022 Consumer Survey from Access One observed. Note that at least one-half of consumers across generations, from Gen Z to Boomers, were likely to delay healthcare expenses in 2023. Furthermore, across incomes, it’s 1 in 2 people expecting to delay healthcare expenses in 2023, ranging from 48% of people earning $100,000 or more a year to 58% of folks earning between $50K and $100K annually. In the U.S., and the larger world, health citizens are all health care consumers now.

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Joke if you must about Big Game cuisine being typically packed with calories and fat and carbs….and as such, not-so-great for health. For me, the ads are the attraction during The Big Game (along with the Philadelphia Eagles). In this year’s ad line-up, health will be featured in high-priced spots as it has for the past few years. Last year, I was intrigued by a female-focused 30-second spot from Hologic, educating viewers on cervical cancer, discussed here in Health Populi.         This year, my eyes are on Bayer Aspirin’s campaign “encouraging sports fans to keep their heart in the game” as the “Official Sponsor of Fans’ Hearts.” This campaign is incredibly well-timed given that the rate of heart disease in the US has been increasing in the past few years after improving for decades. Heart disease remains the leading cause of death in America, accounting for one in every five deaths.                 Bayer offers four recommendations for heart health self-care: Eat Right, packing a daily diet with fiber and low in saturated and trans fats. Stay Active, with the goal of getting at least 30 minutes of physical activity a few days a week – especially doing things you like to bolster fun and engagement (my go-to source on this is University of Michigan’s expert Michelle Segar of Don’t Sweat and The Joy Choice fame) Don’t Smoke – because smoking is a major risk factor for ill health for the heart and beyond; and, Reduce stress, because it damages linings of blood vessels and can lead to inflammation that is a risk for fat and cholesterol building up in your arteries. So why a cardiac health education campaign during the Big Game LVII? Last year, the Big Game had over 208 million viewers watching Game #LVI. according to Nielsen’s estimate including home viewers along with folks watching in bars and restaurants. That’s a lot of eyeballs and pairs of ears to watch and learn about heart health. Bayer’s press release said that focusing on digital live sports, “capitalizes on the community of sports to empower fans with the accessible tools they need to keep their hearts in the game.” Check out the Bayer Aspirin video here that you’ll see sometime during Super Bowl LVII (oh, and GO EAGLES!).                         Health Populi’s Hot Points:   Self-care isn’t selfish, the American Heart Association reminds us. There are many things we can do to lessen stress and take care of our hearts, some shown in the infographic from AHA. These are evidence-based tactics that are free or inexpensive. While caring for pets isn’t cheap or free, our fur family (and other non-furry animal friends) can generate mental and physical health benefits. Caaring for pets — like walking your dog, which has lots of proof-points for healthy aging, for example — is a wonderfully engaging health-promoting activity, for mind, body, and spirit. To further empower us on caring for our hearts, just-in-time on Valentine’s Day next week, a new book from Dr. John Whyte will be available titled Take Control of Your Heart Disease Risk.  Dr. Whyte is Chief Medical Officer at WebMD and a passionate advocate of self-care based on evidence-based approaches. His book is based on the fact that most heart disease is rooted in peoples’ lifestyle choices, so people have the power to shape their heart-health futures. In terms of the consumer-facing heart-health ecosystem, in addition to Bayer’s 4 to-do’s listed above, there’s another DIY aspect to health care in our DIY ecosystem: monitoring blood pressure. Knowing one’s numbers can be a powerful, empowering thing. And today’s consumer-facing blood pressure monitors aren’t your grandfather’s. They are increasingly digital and app-ified, helping you keep track without remembering in your head or meaning to write your readings down (but forgetting to). I’ve been tracking the evolution of this digital health technology for over a decade: a good example of that trajectory of digital heart tech for consumers comes from OMRON whose Connect app (which syncs with every one of the company’s connected BP monitors) recently garnered a TWICE Picks Award for best digital health service at CES 2023. I’m especially keen to see how the app’s “Community Features” will roll out later in 2023 which will allow OMRON Connect app users to join up, share experiences, and support each other. (Remember: health is social, and we can go farther, together). Having had a father who managed heart health risks his whole life until he succumbed to heart failure at 86 years of age, I personally witnessed how those lifestyle decisions shaped his longevity and well-being. He was that role model for me, and so in the past several years, I’ve been monitoring my blood pressure pretty religiously. Doing so is a daily reminder for self-care and as AHA reminds us, not selfish at all. You do it as much for the people you love as for yourself. Happy Big Game. Happy Valentine’s Day. Happy, Healthy You. (Oh, and did I say, “Go Eagles?!!”).

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Life expectancy in the U.S. dropped nearly three years between 2019 and 2021, from close to 79 years down to 76. We ended 2022 with this new, sobering statistic from the Centers tor Disease Control (CDC). We begin 2023 with the opening of CES 2023, the world’s largest annual meet-up of consumer electronics innovators, companies, and retailers. How can digital health and other consumer-facing technologies help our health? First, consider the stark data point(s), and then we can better respond to the question’s answer in the Hot Points, below.                 In case you missed it in your pre-holiday wind-down, the CDC published two reports on declining life expectancy in America on December 22, 2022. Here are links to those two reports: Mortality in the United States, 2021, and Drug Overdose Deaths in the United States, 20021-2021. “The drop [in life expectancy] was primarily due to increases in COVID-19 and drug overdose deaths,” the CDC summarized in the reports’ release. This is the largest fall in U.S. life expectancy in a two-year period since the early 1920s during that era’s dramatic economic shock/decline. This time around, national news media are covering Americans’ shortening life-span with headlines like, “U.S. Life Expectancy Falls Again in ‘Historic’ Setback,” as covered in The New York Times “American life expectancy is now at its lowest in nearly two decades,” via NPR, and “Covid-19 and drug overdoses drive US life expectancy to lowest level in 25 years, CDC reports,” in CNN.           As to CNN’s headlining those drug overdose deaths reducing Americans’ life-years, this line chart from CDC’s report tells us which drugs are especially responsible: the fast-growth line is for synthetic opioids (read: fentanyl). For important insights into this devastating risk-trend, read this Washington Post coverage published just a few days before the CDC reports came out.             One last comparative point to keep in mind: the U.S. is an outlier in the relatively large statistical drop in life-span compared with other nations, even accounting for COVID-19 impacts on populations by country. As this chart from Kaiser Family Foundation and the Peterson Center’s Health System Tracker clearly illustrates, health citizens in the U.S. marked the lowest life expectancy and by far the greatest health spending per person than any other wealthy country tracked in the list of wealthy countries. Doing the simple math, that’s over six years fewer life-years for an American health citizen with roughly twice the health care spending.                 Health Populi’s Hot Points:  N0w to the question at-hand for the week: can consumer-facing technologies help us bolster our health and well-being and — Holy Grail time — reverse the U.S. decline in life expectancy? Check out the top causes of mortality in 2021: the death rates for heart disease significantly rose from 2020 to 2021, as did the rates of death due to unintentional injuries (those so-called Deaths of Despair from overdose, suicide, and accidents), and to be sure, COVID-19. At CES 2023, we’ll see innovations for consumers to help deal with heart health, from prevention to tracking to avoiding stroke — from the likes of AliveCor, Fitbit, OMRON, and Withings, among many others. Inf act, heart health is table-stakes for much of wearable technology in 2023. The American College of Cardiology collaborated with the Consumer Technology Association at CES 2020, so this category has been evolving for some years. How about those Deaths of Despair? How can technology help us address addiction, loneliness, and other contributors to this seemingly intractable challenge for U.S. public and personal health? We cannot expect Technology itself to be a panacea to this national tragedy that public policies must help solve in terms of underlying drivers of health and well-being. But there are technology innovations that can help people deal with addiction through, for example, digital therapeutic solutions . For mental health — particularly, low-to-mid-level anxiety and depression — there are cognitive behavioral therapy apps and tools that have been shown to be useful for many patients backed by clinical evidence. At CES 2023, we will also see alcohol-sensing technologies, automotive safety features, and solutions for people dealing with pain, among other pioneering devices and features embedded in products focused on healthy living and smarter, safer homes and mobility. Bolstering the impact of digital health technologies — and particularly remote health monitoring and clinically-prescribed wearable tech — was the late December 2922 health policy news that telehealth provisions would be included in the FY2023 Omnibus Appropriations Bill. Specifically, there is a two-year extension of Medicare telehealth services that began in the early coronavirus era in 2020. These will now be in place until the end of 2024. To put a fine point answering our question, there is evidence that technology can enable and scale programs and services that channel drivers of health to people when designed with intention, value- and values-orientation, and privacy-by-design. This is front-of-mind for me this week as I explore the myriad announcements and innovations emerging from CES 2023 — in and outside of the digital health tent.

The post Can Consumer Electronics Help Stem the Decline of U.S. Life-Years? A Preface for #CES2023 appeared first on HealthPopuli.com.

While CTA forecasts a sobering consumer technology revenue picture for 2023, one of the few bright spots is health and fitness technology services, expected to increase by 9 percent in 2023.             For the forecast, CTA looked at various spending categories, including gaming, automotive and transportation tech, video and audio streaming, consumer electronics (like big-screen TVs), and fitness and health devices. The chart illustrates that consumers’ spending on software and services is expected to hold steady in 2023, still above pre-pandemic levels.             On 3 January, in the annual #CES update of Technology Trends to Watch, Steve Koenig, CTA’s VP of Research, reviewed the major themes with media and industry analyst folks (of which Health Populi is one). In 2023, Steve advised us to keep our eyes on six key trends: Enterprise tech Metaverse and Web 3.0 (which is “closer than we think,” Steve advised) Transportation and mobility Health technology Sustainability, and, Gaming and services. Health and drivers of wellbeing cross these six trends, and the plethora of services quantified in the on-demand segmentation revealed in the first chart.                   Consider our basic human needs, organized in my take on Maslow’s Hierarchy (with Wi-Fi). Take the most popular on-demand service in CTA’s research, grocery delivery. This was a literal life-saver for many people living at/working from/learning from/cooking at home during the pandemic, during and after lockdown phases, depending on where you lived and what your risk-tolerance was for being out-and-about. Sourcing food is at the base of our basic needs, and it appears that peoples’ demand for grocery delivery services is a changed behavior for over one-half of U.S. consumers post-pandemic. Food delivery follows this pattern as well for those folks who don’t want to scratch-cook. Next think about e-commerce: so many health consumers and patients depended on delivery of prescription drugs, over-the-counter medicines, supplements, and durable medical supplies to self-care at home. More consumers purchased digital health apps and home monitoring technology, as well, especially from Amazon and Best Buy which persisted in health-tech commerce and weathered economic challenges to-date. Finally cast your eyes to the health/wellness/fitness line item in the chart: 4 in 10 consumers were using on-demand health services (read: telehealth, virtual care, tele-therapy) more after the pandemic.                     Steve identified three segments of the new “home health hub” (a concept I detailed in my 2020 book, Health Citizenship): Telehealth, including remote monitoring as well as “access to doctors,” in his words Digital therapeutics, “new ways to manage health conditions;” and, Fitness tech. covering connected exercise and sports equipment building out the home gym experience. As examples at #CES2023, Steve talked about Essence Group’s Care@Home remote patient monitoring solution (which includes fall detection, a key application for safe aging at home), Abbott’s Proclaim Plus connected health device for spinal cord stimulation, and SK’s Zero Glasses for tracking neurological health (e.g., seizures), the latter two 2023 CES innovation honorees and Care@Home honored by CES in 2022. Three “new frontiers” in health-tech innovation were also covered — including on-demand networks (a la virtual care and online pharmacies), mental well-being (for stress relief, anxiety management, and depression monitoring), and virtual reality (VR, ranging from fitness to prescribed, evidence-based therapeutic treatments to address, say, pain and PTSD). Speaking of VR…Steve concluded the trends summary with a discussion on gaming and services, calling out a relatively bullish projection on consumer spending for services versus hardware. And what segments fall within that software and service category? Fitness and digital therapeutics, holding firm in consumers’ spending for 2023. Read more on what we’re seeing at #CES2023 here.

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As we enter the week’s brainstorms and deal-making prospects this week at the annual JP Morgan meet-up for healthcare, I’m kicking off Health Populi’s posts this week by diving into two major reports published in sync with this meeting that’s so pivotal and important for the digital health community: the Silicon Valley Bank (SVB) 2022 Annual Report on Healthcare Investments and Exits and the 2022 Global State of Digital Health Report from FINN Partners and Galen Growth               SVB notes that venture funding in healthcare fell in terms of both deals and dollars each quarter of 2022 after hitting records in 2021. Yet even with that downturn, 2-022 was the 2nd largest funding year ever, SVB quantified, with significant shifts by healthcare segment. The report looks into: Biopharma (declining but valuations “unaffected by public market turmoil”) Healthtech (shifting toward early-stage investment with mental health and primary care dominating the category) Dx/Tools, where early-stage investment set records in 2022 notwithstanding declines for some of the sub-categories (R&D tools investments especially), and Devices, the only one of the four sectors to match, relatively, record investments in 2021.               The bar chart illustrates SVB’s data for the four healthcare sectors by region and years 2020, 2021 and 2022. We can clearly see the lower bars throughout four quarters of 2020 quite similar to those in the latter 3 quarters of 2022 with the bullish funding for healthcare in 2021 and the first quarter of 2022. By region, in the table below the bar chart, see that the US funding level for healthcare in 2022 was nearly five-fold that in the EU and UK. The smallest difference in funding levels was in the healthtech category, where EU + UK dollars differed by 3X versus the biggest delta seen in biopharma and Dx/Tools.                     SVB also points out that investors are shifting their focus to address provider efficiencies and virtual care models, identifying notable 2022 deals such as TEMPUS, Commune, and Aledade on the provider side, and Lyra, Ro, Doctolib, on the alternative care side of funding. (See my post on Doctolib in Italy here from 15th December 2022). This third graphic (two charts in one) on changes in venture funding comes from the FINN + Galen Growth research. First, check out the top portion on funding by therapeutic area: note the blue bars all show declining funding across five therapeutic areas between 2021 and 2022 following go-go growth from 2020 to 2021. Specifically, oncology was down 32%, cardiovascular declining by 27%, mental health falling 49%, neurology by 51%, and gastroenterology by 33%.               We learned from a recent report via GSR Ventures that gathering supporting clinical evidence for digital health innovation will be key to funding in 2023 and future years. The FINN + Galen Growth analysis quantifies regulatory filings by digital health clusters and evidence “signals” for each area. In the bar chart, we see that medical diagnostics, patient solutions, and remote device ventures had the strongest evidence signals compared with other digital health clusters — noting that telemedicine and population health, two major areas of digital health activity, yielded relatively low evidence signals in this assessment.               Health Populi’s Hot Points:  “After an extraordinary two-year pandemic funding spree, there are apparent shifts in how investors place their economic bets,” the FINN + Galen Growth report observes. In light of the global economy and the lessons we must all learn from the pandemic and relatively poor ROI on the digital health investments made in that “funding spree,” the FINN/Galen Growth tea leaves read the next investment factors for 2023 will be more tightly focused on the innovation’s development stage, the specific therapeutic category served, the health care providers’ demand for digital transformation, and “where” the innovators are located.       With these factors in mind, stay tuned for my post to be published tomorrow, on 10 January 2023, which will dive into CES 2023’s theme of Human Security For All (HS4A). Clearly, health, medical care, and drivers of health underpin HS4A which then begs the question: how will #JPM2023 and the upcoming HIMSS2023, SXSW2023, VIVE2023, the ATA2023, and other health-tech conferences address gaps in health equity, healthcare access. and health justice for all health citizens? That’s my 2023 work-theme for the New Year.

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I am grateful to have been given the opportunity to brainstorm omnichannel health care for people to enable better health care for all, anywhere and everywhere, with Team Microsoft. Key opinion leader Molly McCarthy and I covered a lot of ground in this webcast conversation as part of Microsoft’s series of three “Expert  perspectives on trends driving change in healthcare.”             Molly and I covered a lot of ground here, starting with the key forces shaping and accelerating virtual care across the continuum. While these were in place before the COVID-19 pandemic, the public health crisis turbocharged telehealth and its many flavors from real-time clinical encounters to HIPAA-compliant secure messaging “asynchronously” as well as plain-old text messaging which can be a preferred communications channel for many patients — especially those who may lake access to predictable, quality broadband connectivity.               That led us to a discussion on the determinants of health and basic human needs — now with Wi-Fi akin to clean air, clean water, food, and shelter for survival. We learned this lesson during the pandemic quite clearly — connectivity as a social determinant of health. Molly and I then segued into how the health system incumbent players — hospitals, plans, clinicians, and life science companies — can (and should be) part of the telehealth ecosystem and solutions to deliver care, everywhere. In addition to my discussion with Molly, you should also listen to two insightful colleagues’ conversations in the series, with: Dr. Bonnie Clipper, Founder and CEO of Innovation Advantage, sharing learnings on high-tech and high-touch in nursing; and, Gil Bashe, Chair of Global Health and Purpose at FINN Partners, discussing the growing importance of connected data in health care – think AI, machine learning, and the criticality of breaking down siloes of information. Thanks to Microsoft for its leadership in enabling better healthcare, everywhere.

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The pandemic worsened food insecurity for many people in the U.S., putting more people at risk for not only hunger but for chronic diseases that can be managed with access to nutritious, fresh food. In Helping SNAP Consumers During Economic Headwinds from Numerator, we get a current read on food security, the SNAP program, and the challenges of chronic health management that are intimately tied. To set some context on this current challenge to peoples’ health, the U.S. is facing the official end of the pandemic emergency on May 11, 2023. At that point, support for government-sponsored programs that have supported American health citizens’ well-being since the emergency of COVID-19. This included expansion of SNAP and nutrition benefits, among many other services. Exacerbating food insecurity in America, note that food price inflation rose 9.5% in February 2023 versus February 2022; prices will increase by 7.9% in 2023, the U.S. Department of Agriculture expects. People living in low-income households are facing growing stress and insecurity when it comes to food, resulting in a “hunger cliff.” It’s a “cliff,” explained Ellen Vollinger of the Food Research and Action Center, “because this is a very abrupt change in what people are going to have in their food budget,” affecting millions of people in the U.S.             With these data points in mind, we can dig into Numerator’s look into SNAP consumers’ home economics. The first chart shown here from the report profiles enrollees in SNAP programs, the Supplementary Nutrition Assistance Program which is part of the USDA. Numerator, a consumer market research company, profiled SNAP recipients at the end of 2022, finding that 61% of the enrollees were in the bottom 30th percentile of income in America. Nearly one in two SNAP households had children versus 28% of non-SNAP homes. And SNAP households were twice as likely to be Black/African-American or Hispanic/Latino in their race/ethnicity compared with non-SNAP households.             This study looked into the “headwinds” facing SNAP consumers’ home economics, recognizing that the COVID-19 stimulus funds helped to buoy food-insecure householders for many months However, as these funds ran down and out, the inflationary era kicked in the U.S. economy. SNAP households are now more likely to be “overwhelmed” with financial burdens, Numerator observed. These folks heavily over-index with being struggling households, the study found, compared with other U.S. families. One in four are unable to buy enough food to feed their family, and most have low confidence in the economy improving in the next three months. There are four themes for SNAP benefits and enrollees in 2023, explained in the second chart here: brands will need to understand how SNAP recipients are adjusting their shopping baskets, looking for value and lower prices; SNAP consumers are buying more private label products (which are lower-priced); health and wellness are key to SNAP recipients purchasing behaviors, challenged by time constraints in their daily lives; and, brands need to segment consumers looking, in part, at their occupations — heavily indexed toward healthcare and homecare, housekeeping, childcare/daycare, transportation, and other work categories.           Keep in mind these occupational types when considering SNAP enrollees health and wellness goals and challenges. These people are nearly 4 times as likely to be disabled than consumers not enrolled in SNAP benefits: these conditions include respiratory health (COPD, asthma and bronchitis), back pain, and migraines, among other issues. We know folks dealing with one social determinant risk tend to have more than one risk, and in this instance it’s a greater burden of heath expenses over the course of a year. =           These chronic condition management challenges are worsened, risk-wise, due to the fact that SNAP enrollees tend to be time-challenged, and of course, financially insecure as well as food-insecure. Fifty0six percent of these consumers are less likely to not be actively managing their health. One factor Numerator identified that may constrain peoples’ ability to self-care is that SNAP recipients are time-strapped as they are two times more likely to be a caregiver for over 9 hours a week. One in three SNAP enrollees shops at least twice a week as a caregiver, and one-third have the person they care for living in their home (1.2x more likely than non-SNAP recipients).           Health Populi’s Hot Points: “Supply and demand for basic human needs has severe implications,” a brief co-sponsored by Quest Diagnostics and Pack Health calls out. “Just eat healthier” implores the essay on why diet improvement as a chronic condition management strategy has not been effective for people experiencing food insecurity. The pandemic exacerbated peoples’ food insecurity in the U.S., with demand far outstripped the supply of food provided at food banks. And food insecurity raises peoples’ risks for chronic conditions, the straight-line graph illustrates as a direct correlation. As Pack Health and Quest note, “the lack of resources isn’t just about the food itself. Those who are food insecure are also more likely to be affected by other social determinants that contribute to worsened health outcomes.” To address the food security risk for chronic health conditions, Pack Health couples grocery and meal delivery services with nutrition education and digital coaching. Think: telehealth meats meals-on-wheels meets nutrition education.  

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As our homes and health care services continue to converge, we can see signposts of direct-to-consumer strategies from the pillbox (where DTC is a mature thing) to clinical care in peoples’ hands (and on their preferred technology platforms). Some examples this week make this point, which taken together demonstrate the portfolio of ways more people – as health consumers and caregivers – can engage in their health, well-being, and clinical care.             Start with Best Buy’s announcement that they will collaborate with the health system Atrium Health to bolster hospital-to-home effectiveness and activation between hospitals and patients. You know Best Buy for its consumer electronic retail chops, starting up Best Buy Health several years ago as a key pillar for the company’s strategic long term plans. Enter Atrium Health into this mix: the hospital system has had a successful entry into hospital-at-home care, and with Best Buy as partner, will grow the consumer-digital-health front-end capabilities through a trusted retail brand’s Geek Squad expertise. I can’t say it better than Deborah Di Sanzo, President of Best Buy Health, did in the press release: “We knew Atrium Health was the right partner to help tackle the unique challenges within the care at home experience,” said Deborah Di Sanzo, president of Best Buy Health. “We’re excited to leverage our expertise in omnichannel, supply chain, Caring Center support and services, in-home support and our ability to connect patients and providers through Current Health’s care at home platform. Those strengths, combined with Atrium Health’s extensive clinical expertise and deep experience leading in virtual care, will help us improve and enable care in the home for everyone.” Now ad in prescription drugs which is the mature category of DTC in healthcare —  a unique aspect of American medicine as the only country in the world, except for New Zealand, which permits direct-to-consumer pharmaceutical advertising. This week, Teva Pharmaceuticals launched a campaign focused on caregivers — who are among the largest unpaid workforce collectives in the U.S. (For more on this economic and personal challenge, see the good work of ARCHANGELS, led by Alexandra Drane). As actor John Rhys-Davies (whom you have loved in Indiana Jones and Lord of the Rings franchises) attests, “Love doesn’t take a break” when you’re a caregiver. Rhys-Davies knows this so well, speaking out of his experience in caring for his wife until she succumbed to Alzheimer’s disease in 2010. Here, Teva collaborated with the agency VCCP London to raise our awareness of and appreciation for caregivers….baking in the empathy and personal story of Rhys-Davies. Well done, Teva.             On a different self-care front, check out this week’s news that WW (once known as Weight Watchers) acquired Sequence (aka Weekend Health). This acquisition grows WW’s telehealth capabilities, as Sequence built a subscription virtual care platform serving chronic weight management, including the use of GLP-1 prescription drugs. The platform enables patients and clinicians to collaborate in ongoing care and communication to support the long journey of behavior change. As of February 2023, Sequence was serving about 24,000 consumers. There’s more on Sequence here. A concurrent news story in the weight management space is the fast-growing prescribing by clinicians and adopting by consumers of drugs in the weight-loss category, the GLP-1 agonists. If you watch TV or stream radio, there’s no doubt you’ve heard some of the DTC ads for drugs in this group such as Rybelsus, Ozempic and Trulicity (currently three of the top ten DTC Rx spends). Weight-loss has been a top-self-care area for health consumers since the beginning of time, so watch this space closely. (Here’s a salient essay on the “bizarre Americanness” of DTC Rx spending from Vox if you want to know more).                   Add into this mix CHPA’s launch of the Health in Hand app, enabling consumers to access a trustworthy resource for comparing over-the-counter medicines, vitamins and supplements, and digital health devices. Supported by the Consumer Healthcare Products Association CHPA Educational Foundation, HealthinHand.org is designed for greater personalization, including new sections on My Self-Care and Healthy Living. There is updated support for people to hone in on specific diet/food styles, stage of life, and lifestyle choices.                     Health Populi’s Hot Points:  These are but four examples, in real-time, of the evolving home and self-care phenomenon accelerating in U.S. health care. There are many drivers accelerating this, among them peoples’ growing financial skin-in-the-healthcare game through high-deductibles and more out-of-pocket, more transparent costs borne by families. The current financial stress families feel bolsters peoples’ commitment to more care-in-hand and DIY care flows at home. Furthermore, younger people have shown fast-adoption of digital health techs, and lack of interest in making a permanent commitment to a primary care medical home. As the recent ATA conference chanted, #TelehealthIsHealth for more people, across generations, incomes and ethnic backgrounds. This is a major focus of my work these days in the U.S. and Europe. Keep staying tuned to the Health Populi blog as I continue to grow and learn more in the field on our home as site of care.

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Most consumers are bullish on the benefits that digital health technologies can play in their health. Most health care practitioners are also positive about the potential of digital health — recognizing room for improvement for better data integration, interoperability, and the opportunity to bridge gaps to achieve health equity and bolster access. So assesses the Consumer Technology Association in the report, Driving Consumer Adoption of Digital Health Solutions,             To paint this profile, CTA engaged Ipsos to poll 1,000 U.S. consumers 18 years and older, 300 health care providers (HCPs), and 12 health tech company stakeholders in August and September 2022. The health tech company leaders were CTA Health Board members including representatives from Abbott, Best Buy, Elevance Health, Google, Humana, Intel, Microsoft, ResMed, Samsung, and Validic, among others. CTA sought to understand the role of digital health applications in U.S. health care from consumers’ perspectives along with the technologies’ influence on HCPs’ workflows.             The first table arrays the growing range of digital health applications that consumers currently use. CTA sizes the market at $29.5 bn in 2022, expecting growth of nearly 7.5% annually to 2027 when the projected market would be over $42 bn. Most U.S. consumers have used telehealth, one in five for at least a year. Satisfaction has been generally high among these virtual care adopters. The most commonly used digital health solutions in 2022 were blood pressure monitors, weight monitoring devices, glucose/diabetes meters, pulse oximeters, sleep apnea monitors, continuous glucose monitors, mobile apps to manage chronic conditions, and personalized medicine applications. The second chart attests that most consumers who have used digital health tech have felt more in control of their health, motivated to take better care of themselves, improved quality of life, and other positive benefits accrued through digital health self-care adoption.             The COVID-19 pandemic accelerated consumers’ greater DIY and self-care adoption: CTA called out three key drivers shown in the third chart which included the need for alternative support due to strained emergency supply; a vested interest in monitoring personal health; and, the need to access medical care from remote locations physically distanced from hospitals and doctors’ offices.                 To that point, then, clinicians/HCPs currently recommend a broad array of digital health solutions, CTA found; these are shown in the fourth chart, with large numbers of providers recommending technologies from blood pressure monitors and diabetes-management tools to medication adherence devices and fall/motion monitors. Note that very few clinicians have “never heard of” any of the digital health tools assessed; the only one of note would be augmented/virtual reality platforms, recommended by 14% of HCPs and “never head of” by 27% of the clinicians.           With these recommendations or digital health “prescriptions” maturing up the S-curve of adoption, clinicians believe digital health solutions can be improved in several ways — through better data integrations and interoperability between the solutions (and the data). Furthermore, clinicians see the potential for digital health tech’s to address and improve health disparities, access and equity in improving personal and public health.             Health Populi’s Hot Points:  Consumers increasingly view health care as a shared work- and life-flow between their HCPs (who are largely trusted — doctors, nurses and pharmacists alike) and themselves — in their hands and in their homes. This last chart here illustrates the devices and consumers currently use or those they are interested in using to help folks manage health. We can see a maturing of adoption for peoples’ use of smartphones (with internet connectivity), computers and laptops, smart TVs, and tablets — all currently used by over 50% of U.S. consumers. There is also emerging consumer demand to use smartspeakers and voice tech (like Alexa), smartwatches, and wearable devices beyond the wrist for health.                         We’ll continue to see the blurring of home (and our bodies and phones) as our health destination. I’ll be brainstorming this with a wonderful panel at South-by-Southwest in Austin on Saturday March 11th at 1 pm at the Line Hotel during Real Chemistry’s Healthcare Innovation Day. Hoping to see those of you attending #SXSW2023 there!  

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The peak of venture investment for digital health was in 2020 and 2021, precipitously declining later in 2022. And the outlook for 2023 is practical and Show-Me: that is, demonstrate clinical outcomes and return-on-investment before “I” (for investors) can take a leap of faith to spend a dollar, a Yen, a Euro, or British pound on a shiny new-new healthcare thing. If it’s January, then CES and JP Morgan convene their influential annual meetings which feature health technology for globally engaged health industry stakeholders — investors, surely, but also providers, innovators, analysts, and insurers.       In my January 2023 column for Medecision. I weave the pragmatic story together based on datapoints from JP Morgan’s 2023 annual healthcare meeting in San Francisco and CES 2023 held in Las Vegas the previous week. Check out the full plotline here on the Medecision blog portal.

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