November 6, 2013
With the amount of money being spent on health care in America — and our general enthusiasm for all things mobile — you’d think there would be a huge and successful market for mobile apps that empower consumers to take control of their health and wellness.
But according to a report by the IMS Institute for Healthcare Informatics, of the 40,000+ health care apps now available for download on the U.S. Apple App Store, over 50% of them get downloaded fewer than 500 times.
The report is based on an analysis of these apps and an assessment of the potential value they provide at various stages of a patient’s journey to better health. The study was conducted in June 2013.
So what’s the problem?
According to the IMS report, the following issues are holding us back.
1. There are just too many apps!
Forty thousand apps are available on the App Store alone — with reports of at least another 60,000 available from other sources. Seriously? How can we possibly sort through them and decide which ones might meet our needs… let alone which ones are any good.
The sheer number of apps available suggests that app developers are well aware that if they can strike the right chord with consumers, the potential rewards are great. But so far, few seem to have found that magic formula.
Maybe developers should try asking consumers what we want. And perhaps they should also do a better job working with health care providers to determine what we need.
The payday developers are seeking — and the results consumers and their health care providers are looking for — might very well lie at that intersection.
2. For all of the health apps out there, just 54% have a legitimate health-related function, and therefore have the potential to help us stay healthy or manage existing conditions.
Of the 43,689 apps identified as falling into either the “health and fitness” or “medical” categories in the IMS study, 20,007 were excluded early on from additional analysis because they were not really related to health care. According to the study, examples of those include apps related to beauty or fashion or “apps that use gimmicks with no real health benefits.”
Of the remaining 23,682 apps, 16,275 were for consumers and 7,407 were for health care professionals. Of those for consumers, the majority focus on diet and exercise.
The analysis further showed that two-thirds of the apps available for consumers simply provide information. Smaller subsets give instructions, capture data entered by consumers or have an alert/reminder feature.
In other words, the majority of apps for consumers simply move general information from websites and/or printed materials to our mobile phones — and do little else.
3. We have no way to tell the good apps from the bad apps.
The report notes that another issue is that consumers have few options for guidance on the quality of the various apps available. While physicians see the potential benefits of these, they are wary of recommending them to their patients. They too need information about which ones are helpful and which ones aren’t.
With so many apps available, it’s a sure bet that many, many of them are not very good. The report quotes Dr. Israel Green-Hopkins of Boston Children’s Hospital, saying “…40,000 apps within any store is the definition of poor design, because you know that 90% of them are terrible designs.”
Other reports show that some doctors have recommended apps as helpful tools for their patients – to track pollen counts in allergy season, brush teeth for the recommended amount of time or resist urges when quitting smoking. But physicians warn that these apps are supplements and not replacements for in-office care, with most of their benefit coming from encouraging good behavior, not actually improving health.
For the apps evaluated in this study, the App Stores’s popularity rankings do provide one small measure, but it is ultimately insufficient.
4. The vast majority of these apps are completely disconnected from the rest of our health care providers and systems.
The report notes that over time, health care apps will mature from being self-selected by consumers or physician-recommended on an ad hoc basis to being used systematically in health care delivery as an integrated component of our system. But they are not there yet.
What’s working now
Still, amidst this mass of underperforming apps, it is interesting to note that just five of the 40,000+ apps in the App Store make up a whopping 15% of all downloads.
One of these, Calorie Counter by MyFitnessPal, was the second most popular app in the App Store at the time this analysis was conducted and is the most popular free calorie counter and fitness tracker on Google Play. What does it do? And why is it breaking through?
Positive reviews of the app suggest that its primary strength is its community aspect, which allows users to share their progress, weight-loss goals and calorie counts with friends via social media channels like Facebook and Twitter.
While this might not be appealing to everyone, it has been a powerful differentiator in a sea of competitors. An attractive and intuitive interface also allows it to stand out from the crowd.
Despite these distinctions, the Calorie Counter app simply counts calories and nothing more! And counting calories alone has not been proven to improve overall health.
Bottom line, developers need to build better apps and consumers need better ways to find the good ones.
And the health care community needs to fully embrace mobile apps and integrate them into our health care system — empowering consumers to take charge of their own health.
In the meantime, if you’re using apps to get fit, it’s all about finding what works for you – whether it’s tweeting your latest weight loss milestone or tracking your speed on your morning jog.
August 9, 2013
Reports from the Wall Street Journal last month indicated that doctors are increasingly opting out of the Medicare program. But new numbers from CMS indicate that doctor’s biggest issue may not lie with Medicare, but instead with Medicaid.
The Wall Street Journal article reported that the number of doctors leaving the Medicare program has risen from 3,700 in 2009 to 9,539 in 2012. We wrote about this issue a few weeks ago.
While more doctors are leaving the program, there are also many more joining it. CMS reported that, “the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.” In just the past year, 30,000 doctors entered Medicare, vastly outweighing the 6,000 that opted out over the past 3 years.
While Medicare payments may continue to be an issue for doctors, Medicare patients remain a vital part of many doctors’ practices. Reid Blackwelder, president-elect of the American Academy of Family Physicians, stated that Medicare patients make up 24% of the patient population for AAFP members.
So Medicare isn’t perfect, reimbursement rates and the annual doc-fix are still a point of contention for doctors, but the importance of Medicare patients keeps the majority of doctors in the program.
Medicaid participation tells a different story.
Reports show that less than 70% of the nation’s doctors accepted Medicaid in 2012. And the numbers aren’t getting any better. In a new Health Affairs Study, it was found that about 33% of primary care physicians didn’t accept new Medicaid patients last year.
Reimbursement rates for Medicaid patients are low; payments for procedures are much higher through private insurance than the same procedure for a Medicaid patient. The Affordable Care Act provides a 30% pay hike to primary care physicians who treat Medicaid patients, but the growing number of Medicaid recipients is also a concern. As many as 16 million Americans are expected to gain coverage through Medicaid in the coming years, and doctors may be faced with more patients than they can manage.
The good news is that the availability of doctors who accept Medicare patients appears to be adequate, and will continue to be so. Instead, perhaps the focus needs to be placed on helping doctors continue to accept, and prepare for the increasing numbers of Medicaid patients.
July 26, 2013
The bigger the organization, the greater the chance they are providing employee benefits. In last week’s Labor Department annual report on employee benefits, both size and ownership impact whether companies provide health care benefits, retirement plans, paid vacation and sick leave.
The study found that in 2012, 88% of private sector companies with 500 workers or more provided their employees with health care benefits. The percentage dropped with workforce size. For companies with 100-499 employees, the number fell to 82%. For companies with 50-99 employees, the number further dropped to 69%. And for the smallest companies, with 1-49 employees, only 53% of workers had access to employer-sponsored benefits. The trend was very similar in the public sector, with 90% of organizations with 500 or more employees providing coverage.
Access to company health care in both the public and private sectors rarely changes by more than one percentage point from year to year. In 2011, 90% of the largest companies provided health care benefits and 53% of the smallest companies provided access. In 2002, 82% of companies with 100 workers or more workers provided health care benefits and 58% of companies with 1-99 workers provided the same benefits. The 2013 report continues a long-standing trend of larger employers providing benefits.
Payroll and hours data were also examined in the report and analysts concluded that the numbers did not indicate any extreme increase in the part time work force. While the part time work force can fluctuate by thousands, its percentage of the total workforce has stayed level, between 18.5%-20%, since 2009.
The Labor Department’s report indicates that trends in employer sponsorship of health care benefits are continuing as they have over the last few years. Benefits continue to depend on the size of the company, and the small bump in the part time workforce may mean more part time workers, but as a percentage of the total workforce, it remains constant.
Read more about the report here:
July 25, 2013
In a new survey from Health Pocket released this week, 65 percent of respondents said they would prefer to choose their own insurance carriers rather than have their employer choose for them. But the majority of Americans don’t have the ability to choose their own insurance company. Sixty-six percent of insured Americans receive coverage through their employer, where health care options are limited to the insurers selected by the company.
Private exchanges emerging into the market today from a number of companies, including Towers Watson, offer the kind of choice that the survey indicates people want. A report by Accenture predicts that private exchanges will surpass enrollment in public exchanges by 2018.
Read the Health Pocket survey here: http://www.healthpocket.com/healthcare-research/surveys/group-health-insurance-plans-americans-prefer-to-choose-provider
July 23, 2013
The UCLA Fielding School of Public Health released a study last week examining the constitutional right to health care in countries around the globe. Although all members of the United Nations acknowledge the universal right to health, the study shows that not all counties include health care as a constitutional right.
The study found that 73 U.N. member countries (38 percent) guaranteed the right to medical care services, while 27 (14 percent) aspired to protect this right in 2011.
But the numbers don’t tell the whole story. Countries with older constitutions often don’t include the right to health care, but such countries often have excellent national health care systems. In contrast, there are counties that have constitutional protections for health care, but have trouble implementing their health care systems on the ground.
There is a clear global trend towards adopting national health care systems. Only 1 of 33 constitutions adopted between 2000 and 2011 did not protect at least one health right. America is following the global trend as the Affordable Care Act moves the country closer to the goal of health care coverage for every United States citizen.
Read more about the study here: http://newsroom.ucla.edu/portal/ucla/a-constitutional-right-to-health-247449.aspx
July 9, 2013
One of the biggest concerns for both the fans and detractors of the Affordable Care Act (ACA) is the participation of young people. The under-30 age group makes up a vital segment of the health care market, and the ACA relies on this group purchasing coverage in order to establish a pool of healthy individuals to keep plans on the public exchanges affordable.
There has been much worry that young people won’t buy coverage at all, and will opt to pay the fine for not having coverage, as opposed to spending more to buy plans on the exchanges. But a new Kaiser poll shows that this might not be the case. The Kaiser Family Foundation’s June Health Tracking Poll found that 77% of adults 18-25 and 71% of adults 26-30 said that having health insurance was “very important.”
Contrary to the assumption that young people see themselves as “invincible,” only about one quarter of people age 18-30 say they were healthy enough to forgo health care coverage.
While a majority of the young people surveyed do display the desire for coverage, they do not necessarily think that it is affordable. Compared to the 71% who think insurance is very important, only 65% of people ages 26-30 say that health coverage is worth the cost. This is the group of young people who have just left their parent’s plans and are looking to purchase coverage independently, although this group may want health care, cost will definitely play into their decision making process.
But it’s not only young people who are concerned about price. Older participants showed similar results when asked if health insurance was worth the cost, with only 68% of respondents in all age groups confirming that health insurance was worth it.
The Kaiser poll focused on age-specific questions, and it is clear that actions surrounding health care and insurance vary based on age. This survey paints a new picture that says young people may be more willing to purchase insurance than previously thought.
Read more about the Kaiser Family Foundation Poll Here: More young adults see health insurance as a necessity
The ADP Annual Health Benefits Report traces trends in eligibility, participation, and premium rates for employer covered health care from 2010 to 2013. The report finds that, as the full implementation of the Affordable Care Act (ACA) approaches, companies have begun restructuring their benefits packages and corporate coverage options. Changes in employer health coverage in recent years may reflect provisions of the ACA.
The report found that employer sponsored health care eligibility and participation rates among full time employees remained relatively steady from 2010 to 2013, with variations primarily based on demographic group. Although gender and marriage accounted for an insignificant percentage of eligibility and participation variations, age reflected more significant changes, possibly influenced by ACA regulation.
Age played an important role for employer health insurance coverage. Both eligibility and participation rates were higher for older workers. Fulltime employees age 50-59 participated in employer provided health plans at the highest rate, 72%. This trend is consistent with the overall aging of the workforce as the baby boomer generation continues to work into their sixties and seventies.
On the other end of the spectrum, the youngest employees participated least in employer health coverage. Only 50.1% of workers under the age of thirty participated in employer health plans. In addition, the under-thirty age group eligibility rate decreased the most, dropping by 4.6%. Because the youngest workers tend to make the least income and are generally healthier, they are less inclined to purchase health insurance. Thanks to the provision of the ACA that allows people to remain on their parents’ health insurance until 26, younger workers may remain on their parent’s coverage longer, and aging workers may continue work to provide these additional benefits to their older children.
An important change in employer health coverage is the cost of plan premiums. Premiums have increased in price every year. Between 2010 and 2013 premium rates rose 13.9% with a 7.6% jump between 2010 and 2011. But, after 2011, prices began to moderate and the rate of increase slowed, caused in part by employers reducing actual coverage value, using high deductible plans, or implementing consumer directed health plans.
Again, age remained a key factor in the rate of premium growth. The steepest rate of increase fell upon the under-thirty age group, increasing by 16.3% since 2010. The 40-49 age group maintained the highest monthly premiums, averaging $949 a month. These high premiums may also be attributed to the fact that this age group is more often covering their children until they reach 26.
Employer premiums varied widely state-to-state. The report found that New Jersey had the highest premiums at $968, but a low rate of increase. In contrast, Colorado maintained the lowest premiums at just $733. And while North Carolina did not have the highest rates, it had the largest percentage increase at 18.8%.
To view the full report: ADP Annual Health Benefits Report
Is it that simple? Perhaps health care spending really does reflect health differences. A recent study from the journal Medical Care Research and Review indicates health care spending tracks closely with the health status of local populations.
Prior studies based their results on cost of living and various regional adjustments but never health status. The new study explains that health differences around the country account for 75%-85% of cost variations. “People really are sicker in some parts of the country.” said Dr. Patrick Romano, one of the authors of the study. The Dartmouth Institute for Health Policy and Clinical Practice has long asserted that variations in regional spending are due to the aggressive practices of doctors and high rates of diagnosis in certain areas. The new research contests this by examining hip fractures, head injuries and heart attacks, in which there is little discretion in diagnosis. The geographic variations in spending for these conditions remained consistent with conditions that allow doctors leniency in diagnosis. According to this new data, cutting or placing spending caps on doctors and hospitals in higher spending areas may be detrimental. Some areas spend more money per beneficiary because…the people are sicker.
So, it’s not really that simple. But health status may account for more of the spending gap than we previously thought.
The full study is available by subscription to SAGE journals or for individual purchase here:
October 27, 2011
Kaiser recently released the results of its thirteenth annual Kaiser Family Foundation/Health Research & Educational Trust (HRET) Employer Health Benefits survey. Each year they conduct a survey of 3,184 “nonfederal private and public employers with three or more workers.”
This survey looks at many employer-sponsored health coverage trends including premiums, employee contributions, cost-sharing and much more. New for 2011 it also includes, “the percent of firms with grandfathered health plans, changes in benefits for preventive care, enrollment of adult children due to the new health reform law, and the use of stoploss coverage by firms with self-funded plans.”
The findings in this year’s survey show that the percentage of large employers (those with 200 or more workers) offering retiree health benefits in 2011 is 26%, which is the same percentage that was offered in 2010. The steep decline in employers offering retiree benefits seems to have moderated in recent years, and reached a plateau at least for the time being.
Here are a few key findings:
- 26% of large employers are offering retiree Health benefits – no change from last year.
- 72% of all firms have at least one grandfathered plan under ACA.
- 65% of small businesses haven’t checked to see if they qualify for ACA small employer tax credits.
- 56% of covered workers are in grandfathered plans.
You can access the survey online at http://ehbs.kff.org. You read the report online, or down load the full report, a summary, and presentation slides as well as various other documents and supplements.
Visit Extend Health – the nation’s largest private Medicare exchange.
August 22, 2011
If you were to guess where people spend the most money on health care in the U.S. where would you pick? How about a big city like New York or Los Angeles? If you did, the results of a recent study by Thomson Reuters might surprise you.
If you went against your instincts and pick Anderson, IN you’d be right. People there with employer-provided insurance spent $7,231 on health care compared to Ogden-Clearfield, Utah where they spent only $2,623. That’s a pretty big variation compared to the national average of $4,104. Here are the ten highest and lowest spending MSAs according to the study.
Ten Highest Spending MSAs:
- Anderson, IN $7,231
- Punta Gorda, FL $7,168
- Racine, WI $6,528
- Naples-Marco Island, FL $6,312
- Ocean City, NJ $6,128
- Barnstable Town, MA $6,123
- Flint, MI $6,061
- Lake Havasu City-Kingman, AZ $5,977
- Ocala, FL $5,976
- Carson City, NV $5,931
Ten Lowest Spending MSAs:
- Ogden-Clearfield, UT $2,623
- Dubuque, IA $2,719
- Fayetteville-Springdale-Rogers, AR-MO $2,762
- Fort Smith, AR-OK $2,916
- Laredo, TX $2,919
- Amarillo, TX $2,942
- McAllen-Edinburg-Mission, TX $2,950
- Salt Lake City, UT $2,979
- Fargo, ND-MN $2,996
- Sioux City, IA-NE-SD $3,029
The Thomson Reuters study, titled Geographic Variation in Spending and Utilization Among the Commercially Insured utilized the Thomson Reuters MarketScan Research Databases to “examine variation in spending for enrollees with employer-sponsored health insurance (private insurance).”
Their research focused on three age groups
- Children (age 0-17 years)
- Adults (age 18-64 years), and
- Seniors (age 65 years and over)
The study analyzed 382 metropolitan statistical areas (MSAs) with at least 100 enrollees in each of the age categories. It looked at geographic variation across MSAs and age groups for spending on
- Inpatient medical care
- Outpatient medical care
- Outpatient prescription drug, and
- Total spending
Not surprisingly, the study found that healthcare utilization and spending varied across geographic regions in the United States.
The general consensus seems to be that variations cannot be fully explained by age, gender and health status. Perhaps that is why adjustments for “demographic characteristics and health status” were not made in this study.
However, the data did show that within each MSA medical spending varied by age, which had an impact on overall spending and relative ranking compared to other MSAs. For instance, Medicare spending in Anderson, IN was lower than it was in Punta Gorda, FL. But total spending in Anderson was higher overall because more was spent on children and adults. So, while an MSA might have higher overall spending, that does not mean spending is higher for all age categories.
The study pointed out that current beliefs about the causes for geographic variation may need revising due the observed patterns for Medicare and the commercially insured. The study cites the following factors that seem to influence geographic variation:
- Regional differences in practice, training and financial incentives, as well as the availability of physicians and specialists.
- Basic health, health behaviors, and healthcare preferences
- Market structure, pricing and competition
- Fraud and abuse, such as fraudulent billing schemes.
The study concludes that more research needs to be done to fully understand the reasons for the variation. Future health care policy changes will need to take into account these causes if they are to be effective.
The Thomson Reuters study offers the following five main findings:
- There was significant geographic variation in healthcare spending by age
- Location of the highest & lowest spending MSAs varied considerably by age group, and the type of spending was different from past results for Medicare.
- Not including seniors with supplemental insurance, variation in drug spending was greater than variation in medical care spending
- There was a strong positive correlation between inpatient and outpatient spending, and a weak correlation between medical and outpatient drug spending.
- There was a weak correlation on medical spending between age groups, but a stronger correlation with drug spending.
In conclusion, the study found that the variation in spending by commercially-insured populations is significant, but the spending for seniors differed from previous results for Medicare. While the differences may be due to causes such as market structure, pricing and competition, more research is needed to determine if these variations would still be found after adjusting for demographic characteristics and health status.
If you would like to read the Thomson Reuters whitepaper you can find it here.
Additional Reading: The Cost Conundrum, by The New Yorker.
Visit Extend Health – the nation’s largest private Medicare exchange.