IKEA Garners the Top Health & Wellness Award at Cannes Lions 2019 – the Expanding Health/Care Ecosystem

“Health is now everyone’s business,” Shaheed Peera, Executive Creative Director of Publicis LifeBrands, said this week at the 2019 Cannes Lions awards. Shaheed also led the Health & Wellness jury at Cannes Lions 2019, the mission of which is to, in the words of the award’s portal, “celebrate creativity for personal wellbeing.”

The Grand Prix Lions award for Health & Wellness went to IKEA for the company’s ThisAbles campaign.

ThisAbles is a project pioneered by IKEA’s team in Israel, looking to improve everyday living for people with special needs through  well-designed IKEA products.

IKEA collaborated with non-profit organizations to develop this line of products that help people live and thrive independently at home.

Part of IKEA’s mission statement is to, “create a better everyday life for the many people.” Operational values that flow out of this vision are democratic design, sustainability, form, function, and low prices so “the many” can benefit from IKEA products.

So back to the Grand Prix award for Health & Wellness. There are three-pages of short-listed entries in very fine print on the Cannes Lions 2019 website in just the Health & Wellness category.

These applicants by category included over-the-counter medicines, devices, nutraceuticals, technology, branded education and awareness, foundation-led education and awareness, fundraising and advocacy, corporate image and communications, health services, and animal health.

Among the diverse range 120 products and services short-listed were campaigns from Huawei (Storysign), Nestle (Pinch-water), ESPN (Legs to Fly), Monica Lewinsky (on anti-bullying), GSK (for over the counter pain meds), P&G (“Yarmulke Switch” for Head & Shoulders shampoo), Dwight & Church (for Trojan branded condoms), Medmen (for cannabis – a fast growing category), Neurogen Brain and Spine Institute (on One Mindful Mind), Movember (on suicide prevention for Be a Man of More Words), and the UN (“The Bridal Uniform” to raise awareness on anti-child marriage), among many other worthy and impactful projects. This is also a global competition, this year with entries from Argentina, Brazil, Canada, Chile, China, Colombia, Denmark, Ecuador, France, Germany, India, Ireland, Israel, New Zealand, Norway, Peru, Poland, Spain, Switzerland, UAE, the UK, and the U.S.

But it was Israel’s IKEA entry that garnered the top prize, the Grand Prix, for ThisAbles — creative communication not for a drug or device or technology or service or education campaign, but for product innovation.

Health Populi’s Hot Points:  This quote of Shaheed’s from AdAge strikes at the heart of what IKEA’s ThisAbles program really means: “Did the technology bring a level of humanity? The ideas that broke through were very scalable.”

I concluded my book, HealthConsuming: From Health Consumer to Health Citizen, focusing in on our homes as our health/care and medical hubs. IKEA’s ThisAble’s project is the dictionary-definition of my concept of the home-health-hub. Increasingly, we’ll be self-caring from home, at work and in our cars, and IKEA will be part of that evolving health/care ecosystem. In addition to democratizing design and attending to sustainability, IKEA’s focus on low prices also helps to scale innovation to people who most need it: people managing chronic conditions and disability can also tend to earn lower incomes.

Bravo! to the Cannes Lions jury for choosing ThisAbles as the top Health & Wellness innovation for 2019. There was stiff competition from all kinds of worthy programs and products that can help support peoples’ self-care, mental health, physical health outcomes, and community well-being. But ThisAbles speaks to EveryMan and EveryWoman, all of us at-risk one day for needing extra help, EveryDay.

I’m encouraged with traction I perceive, globally, for attending to health in the community and health, broadly-defined, for individual health citizens. If my colleagues working in the U.S. look outside of American borders for evidence of this, you will find lots of it abroad.

And you will also find green shoots of evidence throughout the U.S. if you are mindful and open to seeing them. A week ago today, Providence-St. Joseph’s Health System announced an investment of $1.6 billion (with a “b”) to focus on community benefit for mental health and homelessness. In their community benefit report, PSJH listed the key health and social areas the system has targeted, calling out social determinants of health like housing instability, food insecurity, and social isolation. The system is partnering with local organizations to sustain community support for health citizens, especially people who are vulnerable and dealing with chronic illness.

IKEA’s ThisAbles stakeholders make the case for resilience, creativity, humanity, and pragmatically-inspired design. In 2016, I quoted my colleague Aman Bhandari in a report I wrote for California Healthcare Foundation on technology and the safety net; Aman told me that, “scaling is the new sexy” when it comes to health and technology. The 2019 Cannes Lions awards for Health & Wellness demonstrate this across much of the category. It’s getting (appropriately) hot in here!

Here’s a wonderful video on ThisAbles from IKEA’s YouTube channel:

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Death by 1000 clicks: Where EHRs went wrong

An interesting article over at Kaiser Health News on electronic health records (EHRs):

But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment…Today, 96 percent of hospitals have adopted EHRs, up from just 9 percent in 2008. But on most other counts, the newly installed technology has fallen well short. Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing and trying to navigate them — which is more than the hours they spend with patients. Unlike, say, with the global network of ATMs, the proprietary EHR systems made by more than 700 vendors routinely don’t talk to one another, meaning that doctors still resort to transferring medical data via fax and CD-ROM. ­Patients, meanwhile, still struggle to access their own records — and, sometimes, just plain can’t.

The article claims that EHRs are often optimized for billing (i.e., to extract as much money from insurance companies as possible) rather than for patient care. Further, because of the lack of EHR interoperability, lab orders get lost, prescriptions mixed up and patient outcomes can be worse. Lawsuits have resulted.

While the article focuses on the downsides of EHR, clearly they have the potential to improve efficiencies and communication. How this can work in practice, however, is an area where more research is needed.

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Understanding Price Growth in the Market for Targeted Oncology Therapies

Why is the cost of cancer treatments growing so much in recent years? A new paper in the American Journal of Managed Care (AJMC) by my at Precision Health Economics colleague Jesse Sussell and co-authors (2019) has an explanation using data between 1997 and 2015 on cancer prices and the size of each treatment’s indicated population using both the IQVIA National Sales Perspective (NSP) data and the Medicare Current Beneficiary Survey (MCBS). They find that:

…prices have roughly tripled, whereas average patient counts per therapy have fallen by 85% to 90% over this period. However, the entire distribution of annual revenues has fallen: For instance, median revenues for drugs launched in the early 2010s are about half of what they were for drugs launched in the late 1990s.

The authors also argue that market power doesn’t explain these rising prices (and falling revenues):

As a result, revenues have fallen at every point in the distribution, after accounting for life cycle growth in revenues over years since launch. This suggests that price growth is unlikely to have resulted from greater pricing power, at least within this market segment. Profit-maximizing firms with more pricing power would never willingly make decisions that lead to lower revenues for each drug launched. 

In short, therapies are becoming more targeted. Thus, rising prices may be a good thing. Whereas before cancer treatments were given to a large number of people for whom only a small share of people would benefit. Now that cancer therapies are much more targeted, only the patients who will benefit from the therapy get the treatment. To offset the reduced indicated population, drug companies have raised prices but not in a way that was sufficient to offset the smaller populations targeted.

The study makes a major contribution for understanding how patients and payers can complain about the rising prices, while manufacturers can rightfully argue that the prices need to be this high to maintain revenues.


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The Most Important Trends For Health in Mary Meeker’s 2019 Internet Report Aren’t About Health Care

The health care section of Mary Meeker’s 334-page annual report, Internet Trends 2019, comprises 24 of those pages (270 through 293). These two dozen exhibits detail growing adoption of digital tech in health care, the growth of genomics and EHR adoption, examples of these tools from “A” (Apple) to “Z” (Zocdoc), and on the last page of that chapter, medical spending in the U.S., the highest in raw and per capita numbers versus the rest of the world.

But the most important implications for American health care aren’t found in those pages: they’re in other parts of the report addressing consumers’ digital time spent, growth of voice tech adoption, the growing use of customer data to drive insights and nudge behavior that’s highly personalized,

The first chart, from page 152 in the general discussion on “Data Growth,” illustrates the proliferation of data expanding from core applications out to edges. In health care, this is an underlying tectonic trend with implications for research, translation to therapies, individual treatment plans, population and public health. The outer grey circle details many of the emerging tools and sources for personal and clinical data that can be mashed up and analyzed to benefit care, drive better health outcomes and, our Health Populi Holy Grail, optimize spending. APIs, Internet of (Healthy) Things, and AR/VR among the others are getting deployed in retail channels and at home to support peoples’ health in the real world, in real time outside of the clinical setting. For health care, the application of FHIR standards helps mobilize data for better health, turbocharging this trend.

This quote from Frank Bien, CEO & President of Looker, succinctly summarizes these trends:

Data is now fundamental to how people work & the most successful companies have intelligently integrated it into everyone’s daily workflow…Data is the new application.

There are other data points in the report that strongly impact and shape healthcare — among them, the percent of foreign-born people as a percentage of total U.S. population. This chart, on page 262, is important for healthcare delivery because a large proportion of the healthcare labor force is indeed foreign-born — at all levels of the system, from hyper-specialists in the operating room and research labs to home health aides helping elders with activities of daily living. One in four physicians practicing in the U.S. in 2016 was foreign-born, this JAMA article published in December 2018 attested.

For another big impact for health, outside of the healthcare chapter, turn to the section, “Internet Usage = There Are Concerns…There is Goodness.” Consumers’ concerns about privacy of personal data are “moderating,” one chart illustrates. But then there’s the formidable challenge of medical privacy and the regulation of Big Tech companies’ use of personal data, covered in general terms on page 167 shown here. For health care privacy, Americans’ HIPAA provisions surely don’t cover personal information that informs health beyond the healthcare claim the way Europeans’ GDPR or the soon-to-be-implemented California Consumer Privacy Act of 2020 do.

The blurring of mobile and digital into overall business process is a meta-trend for the global economy, and certainly for the health care ecosystem. Increasingly, “mobile health,” “mHealth,” “telehealth” and “eHealth” are just part of normal health/care workflows and personal life flows that complement face-to-face, synchronous health care delivery. While we read a broad range of industry analysts’ reports using these nouns, their definitions vary so broadly as to be, by 2019, fairly meaningless in terms of how they quantify these markets.

I’ve covered this influential document here in Health Populi through my health economics/consumer tech lens for most years since 2011 (skipping 2012 and 2016). For some perspective on the Internet Trends reports’ implications for health/care over time, my previous posts assessing the report are linked here:

2018 – Mary Meeker on Healthcare in 2018: Connectivity, Consumerization and Costs

2017 – Digital Healthcare at the Inflection Point, a la Mary Meeker

2015 – Musings with Mary Meeker on the Digital/Health Nexus

2014 – Health Care at an Inflection Point: digital trends via Mary Meeker

2013 – The Role of Internet Technologies in Reducing Health Care Costs: Meeker Inspirations

2011 – Meeker & Murphy on Mobile – Through the Lens of Health

Health Populi’s Hot Points:  The fourth chart, on preventable deaths, represents the poor ROI on high U.S. healthcare spending. The chart is succinctly and accurately titled, “USA Worse vs. Peers.” The U.S. spends more and gets far less a return-on-that-investment than other countries do.

In my book HealthConsuming: From Health Consumer to Health Citizen, I detail the health microeconomics which explain that low return. Much of this is due to the fact that U.S. prices are greater than in fellow OECD nations: wages are higher for specialist physicians, prices for digital imaging greater, and of course prescription drug prices the highest in the world. We wait for President Trump’s administration to address this last issue with a comprehensive policy he promised in his President campaign stump speeches along with this compelling TIME magazine article he granted when he was named Person of the Year for 2017, covered here in Health Populi.

Another important contributor to higher medical spending in America is the nation’s lower proportion spend on social care — education, nutritious food supply, public transportation systems, safety baked into neighborhoods and housing, environmental standards like clean air and water (think Newark and Flint, for example). This last chart, from HealthConsuming, quantifies those relative differences in social versus healthcare spending by OECD country, with results for life expectancy for each.

While technology and data can help us improve therapies and individualized healthcare, spending more upstream on infrastructure and health baked into public policies can prevent so many of these deaths per 100,000 in the U.S. The good news is that more attention and resources are flowing to these social determinants of health, largely from private sector interests like health plans, providers, and retail health touchpoints such as grocers and pharmacies.

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What is a patient-informed societal perspective CEA model?

Entities such as the Panel on Cost Effectiveness in Health and Medicine have argued that we should include the societal perspective when measuring the value of a certain treatment through cost-effectiveness analysis (CEA). However, societal perspective is not always the one used. Further, even when the societal perspective is taken, this is often limited to incorporating productivity losses and caregiver burden.

One group who is not traditionally mentioned in CEA is patients. Yet, patients are the most important stakeholders in the health care system. Nevertheless, CEA models may measure patient quality of life using generic utility metrics–e.g., those derived from EQ-5D–which may have poor sensitivity for how different treatments affect the quality of life for patients with a specific disease.

A paper by Slejko et al. (2019), argues that a patient-informed societal perpsective is needed. What does that mean?

Well, one way to better capture patient preferences is to use more disease specific survey metrics to quantify patient tradeoffs across treatment attributes.

In fact, there are data showing that stated preference methods, like a discrete choice experiment, render important information about treatment value to which traditionally derived QALYs are not sensitive. For example, the value sets for preference instruments can be estimated with discrete choice experiments.24 Furthermore, it is important to examine whether the domains measured by instruments used for QALY estimation reflect attributes of interest to patients.

The authors also not while patient input is already included as part of standard CEA, more could be done. For instance, incorporating novel elements of value such as ability to plan, convenience, and effects on family. Even if all value components are included in a model, having patient input into the CEA model is helpful. In particular, information about the patient journey can be useful for defining model health states as well as relevant time horizons.

In short, as patients are the ones who are the end users of our health care system, it is important that they have a same in terms of how treatments are valued.

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