Thinking Small: Health Care Micro-Trends

I have an article in the current issue of Communique magazine about micro-trends in health care that may impact our business. Here’s an abridged version of it (the entire article can be found at http://www.communiquelive.com/)

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Mark Penn may not have been all that helpful to Hillary Clinton last year, but he did make a powerful contribution our understanding of societal trends with his book (authored with E. Kinney Zalesne), Microtrends—the Small Forces Behind Tomorrow’s Big Changes.

“Microtrends,” he writes, “is based on the idea that the most powerful forces in our society are the emerging, counterintuitive trends that are shaping tomorrow right before us.” He postulates that less than one percent of the American population—3 million people—is enough to set in motion a trend or support a new business.

Those in the health care marketing community are accustomed to worrying about the large forces that have tsunami-like impact on our business. The impact of genomics, digital media and the aging of the population are all-important but easy marks. But lurking below the big waves have always been modest-sized currents that have had lasting and profound effects on health marketing.

Here are five small trends in health care that may rattle the marketplace in the future. I am sure there are others, and would love your feedback about what they are.

1. Home, Sweet Medical Home
An intriguing step towards reducing health costs while improving patient care is the “patient-centered medical home” concept.

A tiny, but influential group of physicians and their patients are opting for this new model of health delivery, in which a primary care physician is paid to coordinate the total care of his or her patients, usually patients with chronic medical conditions. The patient’s medical needs—from preventive medicine to specialist care to nutrition counseling—are coordinated by this single physician who is armed with both high-voltage information technology and a cadre of specialists to whom to refer the patient if necessary.

The medical home doctor’s mission is to preserve and enhance health, not simply to treat diseases. He or she is paid a modest fee for coordinating services and may receive a bonus if the patient’s health improves.

Already the concept is demonstrating its bona fides. In the Pacific Northwest, a study of 9,200 patients using the medical home approach showed a 29 percent reduction in emergency room visits and an 11 percent decrease in hospitalizations compared with a matched control group.

“By employing technology such as e-mail and mobile phones, physicians in the medical home were able to provide better care that included screening tests, management of chronic illnesses and monitoring of medications. These methods also helped physicians ease the workload – 10 percent of medical home doctors and staff felt “burnt out” or emotionally exhausted, as opposed to 30 percent reported from the control group,” reported Healthcare Finance News.

2. The Proud and Portly
The battle to reduce obesity-related illness has taken many forms, from the popularity of low-fat diets to punitive measures such as proposed taxes on soft drinks and higher insurance premiums for overweight individuals. An executive of one health clinic said that given his preferences, he would simply not hire fat people.

Paralleling the war on weight is a movement declaring fat isn’t the devil’s brew.

There are really two separate movements. The first is comprised of the fatalists or nihilists, who may know the risks of obesity, but believe there is nothing they can do to alter their destructive behavior. They are wrong and are playing Russian roulette with their health.

But a vocal and I believe growing subset of individuals is rallying against the shibboleth that thin equals healthy and happy. The New York Times reported recently “Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be happy at any size.”

3. Eaters and Self-Treaters
Drugs to ward off health calamities such as stroke and heart attack continue to sell briskly. While prescriptions for these products will continue to increase, in the future we will also see increase sales of food products with substantiated health claims.

Health claims for foods are not necessarily over-inflated or dubious, such as the claims of some dietary supplements. Multiple studies have shown that plant sterols, for instance, when used in combination with statins, are effective in lowering cholesterol by up 17 percent, which is greater than the average five percent benefit seen by doubling a dose of statin. The value of Omega-3 fatty acids in reducing cardiovascular disease and depression has also been confirmed.

Increased drug costs and headlines about under-appreciated safety risks with conventional medications will likely drive some towards “food remedies,” especially when there is compelling evidence that they can be helpful.


4. Welcome to Medicare
While “managed markets” interests the press and policy marketers, most baby boomers, especially middle and upper middle class professionals, are content with the tried and true private fee-for-service model. It is not unusual for an individual to have been treated by the same doctor for 20 or more years. This arrangement has been the gold standard of American medicine and has been responsible for creating the strong bonds between individual doctors and the patients for generations.

But as boomers approach that magical number “65,” will the relationship between the private physicians and the patient change? Will the doctor even be able to keep Mr. Jones, once his private insurance terminates and he enters the land of Medicare?

5. The Old Old
We recognize that our population is aging, however, it is the “old old”, individuals aged over 85 who are gaining market share faster than any other segment of the population. In 2005 there were 5.1 million individuals older than 85 that number is expected to increase to 7.3 million by 2020 and by 2050 will swell again to 21 million, nearly 5 percent of the American population.

As one can imagine, there are substantive and complicated differences between simply older people and the oldest of the old. Depression, for instance, which is the most common mental disorder among the elders, occurs in between 10 percent and 38 percent of the older population though according to The Journal of Allied Health, diagnosis rates are far lower than the actual incidence of the condition. Depression linearly increases with age, as do other diseases such as macular degeneration, Alzheimer’s disease and heart failure.