The Numbers Behind Plastic Surgery

By Clive Riddle, February 21, 2013

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) has just released results of their annual membership study, which provides a wealth of information about what goes on their world.

Let’s take a peek, with some excerpts compiled from their study:

Cosmetic Procedures: The survey indicated 73% of all procedures were cosmetic  (versus reconstructive) in 2012, up from 62% in 2011. Non-surgical treatments made up two-thirds of all 2012 cosmetic procedures. The most common cosmetic non-surgical procedures remain BOTOX® and hyaluronic acid fillers, with the top three areas of the face most treated by injectables being the forehead (42%), cheeks (35%) and the lips (18%).

Volume and Fees: Member surgeons report performing an average of 945 facial cosmetic surgical, cosmetic non-surgical, reconstructive and revision procedures per surgeon in 2012. Facelifts command the highest average fee per procedure ($7,453, on average), followed by: hair transplants ($7,182), revision surgery ($6,542), and rhinoplasty ($5,541).

Women: 80% of all surgical procedures and non-surgical procedures are performed on women.  Two-thirds of women having procedures are mothers, primarily in their 40's and 50's. In 2012 the most common cosmetic surgical procedure for women was facelifts, followed by blepharoplasty, and rhinoplasty. The most common non-surgical cosmetic procedures among women were BOTOX®, hyaluronic acid injections and microdermabrasion, respectively.

Men: Rhinoplasty remains the most requested surgical procedure overall among men.  On average, 20% of male patients request plastic surgery as a result of their significant other having received plastic surgery. Men had a significant increase in Botox  (up 27% from last year - with hyaluronic acid fillers and microdermabrasion also among the most popular maintenance treatments ) while the number of Botox procedures among women was similar to 2011.

Age Groups: 28% of Facial Plastic Surgeons have seen an increase in cosmetic surgery or injectables in those under age 25. For both female and male patients under the age of 35, the most common procedure performed was rhinoplasty (53% females; 70% males), followed by BOTOX® (30% women; 13% men). For all procedures, except rhinoplasty, the majority were performed on patients between the ages of 35 and 60.

Race: The 2012 survey revealed that African Americans and Hispanics were most predisposed to have received rhinoplasty (80% and 65% respectively). Asian Americans were most likely to have blepharoplasty (44%) or rhinoplasty (41%), while Caucasians were more likely to have facelifts (40%) or rhinoplasty (39%).

Consumer Selection: Most patients get their information about plastic surgery online (57%) and are most concerned with the results of the surgery (40%) followed by concern over the cost (33%)  and recovery time (21%)when making their decision to undergo facial plastic surgery. Last year just 7% of prospective patients used social media to research doctors and procedures, down from 35% in 2011. However, there was a 31% increase in requests for surgery as a result of social media photo sharing.  Surgeons report that, on average, 22 women and 12 men that were dissatisfied with previous rhinoplasty surgery from a different office requested corrective surgery.

Aon Hewitt Finds Employee Wellness Incentives Continue to Proliferate, Tie Rewards to Results

By Clive Riddle, August 10, 2012

Aon Hewitt, based on findings from their 2012 Health Care Survey of 1,800 employer organizations that represent over 20 million employees, tells us that “employers are increasingly relying on incentives to drive participation in health programs and encouraging employees and their families to take better care of themselves.”

Here’s data Aon Hewitt shared regarding the state of employers and incentives in 2012:

• 84% offer incentives for participating in a health risk assessment
• 64% offer an incentive for participation in biometric screening
• 51% offer incentives to participants in health improvement and wellness programs
• 59% used monetary incentives to promote participation in wellness and health improvement programs, up from 37% in 2011
• Monetary incentives for participating in disease/condition management programs increased from 17% in 2011 to 54% in 2012
• 46% incorporate some type of VBID (Value Based Insurance Design)
• Less than 10% provide an incentive to address the results of the health risk assessments or take action based on  biometric screening results
• 58% of employers that offer incentives,  provide incentives for completing lifestyle modification programs
• About one-fourth of employers that offer incentives, provide incentives for progress or attainment made towards meeting acceptable ranges for biometric measures

Jim Winkler, Aon Hewitt’s  chief innovation officer for Health & Benefits reaches this conclusion: "Incentives solely tied to participation tend to become entitlement programs, with employees expecting to be rewarded without any sense of accountability for better health. To truly impact employee behavior change, more and more organizations realize they need to closely tie rewards to outcomes and better results rather than just enrollment."

Contracting Web Summit e-Poll Results

By Clive Riddle, May 18, 2012

Survey results are now available from the Contracting e-poll held in conjunction with HealthcareWebSummit’s 2012 Contracting Web Summit, which provide a measure of stakeholder contracting views and priorities, with comparisons to previous year’s answers.

Participants were asked to respond to three items:

1.  Please categorize your organization. Purchaser; Provider; or Vendor/Other

2.  What are the greatest opportunities from a contracting perspective?

3.  What are the greatest challenges from a contracting perspective?

Responses to Greatest Opportunity by Year:

• Advancements in analytics capabilities: 18.5% (2012); 19.4% (2011); 7.5% (2010)
• Advancements in EHRs & transactions: 7.4% (2012); 10.2% (2011); 16.7% (2010)
• Consumer engagement initiatives: 7.4% (2012); 12.0% (2011); 10.8% (2010)
• Emergence of value based/newer payment models: 29.6% (2012); 29.6% (2011); 26.7% (2010)
• Formation of ACOs: 8.6% (2012); 7.4% (2011); 16.7% (2010)
• Increased covered population due to health reform: 18.5% (2012); 13.9% (2011); 17.5% (2010)
• Potential growth in medical homes: 7.4% (2012); 3.7% (2011); 0.8% (2010)
• Other: 2.5% (2012); 3.7% (2011); 3.3% (2010)

Responses to Greatest Challenge by Year:

• Consumer engagement Initiatives: 8.6% (2012); 6.5% (2011); 9.9% (2010)
• Continued market consolidation: 13.6% (2012); 7.4% (2011); 14.1% (2010)
• Cost pressures due to economic downturn: 21.0% (2012); 33.3% (2011); 28.1% (2010)
• ICD-10 transition: 7.4% (2012); 0.9% (2011); 6.6% (2010)
• Increased complexities of benefit design: 12.3% (2012); 11.1% (2011); 8.3% (2010)
• Increased mix of government vs. commercial covered populations: 14.8% (2012); 16.7% (2011); 14.9% (2010)
• Issues related to health reform provisions: 17.3% (2012); 15.7% (2011); 14.1% (2010)
• Other: 4.9% (2012); 8.3% (2011): 4.1% (2010)

For the third year in a row, a plurality of respondents thought that the emergence of value based and other applicable newer payment models was the greatest opportunity from a contracting perspective, with 29.6% of respondents answering this way. In 2011, the same percent of respondents agreed that this was the greatest opportunity which was three percentage points greater than in 2010.

The next most prevalent answers to what was the greatest opportunity were advancements in analytics capabilities and increased covered population due to health reform. For both of these options, 18.5% of respondents answered this way. These responses had been the second and third most prevalent answers in 2011 as well, however, advancements in analytics capabilities was chosen by 19.4% of respondents and increased covered populations due to health reform was chosen by 13.9%.

The remaining answers to what were the greatest opportunities from a contracting perspective (not including other which was chosen by 2.5% of respondents) were chosen by a similar percent of respondents, all of which were within one percentage point of 8%.

When broken down by respondent category there were some variations. While those who categorized their organizations as purchaser or vendors/others followed the overall trend of designating the emergence of value based and other applicable newer payment models as the greatest opportunity from a contracting perspective, providers were split on what the greatest opportunity was between the emergence of value based payment models and increased covered population due to health reform both of which garnered 25% of respondents in that category.

The biggest variation among respondent category was on the response to whether advancements in analytics capabilities was the greatest opportunity from a contracting perspective. Overall, 18% of respondents thought that this was the greatest opportunity. Purchasers were the most likely to answer this way with 30.4% of those respondents choosing this as the greatest opportunity. Respondents categorizing themselves as vendor/other were the least likely to respond this way with only 7.1% believing it as the greatest opportunity.

Just as with the greatest opportunity, the respondent’s choice for the greatest challenge carried over a three year trend with a plurality of respondents signaling that cost pressures due to economic downturn was the greatest challenge with 21% of respondents answering this way. This was a much smaller plurality than in previous years and was only 3.7 percentage points greater than the next most common answer for what the greatest challenge was; issues related to new health reform provisions.

The rest of the options for what the greatest challenges are from a contracting perspective are (excluding other) all fell within ten percentage points of each other. 8.6% of respondents chose consumer engagement Initiatives, 13.6% chose continued market consolidation, 7.4% chose ICD-10 transition, 12.3% chose increased complexities of benefit design, and 14.8% chose increased mix of government program vs. commercial covered populations as the greatest challenge.

Looking at responses year over year, most answers ticked slightly up in 2012 compared with 2011 and 2010 with two exceptions; cost pressures due to economic downturn, which dropped 12.3 percentage points from 2011, and increased mix of government program vs. commercial covered populations, which dropped almost 2 percentage points from 2011.

The Current Facts on Alzheimer's

By Clive Riddle, March 8, 2012

The Alzheimer's Association this week released their 2012 Alzheimer's Disease Facts and Figures, with the full report available from their web site.

Harry Johns, President and CEO of the Alzheimer's Association, tells us "Alzheimer's is already a crisis and it's growing worse with every year. While lives affected and care costs soar, the cost of doing nothing is far greater than acting now. Alzheimer's is a tremendous cost driver for families and for Medicare and Medicaid. This crisis simply cannot be allowed to reach its maximum scale because it will overwhelm an already overburdened system."

Johns goes on to say "this disease must be addressed on parallel tracks: supporting research to find treatments that cure, delay or prevent the disease, and offering assistance and support to the more than 5 million Americans now living with Alzheimer's and their more than 15 million caregivers. This is what the National Alzheimer's Plan is all about. Caring for people with Alzheimer's and other dementias costs America $200 billion in just one year. By committing just one percent of that cost, $2 billion, to research it could begin to put the nation on a path to effective treatments and, ultimately, a cure. Given the human and economic costs of this epidemic, the potential returns on this one percent solution are extremely high."

Here's a selection from the boatload of information provided in their 72 page report on Alzheimer's and other dementias:

• $140 billion will be paid by Medicare and Medicaid in 2012 for care and treatment
• Total costs by payer for 2012 will be $200 billion, broken down as follows: Medicare $104.5B; Medicaid $33.5B; Out-of-pocket payments $33.8B; Other $26.2B
• Medicare payments for an older person with Alzheimer's and other dementias are nearly three times higher and Medicaid payments 19 times higher than for seniors without Alzheimer's and other dementias.
• A senior with Alzheimer's and diabetes costs Medicare 81 percent more than a senior with diabetes but no Alzheimer's.
• An older individual with cancer and Alzheimer's costs Medicare 53 percent more than a beneficiary with cancer and no Alzheimer's.
• An estimated 800,000 individuals have Alzheimer's and live alone, and up to half of these individuals do not have an identifiable caregiver.
• The 15.2 million friends and family members of the 5.4 million individuals with Alzheimer's and other dementias provide 17.4 billion hours of unpaid care valued at more than $210 billion.
• 200,000 of the Alzheimer's population are under age 65 with “younger-onset Alzheimer's”
• 45% of seniors over age 85 have Alzheimer's
• 16 percent of women age 71 and older have Alzheimer’s disease or other dementias compared with 11% of men
• Someone develops the disease every 68 seconds
• Alzheimer's is the sixth-leading cause of death in the country and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.
• Based on final mortality data from 2000-2008, death rates have declined for most major diseases – heart disease (-13 percent), breast cancer (-3 percent), prostate cancer (-8 percent), stroke (-20 percent) and HIV/AIDS (-29) − while deaths from Alzheimer's disease have risen 66 percent during the same period.
• Alzheimer's accounts for somewhere between 60-80% of all dementia cases

The Health Care Employment Situation

Clive Riddle, September 2, 2011

With Labor Day upon us, I decided to click on over to the Department of Labor and see what was going on. As luck would have it, the DOL agency, the Bureau of Labor Statistics, was issuing their monthly report: the Employment Situation, today, so I decided to check out The Situation myself.

Interestingly, health care was mentioned in the opening paragraph of the BLS Employment Situation news release: “Nonfarm payroll employment was unchanged (0) in August, and the unemployment rate held at 9.1 percent, the U.S. Bureau of Labor Statistics reported today. Employment in most major industries changed little over the month. Health care continued to add jobs, and a decline in information employment reflected a strike. Government employment continued to trend down, despite the return of workers from a partial government shutdown in Minnesota.”

A couple of paragraphs down, I learned “Health care employment rose by 30,000 in August. Ambulatory health care services and hospitals added 18,000 and 8,000 jobs, respectively. Over the past 12 months, health care employment has grown by 306,000.”

So this month, while overall national employment was flat, health care added 30,000 jobs, and for the past year, health care has accounting for 24% of employment growth overall (1,259,000 jobs were added overall nationally during the past twelve months.)

Digging down into the detailed tables of the report, I compiled some numbers and learned that health care currently employs 14,127,500 and comprises 10.8% of total non-farm employment overall. Here’s how health care employment breaks down by their sub-categories:

• Offices of physicians: 19.6%
• Outpatient care centers: 5.1%
• Home health care services: 9.4%
• Hospitals: 39.4%
• Nursing and residential care facilities: 26.5%
• Offices of physicians: 19.6%Outpatient care centers: 5.1%Home health care services: 9.4%Hospitals: 39.4%Nursing and residential care facilities: 26.5%

These employment figures don’t account for health care’s overall employment impact, once you factor in vendors to the health care industry, health care insurance, medical schools, etc. For example, the report indicates Insurance Carriers employ 2,207,900 as of August, although health insurance is just a part of that.

Of course, while many of these health care employees will be working this weekend, here’s wishing a happy and safe labor day weekend for all.

Fewer Access Problems, More Uninsured

by Clive Riddle, August 26, 2011

That is the title to the opening section of a new study released from the Center for Studying Health System Change:  Mixed Signals: Trends in Americans' Access to Medical Care, 2007-2010, Tracking Report No. 25, August 2011 by Ellyn R. Boukus and Peter J. Cunningham.

In a statement, the Center commented on this paradox by noting “about 9 million fewer people had health insurance in 2010 compared with 2007, and logically such a large increase in the uninsured population would be accompanied by an increase in access problems. However, approximately 17 percent of the U.S. population in 2010—about one in six people—reported not getting or delaying needed medical in the previous 12 months, down from 20 percent—one in five—in 2007, the study found.”

So how can that be? The statement goes on to answer this question: “the decline in access problems was driven primarily by fewer problems for insured people, likely reflecting recession-related decreases in the demand for medical care and subsequent easing of health system capacity constraints.”

The study authors also say that access for the insured improved much more than for the uninsured.  Ellyn R. Boukus, M.A., health research analyst with the Center, and coauthor of the study tells us “while overall access problems declined, the access gap between insured and uninsured people widened in 2010, especially for lower-income people and those with health problems.”

Here’s some key findings from the study:

• The proportion of insured people reporting an unmet medical need declined from 6.2% to 4.5% between 2007 and 2010.
• 17.5% of the uninsured reported an unmet need in 2010 compared to 16.6% in 2007
• 75.2% of the 52 million people reporting access problems identified cost as an obstacle to needed care in 2010 compared with 69.0% percent in 2007.
• 95.3% of the uninsured cite cost as a barrier compared to 65.9% of the insured in 2010
• In 2010, 9.3% of people with incomes below 200 percent of poverty ($44,100 for a family of four) reported an unmet need compared to 3.0% for those with incomes at or above 400 percent of poverty
• This 2010 ratio of 3.1 (9.3%/3.0%) for low incomes peoples unmet needs/higher income unmet needs compares to a ration of 2.2 in 2007
• 16.9% of those in fair or poor health reported forgoing needed medical care in 2010 compared with 4.6% of those in good, very good or excellent health (16.9% vs. 4.6%)
• 30% of uninsured people in poor or fair health reported they went without needed care in 2010
• Among all people citing a health-system obstacle, the biggest declines were associated with the following reasons: inability to get an appointment soon enough (10.2 percentage point decrease); takes too long to get to the provider (6 percentage point decrease); inability to get to provider when the office was open (5.7 percentage point decrease); and inability to get through on the telephone (5.5 percentage point decrease)

Big Bump in Emergency Department Use of CT Scans

By Clive Riddle, August 11, 2011

Keith Kocher, M.D., M.P.H., a clinical lecturer in U-M Department of Emergency Medicine, was lead author for a 14 page paper just published in the August issue of Annals of Emergency Medicine:  “National Trends in Use of Computed Tomography in the Emergency Department” [doi:10.1016/j.annemergmed.2011.05.020]. They examined national data for CT Scan use in EDs from 1996 to 2007, using CDC’s National Hospital Ambulatory Medical Care Survey, that involved 1.29 billion weighted records of emergency visits , 97.1 million of which included patients who received a CT scan.

Kocher’s team found that the “rate of CT use grew 11 times faster than the rate of ED visits during the study period. The study also showed that the use of CT scans was less common early in the study period, but rose significantly over time. Just 3.2 percent of emergency patients received CT scans in 1996, while 13.9 percent of emergency patients seen in 2007 received them.”

Doctor Kocher tells us "this means that by 2007, 1 in 7 ED patients got a CT scan. It also means that about 25 percent of all the CT scans done in the United States are performed in the ED. There are risks to overuse of CT scans, because each scan involves radiation -- so if they’re done for marginal reasons you have to question why. For example, patients who complained of flank pain [pain in the side] had an almost 1 in 2 chance of getting a CT scan by the end of the study period. Usually most physicians are doing that to look for a kidney stone, but it’s not clear if it’s necessary to use a CT scan for that purpose. I think a lot of the increase is related to changes in how doctors practice medicine and the availability of CT scanners. They provide lots of information quickly and so doctors and patients see CTs as a means of arriving at diagnoses efficiently and conveniently. Couple that with the fact that CT scanners are commonly housed in or near the ED itself, and the barriers to getting the test done are lower than in the past."

On the other hand, they note that “patients who received a CT scan in the beginning of the study had a 25 percent chance of being admitted to the hospital directly from the ED, while by 2007, this rate had been cut in half…[and that] this difference suggests that CT use may also prevent ICU admissions, perhaps shifting these hospitalizations toward a non-ICU bed. In general, however, the effect of CT use in the ED and hospitalization or transfer appeared to diminish after 2003 when the adjusted rate flattened and stabilized between 10.8% and 12.8% despite a continuing increase in overall CT use.”

They also note that “for all of the 20 most common reasons patients came to the ER for treatment, the study found that CT use increased during the study period. However, CT use was particularly high for the following complaints” [% of visits with CT scans indicated] impairments of nerve, spinal cord or brain function (50.7%); flank pain (43.3%); convulsions (38.9%); vertigo, dizziness or light-headedness (36.3%); headache (32.5%); abdominal pain (31.7%); and general weakness (25.6%).

An Extreme Concentration of Expenditures

by Clive Riddle, June 30, 2011

NIHCM Foundation has released a new data brief: Understanding U.S. Health Care Spending – a fifteen page report based on analysis of data from the National Health Expenditure Accounts from CMS and the Medical Expenditure Panel Survey from AHRQ.

NICHM emphasizes that their “analyses document the extreme concentration of expenditures, with just 5 percent of the population responsible for almost half of all spending, and demonstrate the importance of rising spending for hospital and physician services as the primary drivers of expenditure growth.”

Here’s some selected data making these and other points, from their report:

• National Health Expenditures in 2009 annually averaged $8,086 and 17.6% of the GDP, compared to $4,599 and 13.8% ten years earlier in 1999.


• 84% of this spending covers personal health care services and products, including $2,471 annually for hospital care; $1,646 for physicians & clinical services;  $548 for dental & other professional services; $1,066 for home health and long term care; and $1,066 for prescription drugs and DME


• The remaining 16% ($1,289 annually) of national health spending is for public program administration, public health and investment.


• Analyzing portions of the population (civilian, non-institutionalized) and the percentage of health care expenditures they represent (using 2008 data): 15.6% of the population had no health care spending; 50% with the lowest spending accounted for only 3.1% of expenditures; while 63.6% of all spending was incurred by the top 10% of the population with the highest spending; 47.5% of spending by the top 5%; and 20.2% of spending by the top 1%.


• Put another way, the lowest 50% of the population for health care spending averaged $233 annually, while the top 50% average $7,317. The top 30% averaged $11,196; the top 10% averaged $23,992; the top 5% averaged $35,820; and the top 1% averaged $76,476


• Considering proportions of spending by age, those age 65 and up account for 3.6% of the population in the lowest 50% of spending; but 45.1% of the population in the top 5% of spending


• Regarding drivers of the change in healthcare spending from 2005 to 2009 (which totaled an average increase of $1,259 per capita during that time): hospitals accounted for 34% of the increase; physician & clinical services accounted for 18%;  home health and long term care accounted for 16%; prescription drugs and DME accounted for 14%; other spending accounted for 12%; and dental and other professional services accounted for 6%

The report concludes that “these systemic factors affect growth in both public and private health spending:”

• new medical technology


• growing rates of obesity


• fee-for-service payment incentives


• growing economic prosperity (remember the timeframe starts in 2005 and ends in 2009)


• expanding insurance coverage (Medicaid – not commercial)


• defensive medicine and more intensive use of diagnostic testing


• an aging population

Results from Health Plan Contracting e-Poll: Value Based Payment Models

By Clive Riddle, May 25, 2011

With respect to contracting opportunities, insiders say that value based and newer payment models continue to offer the most promise, analytics advances are this year’s darlings, and ACOs hold less hope.

Meanwhile, insiders think cost pressures from the economic downturn are even more of a challenge than last year, and they’re not quite as concerned about market consolidation as they were a year ago.

In conjunction with the 2011 Health Plan Contracting Web Summit, MCOL conducted an e-poll on contracting issues. Participants were asked “what are the greatest opportunities from a contracting perspective” and “what are the greatest challenges from a contracting perspective” in addition to if their organization is a provider, plan or other. These same questions were asked in conjunction with last year’s Health Plan Contracting Web Summit, allowing for comparison to last year’s results.

Here’s a summary of e-poll results for the past two years:

Greatest Opportunities	2011	2010
Emergence of value based and newer payment models	29.6%	26.7%
Advancements in analytics capabilities	19.4%	7.5%
Increased covered population due to health reform	13.9%	17.5%
Consumer engagement initiatives	12.0%	10.8%
Advancements in electronic health records and transactions	10.2%	16.7%
Formation of Accountable Care Organizations	7.4%	16.7%
Potential growth in patient centered medical homes	3.7%	3.3%
Other	3.7%	0.8%
Total	100.0%	100.0%

Greatest Challenges	2011	2010
Cost pressures due to economic downturn	33.3%	28.1%
Increased mix of government program vs. commercial covered populations	16.7%	14.9%
Issues related to new health reform provisions	15.7%	14.1%
Increased complexities of benefit design	11.1%	8.3%
Other	8.3%	4.1%
Continued market consolidation	7.4%	14.1%
Consumer engagement Initiatives	6.5%	9.9%
ICD-10 transition	0.9%	6.6%
Total	100.0%	100.0%

Here are the top two responses for 2011 broken down by type of organizational category:

Top Response
Provider	Emergence of value based & other applicable newer payment models (26.4%)
Purchaser	Emergence of value based & other applicable newer payment models (38.7%)
Vendor/Other	Emergence of value based & other applicable newer payment models (25%)

2nd Highest Response
Provider	Advancements in analytics capabilities (24.5%)
Purchaser	Increased covered population due to health reform (22.6%)
Vendor/Other	Tie: Analytics and ACOs (20.8%)

2011 Predictive Modeling Priorities

by Clive Riddle, May 12, 2011

The Predictive Modeling Web Summit and Predictive Modeling News jointly sponsored a survey of health plan and healthcare professionals conducted by MCOL on “Prioritizing Predictive Modeling Activities.” Participants typically have a more active interest in predictive modeling. This survey has been previously conducted since 2008, allowing the current results to be compared to previous responses.

Participants were asked to respond to two items:

1. Please categorize your organization.
2. Suppose you had to prioritize how an organization could spend its funds on predictive modeling initiatives involving health benefits, and you were given a list of 10 items to prioritize. How would you rank them? (1= highest priority / 10 = lowest priority; rank them 1 through 10).

The items to rank were as follows, with their abbreviated version, referred to subsequently, indicated in parentheses: 

• Identification of High-Risk Patients for Care Management (Identify)
• Plan Design Development (Design)
• Fraud Prevention (Fraud)
• Treatment Guideline Development (Guideline)
• Provider Profiling for Network Development (Profiling)
• Provider Payment Rate and Restructuring (Payment) *[worded differently in previous years]
• Premium Rate Development (Premium)
• Medicare / Medicaid Population Financial Modeling (Medicare)
• Target Marketing Based on Customer / Prospect Risk Scores (Marketing)
• Formulary Development (Formulary)

Here’s what the survey found:

• In 2011, 56.8% of respondents listed Indentify as their number one priority, compared to 51.5% in 2008
• For 2008 through 2011, while there was variation by respondent category for all other items, Identification of High-Risk Patients had the top average priority ranking, and was the mode for the number one priority with all three categories (payer, provider and vendor).
• The next-highest priority mode in 2011 was Treatment Guideline Development, but by category had a mode of 2 for providers & vendors and a mode of 6 for payers..
• Treatment Guidelines and Provider Profiling had significantly higher priority modes in 2011 than in the past while Target Marketing had a much lower priority mode in 2011 than in past years.

The average ranking by item for this year and in 2008 is as follows:

Item	2011	2008
Identify	2.30	2.54
Guideline	4.25	4.75
Design	4.63	4.25
Profiling	4.84	5.16
Payment*	4.86	5.41
Medicare	4.92	5.71
Marketing	5.26	5.84
Premium	5.87	5.59
Fraud	5.93	N/A
Formulary	6.07	6.35

n= 81 in 2011; 88 in 2008

Consumerism: 2011 Industry Insiders Perspective

by Clive Riddle, March 18, 2011

A Consumerism e-poll, involving three brief questions, was conducted in conjunction with the recently concluded 10th Annual Consumerism Web Summit. While questions in the e-poll have changed over the years, the current survey has some recent historical basis for comparison.

Survey respondents were asked the same questions from 2008 - 2011 regarding ranking typical components of consumerism, and their perspective as a respondent. Respondents were also asked in 2010 and 2011, to what degree the success of health care consumerism initiatives depend upon provisions of health care reform.

Below are summary findings from the e-poll. As you can see, overall rankings of these components of consumerism haven’t really shifted from 2008-2011. However, insiders do feel the future success of consumerism initiatives is much less dependent upon health care reform, then they felt a year ago.

1.  Please numerically rank these typical components of Consumerism according to their value from your perspective.

(Rank 1 through 5 with 1 = highest value and 5=lowest value, and only use each ranking once; i.e. only rate one item a 1, one item a 2, etc.)

	2011	2010	2009	2008
	Mean	Mean	Mean	Mean
Price and Quality Transparency	1.76	1.85	2.00	1.83
Wellness Incentive Programs	2.86	3.03	2.65	2.86
Account Based Plans (HSA/HRA/FSA)	2.90	3.06	3.08	2.97
Web Based Consumer Patient Health Records	3.53	3.35	3.70	3.63
Retail Medicine (Convenient Care, etc)	3.57	3.69	3.57	3.71

	2011	2011
	Median	Mode
Price and Quality Transparency	1	1
Wellness Incentive Programs	3	2
Account Based Plans (HSA/HRA/FSA)	3	2
Web Based Consumer Patient Health Records	4	4
Retail Medicine (Convenient Care, etc)	4	5

2. To what degree are the success of health care consumerism initiatives dependent upon provisions of the Affordable Care Act? (in 2010, the question was phrased: "…dependent upon the outcome of any impending health care reform? “)

	2011	2010
Highly dependent	21.2%	36.4%
Somewhat dependent	47.7%	41.2%
Not very dependent	31.1%	22.5%

3. My perspective is as a: 

	2011	2010	2009	2008
Purchaser (Health Plan, Employer, TPA, Agent, PBM)	37.1%	43.4%	30.6%	37.9%
Provider (Hospital, Physician, Pharmaceutical, Other Providers)	34.4%	24.0%	27.1%	36.2%
Vendor/Other  (Vendors, Consultants, Institutions, Gov., All Other)	28.5%	31.8%	42.4%	25.9%

n = 154 for 2011, 189 for 2010, 96 for 2009, 59 for 2008

What Happens to Those Unspent Dollars Inside an HSA?

By Clive Riddle, March 11, 2011

Eric Remjeske, President, and Jon Robb, Investment Associate, at Devenir gave a presentation during this week's Tenth Annual Consumerism Web Summit, in which they addressed Health Savings Account investment options and activity, based on their 2010 Devenir HSA research report.

Here’s some of the data Eric and Jon shared with the audience:

• National HSA assets in 2010 were $9.4 billion in deposits and $0.7 billion in investments
  
  
• This is projected to grow to $50.4 billion in deposits and $10.3 billion in investments in 2015. 
  
  
• 52% of HSA consumers were aware they had investment options for their HAS
  
  
• The average total balance (deposit and investment) in an HSA account was $11,635 for HSA account holders that held investment accounts
  
  
• The average yearly administration fee for HSA investment programs is $32
  
  
• In 2009 the average annual account activity broke down as follows: Personal Deposits $2,050; The average yearly administration fee for HSA investment programs is $32
  
  
• In 2009 the average annual account activity broke down as follows: Personal Deposits $2,050; Plus Employer Contributions $1,058; less Withdrawals $1,850; plus Interest Earnings $17; less Fees $33; yielding a net balance of $1,208.
  
  
• 61% of accounts in 2009 took a withdrawal of some amount
  
  

2010 National Healthcare Quality & Disparities Reports

Clive Riddle, March 4, 2011

HHS’ Agency for Healthcare Research and Quality (AHRQ) has just issued the 2010 National Healthcare Quality Report and National Healthcare Disparities Report. The reports are published annually, as mandated by Congress since 2003.

AHRQ tells us the “reports show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.”

AHRQ summarizes the report findings as indicating “that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures. Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.”

My impression of the state of things is evidenced in a section header entitled: “Quality Is Improving; Access and Disparities Are Not Improving.” The report states found that “across all 179 measures of health care quality tracked in the reports, almost two-thirds showed improvement. However, median rate of change was only 2.3% per year. Access is not improving. Across the 22 measures of health care access tracked in the reports, about 60% did not show improvement and 40% were headed in the wrong direction.”

Of course, patterns of care are regional, not national. The report found that “while every State was in the top 10% for some measure and was part of a benchmark, States in the New England (CT, MA, ME, NH, RI, VT) and Pacific (AK, CA, HI, OR, WA) census divisions were benchmark States most often and States in the East North Central (IL, IN, MI, OH, WI), East South Central (AL, KY, MS, TN), and West South Central (AR, LA, OK, TX) divisions were benchmark States less often.

The full 205 page National Healthcare Quality Report addresses: Effectiveness of Care, Patient Safety, Timeliness of Care, Patient Centeredness, Care Coordination, Efficiency of Care, Health System Infrastructure and Access to Health Care. The full 248 page National Healthcare Disparities Report addresses the same topic plus a section on Priority Populations. There is considerable overlap in the content of the two companion reports.

The reports are definitely worth some clicks to check them out.

Inviting China and other Emerging Countries to a Medical Technology Innovation State Dinner

by Clive Riddle, January 21, 2011

China and other emerging market economies are breathing down the neck of the United States. Look no further than current headlines such as AP’s China's economic might empowers Hu on return U.S. visit, which included the lavish state dinner Hu was denied in his 2006 visit.

Evidently this applies to Medical Technology Innovation as well. PricewaterhouseCoopers (PwC) has just released their Medical Technology Innovation Scorecard, which assesses nine countries’ capacity and capability for medical technology innovation: Brazil, China, France, Germany, India, Israel, Japan, United Kingdom, and the United States.

According to PwC, the “United States continues to lead the world in its capacity to produce the latest in medical technology innovation, but emerging markets led by China, India and Brazil are catching up, and their market power is shifting innovation resources and activity overseas…While the United States is expected to maintain its leadership for the foreseeable future, even a narrowing of the gap has implications for US jobs, exports and Americans’ access to advances in medical technology.”

Michael Swanick, PwC’s US Pharmaceuticals, Medical Device and Life Sciences industry leader tells us “the medical technology field in the US has long benefited from a confluence of social, technical, political and economic forces that came together to create an ecosystem which fosters medical technology innovation. However, the balance of these forces is beginning to change, driven by global economic dynamics, governmental policies and the actions of individual companies and entrepreneurs. As the innovation ecosystem evolves, it creates challenges for those countries and companies that have ridden this wave – and offers opportunities to those, in the US and around the world, who find themselves well-positioned to adapt to new modes of innovation.”

Some key findings PwC has shared include:

• “On a scale of 1 to 9, with 9 as the highest score, the US currently has a total score of 7.1 and is the global leader in medical technology innovation.  Because of decades of innovation dominance, the US continues to show the greatest capacity for medical technology innovation.”

• “The scores of the other developed nations (the UK, Germany, Japan and France) fall within a tight band of 4.8 to 5.4. Among the developed countries included in this study, Germany and the UK demonstrate the strongest support for innovation and Japan the weakest.”

• “Israel, despite its small size, ranks near the level of the European nations, which indicates its strong capacity to foster innovation.”

• “The emerging markets lag behind developed ones. China, with its powerful economic growth engine, scores 3.4, ranking it higher than India and Brazil, each of which scored 2.7.”

• “Looking to the future, the US is expected to continue to lead in medical technology innovation, but also will lose ground to other countries during the next decade.” 

•  Relative declines are projected “for Japan, Israel, France, the UK and Germany. By contrast, China, India and Brazil are likely to see gains during the coming decade.”

• “China, which has shown the largest improvement in its medical technology innovative capacity during the past five years, is expected to continue to outpace other countries and reach near-parity with the developed nations of Europe by 2020.”

But PwC tells U.S. companies that all is not lost. “The shift away from the US to nations such as China, India and Brazil is not necessarily preordained. Factors related to intellectual property protection, difficulty of doing business in some emerging countries and weak local supplier networks could make these markets less attractive, despite their size, and could hinder these nations’ effort to assume innovation leadership.”

Annual U.S. Total Economic Cost of Overweight and Obesity Pegged at $270 Billion

by Clive Riddle, January 14, 2011

The Society of Actuaries this week an 80 page report on their study findings: Obesity and its Relation to Mortality and Morbidity Costs.

The study quantified the following economic impact:

• Total annual economic cost of overweight and obesity in U.S. - $270 billion
• Total annual economic cost in Canada - $30 billion
• Total annual U.S. economic cost of obesity - $198 billion (73% of U.S. total)
• Total annual U.S. economic cost of overweight - $72 billion (27% of U.S. total)

The study also broke down the total U.S. and Canada annual economic cost ($300 billion) by specific causes:

• Total cost of excess medical care caused by overweight and obesity: $127 billion (42.3%)
• Economic loss of productivity caused by excess mortality: $49 billion (16.3%)
• Economic loss of productivity caused by disability for active workers : $43 billion (14.3%)
• Economic loss of productivity caused by overweight or obesity for totally disabled workers: $72 billion (24%)

For the study, lead researchers and actuaries Don Behan and Sam Cox reviewed nearly 500 research articles on obesity and its relation to mortality and morbidity, focusing primarily on papers published from 1980 through 2009.  Don Behan FSA, FCA, MAAA tells us that "there is substantial evidence that overweight and obesity are becoming world-wide epidemics, and are having negative impacts on health and mortality. As actuaries, we are working with the insurance industry to help incentivize consumers through their health plan design to focus on health and wellness, which will hopefully help curb the weight and health problems we face today."

Overweight is defined as a body mass index (BMI) of 25.0 to 29.9 and obese as a BMI of 30.0+.  (Extremely obese is 40.0+). The study cited the following current percentage of population with applicable BMIs:

	USA	Canada	Combined
Overweight	19.2%	17.4%	19.0%
Obese	7.4%	7.6%	7.4%
Extremely Obese	4.2%	4.7%	4.3%

The study goes on to examine the relationships and impact of Obesity with Cardiovascular Disease, Diabetes, Cancer, Osteoarthritis, Asthma, Renal Disease, In-Hospital Infection, and other conditions; as well as disabilities and excess mortality caused by obesity, all from an actuarial perspective.

The study concludes that “perhaps the most convincing results concern the effect of overweight and obesity on cardiovascular disease and diabetes. Relative to normal weight, the relative risk of death from CVD increases significantly for overweight men and women…About 60 percent of diabetes is directly related to weight gain… Several papers provide empirical evidence that obesity is significantly related to increased risk for certain cancers (Renehan et al., 2008b). The relationship is complex and depends on the site of the cancer. Overweight and obesity are significantly related to a variety of negative effects on the body, such as delayed healing of joint injuries, increased risk of arthritis, impaired function of internal organs, and interference with hormone balances. …..The negative effects play a role in a cycle of overweight, depression and decreasing physical activity, which results in increased use of the health care system…Increasing BMI also is related to development of asthma …Many empirical studies found that obesity significantly increases the risk of death, that is, all-cause mortality … The relationship between BMI and all-cause mortality is often found to be U-shaped or J-shaped, since underweight also is associated with increased mortality. The few studies of insured groups generally agree with population results.”

The Insurance Mandate Conundrum

by Clive Riddle, December 9, 2010

Harris Interactive has just released results from a poll, in conjunction with Health Day, taken post-election that measures current public opinion of health care reform  (the survey involved 2,019 adult respondents online between November 19-23.)

In Harris Interactive’s words, “Americans remain deeply divided over the nation's new health-care reform package.” Certainly a plurality (40%) want to repeal all or much of the legislation. But just as polls consistently show that while American’s hate Congress in general, they typically support their own congressman; this poll indicates much of the specifics of health care reform are rated much higher than the package in general.

Humphrey Taylor, chairman of The Harris Poll, tells us "many Americans want to repeal the bill not because they dislike the specifics, but because they feel it is an expensive expansion of an already big government…. Pluralities want to repeal all or most of the law, but want to keep much of what's in it…. it's easy to believe all the bad things about the law if you don't know what's in it."

Expanding on that last point, Sara Collins, vice president for Affordable Health Insurance at The Commonwealth Fund, tells us "I think this suggests that as the public becomes more familiar with the law and how it will benefit them and their families, support will probably climb. There's just a lag while immediate provisions are rolling out like young adult coverage."

But here’s the rub: the public really, really doesn’t like the insurance mandate provision, and time probably won’t improve opinion in that area. So if the a Republican House feels pressure to take some action regarding health reform, given the unlikelihood of pushing through an outright repeal through a Democratic Senate or overcoming the President’s veto, their point of attack would be the insurance mandate.

Yet the mandate is the one provision that helps the more publicly popular provisions, such as guaranteed issue and adult dependent coverage, pencil out a little better (by decreasing adverse selection) for the health plan industry that in many cases lobbied for the Republican party in November. So the party that health plans wished for may cause them to remember the phrase, be careful what you wish for.

Here are some of the poll results by the numbers:

• 40 percent of adults wanting to repeal all or most of the legislation;  31 percent favor keeping all or most of the reforms; 29 percent aren't sure what should be done.
• 57% oppose the insurance mandate and only 19 percent support it
• Two-thirds of respondents like guaranteed issue provision (prohibiting denial of coverage to people with pre-existing medical conditions.)
• 60% want to keep the provision for tax credits so small businesses can afford coverage for employees. 
• 55% like provision allowing children to stay on their parents' insurance plans until they are 26. 
• Just over half of respondents support the idea of new insurance exchanges where people can shop for insurance.
• 81% believe reform will it result in higher taxes, could lead to rationing of health care (74%), and reduce the quality of care they will receive (77%).

Let’s Move to the Atlantic Seaboard or North Dakota: State Specific Premium and Deductible Data

by Clive Riddle, December 3, 2010

The Commonwealth Fund has just released a report with state specific premium and deductible trends for the past seven years: State Trends in Premiums and Deductibles, 2003–2009: How Building on the Affordable Care Act Will Help Stem the Tide of Rising Costs and Eroding Benefits.

The talking points the Commonwealth Fund promotes in conjunction with the report: (Premiums increase 41%! Deductibles increase 80%) are a little disingenuous as those percentages cover a seven year period (which they dutifully note) but the average ready typically relates such percentages into annual terms, and headlining the equivalent average annual increase could have been more meaningful.

The Commonwealth Fund’s theme from their report is, as Commonwealth Fund Senior Vice President Cathy Schoen tells us, “private insurance costs have been increasing faster than working family incomes. For more than a decade, families with job-based insurance have been sacrificing wages to hold on to health insurance. The good news is that the Affordable Care Act reforms provide a foundation to improve coverage and slow health care cost growth in the future."

Regardless of what conclusions you draw from the 32 page report, it contains great state specific data on average health plan single and family premiums and deductibles, further broken down by employer size. They also examine premium as a percent of median household income. The report goes on to project future increases, with and without the impact of the Affordable Care Act, thus indicating projected savings from the Act.

The report notes “by 2009, the average employer-sponsored family premium across all states was $13,027, ranging from $14,000 to $14,700 in the six highest states….to $11,000 to $12,000 in the 11 states with the lowest average private-employer family premium costs…. Average family premiums in the highest-premium-cost states were about 23 percent above those of the lowest-cost states….. By 2009, there were 15 states in which the average annual premium for family coverage equaled 20 percent or more of median household income for the under-65 population, compared with just three states in 2003 ….  In 28 states, family premiums relative to incomes averaged 18 percent or more for middle-income, under-65 households.”

The report found that U.S. average deductibles by firm size were:

Small Firm Single Deductible: $    703 in 2003 / $ 1,283 in 2009
Large Firm Single Deductible: $    452 in 2003 / $    822 in 2009
Small Firm Family Deducible: $ 1,575 in 2003 / $ 2,662 in 2009
Large Firm Family Deductible: $   969 in 2003 / $ 1,610 in 2009

Here’s some interesting state-specific data from the report. From an affordability standpoint (premiums as a percent of income) the Atlantic seaboard or North Dakota may be your best bet.

Five Highest Family Premium States

(2009 Data: US Annual Average $13,027)
Massachusetts: $14,723
Wisconsin: $14,656
Vermont: $14,558
Wyoming: $14,319
District of Columbia: $14,222

Five Lowest Family Premium States

(2009 Data: US Annual Average $13,027)
Arkansas: $10,969
Montana: $11,365
Oklahoma: $11,417
North Dakota: $11,590
South Dakota: $11,596

Five Highest States: Avg Premiums as % of Median Household Incomes

(2009 Data: US Annual Average 18.7%)
Mississippi: 24.6%
Texas: 21.9%
Louisiana: 21.6%
New Mexico: 21.5%
North Carolina: 21.2%

Five Lowest States: Avg Premiums as % of Median Household Incomes

(2009 Data: US Annual Average 18.7%)
Connecticut: 14.6%
New Jersey: 14.7%
Maryland: 15.0%
Virginia: 15.0%
North Dakota: 15.5%

Accountable Care Organizations in California: Lessons Learned

by Clive Riddle, November 10, 2010

While attending the recent Accountable Care Congress in Los Angeles, I had the pleasure of hearing Accountable Care Congress give a presentation on the recently released Integrated Healthcare Association white paper on Accountable Care Organizations in California. I highly recommend you check out the document at: http://www.iha.org/pdfs_documents/home/ACO_whitepaper_final.pdf

The 32 page report includes some great data and discussion, and makes the following nine points regarding lessons learned from the California experience to date:

1. A variety of organizational structures are effective at delivering high quality coordinated care; at least as important to success as structure are an organization's capabilities, culture, and infrastructure, as well as the alignment of goals between the organization and its individual physicians.
2. In California, a range of relationships exist between physician organizations and hospitals. Alignment of incentives between physician organizations and hospitals offer important opportunities for performance improvements across the entire continuum of care.
3. As a method of payment, capitation can be effective at encouraging coordinated care, but payment methods should vary across ACOs depending on an organization's ability to assume risk. Fee-for-service payment with shared savings has not proven a successful incentive for the efficient delivery of care.
4. Health plans acting in concert on payment methods and performance measurement helped facilitate the growth of California's provider organizations, and should also play an integral part in fostering ACO development nationally.
5. ACOs are not a panacea for health care spending control. Some large provider organizations have gained bargaining power and raised prices. Capitation payment and consumer cost sharing partially offset tendencies toward raising prices.
6. ACOs must be agnostic to insurance type; most provider organizations in California have focused on commercial, Medicare, and Medicaid HMO plans for their patients, but for ACOs to be viable across the country, mechanisms must be found to encourage PPO and traditional Medicare and Medicaid patients to use their services.
7. Balancing patient choice with the desire to decrease costs and effectively coordinate care is difficult. California's experience underscores the challenge of promoting care coordination in an environment of unrestricted provider choice.
8. Regulation of the financial solvency of provider organizations is important to ensure market stability.
9. Consumer protections from capitated provider organizations need to be balanced, not overburdening.

Hospital Mortality at Five Star versus One Star Facilities

by Clive Riddle, October 22, 2010

HealthGrades, which touts itself as the “leading independent healthcare ratings organization” has just released a study of patient outcomes at U.S. hospitals, stratified by their ratings, that found “patients at 5-star rated hospitals had a 72% lower risk of dying when compared with patients at 1-star-rated hospitals.”

Other well known ratings and ranking of U.S. hospitals include the U.S. News and World Report rankings of U.S. Best Hospitals, which is based on AHA data in part. Consumer Reports also offers hospital ratings based on results from CMS’ Hospital Consumer Assessment of Healthcare Providers and Systems survey, known as HCAHPS, and CMS directly offers Hospital Compare at Medicare.gov, also providing HCAHPS results.

The Thirteenth Annual HealthGrades Hospital Quality calculated that if all hospitals performed at the level of their 5-star rated hospitals, 232,442 Medicare lives could potentially have been saved from 2007-2009 (the study period.) The study analyzed mortality and complication rates using 40 million hospitalization records obtained from CMS.

The study found overall hospital mortality rates declined by 7.98% from 2007 to 2009. Of the 17 mortality-based diagnoses and procedures analyzed, two experienced increased mortality rates – gastrointestinal surgeries (+8.76%) and coronary intervention procedures (+9.26%). HealthGrades rated individual hospitals with a 1-star (below average), 3-star (average) or 5-star (outperformed national average) rating in each of 26 procedures and diagnoses, from bypass surgery to total knee replacements.

Other findings released from the study included:

• The highest unadjusted mortality rates are among sepsis, respiratory failure, and gastrointestinal surgeries and procedures (20.59%, 19.45%, 10.29%, respectively).
• The most improvement in unadjusted mortality was seen in chronic obstructive pulmonary disease (18.73%), bowel obstruction (14.72%), heart attack (13.68%), and stroke (13.50%).
• Approximately 55.91% (129,949) of the potentially preventable deaths were associated with just four diagnoses: sepsis (48,809); pneumonia (29,017); respiratory failure (26,361); and heart failure (25,762).
• On average, one in nine patients developed a hospital-acquired condition, across the nine procedures evaluated for inhospital complications, from 2007 to 2009.

On average, a typical patient would have a 80.40% lower risk of developing one or more inhospital complications by going to a 5-star rated hospital compared to a 1-star and a 63.64% lower risk of developing one or more inhospital complications by going to a 5-star compared to the U.S. hospital average.

World Alzheimer's Day- September 21st

by Clive Riddle, September 21, 2010

In observance of World Alzheimer's Day, Alzheimer’s Disease International has issued the World Alzheimer Report 2010. Here’s ten quick facts we gathered from the report:

1. There are 35.6 million people living with dementia worldwide in 2010
2. The total estimated worldwide costs of dementia are US$604 billion in 2010
3. Total dementia costs account for around 1% of the world’s gross domestic product
4. The total estimated worldwide costs of dementia are US$604 billion in 2010
5. Direct medical costs account for 16% of total dementia costs
6. Direct social care costs account for 42% of total dementia costs
7. Costs of informal care (unpaid care by families, etc.) account for 42% of total dementia costs
8. About 70% of worldwide dementia costs occur in Western Europe and North America
9. If dementia care were a country, it would be the world’s 18th largest economy, ranking between Turkey and Indonesia
10. If dementia were a company, it would be the world’s largest by annual revenue, exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion).

Dr Daisy Acosta, Chairman of Alzheimer’s Disease International tell us,. "this is a wake-up call that Alzheimer’s disease and other dementias are the single most significant health and social crisis of the 21st century. World governments are woefully unprepared for the social and economic disruptions this disease will cause."

Here, verbatim, is what the report recommends at this point in time:

• Governments worldwide should act urgently to make Alzheimer’s disease a top priority and develop national plans to deal with the social and health consequences of dementia. Several countries have moved forward to develop national plans, including France, Australia and England. It is critical for other governments to follow suit.
• Governments and other major research funders must increase research funding to a level more proportionate to the economic burden of the condition. Recently published data from the UK suggests that a 15-fold increase is required to reach parity with research into heart disease, and a 30-fold increase to achieve parity with cancer research.
• Governments worldwide must develop policies and plans for long-term care that anticipate and address social and demographic trends and have an explicit focus on supporting family caregivers and ensuring social protection of vulnerable people with Alzheimer’s disease and other dementias.
• The scale of what is facing us elevates this to a global challenge, which must be addressed as a top WHO priority and on the G-20/G-8 agenda.