Ever been lost on a new trail on a hike? Or confused between north and south in a new city? Or after a certain age, unsure if you really took that anti-cholesterol pill last night, or was it the blood pressure pill?  They kind-of look the same.

GPS apps in your handheld may lead you back to the right path, but keeping track of your pills is another matter.  Only about 50 percent of patients take their medications as prescribed. And , according to the Centers for Disease Control and Prevention, in 2010 almost 40 percent of adults older than 65 were taking five or more prescriptions a day.

Managing real and potential medication conflicts and confusions is more pressing as 10,000 baby boomers turn sixty-five every day, and 90 percent suffer at least one chronic illness. Many boomers are now swallowing a cocktail of medications prescribed by various specialists: pain medicines for aching backs, antidepressants, proton pump inhibitors to control gastric distress, vitamins and other over-the-counter supplements.

With families sometimes far away and many older people unable to afford personal caregivers, companies have searched for a technological solution to monitoring medicine.

Forget armband monitors like Fitbit, the newest body monitors are as tiny as BBs. These so-called nanomeds, miniscule sensors embedded in a placebo pill that you swallow, set up shop in your gut. As they slowly work their way through your system, these “ingestibles” – which are actually not digested – are switched on by contact with saliva and/or gastric juices. The signal is picked up by another sensor which looks like a Band-Aid and is worn on your chest.

This system records medicine intake as well as other measures, such as heart rate. The information shows up on your smartphone or tablet, via Bluetooth and can automatically go to your doctors, family members or caregivers, with your permission.

“We are entering the commercial era of the Internet of Things (IoT) – your car, your clothes and increasingly your personal care products are going to be connected,” says Andrew Thompson, CEO of Proteus Digital Health, which makes these “ingestibles.”

He adds that the goal is to connect major health systems to consumers “to allow them to switch on their own health care, creating critical information that can be used to ensure they and their doctors make positive decisions about use of medicines and personal health choices.”

The Food and Drug Administration approved these devices in 2012, but they’re not on the open market yet. They’re still being tested in pilot projects, including with England’s National Health Service.

Proper use of powerful, sophisticated meds aimed at keeping the elderly active and out of institutional care, Bill Satariano of the UC Berkeley’s School of Public Health believes, will depend increasingly on these “indigestible chips.”

He says it’s part of the field of “techno-wayfinding” or relying on newer and newer information technologies to help us keep track of where we go, what we eat or drink and increasingly whether we’re following doctor’s orders in our pill consumption.

Satariano’s Berkeley colleague, David Lindeman, noted in a report published this year  that these and other forms of info-tech will play critical roles in what is broadly described as “connected health.” That relies on Internet-based technologies to help provide care in people’s homes or other non-clinical settings. “[T]echnologies is that can be used to monitor individuals with chronic conditions to detect, and thus prevent, complications and crises that can lead to acute episodes. To maintain their health and well-being, it is just as important to provide individuals with automated health coaching, based on monitoring vital signs, activity, and behavior,” the report says.

For example, if an aging baby boomer has elevated blood sugar levels, her medical team can find out about it (information that comes into the boomer’s own cellphone and is then distributed to whomever she’s designated) and correct the problem before the levels get dangerous, even if she doesn’t even notice.

Separate monitoring devices are, however, just the beginning of indigestible medicine.  Coming soon, according to one senior executive at Proteus Digital, will be the implantation of these nearly invisible chips in the actual prescription pills themselves, relieving the patient of even having to remember to take the monitoring pill, because the pills could send back the message that they’re now in the system.

All these new “wayfinding” health technologies could improve both medication usage and effectiveness for elders aging at home, and helping them have a better quality of life. And, these could reduce or eliminate expensive critical care in hospitals.

All good, but some raise a possible dark side: is this the ultimate Orwellian Big Brother technology, like an electronic bracelet attached to your gut?

Satariano’s answer? “Without question. We always have to ask what is the cost to each technological advance.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

For two decades Atlanta restaurant owner Jim Dunn offered a group health plan to his managers and helped pay for it. That ended Dec. 1, after the Affordable Care Act made him an offer he couldn’t refuse.

Health-law subsidies for workers to buy their own coverage combined with years of rising costs in the company plan made dropping the plan an obvious – though not easy – choice.

“I had a lot of regrets going into it,” Dunn, who owns three Italian Oven restaurants in suburban Atlanta, said of his decision. “I don’t think I have as many now — only because I’ve seen the affordability factor for my managers improve.”

Dunn and five managers are now covered under individual plans bought on healthcare.gov. How many other owners make the same decision will help set the future of small-business health insurance. Although the evidence so far is mixed, brokers expect more firms to follow in the next few years.

Companies like Dunn’s — those with fewer than 50 workers — provide medical coverage to roughly 20 million people. Unlike larger employers, they have no obligation under the health law to offer a plan. Now they often have good reason not to.

If employees qualify for government subsidies, like the managers who switched from Italian Oven’s corporate insurance to individual Obamacare coverage, everybody can win.

Owners don’t have to pay premiums, meaning they can give workers raises, invest in equipment or add to profits instead. And employee take-home pay can rise if subsidies — available even to families with middle-class incomes — are worth more than what a company was contributing.

Whether to cancel a company plan and let workers buy insurance on healthcare.gov or another online exchange “is something that I would say comes up in every conversation with a small-group” employer, said Adam Berkowitz, a consultant with Caravus, a benefits firm based in St. Louis.

“I just had another [small] business call in today and say, ‘You know, we can’t do it. We’re packing it in,’” said Roger Howell, head of Howell Benefit Services in Wilkes-Barre, Pa.

Anthem, the largest seller of small-business health insurance, lost almost 300,000 members in such plans — many more than expected — in the first nine months of the year. That was 15 percent of the enrollment. Many of those consumers are presumably switching to individual plans sold through exchanges, including those offered by Anthem, officials said.

It’s far from clear, however, that most companies will take the same steps as Italian Oven.

Many small employers see health coverage as an essential piece of compensation. They note that premiums in company-sponsored plans are tax-deductible — for workers as well as employers — while the tax advantages of individual plans are limited.

“I feel like we have to have a medical plan in order to hire people and keep them employed,” said Dan Allen, head of a 15-worker engineering firm in Decatur, Ill. Allen Engineering renewed its Coventry Health Care plan for 2015 even though the premiums rose 21 percent, he said.

No other major insurer has reported cancellation of small-business plans at the same rate as Anthem.

“We didn’t see that,” said Rick Allegretti, vice president of marketing at Health Care Service Corp., operator of Blue Cross plans in five states including Illinois and Texas. “We actually saw our [small-group] business grow slightly — mind you it’s probably a tenth of a percent.”

Businesses shifting workers into the individual exchanges tend to be the very smallest, employing a handful of people, said Skip Woody, a partner at Hill, Chesson & Woody, a  North Carolina benefits firm. “Anything above 15, we haven’t had any dropping coverage,” he said.

Instead, many small companies are taking advantage of rules letting them maintain insurance bought before the health law took effect. President Barack Obama, who promised consumers they could keep coverage they liked, allowed carriers to extend noncompliant plans after facing fierce criticism over their imminent extinction.

Most, but not all, states approved the adjustment. Because older policies may lack features required by the health law and because their rates are often set according to employee health history, not community-wide costs, they can be less expensive than compliant plans, say brokers and consultants.

“I haven’t sold one of the new plans yet” to a small employer, said John Jaggi, an Illinois broker and consultant. Faced with price increases of as much as a third or more for new plans, all 40 or so of his small-business clients including Allen Engineering renewed older coverage for 2015, he said.

Heavy renewal of old plans plus workers shifting to individual coverage help explain why the health law’s online portal for new small-business plans has attracted only modest interest, analysts say.

For some companies there is logic to ending coverage altogether.

For Italian Oven’s Dunn, “it made sense to recommend that he drop coverage,” said Elena Merino, CEO of the Meridian Group, a benefits firm in Alpharetta, Ga. “It hurts me. But that was the responsible thing to tell him.”

Italian Oven employs the equivalent of about 30 people — less than the 50-worker threshold that would get it fined for not sponsoring insurance. The company does not offer coverage to servers and kitchen staff, but full-time managers have always had a plan.

All are eligible for tax credits to buy insurance on healthcare.gov, said Dunn. Next year, the subsidies are available for individuals with income of up to $46,680 and families of four with income of up to $95,400.

With subsidies factored in along with unrelated pay increases, the managers “are going to be saving money out of the deal” while getting coverage comparable to what they had before, Dunn said. “My managers actually got excited about it because they’re saving money on their health insurance.”

Brokers expect more small businesses to make the same move, especially after the ability to extend older, noncompliant plans expires between now and the end of 2017, depending on state policy. Allen, the engineering firm executive, is concerned premiums could rise even higher next year than they did for the 2015 renewal.

“If it’s up in the 25- to 30-percent increase [range] — I’ve heard as high as 40 — we’ll just have to drop it,” he said. “Turn everybody loose.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Statement by Health and Human Services Secretary Sylvia Burwell on Senate Confirmation of Dr. Vivek Murthy as U.S. Surgeon General

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments and co-insurance, but not premiums. Seventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94 percent of gold plans (average limit, $4,458) and 98 percent of platinum plans (average limit, $2,145).

Avalere said the average spending limits for single coverage were in most cases close to those for 2014 plans: bronze ($6,330); silver ($5,877); gold ($4,443) and platinum, $2,795.

Avalere’s analysis included plans sold on the federal marketplace that serves 37 states, as well as data from the California and New York state marketplaces. Consumers have until Feb. 15 to enroll.

The tradeoff for lower out-of-pocket spending maximums may be a higher deductible, says Pearson. The average deductible for silver plans will increase 7 percent in 2015, to $2,658. Other metal-level average plan deductibles are increasing as well.

Higher deductibles are likely helping keep premiums low, and low premiums are what consumers are looking for, Pearson says.

For people who are generally healthy, a lower premium may be more attractive than a lower deductible. They’re never going to meet their deductible anyway, so they’d prefer to save on monthly premiums.

But for people with chronic conditions, “the lower out-of-pocket maximum helps you because you’re going to exceed your deductible no matter what,” says Pearson.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

With less than a week until the deadline to buy individual health insurance that begins Jan. 1, experts say sign-ups are on course to hit or exceed the Obama administration’s projection of about 9 million enrollees in 2015.

Several weeks into the second year of the Affordable Care Act’s insurance exchanges, about 1.5 million people have enrolled in coverage, according to data from state and federal exchanges.

As of Dec. 5, almost 1.4 million had enrolled through the federal insurance exchange, which serves 37 states, the Centers for Medicare & Medicaid Services reported Wednesday. Another 183,000 chose plans through state exchanges, including nearly 49,000 in California, according to a Kaiser Health News analysis of state exchange data.  Enrollment figures were not available for exchanges in New York, Idaho and Rhode Island.

“Exchange enrollment is far ahead of 2014’s pace due to improved technology performance,” said Caroline Pearson, vice president of Avalere Health, a consulting firm.

She said sign-ups are on track to “far exceed” the Obama administration’s 9 million projection, made just before open enrollment began in November. If enrollment continues at this pace, she said, the federal and state exchanges should enroll between 4 and 5 million new participants, she said. That’s in addition to 6.7 million who got coverage for 2014, many of whom are expected to re-enroll for 2015.

Enrollment in 2014 plans reached nearly 7 million despite the disastrous rollout of the federal and several state exchanges, which made it difficult if not impossible to sign up in the early months.

Sign-ups for 2015 began Nov. 15 and continue through Feb. 15. However, those who want coverage in January must enroll by Monday.

Some Republicans have argued that enrollment would suffer in the law’s second year because people would be unhappy with their coverage and prices would skyrocket. So far, that does not appear to be happening.

Several state insurance exchanges reporting data appear to be ahead of where they were several weeks into open enrollment last year, including Massachusetts, Maryland and Vermont.

It is not known how many of the enrollees in some state exchanges are new to the market. But on the federal exchange about 48 percent of the people selecting plans are new, while 52 percent had coverage in the marketplace this year, according to CMS.
California officials said it was too early to tell how many of the 1.1 million current enrollees have returned for 2015. In most states, consumers will be automatically re-enrolled in the same plan or one like it if they have not selected a plan by Dec. 15. They can switch before Feb. 15.

“The pace of enrollment is very strong,” Peter Lee, executive director of Covered California, told reporters Wednesday. The state is already on its way to meeting its goal of 750,000 new enrollees this year, Lee said.

He said he expected the momentum to continue, with more than 40 enrollment events planned through Dec. 15.

On the federal exchange, tens of thousands of people have started accounts but not yet selected a plan.

Charles Gaba, a blogger based in Bloomfield Hills, Mich. who accurately forecast 2014 enrollment, predicts that about 12 million Americans will enroll in exchange coverage in 2015.

The Congressional Budget Office had predicted about 13 million sign-ups for 2015, but in November, administration officials estimated about 9 million, in part because fewer employers than expected were dropping coverage and sending their workers to the exchanges. That includes those who re-enroll in coverage as well as new sign-ups.

Similar to last year, the biggest surge in enrollment is expected immediately before the Dec. 15 deadline to have coverage by Jan. 1 and then, right before Feb. 15, which is the final deadline to have coverage in 2015, Gaba said.

Dan Schuyler, senior director of exchange technology at consulting firm Leavitt Partners, said state exchanges are performing much better than they did last year, though there have been minor glitches.

Two state exchanges—Nevada and Oregon, switched to the federal healthcare.gov portal after abandoning their own failed software. Maryland, meanwhile, took software from the Connecticut exchange.

“It seems like state exchanges have turned the corner this year,” Schuyler said.

Jon Kingsdale, who oversaw the Massachusetts health insurance exchange from 2006 to 2010 and is a managing director of the Wakely Consulting Group, said customer call centers are also working better with better-trained staff.

One big challenge facing the exchanges, he said, is how well they “hand off” enrollments to health plans which was a problem in some states last year.

The exchanges also have to make sure automatic re-enrollment works later this month, Schuyler said. Many consumers who are automatically re-enrolled may be shocked to learn their plans have raised rates or changed their benefits, he said.

State and federal officials also have to keep reaching out to consumers. California’s insurance exchange has partnered with hospitals and medical groups to get the word out about the availability of coverage. The agency also stepped up advertisements, including a bilingual campaign featuring people who enrolled last year.

There has also been strong interest in Medi-Cal – California’s version of Medicaid, the state-federal program for low-income people. About 160,000 have applied and three-quarters were enrolled immediately, while the others are still going through the process, said Toby Douglas, director of the state’s Department of Health Care Services.  “It is clear that Californians’ desire for health coverage remains really strong,” he said.

Anna Gorman and Lisa Gillespie contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

For centuries, the central challenge in health care was ignorance. There simply wasn’t enough information to know what was making a person sick, or what to do to cure the patient.

Now, health care is being flooded with information. Advances in computing technology mean that gathering, storing and analyzing health information is relatively cheap, and it’s getting cheaper by the day. As computers continue to fall in price, the cost of sequencing a single person’s genome is tumbling, too.

Entrepreneur Dr. Patrick Soon-Shiong is working on wearable, real-time monitors to give doctors the ability to “interrogate” a person’s individual blood cells “all the way down to the atom level” to see how a given drug works or why it fails.

Information from patients around the globe could then be compared, in theory. Computers could ultimately help doctors match specific treatments at the molecular level to the people for whom they would work best. Software might also detect patterns in data that would suggest new uses for existing drugs.

Collecting biochemical and genomic data on billions of people around the world is just the tip of the data iceberg that a few dozen health information technology experts described recently in New York at a gathering sponsored by Forbes magazine.

“You now have all of health care digitized, which is pretty cool,” said Paul Black, president of the electronic health records company Allscripts.

But it’s still unclear how to make sense of all the digital information on a big-picture scale. “There’s different approaches in the marketplace to how you would make this all be actually valuable to people,” Black said.

Some doctors are finding it valuable to “see the community information, versus just the campus information,” meaning: If they know where their patients are going for health care beyond their hospital or office, and whether they’re actually filling all the prescriptions they’ve been given, doctors make different treatment decisions nearly 70 percent of the time, Black said.

Companies like Castlight Health are betting that they can come up with ways to analyze seemingly unrelated data about how and why people use health care to improve health and save corporations money.

Castlight’s Dr. Dena Bravata said, “We can now actually marry information from [corporate human resources] systems — Are you a high performer in your company? What’s your absenteeism been? — with medical claims to really understand that, among our high performers we’re having a lot of absenteeism because their kids’ asthma is not well controlled.”

There are concerns about privacy and data security. Blackberry CEO John Chen pitched his company’s mobile devices as secure enough to meet federal medical privacy laws. But the Forbes event was more focused on the potential benefits in the new Big Data world.

There’s a lot of optimism that having a more complete picture of peoples’ health and how they use the health care system will save insurance companies money, and drive health care premiums down. Kevin Nazemi, co-CEO of Oscar Insurance, believes that a new generation of wearable wireless sensors will soon help doctors detect health problems early enough to prevent expensive treatments.

But, Nazemi said, it’s still hard for insurance companies to justify investing up front in data systems when “the value is reaped in Year 4 or 5 in a market where [people switch insurance] on average every three years. You know, dollar in, 25 cents back. How do you think of that?”

David Goldhill, who runs a cable TV network and is the author of the book Catastrophic Care, is skeptical that technological breakthroughs, even if they make people healthier, will ever tame health care spending.

“We didn’t go from 4 percent to 17 percent of GDP on health care spending because Americans got a lot less healthy,” he said. “The increase in spending in health care isn’t because, ‘Oh my God, we’re sick and if we can just cure ourselves, it’s going to go away,’ ” he said. “It’s a business model issue, it’s the way we subsidize and manage demand.”

Some see a future when wirelessly enabled skin patches are cheap, common and accumulating personal health data on a massive scale, and all that data leads to better cures and detects health problems before they blossom into expensive diagnoses. Others, an era where every minute abnormality, dangerous or not, is identified and money is spent needlessly treating it.

Yale School of Medicine cardiologist and Shots contributor Harlan Krumholz is optimistic about medicine’s ability to reel in meaningful insights in that vast sea of data. But, he says, it’s going to require a major shift in culture in clinics and hospitals. He says it’s still the norm for doctors to rely on their memories to determine whether a given drug is right for a particular patient, “as if nobody’s walking with a computer on their holster.”

This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.