Author: books

During the first two years of the pandemic, the number of people working from home in the United States tripled, home values grew and the percentage of people who spent more than a third of their income on rent went up, according to survey results released Thursday by the U.S. Census Bureau.

Providing the most detailed data to date on how life changed in the U.S. under COVID-19, the bureau’s American Community Survey 1-year estimates for 2021 showed that the share of unmarried couples living together rose, Americans became more wired and the percentage of people who identify as multiracial grew significantly. And in changes that seemed to directly reflect how the pandemic upended people’s choices, fewer people moved, preschool enrollment dropped and commuters using public transportation was cut in half.

The data release offers the first reliable glimpse of life in the U.S. during the COVID-19 era, as the 1-year estimates from the 2020 survey were deemed unusable because of problems getting people to answer during the early months of the pandemic. That left a one-year data gap during a time when the pandemic forced major changes in the way people live their lives.

The survey typically relies on responses from 3.5 million households to provide 11 billion estimates each year about commuting times, internet access, family life, income, education levels, disabilities, military service and employment. The estimates help inform how to distribute hundreds of billions of dollars in federal spending.

Response rates significantly improved from 2020 to 2021, “so we are confident about the data for this year,” said Mark Asiala, the survey’s chief of statistical design.

While the percentage of married-couple households stayed stable over the two years at around 47%, the percent of households with unwed couples cohabiting rose to 7.2% in 2021 from 6.6% in 2019. Contrary to pop culture images of multigenerational family members moving in together during the pandemic, the average household size actually contracted from 2.6 to 2.5 people.

People also stayed put. More than 87% of those surveyed were living in their same house a year ago in 2021, compared to 86% in 2019. America became more wired as people became more reliant on remote learning and working from home. Households with a computer rose, from 92.9% in 2019 to 95% in 2021, and internet subscription services grew from 86% to 90% of households.

The jump in people who identify as multiracial—from 3.4% in 2019 to 12.6% in 2021—and a decline in people identifying as white alone—from 72% to 61.2%—coincided with Census Bureau changes in coding race and Hispanic origin responses. Those adjustments were intended to capture more detailed write-in answers from participants. The period between surveys also overlapped with social justice protests following the killing of George Floyd, who was Black, by a white Minneapolis police officer in 2020 as well as attacks against Asian Americans. Experts say this likely lead some multiracial people who previously might have identified as a single race to instead embrace all of their background.

“The pattern is strong evidence of shifting self-identity. This is not new,” said Paul Ong, a professor emeritus of urban planning and Asian American Studies at UCLA. “Other research has shown that racial or ethnic identity can change even over a short time period. For many, it is contextual and situational. This is particularly true for individuals with multiracial background.”

The estimates show the pandemic-related impact of closed theaters, shuttered theme parks and restaurants with limited seating on workers in arts, entertainment and accommodation businesses. Their numbers declined from 9.7% to 8.2% of the workforce, while other industries stayed comparatively stable. Those who were self-employed inched up to 6.1% from 5.8%.

Housing demand grew over the two years, as the percent of vacant homes dropped from 12.1% to 10.3%. The median value of homes rose from $240,500 to $281,400. The percent of people whose gross rent exceeded more than 30% of their income went from 48.5% to 51%. Historically, renters are considered rent-burdened if they pay more than that.

“Lack of housing that folks can afford relative to the wages they are paid is a continually growing crisis,” said Allison Plyer, chief demographer at The Data Center in New Orleans.

Commutes to work dropped from 27.6 minutes to 25.6 minutes, as the percent of people working from home during a period of return-to-office starts and stops went from 5.7% in 2019 to almost 18% in 2021. Almost half of workers in the District of Columbia worked from home, the highest rate in the nation, while Mississippi had the lowest rate at 6.3% Over the two years, the percent of workers nationwide using public transportation to get to work went from 5% to 2.5%, as fears rose of catching the virus on buses and subways.

“Work and commuting are central to American life, so the widespread adoption of working from home is a defining feature of the COVID-19 pandemic,” said Michael Burrows, a Census Bureau statistician. “With the number of people who primarily work from home tripling over just a two-year period, the pandemic has very strongly impacted the commuting landscape in the United States.”

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Evernorth, the health services arm of insurer Cigna, announced it has added five new programs to its digital health formulary, including offerings from Big Health and Quit Genius.

The new additions to the formulary are Big Health’s Sleepio digital therapeutic for insomnia and its Daylight tool for anxiety, Quit Genius’ alcohol use disorder and opioid use disorder programs, and HealthBeacon’s injectable medication adherence tool for inflammatory conditions.

Evernorth also announced four pilot programs, which will evaluate the chosen tools for clinical impact and user experience. Those pilots are Jasper Health for cancer care, Zerigo Health for psoriasis and eczema, Hinge Health’s new women’s pelvic health program and Lid Sync’s medication adherence tool. 

The subsidiary said the tools included in its formulary have been reviewed by physicians, pharmacists and user experience experts, and meet Evernorth’s standards for clinical effectiveness, security and privacy, value and usability. Health plan sponsors can choose to offer these digital health tools as part of their benefits.

“Evernorth continues to expand our Digital Health Formulary to address unmet health care needs of patients with chronic and complex medical conditions,” Dr. Glen Stettin, chief innovation officer at Evernorth, said in a statement. “The latest additions give patients access to new and affordable options to improve and maintain their health while making it easier and cost effective for our clients to include these solutions in their benefit plans. The Digital Health Formulary is one of the ways we can connect employers, insurers and patients with innovative, affordable and evidence-based care that meet their broader healthcare needs.”

THE LARGER TREND

Express Scripts, a pharmacy benefit manager that is now under the Evernorth portfolio, first announced plans to launch a digital health formulary several years ago. It also added new tools to the program in late 2020, including Wildflower Health’s app-based women’s health offering, Quit Genius’ program for smoking and vaping cessation, and muscle and joint pain programs from Hinge Health.

Evernorth has recently added other offerings in the digital health and health tech space, including a partnership with Bicycle Health for virtual opioid use disorder treatment and an expansion of its continuous glucose monitor coverage. It acquired telehealth provider MDLive last year as well. 

A recent survey of 1,300 physicians by the American Medical Association found more doctors saw digital health tools as an advantage for patient care this year compared with 2016. However, there are still concerns about quality and efficacy. A study published in JMIR earlier this year found many digital health startups weren’t clinically robust, lacking clinical trials or regulatory filings. 

Meanwhile, Big Health announced a $75 million Series C funding round early this year, while Quit Genius closed a $64 million Series B in 2021. Irish firm HealthBeacon went public late last year on Euronext’s growth market in Dublin.

Kyruus announced this week it will purchase patient engagement company Epion Health for an undisclosed sum, marking the provider search and scheduling firm’s second acquisition.

Kyruus offers tools for patients to help them find providers and schedule appointments, as well as a platform for health systems to match and maintain information about their providers. Epion’s services include online check-in, a telehealth platform and tools for connecting with patients, such as reminders to schedule preventive care or explaining pre-surgery instructions.

The companies said the combined entity will work with more than 500 health systems and medical groups. 

“Epion Health is a trusted partner to hundreds of health systems and medical practices,” Kyruus CEO and founder Dr. Graham Gardner said in a statement. “By bringing our solutions together, we are uniquely positioned to deliver an end-to-end offering that makes it easy for patients to find and schedule care, complete pre-visit tasks, and meaningfully engage with their providers regardless of where they begin their search.”

THE LARGER TREND

In late 2020, Kyruus announced plans to acquire patient navigation and price transparency company HealthSparq from Cambia Health Solutions. That deal closed in spring 2021. 

Kyruus announced it had raised $30 million in funding in June 2020, not long after a $42 million Series D round of funding. According to Crunchbase, Epion has a total funding pot of more than $10 million. 

There are a number of competitors in the patient engagement and communication space. UpFront recently announced a $10.5 million Series C round of funding, not long after the company announced it had acquired fellow engagement company PatientBond. 

Luma Health, which offers scheduling, messaging and provider referral tools, announced a $130 million Series C round in November last year, boosting its total raise to $160 million. 

ON THE RECORD

“This is a win for our customers who will now have a broader offering of solutions for their patients, including scheduling, while receiving the same high level of care and service Epion has provided over the years,” Joe Blewitt, Epion’s CEO, said in a statement. “The powerful combination of our platforms will make connecting with patients easier for providers and healthcare organizations of all sizes, in all markets, driving engagement in high-quality care that is convenient, accessible and efficient.”