Author Archives: David Sheon

Lowering Hospital Readmissions through Remote Monitoring of Post-Acute Patients: The University of Virginia Health System – Broad Axe Care Coordination Model

One of the less known policies of the Affordable Care Act, the Hospitals Readmission Reduction Program, requires that hospitals with higher than national average readmission rates for certain medical conditions and surgical procedures be penalized.  For many hospitals, the readmission penalties result in millions of dollars in profit lost.

David Sheon

David Sheon

A recent Wall Street Journal article shines a light on remote patient monitoring and post-acute care coordination, a service that is experiencing rapid growth and focusing on readmission rate reduction.  The service not only helps more people recover successfully from hospital stays, but it also keeps costs down for payers and helps hospitals avoid the risk of growing penalties.

According to an October 2014 article from Kaiser Health News, “Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released {recently} show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed.”

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Leading manufacturers of remote-monitoring equipment include Medtronic Inc., Philips NV and St. Jude Medical Inc., according to the Wall Street Journal article. Sales are expected to total about $32 billion this year, with a compound annual growth rate of 9.2% between 2014 and 2019.

In addition to addressing readmissions, effective remote monitoring represents an outstanding care redesign technique that can be implemented as part of a CMS bundled payment initiative, or as part of the quality program of an accountable care organization or clinically integrated network. The benefits accrue well beyond avoiding the penalties.

“The remote monitoring technology and implementation drives revenue issues beyond the CMS readmission penalties,” said John Kirsner, Partner, Jones Day, an expert on the implications of the ACA on hospitals. “In addition to the penalty avoidance component, this technology can assist in creating shared savings that result in additional topline revenue enhancement.”

Some remote monitoring programs are further along than those mentioned in the Wall Street Journal article. For instance, over a year and half ago, Broad Axe Care Coordination and University of Virginia Health System (UVA) partnered to design and execute a comprehensive platform combining services and technology to reduce readmissions for key conditions where Medicare was imposing penalties, including heart attack, heart failure, pneumonia and COPD.  Because of the success of the program and Medicare’s expansion of the penalty conditions, Broad Axe expanded its service at UVA to remotely monitor patients who had total joint replacements as well. The result for UVA has been a dramatic decrease in joint readmission rates, and a ready for prime time remote monitoring/care coordination program that can be put into place at hospitals across the country.

The system, called C3 at UVA, is a remote care management platform that combines telehealth services from experienced clinicians with robust analytics and an IT platform integrated with the health system’s EMR to provide UVA with a fully-outsourced care coordination solution.

BACC_Image for blog_SM (1)“Broad Axe offered us something unique: a care coordination center that combines outstanding technology with dedicated clinicians — RNs, LPNs, and CNAs — to deliver ongoing care transition and care coordination services,” said Amy L. Tucker, MD, Associate Professor of Cardiovascular Medicine, University of Virginia Health System.  “We’ve seen a great impact on the readmission rate.”

UVA and Broad Axe work together to look closely at those patients who are readmitted to see if the program can be further optimized.

For example, C3 can track not only readmission but when patients have follow-up visits.  The system also can help to ascertain whether patients are following their medication instructions. This provides important feedback to see what areas of opportunity are most important for the health system to target to improve patient care.

Broad Axe executives are pleased with readmission rate performance between 25 and 45 percent below historical benchmarks, depending on the condition and payer population, and the associated penalty savings for the hospital.

“Historically, the adoption of remote monitoring technology has been stymied by the lack of financial incentives to use the technology,” said Scott Edelstein, also a Partner at Jones Day, specializing in regulated medical technologies. “Recent CMS initiatives such as the Hospital Readmissions Reduction Program and new reimbursement codes for remote chronic care management are fueling a renewed interest in this technology. This should create significant opportunities to increase access to, and quality of, care while lowering costs.”

Do you work in a hospital consider remote monitoring? What are your concerns? Or are you a recent patient who has participated in remote monitoring? www.RealWorldHealthCare.org welcomes your feedback.

Categories: Cost-Savings, General

How to Manage an Outbreak: The Ebola Story

Last week, Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention (CDC), gave an update explaining how the current Ebola epidemic is being managed, avoiding an even more disastrous outbreak and avoiding many deaths worldwide.  Dr. Frieden spoke at a joint conference held by the Kaiser Family Foundation (KFF) and the Center for Strategic and International Studies (CSIS).

Ebola is one of the most deadly infectious diseases, causing death in at least 50% of those who become infected.  This is much higher than almost every other known infectious disease.

Dr. Thomas Frieden, Director, CDC

Dr. Thomas Frieden, Director, CDC

The fatality rate for influenza, by comparison is 1%, although far more people die from influenza because it’s more common.

There’s no preventative vaccine, treatment, or cure for Ebola.

The current outbreak, according to the Kaiser Family Foundation, stands at 23,132, with 42% of patients in Sierra Leone, 35% in Liberia, and 12% in Guinea.  All prior outbreaks of Ebola combined totaled about 10% of the current number of infected people.

The United States is by far the largest donor nation to the effort, having donated more than $2.4 billion, and the CDC plays a leading role, complete with boots on the ground, developing “best practices” to contain the virus.

The presentation revealed new U.S. public opinion data from KFF indicating that in 2014, Ebola was the most closely followed story, more than Ferguson, more than the missing Malaysian Air flight, and more than ISIS and terrorism.  The poll also indicated that as of December 2014, four in 10 believe Ebola is now under control.  In October 2014, that number was just one in 10.  In many ways, the public opinion is correct. New cases are dropping rapidly, though we are not yet out of the woods.  So what interventions by CDC and others helped make this turnaround happen?

“This is the most intensive response globally in CDC history,” said Dr. Frieden.  “We knew that for every one month of delay, the size of the epidemic would triple.  If we reached a tipping point where the majority [of Ebola patients] were safely identified and buried it would break.”

First, the CDC helped to diagnose the disease earlier in its staging by educating more health care workers on what symptoms to look for.  By knowing who is or may be infected sooner, the sick can be removed from locations where they might infect others.  The CDC’s efforts extend through providing, maintaining, and driving a fleet of 4 wheel drive vehicles throughout the effected regions to reach remote populations before the virus does and educating the population and health care workers about safety precautions. The CDC has worked quickly to change the culture around burials without compromising rituals and customs, by dressing the deceased in the clothes desired by the family while fully protected and behind glass so that the families can watch and approve.

How was the CDC able to move so quickly?  “There is no pro-Ebola lobby,” quipped Dr. Frieden.  “And this is a national security issue, which had strong support on both sides of the aisle. Health and health protection is an area where there’s common ground.  Public health systems remain a ‘best buy.’ It can have a major payoff not just in terms of lives saved, but social and economic stability too.”

“We’ve made tremendous progress,” said Dr. Frieden.  “The difference is night to day. Centers that used to be full of Ebola patients no longer are.  But there still are some centers where there used to be no cases but there now are.  We’re moving from a ‘build and bury’ stage – building treatment centers and burying the dead, to treatment phase.”

What’s next?  According to Dr. Frieden, an early detection diagnostic will be available soon.  That’s a good way to see that future outbreaks will be managed more expeditiously, resulting in fewer transmissions.

What do you think of the CDC’s ability to help contain Ebola?  While the U.S. is the largest donor, many nations donated as well.  Do you think we should lead the world in funding the effort to manage the Ebola outbreak?

What Happens When an Investigational Drug Cures Some Patients, but not Most?

David Sheon

David Sheon

To date, 179,158 clinical studies have been registered on ClinicalTrials.gov. Though the majority of these trials result in unsuccessful attempts to bring a drug to market, an untold number of lives have been saved or extended as a result of the successes.

But how many lives were saved by drugs that did not meet their clinical endpoint? Recently, the attention of the medical community has been drawn to “exceptional responders.” These are patients who, contrary to expectation, respond extremely well to drugs that are not found to be effective (or even safe) for use in the general patient population studied in a clinical trial.  The study doesn’t meet its endpoints, but a small number of patients thrive.

With the advent of relatively cheap and easy genetic sequencing, researchers are beginning to better understand why exceptional responders do so well on drugs that have little to no benefit for most patients.

In one case, featured recently in an article in The New York Times, a patient has been living four years with a cancer she was told was untreatable, because she responded well to an experimental drug. Of the seven people given the drug, she was the only one who responded. Sequencing her tumor’s genes, the researchers were able to determine that her response was due to the natural presence of a protein that her cancer needed in order to grow.  The experimental drug stops the production of the same protein. Doctors and researchers have been perplexed by these types of cases for years, yet have only recently been able to examine why this is occurring. Researchers at the National Cancer Institute have begun a study to “understand the molecular underpinnings of exceptional responses to treatment.”

Regardless of the science behind it, there is a very real, ethical dilemma raised by the existence of these exceptional responders. If the drug does not get approved, and especially if the company producing the drug  loses investors and goes out of business because the drug trial didn’t meet its endpoints, exceptional responders will have no way of accessing a treatment that could well save their lives just because of an anomalous genetic makeup. There is nothing in place to guarantee that these patients will be able to access their treatments, even if there are no other alternatives.

According to Wayne Pines, President of Regulatory Services and Healthcare at APCO Worldwide and former Associate Commissioner for Public Affairs at the FDA, however, this issue is not so clear-cut.

“There are a lot of factors that go into a decision as to what an individual patient should do.  Each decision has to be individual,” he said. “We must also take into account the fact that clinical trials are essential to determine if a new drug works and is safe, and there are limits to how much of an experimental product can be produced.”

All of this would seem to indicate that a blanketing policy for dealing with individual patients is not where we have to focus. The presence of the exceptional responder makes it difficult to determine a drug’s efficacy, especially when researchers cannot explain the patient’s response.

“If reasonable endpoints have not been met, then the question is whether the drug has the potential to work,” Mr. Pines said. “Again, this is a decision that has to be made on specific facts, not on the basis of a set policy. A general one size fits all answer to these kinds of questions does not work.”

Ultimately, more research must be done on these cases before making decisions about how to deal with them. With recent advances in molecular testing, hopefully the day is near when we can understand what causes a patient to respond exceptionally, and where to go from there.

What do you think? Should there be policies set in place to protect these patients? If not, how can we ensure that patients can access the drugs they need, when they need them? Let us know in the comment section.

Categories: Access to Care, General

The 21st Century Cures Initiative…And a Bold Plan

David Sheon

David Sheon

The one thing that Democrats and Republicans in the House of Representatives agree on is that they just don’t agree. It’s an old, tired state of affairs and the resulting gridlock affects everything from education to crime to defense. Thanks to two typical party rivals, this unfortunate paradigm may be shifting…all in the name of health and science.

Fred Upton (R-Michigan) and Diane DeGette (D-Colorado) have set aside their differences and joined together to lead the 21st Century Cures Initiative. The initiative marks the first time in memory that Congress is taking a comprehensive look at what steps can be taken to accelerate the pace of cures in America. With the backing of the Energy & Commerce Committee (which Rep. Upton chairs), The House of Representatives is looking at “the full arc of this process – from the discovery of clues in basic science, to streamlining the drug and device development process, to unleashing the power of digital medicine and social media at the treatment delivery phase.”

In a recent bylined article in The Hill, a newspaper read by members of Congress and their staff, Jim Greenwood, President and CEO of the Biotechnology Industry Organization, offers an idea that could take hold in the spirit of this ember of bipartisanship. His idea includes potential funding for a massive, long-term research study that will involve over 100,000 Americans and examine some of the most devastating diseases, including Alzheimers. Part of the study will be to identify biomarkers common to those who develop the diseases, which will then lead to cures. Once a biomarker is identified, drugs can be developed that hit that biomarker.

Mr. Greenwood, once a member of Congress himself, addressed the Upton-DeGette initiative during the Rare Disease and Orphan Product Breakthrough Summit held by the National Organization for Rare Disorders that convened in Alexandria, Virginia earlier this week.

Mr. Greenwood pointed out that many scientists have failed to find cures to diseases like Alzheimer’s because by the time the patient shows symptoms, the neurological damage is already done. His long-term biomarker study is designed to overcome this hurdle. Greenwood challenged the conference attendees to help think through how this could work to develop cures for rare diseases as well.

The 21st Century Cures Initiative recognizes that innovation is happening at lightning speed. From the mapping of the human genome to the rise of personalized medicines that are linked to advances in molecular medicine, constant breakthroughs are changing the face of disease treatment, management, and cures. Health research is moving quickly, but the federal drug and device approval apparatus is not keeping pace. And when the laws don’t keep up with the innovation, we all lose.

Representatives Upton and DeGette recognize that for more lives to be saved, Congress will need to take a comprehensive look at the process of getting drugs to market – from discovery to development to delivery with the simple goal of saving lives. Add Mr. Greenwood’s idea into the mix, and we may be able to save billions of dollars that would otherwise go to the long-term treatment of Alzheimer’s patients. More importantly, we could save millions of patients and their families the painful loss caused by the disease.

This makes so much sense that not even Congress can disagree. Will you tell your member of Congress to support this bipartisan initiative?  What do you think of it?

Inspiring Older Patients to Seek Online Communities: How the National Osteoporosis Foundation Engages Over 19,000 Middle-Aged and Senior Women and Men

David Sheon

David Sheon

By David Sheon

 

When it comes to talking about health, online communities are turning shades of gray.

Websites hosting online patient communities, such as Inspire.com, are bringing seniors together on a common platform where they can learn about their condition from other patients in similar situations.  Inspire offers discussion forums where patients can communicate to fulfill scientific, emotional, and practical needs regarding their medical conditions.

What sets Inspire apart from other online disease communities is the partnerships that it creates with condition-specific patient advocacy groups, including the National Osteoporosis Foundation (NOF), which works with Inspire to offer credible information and to deliver timely research and news of interest to the community of osteoporosis patients.

NOF is the nation’s only health organization dedicated specifically to promoting bone health.  NOF takes a strong stance on bringing awareness to the fact that one in two women, and one in four men over the age of 50 will have an osteoporotic fracture.  NOF informs the patient community and key opinion leaders that fractures caused without blunt force, such as the result of a car accident, typically are the result of low bone density.  NOF hopes to turn the tide of bone fractures from osteoporosis by raising awareness of prevention and treatment options.

Brian Loew and Claire Gill at the 2014 Patient Centricity and Advocacy Summit

Brian Loew and Claire Gill at the 2014 Patient Centricity and Advocacy Summit 

In their September 29th presentation at the World Congress Summit on Patient Centricity and Advocacy, Alexandria, Virginia, Brian Loew, CEO of Inspire, and Claire Gill, Senior Director of Marketing and Consumer and Corporate Outreach of NOF spoke of the successes that have come from their partnership, noting the dynamic growth of the osteoporosis community on Inspire.com.  The community has over 19,000 members, with about 500 new users every month.  Posted surveys and hot topics drive engagement.

“We check everyday online, answer questions, [and] send information,” said Ms. Gill. “We’ve never had a need to stimulate conversations.  There’s a robust dialogue on every imaginable topic.”

Osteoporosis patients are holding the majority of these conversations, with some contribution coming from family members and caregivers.  Because of the age of appearance of most bone-related diseases, these patients are usually over the age of 55.

According to Loew, “the online tax of usability for elderly people is either gone or dramatically diminished.”

“We know the age of new users on Facebook is older, and the growth of the online community is further proof that older users are here to stay,” said Gill.

Gill related her experience with this community’s adaptability to the Internet when NOF eliminated the option to immediately speak to an operator by telephone. Now, upon calling NOF, patients are directed to the website.  After the change was implemented, the site’s page views jumped from 60,000 to 100,000 per month, according to Gill. Callers could leave a message if they prefer, and would later be contacted.  Instead, many chose to go online.

The partnership between Inspire and NOF shows that middle-aged and senior patients are turning in record numbers to online communities to manage their health.  Does this surprise you? Would you recommend Inspire to a patient with osteoporosis that you know?

Artist Turned Health Advocate: An Interview with Regina Holliday

David Sheon

David Sheon

By David Sheon

Artist Regina Holliday uses her talent to change the way health care professionals see and experience their patients.  Her innovative approach to draw attention to the needs of patients to be treated as individuals has already impressed thousands of health care practitioners.

 

When her husband suddenly became sick in early 2009, she saw the flaws in the health care system first-hand.  Now, she uses unique art to advocate for patients and push for changes in health care.  Holliday, joined now with other artists she’s inspired, paints patient stories on the backs of blazers and lab coats, so that they can be worn to medical summits and conferences. When doctors, policy makers, and hospital administrators see these jackets, they are reminded to put patients first and view each for their own unique health history.

 

Through her ambitious initiative, “The Walking Gallery,” Holliday and other artists have painted over 300 jackets, each worn by a proud patient, family member, or friend.

 

Patient advocacy needs fresh ideas, and we admire what Holliday is trying to do, so we interviewed her recently.

 

The Walking Gallery at the 2011 Health Innovation Summit at The Kaiser Permanente Center for Total Health
(Source: https://www.flickr.com/photos/taedc/5824507774/in/photostream/)

 

 “Don’t tell me to zip it”- By Regina Holliday (Source: http://reginaholliday.blogspot.com/2012/06/walking-gallery-walks-on-year-two.html)

“Don’t tell me to zip it”- By Regina Holliday
(Source: http://reginaholliday.blogspot.com/2012/06/walking-gallery-walks-on-year-two.html)

RWHC: How did you become interested in health care issues?

Holliday: I became involved in health care after my husband, Fred Holliday, was hospitalized in 2009 and we saw how dysfunctional things could be.  He was admitted to five facilities in 11 weeks. He died in home hospice during the 12th week.  We had trouble accessing his medical record and I became an advocate for patient data access.

 

What issues particularly interest you right now?

I study patient data access, the intersection of art and health, hospital hygiene and national autopsy rates to name a few areas of interest.

 

If you weren’t a patient advocate, what would you be doing?

I would probably still be selling toys at my old toy store and teaching pre-k art.

 

What are you most proud of achieving throughout your time as a patient advocate?

I testified in 2010 to make sure that patient data access was included in Meaningful Use as a core measure. It was.

 

[Meaningful Use is a government regulation that provides incentives to providers to show that electronic health records are being used in meaningful ways by reaching certain thresholds.  The first threshold includes capturing all patient’s electronic health records in a standard format.  The second threshold focuses on increasing the access of medical records to other health professionals, including hospitals, pharmacies, and labs. The final threshold focuses on improving overall public health with better quality assurance, safety, and efficiency of health care by using these health record databases.]

 

What is the greatest lesson that you have learned along the way?

Never give up. Perseverance wins in the end.

 

What is the most important thing that you want our readers to take away from this?

You can do great things even if you are one person.

 

How can our readers get involved?

I highly recommend using Twitter if you are focused on a cause in health care.  Tweets can help you crowd source and crowd fund.  You will make many friends while helping patients.

 

How did the idea for The Walking Gallery come about?

The Walking Gallery exists because Jen McCabe followed me on Twitter on May 30th 2009.  That was the day before I placed the Medical Facts Mural in Pumpernickels Deli on Connecticut Ave.  That was a day when my Fred was still alive and could speak and eat again because of the wonderful care he was receiving in Washington Home Hospice.  On August 20th, she emailed me after I had posted a comment on her blog and asked me if I would paint a series of paintings on the back of her blazers to wear to upcoming health meetings.  I told her I would be honored to paint jackets for her. The art jacket were the first part of the origin of The Walking Gallery.

 

In April of 2011, I went to an event with Ted Eytan, MD at the new Kaiser Permanente Center for Total Health.  I told him the space was so beautiful that we should do a gallery show there.  He said that they would never let us nail into the smart walls to place canvas work.

 

I told him the art would not be on the walls.  We would wear the art and each be a docent of our own lives.

 

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What is your favorite thing about The Walking Gallery?

Every one has a patient story and all are welcome.

 

Do you have a favorite jacket?

No. I love each for its unique story.

 

We noticed in your video that other artists are encouraged to paint these medical stories for The Walking Gallery, what can we do to help to inform other artists to join in this effort?

It is my hope that people will watch [this video] and paint the stories of patients far and wide.

 

What are you hoping The Walking Gallery will change?

I hope that when members of The Walking Gallery meet people they talk [about] the most important moment in their life and then that reframes their entire conversation on health care.

 

How can our readers have their health story painted on a Walking Gallery jacket?

Reach out to me. I get them done eventually. Otherwise, if you know an artist explain the concept and you can join together.

 

What’s next? Where do you see this going?

Next summer, I am planning a conference that will be a kind of Burning Man meets health care. That will be June 4-6, 2015 [in] Grantsville, MD #Cinderblocks is our hashtag.

Categories: General

Research America Wants YOU to Support Public and Private Sector Investment in Research!

We’ll be live blogging today from the National Health Research Forum: Straight Talk about the Future of Medical and Health Research at Newseum.  Sponsored by Celgene, Johnson & Johnson, Onyx Pharmaceuticals, TEVA, Genentech, University of Maryland School of Medicine, and HudsonAlpha Institute for Biotechnology, we’re pleased to bring you updates from inside the room!

{Note from Editor: our updates below paraphrase speaker comments so that we can share the points being made in real time without the benefit of a recording to verify or use a transcript}

The first panel is titled, “Where will medical research be in 2023?”

We’re underway with our first panel.  Dr Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, is told that he does a good job of advocating for his division. Has the pendulum shifted away from investment in research?

Dr. Fauci: When you have even a modest increase in a budget, you can preserve the fundamental research activities. But the problem is the budget has been flat for 10 years and inflation takes a bigger toll. As a nation we have to make a commitment that fundamental research should not be part of a discretionary pool.  So any cutting of a budget hits the discretionary pool.  Some people get it and some don’t when we tell this story that basic research is what it is we’ve done for you.  Five years from now we’re not going to be able to tell anyone if we continue to stay flat and not even account for inflation.

John Seffrin, PhD, CEO American Cancer Society: Research America has doubled the NIH budget in a period of five years.  But we haven’t made the case to the public to explain the need for long term investment.  The tsunami of non-communicable diseases coming down the road – we need to convince the public of the need to invest.

France Cordova, PhD, Director, National Science Foundation: Industry gets the need to invest in basic research and advocacy for it, but it seems to be number 10 on the priority list.

Dr. Fauci: I can assure you that no one will stop me and say, with regard to the ebola outbreak, why didn’t we invest more in basic research years ago?  They’ll say: why don’t you have a vaccine now?

Dr. Cordova: We need to make science more accessible, to what I like to call “K to gray.”  With this science is accessible to all ages.

Panel 2: Code Red Again: Can We End the Assault on Public Health Research and Practice

Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention: We save $3 for every $1 invested in vaccines, in the health sector alone, and $10 overall…..

Only for this event would I take an hour off from ebola.  The ebola epidemic is worse than is recognized. Reported cases are a small fraction of the total.  Despite maximum efforts – 100 field officers – the largest response in CDC history.  If we had  invested in systems that would find, respond, prevent we could have prevented this disaster…..

Public health is a “best buy.” It keeps us safe and prevents disaster. Every dollar investment in public health pays off.  Ebola, drug resistance – ongoing threats – it will take a funding commitment and partnerships. We at CDC have a partnership with CMS that never existed before.  Public health is the governments responsibility but the government can’t do it alone…..

Handwashing in hospital is not up to par, neither is blood pressure maintenance. We have room to grow in health quality.  Hospital acquired infections are too common…..

The average person can have a big impact on the government. One person is able to change policy. One person made government improve and keep open TB clinics in NY….

With regard to health disparities, high blood pressure and heart attacks is the single largest cause of differences among the races.  The second big issue is teen pregnancy.  These are two areas where intervening makes a huge difference.

Georges Benjamin, MD, Exec Director, American Public Health Association.  The public thinks we have a better protection system than we do….

Seeing your doctor 2-4 times a year is a system where patients think they are staying healthy, but many times this is not effective.  We need to create a better system to keep patients healthy.  Prevention Research should be funded more…..

Saying that you support research, and actually voting to increase or keep funding for research is different.  We need to hold policy makers accountable. Meet with local or state elected officials, with out an agenda, so when you do have an agenda they are more willing to help….

Lynn Goldman, MD, MS, MPH, Dean, Milken Institute School of Public Health, George Washington University:  In the US we feel comfortable that we have systems in place, however it would be possible for a slightly different pathogen to arise that we could not protect ourselves from. We’re doing very little about antibiotic resistant pathogens. We’re not going to be able to control something like that…..

The pay off for the American tax payer is tremendous for increasing vaccinations…..

Richard Kronick, PhD, Director, Agency for Healthcare Research and Quality, HHS: Is there a perception problem? Yes. The public can see that price and accessibility are not perfect, but most people see safety and quality as a non-issue, when it is, especially in less developed countries…..

Where are where failing? What can your organization do better? and in what time frame? This should have been done yesterday.  We need to not only produce evidence, but make sure that this evidence is used.  We have funded work to show how low-income children are overly prescribed anti-psychotics, but we are not able to implement any rules or policies to change this. ….

Jack Watters, MD, VP, External Medical Affairs, Pfizer: The happiest news is that we are all living longer – a cause for celebration. One of the best thing that’s happening is that healthy younger people are living to be healthier older people…..

I see far more appetite for public/private partnerships, in research, in delivering public health. We should recognize that we are all in this together and we must partner more – I welcome the increased appetite……

Seeing a doctor a couple of times per year is better than not at all, but we need to increase contact between all health professionals and patients (nurses and pharmacists)….

We are seeing an improvement in the private sector.  There is a shift in the appreciation to public health by the pharmaceutical industry. Some money is being used for research, but it is harder to convince policy makers for more.  Public health problems are not as “sexy” as proactive research in medicine for uncured/treated conditions…..

There are simple things we can do to increase public health, for example with depression, just asking a person could make a significant difference.

Panel 3: What’s Right – and Wrong – with the Research Ecosystem?

Moderator Margot Sanger-Katz, Health Care Correspondent, The New York Times:

Pablo Cagnoni, MD, President, Onyx Pharmaceuticals: What do you think of the US Research system? We are not moving as quickly as necessary, we could be moving more quickly. From lab to market, the timing is too long.  That being said, we still have the best ecosystem in the world.

The competitive system keeps priorities in the wrong place.

We have to extend Dr Woodcock’s good work to CBER and get companion diagnostic testing approved rapidly.

There are 2 areas where “big data” is playing out. One is in research, more importantly another is in utilization.  Are we utilizing the right drugs with the right patients?

Kathy Giusti, MBA, Founder and CEO, Multiple Myeloma Research Foundation (was unable to make it to the event)

Robert Hugin, Chairman, CEO, Celgene: What do you think of the US Research system? I think that it is a fact that we have the best research system in the world.  Yes we still need to improve, but we always need to. We have a very competitive system, that makes for a great spirit in the science community, and we are always improving. Transational medicine (bringing research to the patients) does not get the visibility, but it is important and appreciated.

We need to provide more economic incentives to collaborate, to avoid redundancies between different research centers. More transparency would help this problem.

Ways to improve- Prevention research by asking for congressional help, more investments.

At $1.5 billion per drug who can sustain this? Something has to change. It’s not sustainable. We must review the system.

With regard to the increasing costs of drugs: I think we look at this in an inappropriate way, the only way we can capture costs is through price. If someone could create a drug that can cure a cancer (and avoid downstream costs), we have to remember that.  The overall impact is very positive. We do a better job than Europe with access.  We should never be embarrassed to talk about it.  Taking cancer for example. In 1970, the cost was 1 percent of spending for oncology drug spending, now it’s at .5 percent.  Remember, the generics didn’t discover those drugs – they wouldn’t have them without our research. Exchange programs discriminate against the working poor – at Fred Hutch, Memorial Sloan Kettering, MD Anderson, people are kept out of those excellent care facilities….CBO says when Rx costs rise, other healthcare costs go down.  We want to talk about Lindsay Lohan and rehab instead of better access to care.  We have this discussion backwards. (Applause)

We are finally able to bring technology to the research because of the high costs. Ten years from now, our lives will be fundamentally different, because of (advances)…

E. Albert Reece, MD, PhD, MBA, Dean, University of Maryland, School of Medicine: What do you think of the US Research system? Our system is very rigorous, and it works very well, but it is not perfect.  Looking at other countries, our research infrastructure is more rigorous, and that is our strength. Our weakness is that we are not sustainable.

Boom or Busts in research, training young people takes a long time, so there is a constant roller coaster in the amount of researchers that we have. The amount of researchers that we needs is constantly changing also.

I agree with Bob, there have to be improvements and legislation to increase efficiencies.

Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, FDA: What do you think of the US Research system? We don’t have the infrastructure necessary to carry the information, that we find through our research, to the American public, and to implement new findings.

Is money being spent in the right way on the right research?  A problem that we have is that a big amount of research is not able to produce the same findings more than once. We need to be more intentional with research. We are trying to change the way that clinical evaluation is done. It is too expensive and not sustainable. We should not have a brand new clinical trial for every single experimental drug, we need to come up with a system that can be reused, and is therefore more sustainable.

How does the regulatory system change the research ecosystem? It creates a lot of challenges, we’re seeing a shift in pharmaceutical research to drugs that depend on genome, more precise medicine. Because this is so new, there are a lot of uncertainties.

Unless we change the cost and drug development process, then we will not keep improving.  We don’t have the right science to actually make the right drugs, only 2/10 drugs even make it to trials. Efficiency needs to change, and this can change through changing the drug manufacturing process.

Our healthcare system is poorly designed when it comes to non-drug interventions. The final translation into practice – we’re trying to look at more patient centered measures to look for ways to benefit through proven, unconventional benefits.

 

Categories: General

How a Teaspoon of “Exponential Growth” Learning Can Help Keep the Doctor Away

A certain doctor of mine, who shall remain nameless, refuses to use anything but the fax machine to communicate with his patients when they are not in the office.  Need a copy of your invoice with his name, license number, and the billing codes for service? His office is happy to fax or mail it, but if you want it scanned and sent by email you’re out of luck.

How 1994 is that?

David Sheon

David Sheon

If exponential growth trends in medicine hold true, the doctor’s office that refuses to keep up with technology will have little choice but to close its doors.  In this post, we’ll take a close look at exponential medicine and the growth model behind it.   Most of the new technologies includes instantaneous transfer of data for medical records or to otherwise benefit patients.  We’ll take a look at some examples of the future of medicine derived from advances in hand-held technology.

Week in and week out, RealWorldHealthCare.org focuses on advances in healthcare delivery that improve patient outcomes.  But when we’re looking at combining healthcare with technology, it’s important to understand a concept called Moore’s law.  Named after Gordon Moore, co-founder of the Intel Corporation, Moore’s law is the observation that, over the history of computer hardware, the number of transistors in a dense integrated circuit doubles approximately every two years.  Similarly, cost is cut in half in about the same period.  Moore’s law has been used successfully to accurately help predict the timeframe for advances in artificial intelligence, biotechnology, nanotechnology, medical apps, and other computer assisted technologies.

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Understanding the implication of doubling every two years within medical technology requires understanding that many real world phenomena can be modeled by understanding exponential growth.  Think of phenomena such as the growth or shrinking of populations, bacteria and viruses such as HIV/AIDS, radioactive substances, electricity, or temperatures impacted global warming.

Activities that evolve by a fixed percent at regular intervals exhibit exponential growth.  This is different than our typical linear concept of growth.  If you were asked to walk 30 steps out your front door, even without walking an inch you’d have a pretty good idea of where you’d end up standing.  But take 30 exponential steps so that first you walk one step, then two, then four, then eight and by the 30th exponential cycle, you will have walked over a billion steps from your front door.

One example of Moore’s law and exponential growth is that the typical smart phone today has as much computing power as all of NASA had in 1969.  And it’s built at a tiny fraction of the 1969 cost to NASA.

So where is exponential growth taking medical apps?

How about GE’s new handheld Vscan, which can deliver high quality ultrasound easily and send the file directly to a patient’s electronic medical record so that it can be pulled up by any doctor at any hospital, any time you come in?

Looking to make sure you are staying compliant with your asthma treatment? The Assist Me, by Use Inhalers App has you covered. Your doctor will learn whether you are using the inhaler as frequently as you should.

Would you like to have inexpensive real time heart monitoring, with your heart rate, blood pressure, and pulse rate sent directly to your doctor so that on your next visit she can offer medical advice based on long term data? AliveCor turns your Android or iPhone into an FDA cleared device for that purpose.

“Today, healthcare is in many ways being practiced as it has been for millennium — as ‘SickCare’ — using old, reactive models and mindsets where the FAX machine is still the primary mode of sending patient information, where data is still silo’d amongst paper charts or rudimentary EMRS, and feedback loops between clinician and patient are broken or limited,” says Daniel Kraft, M.D., Conference Chair of Singularity University’s Exponential Medicine program, which gives a front row seat to those interested in seeing the next exponential step in medical technology.  “But we are living in a fast moving, exponential age, where the convergence of rapidly developing technologies are enabling vast new capabilities with the potential to radically improve and disrupt the future of wellness, prevention, clinical practice and to address many of the grand challenges facing the healthcare and biomedical industry across the planet.”

If medical technology can communicate so instantly and successfully with us, then there is no reason that doctors can’t be more responsive using more current technology to communicate with patients.

Does your doctor still rely on 20 year old technology to communicate? Have you tried wireless disruptive medical technologies?  Tell us about your experience!

Categories: Access to Care, General

Keeping Minds of Seniors Sharp: Some Answers Emerge

As a member of the Atari Generation, I remember my parents telling me to limit my time playing video games. Well guess what? Now I can tell them that if they want to improve their ability to fight cognitive decline, they should increase their time playing video games – at least when it comes to the games from www.Lumosity.com. A well-designed study published in PLoS One found cognitive benefits for seniors. No, this is not a paid advertisement. None of the funding for the study came from Lumosity. The study was funded by the government of Spain.

David Sheon

David Sheon

Let’s back up a bit. America is aging. As the massive number of baby boomers reach their twilight years, we’re well served to think through the implications of a couple of statistics mentioned on the recent 60 Minutes story, Living to 90 and Beyond. The fascinating story finds compelling evidence that as we age, drinking a glass of any alcohol a day, consuming coffee, and gaining weight (but not to the point of obesity) all increase the chances of living past 90.

The story also mentions that by about 2050, the number of Americans over age 90 is projected to quadruple. It also reports that the risk of developing dementia doubles every 5 years starting at the age of 65.

Although more research needs to be done before we can say that games for your brain delay dementia, we can say that Lumosity improves the ability of seniors to stay attentive and alert thanks to the Spanish-funded study by Julia Mayas et al.

Recently, research on aging has begun to examine cognitive “plasticity” in seniors and its capacity to counteract cognitive decline. The aim of the Spanish-funded study was to investigate whether older adults could benefit from brain training with video games, with additional distractions, like randomly generated noises created by the researchers, to assess distraction and alertness.

For example, participants were presented with a sequence of numbers on the screen that they labelled as “odd” or “even” while ignoring irrelevant sounds such as drilling, rain, or hammering, just before being shown the number. In most trials the sound was consistent, while in a small proportion of the trials, interspersed at random, the standard sound was replaced by a random sound not presented earlier in the task. Other studies have shown that random sounds seemed to startle and take study volunteers off task, if only for a second or two.

The researchers hypothesized that if video game training improves auditory attentional functions as it does visual attention or executive functions, then older adults in the study who used Lumosity for training would show reduced distraction and maintain their level of alertness or prevent its decline.

Forty healthy adult volunteers aged 57 to 77 years were randomly assigned to either the experimental or the control group. The study was completed by 15 of the 20 participants of the experimental group and 12 of the 20 members of the control group. All participants had normal hearing and normal or corrected-to-normal vision. In addition to the random noise task, all participants completed a battery of cognitive tests to be sure that participants in both groups had similar capabilities.

Each participant assigned to use the computer video games had 20 sessions of game training. They practiced 10 video games selected from Lumosity’s commercially available package. The games practiced were specifically designed to train a variety of mental abilities, including speed of processing and mental rotation, working memory, concentration, and mental calculation.

Points were awarded to participants based on their performance and on the time taken to complete the games. To make sure the data wasn’t biased, participants were not allowed to play any other video game during the study. None of the participants reported any previous experience with video games. The control group did not receive video games training but participated in three group meetings during this time in which they socialized with each other but didn’t try the games.

All participants were measured for the ability to cope with distractions and stay alert before and after the study. On both accounts, those who used the video games improved compared to those who did not do the video games.

The ability to ignore irrelevant sounds improved after video game training by about 12 milliseconds, while those in the control group saw no improvement.

Similar pre- and post-training comparisons showed a 26 millisecond increase of alertness in the experimental group with no significant difference in the control.

One thing that makes this study stand out is its ability to transfer findings from the computer games to real-world improvements.

According to the study authors, “practicing video games of this type may offer some protective factor against the effects of aging and may potentially be recommended to older individuals, alongside other interventions found to improve mental functions. These include, for example, a long-term physically active lifestyle (improving executive control and speed of processing), aerobic exercise (improving cognition by increasing the volume of grey and white matter in frontal and temporal sites), or social networking and innovative solutions to connect people in a multimodal way with family members, friends and caretakers.”

So I guess that like when my parents told me to put down the joystick and play outside, I get to remind them to do the same. Just don’t be quick to dismiss video games as part of the equation to a healthier mind in our senior years.

Do you use Lumosity or any other brain training program? Have you noticed it helping you? We’d love to hear about it.

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care