Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Most Americans grateful for their job's health coverage, but still struggle with healthcare costs

Most people with employer-sponsored insurance are generally happy with their health plans, but many still struggle with healthcare affordability, according to a Kaiser Family Foundation/Los Angeles Times survey.

Becker's Hospital Review

Friday, May 3, 2019

Insys’s John Kapoor Is First CEO Convicted of Opioid Racketeering

Insys Therapeutics Inc. founder John Kapoor was convicted of a racketeering conspiracy that drove sales of a highly addictive opioid while contributing to a nationwide epidemic.


Friday, May 3, 2019

Budget office: Caveats to government-run health system

Congressional budget experts said Wednesday that moving to a government-run health care system like “Medicare for All” could be complicated and potentially disruptive for Americans.

AP News

Thursday, May 2, 2019

Medicaid Work Requirements Hit Roadblocks

Toward the end of 2018, the Trump administration seemed to be marching briskly toward its goal of requiring able-bodied adults in Medicaid to prove they had jobs to participate in the public health plan for the poor.

Pew Trust

Wednesday, May 1, 2019

Officials declare measles outbreak in Pacific Northwest over

A measles outbreak that sickened more than 70 people, mostly children, in the Pacific Northwest is finally over even as the total number of cases nationwide continues to spike to near-record levels, officials said Monday.

AP News

Tuesday, April 30, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

Medicaid, CHIP enrollment for kids dropped by 861,000 in 2018

An estimated 861,000 fewer children were covered by Medicaid and the Children's Health Insurance Program in 2018 compared with the year before, according to an analysis by Georgetown University's Center for Children and Families drawing on new CMS data.

Thursday, April 25, 2019 

Anthem Beats Earnings Estimates, Outlines Plans for Pharmacy Benefits Unit

Anthem Inc on Wednesday posted a better-than-expected quarterly profit and laid out its plans to transition most customers to its revamped pharmacy benefits business this year.

NY Times

Thursday, April 25, 2019

Pharma Lobby Nears Spending Records With Drug Prices Under Fire

Large drug makers and the industry’s primary trade group neared previous spending records on lobbying in the first three months of the year as President Donald Trump and Congress increased pressure to rein in the cost of medicine.


Tuesday, April 23, 2019 

More than 1 million Americans have lost health insurance since 2016

More than 1 million Americans have lost health insurance coverage since 2016, according to a new report from the Congressional Budget Office (CBO).

The Hill

Monday, April 22, 2019 

Hospitals Stand to Lose Billions Under ‘Medicare for All’

For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.

NY Times

Monday, April 22, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.


Robots Need DNA Too

by Kim Bellard, April 22, 2019 

DNA, it seems, never ceases to amaze. Now scientists are using it to create new kinds of "lifelike" mechanisms.   Pandora, we may have found your box. 

Researchers from Cornell recently reported on their advances.  They used something called DASH -- DNA-based Assembly and Synthesis of Hierarchical -- to create "a DNA material with capabilities of metabolism, in addition to self-assembly and organization – three key traits of life."

That sends chills up my spine, and not necessarily in a good way. 

Lead author Shogo Hamada 

The designs are still primitive, but they showed a new route to create dynamic machines from biomolecules. We are at a first step of building lifelike robots by artificial metabolism.  Even from a simple design, we were able to create sophisticated behaviors like racing. Artificial metabolism could open a new frontier in robotics.

The reference to racing in his quote refers to the fact their mechanisms were capable to motion -- likened to how slime mold moves -- and they literally had their "lifelike materials" racing each other.  If I'm reading the research paper correctly, the mechanisms were even capable of hindering their competitor."

Well, that's lifelike, all right.

It wasn't all days at the race track; oh-by-the-way, they also demonstrated its potential for pathogen detection, which sounds like it could prove pretty useful.

These mechanisms eat, grow, move, replicate, evolve,and die.  Dr. Luo 
says: "More excitingly, the use of DNA gives the whole system a self-evolutionary possibility.  That is huge."  Dr. Hamada adds: "Ultimately, the system may lead to lifelike self-reproducing machines."

Those chills are back.

There has been a lot of attention on engineering advances that will allow for nanobots, including uses with our bodies and so-called "soft robots," but we should be given equal attention to what is called synthetic biology.

Synthetic biology isn't necessarily or even predominately about creating new kinds of biology, as the researchers at Cornell are doing, but reprogramming existing forms of life. They're being programmed to eat CO2 (thus helping with global warming), help with recyclingget rid of toxic wastes, even make medicines

A Columbia researcher 
believes that new techniques for programming bacteria, for example, "will help us personalize medical treatments by creating a patient’s cancer in a dish, and rapidly identify the best therapy for the specific individual."

In the not-too-distant future, we're going to be programming lifeforms and "lifelike materials" to do our bidding at the molecular or cellular level.  We've been debating and worrying about when A.I. might become truly intelligent, even self-aware, but the Cornell research is giving us something equally profound to debate: how to draw the line between "life" and "things"?

Medicine, healthcare, and health are going to have to develop more 21st century versions.  What we've been doing will look like brute force, human-centric approaches.  Synthetic biology and molecular engineering open up new and exciting possibilities, and some of those possibilities will upend the status quo in healthcare in ways we can barely even imagine now.  

It's not going to be enough to think of new approaches.  We're going to have to find new ways to even think about those new approaches.  

In the meantime, let's go watch some DASH dashes!


This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting. 


Five Sterile Processing Questions for Stephen Cuthbertson, College Medical Center and Jeremy Gibson-Roark, DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, April 18, 2019

Improvement, Regulatory Compliance & Case Management of College Medical Center in Long Beach California, and Jeremy Gibson-Roark, a lead clinical and certification surveyor with DNV GL Healthcare, participated in a Healthcare Web Summit discussion on sterile processing.

If you missed this informative webinar, Is Your Sterile Processing Department Safe? Risks and Opportunities in Sterile Processing, watch the On-Demand version here. After the webinar, we interviewed Stephen and Jeremy on five key takeaways from the webinar: 

1. What are a few of the opportunities you've identified in sterile processing departments for quality improvement? 

Jeremy Gibson-Roark: 

  • IUSS use
  • Tray Completion – All instruments accounted for and delivered
  • Instrument Quality
  • Instrument/Set Availability
  • Tray Management – Removing and repurposing of trays not being utilized
  • Tray Management – Condensing of trays to reduce volume of processing  

2. How does the certification in sterile processing benefit the patient? 

Jeremy Gibson-Roark: It allows an organization to ensure that a Quality Management System (QMS) is in place in the sterile processing department.  This system should be designed to achieve continual improvement in the department.  The benefit to the patient is the assurance that the organization has dedicated the resources and leadership to the processing of surgical/medical instrumentation. 

3. Why were you interested in obtaining Sterile Processing Program Certification for your hospital? 

Stephen Cuthbertson: We wanted a certification to set us apart from our local area hospitals. After review of the SPPC standards, we felt confident we could achieve the certification. We don’t have the volume for attempting, stroke, VAD, or hip and knee, etc… 

4. What are some of the key steps involved in the certification process? 

Stephen Cuthbertson: I think the biggest key steps are first understanding that the standards speak to and expect to see data, policies, QMS, etc.., specific to the SPD. The document review is extensive and the tour of the various departments affected by SPD are the other big steps. It’s also important to realize that the nonconformities aren’t a bad thing, they assist the organization in improving their patient safety related to SPD. 

5. Is certification only available for Hospital? 

Jeremy Gibson-Roark: This is the only certification available for the Sterile Processing Department in the United States. While individual certification is available through other organizations, DNV GL is the only organization that will certify a hospitals SPD.


CVS Caremark PBM Releases Its Own Report Card and Gives Itself A’s

by Clive Riddle, April 12, 2019

CVS Health’s Caremark PBM has just released their annual Drug Trend Report, and tells is that they “blunted the impact of drug price inflation achieving a negative -4.2 percent price growth for non-specialty drugs and a 1.7 percent price growth for specialty drugs. Furthermore, 44 percent of CVS Caremark's commercial PBM clients saw their net prescription drug prices decline from 2017 to 2018.”


In the 12-page report, CVS Caremark notes that while medical costs have increased by 14% since 2013, their member average cost per 30-day Rx decreased 8.4% during that time, from, $11.96 to $10.95. They also remind us Non specialty brand AWP increased 8.1% last year, and specialty brand AWP increased 7.6% last year, while overall U.S. inflation increased 1.9%.

CVS Caremark reports that specialty drugs account for 1% of their Rxs, but 45% of their pharmacy spend.  They cite specialty drug cost growth as the number one trend to keep on your radar going forward. The rest of the top five trends:

2) Integrated management of specialty drug spend that falls under the medical benefit, given 45% of the specialty spend falls under medical benefits

3) Addressing pharma manufacturer innovations in marketing and product protection to reduce market competition

4) Strategies to improve medication adherence for chronic disease patients

5) Identifying “bad actors” through analytics

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