Friday
Oct312014

Top Ten Medical Innovations for 2015

By Clive Riddle, October 31st, 2014

The Cleveland Clinic annually announces their take on the Top Ten Medical Innovations that are likely to have major impact on improving patient care in the coming year. They have just released their ninth annual version of this list, selected by a panel of 110 Cleveland Clinic physicians and scientists. With no further adieu, here – verbatim – is their narrative on their compilation of the Top 10 Medical Innovations for 2015:

  1. Mobile Stroke Unit
    Time lost is brain lost. High-tech ambulances bring the emergency department straight to the patient with stroke symptoms. Using telemedicine, in-hospital stroke neurologists interpret symptoms via broadband video link, while an onboard paramedic, critical care nurse and CT technologist perform neurological evaluation and administer t-PA after stroke detection, providing faster, effective treatment for the affected patient.
  2. Dengue Fever Vaccine
    One mosquito bite is all it takes. More than 50 to 100 million people in more than 100 countries contract the dengue virus each year. The world's first vaccine has been developed and tested, and is expected to be submitted to regulatory groups in 2015, with commercialization expected later that year.
  3. Cost-effective, Fast, Painless Blood-Testing
    Have the days of needles and vials come to an end? The new art of blood collection uses a drop of blood drawn from the fingertip in a virtually painless procedure. Test results are available within hours of the original draw and are estimated to cost as little as 10% of the traditional Medicare reimbursement.
  4. PCSK9 Inhibitors for Cholesterol Reduction
    Effective statin medications have been used to reduce cholesterol in heart disease patients for over two decades, but some people are intolerant and cannot benefit from them. Several PCSK9 inhibitors, or injectable cholesterol lowering drugs, are in development for those who don't benefit from statins. The FDA is expected to approve the first PCSK9 in 2015 for its ability to significantly lower LDL cholesterol to levels never seen before.
  5. Antibody-Drug Conjugates
    Chemotherapy, the only form of treatment available for treating some cancers, destroys cancer cells and harms healthy cells at the same time. A promising new approach for advanced cancer selectively delivers cytotoxic agents to tumor cells while avoiding normal, healthy tissue.
  6. Checkpoint Inhibitors
    Cancer kills approximately 8 million people annually and is difficult to treat, let alone cure. Immune checkpoint inhibitors have allowed physicians to make significantly more progress against advanced cancer than they've achieved in decades. Combined with traditional chemotherapy and radiation treatment, the novel drugs boost the immune system and offer significant, long-term cancer remissions for patients with metastatic melanoma, and there is increasing evidence that they can work on other types of malignancies.
  7. Leadless Cardiac Pacemaker
    Since 1958, the technology involved in cardiac pacemakers hasn't changed much. A silver-dollar-sized pulse generator and a thin wire, or lead, inserted through the vein kept the heart beating at a steady pace. Leads, though, can break and crack, and become infection sites in 2 percent of cases. Vitamin-sized wireless cardiac pacemakers can be implanted directly in the heart without surgery and eliminate malfunction complications and restriction on daily physical activities.
  8. New Drugs for Idiopathic Pulmonary Fibrosis
    Nearly 80,000 American adults with idiopathic pulmonary fibrosis may breathe easier in 2015 with the recent FDA-approval of two new experimental drugs. Pirfenidone and nintedanib slow the disease progress of the lethal lung disease, which causes scarring of the air sacs. Prior to these developments, there was no known treatment for IPF, in which life expectancy after diagnosis is just three to five years.
  9. Single-Dose Intra-Operative Radiation Therapy for Breast Cancer
    Finding and treating breast cancer in its earliest stages can oftentimes lead to a cure. For most women with early-stage breast cancer, a lumpectomy is performed, followed by weeks of radiation therapy to reduce the likelihood of recurrence. Intra-operative radiation therapy, or IORT, focuses the radiation on the tumor during surgery as a single-dose, and has proven effective as whole breast radiation.
  10. New Drug for Heart Failure
    Angiotensin-receptor neprilysin inhibitor, or ARNI, has been granted "fast-track status" by the FDA because of its impressive survival advantage over the ACE inhibitor enalapril, the current "gold standard" for treating patients with heart failure. The unique drug compound represents a paradigm shift in heart failure therapy.

Wondering what Cleveland Clinic proclaimed a year ago would be the top innovations for this year? Here was their top ten list from last year:

  1. Retinal Prosthesis System – Early Stage Bionic Eye
  2. Genome-Guided Solid Tumor Diagnostics
  3. Responsive Neurostimulator For Intractable Epilepsy
  4. Direct-Acting Antiviral Oral Hepatitis C Drugs
  5. Perioperative Decision Support System
  6. Fecal Microbiota Transplantation

  7. Relaxin For Acute Heart Failure
  8. Computer-Assisted Personalized Sedation System
  9. TMAO: A Novel Biomarker For Heart Attack, Stroke Risk
  10. B-Cell Receptor Pathway To Treat Blood Cancers
Tuesday
Oct212014

Google Wants to Helpout Your Health

by Kim Bellard, October 21, 2014

I suppose it was inevitable that I'd end up writing something about Google's interest in health, since recent posts have focused on efforts from Facebook and Amazon, as well as the general gold rush for health IT.  Fortunately Google has obliged me by introducing a neat health-related wrinkle on their Helpouts service.

Google's new service pops up an offer to do a video chat with one of their Helpouts physicians when you are doing health-related searches, in case you want more expert opinions and advice.  It certainly beats getting an ad for a pill or a health aid (although I don't imagine Google will stop presenting those as well).

Let's back up.  For those of you not previously familiar with it (and count me among those), Helpouts is a Google service, launched last November, that allows consumers to connect with applicable experts via live video chats. 

The new feature connects the service to search results.  You may not have Google Helpouts top-of-mind when looking for health information, but it's a pretty safe bet that you might use Google search in doing your research.  Pew says 72% of Internet users searched for health information within the past year, with 77% of them starting with a search engine. 

"Google Docs" takes on a whole new meaning now, doesn't it?

The telemedicine aspect of Helpouts is not strikingly new.  What distinguishes Google's effort, of course, that it is pro-active.  It doesn't wait for you to decide things are serious enough to seek out a doctor, but, rather, uses your search activity to trigger the offer of a consult.  I think this will be an important part of our health system's future -- not merely reacting but being proactive.  All these remote monitoring devices are pretty pointless if we don't use them to try to intervene early, instead of waiting for an acute event or an office visit to trigger care.

I have a couple of suggestions, or at least questions, on the new Helpouts feature:

  • It's not clear to me how specific the type of physician available is to the search request.  If you are searching on angina, for example, it'd be nice if you got a cardiologist to talk with rather than a dermatologist.
  • It's not clear to me if the experts are always physicians, or if they triage the experts based on the severity of the information being searched for.  

On the second point, I've written before about personal health assistants -- including Better from The Mayo Clinic -- as well as potentially using AI to provide such a service.  I think it'd be even cooler if Helpouts gave you a personal health assistant, starting with an AI agent and progressing to a specific human team if necessary, with physicians available for the most complex needs.  Maybe that's Helpouts 2.0.

Of course, Google's health interests don't end with the current Helpouts approach.  They are already pushing Google Fit as a way for Android developers to connect their health apps, and it'd be a great next step if Google could tie Helpouts to those apps, using the data mined from them to trigger an offer of a consult -- or an intervention, depending on the urgency of the need.

It'd be even better if you could opt-in your own physician(s) and health system to the Helpouts service instead of relying on Google's set of physicians.  

As long as I'm already trying to come up with more things Google could do in health, I might as well add that I'd love to see them get into the transparency business.  They try to help consumers find the best prices for other goods, and certainly health care can use all the help it can get in this regard.

Google is thinking bigger than these more modest expansions, like their "moonshot" to genetically map a healthy human body, or their new health and well-being company Calico, which has already announced the building of a major research facility.  I like that they are taking the long view, focusing on prevention and cures rather than simply more treatments, but there's still plenty of ways they can help the health care system in the short term as well.

Hmm, Google loves robots: maybe robotic surgery -- or doctors -- is next.

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

Friday
Oct172014

Surveying Physicians on Their Views of the ACA

By Clive Riddle, October 17, 2014

The Medicus Firm, a national healthcare recruiting firm has just released results regarding health reform, from their 11th annual Physician Practice Preference Survey. This year’s survey shows an uptick grades doctors give the Affordable Care Act, but a still overall negative review. 2,272 physicians and advanced practice providers from 19 specialties and all 50 states participated in this year’s survey.

When asked to give the ACA an overall grade, 8.6% awarded an “A”, up from 6.3% last year. Meanwhile, 22.35% graded the ACA an “F” this year, down from 30.2% a year ago.

The survey went on to ask doctors to rate the ACA on specific objectives, such as improving efficiency of healthcare, improving access to healthcare, improving quality of healthcare, and decreasing healthcare costs. Medicus reports that “the best and most improved grades were awarded for ‘improving access to healthcare’, with a resounding 23.4 percent giving the ACA an ‘A’ in this objective, up from 11.8 percent last year. Additionally, 27.11 percent of physicians gave the ACA a ‘B’ for improving healthcare access. Only 13.68 percent of respondents failed the ACA in this category, down from 23.6 percent who gave it an ‘F’ last year for this objective. The objective receiving the lowest grades was ‘improving efficiency of healthcare.’ However, even this category showed some improvement over last year. Only about 7 percent of physicians gave the ACA an ‘A’ for improving efficiency, which is up slightly from 5.6 percent last year. Furthermore, 29.73 percent of physicians gave the ACA an ‘F’ for improving efficiency, which is down from 35.4 percent who gave it a failing grade in this category last year.”

It should come as no surprise that from the onset, physicians would view the ACA negatively. Perhaps it should also not be surprising that some of them would view things more positively once the core of the Act was finally implemented. Jim Stone, President of The Medicus Firm, tells us "Physicians seem to have become slightly more positive about the ACA compared to last year's survey. As of last year's survey, the ACA had not yet been fully implemented, although many aspects of the legislation were already in motion. This year's survey was conducted after the ACA was in full effect for several months, and four years after its passage into law. Unfortunately, the grades on the whole are not very positive, so it's good that there is some improvement in physicians' perceptions of the effectiveness of the ACA."

The Medicus Firm isn’t the only organization surveying physicians on their views of the Affordable Care Act. Physicians Practice Magazine conducts the annual Great American Physician Survey, which this year had 1,311 respondents. Their results, announced in August, included this reform question:
“Which statement best describes your personal feelings about the Affordable Care Act, in terms of its effect on patient access to care: [A] I think it’s been great for Americans (18.9%); [B] I think it’s mostly good, but not all good; and [C] I think it has done a disservice to Americans (39.2%).”

Finally, The Physicians Foundation commissioned Merritt Hawkins, a physician search and consulting firm, to conduct a survey of 20,000 physicians, with the resulting report 2014 Survey of America’s Physicians: Practice Patterns and Perspectives released last month. The survey included a question similar to The Medicus Fund’s grading of the ACA, with Merritt Hawkins finding that “when asked about what grade physicians would give the Affordable Care Act (ACA), 46 percent give a D or F grade. Younger (ages 45 or lower), employed physicians were more inclined to give the ACA favorable marks than older (46 or higher), private practice owners. In fact, 63 percent of younger physicians (ages 45 or lower), would give the ACA a grade of C or above.”

Wednesday
Oct152014

Population Health Management Costs & Risks

By Claire Thayer, October 15, 2014

Chronic disease is defined as a long-lasting condition that can be controlled but not cured.  In the United States alone, 75% of our healthcare spending is now directed towards the treatment of chronic disease.  Studies find that almost 50% of this population copes with at least one chronic condition.  MCOL’s infoGraphoid this week highlighted these trends, along with a recent study published in the journal Health Affairs  on the cost impact of disease management and components of Pepsico’s wellness program focused on reducing employee costs and hospital readmissions:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Friday
Oct102014

Study on Health Plan Shopping – Reluctants, Premiums and Defaulters

By Clive Riddle, October 10, 2014

Vitals – who provide a consumer health information platform including doctor ratings and reviews, has released a study on health plan shoppers in open enrollment season, and lumping many of the shoppers into three categories: (1) The Reluctant; (2) The Premium; and (3) The Defaulter. Vitals study was based on their August online survey of 1,000 adults.

The big takeaways from their survey?

  • 80 percent of respondents said they were not planning to switch their insurance this year.
  • More than 1 in 5 are dissatisfied with their plan.
  • Nearly one-third said they were unhappy with the value for cost of their plan.
  • 27 percent were unhappy with customer support services
  • 9 percent were unhappy with the lack of quality network doctors and hospitals

So what the heck are Vitals’ trio of Reluctants, Premiums and Defaulters?

Vitals classifies Reluctants as age 30-44 with no dependents and household income under $25k, who are satisfied with their plan provider network but not the plan value. Vitals says “the Reluctant doesn’t want to buy insurance and isn’t satisfied with their plan – if they even have one. They’re more likely to have an HMO to keep costs down, but still say they’re not getting a good value for cost. Over 1 in 4 will switch their health plan during open enrollment this year. Their main gripe: Cost. They index higher for cost increases over the past year and report being surprised more by health care costs this year, compared to last year.”

Vitals classifies Premiums as age 45-60 with dependents and household income over $100k, who also are happiest with the network and unhappiest with plan value. Vitals tells us “the Premium is most likely to have Cadillac-like coverage for their health care. They index higher for employer-provided health care and PPO-type plans, which offer the most flexibility. Premium shoppers are most likely to say they’re happy with their health insurance – only 5 percent will switch during open enrollment! And they uniformly agree they have adequate access to medical care.”

Finally, Vitals classifies Defaulters as any age adult (but often age 60+) with no dependents and household income of $50 - $99k. They define the Defaulter as someone “on cruise control and typically doesn’t review or change their plan from year to year.”