The Integration of Care for Mental Health into Primary Care – American College of Physicians Position Paper

MentalHealthStigma

Integrate mental health into primary care to deliver better outcomes for the patients

A new position paper (subscription required) published by the American College of Physicians is focusing on the integration of mental health care into primary care in order to improve outcomes

Mental health disorders have been estimated to be a major burden by 2020 by WHO.  They are “linked to increased physical illness, higher mortality rates, poorer treatment outcomes and higher healthcare costs”.

Mental health conditions are not always properly diagnosed because of stigma and financial barriers such as insurance coverage gaps. These are the reasons behind the “call for the use of the primary care delivery platform and the related patient-centered medical home model to effectively address these conditions” as stated in the position paper. Health care providers will have to be trained to ask difficult questions, diagnose and treat these diseases.

 

Additional resources

Use data to challenge mental-health stigma – 2015 – Nature

Treat ‘whole person’ by bringing behavioral health into primary care: docs – 2015 – Reuters

The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010 – 2015 – Harvey A. Whiteford

Global Burden of Neurological and Mental Disorders – 2014 – Brain Facts

 

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Memorial Sloan Kettering Cancer Center Interactive Drug Calculator – What will it bring?

DrugPrices

A lot of buzz has been around these days about an initiative launched by a well-know cancer center. We take a step back and think about the rationale and the benefits.

The Memorial Sloan Kettering Cancer Center launched an interactive cancer drug calculator comparing the cost of several cancer drugs with a “fair” price based on factors such as the benefits (extended life expectancy for example) and the issues (like the side effects, development costs,…). The calculated price and the official list price do not match in many cases.

The concept

The rationale

Several doctors, especially oncologists, complained and are still angry about the escalating costs of cancer drugs in the US. It is not rare to see price tags around USD 100’000 per patient per year of treatment. It is clearly unsustainable for the whole system and could be a huge issue for patients as they are required to pay a portion of the cost. See more in one of my past blog posts.

The project leader, Dr. Peter Bach, said: “Prices for many new cancer drugs don’t reflect their value to doctors and patients. Right now, manufacturers have total price control, and total control of prices has led to irrational pricing behaviors.” This situation is not easy to manage.

With the Abacus Tool, we can see the official list price and the “abacus” price, that will be determined by different factors chosen by the user.

The benefits

This tool reflects the implementation of value-based pricing, discovered by M. E. Porter. More on this concept by following this link.

As said earlier by Daniel Goldstein, “currently cancer drug prices are not linked to the benefit they provide. They’re priced on what the market can bear, which is an unsustainable system.”

Patricia Danzon agrees and states that “assigning a monetary value to an additional year of life and discounting a drug’s toxicity should be key components of any pricing system.”

Each user will find a different price depending on the value of each factor he/she decides to select. It is a real personalizable tool for each individual confronted to cancer and its financial burden.

Conclusion

Paying for a specific value is true in any industry apart from the pharmaceutical area. Value-based pricing should be put in place to bring benefits to patients as well as to guarantee the reimbursement of life-saving treatments to each person without destabilizing the health system budget. The ASCO initiative is also working on a conceptual framework to assess the value of cancer drugs (see below).

The value-based pricing for drugs will work its way and it is definitely worth it for all the stakeholders!

Additional resources

‘Financial toxicity’ looms as cancer combinations proliferate – Nature Biotechnology (subscription required) – 2015

How Much Should Cancer Drugs Cost? – 2015 – WSJ

Another initiative by ASCO: American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options – 2015 – Journal of Clinical Oncology

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Scientists want to make sure medical breakthroughs aren’t just for white men

Precision medicine could reduce the gender gap in clinical trials and genetic databases. This will lead to better care and improved outcomes for women and minorities.

The Rise of the Empowered Health Care Consumer – Deloitte Dbriefs Health Sciences Series

Deloitte-Debrief-EmpoweredConsumer-June2015

An excellent webcast took place yesterday.

The key points are above on the MindMap I did. The presentation is available here: Deloitte_Dbriefs_Empowered_Healthcare_Consumer_Jun2015

The main take-home message: companies really should include the new health care consumer as a stakeholder. The patient has now more power than ever. He/she is more informed, more connected, more commited but also more demanding.

Addressing the Financial Burden of Cancer Treatment – From Copay to Can’t Pay – JAMA Oncology

anguish

Cancer care is not only about individual health but also financial health

A new article in JAMA Oncology is raising awareness of the disastrous consequences cancer treatment could have on the financial health of patients.

There is substantial evidence that high financial burden could lead to decreased clinical benefits due to poor treatment adherence and deteriorating quality of life. This is a challenge for oncologists as they are looking to provide the best care for each patient. But what happen if she or he cannot afford it?

The authors suggest several measures to improve patients’financial health:

Restructure cost sharing and insurance design. Due to the current US insurance system designed with deductibles, copays and tiering, cancer patients could face extreme financial burden and, consequently poor health outcomes. Deteriorating health is tied to unaffordable treatments involving lack of adherence.

Eliminate low-value prescribing practices. Common high-cost practices that do not improve clinical outcomes should be excluded in order to preserve patients’financial health.

Create tools to evaluate patient risk regarding financial distress. The routine assessment of financial health should be done early and, if necessary, patient could be addressed to dedicated programs to facilitate care access like patient assistance programs offered by charities.

Improve cost transparency. Providing this information as well as out-of-the-pocket cost information are valuable and allow patients to choose healthcare providers to minimize the impact on their personal budget.

Provide financial counseling as part of cancer care. Patients need to understand what impact(s) their cancer diagnosis could have on their private life (employment, future income, family financial security,…). It is crucial in order to avoid financial pressure and improve planning for the patient’s family and relatives.

Express Scripts is also concerned about the price of cancer drugs as shown in a recent article. As a payer, it would like to really focus on value-based reimbursement and implement indication-based formularies. They will allow to better decide on which treatment/drug works best for which patient. Today, several tools are available to improve treatment decision like tumor testing, genetic analysis, predictive analytics,… Integrated care along with better claims management will complement the measures discussed above in order to provide real solutions and benefits for the patients.

Additional resources

1,495 Americans Describe the Financial Reality of Being Really Sick – NYT – 2018

Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care – JAMA Network – 2017

Cancer patients skipping medicines or delaying treatment due to high drug prices – STAT News – 2017

Financial toxicity: 1 in 3 cancer patients have to turn to friends or family to pay for care – STAT News – 2016

Drug Abacus – Interactive Exploration of Drug Pricing – 2015 – Memorial Sloan Kettering

How Much Should Cancer Drugs Cost? – 2015 – WSJ

New Cancer Drugs are Expensive, but Price Controls are Misguided – 2015 – Forbes

Cost of Cancer Drugs Should Be Part of Treatment Decisions – 2015 – ASCO

Pricing in the Market for Anticancer Drugs – 2015 – Journal of Economic Perspectives

The High Cost of Cancer Drugs and What We Can Do About It – 2012 – Mayo Clinic Proceedings

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Doctor On Demand Pulls In $50 Million To Continue Expansion Of Its Virtual Doctor Visit Platform

Telemedicine is on the rise. It could be extremely useful for remote areas as well as disabled people unable to visit the GP office. Availability 24/7 is also reassuring for chronic disease patients.
This is clearly one of the main trend in the healthcare industry.

Healthcare – From volume to value – NEJM

stethoscope on open book on a white background

Behavioral economics and physician compensation…

… is the title of an article published last week in the New England Journal of Medicine.

Switching from fee-for-service to value-based payment or pay-for-performance will change the behavior of doctors in prescribing tests, procedures and drugs. As mentioned in the article, “fee-for-service reimbursement tends to promote well-compensated procedures.” Value-based payment will focus on patient outcomes and will drive a change in decision-making. Incentives will be different and drive the behavior of doctors, but incentives are strongly needed to help transition from one system to the other.

Behavioral economics views incentives as fundamental determinants of behavior, but it can help elucidate how the timing, frequency, and amount of payment influences behavior; how to address unintended consequences of incentives; and how to create environments supporting better decision-making.”

Deviations from rational decisions are often triggered by context and benchmarks. Several measures can be implemented to go over these deviations, the article highlights some of them:

– the power of default. By default, when prescribing a drug, the information system shows the generic instead of the brand;

– the loss aversion. Giving payments in advance of mandatory behavior (hand hygiene, electronic prescribing,…) pushes doctors to adhere to guidelines in order not to lose the money won;

– the incentives series. Giving payments in small and fragmented quantities is more efficacious than in larger amounts because immediate feedback is needed to influence behavior;

– the positive self-image. “Pairing performance incentives with appeals to self-image and professional identity provides an additional lever for meeting quality and efficiency goals. Making public some component of physicians’performance, at least within organizations, may enhance the effect of monetary incentives.”

The conclusion speaks for itself: “Not all clinical decisions will or should be amenable to interventions based on behavioral economics insights, but for some transformations in health care delivery and payment, such insights may be a powerful force for change. One challenge is identifying the clinicians, patients, and system inefficiencies for which incentive payments can be most helpful.”

 

Additional resources

Should the U.S. Move Away From Fee-for-Service Medicine? – 2015 – Wall Street Journal

The Behavioral Economics Guide – 2014 – A. Samson

 

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Economic crisis, health systems and health in Europe – WHO European Observatory

austerity

How did European Countries cope with the economic crisis and its impact on their national health system?

The last report published by the WHO European Observatory on Health and Health Systems on the impact of the economic crisis on health and health systems allows to take a step back and look at the deterioration of health care in the context of an economic crisis over the last few years in several European countries. It is a desk reference where it is easy to pick the country or the countries that are of interest. Austerity measures have a huge impact on the quality as well as quantity of care in specific countries. Too much cost cutting leads to catastrophic situations, like in Greece.

The structure of the report:

– In the 1st part of the report, 9 countries were chosen for in-depth analysis: Belgium, Estonia, France, Greece, Ireland, Latvia, Lithuania, Netherlands and Portugal. These are probably the most impacted by the economic crisis.

– In the 2nd part of the report, all the countries are covered with regards to their response to the crisis. For each country analyzed in this part, economic trends are evaluated as well as policy responses. Changes are then detailed by category: adjustments to public funding for the health system (budget cut, reforms, subsidies, insurance premiums, cost-containment measures,…), variations to health coverage (population, benefits, user charges,…), revisions to health service planning, purchasing and delivery (price of medical goods, salaries and motivation of health sector workers, payment to providers, overhead costs, provider infrastructure and capital investment, priority setting to change access to treatments, waiting times, prevention,…).

 

Additional resources:

Health and Financial Crisis Monitor – Always up to date

Systematic Review on Health Resilience to Economic Crises – 2015 – PLOSOne

Health, Austerity and Economic Crisis – 2014 – OECD Health Working Paper n. 76

European economic crisis and health inequities: research challenges in an uncertain scenario – 2014 – International Journal for Equity in Health

Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review – 2014 – Health Policy

Impact of Austerity on European Pharmaceutical Policy and Pricing – 2013 – Deloitte Centre for Health Solutions

Financial crisis, austerity, and health in Europe – 2013 – The Lancet

Global Health and the Global Economic Crisis – 2011 – American Journal of Public Health

 

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Defining Digital Medicine – Nature Biotechnology

Notes from the AppsWorld Europe 2013 panel "The Internet of Things Revolution - Functional, Usable, Wearable" with Tamara Roukaerts, Saverio Romeo, Paul Lee, Ben Moir and Mike Barlow.

Notes from the AppsWorld Europe 2013 panel “The Internet of Things Revolution – Functional, Usable, Wearable” with Tamara Roukaerts, Saverio Romeo, Paul Lee, Ben Moir and Mike Barlow.

Healthcare transformation ahead

In this excellent article from Nature Biotechnology written by people at PureTech, we have the chance to get an overview of this new exciting field: Digital Medicine.

This convergence of technology and health will lead to several transformations: disease management, research, clinical trials, medical practice,… A new era is beginning!

However, opportunities are doubled by challenges. We need to tackle the lasts to profit from the firsts.

Definition

Why do we use digital medicine instead of digital health? According to the authors, digital health is too broad as it also includes apps and products not medically validated but simply focused to enhance people’s wellness and wellbeing.

Digital medicine is defined by “technology and products that are undergoing rigorous clinical validation and/or that ultimately will have a direct impact on diagnosing, preventing, monitoring or treating a disease, condition or syndrome.” (quote from the article p. 457)

Digital medicine themes

1. Continuous and remote monitoring. A tool to detect disease earlier leading to lower healthcare costs.

2. Digital phenotype. A additional layer of information enabling the construction of more accurate disease models in order to better understand them.

3. Remote disease management. Chronic disease management will be nearly effortless and the lack of data gap will allow doctors to improve their medical follow-up of patients.

4. The connected patient. The empowered patient. The engaged and sharing patient. Communities of patients.

5. Interpreting the data torrent. The challenge of integrating large and heterogenous datasets could be solved one day with powerful algorithms and machine Learning.

6. Security and privacy. The obtention of the patient’s consent is crucial and should be much simpler than today.

7. Opportunities and challenges. Increased scientific evidence but reimbursement issues, new field of research based on wearables, changes to patient-doctor interactions, integration of patient-specific data by the doctor.

Conclusion

Digital medicine is unavoidable and doctors will have to integrate this trend in order to optimize their relationships with their patients by empowering them and maintaining a two-way discussion toward a unique goal: better patient outcomes.

Nature Biotechnology Article (free)

More on Digital Medicine

Have a look at my posts on this topic.

Why Digital Health Has Not (Yet) Transformed Pharmaceutical Drug Development – 2015 – Forbes

Rock Health Founder On The Future Of Digital Medicine – 2015 – TechCrunch (Video)

Top 20 Technologies that Will Change our Lives: Next Up – Digital Medicine – 2014 – Forbes

How Digital Medicine Will Soon Save Your Life – 2014 – WSJ

Medicine goes digital – 2009 – The Economist

Digital Medicine – Implication for Healthcare Leaders – 2003 – Healthfutures.net (a nice document from 2003, projecting the reader in 2013… with futuristic visions sometimes…)

What is digital medicine? – 2002 – D. W. Shaffer (the first article on the subject)

 

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Obesity as a “Brain Disease”, a Driver for New Therapies – Medscape

obesity

We all know that obesity is an unstoppable epidemic of this century. New analysis of this disease could maybe lead to solutions

Obesity is not only an issue in itself; it drives the emergence of other diseases, like cancer for example. Obesity is a complex multifactorial disease that should actually be viewed as a brain disease, bariatric surgeon Carel Le Roux, MBChB, PhD, of University College Dublin, Ireland, argues.

Saying obesity is a brain disease could allow us to better understand it and help us develop new treatments with this paradigm shift.

External factors (stress, sleep deprivation, depression,…) and internal factors (hormone levels and disruptions) could have their say in obesity. Each individual will have different factors influencing his/her condition as well as different reactions to the treaments prescribed. A personalized approach is crucial in this disease.

Beyond treatment, prevention is equally important. More should be done in collaboration with food producers and agribusinesses.

Medscape Article

More on obesity:

Impact of the Obesity Epidemic on Cancer – 2015 – Annual Review of Médicine (subscription required)

Ending Childhood Obesity – 2015 – WHO

USA – The State of Obesity – 2014 – Trust for America’s Health

 

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Blood: Underappreciated Resource in the Health/Disease? – The Next Element

Bloodanalysis

Very well written and insightful post about the use of blood in medicine. Worth a look!

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The Next Element

Alternative title: Pitching a VC on Disruption of Blood Testing

You may have seen some recent editorials about the necessary frequency of blood tests for healthy individuals, many of them prompted by a series of tweets from Mark Cuban:

MarkCubanTwitter BloodTests

Although there are certainly potential dangers in expecting any and all test results to be immediately informative and/or actionable, there are benefits in disrupting the status quo of how and when we collect information. A potential parallel is the “wearables” market, which has seeped from the “enthusiasts” (so-called quantified self-ers) to being used in trials of new drugs as well as disease research.

Blood Testing: Cost

One significant area of potential benefit to increased attention is cost. Generally when your physician prescribes a drug, you are asked what pharmacy to send the prescription. When told to get blood tests or imaging services, patients (in my experience) are sent to the affiliated…

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How can we improve patient access to experimental drugs? – WSJ

Ambulance

New approaches are needed for terminally-ill patients

In this article published in the Wall Street Journal by J. D. Rockoff a very important issue is raised: how can we give some hope to terminally-ill patients that could benefit from unregistered experimental drugs?

Johnson & Johnson has found a way with the set-up of an independent panel which will review requests from seriously ill patients. A committee of doctors, bioethicists and patient representatives will be organized and managed by the New York University School of Medicine in order to give a quick and relevant answer to all these requests.

The current law prohibits companies to give out unapproved drugs but the FDA has a “compassionate use” exception where companies can give medicines to patients with serious conditions and who are not participating in clinical trials. Over 1’800 requests reached the FDA in 2014.

Expanded-Access-Requests-Granted-by-FDA

From the article: “Amrit Ray, chief medical officer of J&J’s Janssen pharmaceuticals unit, said “the setup should be easier for patients because the company is establishing a single website and toll-free hotline for requests, rather than the current patchwork of entry points across the company and its drug trials”. Dr. Ray expects the committee could issue recommendations within days for urgent requests.”

WSJ Article

 

More on compassionate use and programs:

FDA Expanded Access Program

Compassionate use of medicinal products in Europe: current status and perspectives

Compassionate use of medicines in the European Union

Navigating the landscape of compassionate use (how to manage expanded access from an industry point of view)

Expanded access programmes: patient interests versus clinical trial integrity – 2015 – The Lancet Oncology (subscription required)

From 100 Hours to 1: FDA Dramatically Simplifies its Compassionate Use Process – 2015 – RAPS

 

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Virtual Visits — Confronting the Challenges of Telemedicine – NEJM

telemedicine2

Telemedicine = high-quality care for a broader population but…

This article, written by Jeremy M. Kahn and published in the New England Journal of Medicine, details the profound implications for the healthcare system. There are 2 main positive impacts:

1. Potential to substantially expand access to high-quality health care. Geographic barriers will be overcome, community-based care will be easier to provide to the one in need, healthcare will be more convenient not only for patients but also for providers.

2. Capacity to substantially reduce health care costs. For every stakeholder, telemedicine has real cost-saving possibilities: for providers, it reduces the time and space needed (more patients can be seen); for patients, it dramatically lowers travel expenses and productivity losses; for payers, it leads to a double-impact with more productivity in one hand (and lower costs) and the ability to have better care for patients living in remote locations.

Despite these advantages, challenges remain:

1. Concerns about effectiveness and cost-effectiveness. Theory is nice (see above) but what about reality? Telemedicine studies are methodologically weak… none of them include patient-reported outcomes. Solution? Do more research in order to prove the real benefits of telemedicine.

2. Technology issues and implementation questions. Solution? Study the context and provide a roadmap.

3. Lack of regulatory and legal frame (especially liability). Solution? Health care régulations revision.

4. No understanding of unintended consequences: financial (more encounters = more costs); interprofessional relationships (lack of continuum between a nurse and a doctor, a team; difficult collaborations as they are not long-term oriented); change in doctor-patient relationship and trust building. Solution? Integrate telemedicine in the current healthcare system; mix telemedicine with traditional face-to-face encounters with patients.

Technology is key in improving efficiency but it has to be used widely and as a complement (and not substitution) to the traditional system.

NEJM Article

Another excellent article on WIRED: Video is about to become the way we all visit the doctor

More on Telemedicine: American Telemedicine Association

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Mental Health – Awareness and Care vs. Stigma

DepressionMental Health Awareness is Starting to win over Stigma

During the last week I read several articles on mental health (you can see the list at the bottom of my post). I think that there is something going on, more awareness on how sick or sad people feel and what can we do about it. It has been found by a recent study that if nothing is done, the burden would be unbearable in the coming years.

Marilyn Wedge has wonderful insights in her article. Some of her quotes are revealing the sick and sad truth about our society:

– “The notion of mental health or mental illness is relative to the values of a particular society at a particular time in history. Our hectic society paradoxically frowns on overly active children—even children as young as four or five years old. Our society wants children to be restrained, orderly, and eager to please adults.”

– “There is another aspect of ADHD that worries me. As stimulants have come to be prescribed for ever larger numbers of children, our society’s very perception of childhood has changed. Instead of seeing ADHD-type behaviors as part of the spectrum of normal childhood that most kids eventually grow out of, or as responses to bumps or rough patches in a child’s life, we cluster these behaviors into a discrete (and chronic) “illness” or “mental health condition” with clearly defined boundaries. And we are led to believe that this “illness” is rooted in the child’s genetic makeup and requires treatment with psychiatric medication.”

– “In Prozac Nation, Elizabeth Wurtzel also discusses the one drug/one disease phenomenon. She says that her doctors defined her illness as “depression” because she responded to a specific antidepressant drug, Prozac. The drug defined her disease. Like Kramer, Wurtzel also noticed that a psychiatric drug not only came to define a particular mental disorder, but the drug also expanded that disorder across society. She observed, too, that the process was driven by profits to drug companies. The discovery of a new drug to treat depression resulted in many more patients being diagnosed with depression.”

– “As Wurtzel points out, the process of defining a disease by a drug is illogical and backward. Medicine has traditionally defined diseases by their causes, not by the drugs to which patients with similar symptoms respond. If psychiatry aspires to be scientific, on a par with other branches of medicine, how can it be content with this peculiar practice of delineating the outlines of a disease by a drug treatment?”

In conclusion, we really need to change the perception of our human behaviors: normality doesn’t exist and will never exist. We are all different and we have to accept ourselves with our own personality and identity. Something is changing and I hope that more people will find relief by being accepted as they are (as a starting point!).

 

Out of the shadows – 2015 – The Economist

The ADHD Fallacy: It’s Time To Stop Treating Childhood as a Disease – 2015 – TIME

It’s Time To Stop Using These Phrases When It Comes To Mental Illness – 2015 – Huffington Post

Probiotics May One Day Be Used To Treat Depression – 2015 – Huffington Post

Mental Health and Integration – 2014 – The Economist Intelligence Unit & Janssen

Mental Health Atlas – 2011 – WHO

 

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Improvement in US doctors’s adoption of EHR (Electronic Health Records) – Accenture

ipad

A survey of US doctors created by Accenture shows improvement in EHR use. Good news!

An insightful survey has been conducted by Accenture on the use of EHR by US doctors. Have a look at the infographic!

5 take-home messages:

1. 79% of US doctors are more proficient using EHR. They use EHR to enter patient notes electronically, e-prescribe and receive clinical results

2. They communicate with their patient electronically more frequently and regularly use software-based clinical decision support systems

3. Patients are also engaged with these new tools for requesting prescription refills, email their doctors and access their medical information online

4. EHR lead to a lot of benefits: better patient engagement and satisfaction; improved understanding of their medical condition; more valuable communication with their GP; records accuracy

5. EHR challenges: more user-friendly EHR softwares need to be implemented as doctors complain about the use of EHR; doctors do not always think of accessing EHR of a new patient (seen by another doctor)

Conclusion: the progress shown by the report are good news but there is still work to do and improvements to implement.

Accenture Report

More resources on EHR:

My blog posts on digital health

Intro to EHR: Introduction_to_EHR_McGrawHill_2011

Implementing Electronic Health Records in Hospitals – 2014 – Albert Boonstra & al. – BioMedCentral

Integrating Electronic Health Records Into Clinical Workflow – 2014 – Svetlana Lowry & al. – US Department of Commerce

Using Electronic Health Records to Improve Quality & Efficiency – 2012 – Sharon Sillow-Carroll & al. – 2012 – Commonwealth Fund

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How to create value for drugs? Comparative effectiveness and improved patient consideration – Office of Health Economics

microscopeFuture expectations for new drugs – 3 new papers written by the experts from OHE

A series of three articles exploring future expectations for new drugs of evidence of relative effectiveness in Europe and comparative effectiveness in the USA in 2020 have been published in the Journal of Comparative Effectiveness Research.

In a value-based and outcomes-based health care environment, there is a mandatory requirement for pharmaceutical companies to demonstrate the value of their products not vs. placebo but vs. the current standard of care.

Key questions must be answered:

Market Access

Source: Bridgehead Oncology Workshop, London 2012.

As mentioned in our page on Strategy & Vision, an increasing focus and trend toward value-based healthcare initiated by M. E. Porter will really make a difference for our health systems. We will stop paying for me-too products and pay only for value-added products that will bring real outcomes for all the stakeholders.

We will also probably be much more patient-centric in the future and use patient value to better select relevant projects as described by Stuart Dollow in his recent blog post on Prioritising Projects by Predicting Patient Value. Considering the patient as a partner and valuing his/her opinion to target precisely his/her needs as well as the clinical requirements will push the pharmaceutical industry toward more value generation because of the integration of the related stakeholders in the development process.

OHE Article (where you can access all the articles and working papers) – To download working papers you have to register (it’s free).

Direct Access to the Articles

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Fixing Health Care Will Require More than a New Payment System – HBR Blog

Nepal

Beyond the implementation of a new payment system, healthcare providers needs to change their behavior

A really interesting article from HBR about healthcare systems and how can we improve health outcomes and managing costs.

Here are the key points from the article:

– the example of Possible Health in rural Nepal

– managerial discipline implementation has been crucial in the success of worker behavior change and the delivery of high-quality care

– defining areas of responsibility to avoid conflicts that arise from lack of role clarity is very important and has been implemented

– 4 areas having a clear impact in healthcare:

  1. Let doctors be doctors – not managers. Administrative tasks and managerial functions were removed for them to focus on clinical skills.
  2. Develop standard protocols for care. The lack of protocols leads to lack of care efficacy and very often costs much more.
  3. Hold people accountable for the little things. Every tasks needs to be done and task attribution is a fundamental element in healthcare. Even small tasks are important and could be disruptive of a whole process if not done properly and on time.
  4. Invest in technologies that promote efficiency and transparency. The example of Asana used as their computer-based project management system leading to great results (less waste of time, energy, and resources).

HBR Article

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How medical technology can be hacked? – Wired

Drug Pump’s Security Flaws Lets Hackers Raise Dose Limits

hackerHealth data hacked, hospital system bugged… A lot of news are emerging every day about breaches into the safety and security of electronic medical devices.

In this article written by Kim Zetter in Wired, it is explained that drug infusion pumps could be controlled by anybody anywhere. “Hospira systems don’t use authentication for their internal drug libraries, which help set upper and lower boundaries for the dosages of various intravenous drugs that a pump can safely administer. As a result, anyone on the hospital’s network—including a patient in the hospital or a hacker accessing the pumps over the internet—can load a new drug library to the pumps that alters the limits, thereby potentially allowing the delivery of a deadly dosage.”

Awareness should be raised inside and outside the hospital but, more importantly, in the medical technology industry. They should hire experts in security as well as former hackers to make their devices safe enough to be used in any setting worldwide.

Wired Article

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