Posts Tagged Affordable Care Act

2014 – Year-end Review ——- Theme: Confront Reality & Get Things Done!


English: Biosafety level 4 hazmat suit: resear...

English: Biosafety level 4 hazmat suit: researcher is working with the Ebola virus (Photo credit: Wikipedia)

Year 2014 is coming to a close.  As I see it, it has been a year to confront the reality and get things done.  Affordable Care Act became law in January, increasing the accessibility of healthcare, in the US.  TIME declared Ebola as the defining issue of the 20th century. It was no more in remote regions of Africa but in the capitals and it landed in the USA.  The reality is that we are living in a global world.  

And then President Obama reminded us that even though some of our neighbors entered the border illegally, they have made their home here, are working hard, supporting their families and they should have NOT amnesty, but an opportunity to make it right with the law, and live here temporarily, AND pay their share of the taxes, because people can’t live in the shadows, in a global world of visibility and accountability.   Long overdue immigration reform will enable many people to come out of the shadows and add to the national treasury – a win-win – what’s not to like?

The same applies to our gay neighbors.  They should not have to live in the shadows.  Majority of the states this year, legalized same sex marriages and US supreme court refused to hear appeals from states seeking to keep same sex marriage ban in place.  Many states also legalized marijuana.  But what about our veterans living in the shadows?  Department of Veterans Affairs got more resources (as house passed the bill, at the end of the year, averting shutdown), and it now has to get its act together and make it right with those who defend our freedom and values.

And what about skin color?  We are confronting the reality that more than 50 years after Dr. King laid out his vision for color-fair society, people are still being judged on the basis of the color of their skin and paying with their lives.  This does not just happen when young men turn 22 but prejudice hits in childhood  http://bit.ly/15EInJ4 and it splinters society.  We can heal and move ahead, but scars made by history, and distrust can only heal when there are no new wounds, when there is real dialog, when each side gets to even briefly experience the reality that the other lives with, and have compassion.  We are confronting the reality and lot of dialog is happening.  Much work remains to be done but the issue can’t be ignored any longer.

And then the lowest of the low, terrorists and those plotting terror.  How do we deal with them?  Report on CIA’s use of “enhanced interrogation techniques” in the post-9/11 era reveals that “CIA detainees were tortured”.  When we lose sight of our values, when the boundaries between moral and immoral gets blurry, then we lose, regardless of what we were seeking to gain.  This is a true moment for national soul searching. (the fact some people may be only suspected of being terrorists is whole other story).

Globally, also we are confronting realities.  World’s largest democracy, India, elected controversial Mr. Narendra Modi as Prime Minister.  Mr. Modi has reached out to leaders across the world and declared campaigns to clean up India.  My birthplace has so much to offer to the world and if it cleans up its act, under the helm of Mr. Modi, I couldn’t be happier.  Our neighbors need to clean up their act too, even as they rightfully blame the US for its insatiable appetite for drugs.  Capture of “El Chapo” Guzman in Mexico was a HUGE victory that got overshadowed later by disappearance and ruthless murder of 43 Mexican college students.  “#YaMeCanse12”!  Abduction of 270 high school girls by Boko Haram in Nigeria #BringBackOurGirls and scores of Yazidi women bought, sold, raped, and murdered, underscores the need to define rape during conflict as a war crime and not a woman’s issue.  By some estimates, more than 7 million (50% are children) are displaced by war in Syria (200,000 are killed) and 100,000+ Yazidis are displaced by ISIS.  Let us continue to keep theses issues in the spotlight.

The year is ending on a rather sad note of the children who lost their lives in #PeshawarSchoolAttack in Pakistan.  Here is my short poem in their memory – http://bit.ly/1wfp47D .  It was heart warming to see India support its neighbor in the hour of grief as #IndiawithPakistan was a popular hashtag on twitter. And also deeply heartwarming to see Pakistan echo the sentiments when #PakistanwithIndia and sepecially #PakistanwithIndiaNoToLakhviBail became trendy topics on twitter as overwhelmingly Pakistani people reacted negatively to their government’s decision to give bail to Mumbai terror mastermind Lakhvi.  May the balanced sentiments always prevail over extremism, because the reality is that we live in a global world and terror can’t be nurtured and targeted because sooner or later it would hit home.  Global world also demands secularism.

As a ray of light and hope, Malala Yousafzai, courageous young lady from Pakistan, spearheading girls’ right to education and Kailash Satyarthi from india, a brave and dedicated activist for children’s rights and against child labor, shared the Nobel Prize, sending strong messages that fight to honor children’s rights will continue.

Personal

wpid-20140920_173123.jpgHard as it is to confront the reality that one’s parents may not be there forever, I was very happy to spend wonderful time with my mother and my aunty (her sister).  I tried to focus on giving them a break from their routines and enable them to have some fun, some unusual experiences.  Isn’t it amazing that when a mother gives, she gives with her heart and soul, but when she receives from her children, she receives with a feeling of enormous debt and gratitude!  Both my children are focused on their careers; wpid-20140805_201145-1.jpgNeil is working with Cisco in IT and Neesha is finishing college this coming year.  Both are my pride and joy :).  It has also been fun hosting my daughter’s friend from UCSD, originally from Palestine, during the holidays, and alternately being “naughty” with the girls, and playing aunty-mom to two daughters :).wpid-20141221_150415.jpg

wpid-20141221_161442.jpgThis year, I also visited Japan (we were hosted by many amazing friends and you can see all details in my travel blogs), an amazingly polite and most efficient culture, with world’s most interesting toilets http://bit.ly/1sYL5qs.  This year I also started travel blogs and you can see my many blogs at www.darshanavnadkarni.wordpress.com.

And finally, here are links to some of the most amazing things that I blogged about, this year.
Best movie – “Last Days in Vietnam” http://bit.ly/1qFIL28
Best play – “Truce” http://bit.ly/1trGhEG and “Andhera Hone Tak” http://bit.ly/1Aij5Rz
Best book – “The Glass Castle” http://bit.ly/1fchcIo
Best biomedical technologies — so many exciting technologies in early to mid stages of development for — treatment of ALS http://bit.ly/1AP2Yd0, for technology for early detection of cervical cancer http://bit.ly/1jalqEz, technology that aims to deliver drugs via inhalation for AFib, point of care solution to minimize prescription filling errors http://bit.ly/1jdfmgr

Wishing my readers, family & friends, and my clients and colleagues, peace and joy in the year 2015.  Best wishes to my many friends in fantastic groups that I am routinely affiliated with (each of them enhance life for many, personally and/or professionally) http://www.bio2devicegroup.org, http://www.eppicglobal.org, http://www.citylights.org, http://www.thestage.org, http://www.theatreworks.org, http://www.naatak.org, http://www.enacte.org, http://www.iwings.org .

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Health Information Technology (HIT) – Hype or Promise of a Better Healthcare System?


Salim Kizaraly, Founder & SVP of Business Development at Stella Technology, a healthcare information technology start-up, talked about the promise of  Health Information Technology in solving care coordination, physician collaboration, and system integration challenges to improve healthcare, at a recent http://www.bio2devicegroup.org event.

Kizaraly began by sharing the known fact that the mounting and huge healthcare costs in the US, that do not result in significant improvement in health, are not sustainable.  According to some estimates, almost 18.3% of GDP in the US, goes towards healthcare expenditure.  If the cost of healthcare continues to rise at historical rates, the share of GDP going towards healthcare in the US, is projected to reach 34%, by 2040.  While the costs continue to rise, gains on health improvement do not keep pace.  For instance, life expectancy in the US is only 78.4 years and US ranks 27th out of 34 industrialized nations.  In this study of industrialized nations, US had highest to near highest infant mortality rates.

Kizaraly discussed the three defining historical events that got the ball rolling on healthcare transformation.  In 2004, President Bush announced that in the next 10 years, by 2014, every American would have an access to electronic health records. We have a long way to go, but certainly we are moving in that direction.  In 2009, HITECH (Health Information Technology for Economic & Clinical Health) Act, enacted as part of the ARRA (American Recovery & Reinvestment) Act, was signed into law, to promote the adoption and meaningful use of HIT and included incentives for faster adoption of EMR (Electronic Medical Records).  In 2010, the Affordable Care Act or Obamacare, with its mandate to expand coverage, cemented the case regarding the need towards transformation.

Barack Obama signing the Patient Protection an...

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

The Affordable Care Act’s most significant contribution is to creating ACOs or Accountable Care Organizations.  An ACO can be defined “as a set of health care providers, including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients”. There are incentives to keep patients out of the extreme settings of care, including hospitals and nursing homes.  Different models are emerging of how these organizations put this into practice.  Underlying issue is that hospitals have to get better at treating patients.  Hospitals are bracing for lower revenues as they get better at keeping patients out of hospitals.  Different models of care are emerging.  Technology will be a big enabler to change workflow, rethink care, as homes emerge as places of care.  Here is link to my article on Keynote by Dr. Toby Cosgrove, CEO of Cleveland Clinic, at 2014 J P Morgan Healthcare Conference in San Francisco –http://bit.ly/1c3EyBB .  Cosgrove also said, that hospitals will not longer be epicenters of care, and while a few hospitals (e.g Cleveland Clinic) will be super high tech, they will partner and share resources with other care providers, to offset costs.  The disruptions will eventually enable us to “build a healthcare system that is humane, high quality, and sustainable”, said Cosgrove.

Kizraly discussed several national initiatives that are implemented or partially implemented to enhance collaboration among care providers and integration of information.  For instance, if a person experiences an emergency visiting New York, then eHealth Exchange will make it easy to get their health records from the state of their residence. Similarly, Blue Button makes it easy for Americans to get easy, secure, online access to their health records, with a single click.

Stella Technology is a self-funded health information technology services and product development company that focuses on care coordination, patient access, and information exchange projects.  Kizraly shared use cases and information on how Stella is helping providers, with great success, in integrating care.  Through aggregating data from a variety of sources, through identifying gaps in care, and with real-time, proactive analytics, Stella’s technology identifies care opportunities that can be improved and accordingly targets interventions.  In the long term these kinds of strategic technological interventions will enable care providers to curtail expenditure, while improving care. In the interim, we still have a long way to go and there are many opportunities for entrepreneurs to use technological advancements in big data, cloud, machine learning, (IOT) internet of things, and enable US healthcare system to become more efficient, with lower costs and improved outcomes.  Kizraly’s talk was followed by Q&A.

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OneMedForum – San Francisco, 2014


The OneMed forum conference was launched in January of 2008, when economy was showing all signs of progressing to new heights, with an objective to showcase innovation in medtech.  The conference aimed to bring together the companies and investors, during the large influx of healthcare investors and executives, during the JP Morgan Healthcare Conference, in San Franciso.  Fast forward to 2014 and we are perhaps just emerging from one of the worst recessions; a downturn that hit the medtech sector more than any other industry segment.

This year, the location of OneMed Forum was changed and the venue was moved further away from the JP Morgan Conference.  Since the weather in SF was gorgeous, it was not a problem; but if the venue continues to be further away in future, and in the event of cold and rainy weather, it can have an impact and lower the attendance at future OneMed events.  This year also OneMed event seemed to be sparsely attended, although that appearance might also be enhanced because the meeting rooms were spread out on two different floors and there wasn’t a single spill out location for the participants to meet and network – another problem with the venue.

There was also a palpable difference between the JP Morgan conference and the OneMed Forum, this year, in terms of optimism.  While biotech and pharma sector is returning to pre-recession levels with a large number of IPOs and higher numbers of dollars raised, medical technology companies have yet to see significant investment dollars.  On talking with the participants, I heard a note of disappointment regarding low attendance from VCs and other investors, just like in the last few years.

However, despite slow pickup and staggering growth in the medtech sector, it is transforming and the companies are learning to operate more efficiently.  It is also recognized that healthcare is at a critical point and medical innovation will have to address some key challenges.  Various panels and speakers at the OneMed Forum, addressed the changing healthcare landscape and how the future of health and medicine will need to be shaped, in the coming years to address the key issues. 

Major Highlights

Personalized Medicine Panel discussed the promise offered by customized diagnosis and treatments, in lowering the cost and increasing effectiveness.  Panel sessions addressing the JOBS Act and the Affordable Care Act, explored the impact of the legislation on cost of care and access to care.  Companies and solutions that may be poised to offer effective healthcare solutions and may also present interesting investment opportunities were highlighted.  In somewhat grim medtech landscape, digital health is emerging as the hottest new trend, with much potential.  The Digital Health panel discussed the impact of Affordable Care Act in increasing information transparency and empowered consumers taking greater control of their health information.  The changing role of the patients/ consumers will require change in the healthcare delivery and transformation in the business model.

A panel addressing “reimbursement strategy after the affordable care act”, discussed impact of medicare payment rules on medtech and hospital markets.  The panel also discussed trends in coverage and payment for newly emerging molecular diagnostic tests.  One key advice from the panel was that thinking upfront about the reimbursement strategy will be increasingly more important for companies with new, innovative products.  A panelist also suggested that during clinical trials, companies can also think about reimbursement and instead of doing only what may be required by the FDA, if they can also collect reimbursement data then they would come out ahead.  During innovation, the companies should relentlessly focus on disease management, and that would lead to them to appropriate and effective reimbursement strategy, advised the panel.

Financing and IPO issues were addressed in various panels.  One interesting panel on Crowdfunding discussed a handful of portals that are beginning to raise some capital for emerging growth companies.  One investor who was attending the panel, later told me, that it is too early to give an opinion on what kind of success this strategy would yield, but he had some grave concerns.    AdvaMed CEO’s Unplugged Panel featured some of top leaders of the MedTech industry, who shared their insights on key challenges facing the industry.  Stuart Randle, CEO of GI Dynamics advised startups to focus on crucial healthcare issues including obesity.  He also advise companies to pursue capital intensive strategy, and at least initially sell products outside the US.  Scott Brooks, CEO of Regenesis Biomedical, advised startups to get good legal and regulatory counsel early on.  Patrick Daly, CEO of Cohera Medical was optimistic about the future of MedTech.  “IPOs are coming back, M&A is picking up, and dollars are rolling in, big companies have record levels of cash, and I feel positive”, he said.

One of the most prolific financiers, Bill Hambrecht gave a keynote address.  Hambrecht has over 500 IPO’s to his credit that include seed level funding in nascent industries.  Although I did not attend the keynote, I heard some highly positive comments from an attendee.  Steven Burrill, who has been at the helm of innovation in healthcare and shares and who regularly shares his insights through his annual reports, gave a second keynote.  Again, I missed the address but both keynotes were major highlights of the event.  Throughout the conference, over 800 emerging companies gave presentations.  Following the presentations, partnering and breakout sessions gave the opportunity for conference delegates to meet the CEO’s of these companies.

Although it may seem hard to believe, it appears that now the MedTech sector has nowhere to go but up.  The industry has learned some hard lessons, the companies are lean, operating with greater efficiency, spending cash wisely, and instead of hawking next new technology, they are focused on key problems facing the healthcare industry, and on providing effective solutions.  If the healthcare providers are not eager to incorporate some of the solutions, then it will happen out of necessity.  It will become incumbent upon the healthcare industry to implement solutions offering greater ROI in terms of improved health and lower cost.  Healthcare providers will be looking for solutions that provide digital and point of care diagnosis and health monitoring and treatment options and solutions from personalized medicine and genomic health.  Let us stay tuned for some cool innovations from the MedTech sector in 2014.  Senior Analyst at Wells Fargo, Larry Biegelsen has also observed that not only acceleration in healthcare spending is expected in 2014 but there are number of other tailwinds including, “emerging technologies and emerging markets contributing more to growth and a more industry-friendly FDA, which should lead to faster approval times for medical devices”.   

 

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JPM 2014 – Dr. Delos M. “Toby” Cosgrove, CEO & President, Cleveland Clinic: on Challenges, Opportunities & Affordable Care Act


During the luncheon keynote, Cosgrove began by quoting Lenin, “there are decades when nothing happens, and then there are weeks when decades happen”.  Clearly there is tremendous activity and major and disruptive overhaul happening in the healthcare sector.  To meet increasing demands proactively, Cleveland Clinic has made some significant changes in how they operate.  These include, one year contracts for employees, eliminating tenure tracks, implementing annual performance reviews, offering high deductible insurance policies, and greater transparency throughout the system, said Cosgrove.  Many other businesses are also moving towards some of these reforms.   In the new healthcare environment, retail clinics like Walmart and CVS will play a significant role.  Over 813 branded clinics and hospitals and other providers are partnering with these retail clinics, in anticipation of the shortage of physicians that will hit the system.  Cost pressures will also intensify as providers are increasingly pressured to move from the volume based system of providing care to value based system, linked with outcomes, said Cosgrove.  Cost pressures are coupled with pay cuts in education for physicians and other practitioners and there less money coming from VC funding sources.

Among the challenges, are hidden opportunities that can help overhaul the system to make healthcare better.  For instance VC funding for Health IT has gone up, M&A continues at rapid pace, and some of the focus on behavior changes is yielding good outcomes, said Cosgrove.  Genomics and behavior modification represents some of the largest unmet challenges and they account for 70% of premature deaths in the US.  At CC, with a relentless focus on behavior modification, employees collectively lost 430,000 pounds.  Similarly, genomics has opened up a huge opportunity in healthcare.  Approximately, 4300 single gene diseases have been so far been identified, and the cost of sequencing of full genome is dropping rapidly.  Other huge opportunities are with respect to patient health records and management of big data in healthcare.  CC has given 1.8 million patients access to their electronic health records.  Quoting “IBM’s Watson Computer”, Cosgrove observed that artificial intelligence is opening huge opportunities in healthcare.

All the disruptions in the healthcare should eventually enable society to “build a healthcare system that is humane, high quality, and sustainable”, said Cosgrove.  But this transformation will not be painless.  It will require a great shift in mindset for physicians and also in how people view healthcare, in society at large.  Roles of care providers are changing rapidly.  Only about 10 years ago, hospitals used to be epicenters of care.  Now increasingly care is delivered outside the hospitals and we need to develop systems that support and scale out of hospitals care delivery, said Cosgrove.  A few hospitals will need to be very high tech and to offset costs, they will need to share and partner with other care providers.  Cosgrove gave the example of CC’s high tech data center built at the cost of $170 million.  Cosgrove said, healthcare is the only industry that has not consolidated and it will need to consolidate in the coming years.

The only criticism Cosgrove offered with the implementation of affordable care was that it has not built in incentives for wellness.  Obesity is sharply rising in the US and it needs to be contained, in order to control costs, said Cosgrove.  Affordable care bill is not perfect and there will be unintended consequences, but they can be dealt with.  One of the shocking thing that Cosgrove opined upon was that US will one day have a single payer system, with basic healthcare provision for everyone, and optional choices in supplementary insurance on top of that.  This was an exciting keynote.  The whole bar in healthcare is being raised and Cleveland Clinic is clearly taking a leadership role in meeting the challenges head-on.

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