When seeking healthcare innovations, it’s traditional to look first at basic science, then clinical research, or at engineers tinkering with new devices. But this view might be a little too narrow, as advances with the greatest impact may come from industries that have nothing to do with healthcare.
Take Purell, for example. Ohio-based Gojo Industries designed the now-ubiquitous hand-sanitizing gel for auto mechanics. And it was almost a failure; mechanics and consumers alike first rejected the product as a little strange, and nobody, including the U.S. Centers for Disease Control & Prevention, originally believed that alcohol-based cleaners provided more value than plain old soap and water.
But Purell started to take off when nurses who used it in hospitals started requesting more samples. The nurses had been looking for an antiseptic alternative to stringent, frequent washing with soap and water, which was very tough on hands. Now, not only has Purell (and other alcohol-based cleaners) been approved by the CDC, it is selling by the hundreds of millions of dollars each year; Gojo even has a test hospital lab to find more uses for the cleaning gel.
What does Purell tell us about healthcare innovation? First, that great healthcare ideas don’t always emanate from healthcare industries; Purell came from a firm that didn’t have a purpose for or intended buyer audience in healthcare at first. Second, just because an innovation is a good idea doesn’t mean it will be accepted. Sanitation pioneer Ignaz Semmelweis famously demanded that his surgeons wash their hands more than 150 years ago; his advice was rejected, partly because of his own personality quirks and partly because of the harsh cleaning regimen he required. And finally, managers and leaders aren’t the only people who introduce innovation. Like Purell, other healthcare innovations have been introduced to the field by nurses, simply because the advance makes their immediate jobs that much easier.
At Popper and Company, we seek out engineers, scientists and other innovators who have great ideas, or a great clinical application for an idea. While we will first examine the innovation’s utility (will it work?), we then need to see if the innovation will be adopted and to develop solutions for potential obstacles. Some older-generation leaders may automatically be suspicious of digital health and other technological innovations, for example. Still others have been frustrated with previous “advances” that didn’t deliver as promised or required hours of training. These issues have actually become more important for introducing and adoption of a new product or service than approval by the FDA.
How do we make these innovations more adoptable? One way is to take the example of Purell—find a non-health advance that can be applied to make healthcare easier (in other posts, we’ve discussed the idea of looking beyond the “usual suspects” for innovation strategy). Another is to draw everyone into the design and conceptualization process—start asking doctors, nurses, patients and other stakeholders what they’d like to see in tomorrow’s healthcare. That way, they won’t be as likely to wash their hands of your new business idea.
Our life sciences clients value our ability to find unusual technologies from the least likely sources, and match them to existing healthcare needs. We can help you create new strategies to help get your healthcare solution—and company—moving ahead on the commercialization (or clinical study) path. To learn more, please subscribe to our newsletter, follow us on Twitter, or send me an email.
Tags: clinical research, healthcare innovation, healthcare strategy
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The traditional clinical trial (which, by the way, has been a “tradition” for only about 30 years) involves recruiting a number of people who are required to come to a site on a regular basis to participate. After the trial is over, the trial participant receives payment (sometimes) and not much else. Rarely, if ever, are results or data shared with participants.
This model is starting to show some cracks (particularly for U.S.-based trials), however, as recruitment becomes more challenging, and regulatory and liability issues require larger and more complex trial structures. But our era of the Internet, greater consumer power and a trajectory towards tailored, “precision” medicine could provide an answer: more personalized, patient-centered clinical trials. And the trials are more than just a lure for volunteers; they can change how medical research is conducted, all the way down to the results.
Clinical trial planners and coordinators might take a cue from Google. Instead of developing a solution or product and then marketing it to potential customers (Google Health notwithstanding), the company develops products based on what customers are searching for. Likewise, clinical trials should instead seek to address the question; “What do patients want?”
The Dutch Burns Foundation took this approach recently. First it surveyed burn physicians and found that practitioners wanted to see better ways to treat burned skin, or new techniques in cosmetic surgery. Then it surveyed the patients, and found a different answer. The patients wanted solutions to wound itching. Similarly, in cancer studies, survival rates are the most common endpoint, but many patients are most concerned about side effects. In this case, addressing the side effect problem might increase patients’ willingness to continue with chemotherapy treatments, a common problem in cancer therapy.
Online reporting and record-keeping will also help create more patient-centric trials. Mytrus Inc., helped Pfizer create its first “virtual” clinical trial, which included online check-ins and reporting, and electronic informed consent. Mytrus estimates that 30% of studies could be done virtually, directly with each patient, reducing the number of trial sites needed by 80%, slashing study time and costs, and easing recruitment woes.
Data sharing will probably be a large part of tomorrow’s clinical trials, too. The group Genetic Alliance launched a site Reg4All (Registries for All Diseases), which gives clinical trial participants access to their trial data. Trial coordinators can use the registry’s online platform to share data, while preserving privacy.
The computer is not a miracle worker, however. In randomized, double-blind trials, sharing data can be a problem. And it’s still important to make sure volunteers understand why they’re there, and that they won’t necessarily receive a treatment for their disease (and even if they do, it might not work). But these more tailored approaches certainly make it more possible for the patient to have a greater investment in the study.
Our life sciences clients have valued our ability to match new technologies with existing healthcare needs, including new ways to conduct clinical tests. We can help you create new strategies to help get your healthcare solution—and company—moving ahead on the commercialization (or clinical study) path. To learn more, please subscribe to our newsletter, follow us on Twitter, or send me an email.
Tags: clinical trial participation, clinical trial patients, clinical trials, medical research, patient-centered trials
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Review any drug’s development history: Clearly, the execution of clinical trials makes up the lion’s share of the timeline. To further complicate matters and extend development timelines, as more drugs are being developed on a global basis, it’s more difficult to keep a clinical trial on target with multiple sites around the world, site qualification visits, and record keeping. In fact, 80% of today’s clinical trials fail to meet one or more milestones. Fortunately, digital technologies – increasingly being adopted by contract research organizations (CROs) and larger biopharmaceutical companies – may offer a way around the limitations of today’s paper-based practices.
Recently, Johnson & Johnson, Merck & Co. and Eli Lilly & Co. announced their plans to create a database of global clinical trial sites, which would streamline any participating trial’s significant paperwork requirements. The database would contain site and experimental infrastructure details, and good clinical practice GCP records. The partners will be presenting their progress at the Partnerships in Clinical Trials meeting in April.
In addition, Acurian, the patient recruitment company, is starting to use social media networks like Facebook to find patients for its trials. For this purpose, social media seems to be catching on, at least in trials that impact a wide range of people. For a recent Phase III study for diabetes, for example, Acurian said that nearly half of its patients were recruited from a digital source, while 39% came from direct mail solicitations and 15% from television advertising. For its part, Lilly has integrated social media into pilot trials for diabetes and head and neck cancer; it claims a cost savings of more than 10% over traditional recruitment methods.
Better decision-making; streamlining processes
Sharing information on a real-time basis and making data more easily available allows for better decision-making, streamlining processes from early-stage planning and protocol development through regulatory submission to publication of clinical results. And initial resistance due to fears of violating HIPAA (the Health Insurance Portability and Accountability Act) is starting to weaken, as more companies involved in remote monitoring are using cloud computing, know that they have to be HIPAA compliant to be successful, and add safety and security features to their software services.
Digital trials’ increased efficiency doesn’t stop with databases and recruiting, however. For example, at Popper and Co., we have discussed the idea of adding more digital technology to mobile medical carts. The carts can be equipped with cameras, point of care testing kits for glucose, respiratory infections, or other lab tests. With an internet connection, a nurse can see a rash, infection, or adverse effect of a trial drug, image it, and send it to the physician. Imagine the possibilities of sending any kind of trial data from hundreds of these carts at a multisite trial.
Is your company seeking to develop a strategy to fill this critical digital gap and to develop more ways to bring drugs and devices to patients faster? We can help you create new strategies, ideas, and inventions to address true unmet needs, and give your company (and its products) a sustainable market advantage. To learn more, please subscribe to our newsletter, follow us on Twitter, or send me an email.
Tags: clinical trials, digital gap, digital health, digital trials
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Earlier this week, I reflected on the Cleveland Clinic predictions on the Top 10 innovations in healthcare for 2012 from the vantage point of the year coming to a close. Today, I’ll review the predictions for 2013:
- Healthcare programs with monetary incentives (Medicare Better Health Rewards Program)—Due to rising costs of healthcare, this program is designed to empower the patient to reach achievable health goals. Metrics gauge improvement in six areas: body mass index, diabetes indicators, blood pressure, cholesterol, vaccinations, and tobacco use. The program gives participants an incentive of up to $400 after they follow the program for two to three years. The rewards: better outcomes for seniors and reduced utilization of healthcare services. While this is not a medical device, it will be interesting to see results over the year ahead.
- Breast tomosynthesis (3D mammography) screening for breast cancer—The technology is FDA approved and does not replace standard two-dimensional mammograms. Instead, it is performed along with conventional mammograms for a more accurate view of the breast—tissue, ducts, vessels, and ligaments at varying depths. This could help women with dense breasts where standard mammography may not detect the tumor. Preliminary studies indicate a substantial increase in cancer detection over standard mammography.
- Modular device for complex aneurysms—Ruptured aneurysms are often fatal. Monitoring and treatment can deter a ruptured abdominal aortic aneurysm, using meticulous measurements of the aneurysm’s size and location and fitting an appropriately sized stent-graft. A custom-fit graft can take weeks to make and deliver; however, a new fenestrated stent-graft system allows treatment of the patient without detailed measurements or prolonged wait times.
- Ex-vivo lung perfusion to reverse lung injury in donor organs rejected for transplantation—Damaged lungs are removed from a donor and connected to a cardiopulmonary pump and ventilator. As the lungs inflate/deflate, fluids and nutrients are pumped through blood vessels to repair and nourish the tissue. Ex vivo lung perfusion is approved in Europe and Canada and a multicenter study in the U.S. is underway.
- Femtosecond laser cataract surgery—allows greater precision without a blade. Cataracts are a common eye ailment in people over 60 years of age, and cataract surgery is one of the most common and effective surgeries performed. This laser is FDA approved.
- Handheld optical scan to identify skin lesions—The technology was used in the military for guided missile navigation. This FDA approved device is showing promising results in the largest study ever on melanoma, with a 98% detection rate.
- Novel advanced prostate cancer medications—These drugs block testosterone production and prevent stimulation of genes that cause prostate cancer growth. Metastatic bone pain is a common problem in advanced prostate cancer; treatment with an injectable form of radiation that targets bone metastases and avoids damaging healthy cells is showing promise. Treatment of advanced prostate cancer may be managed as a chronic disease with improved survival.
- Mass spectrometry using matrix assisted laser desorption/ionization time of flight (MALDI-TOF)—Identify pathogens causing infection in far less time compared to inoculating an agar plate and waiting hours to days for the organism to grow. This basic science lab technique may help avoid inappropriate antibiotic use and improve outcomes.
- Neuromodulation therapy for cluster and migraine headaches—This uses a small implantable neurostimulator, placed in the upper gum. The tip of the device is placed near the sphenopalatine ganglion nerve bundle (SPG), a target for treating severe headache. A remote control delivers stimulation to the SPG when a headache is looming. In the U.S., the device is in multicenter trials. It is approved and available in Europe.
- Bariatric surgery for control of diabetes—Initially used for weight reduction in obesity, it appears to also diminish Type 2 diabetes soon after surgery. A study in the New England Journal of Medicine showed that patients who underwent bariatric surgery reduced their medications for diabetes or were diabetes-free. Other benefits were lower blood pressure and cholesterol levels. Due to these positive results, some Type 2 diabetes patients are now being offered the surgery.
The themes for these 2013 innovations strike me as cost reduction and re-purposing. The Medicare Program, if only because of its sheer size, could make dramatic differences in healthcare spending while handing responsibility for healthcare to the patient/consumer. Meanwhile, handheld optical scanners illustrate the transfer of military technology to healthcare, and MALDI-TOF, bariatric surgery and lung rejuvenation are cases of using science and medical technology for an innovative purpose, or using previously rejected tissue. We’ll see how effective they are in the longer term.
Do you think these are the top ten innovations? What would you replace? How can the life sciences industry impact healthcare innovation over the next year? We’d love to hear your thoughts.
Tags: cleveland clinic, Cleveland Clinic Top 10 Innovations, healthcare innovations, top 10 healthcare innovations 2013, top healthcare innovations
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Last year, the Cleveland Clinic predicted what the Top 10 innovations in healthcare for 2012 would be. Before we report on the Cleveland Clinic’s predictions for 2013, let’s review how well the Top 10 Innovations for this year actually fared:
- Catheter-based renal denervation for resistant hypertension—Five companies are manufacturing the devices, which are now available in Europe and are under study in the U.S.
- CT scans for early detection of lung cancer—New practice guidelines recommend screening using low-dose CT scans for people at high risk of developing lung cancer and can only be performed in experienced facilities. The cost? About $100 per screening (not covered by insurance).
- Concussion management for athletes—The Cleveland Clinic is developing a concussion app for use in high schools that checks athletes’ memory, reaction time, and balance and compares scores to previous data points.
- Mobile health devices and apps—This is now an area of enormous growth, with more than 40,000 mobile apps related to health and wellness. The FDA recently released draft guidelines for apps that make medical claims. At Popper and Company, we added Paul Sonnier to our team as head of digital health strategy, due in part to our recognition that mobile and other technologies from other industries have become incorporated into healthcare.
- Next-generation sequencing—This technology has expanded into pathology laboratories with a small footprint and low cost. As the price of sequencing and the speed at which sequencing can occur both drop, look for handheld devices to hit the market next year that will have the ability to sequence the genome in 15 minutes.
- Implantable device for complex brain aneurysms—An FDA-approved device that reconstructs blood vessels in the brain is gaining traction over older coil and stent technologies.
- Active bionic prosthesis—Limb prosthetics are improving thanks to better materials and advancements that allow lighter limbs, and increased activity and stability. The first exoskeleton device was available this year for paraplegics, for over $100,000. However, insurance companies currently pay only for basic prosthetics.
- Big data—This will become the norm in managing patients, due in part to the Affordable Care Act and the implementation of electronic health records.
- Diabetes Therapy—SGLT2 Inhibitors (sodium-glucose co-transporter 2 protein) rid glucose by excreting it in the urine. They also lower A1C levels but the FDA rejected the drug application for dapagliflozin, an experimental drug being studied by Bristol-Myers Squibb in partnership with AstraZeneca, due to concern over side effects and requested more data. The European Commission approved the drug.
- Genetically modified mosquitoes—The U.S. Department of Agriculture is considering the release of millions of GM mosquitoes in Florida but citizen protests touting fears of disrupting the food chain have involved the FDA.
While there have been more than a few stumbling blocks, a few trends are clear: mobile apps and more accessible electronic records are a growing phenomenon, and devices are becoming more flexible, light, and more often than not, implantable. And so what’s to come in the year ahead? In my next post, I’ll look at the Cleveland Clinic’s predictions for 2013.
Do you think these were the top 10 healthcare innovations for 2012? Were there others more worthy of the list? What trends do you see? How do they impact your medical device or diagnostics business? What can life science leaders to do keep up with these trends? Let us know your thoughts.
Tags: cleveland clinic, Cleveland Clinic Top 10 Innovations, healthcare innovations, top 10 healthcare innovations 2013, top healthcare innovations
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We have followed the progress of Walgreens as the drugstore chain integrates health clinics into its stores as one example of what appears to be a growing trend throughout the drugstore industry. But it’s still not clear how these clinics will fit into the mix of healthcare offerings.
Walgreens now has 356 in-store clinics, and other drugstore chains are more than catching up: CVS has about 588 CVS “MinuteClinics,” and Wal-Mart includes 143 clinics across some of its stores nationwide. The consulting firm Merchant Medicine estimates that there are almost 1,400 in-store health clinics in the United States.
Recently, National Public Radio and Truven Health Analytics conducted a poll of consumers, and found that:
- Two-thirds of people would try an in-store clinic, while about half said they were aware of a clinic near them.
- Eighty percent of people who tried a clinic were happy with the experience.
- Most consumers went to a clinic to treat a cold or minor illness, or to receive an immunization.
Why are these clinics popular? The reasons could be a warning shot to physicians and other providers. Although most people who used the clinics also had “regular” doctors, the consumers reported that the clinics were cheaper, more accessible than a doctor’s office, and provided the “perceived” same quality care as that received from a physician.
While Rand Corp. and other studies found that clinics indeed are 80 percent cheaper than an emergency room and half the price of a doctor’s office visit, the clinics could cause headaches for doctors and patients:
- Patients who try clinics are less likely to visit a doctor the next time they get sick. Since clinics don’t have patient records or a regularly scheduled provider, there’s no provider-patient relationship.
- Clinics aren’t staffed by doctors—usually a nurse practitioner or physician assistant sees customers. Serious or chronic problems could easily be overlooked.
- Consistency could become a problem—some in-store clinics could over-prescribe drugs, and in extreme cases, certain free-standing clinics were found to be “pill mills” in disguise, illegally selling narcotics and painkillers.
There’s no doubt that the consumer revolution in healthcare is demanding more access at a more reasonable cost, but are in-store clinics the solution? Right now, less than one percent of outpatient care is handled through such facilities. But as they grow, there will have to be a good, secure fit within the overall healthcare delivery system.
What do you think: Do in-store clinics have a rightful place in healthcare delivery? Or are they undermining physicians and other providers, and possibly putting patients at risk? What other solutions incorporate quality care, accessibility and low cost?
Tags: drugstore chains, health clinics, healthcare delivery, healthcare offerings, in-store clinics, Walgreens
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Sometimes the state of healthcare seems more like the movie “Snakes on a Plane” rather than the symbol of the serpent entwined on the Rod of Asclepius (the Greek god associated with healing and medicine). The movie title alone conjures pretty frightening images. The good news is that the rising numbers for healthcare investment, information technology spending, and consumer behavior related to their healthcare choices reveal a course change that’s not reptilian at all:
- According to a recent report in MedCity News, healthcare spending on telecommunications will outpace overall healthcare industry growth rates—climbing to $14.4 billion by 2017, at an annual growth rate of 10 percent.
- Venture capitalists and incubators are researching both life sciences companies and IT companies—they could create matches between life science innovators and IT to spur more digital health innovations.
- Improved networks and information technology are allowing providers to leverage their traditional medical care resources (e.g., hospitals, clinics, equipment) across a larger base of remote patients. These networks and electronic health records (EHR) will allow collaboration among clinicians, care teams, patients and provider organizations.
At the same time, however, healthcare costs are rising, in part, due to the nature of how many Americans seek treatment and manage their own health conditions:
This all makes for very expensive healthcare delivery.
Something has to give; but what?
- Chronic management is starting to move from the ER and doctor’s offices, while home monitoring and mobile monitoring is growing. The current market for home blood pressure monitors is $1 billion, glucose monitors is $7 billion and markets are growing for blood coagulation monitors and home-based cholesterol testing kits.
- Online physician-patient visits are growing and 39% of doctors now communicate with their patients through email. The U.S. Veterans Administration showed that telehealth resulted in 25% fewer hospital bed days, and 19% fewer admissions.
- Several companies in the U.S. and elsewhere, small and large, health and non-health–related, are coming up with solutions to care for patients at home utilizing various platforms and devices.
- Kiosks and mobile units are springing up across the country to bring healthcare to the consumer.
How can we continue on this journey toward even more healthcare efficiencies?
Calibrated care refers to ranking patient-provider interactions in order of severity, much like an automated telephone system works in customer service for other products. It determines the lowest interaction mode necessary (via the web, a smart phone or tablet), and can use software programs to measure need (e.g., Is this a prescription refill? A need to change dosage? A complaint of chest pains?), and determine the right interaction level. Moreover, software is under development (with more on the way) that saves data from every interaction to aid in follow-ups.
While some nurses report feeling their jobs are threatened by telehealth, nursing has historically embraced innovation and new ways to improve patient care. A recent report on nurse-led telehealth intervention for diabetics resulted in a significant reduction in HbA1c levels.
While doctors may be slow to adapt to changes and insurers are not fully confident, the bottom line is: consumers are demanding these changes. More than 80% of consumers want more internet-based information on their health, and Kaiser Permanente reported that 87% percent of seniors using its online health record system were happy enough to pay for it.
Ultimately, these innovations will allow a fully remote, digital version of Patient-Centered Medical Homes (which will, of course, depend on having the right technology to make them work). This new focus could create a real movement toward digital health and make it a significant part of our healthcare system.
Do you think a software-based calibrated care system could work? What possible obstacles could there be? Could these systems reduce healthcare costs? In what specific ways? Share your thoughts with us.
Tags: consumer behavior in healthcare, Health Care, health IT, healthcare costs, healthcare efficiencies, healthcare investment, healthcare IT
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Predicting the future is a risky game; too often, the prognosticator is wrong. But the exercise can be valuable, because it forces an analysis of forces driving technological and other change, and of what challenges may lay in the path of change.
Recently, an infographic on emerging technology published in MedCity News charted several paths that predict how (and how quickly) technological change is likely to occur; this infographic included healthcare innovations. While the graphic resembles the independent lanes of an electrophoresis gel (or an Olympic swimming pool for those of you who may have spent less time in the lab), many of the technological advances profiled are intertwined: for example, telepresence (predicted for 2024) could merge with certain advances in robotics as well as the advent of synthetic biology to develop a remote way of delivering cell therapy that was created entirely in a laboratory.
Some other future innovations that affect healthcare (especially digital health):
- Biometric sensors (predicted to arrive in 2016): there is a lot of activity around developing in-home patient monitoring, and many stakeholders are comparing the costs versus benefits of home monitoring versus hospital-based care. Sensors could capture vital health information at home, and alert a caregiver of any significant changes. The caregiver could then make some adjustments immediately (changing medication dosages, for example), preventing worsening symptoms that require a hospital admission. While a promising area, technology infrastructure must be a key part of this advancement.
- Personalized medicine (predicted for 2020): we have started to see the benefits of personalized medicine, with the costs of personal genome sequencing approaching $1,000, and with FDA approvals of a number of personalized medicines and companion diagnostic tests. This field will advance rapidly, accelerating due to consumer demand, and adoption rates by practitioners and coverage rates by insurers (assuming proof of cost effectiveness) will follow suit.
- Biomarkers (due for 2018): obviously, many biomarkers are known today, including those that determine responders from non-responders (i.e., those patients who may or may not respond to certain drugs). In cancer chemotherapy, the drugs Erbitux and Vectibix are not recommended for treating tumors that contain KRAS mutations because of the lack of clinical efficacy. Utilization of the biomarker test for KRAS can then help eliminate some costly treatments that may have no effect on patient outcomes. Thousands of biomarkers have yet to be connected to a disease state (another form of prediction); but, as with personalized medicine, consumer demand for these biomarker-based approaches can accelerate innovation.
Each of us may have different ideas on which technology will have the greatest impact and whether it will be adopted by consumers. At Popper and Company, we work with many life science clients whose innovations and products extend into these new areas—personalized medicine, stem cells, biosensors, and digital health. It’s a matter of time, and relevance, before these become state-of-the-art systems, devices or drugs.
Do these predictions seem accurate to you? What would accelerate (or impede) their development? Are there other technological areas that look more promising in terms of their impact on healthcare? Let us know what you think.
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At Popper and Company, we’ve watched and commented upon how the Walgreens drugstore chain has developed unique strategies, from prescription price negotiations to bringing pharmacists and customers closer together. Now, the chain is exploring ways its stores can better distribute and educate their customers on medical devices and the emerging world of mobile healthcare. In this post, I share highlights from my interview with Dr. Jay Rosan, VP of Health Innovation at Walgreens.
Is Walgreen’s moving into mobile health?
Most people view Walgreens as the community pharmacy—we have nearly 8,000 such stores. About two-thirds of Americans live within three miles of a Walgreens. We also have more than 350 retail clinics. We are one of the top specialty pharma retailers in the country, and the largest provider of workplace health and wellness centers in the U.S., with about 360 locations including many Fortune 500 companies. We are the closest place to home (for many Americans) so we have a lot of opportunities to facilitate personal health.
When your technology group looks at supplies and devices for diabetes, for example, are there devices that are covered that you provide but do not necessarily promote?
We have a large distribution channel. We have 27,000 pharmacists, and in our new pilot format stores we’re taking them from behind the counter and putting them in front. So we are going to take pharmacists away from the production aspect of filling prescriptions and have them interact more directly with patients. We don’t cover devices, but these pharmacists will help distribute and educate customers about almost all the devices for diabetics that are out there since we carry most of them. We review devices all the time, and we promote those we feel are appropriate for the patient.
If a device were to be used by someone with diabetes, I would send it to individuals in our innovation, purchasing, diabetes and our mhealth teams for their opinions. I think that the Holy Grail for diabetes devices is a noninvasive glucometer; when that is successful, that will change the world. There are a few companies who are getting close to this. They are small companies and not necessarily the larger ones.
Do you see trends in reimbursement with regard to telehealth and remote monitoring?
Insurers see these technologies as more of a value than they had before, but for the right types of patients. It is beginning to shift. No question they are starting to reimburse, but they are cautious; appropriately so, because the technologies are not exactly perfect.
Is a lot of reimbursement tied to outcomes?
Yes absolutely. That reflects the general trend in health care and the efforts under health care reform. Today, payers, providers and health plans are all focusing more and more on outcomes and how treatments can lower overall health care costs and improve care.
What would tip their view on reimbursement?
Reimbursement depends on the device, so for instance with continuous glucose monitoring, certain criteria need to be met before reimbursement will occur. Devices can be consumer or medical. Consumer items are not reimbursed by insurers. Medical devices are prescription-based but also based on what the device does. So if someone wants a Jawbone Up, which is an activity sensor; there is no real medical indication for it and it is not reimbursed by insurers. But if someone wants a glucometer, that is a medical device because you are relying on a specific number to make treatment decisions. So it is reimbursable. But could any device help a patient with type 2 diabetes who is overweight? Certainly, to some extent. However whether it is reimbursable is a question because there might be people who would abuse the situation.
So, now, what do you think: Are digital health devices becoming more “insurer-friendly?” Or do we have a ways to go before non-invasive devices are reliable enough health delivery instruments? Should mobile health delivery be in the hands of pharmacists, or somebody else? Share your thoughts with us below.
Tags: digital health, digital health devices, m health, mobile health, mobile health delivery, mobile healthcare, walgreens innovation, walgreens way
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It is common knowledge that antibiotic resistance is on the rise. For example, infection with resistant Klebsiella pneumoniae carbapenemase (KPC), once found only in North Carolina, now plagues 37 states. While antibiotics are important tools, their overuse results in more antibiotic resistance cases such as KPC. In fact, suboptimal use of antibiotics may be as high as 68% of all applications in healthcare. Some researchers even suggest that overuse may force bacteria to mutate faster, creating an evolutionary trend of ever-increasing rates of antibiotic resistance.
Reducing antibiotic use can, in turn, reduce antibiotic resistance rates. Most overuse of antibiotics stems from inadequate instruction about bacterial resistance, improper use of broad-spectrum antibiotics when narrow-spectrum drugs are available, and unnecessarily long durations of treatment.
To remedy these problems, antibiotic stewardship programs – complete with the use of health IT and medical device innovations and a team approach – educate and aid decision-making among physicians and nurses, providing optimal antibiotic treatment regimens. These programs shorten hospital stays, improve patient care, and are cost effective. Some specific factors for an effective stewardship program include:
- Faster blood culture—while the U.S. Centers for Disease Control and others advocate using narrow- over broad-spectrum antibiotics, one obstacle to this preference is the length of time a blood culture takes (currently up to 72 hours). As I’ve discussed previously, companies are developing innovative pathogen detection systems that could replace today’s century-old blood culture methods.
- Bathing more than the patient—hospital rooms that are bathed with ultraviolet light can help decrease hospital-acquired infections. Next-generation disinfectants also can kill bacteria, including antibiotic-resistant strains.
- Changing practices—keeping intensive care patients hooked up to ventilators for shorter times (while not jeopardizing their care) can prevent infections transmitted through the machines.
- Surveillance—automated data gathering, storage and sharing via health IT programs and devices can be used to determine real versus ideal antibiotic use, discover patterns and incidence of resistance and identify hospital-acquired infections.
- Acceptance—education alone cannot eliminate hospital-acquired and resistant infections. But the creation of stewardship teams to adopt new methods and technologies can help encourage adoption by physicians, and place them in leadership roles to reduce infection rates.
- Audit/tracking—these are necessary to determine actual prescription behavior, and determine education and policy needs of the stewardship program. Effective audits can incorporate the use of rapid-detection hand-held devices that use visible light to detect microbes, for example.
What would you incorporate into an antibiotic stewardship program? Do you think advanced detection technology can make a difference? What will and won’t work? Is your life science company working on any solutions? Share your thoughts with us.
Tags: antibiotic resistance, antibiotic stewardship, antibiotic stewardship program, effective antibiotic stewardship, health IT, medical device innovation
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