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Making Precision Medicine a Reality at Cleveland’s University Hospitals

September 25, 2018
by Rajiv Leventhal, Managing Editor
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Genomic data—once in consumable and action form—is information that clinicians will be excited to tap into, says one leading CMIO

Earlier this year, University Hospitals, an integrated health system in northern Ohio, took a big step into the world of precision medicine when it entered into an agreement with an Allscripts subsidiary with the goal to bring genomic data into the clinical workflow.

According to University Hospitals officials, the genomic data points were already part of the EHR (electronic health record) system, but with the 2bPrecise delivery program— an offering from 2bPrecise LLC, a wholly owned subsidiary of Allscripts—patient information will be more accessible to physicians allowing for the data to be part of the medical record and subsequently shape and tailor the best treatment or therapy options for patients.

University Hospitals (UH) serves the needs of patients through an integrated network of 18 hospitals, more than 50 outpatient health centers and 200 physician offices in 15 counties throughout northern Ohio. According to UH’s Jeffrey Sunshine, M.D., Ph.D., chief medical information officer (CMIO), the collaboration is another step in the journey to make healthcare as personalized as possible for all patients.

Indeed, Sunshine says that the collaboration “fits squarely in the larger strategy of providing patient-centered health, wellness and care. That’s been our strategy for quite some time, and precision medicine, which is becoming more commonly used, means something a little different every time it’s used for every different person,” he says. And the broader question, Sunshine adds, is “How do we provide the best tools we can for each patient? That [concept] is what’s driving this.”

The new system also will allow UH to use the gene data to better align tests and treatments for patients that have a history of cholesterol or psychiatric markers, as well as other conditions that genomic markers could provide the best treatment avenues, officials have noted.

Having an Effect on Patient Care

University Hospitals is no stranger to precision medicine initiatives with the most common uses cases currently taking place in oncology, Sunshine notes. In oncology settings, when suitable, “We will take advantage of markers of the patient or the tumor to make best recommendations of appropriate therapy, or preventive measures, based on who you are, our ability understand your genetic code, and/or what’s growing in ill form. And that is precise to the circumstances for the patient. Precision medicine not only means genetically modified care, but it’s most often used in that context right now,” he explains.

Sunshine specifically points to three areas he believes this initiative, and precision medicine more broadly, will have a positive impact on patient care. The first involves when there is a specific disease for which something in a patient’s genetic markers might let clinicians know that either the patient has that disease and has a genetic marker that says he or she should be treated differently because of that marker; or the patient is at high risk for something bad and a preventative measure could be taken, he explains.  

What’s more, he notes, there is already evidence in oncology, and growing elsewhere, that “not everyone will respond the same to the drugs we might recommend for you, and we all understand that. But there is starting to be a growing experience that certain genetic markers can definitively predict for certain drugs that the drug won’t work or that it’s the wrong dose, so it could help us be very specific about the drug or dosage you should get,” Sunshine says. And that’s not limited to oncology; it crosses lots of domains. For example, he offers, there is growing evidence in the psychiatric domain that for certain gene markers, certain drugs won’t work, or that the dosage should be changed dramatically.

The third area that Sunshine points to is in preventive screening, where one might find through genetic markers that a certain patient is in a class of patients, who without that screening, clinicians wouldn’t have known are at a much higher risk for a disease. “So we should screen you more,” he attests. “And maybe that screening test has a certain cost that no one thinks we can afford for all U.S. citizens, but for 1,000 patients in the U.S. who need it, it’s a perfectly rational use of healthcare dollars,” he says.

To this end, speaking to the increasing pressure to lower healthcare costs, Sunshine believes that more personalized healthcare will be a big step in the right direction. “We've gone almost as far as we can on doing the same thing for everyone the same way, and now we have to figure out how to do it uniquely for the individual, because everyone doesn’t need everything, and we can’t afford to do everything for everyone." Therein lies the opportunity to be smart about it, Sunshine says, and figure out who needs what, at what highest priority, and what’s the best thing to do for that person or group of people. “And that opens a wide-open universe,” he says.

From an industry-wide perspective, Sunshine believes that CMIOs at integrated health systems like UH would say that they are doing “some form of precision medicine.” But it’s an ongoing development everywhere, he notes, adding that right now, precision medicine is probably not a top-three priority in in any organization’s broad outlook, but if narrowed down to a patient-centered care or patient engagement perspective, then it ranks high on that list. “With everything happening around EHRs, there is a lot of short-term attention on that, so some organizations are more or less along the strategy or momentum phase, but no one has a fully mature [precision medicine] model out there,” he says.

Going forward, Sunshine feels that to be successful in precision medicine endeavors, a continuous improvement culture will be needed—or as he explains it, “the culture that wants you to focus attention on having to do tomorrow different than today; a ‘get us to the future’ mentality.”

And perhaps even more important than that is making this data available and actionable for the front lines of care—a task that Sunshine puts squarely on himself and others in his position. “Primary care [physicians] would be excited to know if there were markers that could be obtained so they can alter their pharmaceutical approach to high cholesterol, hypertension or cardiac prevention for that patient,” he says. “If we, or anyone, who wants to do this can deliver that in a consumable and actionable form, the excitement and curiosity is waiting to be tapped.”


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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”


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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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