We Must Hold Big Pharma Accountable For Predatory Pricing

https://www.huffingtonpost.com/entry/opinion-beggelman-price-gouging_us_5ab45270e4b008c9e5f5c47f

 

It’s hard to remember now, but there once was a time when pharmaceutical companies were considered heroes, not villains.

In the 1920s, Dr. Frederick Banting and Charles Best discovered insulin could be purified and administered to diabetes patients via injection. Before this groundbreaking discovery, people living with diabetes were placed on starvation diets as a form of treatment, and many patients died.

Banting and Best understood the enormity of their discovery and considered insulin a public good. But as these researchers soon realized, insulin wouldn’t be able to save lives if patients couldn’t access it. They sold the rights to the drug to the University of Toronto for $1. The university, in turn, gave it to pharmaceutical company Eli Lilly for a 5 percent royalty so the company could manufacture at scale to meet the enormous demand. In 1923, insulin became widely available and saved countless lives, thanks to Banting and Best – and Eli Lilly.

Now, just under a century later, Eli Lilly and other insulin manufacturers are taking the exact opposite approach.

Big Pharma is pushing every scheme imaginable to squeeze money from the pockets of patients who need insulin to survive. Many with diabetes, faced with tripling insulin prices ($200 to $700 per month), are now forced to choose between life and rent. Some patients ― like 26-year-old Alec Raeshawn Smith, who aged out of his parents’ health insurance plan and whose job didn’t offer comprehensive coverage ― have died from a lack of affordable insulin.

Pharmaceutical companies can become heroes again, but only if they stop taking advantage of the patients who need them.

Eli Lilly says the company strives “to make life better for all those affected by diabetes around the world.” And because drug companies do save and improve lives (or, at least, are supposed to), the U.S. government allows them special privileges and protections. This includes tax breaks, government subsidies, extensive patent protection, free access to publicly funded scientific discoveries and more.

However, when drug companies use empty words to make promises they have no intentions of honoring, they do not deserve the public’s largesse.

Big Pharma has not shown any inclination to change its price gouging practices. On the contrary, drug companies continue to push higher costs despite the horrific impact this has both on human life and the U.S. economy. Price freezes in the U.S. are rare (and are exclusively voluntary). They also tend to be set at high levels, like the price “freeze” for the HIV drug Isentress, which caused a stir among HIV patients because of its exorbitant cost compared to competitive products.

Some companies have rolled back drug prices but typically only in response to public humiliation. Doctors at Memorial Sloan-Kettering publicly rejected Sanofi’s Zaltrap, a colon cancer drug, because it was priced twice as high as a competing product. Three weeks after the doctors’ announcement, Sanofi cut its price in half. This is why consumers shouldn’t be satisfied with price freezes; only rolling back prices will return us to reasonable drug costs.

Pharmaceutical companies do sometimes offer “solutions” to runaway drug prices, like value-based pricing and discount cards, but though these practices may help some, they are generally gimmicks meant to distract the public. Value-based pricing sets prices according to a drug’s perceived value rather than according to the actual costs of developing and manufacturing it. Such a practice can put a limit on the price of marginally effective drugs, but on the other hand, it increases the price of medications like insulin ― drugs that save lives but have been around for years and are cheap to produce. Discount cards are sometimes offered to a small subset of insured patients and do very little to help the vast majority of users or those who need the drugs most.

In the U.S., our 20 top-selling medications cost consumers three times more than the exact same drugs cost in Britain. I once paid $36 for a medication in Canada that costs me more than $700 here at home. In many European countries, government committees calculate “reference prices” for classes of drugs with similar ingredients, based on the costs to develop and manufacture them and their clinical effectiveness. That said, it’s probably not realistic to expect our politicians to agree to this kind of approach; in the U.S., pharmaceutical companies are some of the largest contributors to political campaigns, giving more than $2.3 billion over the past 10 years.

Big Pharma is pushing every scheme imaginable to squeeze money from the pockets of patients who need insulin to survive.

Our legislators, too afraid to challenge Big Pharma’s pocketbooks, continue to propose tepid solutions, like price transparency, that only work around the edges. Pharmacy benefit managers ― the industry middlemen who play a role in drug pricing ― take a piece of the pie, but how large a piece remains a secret. Legislation around transparency regarding undisclosed PBM deals could drive down drug prices somewhat, but it likely wouldn’t affect the baseline prices set by drug manufacturers.

The Right Care Alliance ― a group of patients, physicians, nurses, patient advocates, students and other community members with chapters around the country ― is currently organizing a campaign to target price gouging in the pharmaceutical industry. We are planning year-long grassroots actions, including town hall meetings, marches and demonstrations, to pressure Big Pharma to stop predatory pricing, particularly for life-saving medications.

We must force companies like Eli Lilly to address the gap between what they say they stand for and their actions. We must be loud with our demands to counterbalance the hold Big Pharma has on U.S. politics. Drug companies can become heroes again but only if they stop taking advantage of the patients who need them.

 

Protein Engineering May Be the Future of Science

https://www.bloomberg.com/view/articles/2018-03-27/protein-engineering-may-be-the-future-of-science

Some scientists think designing new proteins could become as significant as tweaking DNA.

Scientists are increasingly betting their time and effort that the way to control the world is through proteins. Proteins are what makes life animated. They take information encoded in DNA and turn it into intricate three-dimensional structures, many of which act as tiny machines. Proteins work to ferry oxygen through the bloodstream, extract energy from food, fire neurons, and attack invaders. One can think of DNA as working in the service of the proteins, carrying the information on how, when and in what quantities to make them.

Living things make thousands of different proteins, but soon there could be many more, as scientists are starting to learn to design new ones from scratch with specific purposes in mind. Some are looking to design new proteins for drugs and vaccines, while others are seeking cleaner catalysts for the chemical industry and new materials.

David Baker, director for the Institute for Protein Design at the University of Washington, compares protein design to the advent of custom tool-making. At some point, proto-humans went beyond merely finding uses for pieces of wood, rock or bone, and started designing tools to suit specific needs — from screwdrivers to sports cars.

Now it’s possible to make a similar transition on a molecular scale, since scientists can create proteins with structures that nature never produced. “They can transcend the natural protein universe,” said William DeGrado, a chemist at the University of California, San Francisco.

People have been talking about protein engineering for decades. But until the last couple of years, carrying it out was a dauntingly complex problem. There are no simple rules to predict how proteins fold into their various three-dimensional structures. So even if you could design a protein with just the right shape for some job, there would be no obvious way to know how make it from protein’s building blocks, the amino acids.

But over many years, scientists have been chipping away at the problem, DeGrado said. Unlike in other more widely publicized fields, there haven’t been any celebrated milestones (such as the completion of the $3 billion human genome project). Nor have there been any single, surprise breakthroughs such as CRISPR -– a component of yogurt bacteria that revolutionized the ability to manipulate genes. But now some scientists think designing proteins will become at least as important as manipulating DNA has been in the past couple of decades.

What’s recently changed is the ability to decipher the complex language of protein shapes. There’s a very simple way that the linear chemical code carried by strands of DNA translates into strings of amino acids in proteins. But then the laws of physics come into play. The proteins snap into folded structures because amino acids are attracted or repelled by others many places down the chain.

University of Washington’s Baker said that when he was starting his career some 30 years ago, senior scientists tried to steer him away from protein engineering because there was no guarantee he would make any appreciable progress in his lifetime. But he said he liked the challenge and the interdisciplinary nature of the quest, which combined computer science, biology, chemistry and physics.

Since then, scientists have advanced their understanding of the physics of proteins, and computing power has increased. Baker started a translation system called Rosetta, but — realizing that he was running out of computer power at his university — he engaged citizens to lend their computers in a project called Rosetta@home.

Baker and colleagues then devised a sort of game called Foldit, in which citizen scientists could try figure out how certain proteins would fold. They eventually enlisted the help of more than a million people, he told me. That won them the ability to predict how smaller proteins would fold, but larger ones were still too complex. According to a news feature in the magazine Science, they got a boost from scientists studying how evolution has led to the proteins we already have. Most genetic mutations that affect the structure of proteins will lead to something that doesn’t work, and the death of whatever inherited it. But certain combinations of different mutations will lead to a modified version of the same thing, allowing new proteins to evolve.

And finally, their biological Rosetta stone is working. UCSF’s DeGrado said his lab is looking at how to create new medicines with better stability — on the shelf and in the body. He’s also studying Alzheimer’s disease and similar neurological conditions, which are characterized by brain proteins that fold up incorrectly into toxic deposits.

Baker’s lab is working on an equally diverse set of applications, including a vaccine that would simultaneously protect against all strains of the influenza virus, and a system to break down the common grain protein gluten, in the hope of helping people with celiac disease. Others are looking for proteins that help convert solar energy to fuel. Baker pointed out that there are 20 to the 200th possible proteins — which is more than the number of atoms in the universe. Evolution has produced just a minute fraction. So there’s plenty of room to expand.

Two key areas hospitals are planning major tech investments in the immediate future

http://www.healthcarefinancenews.com/news/two-key-areas-hospitals-are-planning-major-tech-investments-immediate-future?mkt_tok=eyJpIjoiTkRsaU5HTTJNVEV5WldaaSIsInQiOiJFSTVVaHdzRmdQTGVCSXZORmhReEkrbVVWNjZOdzhlOWRuRUwxeUVXNktOa2FyNVpQWkc1dXk5SGNTQjc0YndcL3BuUTkrV2xkWEVLd01qWnd2UGNrWTBFTFFzRWxWaGM3bVFOclwvYjNlbXBPSjA2d1prU0tyMmNpQ0Qwdlg4TGhUIn0%3D

 

Providers are ramping up to focus on urgent care centers and population health initiatives.

Hospitals are gearing up to spend more on population health and urgent care centers in the coming years, according to new research from two different firms.

The market for population health technologies is expected to reach $69 billion by 2025 while the urgent care center space is forecasted to grow by roughly $8 billion in 2018 to $25.93 billion by 2023.

The global population health management market was worth $118.5 million in 2016 and is slated to grow at a CAGR of roughly 16 percent from 2017 to 2025, with the rise in demand for innovative technologies and adoption of healthcare IT tools fueling the growth, Transparency Market Research said in a new report.

In terms of end-users, it’s the healthcare provider segment of the market that is expected to account for the largest share of the global market thanks to rising use of PHM tools. Insurers, pharma and “others” follow in terms of segments.

The benefits of PHM tools like data integration, data analysis, care coordination, and lowering care costs have driven an increase in their adoption, especially in the case of chronic diseases like diabetes and cardiovascular diseases which require identifying high-risk patients and disease management measures.

“This is one of the factors projected to drive the global population health management market during the forecast period,” the report authors wrote. “Developed healthcare IT infrastructure and increase in healthcare IT spending are the other factors anticipated to propel the global market during the forecast period.”

Geographically, North America and Europe are expected to dominate the market thanks to the Affordable Care Act and a rise in healthcare IT spending, owing largely to providers.

“Well-established healthcare infrastructure and strong support from public and private sectors in terms of reimbursement are attributed to the largest market share of North America,” the firm said. “A rise in awareness about population health and government initiatives such as the Affordable Care Act are anticipated to drive the market during the forecast period.”

Urgent Care Centers, meanwhile, will represent a $26 billion market by 2023, and in this year will reach just over $20 billion, ReportsnReports projected. Health systems and corporations with a stake in the healthcare industry know the model is flourishing thanks to affordable pricing, shorter wait times, an increasing elderly population, and the market is seeing more investment activity as well as strategic development partnerships between urgent care providers and hospitals. Corporate-owned urgent care centers, however, are expected to occupy the largest share of this market in 2018.

Concentra, MedExpress, American Family Care, NextCare Holdings, and FastMed Urgent Care are already major market players with CareNow Urgent Care, GoHealth Urgent Care starting to gain more of a presence as well in the United States.

Health systems looking to diversify their portfolios might do well to look at both urgent care centers and population health programs when considering how to expand their footprints. With a reputation for faster service and better pricing, both things that the rising millennial population smile at, they could be a beacon for both primary and specialty care for younger consumers as opposed to traditional practices. Additionally, with the high-deductible health plans, reasonably priced care will be especially attractive to patients who will bear a greater portion of the financial responsibility related to their care.

As these facilities grow in popularity, including them could boost not only your reputation but also your bottom line.

 

Sharp HealthCare ACO is evaluating its legal options after leaving Next Generation

http://www.healthcarefinancenews.com/news/sharp-healthcare-aco-evaluating-its-legal-options-after-leaving-next-generation?mkt_tok=eyJpIjoiTkRsaU5HTTJNVEV5WldaaSIsInQiOiJFSTVVaHdzRmdQTGVCSXZORmhReEkrbVVWNjZOdzhlOWRuRUwxeUVXNktOa2FyNVpQWkc1dXk5SGNTQjc0YndcL3BuUTkrV2xkWEVLd01qWnd2UGNrWTBFTFFzRWxWaGM3bVFOclwvYjNlbXBPSjA2d1prU0tyMmNpQ0Qwdlg4TGhUIn0%3D

Image result for sharp healthcare ACO

 

ACOs have left because of a surprise risk adjustment that pushed some from receiving bonus payments to paying penalties, expert says.

Sharp HealthCare ACO, one of the seven that has dropped out of Next Generation, is evaluating its legal options after the Centers for Medicare and Medicaid Services introduced a risk adjustment factor midstream, a decision that will cause the ACO to lose rather than save money, according to the CEO of the accountable care organization.

“We are evaluating what our legal options are,” said Alison Fleury, CEO of Sharp HealthCare Accountable Care Organization and senior vice president of Business Development for Sharp HealthCare in San Diego, California. “The sections of the agreement that CMS adjusted unilaterally are not sections they are able to adjust unilaterally.”

Sharp HealthCare ACO is awaiting the results of a preliminary settlement report, expected in April, that will give a clearer financial picture, according to Fleury.

The ACO, which signed on to Next Generation for two years on January 1, 2017, is now on the hook for losses from 2017, but not for 2018.

Sharp’s ACO of two medical groups and the ACO parent organization made the decision to withdraw from Next Generation effective this past February 28. Its Sharp Health Plan is not part of the ACO.

Fleury did not say how much money the ACO is losing from its year spent in Next Generation, a CMS model intended to reward health systems for assuming higher levels of financial risk.

Had CMS not introduced the risk adjustment factor, the ACO would have come out on the plus side and would have achieved savings, she said.

Six other ACOs have also left Next Generation, with one of those, KentuckyOne Health Partners, also citing the risk adjustment factor as a reason.

Sharp HealthCare ACO, which had been in the previous Pioneer model from 2012 to 2014, joined Next Generation after the Pioneer program stopped at the end of 2016. In Pioneer, Sharp neither lost nor gained savings but did well from a utilization standpoint, Fleury said.

One reason the ACO was optimistic about Next Generation was that unlike Pioneer, that used national inflation factors in its benchmark,  CMS took regional factors into account.

Another was because CMS said Next Generation would be predictable, Fleury said, compared to Pioneer, in which benchmarks changed every quarter.

But on October 1, 2017, CMS introduced a risk adjustment factor into the model that reduced actual risk scores by 4.82 percent.

“It’s a material impact,” Fleury said. “One of the key things CMS said about this model, was that it’s predictable. I think it’s unfortunate that this has not become a predictable model.”

In October, CMS gave ACOs the option of signing on to the 4.82 percent risk adjustment and receiving certain benefits, or not signing.

Sharp decided not to sign as the ACO would have gone from financial gain to loss, but on December 7, 2017, CMS mandated the amendment to the original participation agreement on benchmark calculations, that forced the 4.82 percent risk adjustment, Fleury said.

CMS made the change because the agency predicted risk scores would go down as younger, healthier baby boomers went on  Medicare, according to Fleury. CMS actually saw risk scores go up, but believed this was due to health systems doing a better job of coding, rather than actually having a sicker population.

Sharp HealthCare’s Medicare beneficiaries are older, on average about 74-years-old, according to Fleury.

The senior population in San Diego has grown by 12.4 percent between 2013 and 2016, and the Medicare Advantage population has grown by more than 16 percent, she said.

Also putting the ACO at a disadvantage for CMS’s risk adjustment, Sharp is already cost effective, having been in capitation models for 30 years. Both primary care physicians and specialists are in the ACO, meaning that the traditionally sicker population that sees specialists would also be in the model.

“But the model is risk-adjusted so that’s OK,” Fleury said was the thinking.

In fact, expecting savings out of Next Gen, Sharp spent $1.9 million integrating its Medicare fee-for-service beneficiaries, about 9 percent of its Medicare population, to its alignment of PCPs and specialists.

Fleury said she has not coordinated Sharp’s argument with the six other ACOs that have left Next Generation. Each system would be impacted differently by the risk adjustment, but she feels that the reasons why they left would be consistent.

KentuckyOne Health Partners ACO is among those. President Don Lovasz also referred to the unpredictable nature of the model and its risk adjustment as a reason for leaving.

“Since 2013, KentuckyOne Health Partners has participated in CMS Medicare ACO programs, including the 2017 Next Generation ACO model, with excellent outcomes,” Lovasz said. “Because the Next Generation ACO Model is still maturing and is demonstrating to be unpredictable with changes to risk coding intensity adjustments and mandatory caps on risk adjustments, KentuckyOne Health Partners chose not to participate in the 2018 performance year.  Through our membership in the America’s Physician Group, and along with other accountable care organizations across the country, we are working with CMS and CMMI to improve the predictability and transparency of their programs so we may participate in future Medicare value- based programs.

David Muhlestein, chief research officer for Leavitt Partners who gave the names of the ACOs which left Next Gen through a tweet said, “In short, the ACOs I’m familiar with were concerned with changes to risk adjustment that, for some, pushed them from receiving bonus payments to paying penalties.”

Jefferson, Einstein Healthcare Network to explore merger

https://www.beckershospitalreview.com/hospital-transactions-and-valuation/jefferson-einstein-healthcare-network-to-explore-merger.html

Image result for einstein healthcare networkImage result for jefferson health

 

Jefferson Health and Einstein Healthcare Network, both in Philadelphia, signed a nonbinding letter of intent to merge, Jefferson Health confirmed to Becker’s Hospital Review March 27.

Jefferson Health comprises 14 hospitals and 50-plus outpatient and urgent care locations, while Einstein Healthcare Network maintains three hospitals, approximately 1,000 licensed beds and 8,800-plus employees across its facilities.

With the move, Jefferson and Einstein Healthcare Network will set the stage for the creation of one of the region’s largest residency programs, officials said.

The organizations will enter a period of due diligence, and will sign a definitive agreement should they choose to move forward.

“Einstein Health Network is the perfect match for our vision of an academic and health system ‘with no address’ where the patients and students are the boss. Einstein has a history of caring for the underserved, training health professionals of the future and embracing change and innovation which makes them the perfect partner for our trustees’ goal of helping to create a healthcare innovation revolution in Philadelphia,” Jefferson Health President and CEO Stephen K. Klasko, MD, said in a statement to Becker’s Hospital ReviewMarch 27.

“Einstein represents an academic medical center with a 150-year history of caring for the underserved despite challenges in healthcare. [Einstein Healthcare Network President and CEO] Barry Freedman knows that urban hospitals still fill a unique role in their communities, despite many other hospitals packing up and heading for the suburbs. Einstein had many options for future partners and I’m glad they went with us,” he continued.

 

Geisinger, St. Luke’s University Health partner to construct 80-bed hospital

https://www.beckershospitalreview.com/facilities-management/geisinger-st-luke-s-university-health-partner-to-construct-80-bed-hospital.html

Image result for geisinger st lukes new hospital

Danville, Pa.-based Geisinger and Bethlehem, Pa.-based St. Luke’s University Health Network will build a new 80-bed acute care hospital in Orwigsburg, Pa. — marking the first time in Pennsylvania’s history two healthcare systems agreed to build and co-own a hospital.

The three-story, 120,000-square-foot facility will house an emergency department and offer a wide array of specialties and services. Construction on the facility will begin in spring 2018, wrapping up late next year.

Under the terms of the partnership, the hospital will operate under both parties as a joint venture, with funding and governance shared equally. St. Luke’s will build and manage the hospital, while both parties will contribute physicians, support staff and expertise.

“The new hospital in Orwigsburg will emphasize the strengths of St. Luke’s and Geisinger, extending the best value in healthcare  that is, the highest quality at the lowest cost — to more residents of Schuylkill County and surrounding areas,” St. Luke’s President and CEO Rick Anderson said.