Posted by on in Consumer Health, Digital Health, Providers

Summary Cheap home devices are starting to generate a flood of high frequency, low latency biometric data, much of it of uncertain clinical value This uncertainty makes designing the service model difficult: high value use cases may get bundled with broader, low value, more speculative ones (e.g. behavior change), reducing overall ROI and uptake Given the patient-generated nature of the data and uncertain accuracy / calibration of the devices, use cases will need specific targeting or depend on subsequent clinical grade investigation to sort signal from noise High value use cases are likely going to require tightly designed delivery models… Read More

Posted by on in NEJM Highlights

Adaptive clinical trials slowly coming of age In an adaptive clinical trial, the protocol of the trial is allowed to change in a pre-specified manner during the study based on on-going study events.  In this issue of the NEJM, two research papers, one perspective, and one editorial are devoted to the I-SPY 2 trials which dynamically changed randomization procedures for neo-adjuvant (pre-surgery) chemotherapy for stage II and III breast cancer and allowed accelerated identification of subgroups that benefit from a novel tyrosine kinase inhibitor (neratinib – Puma Biotechnology) and a PARP inhibitor (veliparib – Abbvie).  Adaptive trials are described in… Read More

Posted by on in NEJM Highlights, Population Health

Disappointing interim results from two ACA experiments Two papers reporting results from ACA experiments – the Comprehensive Primary Care (CPC) Initiative in which primary practices were incentivized with fairly generous payments to strengthen care management activities such as management of chronic conditions, or coordination of care – and the ACO initiatives (2012 cohort) described elsewhere in many reviews. Both papers provide a view on the early impact of these initiatives (2 years out) on costs and outcomes by using well controlled no-intervention comparison groups. The upshot is that so far, the CPC and ACO (v. 2012) initiatives do not show… Read More

Posted by on in Consumer Health, Digital Health, Medical Devices, Uncategorized

Summary Livongo is marrying a cellular-enabled glucometer and a data cloud with patient engagement services to help manage sugar levels Glucometer incumbents could match Livongo’s technology but will struggle to counter the business model innovation By expanding into services, however, Livongo is expanding its potential competitive set to include incumbent downstream care providers If Livongo’s model demonstrates compelling value, both device and services incumbents could find ways to stitch together competing solutions in collaborative ecosystems Closed loops are great ways to develop value propositions but can be rickety for trying to scale a solution in healthcare given the frictions which… Read More

Posted by on in Population Health, Providers

It is a long-standing hypothesis shared by many providers that community-based interventions that improve primary care could lead to overall healthcare savings by preventing (or delaying) the occurrence of medically expensive conditions.  Rigorously proving this has been difficult, and only a few appropriately controlled studies have been published. In a Letter to the Editor of the American Journal of Managed Care[1], my colleague Alex Brown and I commented on an earlier article[2] evaluating the impact of a community health worker (CHW) intervention on healthcare costs. The study showed no significant reduction in average cost… Read More

Posted by on in NEJM Highlights

Surgical volume and referral for surgery: The impact of surgical volume on outcomes has been well documented, but is it top of mind with physicians referring patients to surgery? Readers of the Journal were polled on a hypothetical scenario whereby a community physician would be referring a patient in need of a major surgical procedure to either a nearby community hospital with a well-respected general surgeon doing approximately 5 of these cases a year versus a tertiary medical center 40 miles away. The great majority of readers chose the option to refer to the tertiary medical center. This does not… Read More

Posted by on in Biopharma, Medical Devices

The recent World Medical Innovation Forum on Cancer convened by Partners Healthcare in Boston was attended by leaders in oncology from around the world including top: clinicians, bench scientists, policy leaders, and executives from hospitals and life-science companies.  Two plus days of intense discussion and sharing of perspectives ably curated by Partners Innovation head Chris Coburn covered a range of topics from technology developments, to the healthcare system, and the patient/ doctor perspectives. The mind-map below is an attempt to organize the key themes that I heard through the conference and to try to convey why I came away feeling incredibly optimistic about the future of cancer care. The… Read More

Posted by on in Consumer Health, Digital Health, Medical Devices, Population Health

I have been conducting an informal test for the past year and a half.  And while it has not been a full statistically-significant clinical trial with test and control groups, and “double blind” testing methods, the results have been striking… The way this test works is that when I meet someone new or reconnect with someone I have not seen in a long time, I ask them to describe themselves and then listen carefully to the answer.  Some clear patterns emerge: It’s most common for people, and particularly my American friends and colleagues, to identify themselves by their occupation…as a… Read More

Posted by on in NEJM Highlights

RBRVS: an acronym we ought to think more about RBRVS stands for the Resource Based Relative Value Scale, and codifies the time and effort involved for a comprehensive set of physician activities on which Medicare payments are based. In this perspective, the authors highlight that most value-based payment (VBP) systems currently under development are essentially built as modifiers on top of the RBRVS. But the RBRVS has two major issues with it: it is “downward sticky” and has not evolved to take into account increased efficiency (e.g. automation), and it underestimates E/M (Evaluation/Management) activities which have become more and more… Read More

Posted by on in Network strategy, Providers

With new two affiliations, Ochsner Health has solidified its clinically integrated network in the most populous parish (East Baton Rouge) and built a beachhead in the one part of the state where it lacked a partner (the northeast). The two new partners are General Health System in Baton Rouge (announced in late March) and Glenwood Regional Medical Center in Monroe (announced in early April). These affiliations have a several implications: Ochsner Health Network is now viably state-wide. Its affiliates are directly present in 11 of the most populous 15 parishes in the state and the remaining 4 (Livingston,… Read More