Blog Archive - Page 6 of 15

An opinionated take on NEJM highlights for June 2018

Marc Herant July 2, 2018

It’s hard to quit (and E-cigs don’t help) A large trial (6000 participants) comparing free cessation support, e-cigarettes, and a $600 cash incentive for sustained abstinence shows that none of these approaches are particularly effective with 1-3% overall success rates depending on the arm. Prevention is where it’s at. A Pragmatic Trial of E-Cigarettes, Incentives, and Drugs for Smoking Cessation (free access) NPs and PAs numbers are growing fast A look back at the last 15 years and forward to the next 15 shows that the physician workforce is

Struggling: An opinionated take on NEJM highlights for May 2018

Marc Herant May 31, 2018

One more on the chin for Alzheimer’s A report of a large phase 3 study of the highly potent oral BACE inhibitor verubecestat (Merck) with yet again a lack of therapeutic effect, despite a dramatic reduction of the cerebrospinal fluid content of beta amyloid in various forms. With a string of prior failures, this may be the near final blow for amyloid as a treatment target for Alzheimer’s disease (and Biogen’s adacanumab would be the end of the line if it also comes up tails). But note that the study

An opinionated take on NEJM highlights for April 2018

Marc Herant April 30, 2018

Are we nearing an asymptote with implantable cardiac pumps? Severe heart failure is common, and spare hearts for transplant are rare, which has led to the development of implantable mechanical alternatives. In the last few decades, progress has been immense, and in the latest installment of a 3rd (4th?) generation pump, outcomes have reached a level where survival of several years is the rule. Still, at every iteration incremental improvement is less, and performance remains well behind what happens with transplant in terms of complications such as infection, stroke, or

The Healthcare Blog: Consider this Speculative Scenario on Walmart & Humana

Miriam Alandydy April 24, 2018

Disease as an information defect

Marc Herant April 23, 2018

One way to think about disease[1] is as a loss of information[2] from the operating blueprint for human physiology. Broadly speaking, there are three main possible types of informational defects depending on the nature of the informational encoding that is compromised. The first is genetic through loss of information due to corruption of the genetic (and sometime epigenetic) code, for instance in congenital disease or in cancer. The second is spatial through loss of architectural information due to cumulative changes away from a structural template. This prevents turnover of tissue

Consider this speculative scenario on WMT-HUM: nibbling at the bottom and taking a slice off the top of the healthcare delivery pyramid

Tory Wolff April 13, 2018

WMT is in talks with HUM about a relationship enhancement, possibly an acquisition. The two already know how to work together in alliances (narrow pharmacy network, marketing collaborations, points programs). If a new structure is needed, WMT and HUM must be considering a major expansion of scope or a set of operating models where contributions are difficult to attribute and reward (e.g. joint asset builds). What is on their minds? Beyond any interim incremental moves, what could be the endgame? Catching convergence fever Horizontal combinations among the top five health

Bloomberg: 30,000 Strong and Counting, UnitedHealth Gathers a Doctor Army

Miriam Alandydy April 9, 2018

United’s Medicare Advantage footprint and OptumCare network do not overlap much (so far)

Tory Wolff April 4, 2018

United’s OptumCare promises a lot of value for health plans. An integrated system supported by Optum technology should be able to deliver consistent, analytically sophisticated care. Its ambulatory-focused configuration (clinics plus urgent care plus ambulatory surgical centers or ASCs) should keep patients out of high-cost settings through mutually reinforcing referral loops (where it has density[1]). One obvious question is whether United can use OptumCare to materially advantage its own health plans. Is a new, nationally-scaled Kaiser in the offing? If that is its endgame, United has a lot of work

EHRs + Genomics = Drugs? – An opinionated take on NEJM highlights for March 2018

Marc Herant April 2, 2018

GWAS, Regeneron and Geisinger, and liver disease Genome wide association studies (GWAS) look at broad populations for gene variants associated with a particular phenotype. Often, like in Type II diabetes, one finds hundreds of genes correlated with disease, and that’s obviously not very helpful. In lucky cases there are only a few variants, and that gives clues on potential underlying mechanisms of disease. But for the very lucky, there is a jackpot which is finding a variant that is actually protective against the disease – this is what happened with

Health Affairs: Reduced Cost Variability May Be An Unrecognized But Valuable Outcome Of Care Management Interventions

Miriam Alandydy March 28, 2018

Google’s health insurance apprenticeship: some unicorns (maybe) but no masterpieces

Tory Wolff March 19, 2018

Last month, word got out that Verily is in talks with health plans to “jointly bid” on care management contracts. Medicaid populations might be a reasonable surmised as the target given that (1) managed Medicaid requires bidding, (2) Medicaid contracts typically come in packets of hundreds of thousands of lives (which was the scale mentioned in the press reports) and (3) Verily had been considering (but decided against) bidding on Medicaid contracts using Oscar Health as a partner. It is curious, however, to see an organization seek collaboration with health

What precisely lies behind UPMC’s $2B investment in three new specialty hospitals?

Tory Wolff March 8, 2018

Last December, UPMC announced plans to spend $2B on three new specialty hospitals in downtown Pittsburgh. Each will abut an existing UPMC hospital currently serving as system center of excellence for the particular specialty: cancer will be located near Shadyside; cardiac and transplant near Presbyterian; eye and rehab near Mercy. Given inpatient’s declining share in care delivery, any new hospital construction in an over-bedded market with slow-moving demographics is a curiosity. Even if, as UPMC has promised, no net new beds will be added to the market, the new hospitals

Amazon offering health insurance: a potential mistake

Tory Wolff March 1, 2018

35%+ of consumers who purchased on Amazon over a 30-day period say they would be “open” to health insurance created by Amazon according to a new survey (see Becker’s headline and the LendEdu study description). Not surprisingly, interest varied depending on degree of commitment the consumer had to Amazon: 62% of the sample were Amazon Prime customers, and, of them, 42% were open to the idea. That implies that 26% of non-Prime customers were open. This data point is a fine example of the kind of freebie thinking Amazon can

NPR: Why Health Care Systems Are Building Micro Hospitals

Miriam Alandydy February 26, 2018

An opinionated take on NEJM highlights for February 2018

Marc Herant February 25, 2018

A-fib in heart failure – time to be aggressive Over the last 15 years, there has been a growing body of evidence for the effectiveness of catheter ablation to treat atrial fibrillation (a-fib), a condition for which the standard of care has been anti-arrhythmic medications. A-fib commonly coexists with heart failure but until now it has not been clear whether medication or catheter ablation would be the preferred treatment – we now have the answer, at least for patients with a substantially reduced ejection fraction. In a randomized trial of

Consider this speculative Amazon scenario in your strategic planning

Tory Wolff February 23, 2018

Amazon has many puzzled about its plans for healthcare. Arguably, Amazon is just as puzzled, but is – in effect — running a massive Delphi process to sort out the plan. Amazon is, after all, the Breaker of Industries, Destroyer of Margins. Allow rumors to float, hire some people, have meetings, seek a few regulatory approvals, start a vaguely missioned non-profit with other business titans. Fear and greed do the rest. Stock prices gyrate as investors bet and counter bet on who is vulnerable, incumbent CEOs promise cooperation or competitive

Partners Blog: AI in Healthcare – Setting a Common Perspective

Miriam Alandydy February 14, 2018

Will the coming wave of gene therapies have a Sovaldi-like impact?

Jason Brauner January 31, 2018

The first approval of a gene therapy for congenital disease in the US (Luxturna) inaugurates a new – though long anticipated – era for therapeutics. Along with questions around durability of response and long-term safety, pricing and reimbursement is a particular challenge. At $850,000, the price of Luxturna is nominally higher than other high-cost specialty medicines. However, as a one-time cost with a multi-year benefit, the cost per year of efficacy is far lower. This is not a new challenge for the industry: Hepatitis C antiviral therapies such as Sovaldi

How can Optum be in only 35 out of 75 target markets while also being available to 70%+ of the US population? An analytical speculation

Tory Wolff January 30, 2018

During the UnitedHealth quarterly earnings call earlier this month, Larry Renfro, CEO of Optum, offered some additional color on the growth of OptumCare: “Combined with [Davita], OptumCare will be in 35 local care delivery markets, nearly one-half of the 75 markets targeted for engagement or development. And these market operations are still in the early stages of growth and development” (per transcript on SeekingAlpha). Yet, based on our data, we think OptumCare (including Davita Medical Group and its MedExpress and Surgical Care Affiliates components) is already present in Hospital Referral

Two steps forward, one step back: an opinionated take on NEJM highlights for January 2018

Marc Herant January 29, 2018

Playing chess against cancer Tumors are not intelligent, but, because they have escaped mutational control, they constantly probe for mutations that will allow them to escape chemotherapeutic suppression. The epidermal growth factor receptor (EGFR) is a frequent driver of malignancy in the lung and as such, a target for EGFR inhibitors such as erlotinib (Tarceva, Roche) or gefitinib (Iressa, Astra Zeneca); unfortunately, tumors initially responsive to these agents quickly develop mutations which make them resistant. Osimertinib (Tagrisso, Astra Zeneca) was designed to overcome the most common resistance mutations and has

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