Blog Archive - Page 9 of 16

An opinionated take on NEJM highlights for October 2016

Marc Herant November 2, 2016

Continued progress in multiple myeloma About 25,000 patients are diagnosed with multiple myeloma yearly in the US. Despite being initially treatable, typically this disease is ultimately lethal. Following a highly successful phase 1-2 study a monoclonal antibody against a marker of myeloma cells (daratumumab, Janssen) underwent phase 3 studies in combinations with established mainstays of therapy (the proteasome inhibitor bortezomib and the immune modulator lenalinomide) in a patient population several years out from their initial diagnosis. Results were stellar, with the inclusion of daratumumab decreasing the disease progression rate by

An opinionated take on NEJM highlights for September 2016

Marc Herant October 3, 2016

Taking a page from HIV to build a response to opioid abuse A couple of perspectives on the challenges of treating individuals who suffer from opioid dependence. The first highlights the importance of integrating medication assisted treatment (e.g. methadone or buprenorphine) into hospital and post-hospital care – plausibly an ED visit or a hospital stay for an event triggered by opioid abuse (such as an overdose) is a significant opportunity to go beyond treating the acute issue and starting patients on long term treatments. In the second, the author recalls

An opinionated take on NEJM highlights for August 2016: cleanliness is not next to healthiness, testing before thinking, a long slog for precision medicine

Marc Herant September 2, 2016

There is such a thing as too much hygiene The prevalence of asthma in children has increased dramatically over the last few decades. Observational studies have shown that children in “dirty” environments such as farms seem to be relatively protected from asthma. A theory is that the lack of exposure to microbes leads to higher sensitivity to allergens, but this causality has been hard to show. Amish and Hutterite farm communities are genetically similar, but Amish rely on animals instead of machinery, and Amish children have much lower incidence of

Rapid cycling to get medications right: a potential use case for coupling wireless patient monitoring with remote support?

Tory Wolff August 22, 2016

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

NEJM Highlights for July 2016: Bayesians vs. frequentists, PCPs vs. specialists, SGLT-2 vs. GFR

Marc Herant August 2, 2016

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

NEJM Highlights for June 2016: Improving care delivery is just plain #%^*! hard

Marc Herant July 5, 2016

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,

Attacking an oligopoly by integrating downstream services: Can Livongo’s closed loop get traction vs. the big glucometer incumbents?

Tory Wolff June 22, 2016

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

AJMC: The Value of Decreasing Health Cost Volatility

Miriam Alandydy June 17, 2016

The many ways in which decreasing volatility in individual health care utilization is valuable

Marc Herant June 17, 2016

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

NEJM Highlights for May 2016: Referral for surgery, and a miscellany of interesting biochemistry

Marc Herant June 2, 2016

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

The future of cancer care: A bird’s-eye view

Nikhil Bhojwani May 20, 2016

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

When is a patient not a patient? More often than you think

Alex Brown May 6, 2016

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

NEJM Highlights April 2016: Value and values: RBRVS, ACA and readmissions, E-cigs

Marc Herant May 2, 2016

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

Ochsner solidifies its position in northern Louisiana (updated)

Tory Wolff April 22, 2016

Please see update at the end of the post. 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

Tincture: Biopharma risk sharing

wpadmin April 21, 2016

Biopharma risk-sharing: what needs to happen

Nikhil Bhojwani April 6, 2016

A couple of years ago, we addressed the question of whether drug companies could use new business models to capture more of the value they create. At the time, we pointed out that drug makers had struggled to get payers interested in new models, and that any potential solution would need to consider aspects of the drug (as it relates to the overall care paradigm and system), and of the payer. Fast forward to 2016, and there are a number of factors that suggest that now may be the right time for drug makers and payers

NEJM Highlights March 2016: Getting value for money in healthcare, Zika bad news, linking the microbiome to the metabolic syndrome

Marc Herant April 3, 2016

Could Uber happen to healthcare? A Perspective article that points out that the success of Uber is rooted in the flaws of an industry where customer convenience and value for money took the backseat to the interest of a set of service providers highly protected by regulation. Sounds familiar? Obviously, the regulatory moats of healthcare are much wider and deeper, but in a curious mix of warning (watch out!) and encouragement (this will be good for you if you embrace it!) the authors argue that the medical profession should not

Context is King – When to use an Agile corporate strategy?

Alex Brown April 1, 2016

“Agile corporate strategy” (as defined in a previous post) is already the established the weapon of choice for small, early-stage innovators trying to re-invent their marketplace, where the product is the company and uncertainty is the hallmark new emerging markets. Startups like agile strategies – often referred to a “Lean Startup” – because they effectively counter the scale advantage of incumbent competitors without requiring massive initial investment. But contrary to the conventional wisdom that firms must abandon agility as they get larger and more complex, in the right market context

Sustainable Agility – Activity Systems for the Agile Competitor

Alex Brown April 1, 2016

The dirty little secret of the booming agile training and coaching industry is that most Agile implementations ultimately fail, meaning that the companies revert back to their previous working methods. Even ones that experience dramatic early success and drive their entire industry to implement similar approaches typically lose momentum after several years or with a change in leadership. It is telling that, of the first wave of companies to implement Scrum in the mid 1990’s, not one is still using the framework today. In light of this, it is tempting

Enterprise Agility as Corporate Strategy

Alex Brown April 1, 2016

In a previous post, I explored Maxwell Health as an example of agile product development strategy in healthcare. For small single-product companies the product strategy is the corporate strategy, but agile principles can yield profound benefits for larger multi-product business units and even entire firms. This blog focuses on Agile Corporate Strategy, and specifically how a subset of companies in the right strategic context could greatly benefit from institutionalizing agility across the entire enterprise. Agile corporate strategy “Agility” is a term that gets thrown around liberally, often in a very

OUR BLOG

Recon takes an analytical look behind select developments in healthcare

An opinionated take on NEJM highlights for October 2016

An opinionated take on NEJM highlights for September 2016

An opinionated take on NEJM highlights for August 2016: cleanliness is not next to healthiness, testing before thinking, a long slog for precision medicine

Rapid cycling to get medications right: a potential use case for coupling wireless patient monitoring with remote support?

NEJM Highlights for July 2016: Bayesians vs. frequentists, PCPs vs. specialists, SGLT-2 vs. GFR

NEJM Highlights for June 2016: Improving care delivery is just plain #%^*! hard

Attacking an oligopoly by integrating downstream services: Can Livongo’s closed loop get traction vs. the big glucometer incumbents?

AJMC: The Value of Decreasing Health Cost Volatility

The many ways in which decreasing volatility in individual health care utilization is valuable

NEJM Highlights for May 2016: Referral for surgery, and a miscellany of interesting biochemistry

The future of cancer care: A bird’s-eye view

When is a patient not a patient? More often than you think

NEJM Highlights April 2016: Value and values: RBRVS, ACA and readmissions, E-cigs

Ochsner solidifies its position in northern Louisiana (updated)

Tincture: Biopharma risk sharing

Biopharma risk-sharing: what needs to happen

NEJM Highlights March 2016: Getting value for money in healthcare, Zika bad news, linking the microbiome to the metabolic syndrome

Context is King – When to use an Agile corporate strategy?

Sustainable Agility – Activity Systems for the Agile Competitor

Enterprise Agility as Corporate Strategy

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