Amazon’s healthcare play appears to be heavily focused on platforms rather than specific applications
They would prefer startups focus on elements that are truly differentiating for consumers and let …
By bringing together accountable-minded physicians, urgent care and ambulatory surgery centers (ASCs) on a national scale, OptumCare could prevent a lot of avoidable hospital care and move much of wha…
He’s dead, Jim
As previously widely advertised, the BACE-1 inhibitor verubecestat (Merck) (and in journal correspondence atabecestat, Janssen) has now failed in a population with very early signs of c…
Target assessment with genetic polymorphisms
Please bear with me for a long (but interesting!) story. Bempedoic acid (Esperion) is an inhibitor of ATP citrate lyase (ACLY), an enzyme in the cholestero…
Targeted conjugated cancer therapeutics – so few, but may be more soon
The idea that one could combine the precision of a targeted biologic with the potency of a traditional cytotoxic to demolish a tu…
With the closing of the CVS/AET and CI/ESRX combinations, healthcare services are now led by a triumvirate of vertically-oriented goliaths. And we can anticipate that there will be more care delivery …
The bundle
Unlike many other CMMI experiments, the Comprehensive Care for Joint Replacement (CJR) program was a true randomized control trial in that participation was mandatory in a selection of metr…
Genetic trade secrets
In 2012, the US Supreme Court decided a case known as “Prometheus” establishing that therapeutic methods based on biomarkers were not patentable – this essentially blocked one of…
Peanut medicine that won’t cost peanuts
Allergy to peanuts is a major issue and though prevention is now possible in infants there is a huge population for whom actual survival is connected to vigilan…
Interest and investment in digital health has increased rapidly in recent years. Some digital health software is impactful enough that it requires FDA approval, but current regulatory pathways are sl…
One century after the use of convalescent serum, convalescent T-cells
The use of tailored T-cells (e.g. CAR-T) is transforming our approach to (blood) cancers, but what about using T-cells against the…
Primary care organizations are better ACOs when it comes to achieving savings
Initial results from the Medicare Shared Savings Program ACO have been disappointing pointing to small to negligible net e…
Transthyretin heats up
Last month saw a couple landmark papers about the use of parenteral RNA drugs (from Alnylam and Ionis) in hereditary transthyretin amyloidosis with a focus mainly on mitigating …
RNA drugs coming of age
Hereditary Transthyretin Amyloidosis (ATTR) is a genetic disease in which one of the alleles of Transthyretin (TTR), a protein produced by the liver and with a role in thyroid …
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 …
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 red…
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 alterna…
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 depe…
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 pr…
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-…
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 diabe…
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) manag…
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 …
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 des…
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 cond…
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 Brea…
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 …
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 …
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 suppress…
(For background on Pennsylvania market, please take a look at previous note here)
Summary
The UPMC/Highmark rivalry continues to open new fronts in Pennsylvania
Highmark’s response to UPMC is differe…
(For Louisiana market context, please take a look at previous notes on Ochsner here and here)
Before the holidays, Ochsner signed an LOI to take over the management of ailing University Health located…
Successes in gene therapy for hemophilia B and A
Hemophilia A and B are X-linked genetic diseases which prevents the formation of functional coagulant factors VII and IX respectively and cause a prope…
OptumHealth and its proposed acquisition target DaVita Medical Group (DMG) have a lot in common:
Ambulatory care portfolios: physician practices, urgent care centers and ambulatory surgical centers (…
Who will be the first to take integrated health care delivery national?
A few years ago, the best bet might have been an established provider with a nationally compelling brand and a growing affiliate…
Two new therapies against a horrible congenital disease – but trouble ahead on pricing…
Spinal Muscular Atrophy (SMA) is a genetic disease that declares itself at a few months of age, and typically le…
UPMC’s recent spectacular deal-making careen through central Pennsylvania (picking up the big Susquehanna and Pinnacle systems as affiliates and Tower as a joint venture partner all in under a year) c…
Between the very common and the very rare – An opinionated take on NEJM highlights for October 2017
Another tool for prevention in cardiovascular disease
Taking aspirin daily has been standard of ca…
Back in 2013, Dignity and Optum formed a joint venture for revenue cycle management (RCM) services named Optum360. Dignity contributed processing centers and 1,700 employees in return for ~25% share i…
A new drug to address hard-to-treat severe asthma
In ~10% of people with asthma, traditional therapies do not work well and they have recurrent exacerbations leading them to the ED. Over the past few …
At last, drug prices influence physician usage patterns
Association of Reference Pricing with Drug Selection and Spending (subscriber access); Nitroprusside and Isoproterenol Use after Major Price Inc…
Taking stock: two decades of progress in heart failure:
Here comes a clever study using existing clinical trial data to assess progress in standard of care over time for heart failure. For each trial,…
On May 10, Highmark and Geisinger announced plans for a clinical joint venture to create community-based care in four rural north-central Pennsylvania counties. The target counties are small (200K liv…
Stent news
First there was angioplasty, then bare stents, then drug-eluting stents, and now the next generation: bioresorbable stents: each generation commanding a significant price premium for the m…
A hammer finds new nails (which happen to be eyeballs)
The insulin growth factor receptor 1 (IGF-1R) was once upon a time a popular cancer target pursued by multiple biopharmas each with their own hum…
Calendaring care
The length of our sidereal year is an accident – we happen to be circling a G2 star from which the habitable zone where free surface liquid water can exist lies at around 150,000,000 …
Warburg Pincus, the new majority owners of CityMD, a 68 site urgent care chain, will need to bring plenty of capital to an urgent care industry approaching its endgame. CityMD competes on a national s…
Working Paper
Summary
Drug companies are naturally incentivized to price their drugs under assumptions of optimal clinical value, i.e. as high as possible. Payers react to this by setting stri…
Gene therapy for sickle cell disease
Typical diseases targeted by gene therapy are those for which there is a defect that prevents the production of a functional protein needed for normal life; remedi…
A knock at the door of a monster franchise
Adalimumab (Humira, Abbvie) is the best-selling drug on the planet with the bulk of sales coming from patients suffering from rheumatoid arthritis (RA). It i…
An innovative modality to suppress PCSK9
Antisense technology relies on the concept that it is possible to interfere with the cellular genetic machinery in very specific ways by deploying short RNA se…
The public debate on drug pricing has sharpened markedly over the past year. We are seeing more political scrutiny and media coverage, including the blowback on Mylan’s EpiPen pricing, tweets from now…
Successful use of CAR-T therapy in a solid tumor
Chimeric Antigen Reception T-cells (CAR-T) are immune cells molecularly engineered to seek out and destroy cancer cells; the push to develop them into …
“My name is T-Cell…, James T-Cell”
Immune T-cells are licensed to kill other cells through a quick molecular kiss of death, and as such are potentially powerful allies in controlling a tumor. For obvi…
I am not sure how many docs continue to do this, but I still read the actual hard copy of my NEJM, and that means I flip past ad pages with smiling grandfathers playing with grandchildren thanks to su…
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. Follo…
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 …
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” environme…
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 di…
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. …
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 …
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…
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 occurren…
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 Journa…
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, pol…
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” testin…
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 wh…
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 beachhea…
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 stru…
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 …
“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 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…
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…
Earlier this month, Mercy Health announced deals to dismantle HealthSpan (the former Kaiser business in northeast Ohio acquired in 2013), selling the insurance arm to local powerhouse Med Mutual, diss…
A new article in JAMA recommends that ACOs and health systems develop patient loyalty programs comparable to those offered by coffee shops, hotels and airlines (McMahon et al, "Health System Loyalty P…
Defining success in health care
A perspective advertising yeoman’s work of the International Consortium for Health Outcomes Measurement (ICHOM) which has defined specific metrics for dozens of disease…
Correctional health and correctional pharmacy
2.2M people are incarcerated in local jails and state and federal prisons at any one time in the U.S. for whose healthcare various government agencies are…
This past January, Walgreens assigned operational control of 56 in-store clinics to Advocate Health. The deal signals another intensification of the already fierce hospital competition in Chicago, and…
Leveraging community services for health
In poor individuals, a lot of health issues are intimately connected to their socioeconomic circumstances. However, at the system level, there has been a chron…
Earlier this month, CMS announced the first cohort of Next Generation ACO (“NGACO”) providers (see here our summary of the key changes made in the Next Generation). Below are a few thoughts on who sig…
Leif Solberg and team published research last month contrasting how patients value outcomes vs. how physicians think patients value outcomes. The approach was novel: they asked patients! They identifi…
A new focus on the diagnostic reliability of clinicians
Two perspectives highlighting the recent report from the National Academy of Medicine (formerly IOM) entitled “Improving Diagnosis in Health Car…
Earlier this month, researchers released a study of patient-initiated emails to providers with Northern California Kaiser Permanente (KPNC) in 2011/12 in the JAMC . The study focused on patients with …
Maxwell Health LLC is a rapidly growing company that offers a platform to make it easy and intuitive for employees to manage their employer-sponsored benefits. It is at the intersection of several ma…
Mercy Health – the largest system in Ohio – has recently formed a Clinically Integrated Network (CIN) with Summa Health called Advanced Health Select. CINs allow separately owned provider systems to j…
Systems biology finally gets real: an unexpected use for a diabetes drug
Chronic Myelogenous Leukemia (CML) has been the poster child first for a disease with a precise genetic cause (the Philadelphia…
What are annual physicals for?
Annual physicals are costly (~$10 billion annually) and have never been shown to improve outcomes, but people value them. In this dichotomy lies a lot of the inner tensi…
A few problems
Geographic barriers to the entry have long protected providers from best-in-class competition. Provider consolidation – theoretically a logical response to the current operating enviro…
Summary
In this working paper, we develop the following thesis. In the not so distant future (a decade or two), medicine will be largely governed by algorithms -- highly deterministic clinical pathway…
Over eight months between October 2014 and June of this year, Ochsner formalized alliances with five major provider systems in Louisiana. The first wave (with St. Tammany Parish, Terrebonne and Slidel…
Promise for systemic amyloidosis (and beyond?)
Systemic amyloidosis is an uncommon disease in which abnormal cells (typically antibody-producing B cells) produce large amounts of protein that deposit …
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