Tuesday, August 15, 2017

The Future of Medicine in the Human Genome Genomics -- Making a difference in patients’ lives / By Mary Branham

From CSG-ERC’s Annual Meeting in Connecticut
Mapping the first human genome in 2000 cost about $4 billion; today, it costs about $1,000.

The cost has come down because of investment, and because of the important role genomics is playing in medicine today, according to Dr. Murat Gunel, a professor of neurosurgery, genetics and neuroscience at Yale University, who spoke during Sunday’s luncheon plenary, “Genomics and Precision Medicine: Investing in the Future of Health Care.”

“We have all recognized the power of genomics,” Gunel said. “This is clinical. This is making a difference in our patients’ lives everyday.”

Plus, he said, “this is the new Internet race.” Various nations are investing in the research, recognizing the main race now is learning how to decode the genomic makeup of people to understand their diseases. It is one of four areas in which China is making multi-billion dollar investments. The U.S. also has made significant investments in the area, starting with the 2000 investment in mapping the first genome.

“You can imagine the impact it will have on our health care system if you can predict a disease before it starts,” he said.

Now, for the most part, while the ability to diagnose disease is evolving, treatments are often a best guess based on effectiveness over a general population. Genomic testing will allow for precision—also referred to as individualized—medicine to treat patients based on many factors.

But, Gunel cautioned, “genomics in isolation does not mean much.”

He said that information must be combined with what is known about the quality of the air or water in a person’s environment or about how much they exercise, for example.

Having that information for individuals can help them tailor their lifestyles to improve their health. Even so, Gunel said a bigger purpose would be to use that information in population health. Precision medicine has already seen some success, such as addressing newborn diseases, prenatal diagnosis, pharmacogenomics and individualized treatment for cancer, he said.

That’s because genomic testing has increased the number of genes that can be tested. Gunel said cancer patients are looked at with regard to their genomic makeup. That ability has helped bring a 30 percent cure rate for metastatic melanoma, he said.

It’s changing the way diseases are treated. For instance, now everyone diagnosed with lung cancer is given the same treatment, according to Gunel. With genomic testing, physicians are able to understand the baseline risks individuals have and make specific lifestyle recommendations to help prevent the diseases. Then, if the disease occurs, “we could diagnose it faster and give more effective and more individualized treatments.”

While precision medicine will have major impacts on health care, Gunel said it could also bring $1 trillion in economic growth. That could impact the development of things like new medicines and the creation of new fields to fill such roles as genetic counseling and computational biology—the people who can run the artificial intelligence (AI) in the data center.

“We think the number of people we are going to need in that field is going to ramp up tremendously,” said Rich Lisitano, vice president at Yale-New Haven Hospital.

Thursday, August 10, 2017

Early look at exchange premiums finds Hartford premium trends modest compared to other US cities

A Kaiser Foundation very early look at 2018 health insurance exchange monthly premium proposals, subject to change, across 21 US cities predicts that Hartford consumers will do well next year. The report compares early rate filings for a 40 year old non-smoker making $30,000/year choosing the second-lowest silver plan. Silver plans are the most popular. Among the 21 cities, Wilmington DE consumers face both the highest premium ($631) and the biggest increase over this year (up 49%). Detroit consumers will have the best bargain next year at $244/month and Providence consumers will see a decrease of 5% in their premiums. Hartford premiums are at about the middle of the pack at $417/month next year without subsidies, up 9% from this year, but $201/month with the premium tax credit, down 3% from this year. Most exchange consumers qualify for subsidies. Overall, Hartford’s average annual trend from 2014 to 2018 without the tax credit is up 6%, better than 13 of the 21 cities, but down 1% annually with the credit, similar to most cities.

It is very important to note that these numbers, for all cities, are based on early rate filings; final rates will not be set until the fall. Insurers are facing far greater uncertainty this year about federal policies and resources that impact premiums.

Wednesday, August 9, 2017

One in ten CT adults has high medical needs

Understanding high-need adults with complex conditions and their barriers to care are key to developing solutions that improve health and control costs. High-need adults have at least two chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks. A new report from the Commonwealth Fund outlines in depth the number of high-need adults and their challenges across states. Ten percent of adults in CT have high medical needs, just below the US average of 12%. High-need adults tend to be older and over one in three in CT has income below 200% of the Federal Poverty Level. In good news, only 7% are uninsured, compared to 9% of all CT adults, and 94% have a usual source of care. Unfortunately high need adults in CT are more to have gone without or delayed needed care due to cost. Almost one in three (31%) went without a provider visit because of cost and 15% went without a prescription due to cost.  Ot those who delayed care for reasons other than cost, 40% were due to transportation problems and 24% could not get a timely appointment for care.

Monday, August 7, 2017

CT Medical Society standing up an HIE for the state

Miscommunication is blamed for thousands of deaths and billions of dollars in costs. One part of miscommunication involves providers not being able to access records for patients they are treating. Numerous state groups working to reform CT’s broken health care system over the last decade have urged policymakers to develop a Health Information Exchange (HIE) to help with that problem. But despite several attempts costing millions of dollars, the state has failed for a variety of reasons. The CT State Medicaid Society has decided not to wait for the state and is building their own HIE – CT Health Link. CSMS is investing hundreds of thousands of dollars to have Kansas customize their successful HIE for our state’s needs. Kansas’s HIE launched in 2012 and now includes all hospitals and three out of four physician practices in the network. CT Health Link gives providers tools to share information, making care coordination far more effective, but the tool goes much further as well. Patients will be able to see all their information with opportunities to opt-out or in, correct errors and better understand their care. CT Health Link will enable public health reporting for providers, a significant administrative burden. The tool also includes an analytics dashboard that focuses on high-risk patients, disease registry, preventive care, readmissions, and population health that will be invaluable in improving quality and effectiveness of care. It is disappointing that CT Health Link has decided to, by default, include all patients’ information without first getting permission. They do make it easy to opt-out and have committed to a robust patient education process.

Tuesday, August 1, 2017

August CT Health Reform Dashboard – Medicaid concerns grow but continuing hope for drug costs

CT’s August Health Reform Dashboard remains mixed. Medicaid policy development and implementation remains mired in mistrust, rushing ahead without data, quality problems, and a lack of transparency while state officials refuse to answer questions. The new state HIT plan is travelling the same troubled path from the past but thankfully physicians and others are just getting it done, despite state government. The state budget remains dreary but ACA repeal and replace efforts were dealt a setback when the latest bill died in the Senate. In other good news, the Health Care Cabinet is digging into our work to control drug costs in CT with new workgroups to develop options. Growing mistrust remains at the core of problems in CT.

Thursday, July 27, 2017

CT health provider capacity varies significantly

A new mapping and data tool from CMS allows web visitors to visualize the density of a range of health care providers relative to the number of consumers. The updated Market Saturation and Utilization Tool uses Medicare claims data and can be sorted by state or county. Policymakers can use the Tool for health services location planning and to assess how provider supply impacts utilization. Services in the Tool include ambulance, clinical lab, chiropractic, home health, hospice, long term care hospitals, skilled nursing facilities, and physical and occupational therapies. Users per provider vary considerably in CT from access to chiropractic care (we are in the lowest quartile) to long term care hospitals, home health and hospice care (we are in the top quartile).

Wednesday, July 26, 2017

ICER seeks comment on Value Framework Changes for Ultra-Rare Condition Treatments

The Institute for Clinical and Economic Review (ICER) has proposed adaptations to its value framework for very rare conditions. ICER is a leader in evidence-based analysis of the effectiveness of drugs and other medical treatments. ICER’s analyses, including benchmark value-based prices for new drugs, are used by a growing list of payers in developing fair prices. To address the different economics of value assessments for very rare conditions, ICER published a white paper on the research and ethics of the issue and convened an all-stakeholder meeting in May. ICER is now soliciting feedback from stakeholders on their proposal. Proposed adaptations include a broader range of cost-effectiveness thresholds, the context of difficulty in research on very rare conditions, a broader definition of other advantages such as improvements in school, family and community, and benefits to systems for screening and care of people with rare conditions. Send comments to publiccomments@icer-review.org by Monday, September 25th at 5pm ET for consideration.