Healthcare analytics, AI solutions for biological big data, providing an AI platform for the biotech, life sciences, medical and pharmaceutical industries, as well as for related technological approaches, i.e., curation and text analysis with machine learning and other activities related to AI applications to these industries.
CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare Proposed regulation for Medicare Parts C & D would strengthen negotiations with prescription drug manufacturers to lower costs and increase transparency for patients
Today, the Centers for Medicare & Medicaid Services (CMS) proposed polices for 2020 to strengthen and modernize the Medicare Part C and D programs. The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.
“President Trump is following through on his promise to bring tougher negotiation to Medicare and bring down drug costs for patients, without restricting patient access or choice,” said HHS Secretary Alex Azar. “By bringing the latest tools from the private sector to Medicare Part D, we can save money for taxpayers and seniors, improve access to expensive drugs many seniors need, and expand their choice of plans. The Part D proposals complement efforts to bring down costs in Medicare Advantage and in Medicare Part B through negotiation, all part of the President’s plan to put American patients first by bringing down prescription-drug prices and out-of-pocket costs.”
In the twelve years since the Part D program was launched, many of the tools outlined in today’s proposal have been developed in the commercial health insurance marketplace, and the result has been lower costs for patients. Seniors in Medicare also deserve to benefit from these approaches to reducing costs, so today CMS is proposing to modernize the Medicare Advantage and Part D programs and remove barriers that keep plans from leveraging these tools.
“In designing today’s proposal, foremost in the agency’s mind was the impact on patients, and the proposal is yet another action CMS has taken to deliver on President Trump and Secretary Azar’s commitment on drug prices,” said CMS Administrator Seema Verma. “Today’s changes will provide seniors with more plan options featuring lower costs for prescription drugs, and seniors will remain in the driver’s seat as they can choose the plan that works best for them. The result will be increasing access to the medicines that seniors depend on by lowering their out-of-pocket costs.”
Private plan options for receiving Medicare benefits are increasing in popularity, with almost 37 percent of Medicare beneficiaries expected to enroll in Medicare Advantage in 2019, and Part D enrollment increasing year-over-year as well. The programs are driven by market competition; plans compete for beneficiaries’ business, and each enrollee chooses the plan that best meets his or her needs. Consumer choice puts pressure on plans to improve quality and lower costs. Premiums in both Medicare Advantage and Part D are projected to decline next year.
Today’s proposed changes include:
Providing Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes, so beneficiaries who need these drugs will see lower costs;
Requiring Part D plans to increase transparency and provide enrollees and their doctors with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written;
Codifying a policy similar to the one implemented for 2019 to allow “step therapy” in Medicare Advantage for Part B drugs, encouraging access to high-value products including biosimilars; and
Implementing a statutory requirement, recently signed by President Trump, that prohibits pharmacy gag clauses in Part D.
CMS is also considering for a future plan year, which may be as early as 2020, a policy that would ensure that enrollees pay the lowest cost for the prescription drugs they pick up at a pharmacy, after taking into account back-end payments from pharmacies to plans.
Medicare Advantage and Part D will continue to protect patient access, as both programs are embedded with robust beneficiary protections. These include CMS’s review of Part D plan formularies, an expedited appeals process, and a requirement for plans to cover two drugs in every therapeutic class.
CMS looks forward to receiving comments on these proposals and other policies under consideration.
HUBweek 2018, October 8-14, 2018, Greater Boston – “We The Future” – coming together, of breaking down barriers, of convening across disciplinary lines to shape our future
Reporter: Aviva Lev-Ari, PhD, RN
Article ID #257: HUBweek 2018, October 8-14, 2018, Greater Boston – “We The Future” – coming together, of breaking down barriers, of convening across disciplinary lines to shape our future. Published on 10/8/2018
WordCloud Image Produced by Adam Tubman
3.4.6 HUBweek 2018, October 8-14, 2018, Greater Boston – “We The Future” – coming together, of breaking down barriers, of convening across disciplinary lines to shape our future, Volume 2 (Volume Two: Latest in Genomics Methodologies for Therapeutics: Gene Editing, NGS and BioInformatics, Simulations and the Genome Ontology), Part 2: CRISPR for Gene Editing and DNA Repair
At HUBweek and in this community, we believe a brighter future is built together. In these times of division, particularly when many are feeling excluded from the benefits brought forth by rapid technological development, there is critical importance in the act of coming together, of breaking down barriers, of convening across disciplinary lines to shape our future.
That’s why this year’s theme for HUBweek is We the Future. It is a call to action and an invitation. Throughout the week, we’ll bring together innovators, artists, and curious minds to explore the ways in which we can shape a more inclusive and equitable future for all.
At its core, HUBweek is a collaboration. If not for our partners and the unwavering support of this community, this would not be a reality. A big thank you to our presenting partners Blue Cross Blue Shield of Massachusetts, Liberty Mutual Insurance, and Merck KGaA, to our sponsors, and to the hundreds of collaborating organizations, speakers, artists, and creative minds that are behind this year’s festival.
On behalf of the HUBweek team and our founders The Boston Globe, Harvard University, Mass. General Hospital, and MIT, we’re thrilled to invite you to join us at HUBweek 2018.
Linda Pizzuti Henry
SOURCE
From: Linda Pizzuti Henry <hello@hubweek.org>
Reply-To: <hello@hubweek.org>
Date: Monday, October 8, 2018 at 9:38 AM
To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>
PCI, CABG, CHF, AMI – Two Payment Methods: Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.
Reporter: Aviva Lev-Ari, PhD, RN
UPDATED on 8/17/2018
Certain risk factors make survivors of an acute MI more likely to suffer major cardiovascular events within a year, researchers said.
A model with 19 factors (comprising 15 unique variables) was created for the identification of high-risk patients; the strongest factors in the training sample (n=2,113) were found to be:
Age 85 years and older: HR 6.73 (95% CI 2.83-15.96)
Prior angina: HR 2.05 (95% CI 1.17-3.58)
Prior ventricular tachycardia or fibrillation: HR 2.15 (95% CI 0.99-4.70)
Ejection fraction under 40%: HR 2.86 (95% CI 1.89-4.34)
White blood cell count greater than 12,000 per μL: HR 2.65 (95% CI 1.53-4.61)
Heart rate faster than 90 beats per minute: HR 2.02 (95% CI 1.43-2.84)
With the tool, 11.3%, 81.0%, and 7.7% of patients were stratified to high-, average-, and low-risk groups, with respective probabilities of 0.32, 0.06, and 0.01 for 1-year events. Moreover, the model showed predictive ranges of 1.2%-33.9%, 1.2%-37.9%, and 1.3%-34.3% in these groups.
“This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction,” the researchers wrote, noting that past efforts to identify risk factors have focused on the period immediately after initial hospitalization for acute MI.
PCI, CABG, CHF, AMI – Two Payment Methods: Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.
Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.
A retrospective, cross-sectional comparison of the BPCI model 2 bundles for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), congestive heart failure (CHF), and acute myocardial infarction (AMI).
The bundled payments covered hospitalization costs and, in most cases, up to 90 days of post-acute care, including nursing home care, complications, and rehospitalizations. Diagnosis-related groupings cover only what happens in the hospital, while bundled payments cover the entire 90-day episode in most cases.
A Good, Not Simple Idea
Blumenthal and Joynt Maddox agree that the idea of using financial incentives to drive quality improvement is a good one, but one that requires careful consideration and input from clinicians.
“I think policymakers think that it’s easier than it really is and, to be fair, why would a lawyer in DC understand how to make good health policy? I think we really need more clinicians and people with clinical knowledge involved in policymaking,” Joynt Maddox said.
“The idea is to build the bridge between inpatient and outpatient care, by coordinating care better, coordinating transitions better, reducing unnecessary care, and avoiding complications and readmissions,” she added.
An example might be to switch from automatically sending certain patients from the hospital to a nursing home for 30 days. “Maybe they only need 10 days or 1 week, or maybe they can just go home,” she said, but to allow better transitions and lower costs, there needs to be “someone to strategically approach the issue, and a lot of hospitals don’t have that ability.”
“You could argue that all hospitals should have the ability, and I totally agree that we should be doing a better job of organizing across settings, but the problem is that realistically these voluntary programs aren’t going to attract under-resourced hospitals, so this pilot will tell us what is possible in a well-resourced hospital but not much more,” said Joynt Maddox.
To date, the only outcomes reported on the new payment models have been a few evaluations from the federal government. Joynt Maddox recently reported some preliminary outcomes showing a lack of “clinically meaningful changes in access, utilization, or clinical outcomes” with episode-based payment for AMI, CHF, and pneumonia. Her final findings will be published soon.
Question Are hospitals participating in Medicare’s Bundled Payments for Care Improvement initiative for cardiac bundles different from nonparticipating hospitals in ways that could limit the generalizability of program outcomes to all US acute care hospitals?
Findings In this cross-sectional study, participation in Bundled Payments for Care Improvement model 2 bundled payments for acute myocardial infarction, congestive heart failure, coronary artery bypass graft surgery, and percutaneous coronary intervention was associated with larger hospital size, non–safety net hospital status, and access to cardiac catheterization laboratories.
Meaning Outcomes of cardiac bundled payments included in Bundled Payments for Care Improvement may have limited external validity, particularly among small and safety net hospitals with more limited cardiac capabilities.
Abstract
Importance Medicare’s Bundled Payments for Care Improvement (BPCI) is a voluntary pilot program evaluating bundled payments for several common cardiovascular conditions. Evaluating the external validity of this program is important for understanding the effects of bundled payments on cardiovascular care.
Objective To determine whether participants in BPCI cardiovascular bundles are representative of US acute care hospitals and identify factors associated with participation.
Design, Setting, and Participants Retrospective cross-sectional study of hospitals participating in BPCI model 2 bundles for acute myocardial infarction (AMI), congestive heart failure (CHF), coronary artery bypass graft, and percutaneous coronary intervention and nonparticipating control hospitals (October 2013 to January 2017). The BPCI participants were identified using data from the Centers for Medicare and Medicaid Services, and controls were identified using the 2013 American Hospital Association’s Survey of US Hospitals. Hospital structural characteristics and clinical performance data were obtained from the American Heart Association survey and Centers for Medicare and Medicaid Services. One hundred fifty-nine hospitals participating in BPCI model 2 cardiac bundles and 1240 nonparticipating control hospitals were compared, and a multivariable logistic regression was estimated to identify predictors of BPCI participation.
Exposures Bundled payments.
Main Outcomes and Measures Hospital-level structural characteristics and 30-day risk-adjusted readmission and mortality rates for AMI and CHF.
Results Compared with nonparticipants, BPCI participants were larger, more likely to be privately owned or teaching hospitals, had lower Medicaid bed day ratios (ratio of Medicaid inpatient days to total inpatient days: 17.0 vs 19.3; P < .001), and were less likely to be safety net hospitals (2.5% vs 12.3%; P < .001). The BPCI participants had higher AMI and CHF discharge volumes, were more likely to have cardiac intensive care units and catheterization laboratories, and had lower risk-standardized 30-day mortality rates for AMI (13.7% vs 16.6%; P = .001) and CHF (11.3 vs 12.4; P = .005). In multivariable analysis, larger hospital size and access to a cardiac catheterization laboratory were positively associated with participation. Being a safety net hospital was negatively associated with participation (odds ratio, 0.3; 95% CI, 0.1-0.7; P = .001).
Conclusions and Relevance Hospitals participating in BPCI model 2 cardiac bundles differed in significant ways from nonparticipating hospitals. The BPCI outcomes may therefore have limited external validity, particularly among small and safety net hospitals with limited clinical cardiac services.
Here, in order of anticipated importance, are the Top 10 Medical Innovations for 2021:
1. Gene Therapy for Hemoglobinopathies
Hemoglobinopathies are genetic disorders affecting the structure or production of the hemoglobin molecule – the red protein responsible for transporting oxygen in the blood. The most common hemoglobinopathies include sickle cell disease and thalassemia – which combined affect more than 330,000 children born worldwide every year and more than 100,000 patients with sickle cell disease in the United States alone. The latest research in hemoglobinopathies has brought an experimental gene therapy, giving those who have the condition the potential ability to make functional hemoglobin molecules – reducing the presence of sickled blood cells or ineffective red blood cells in thalassemia to prevent associated complications.
2. Novel Drug for Primary-Progressive Multiple Sclerosis
In individuals with multiple sclerosis (MS), the immune system attacks the fatty protective myelin sheath that covers the nerve fibers – causing communication problems between the brain and the rest of the body that can result in permanent damage or deterioration and eventual death. Approximately 15 percent of people with MS experience a disease subset known as primary-progressive, characterized by gradual onset and steady progression of signs and symptoms. A new, FDA-approved therapeutic monoclonal antibody with a novel target is the first and only MS treatment for the primary-progressive population.
3. Smartphone-Connected Pacemaker Devices
Implantable devices like pacemakers and defibrillators deliver electrical impulses to the heart muscle chambers to contract and pump blood to the body. They are used to prevent or correct arrhythmias – heartbeats that are uneven, too slow or too fast. Remote monitoring of these devices is an essential part of care. Traditionally, remote monitoring of this device takes place through a bed-side console that transmits the pacemaker or defibrillator data to the physician. Though millions of patients have pacemakers and defibrillators, many lack a basic understanding of the device or how it functions and adherence to remote monitoring has been suboptimal. Bluetooth-enabled pacemaker devices can remedy these issues of disconnection between patients and their cardiac treatment. Used in conjunction with a mobile app, these connected devices allow patients greater insight into the health data from the pacemakers and transmit the health information to their physicians.
4. New Medication for Cystic Fibrosis
Today, more than 30,000 people in the United States are living with cystic fibrosis (CF) – a hereditary condition characterized by thick, sticky mucus that clogs airways and traps germs, leading to infections, inflammation and other complications. CF is caused by a defective cystic fibrosis transmembrane conductance regulator (CFTR) protein. A class of drugs called CFTR modulators correct the protein’s action, but medications developed prior to last year had only been effective in a subset of people with certain mutations. A new combination drug, FDA approved in October 2019, provides relief for patients with the most common CF gene mutation (F508 del) – estimated to represent 90 percent of individuals living with the disease.
5. Universal Hepatitis C Treatment
Classified as a “silent epidemic” by the CDC, hepatitis C has emerged as a major public health issue in the U.S. Infection with the hepatitis C virus can lead to serious, life-threatening health problems like liver failure, cirrhosis and liver cancer. With no vaccine for the virus, patients have been limited to medication, but many treatments were accompanied by adverse side effects or only effective for certain genotypes of the disease. A new, approved fixed-dose combination medication has vastly improved hepatitis C treatment. More than 90 percent effective for hepatitis C genotypes one through six, the therapy represents an effective option for a wider scope of patients.
6. Bubble CPAP for Increased Lung Function in Premature Babies
Underweight and frail, babies born prematurely often require specialized care – including ventilation for those with infant respiratory distress syndrome (IRDS). For IRDS, infants are commonly administered surfactant during mechanical ventilation, a practice that can cause lasting lung injury in preterm infants and contribute to the development of chronic lung disease. Unlike mechanical ventilation, b-CPAP is a non-invasive ventilation strategy – delivering continuous positive airway pressure to newborns to maintain lung volumes during exhalation. The oscillating, rather than constant pressure, plays a role in its safety and efficacy, minimizing physical trauma and stimulating lung growth when administered over a prolonged period.
7. Increased Access to Telemedicine through Novel Practice and Policy Changes
COVID-19 saw increased adoption of telemedical practices as clinicians needed to conduct patient visits online. An increasingly virtual care model and increased consumer adoption came by way of fundamental shifts in policy at both the government and provider level. Since March, state and federal regulators have moved quickly to reduce barriers to telehealth, understanding that these new tools can speed access to care while protecting healthcare workers and community members. These measures opened the floodgates for telehealth, allowing for new programs and the expansion of existing networks.
8. Vacuum-Induced Uterine Tamponade Device for Postpartum Hemorrhage
Characterized as excessive bleeding after having a baby, postpartum hemorrhage is a devastating complication of childbirth, affecting from one to five percent of women who give birth. Mothers experiencing postpartum hemorrhage may require blood transfusions, drugs which may cause dangerous side effects, long uncomfortable procedures, and even emergency hysterectomy with loss of fertility. Non-surgical interventions directed at the site of bleeding has been limited to balloon devices that expand the uterus while compressing the site of bleeding. But the newest advancement is that of vacuum-induced uterine tamponade – a method that uses negative pressure created inside the uterus to collapse the bleeding cavity causing the muscle to close off the vessels. The vacuum-induced device represents another minimally invasive tool for clinicians as they treat the complication and provides a low-tech solution that is potentially translatable to developing countries with low resource availability.
9. PARP Inhibitors for Prostate Cancer
About one man in nine will be diagnosed with prostate cancer in his lifetime. While there has been progress in the last decade, the disease remains the second-leading cause of cancer death among men in the U.S. PARP inhibitors – pharmacological inhibitors for cancer treatment – block proteins called PARP that help repair damaged tumor DNA in people with BRCA1 and BRCA2 gene mutations. Though known for their success in women’s cancers, two PARP inhibitors have been demonstrated to delay the progression of prostate cancer in men with refractory cancer and DNA repair pathway mutations. Both were approved for prostate cancer in May 2020.
10. Immunologics for Migraine Prophylaxis
Migraines affect more than 38 million people in the U.S. – an estimated 12 percent of the adult population. For some time, multi-purpose drugs like blood pressure medications, antidepressants, anti-seizure drugs and Botox injections have been used to prevent attacks. However, not developed specifically for migraines, these methods have been met with mixed results. In 2018, new medications were developed to help head off migraine pain. The class of drugs works by blocking the activity of a molecule called calcitonin gene-related peptide (CGRP), which spikes during a migraine. Actively prescribed in 2020, this new FDA-approved class of medication is the first to be specifically designed for the preventive treatment of migraine, marking a new era of migraine therapeutics.
At next year’s Medical Innovation Summit, in addition to the annual Top 10 list, Cleveland Clinic will present a new award in honor of its rich history of innovation and advancements in healthcare delivery. The inaugural prize will be awarded to a team, organization or individual who has made a significant contribution to healthcare delivery with a focus on one or more defined areas. Details will be released in early 2021.
Osteoporosis is a condition in which bones become weak and brittle, effectively increasing their risk of breaking. With osteoporosis, the loss of bone occurs silently and progressively – often without symptoms until the first fracture. Providing more bone-strengthening power, the recent FDA approval of a new dual-acting drug (romosozumab) is giving patients with osteoporosis more control in preventing additional fractures.
2. Expanded Use of Minimally Invasive Mitral Valve Surgery
The mitral valve allows blood flow from the heart’s left atrium to the left ventricle. But in about 1 in 10 individuals over the age of 75, the mitral valve is defective causing the action of regurgitation. Expanding the approval of a minimally invasive valve repair device to a population of patients who have failed to get symptom relief from other therapies provides an important new treatment option.
3. Inaugural Treatment for Transthyretin Amyloid Cardiomyopathy
A disheartening cardiovascular disorder, ATTR-CM is a progressive, underdiagnosed, potentially fatal disease in which amyloid protein fibrils deposit in, and stiffen, the walls of the heart’s left ventricle. But a new agent to prevent misfolding of the deposited protein is showing a significantly reduced risk of death. Following Fast-Track and Breakthrough designations in 2017 and 2018, 2019 marked the FDA approval of tafamidis, the first-ever medication for treatment of this increasingly recognized condition.
4. Therapy for Peanut Allergies
It’s a terrifying reality for 2.5 percent of parents – the possibility that at any moment, their child might be unable to breathe due to an allergic reaction. Though emergency epinephrine has reduced the severity and risk of accidental exposure, these innovations are not enough to quell the ever-present anxiety. But development of a new oral immunotherapy medication to gradually build tolerance to peanut exposure holds the opportunity to lend protection against attack.
5. Closed-Loop Spinal Cord Stimulation
Chronic pain is a terribly frustrating condition, and a large reason for prescription of opioid medication. Spinal cord stimulation is a popular treatment for chronic pain through which an implantable device provides electrical stimulus to the spinal cord. But unsatisfactory outcomes due to subtherapeutic or overstimulation events are common. Closed-loop stimulation is allowing for better communication between the device and the spinal cord providing more optimal stimulation and relief of pain.
6. Biologics in Orthopaedic Repair
After orthopaedic surgery, the body can take anywhere from months to years to recover. But biologics – cells, blood components, growth factors, and other natural substances – have the power to replace or harness the body’s own power and promote healing. These elements are finding their way into orthopaedic care, allowing for the possibility of expedited improved outcomes.
7. Antibiotic Envelope for Cardiac Implantable Device Infection Prevention
Worldwide, roughly 1.5 million patients receive an implantable cardiac electronic device every year. In these patients, infection remains a major, potentially life-threatening complication. Antibiotic-embedded envelopes are now made to encase these cardiac devices, effectively preventing infection.
8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients
High cholesterol is a major concern for nearly 40 percent of adults in the U.S. Left untreated, the condition could lead to serious health problems like heart attack and stroke. Though typically managed with statins, some individuals experience unacceptable muscle pain with statins. Bempedoic acid provides an alternative approach to lowering of LDL-cholesterol while avoiding these side effects.
9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer
PARP, or poly-ADP ribose polymerase, inhibitors block repair of damaged DNA in tumor cells which increases cell death, especially in tumors with deficient repair mechanisms. One of the most recent important advances ovarian cancer treatment, PARP inhibitors have improved progression-free survival and are now being approved for first-line maintenance therapy in advanced stage disease. Several additional large-scale trials are underway with PARP inhibitors set to make great strides in improving outcomes in cancer therapy.
10. Drugs for Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) – also known as diastolic heart failure – is the condition in which the ventricular heart muscles contract normally, but do not relax as they should. With preserved ejection fraction, the heart is unable to properly fill with blood – leaving less available to be pumped out to the body. Currently, recommendations for this treatment are directed at accompanying conditions and mere symptom relief. But SGLT2 inhibitors, a class of medications used in the treatment of type 2 diabetes, is now being explored in HFpEF – alluding to a potential new treatment option.
#2 Neuromodulation to Treat Obstructive Sleep Apnea
While C.P.A.P. is the gold standard treatment for OSA, the risk of misuse or discontinued use has created an opportunity for innovators to search for a less intrusive way to treat it. The result is ne
In 2018, innovators will be upgrading the entire vaccine infrastructure to support the rapid development of new vaccines (a concept that was #1 on the Top 10 Medical Innovations for 2015).
For breast cancer patients that are BRCA1 or BRCA2 positive, there is new hope for a targeted therapy that is already seeing success in the ovarian cancer market.
After seeing substantial growth in hospital readmissions and an opioid epidemic spiraling out of control, it is clear that physicians need to overhaul the post-surgery strategies currently in use.
Centralized monitoring has emerged as the answer, as part of a “mission control” operation in which off-site personnel use advanced equipment monitor patients.
#10 Scalp Cooling for Reducing Chemotherapy Induced Hair Loss
The practice of “Scalp Cooling” has been shown to be highly effective for preserving hair in women receiving neoadjuvant or adjuvant chemotherapy for early-stage breast cancer.
Defining Health Care’s Future: Digital Health, Innovation Accessible, Prevention Importance as Cure – The Vision of Stanford Medical School Dean delivered at 2018 JP Morgan in San Francisco
Reporter: Aviva Lev-Ari, PhD, RN
Article ID #249: Defining Health Care’s Future: Digital Health, Innovation Accessible, Prevention Importance as Cure. Published on 1/9/2018
WordCloud Image Produced by Adam Tubman
At JPM 2018: Three Challenges That Will Define Health Care’s Future
Lloyd Minor, LinkedIn Influencer
Carl and Elizabeth Naumann Dean, Stanford University School of Medicine
In response to a Wall Street Journal op-ed and request for information about innovative ways to pay for and deliver health care in the U.S., the Personalized Medicine Coalition has encouraged the Centers for Medicare & Medicaid Services (CMS) to spearhead models that empower physicians to move away from the current standard of care when patient outcomes can be improved by tailoring care to a patient’s genetics and other factors:
In keeping with PMC’s mission to underline the significance of personalized medicine to patients and the health system, the Coalition’s comment letter contends that personalized medicine products and services can increase the overall value of dollars spent by improving health outcomes.
CMS’ previous efforts to advance new payment models, the letter notes, were met with resistance largely because they focused on reducing overall health care costs without adequately considering whether those reductions would result in a disproportionate decrease in the outcomes that matter to patients.
PMC indicates in the letter that the guiding principles put forth in CMS’ request for information provide “reasonable assurance” that the agency plans to proceed at “a more measured pace” going forward.
“We believe that personalized medicine has the potential to help CMS deliver on its goal of [affordable, accessible health care] if [the agency] focuses on maximizing individual patient outcomes, if new models are fully evaluated before large-scale implementation, if payment is not rooted in current standard of care, and if physicians have the flexibility to tailor care based on a patient’s genetics and other factors,” the letter reads.
Create a personalized high-performance computer by crossing the barriers between clouds
Reporter: Aviva Lev-Ari, PhD, RN
The Information Technology Research Institute of the National Institute of Advanced Industrial Science and Technology has developed a technology with which once an environment to perform high-performance computing has been established, a virtual cluster-type computer can easily be built on a different cloud and made available for immediate use.
Generally, in high-performance computing, cluster-type computers where many computers are bundled and run as a single computer are used. However, their hardware configuration is not uniform. On the other hand, virtual computers that are not dependent on hardware configuration are provided in clouds, and by bundling them together, a virtual cluster-type computer can be created. However, in this case, the user had to re-install software or reset the settings for a different cloud. Therefore, a technology to build a virtual cluster-type computer based on the design concept of “Build Once, Run Everywhere” has been developed. Once the environment to run the application has been established it may be run on any cloud, be it a private, commercial, or other cloud. Furthermore, since there are no constraints on the number of virtual computers that can be incorporated into the cluster, when the computing power is insufficient, an even larger virtual cluster-type computer can be formed on another cloud that allows the use of even more virtual computers, but allowing it to be used in exactly the same manner.
A virtual cluster-type computer was formed on AIST’s private cloud, AIST Super Green Cloud (ASGC), and the ability to use it on Amazon EC2, a commercial cloud, was verified. With this technology, users and application fields that could not use high-performance computing previously can now use high-performance computing. Thus, the developed technology is expected to contribute to the enhancement of industrial competitiveness.
There are many research organizations and companies that require high-performance computing, such as in the development of automobiles and for drug discovery. Conventionally, each organization prepared cluster-type computers within their organization. This required the introduction of a system with even higher performance to solve problems exceeding its computing capacity. Further, it was not readily available for introduction when it was required.
In clouds now widely available today, computing performance can be increased through the addition of computers by bundling virtual computers to form a cluster-type computer. However, when the built environment is to be re-created on a different cloud, it required the software to be re-installed and the settings reconfigured, necessitating extra time, labor, and cost.
Furthermore, because initial introduction and operating costs for cluster-type computers are high, the environment for high-performance computing could not be maintained, especially for small- and medium-scale enterprises. Expansion of the fields in which high-performance computing can be applied in support of such users is required for the enhancement of industrial competitiveness.
AIST is conducting R&D aimed at achieving a high-performance computing infrastructure with both the convenience to run on any cluster-type computer once a high-performance computing application-executing environment has been created, and high computing performance. In the process, R&D was conducted under the concept of separating the application-executing environment from actual machines by virtualization using cloud technologies to establish cluster-type computers on various clouds as required. In addition, although a cloud is established with virtualization technology, in the field of high-performance computing, there has been an issue of a drop in computing performance when virtualized, which has hindered its popularization. Therefore, evaluation of the effects of virtualization when executing high-performance computing applications was conducted in detail and technologies to reduce the deterioration of performance caused by virtualization have been developed.
2012pharmaceutical
sjwilliamspa