The Street is pushing Big Pharma members to sell off their non-core assets. Why? To keep stockholders happy, of course. Even the media-deprived know that last year was not a stellar year for pharma, finance-wise or any other wise.
The Street people are arguing that some Big Pharma members are worth more dissected than they are whole. If Abbott Labs, for example, were torn asunder and its various pieces sold off, it would make a handsome profit, and its stock price could jump 30%, according to an analyst quoted in Barron’s.
Obviously, that money could be used for what’s needed: R and D.
FiercePharma brings up the point, and it’s a good one, that such dissection would run counter to what pharma members have been trying to do with all these mergers and acquisitions, and that is survive – a sophisticated way of hitting the mattresses, if you will.
Our two cents: We’re with the Street, but not for the same reason. We think it’s time for pharma members to get back to their roots, and that is Research and Development, 24/7. If discovery, trials, regulatory, and so on were the same as they were 30 years ago, it would be one thing, but they are all much tougher today. The amount of focus and concentration needed is exceptional.
Too many divisions cause too many distractions, too many worries.
Barron’s is right: Bigger is not always better. In fact, it can be a real burden.
Thursday, February 17, 2011
Monday, February 14, 2011
Telehealth: Simple Is Beautiful
One challenge with healthcare is figuring out when people alone can produce the best healthcare outcome for the patient, or when technology can do the job better.
Or a combination of the two.
We present, as an example, a three-year Department of Defense study involving pediatric care in the Pacific Rim. The DoD wanted to see if physicians who consulted with pediatric subspecialists online regarding consultations, treatments and so on, could improve health outcomes for young patients while saving the DoD money. The conclusion: Yes on both counts.
The study, conducted between 2006 and 2009, looked at more than 1,000 tele-consultations in community hospitals from the area, including Guam and South Korea, often in areas where pediatric subspecialists are not available. Most of the tele-consultations, 75 percent, came from these areas.
Because the doctors spoke, the diagnosis and/or treatment plan was changed for 74 percent of the children – preventing patient transfers to other facilities between 12 percent and 43 percent, saving American taxpayers between $208,283 and $746,348 each year – not to mention saving the children and their families unnecessary expense and concern. The study authors said the number of “tele-consultations has grown significantly since 2006.”
It didn’t take long for the Twitter world to react to this study. One tweet [Feb. 8, 8 p.m.] asked if healthcare pros who don’t use telemedicine are negligent; another [same time] said Alaska and Hawaii are teaming up to extend telehealth to remote locations in those states.
The straightforwardness of this study, and its convincing outcomes, dispels the healthcare challenge this particular problem presented. That is why we wanted to bring it to your attention. If only all things were this simple.
Or a combination of the two.
We present, as an example, a three-year Department of Defense study involving pediatric care in the Pacific Rim. The DoD wanted to see if physicians who consulted with pediatric subspecialists online regarding consultations, treatments and so on, could improve health outcomes for young patients while saving the DoD money. The conclusion: Yes on both counts.
The study, conducted between 2006 and 2009, looked at more than 1,000 tele-consultations in community hospitals from the area, including Guam and South Korea, often in areas where pediatric subspecialists are not available. Most of the tele-consultations, 75 percent, came from these areas.
Because the doctors spoke, the diagnosis and/or treatment plan was changed for 74 percent of the children – preventing patient transfers to other facilities between 12 percent and 43 percent, saving American taxpayers between $208,283 and $746,348 each year – not to mention saving the children and their families unnecessary expense and concern. The study authors said the number of “tele-consultations has grown significantly since 2006.”
It didn’t take long for the Twitter world to react to this study. One tweet [Feb. 8, 8 p.m.] asked if healthcare pros who don’t use telemedicine are negligent; another [same time] said Alaska and Hawaii are teaming up to extend telehealth to remote locations in those states.
The straightforwardness of this study, and its convincing outcomes, dispels the healthcare challenge this particular problem presented. That is why we wanted to bring it to your attention. If only all things were this simple.
Thursday, February 10, 2011
Medication Adherence: Two Views
We have a friend who’s done a lot of research on medication adherence, and he says that healthcare professionals fall into two camps regarding how they see patients and their capacity to maintain their treatment regimens. In the one camp, he says, are those who think patients can't motivate themselves for their own betterment. It’s the doctors who have the answers, not the patients.
Those in the other camp think just the opposite. They say patients are smart enough to know they need to maintain their prescribed regimen – they just need a little help to stick with the program.
Is it possible both camps are right? A study of hypertensive Medicaid patients who used a pill phone app on their cell phone reminding them to take their meds is pointing that way. It was a small study – 50 patients -- so we’re loathe to do more than surmise.
In a nutshell, the 50 patients accepted the idea, and used the app throughout the seven-month study. The patients were “generally satisfied” with the software, and patients continued to have their scripts refilled. But – once the study was over, there was a “decrease” in refills “after the application was discontinued.”
So, the study’s sponsors and researchers, including George Washington University Medical Center, appreciated that the participants were smart enough to be taught how to use the technology. And these patients used it for the study's duration. But once they no longer had the phone, they stopped.
Why? It would be good if the researchers asked some follow-up questions of these study participants. Any insight into how patients feel about maintaining their treatment regimens can only help.
Those in the other camp think just the opposite. They say patients are smart enough to know they need to maintain their prescribed regimen – they just need a little help to stick with the program.
Is it possible both camps are right? A study of hypertensive Medicaid patients who used a pill phone app on their cell phone reminding them to take their meds is pointing that way. It was a small study – 50 patients -- so we’re loathe to do more than surmise.
In a nutshell, the 50 patients accepted the idea, and used the app throughout the seven-month study. The patients were “generally satisfied” with the software, and patients continued to have their scripts refilled. But – once the study was over, there was a “decrease” in refills “after the application was discontinued.”
So, the study’s sponsors and researchers, including George Washington University Medical Center, appreciated that the participants were smart enough to be taught how to use the technology. And these patients used it for the study's duration. But once they no longer had the phone, they stopped.
Why? It would be good if the researchers asked some follow-up questions of these study participants. Any insight into how patients feel about maintaining their treatment regimens can only help.
Monday, February 7, 2011
Invest in Healthcare, But What Exactly?
A recent Wall Street Journal piece regarding why pharma is having problems producing effective product caught our eye. The Feb. 9 op-ed article, called “Health-Care Investment: The Hidden Crisis” [subscription-only access] lays out ways that Washington “can remove some of the barriers to growth in medical research.” Its author: Michael Milken.
He argues that “improved public health translates directly into greater national productivity, which underpins all economic growth.” He cites figures showing how life-expectancy gains have added to America’s prosperity, and expresses concern that cuts in NIH funding “will cause some younger medical scientists to either change careers or take their work to places like Singapore” which welcome researchers.
The barriers he talks about are the usual suspects: anticipated patent expirations, regulatory issues, qualms about litigation exposure, and high U.S. taxes on repatriated overseas earnings.
Mr. Milken is on point linking ROI and extended lifespan. The study he cites –- that gains in life-expectancy since 1970 have added $3.2 trillion per year to "America's national wealth" – is impressive. We further argue that if more attention were paid to medication adherence, then that figure would be even more impressive.
Mr. Milken also argues that the FDA needs more resources to “keep up with the pace of innovation in such areas as medical-device development and regenerative medicine.” Agreed – let alone with inspecting clinical trials on foreign soil.
But let’s also consider this: The FDA needs resources to find different ways to solve their medical information problems. While the FDA guards public health, the FDA doesn’t produce good guidance on medical information and as a result industry may not provide good medical information to the patients using its products. A few years ago, the public didn’t have access to this information, but now it does. And the public will be talking about this information on social media sites. We believe the FDA isn’t moving quickly enough on its social site regulations or being adaptive enough about the content it regulates. It needs the time and resources to define flexible policies, not to apply additional funds to enforcement.
To our way of thinking, the FDA should become less regulator, and more healthcare-outcome policy initiator and promoter.
He argues that “improved public health translates directly into greater national productivity, which underpins all economic growth.” He cites figures showing how life-expectancy gains have added to America’s prosperity, and expresses concern that cuts in NIH funding “will cause some younger medical scientists to either change careers or take their work to places like Singapore” which welcome researchers.
The barriers he talks about are the usual suspects: anticipated patent expirations, regulatory issues, qualms about litigation exposure, and high U.S. taxes on repatriated overseas earnings.
Mr. Milken is on point linking ROI and extended lifespan. The study he cites –- that gains in life-expectancy since 1970 have added $3.2 trillion per year to "America's national wealth" – is impressive. We further argue that if more attention were paid to medication adherence, then that figure would be even more impressive.
Mr. Milken also argues that the FDA needs more resources to “keep up with the pace of innovation in such areas as medical-device development and regenerative medicine.” Agreed – let alone with inspecting clinical trials on foreign soil.
But let’s also consider this: The FDA needs resources to find different ways to solve their medical information problems. While the FDA guards public health, the FDA doesn’t produce good guidance on medical information and as a result industry may not provide good medical information to the patients using its products. A few years ago, the public didn’t have access to this information, but now it does. And the public will be talking about this information on social media sites. We believe the FDA isn’t moving quickly enough on its social site regulations or being adaptive enough about the content it regulates. It needs the time and resources to define flexible policies, not to apply additional funds to enforcement.
To our way of thinking, the FDA should become less regulator, and more healthcare-outcome policy initiator and promoter.
Thursday, February 3, 2011
EMRs and Pay for Performance: Stay the Course
Consider: When people must choose between changing an ingrained behavior, or proving why they don’t need to change their behavior, they will put their energies into the latter. Depending on what that behavior is will determine how much conflict there will be, and how uncomfortable the situation will get.
We fear that those who see no future in health IT or pay for performance will use lots of energy to convince others. One analysis study published in the Archives of Internal Medicine, one IT survey from Thomson Reuters/HCPlexus, and one pay for performance study published in BMJ suggest that physicians have no need to change behavior.
“Don’t spend any more money on this foolishness,” they are saying.
In our mind, is the question about the technology, or about change management?
In the Archives study, researchers from Stanford University pored over 255,402 non-hospital patient visits that occurred between 2005 and 2007 to non-federal treatment facilities. The authors looked at the role of electronic medical records (EMRs) and clinical decision support software (CDS) in assessing whether patients received better care, using 20 quality indicators as benchmarks. EMRs and CDS only exceeded one benchmark, the authors concluded.
"These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality," they wrote.
In the IT study, 3,000 MDs were queried as to whether EMRs would help patients: 39 percent said yes, 37 percent said there would be no effect, and 24 percent said the effect would be detrimental.
But could it be that some doctors aren’t tech-savvy, or that they just don’t have the time to learn how to use the system? We do not think the former, but it's true EMRs will likely,at least in the beginning, take them away from their patients. But over time, that should pass.
Maybe it's all in the way IT is approached.An analysis study highlighted in FierceHealthIT showed that using IT, along with clinical guidelines, cut down on imaging studies for lower back and headache MRIs, and hence the costs. Yet another study in the same article noted that improvements came about when “healthcare organizations wholeheartedly embraced the technology and customized it to maximize performance.”
The operative word here: wholeheartedly.
Writes FierceHealthIT: “Physician complaints about computers detracting from patient encounters show that many doctors don't yet know how to use EHRs properly. …While today's health IT leaves much to be desired, doctors must make the effort to meet computers halfway if they expect the technology to help them improve care.”
In the BMJ pay for performance study, the researchers chose 470,725 hypertensive patients to follow between 2000 and 2007. The point: to see if their physicians could improve their patients’ numbers, earning money if they did. Nada.
“Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes,” the authors wrote. “Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.”
It’s very possible the researchers chose the wrong disease. After all, hypertension doesn’t have any initial symptoms. Patient adherence could have been an issue.
On his blog, KevinMD writes that health reformers need to “be careful about overstating the benefits” of IT and pay for performance. “The data isn’t there yet,” he says.
Our point exactly. These studies have older data. Let's see what newer data can tell us before hardline decisions are made.
We fear that those who see no future in health IT or pay for performance will use lots of energy to convince others. One analysis study published in the Archives of Internal Medicine, one IT survey from Thomson Reuters/HCPlexus, and one pay for performance study published in BMJ suggest that physicians have no need to change behavior.
“Don’t spend any more money on this foolishness,” they are saying.
In our mind, is the question about the technology, or about change management?
In the Archives study, researchers from Stanford University pored over 255,402 non-hospital patient visits that occurred between 2005 and 2007 to non-federal treatment facilities. The authors looked at the role of electronic medical records (EMRs) and clinical decision support software (CDS) in assessing whether patients received better care, using 20 quality indicators as benchmarks. EMRs and CDS only exceeded one benchmark, the authors concluded.
"These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality," they wrote.
In the IT study, 3,000 MDs were queried as to whether EMRs would help patients: 39 percent said yes, 37 percent said there would be no effect, and 24 percent said the effect would be detrimental.
But could it be that some doctors aren’t tech-savvy, or that they just don’t have the time to learn how to use the system? We do not think the former, but it's true EMRs will likely,at least in the beginning, take them away from their patients. But over time, that should pass.
Maybe it's all in the way IT is approached.An analysis study highlighted in FierceHealthIT showed that using IT, along with clinical guidelines, cut down on imaging studies for lower back and headache MRIs, and hence the costs. Yet another study in the same article noted that improvements came about when “healthcare organizations wholeheartedly embraced the technology and customized it to maximize performance.”
The operative word here: wholeheartedly.
Writes FierceHealthIT: “Physician complaints about computers detracting from patient encounters show that many doctors don't yet know how to use EHRs properly. …While today's health IT leaves much to be desired, doctors must make the effort to meet computers halfway if they expect the technology to help them improve care.”
In the BMJ pay for performance study, the researchers chose 470,725 hypertensive patients to follow between 2000 and 2007. The point: to see if their physicians could improve their patients’ numbers, earning money if they did. Nada.
“Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes,” the authors wrote. “Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.”
It’s very possible the researchers chose the wrong disease. After all, hypertension doesn’t have any initial symptoms. Patient adherence could have been an issue.
On his blog, KevinMD writes that health reformers need to “be careful about overstating the benefits” of IT and pay for performance. “The data isn’t there yet,” he says.
Our point exactly. These studies have older data. Let's see what newer data can tell us before hardline decisions are made.
Monday, January 31, 2011
KOLs: Here's Another Reason to Get Your House in Order
So, the pharma reporting errors are beginning. For a few years members have disclosed to the state of Minnesota how much they pay physicians for services they provide, but now they must also report those numbers on their own sites as well. So what happens when the figures on the company's web site are different than the figures reported on a state's website?
Are these honest mistakes, or is there real deception involved? We can’t really tell from the following story.
ProPublica compared its database, compiled from the seven industry sites that have gone public with their financial relationships, to the database maintained by Minnesota, the first state to mandate disclosure, and found “multiple” examples of mismatched figures.
ProPublica didn’t provide exact numbers, but said some dollar amounts didn’t match.
Anyone even remotely connected to the business knows that a database containing the names of physicians who have represented these companies must be fairly large: Pfizer’s web site alone has 4,850 “entities” paid between July 1 and December 31, 2009. Is it possible that a few misreports could happen? One would think -- especially if different departments use the same KOL -- and didn't share the information.
Without the exact data, we can only guess. Either way, the reporting is incomplete. More robust reporting would be helpful, but frankly, the real need is for everyone to realize this financial reporting will likely have unintended consequences -- for starters, less informed physicians, because fewer physicians will want to act as speakers. They won't want to undergo this kind of public scrutiny.
There is no question that pharma needs to get its house in order regarding KOL payments. This is why we believe KOL selection, contracting monitoring and management must be done from a centralized unit. We have written extensively on this subject, and are expert in guiding members in how to coordinate, manage, and maintain KOL relationships.
The sooner, the better.
Are these honest mistakes, or is there real deception involved? We can’t really tell from the following story.
ProPublica compared its database, compiled from the seven industry sites that have gone public with their financial relationships, to the database maintained by Minnesota, the first state to mandate disclosure, and found “multiple” examples of mismatched figures.
ProPublica didn’t provide exact numbers, but said some dollar amounts didn’t match.
Anyone even remotely connected to the business knows that a database containing the names of physicians who have represented these companies must be fairly large: Pfizer’s web site alone has 4,850 “entities” paid between July 1 and December 31, 2009. Is it possible that a few misreports could happen? One would think -- especially if different departments use the same KOL -- and didn't share the information.
Without the exact data, we can only guess. Either way, the reporting is incomplete. More robust reporting would be helpful, but frankly, the real need is for everyone to realize this financial reporting will likely have unintended consequences -- for starters, less informed physicians, because fewer physicians will want to act as speakers. They won't want to undergo this kind of public scrutiny.
There is no question that pharma needs to get its house in order regarding KOL payments. This is why we believe KOL selection, contracting monitoring and management must be done from a centralized unit. We have written extensively on this subject, and are expert in guiding members in how to coordinate, manage, and maintain KOL relationships.
The sooner, the better.
Wednesday, January 26, 2011
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