On behavioral change, health and age

A Health Affairs article (Meyer 2021) discusses the potential benefits of Medicare Diabetes Prevention Programs (MDPP). MDPP aims to reduce patient weight and prevent patients from becoming diabetic. Commenting on her Medicare clientele enrolled in the program, one instructor noted:

“I’ve seen a lot of Medicare people do really well with the program because they have more time than younger people who are working or raising children,” she said. “But Medicare folks may have a harder time making [lifestyle] changes because they’ve been doing things the same way for a long time.”

MDPP was the first Center for Medicare and Medicaid Innovation (a.k.a., CMMI; a.k.a., the CMS Innovation Center) demonstration of a preventive care model that was expanded to program available to al Medicare beneficiaries. However, uptake of the program is poor; only 3,600 Medicare beneficiaries across the nation have taken advantage of the MDPP benefit.

On behavioral change, health and age posted first on https://carilloncitydental.blogspot.com

How much money should governments spend to incentivize the development of new antibiotics?

As the number of infections that are anti-biotic resistant grows, we need to have more novel antibiotics in our arsenal. The problem is that many antibiotics are not commercially viable. For instance, if a new antibiotic is marginally better than the existing one, few payers will be willing to cover this cost. However, if new bacteria become resistant to the standard of care antibiotic, then the novel antibiotic would be highly valued. In short, antibiotics have a very high option value.

There have been a number of approaches to try to incentivize new R&D on antibiotics, including various prizes and subscription models.

The most prominent examples of antibacterial subscriptions are the pilot program created in 2019 by the National Health Service England (the UK pilot)14,15 and the Pioneering Antibiotic Subscriptions to End Upsurging Resistance (PASTEUR) Act, which was reintroduced in 2021 in the US Congress.16 In a subscription, the company is paid an annual subscription amount and agrees to provide as much of the antibacterial as is needed by the subscriber at no additional cost. As with earlier proposals to offer prizes for successful antibacterial R&D,17–20 one key question is the appropriate size of the pull incentive

A key question is how large these incentives should be. Some previous literature have proposed the following amounts:

• Department of Health and Human Services. Push and pull incentives should be $919m (2012 USD) for a single indication. (Sertkaya et al. 2014)
• Review on Antimicrobial Resistance (AMR Review): Market entry rewards should be $800m to $1.3 billion USD, plus an additional $400m per year in research grants. (O’Neill 2016)
• German Federal Ministry of Health’s Global Union for Antibiotics Research and Development report. $1 billion global launch reward–similar to a market entry award–plus $400 million in push incentives per year. Half of the $400m would go to preclinical research and the other half to clinical research. (Bundesministerium für Gesundheit 2011)
• DRIVE-AB. The acronym stands for “Driving reinvestment in research and development for antibiotics and advocating their responsible use”; DRIVE-AB was a consortium of academics and industry experts. It was funded by the European Commission’s Innovative Medicines Initiative. DRIVE-AB recommended a $1 billion global market entry reward (pull), plus $800m in research funding (push) and ideally peak year sales of >$1 billion would lead to 18 new antibacterial medications over 3 decades. (Årdal et al. 2018; Okhravi et al. 2018)
• World Health Organization (WHO) report. This report largely averages the estimates from previous reports. (Breyer et al. 2020; WHO 2020)

A paper by Outterson (2021) in Health Affairs published today aimed to update these estimates. He creates a net present value (NPV) calculation which depends on development cost (i.e., cost, duration and probability of success for any phase in the drug development process); revenues and expenses after antimicrobial approval; and the discount rate. The authors models different approaches to reach the NPV: based on global peak year sales (GPYS); based on a market entry reward paid in one year (MER1); based on subscription paid over ten years (SUB10); of based on the acquisition of a Phase II-ready asset (AQ). Using these approaches, Outterson finds that:

The partially delinked market entry reward required for an asset acquired at the initiation of Phase II was $1.6 billion (best estimate), with the upper and lower-bound estimates being $2.6 billion and $900 million, respectively (MER1 + ACQ). For a fully delinked subscription, the results are $3.1 billion (best estimate), with the upper and lower bounds being $4.8 billion and $2.2 billion, respectively.

The level of global peak year sales (GPYS) required for profitable antibiotic R&D is $1.9 billion (range: $1.6–$3.8 billion), which is a significantly higher sales amount than that achieved by any recent antibacterial. Only two antibacterials launched since 2000 have achieved $1 billion in peak sales: linezolid (Zyvox), with $1.353 billion in 2015 (launched in April 2000), and daptomycin (Cubicin), with $1.312 billion in 2016 (launched in November 2003)…

The partially delinked global market entry reward required (MER1) is $2.2 billion (best estimate), with lower- and upper-bound estimates of $1.5 billion and $4.8 billion, respectively…

The fully delinked global subscription required over the course of ten years (SUB10) is $4.2 billion (best estimate), with lower- and upper-bound estimates of $3.3 billion and $8.9 billion, respectively

The authors find that subscriptions are more expensive because (i) subscriptions are delinked from actual volumes and thus manufacturers must make the drugs without potentially any compensation (beyond the subscription); and (ii) payments are pushed into the future and thus additional funds must be found to compensate for the reduced time-cost of revenues received in the future. They also find that push incentives alone are typically insufficient to bring new antimicrobials to market.

The article is interesting throughout and do read the whole article here.

How much money should governments spend to incentivize the development of new antibiotics? posted first on https://carilloncitydental.blogspot.com

Health Consumers, Health Citizens, and Wearable Tech – My Chat with João Bocas

The most effective, engaging, and enchanting digital health innovations speak to patients beyond their role as health consumers and caregivers: digital health is at its best when it addresses peoples’ health citizenship.

I had the great experience brainstorming the convergence of digital health, wearable tech, user-centered (UX) design, and health citizenship with João Bocas, @WearablesExpert, in a on his podcast.

And if those topics weren’t enough, I wove in the role of LEGO for our well-being, “playing well,” and inspiring STEM- and science-thinking.

João and I started our chat first defining health citizenship, which is a phrase I first learned from European Commission bioinformatics leader Jean-Claude Healy whom I met when I first worked in Europe. After hearing the words “health citizenship,” the concept stayed with me over the years I’d been working as an advisor to the health/tech industry across every part of the health ecosystem.

Once I actually became a health citizen in the EU, I’ve made the personal professional, incorporating the concept as part of my work on ESG principles in health care with my clients and collaborators.

The coronavirus pandemic has surely revealed the importance of public health and the nature of the fragile safety net for people under-served and left out of health/care access.

Our chat then segued to how digital health tools and platforms can help scale health and well-being to address barriers to the social determinants of health and well-being, when well-intended and enchanting design can do good and do well at the same time. THINK: food security, transportation, on-line scheduling, expanding access to mental and behavioral health programs, and bolstering peoples’ digital access and literacy especially among people long under-served by the brick-and-mortar health care system.

We concluded with João’s signature question of “1 Minute of Fame,” an open-ended ask for me to riff on anything I felt like riffing on. I noted that the day before was International Day of the Girl, giving a shout-out to my daughter (a delightful digital designer herself) as well as LEGO and our family’s LEGOmaniacal ways.

“LEGO” from its Danish roots was named as such based on the words “Leg Godt,” meaning “Play Well.” My end-note was a call-to-action for all of us in the health care ecosystem to Play Well.

Health Populi’s Hot Points:  Part of Playing Well in health care, globally, is to keep Health Citizenship in mind when conceiving, planning for, and designing health care products and services.

There are four key pillars to Health Citizenship, as I discuss in my book titled just that (with the sub-title: “How a virus opened hearts and minds”).

First, healthcare access for all — as a civil right.

Second: digital citizenship, bolstering privacy (a la the GDPR or California’s CCPA) which ensures people as health citizens (and citizens overall) have a right to be forgotten and to control their personal data.

Third: trust as a precursor to civil engagement. Without trust, there’s no commons or collective respect to nurture public health and other broad commitments and objectives to making life better for everyone.

Fourth, finally, let’s imagine together a new social contract of love, as in Love Thy Neighbor as Thyself.

The post Health Consumers, Health Citizens, and Wearable Tech – My Chat with João Bocas appeared first on HealthPopuli.com.

Health Consumers, Health Citizens, and Wearable Tech – My Chat with João Bocas posted first on https://carilloncitydental.blogspot.com

Vaccine hesitancy in low- and middle-income countries

While the recently developed COVID-19 vaccines offer the hope of ending the pandemic, ending the pandemic is only feasible if individuals take the vaccine. In the US, a large portion of individuals report being hesitant to receive the vaccine. A key question then is whether individuals living in low and middle-income countries (LMIC) are have high rates of vaccine hesitancy.

A paper by Solís Arce et al. 2021 answers this question by conducting a survey of nearly 45,000 individuals living in 10 LMICs, Russia and the United States. The authors find that: , including a total of 44,260 individuals

The average acceptance rate across the full set of LMIC studies is 80.3% (95% confidence interval (CI) 74.9–85.6%), with a median of 78%…The acceptance rate in every LMIC sample is higher than in the United States (64.6%, CI 61.8–67.3%) and Russia (30.4%, CI 29.1–31.7%). Reported acceptance is lowest in Burkina Faso (66.5%, CI 63.5–69.5%) and Pakistan (survey 2; 66.5%, CI 64.1–68.9%). 

Across individuals who were willing to take the vaccine, the main reason for taking the vaccine was personal protection, with family protection typically coming in second place. Across individuals who were not willing ot take the vaccine, the main reason was concern over side effects, although some countries (Mozambique, Uganda and Pakistan) noted skepticism over vaccine efficacy.

Vaccine hesitancy in low- and middle-income countries posted first on https://carilloncitydental.blogspot.com

Why CrossFit and 23andMe Are Moving from Health to Primary Care

As we see the medical and acute care sector moving toward health and wellness, there’s a sort of equal and opposite reaction moving from the other end of the continuum of health/care: that is, wellness and fitness companies blurring into health care.

Let’s start with the news about CrossFit and 23andMe, then synthesize some key market forces that will help us anticipate more ecosystem change for 2022 and beyond.

CrossFit announced the company’s launch of CrossFit Precision Care, described as primary care that provides personalized, data-driven services for “lifelong health,” according to the press release for the program.

The service is based on four components:

• Genomic testing to identify a consumer’s genetic advantages, disadvantages and predispositions
• Blood testing to assess cardiovascular risks, hormone status, lipids, minerals, thyroid function, and other factors that shape health and performance
• Longevity analysis to estimate a person’s biologic age (using a DNA methylation test kit, adding in the genomic and blood tests), and
• Lifestyle review which formulates eating plans, exercises, family and social life, sleep, hobbies, recreation, and personal goals.

The program was developed by Dr. Julie Foucher and fellow CrossFit-trained physicians collaborating with Wild Health, which has developed what it calls a “platform for personalized medicine” with which the CrossFit Precision Care looks to be linked. Wild Health calls its Clarity algorithm “the world’s first true precision medicine algorithm” applying machine learning to DNA analysis, biometrics, microbiome studies, and phenotype data.

Dr. Foucher, a family medicine physicians, is a former CrossFit Games athlete.

Speaking of genomic testing….how does 23andMe fit into the health-to-healthcare scenario? The company acquired Lemonaid Health this week, bringing together the consumer-facing genomics company with a prescription drug distribution channel for the purpose of channeling personalized medicine to consumers. This combination is meant to deliver, in the words of 23andme, “individualized primary care that empowers consumers to live healthier lives.”

Lemonaid Health has married prescription drug deliver with telemedicine, one of the group of companies akin to Ro, Hims & Hers, and Nurx, among others.

Anne Wojcicki, the CEO and Co-Founder of 23andMe, explained that the merging of Lemonaid Health’s telehealth platform, underpinned with its team of medical professionals and pharmacy services, will combine with 23andme’s genetics expertise to bring personalized healthcare, “empowering people to take control of their health.”

Together, these two cases — occurring within days of each other — tell us a lot about how U.S. healthcare is accelerating into peoples’ hands, homes, and hearts. The converging factors are:

1. Primary care
2. Telehealth
3. Retail health
4. Genetic testing, and
5. Collaboration and combination.

It’s that #1 pillar we’ll focus on in the Hot Points, below.

Health Populi’s Hot Points:  We only have to look back a matter of here days to understand how profoundly the new-new primary care acceleration is happening. Just last week, Walgreens Boots Alliance announced a doubling down on primary care, mental health services, and telehealth including a $5 billion further investment in VillageMD (giving the company a larger share of the clinic firm). Per the press release, WBA is “reimagining retail through expanded health and wellness offerings and mass personalization.”

CVS Health, which has been building its own primary care vision for several years through the HealthHub, Aetna, and other investments, has a new vision for “SuperClinics” as coined by Karen Lynch, CEO, in a profile of her in Fortune magazine’s Most Powerful Women of 2021.

And, several other news items further paint the current portrait of primary-care-in-motion…

• One Medical’s acquisition of Iora Health
• The launch of Marley Medical, to fill the gaps in primary care for people managing chronic conditions (important to mention initial investors in the company are “OGs” [as the press release says) including digital health pioneers like Anne Wojcicki, David Van Sickle, Halle Tecco, Thomas Goeta, among others who know how to build sustainable digital health ventures}
• Health plans launching “virtual first” plans, such as Humana working with Doctor on Demand, UnitedHealthcare and Optum, Oscar, and Cigna aligned with MDLive, and
• Teladoc’s expanding its virtual primary care program, Primary360, growing from its core telehealth roots,

among many other primary care-focused ventures leveraging virtual care and collaborations.

Finally, never under-estimate what Amazon Care and the company’s other health care workflows can/will do in primary care.

The fact is that nations that invest in resilient, strong primary care backbones ultimately spend less per health citizen than the U.S., with a fragmented on-ramp to primary care for millions of consumers lacking access to upstream, preventive and early-detecting services. This current bullish phrase for new primary care suppliers and business models will add chaos before creation and consolidation where we learn which models work toward the Quintuple Aim.

We will continue to see the mashup and blurring of primary care with personalized medicine, with models built on omnichannel approaches designed for every kind of people if suppliers are design-ful.

The post Why CrossFit and 23andMe Are Moving from Health to Primary Care appeared first on HealthPopuli.com.

Why CrossFit and 23andMe Are Moving from Health to Primary Care posted first on https://carilloncitydental.blogspot.com

Mid-week reading

• CBO analysis of the Build Back Better Act.
• Information frictions helps explain why there isn’t more behavioral response to government interventions.
• Wealth = networks, not assets.
• Impact of same sex legalization on mental health.
• Patient selection in CJR.

Mid-week reading posted first on https://carilloncitydental.blogspot.com

Characteristics of neighborhoods with high and low COVID-19 vaccination rates

What do the vaccination rates look like in the largest U.S. cities? In these cities, how do the characteristics of individuals in neighborhoods with low vs. high vaccination rates differ?

To answer this question, a paper by Sacarny and Daw (2021) use data from 9 large US cities: New York, Los Angeles, Chicago, Houston, Phoenix, Philadelphia, San Antonio, San Diego, and Dallas. Specifically, they gather data on COVID-19 vaccination and death rates for these cites from health authority websites and sociodemographic information from the American Community Survey (ACS).

They find that neighborhood with high vaccination rates have: (i) more Whites and Asians and fewer Blacks and Hispanics, (ii) more people who received a bachelor’s degree or higher, and (iii) higher income levels, (iv) a higher share of individuals aged 65 and above. Unsurprisingly, COVID-19 deaths are lower in the highly vaccinated neighborhoods in these cities.

Characteristics of neighborhoods with high and low COVID-19 vaccination rates posted first on https://carilloncitydental.blogspot.com