Tuesday, April 23, 2013

#PCTUS 2013: Healthcare, data management and reform

Speaker Eric Topol
The morning kicked off with our conference chairs Deidre Bavarde and Craig Lipset,  They again focused on how patients are waiting while Pharma is figuring out how to work bigger, faster and better.   They encouraged attendees to be open to new connections, ideas and solutions to the healthcare problems Pharma is here to solve. Dr. Eric Topol is coming to the stage to look at the future of drug development in the digital world. Technology now allows you to bypass a doctor. The SmartPhone is the most radical change in healthcare. The webcam can do the same thing yet connect you to a doctor on the other end. DNA mapping can save a life. Top 3 drugs in 2012: Humira, Remicade, Enbrel. They’ll sell over $30 billion this year. Clinical response to these drugs is 30-35%. By doing a genomic assessment, we can increase that rate by judging who will respond to the drugs. Genomic treatments that treat those who map to the specific genome can
significantly increase the positive response rate.   The democratization of medicine is the future. In the past, the doctor has had all the information and the patient had to seek the information out. Now, the doctors and patients have equal access to the information. But currently, we have 2/3rd of doctors who won’t email their patients. There are 66% of doctors who don’t believe patients should get their patient notes.

Senator Robert Bennett
Senator Robert Bennett believes that healthcare plays a large role in the government and vice versa. The deficit is significantly a result of the healthcare. If we don't get our healthcare costs under control, significant debt will follow. Bennett identified three key Rs when it comes to challenges in healthcare: Research, Regulation, Rationing. Rationing is a standard form of controlling healthcare throughout the world. healthcare is data management. The more data we get on healthcare, the more sophisticated
we become. The best healthcare is the cheapest and in Seattle, WA, Rochester, MN and Salt Lake City, Utah. The three of these places have research centers that have great data management centers. Government lacks when it comes to intervention and innovation. They don’t know how to create a market place, where the demand is, etc. Better quality healthcare means lower costs.

For the next session,Dr. Eric Topel and James Heywood joined a panel discussion with Conference Chair Lipset Key to Connectivity: Opportunities for Disruptive Innovation in Clinical Trials.

Lipset, Topol, Haywood
Topol believes that trials can be developed that can be guaranteed to work. Each individual can provide the information that can lead to the knowing of that drug working. Although many drugs are really expensive, if they’re tested and mapped, they will work. Pharma is not getting the right type of information from the technology that we have. Heywood believes there needs to better control the information Pharma is collecting during clinical trials.  The cost of validation is a serious issue in clinical research. Pharma has to be asked to exploit unproven ideas. The next war is who wins the information battle. Topel believes that if a trial takes more than 100 people to conduct, it should be a slam dunk. As long as 1/100 benefits, that’s a success. A trial this small with the right framework can be really inexpensive. Each disease is a rare disease because it’s unique to the way it affects each person. Topol believes that Twitter is the nervous center of research.

Patients in Pharma Companies sponsor trials for investigate drugs, report to their investigators. They self-report into online platforms and provide the ability for scientists to mine the data an determine if they drug in clinical trials is effective or not. Pharma is concerned about patients exposing the results in real time. Heywood believes that we have to start studying the bias. We don’t have any standards in this field on that bias.

Follow the jump to see what Dr. Jonathan Gruber shared about healthcare reform.

Finally, to wrap up the morning, we heard from Jonathan Gruber, World Rebound Economist, Mass Institute of Technology on The Impact of Healthcare Reform on Drug Development: What Does The Future Hold?

Next year will be messy when it comes to healthcare reform. This law will not work well right away at implementation, but it will eventually work once the population knows the benefits of the Affordable Care Act. Pharma benefits from this rule significantly. The law is primarily a coverage law.

The cost control aspect is difficult to manage.  We don’t know how to control the costs. Two factors play into this: Healthcare cost has quadrupled becoming 18% of our economy and will grow to over 40% before 2018.  We also waste significant amounts of healthcare – up to one third of spending. There are also many third party factors that play into how healthcare spending is perceived including the coverage on news programming.

One way to help fix healthcare is to get patients more involved in their healthcare – they need to pay more for what they use and they need to have more knowledge. Providers need to move away from a fee per service system to outcomes based care.  The flaws of the current healthcare system are three fold: It’s expensive, it’s unfair, it’s inefficient. But as the industry evolves to support the Affordable Healthcare Act, the Pharma industry will move towards cost effectiveness. It’s not about delivering the next expensive innovation but the next cheaper innovation that’s just as effective for the patient.  This is where Pharma will benefit.  The nature of insurance is going to change and decide what drugs they’ll reimburse. The system will allow everyone to have access to cost effective treatments.

So now that we have this new healthcare structure, how is it financed?  The financing of the Affordable Care Act half of the money will go to expanding programs and the other will go to tax credits.  The government has chosen to tax the two industries who will benefit the most from the new population they're serving: the Pharma Industry and the Medical Device sector. There is also a new Medicare Payroll tax.  Cuts include the Medicare Advantage Program will be reduced. There is also a reduction of 1% in hospital reimbursement per year.  While this seems like a significant amount, Bennett points out that growth will merely have to slow, as the expenses are running at a higher rate than can currently be sustained.

Bennett then looks at the exchanges and points out their significance in the reform. The Massachusetts Health Connector. Gruber believes that maybe not all states need to run their own exchange – look at the economies of scale. The disappointment is that states are turning down the opportunity to help design the nation-wide exchange.

The Mandate is a critical aspect that needs to be sold. The public must accept that we get health insurance – it’s subsidized and easy to get. There is no doubt that by 2016, millions more Americans will have health insurance. This will be directly dependent upon how well we sell and explain the law.

This afternoon,we'll focus on current clinical outsourcing models and good clinical practices.

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