In the world of Alzheimer’s disease drugs, the past year has been marked by disappointing Phase 3 clinical trial results for a handful of much-anticipated antibody drugs.

But the failure of those drugs, designed to clear toxic beta amyloid plaques that accumulate in the brain, isn’t discouraging to Cleveland startup ReXceptor Inc., which has just obtained an exclusive license to commercialize a treatment method from Case Western Reserve University.

ReXceptor is taking a fundamentally different approach. “We’re not trying to take (beta amyloid) out of the body entirely; we’re trying to restore a natural function,” explained CEO Michael Haag, who’s also the interim director of technology management at CWRU. “Everyone produces a certain amount of amyloid beta which can be shuttled out of the brain, but as you age, you have less and less of those carrier proteins. We want to give the brain back these carrier proteins.”

ReXceptor thinks it can do that by using a drug that’s already been approved by the U.S. Food and Drug Administration. Bexarotene, marketed by Medicis as Targretin, is approved for treatment of cutaneous T-cell lymphoma. But last year, CWRU neuroscience professor Gary Landreth and then-graduate student Paige Cramer published a paper in Science detailing how the drug, when administered to mice, cleared 25 percent of amyloid beta build up in the brain and reversed some of the cognitive impairment of Alzheimer’s disease within 72 hours of a single dose.

So far, the company has worked with $1.4 million in grants and investments and is now ready to initiate a Phase I, proof of mechanism study in the second half of this year. According to Haag, it will involve 12 healthy volunteers and take six months to a year.

“Gary’s paper showed a robust response in mice, and we want to make sure that the same response is recapitulated in human subjects,” he said. “The endpoint is that the drug gets to brain, and that the biomarkers that we’re interested in move the way that we think they will.”

As the number of U.S. adults with Alzheimer’s is expected to nearly triple by 2050, and the risk of death from the disease appears to be going up. The need for disease-altering therapies led the FDA to issue more flexible guidelines to drug developers in March.

NEW YORK (Reuters Health) - Publicly reported statistics about how patients fare after a common heart procedure often are inaccurate, says a new study that suggests publishing the poor quality numbers may do more harm than good.

The proportion of patients who die within 30 days of a medical procedure is sometimes used to gauge the effectiveness of the treatment, or of the hospital or doctor administering it.

After analyzing thousands of patient records at one U.S. hospital, researchers found that less than half of the deaths following percutaneous coronary intervention (PCI) - also known as coronary angioplasty - were related to the procedure.

That's far fewer than the number of deaths usually attributed to the surgery, which involves clearing a narrowed artery then inserting a mesh tube called a stent to prop the vessel open.

"I think what this really points out is that (with) the clinical complexity of medicine (it) can be tough to get a policy that's sort of one size fits all," said Dr. Karen Joynt, a cardiologist at Brigham and Women's Hospital in Boston.

Joynt, who was not involved with the new study but has done similar research, said there are a number of factors that determine whether or not a person dies after PCI - many of them unrelated to the actual procedure.

About 500,000 angioplasties are performed in the U.S. every year. It's often used in emergency situations, for instance to stop heart attacks caused by blocked blood vessels.

New York State first reported the number of people who died after PCI in its hospitals in 1991. Since then, Massachusetts and Pennsylvania started to report that figure as well.

According to the new study's authors, the U.S. Centers for Medicare and Medicaid Services have also proposed using the number as a quality measure, in the hope of improving patient care.

For the new study, researchers led by the Cleveland Clinic's Dr. Mehdi Shishehbor used patients' medical records to see whether deaths following PCI could be blamed on the procedure.

Out of 4,078 PCIs performed between January 2009 and April 2011 at one U.S. hospital, they found 81 deaths within 30 days of the surgery, representing 2 percent of patients who had the procedure.

Forty-seven, or about 60 percent, of those 81 patients died of a heart-related problem, but only 34, or 42 percent, of the deaths resulted from a complication of the procedure itself.

Previous research has attributed up to 60 percent of deaths following PCI to the procedure, but those figures were often based on causes of death listed on death certificates, which are frequently inaccurate, according to Shishehbor and his colleagues.

In the current study, based on close reading of every patient's chart, many of the deaths were among patients who were very sick when they got to the hospital and might have died with or without PCI, the researchers report in the Journal of the American College of Cardiology.

Fifty eight percent of the patients who died arrived in cardiac arrest, cardiogenic shock or with the most lethal type of heart attack, the authors point out.

But Joynt said doing PCI on these patients may have given them a better chance of survival, even though they ultimately died.

"That's the kind of overuse (of PCI) that we're probably willing to accept in many cases," she said.

However, Joynt's own research has suggested that hospitals avoid doing PCI in the sickest patients when their states start reporting the number of 30-day deaths.

In 2012, her study found that hospitals in Massachusetts, New York and Pennsylvania performed fewer PCIs - especially among the sickest patients who could possibly have benefited the most.

"Public reporting is a good thing and needs to be done, but when done incorrectly there are a lot of downstream consequences, such as denying patients treatment," said Dr. Duane Pinto, head of interventional cardiology at Boston's Beth Israel Deaconess Medical Center, who wrote an editorial accompanying the new study.

"We have to recognize and adapt to the unintended consequences of public reporting and fix them when we identify them," Pinto said.

SOURCE: http://bit.ly/10L9DPz Journal of the American College of Cardiology, online May 7, 2013.

Users enter their information in an ATM-style sign in and can have video conferencing sessions with physicians to discuss symptoms, diagnose conditions with the help of interactive medical devices housed in the kiosk, an prescribe medications.

Telemedicine as a remedy to communities underserved by behavioral health specialists has been a a big talking point at the American Telemedicine Association’s Austin conference this year, although reimbursement continues to be a challenging obstacle to surmount.

In an interview with MedCity News, HealthSpot CEO Steve Cashman said its biggest customers are employers and health systems and views community access centers, schools and family health centers as growth areas.

University Hospitals, for example, is using them as a less costly way to serve patients with minor ailments who visit the emergency room because they need after-hours care. The Cleveland Clinic is piloting units in three of its family health centers as an option for after-hours care.

Earlier this ear the company raised $10.45 million to expand its business. Cashman said it has orders for 150 units with 20 expected to go live in the next 45 days. He sees his solution as adding value to the consumer experience of technology.

“About 51 percent of people don’t have a primary care physician.  There are all these gaps in care…The biggest challenge is having the right care at the right time and place for the right patient.”

Nationwide Children’s Hospital in Columbus, Ohio will test the kiosk technology with its pediatric patient population. HealthSpot already works with Miami Children’s Hospital and Rainbow Babies and Children’s Hospital, part of University Hospital health system.

The latest startup commercializing intellectual property developed by heart doctors at the Cleveland Clinic is hoping to give doctors a way to tell which patients might develop arrhythmia after cardiac surgery.

Atrial fibrillation is one of the most common complications of coronary and valve surgeries. While there are a variety of drugs used to treat it, in some cases it’s been associated with heart failure, increased risk of stroke and longer hospital stays. Physicians typically don’t know when it’s going to occur in patients, but Cleveland Clinic research could change that.

Work done in the lab of Dr. C. Allen Bashour indicated that most patients who experience atrial fibrillation after heart surgery show clues beforehand in the form of subtle changes in their ECG readings that aren’t detected with the way they’re monitored now.

Rindex Medical is commercializing a tool that would enable physicians to predict which patients will experience AF so they can receive prophylactic treatment before it occurs.

“Right now they basically guess, or treat everyone prophylactically,” said co-founder Alex Arrow. “Some clinicians say they have an intuition about who will get it, but it’s mostly guesswork.”

Rindex’s A-50 AF Prediction System uses algorithms developed at the Clinic to analyze a patient’s ECG signals through 17 steps and produce a score, from 1 to 100, of how likely that patient is to experience AF. Arrow said the final product will be a touch-screen monitor that displays a score and tracks the score over a nine-hour period.

The Redwood City, California, company has been issued the first of its patents for the device and the exclusive license from Cleveland Clinic to develop the technology. Self-funded by Arrow and co-founders Denis Hickey and Lucas Fairfield, Rindex has a working prototype and is making progress on preparations for its 510(k) application. Arrow said the company shouldn’t need to raise a series A until it’s ready for a clinical trial.

Many other research groups have explored ways to predict AF in its various forms from natriuretic peptides to ECG changes, but no standard method exists for this application.

[Photo from Flickr user rosmary]

The only certainty about Medicaid expansion in Ohio at this point is that it will not be in the two-year budget bill now under discussion. Keith Faber, the Senate president, last week followed the short-sighted lead of House Republicans to put aside the expansion plan presented in Gov. John Kasich's budget proposal.

It is a disturbing reflection on Statehouse priorities when lawmakers put distaste for the federal government (not to mention fear of retribution from the tea party) above the demonstrated need across the state to address the consequences for health and the state economy that large numbers of residents cannot afford health insurance.

Faber and Speaker William Batchelder have indicated that Medicaid "reform" -- not necessarily expansion -- will remain in discussion, separate from the budget debate. The promise is that subcommittees in the two chambers will work with officials in the governor's office to come up with a plan for Medicaid reform that is best for Ohio.

In a climate of unrelenting Republican hostility to anything related to the federal health legislation, it passes as a hopeful sign that lawmakers did not slam the door all the way shut. But what little assurance there is must be tempered. When lawmakers get a sudden urge to explore alternatives, it serves often to stall or derail action.

It is a good measure of the skepticism surrounding talk of Medicaid "reform" in the Republican-controlled Statehouse that advocates of expansion are beginning to weigh the option of a ballot initiative in November. As reported by the Cincinnati Enquirer last week, they are moving to "cover the bases" in case legislative leaders don't deliver.

The decision to drop Medicaid expansion from the budget is equally disappointing on other levels. It ignores the findings of reputable independent studies, such as those led by the Health Policy Institute of Ohio, detailing the health and economic benefits that would derive from implementing reform along the lines of the Affordable Care Act, as Kasich has proposed. For instance, the average health insurance premium in 2012 cost $5,615 for single coverage and $15,745 for family coverage, according to the Kaiser Family Foundation survey. Expanding Medicaid would enable Ohio to cover more than a quarter-million residents who make less than $16,000 a year. These are not people seeking to game the system. Most earn wages that would not cover the cost of premiums.

The proposal has garnered strong support well beyond the typical welfare advocacy groups. Hospitals of all sizes have argued strongly for it to relieve financial strains. Government agencies, prisons and mental health facilities among them, recognize the advantage in expansion. Chambers of commerce have stressed the economic impact of health spending. But House and Senate leaders utterly disregard the breadth of the support. ___

COLUMBUS - Cardinal Health announced the renewal of its contract with CVS Caremark Corp. this morning, a deal expected to be worth about $23 billion a year for the Dublin-based drug distributor and medical supply company.

The contract runs through the middle of 2016.

"CVS Caremark has been a long and valued partner to Cardinal Health," said Cardinal CEO George Barrett. "We are excited to continue to build on that tradition. We look forward to working together to create value for our evolving heath care system."

Cardinal will continue to supply the CVS network of retail pharmacies and distribution centers under the agreement.

The new contract with CVS was a big win for Cardinal, and comes after two losses.

In March, Cardinal lost its $22 billion annual contract to supply pharmaceuticals to Walgreen Co. to rival supplier AmerisourceBergen Corp. Last year, Cardinal lost a contract that had been valued at $9 billion annually, also to AmerisourceBergen.

"While financial details of the renewals are unclear, the simple renewal will be viewed as a relief for investors," said Ross Muken, an analyst with the ISI Group.

According to Cardinal's SEC filings, the CVS contract accounts for 22 percent of its revenue. The company's revenue for the year that ended June 30 was $107.6 billion.

swartenberg@dispatch.com

@stevewartenberg ___

The Clinic said today that Gary Fingerhut will head Cleveland Clinic Innovations as interim executive director when Coburn leaves at the end of May to begin a similar position at Partners HealthCare in Boston.

Fingerhut has been general manager of information technology commercialization for the past two years, and has grown CCI’s health IT portfolio with iVHR (interactive visual health records), iComet Technologies (concussion assessment tools) and Talis Clinical (anesthesia management). Prior to that, he was co-founder and a senior vice president at Axentis, an IT company that offers compliance management systems for highly regulated industries such as life sciences.

“In addition to the growth of healthcare information technology, we see tremendous opportunity in the areas of process improvement, device and therapeutic development, as well as advances in value-based care delivery models,” Fingerhut said in a statement.

A Cleveland Clinic representative declined to offer any details on the search for a permanent executive director for its commercialization efforts.

[Photo from CCI]

Healthcare craves innovation, but with innovation comes a certain amount risk. So when it comes to purchasing a new, innovative technology, healthcare providers, researchers and companies will naturally want to take a very close look.

STERIS Corp. (NYSE:STE), for one, opened a Customer Solutions Center in July 2011 at its Mentor, Ohio, headquarters as a place where customers could see all of its existing offerings and get a glimpse at future projects. In its healthcare division, the company makes infection prevention, perioperative and GI/endoscopy solutions for a customer base of hospitals, researcher institutions, distributors, pharmaceutical companies and medical device companies.

Tim Chapman, senior vice president and group president for healthcare, has noticed a few common requests from potential customers that may also ring true for other manufacturers with similar customers:

Independent research: Chapman said customers prefer to see independent, third-party research–rather than research paid for by the manufacturer–that demonstrates efficacy of the product. In the post-reform, post-Sunshine Act world of healthcare, he sees it as standard operating procedure to have that kind of credible research available for customers.

Show me where it’s been beta-tested: Customers also want to see that a product has been tested over a significant period of time. Thanks in part to an increase in physician interest in pursuing research, neither this nor the research component has been a problem for STERIS, Chapman said.

Put your money where your mouth is: Adopting a new technology is risky and customers often ask vendors to enter into some form of risk-sharing agreement. Chapman expressed caution in this area. Risk sharing in itself is a contentious proposition and can put a company and its customers on different sides of the table, he said. If the product doesn’t work as the customer anticipated, for example, was the technology flawed, or was it the business’ implementation and use that affected the efficacy of the product? STERIS will consult with potential customers about new technology adoption and allow them try a product for a few weeks. If the trial is successful, the customer pays for the product; if not, an alternative solution is sought.

IBM has acquired software delivery startup UrbanCode to better help businesses push out updates of mobile, cloud, social, and big data applications, the company announced today.

Cleveland-based UrbanCode claims to reduce the time it takes to move new apps or updates of apps onto the market. The company offers up its DevOps platform, which includes apps like uDeploy, uBuild, uProvision, and uRelease. These serve to help companies push out updates, take in feedback, and improve quality of apps faster.

Ideally, it will help IBM better connect with social, cloud, and big data app makers that rely on rapid software development and releases.

“Companies that master effective software development and delivery in rapidly changing environments such as cloud, mobile, and social will have a significant competitive advantage,” Kristof Kloeckner, general manager of IBM Rational Software, said in a statement. “With the acquisition of UrbanCode, IBM is uniquely positioned to help businesses from every industry accelerate delivery of their products and services to better meet client demands.”

The terms of the deal were not disclosed. IBM said it plans to continue supporting UrbanCode clients.

This article originally appeared on VentureBeat

NEW YORK (Reuters Health) - A quality improvement program at a single children's hospital succeeded in cutting back inappropriate antibiotic prescribing, in a new study.

Researchers found within six months of introducing new electronic and educational tools, doctors were meeting national guidelines for treatment of childhood pneumonia in 100 percent of patients.

"It's quite truthfully astounding," said Dr. Thomas Brogan, a pediatrician at the University of Washington School of Medicine in Seattle who wasn't involved in the new study.

"They did an incredible job."

Brogan said the program, instituted by Cincinnati Children's Hospital Medical Center, can serve as a model for other institutions looking to get their antibiotic prescribing practices up to speed with current recommendations.

In mid-2011, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America issued guidelines for treating kids who develop pneumonia outside of the hospital, called community-acquired pneumonia.

The recommendations state that doctors should prescribe the antibiotic ampicillin as a first line of therapy unless other circumstances - such as a child's underlying medical conditions - require a different approach.

Choosing this drug could help prevent antibiotic resistance, in which bacteria become immune to certain antibiotics because they are used inappropriately, said Brogan.

Ampicillin is considered a "narrow spectrum" antibiotic, meaning it only affects a select type of bacteria.

On the other hand, "broad spectrum" antibiotics, which are often used to treat pneumonia, can wipe out a wide range of bacteria.

If bacteria become resistant to ampicillin, there are still plenty of other antibiotics that could work on the organisms that ampicillin doesn't affect. But resistance to broad spectrum drugs leaves doctors with fewer options to treat those resistant bugs, Brogan said.

Lilliam Ambroggio, a research fellow at the University of Cincinnati College of Medicine and the lead author of the study, said previous research showed significant variation in how doctors treat pneumonia in children.

In an effort to get Cincinnati Children's up to date with the 2011 guidelines, she and her colleagues initiated a quality improvement program.

The team educated senior-level physicians on the new antibiotic prescribing rules and created a quick reference guide for doctors-in-training.

The researchers also updated the hospital's electronic medical records so they defaulted to the recommended antibiotics when a patient was diagnosed with pneumonia. Before this change, the default antibiotic that doctors would see pop up in the chart was a broad spectrum drug.

Ambroggio's team tracked patients' treatment starting six months prior to introducing the prescribing program and for nine months after. A total of 217 kids with pneumonia were treated during that span.

During the six months prior to the changes, doctors were rarely in line with the national guidelines, which were issued mid-way through this period.

In the emergency room, physicians' prescribing practices were virtually never consistent with the recommendations, and on the hospital floors, doctors were adherent about 30 percent of the time.

Ambroggio pointed out that children were still being treated with antibiotics, just not the ones that the professional organizations would consider appropriate.

Immediately after she and her colleagues began educating doctors, adherence jumped to 80 to 90 percent and ultimately reached 100 percent within a few months, according to findings published Monday in Pediatrics.

"It was better than anticipated," Ambroggio told Reuters Health.

She could not estimate how much the program would cost to set up at other institutions. The study also could not prove adhering to the national guidelines makes a difference to children's health or to antibiotic resistance.

An earlier study at Children's Mercy Hospital in Kansas City found that switching from regularly using a broad spectrum antibiotic to ampicillin did not result in any additional cases of the antibiotic not working (see Reuters Health report of February 21, 2012 here: http://reut.rs/yDrJUx).

Ambroggio said her group is following up on its study to see whether adhering to the guidelines does improve outcomes.

SOURCE: http://bit.ly/10Ygt6n Pediatrics, online April 15, 2013.

If you’ve spent any time working with a lawyer lately, you know how difficult it is to track the hours he or she is billing you.

You basically just have trust the lawyer to be honest.

Their invoice will float in a month after they do the work, and by then you have limited powers to cross-examine whether he or she did as much as work as they claimed. Your memory of your conversations has faded, and if the billing has gone up more rapidly than expected, well, it’s too late to rein the lawyer in.

A new desktop and mobile app, Viewabill, has launched to help. It provides you with a real-time dashboard of everything your lawyer is billing you for, including the actual activities they’re working on, and the time they’re taking to do so. While you obviously still have to take your lawyer at their word on the specifics, the live and transparent nature of the reporting gives you more of a chance to hold them accountable in the moment — and it gives you the chance to dial them back if they’re billing too many hours too quickly.

Viewabill, a Columbus, Ohio startup, was co-founded by entrepreneurs David Schottenstein and Robbie Friedman. The two came up with the product after they’d created a system to track Schottenstein’s legal bills.  Schottenstein built a clothing business Astor & Black into a $45 million company, and sold his interests in 2011 to a private equity firm.

Alan Derschowitz, a professor at Harvard Law School, and a well-known political commentator, learned of the project, and also joined as a co-founder to advise on ethical maters, according to the New York Times.

The Viewabill service arrives just the issue of legal billing has heated up recently. Last month, a legal fight that broke out between law firm DLA Piper and a client Adam Victor, in which Victor claimed DLA Piper had inflated its invoices by performing needless tasks.

Viewabill is offered on the web and also via mobile applications. Its cloud-based software lets you track work being performed across multiple firms and industries. The dashboard also lets you request real-time clarification regarding activities, and receive alerts or emails when specified thresholds are reached. It gives you a “Pencils Down” feature to notify providers when to stop work. Viewabill also integrates with existing billing software systems, and the company pledges “bank-level” security of data.

Notably, law firms must agree to use the app, and there’s obviously some question about how readily they’ll adopt it. If a law firm refuses to use it, Viewabill’s founders encourage you to ask law firms why exactly they’re against it. Law firms must pay annual fees of $25 to $40 for each matter they give clients access to on the app, or $25,000 to $48,000 for unlimited use, depending on a law firm’s size — so it’s not exactly a minimal cost for lawyers. The company told the NYT that nearly 80 law firms have signed up for the service.

This article originally appeared on VentureBeat

With the news that Chris Coburn is leaving Cleveland Clinic Innovations comes the question who’s going to take over? The Clinic isn’t giving any clues,  but it’s going to be a huge undertaking for whoever that might be.

In the 13 years its been around, CCI claims to have spun out 50+ companies that have raised $700 million in investments and resulted in three exits. Here’s a quick look at some of the highlights (and lowlights).

2000 – Spins off one of its earliest companies, Atlanta-based CardioMEMS, which is commercializing implantable wireless sensors to aid in the management of chronic cardiovascular diseases.

2002 – Launches Arterial Remodeling Technology, a joint development between the Clinic, the Centre National de Recherche Scientifique and Necker University in France.

October 2003 – Hosts the first Medical Innovations Summit. The theme? “Healthcare Innovation.”

2006 - Creates regenerative medicine company Juventas Therapeutics, which has a drug candidate in Phase 2 trials in heart failure and critical limb ischemia patients.

June 2006 – Spinoff Cleveland BioLabs (NASDAQ:CBLI) goes public.

August 2006 – Board chair and CardioMEMS founder/CEO Dr. Jay Yadav is dismissed from the Clinic under allegations, later acknowledged to be false, that he failed to disclose certain conflicts of interest.

January 2007 – Spins off Tolera Therapeutics to commercialize an immunosuppressant drug that fights organ rejection in transplant patients.

July 2007 - Micrus Endovascular acquires technology from startup ReVasc Technologies for treatment of ischemic stroke.

2008 – Forms Cleveland Heart Inc. to develop a total artificial heart. This company recently raised the largest deal from a single investor for a Clinic spinoff, garnering $30 million from a private equity group in Korea.

2009 – Creates two of its most promising startup, cardiac testing firm Cleveland HeartLab and big data management company Explorys.

2010 – Hand surgeon Dr. Thomas Graham is appointed chairman.

Mid-2010 – The Global Cardiovascular Innovation Center, where some of the heart-focused companies are based, opens.

August 2010 – Portfolio company IntellisEPM sells its business intelligence software to Carefx Corp.

January 2011 – Boston Scientific announces it’s purchased Intelect Medical, a transaction that nets the Clinic $28 million.

January 2011 – Inks a commercialization deal with MedStar that anchors the Innovation Alliance, which has continued to expand to half a dozen other institutions.

April 2011 – Hires Tom Thornton, who was embroiled in controversy in Kansas, to expand those research and collaboration efforts.

May 2011 – Unveils imaging contract research organization ImageIQ and starts up NaviGate Cardiac Structures with transcatheter mitral valve technology from the Clinic.

December 2011 – CCI receives $10 million gift – its largest ever – from West Virginia entrepreneurs and philanthropists Jim and Cathy Justice.

2012 – Continues to develop its Innovation Alliance, adding half a dozen new partners.

2013 - Forms Talis Clinical to commercialize an anesthesia information management system developed in the clinic’s Anesthesiology Institute.

The new financing came from private investors including Cardinal Health, according to Lisa Maughan, HealthSpot’s vice president of marketing, and will support the company’s efforts to create the “highest quality and lowest cost in overhead healthcare appointment in America.”

Each of HealthSpot’s walk-in kiosks contains a high-definition videoconferencing system that allow a doctor to discuss symptoms with patients, diagnose conditions and prescribe medications. The kiosks also contain several digital medical devices, described by the company this way:

Inside the HealthSpot Station, a scale built into the floor records weight. With the push of a button, the doctor can unlock small cabinets that hold high-tech, digital medical devices that transmit information, audio video and pictures back to them through a secured connectivity FDA Medical Device Data System. A removable cuff captures blood pressure. An instant-read thermometer is behind one door. A dermascope provides a magnified view of rashes and skin conditions, as well as the back of your throat or eye. If you have an earache, the doctor asks you to slip the otoscope into your ear as you both look at a high-resolution image of the inside of your ear on the screen in front of you. The stethoscope transmits heart, lung and bowel sounds digitally. The pulse oximeter is used to take the patient’s pulse and monitor oxygen saturation of the blood.

The company has started its rollout by partnering with a few health systems to put kiosks on their campuses. Maughan said University Hospitals, for example, is using them as a less costly way to serve patients with minor ailments who visit the emergency room because they need after-hours care. The Cleveland Clinic has units that it uses to control urgent care overflow, she said.

The next goal is developing a network of physicians who will “see” patients through kiosks to be placed in retail pharmacies. The company is hopeful it will be able to make announcements on that front soon, Maughan said.

Next week, the Columbus, Ohio-based startup will exhibit alongside AT&T, Google, Intel and others at CES on the Hill, an event that connects policymakers with cutting-edge technologies and companies.

[Photo by Veronica Combs]

Chris Coburn

UPDATED 2:45 p.m. to add job title and comments from Partners HealthCare.

Cleveland Clinic Innovations’ executive director, Chris Coburn, who has led the prolific technology commercialization arm of the Clinic since its formation in 2000, is heading to the life science capital of the U.S.

The Clinic confirmed this morning that Coburn will be departing June 1 to take a position at Partners HealthCare, an academic hospital system in Boston. According to Partners HealthCare in Boston, he’ll join as the vice president of Research Ventures & Licensing, the division of the health system that coordinates industrial relationships and intellectual property management across Partners HealthCare, Massachusetts General Hospital and Brigham and Women’s Hospital.

“Chris brings to Partners years of experience — on both the national and international stage — in the field of forging closer ties between industry and academic medicine,” said Partners Chief Academic Officer Dr. Anne Klibanski in a statement.

Under Coburn, Innovations has spun off about four dozen startups to commercialize medical innovations discovered and developed by Cleveland Clinic employees, including artificial heart company Cleveland Heart Inc. and Intelect Medical, which sold to Boston Scientific for $78 million in 2011 (and generated a nice return for the Clinic and its Innovations chief).

Through Innovations, the Clinic is now helping a network of other institutions like MedStar Health and the University of Notre Dame commercialize their own technologies.

A Cleveland Clinic representative declined to comment on plans to fill the position at Innovations.

Although the narrator is a little over the top (that deep voice is a better fit for announcing movie previews or an alien invasion), this new video from the Cleveland Clinic is an interesting visual history of medicine in general and the Clinic in particular.
The story starts in 1921 with a belief in “cooperative medical practice, research and education” and goes to today and the clinic’s telemedicine work and its campus in Abu Dhabi.
As the years go by, the mix of people changes from a room full of white dudes to men and women of all races and nationalities.
Time lapse photography illustrates how the clinic’s physical footprint has grown, just as medical centers across the country have expanded over the last decade also.
The size and scope are all Cleveland Clinic’s though, as the second largest group practice in the world with 43,000 caregivers.

H/T to Ves Dimov, MD at CasesBlog for a heads up about the video.

The Google Flu Trends project is a great example of not only the potential use for big data at a public health level, but also some of the challenges that come with it.

When armed with de-identified health data from multiple sources – rather than the smaller pool of patients an institution sees within its own walls – public health researchers can run disease-wide studies on bigger and more varied groups of patients (for a look at other examples of how different types of data analyses are being used in public health, see Stephanie Baum’s story from last month). That’s great except that, as demonstrated by Google Flu Trends, data without context doesn’t always lead to accurate assessments and predictions.

That’s just one of the challenges facing public health researchers as they leverage the growing mass of healthcare data to better understand and predict disease. In a public symposium on the use of electronic medical records for non-treatment purposes hosted by Case Western Reserve University on Friday, researchers gathered to shared thoughts on some of the most pressing issues.

Legal framework

Fitting with the primary topic of the event, the speakers noted wide gaps in the legal framework for data privacy, security and ownership. “The hugest opportunity is to get some of the legal paradigm and structure to support the growing data,” said Dr. David Kaelber, a primary care pediatrician and chief medical informatics officer at MetroHealth in Cleveland. “We don’t yet understand all the risk of all this data being out there.”

The assumption of patient ownership causes some bumps in the road for public health researchers, as patients may be willing to share some parts of their data but are not willing to share other pieces of related data. “Patients do really want to be in charge of what gets shared, and that’s been a bit of a challenge,” said Anil Jain, a former staff physician at Cleveland Clinic who is now chief medical information officer at big data company Explorys.

What’s being documented

There are plenty of technical challenges, as well. “When I’m collecting this data as a physician, I’m not doing it so that someone else can do a study later; I’m doing it because I have a patient and I have 10 minutes to figure out what’s going on,” Jain said.

Thus, much of the information that researchers want is not stored or collected in electronic medical records or clinical notes for routine care, Kaelber said. That may include minor side effects, a patient’s home environment or dietary habits, for example.

On top of that is the issue of translating clinical notes into usable data. “People are working on natural language processing but, at least in my view, in most cases it certainly hasn’t reached prime time,” Kaelber said.

Standardization

Even when that kind of valuable data is collected, it isn’t always done in a way that makes it easy to aggregate. “There’s 10 different ways on one of our customers’ sites to enter the fact that a patient has quit smoking,” Jain said. “Well, if there are 10 different ways, how would anyone know whether a patient quit smoking or whether it just didn’t get that piece of data?”

While the industry has adopted data standards for certain kinds of health and demographics data, there’s still much work to be done in creating a common framework.

Personnel

EMRs and other health IT are just tools and alone are not enough to have a positive or negative impact. Their real value is determined by the people using them. “Giving a stethoscope to a clinician doesn’t make them any better at being able to detect murmurs unless you teach them what to listen for and how to distinguish between normal and abnormal. It’s the same thing with health IT,” Jain said. Clinicians need proper training on how to use new IT tools like they would anything else.

And, the industry needs more people who understanding how to analyze big data, especially when it’s been de-identified. “These data scientists are really rare to find,” Jain said.

AKRON - Summa Western Reserve Hospital in Cuyahoga Falls recently ditched its paper charts in favor of a completely computerized system for patient care and billing.

The project -- known as CARE One, or Connecting Across the Reserve Electronically -- involved nearly all of the hospital's 855 employees, Pam Banchy, Western Reserve's chief information officer, said in an interview on Monday.

The entire hospital and its outpatient locations went live last month with the electronic medical records system from McKesson, Banchy said.

"Our patients received a totally new care delivery process overnight," she said. "There's more efficiency in the exchange of information. The processing is automatic."

With the new system, she said, every patient now receives a wristband with a unique barcode that is scanned before tests or medication administration.

Physicians use laptops, computers on wheels or hand-held devices that are available throughout the facilities to electronically enter orders for patient care, Banchy said. The system makes information such as drug interaction or allergies immediately available to the doctors.

Nurses also use workstations on wheels to electronically enter patients' chart information, she said.

"We've started to realize some of the benefits in a short time," she said.

Western Reserve invested several million dollars in the system.

"It's one of the most expensive commitments we've made to the organization, focusing on the patients' safety," she said.

Hospitals can receive millions of dollars in federal incentives for meeting initial goals for adopting computerized health records. The incentives were established in 2009 by the federal stimulus bill to encourage the adoption of electronic health records.

To qualify for the payments through Medicare and Medicaid, hospitals and doctors must attest that they have installed and started using a certified system.

The first of three stages of "meaningful use" standards include the ability to enter doctors' orders electronically and provide automatic feedback about possible dosing errors and other safety concerns.

Qualifying systems also must check for drug interaction, track patient demographics, record vital signs and other patient information, capture and report communicable diseases to public health agencies and perform other functions.

Western Reserve plans to begin the process of proving the hospital meets those requirements this summer, Banchy said.

Other hospitals in the Akron area -- including Summa Akron City and St. Thomas hospitals, Akron General Medical Center and Akron Children's Hospital -- also have converted to electronic patient records in recent years.

Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/abjcherylpowell. ___

(Reuters) - Navidea Biopharmaceuticals Inc said its cancer diagnostic agent was effective in identifying the first lymph node reached by the disease in patients with head and neck cancer, paving the way to expand its use in all solid cancers.

The company said a safety monitoring committee recommended that the trial be stopped early due to the positive results.

The diagnostic agent, Lymphoseek, correctly identified cancer in 38 of the 39 patients determined to have cancer in their lymph nodes, the company said, citing an interim analysis of a late-stage trial of the imaging agent that is already approved for use in two other cancers.

The company said detection of cancer-affected nodes by Lymphoseek led to the removal of only about four lymph nodes per patient on an average, while surgery — considered the gold standard to detect the spread of cancer — led to the removal of about 38 lymph nodes per patient.

The false negative rate of the study was 2.56 percent, which was also statistically significant, Navidea said.

The company expects to file an approval application for the expanded use of Lymphoseek later in the year.

Lymphoseek was approved in March - the first such drug to be approved in 30 years - to identify cancer-carrying lymph nodes in patients with breast cancer or melanoma.

The agent will be launched in the second quarter by drug wholesaler Cardinal Health, Navidea's commercial partner.

The company also intends to get it approved for mapping sentinel lymph nodes, the first nodes affected by cancer and which indicate whether the cancer has spread to other parts of the body. There is no approved agent for this indication.

Navidea is also developing two other imaging agents to detect Alzheimer's disease and Parkinson's disease.

The company's shares, which have fallen 26 percent since Lypmhoseek's approval, closed at $2.55 on the American Stock Exchange on Wednesday.

(Reporting by Esha Dey and Vrinda Manocha in Bangalore; Editing by Maju Samuel)

A recent transplant from Louisville, OrthoData Inc. is developing an implantable sensor that attaches to a rod in a pedicle screw system put in place during a spinal fusion surgery.

Lumbar spinal fusions are done to relieve symptoms of many conditions, including degenerative disc disease and spinal stenosis. And they’re on the rise — one analysis estimated that the number of procedures more than doubled between 1998 and 2008.

Called IntelliRod, OrthoData’s sensor monitors the load being placed on the rod to which it’s attached, indicating to physicians the strength of the new bone that’s growing. “By knowing that load and watching whether it’s declining over time or not, it tells you the status of whether bone is growing across the disc space,” CEO Ric Navarro said.

The idea came from Dr. Randy Puno, an orthopedic surgeon in Louisville, who sought a better way to evaluate how well the spine was healing in his patients. Typically, this is assessed with an X-ray and, several months after surgery, a CT scan. But images only provide a snapshot in time, and that’s not always satisfactory for patients who are anxious to get back to work or play. It also exposes them to considerable amounts of radiation. And in rare cases, even those images aren’t clear and exploratory surgery may be necessary.

To collect a measurement with IntelliRod, physicians hold a reader device up to the patient’s back that collects data wirelessly from the sensor. “Once the strain in the rod drops and plateaus, then you know the bone is taking on most of the stress and the bone is healed,” Puno said. “If we’re able to send patients back to work early, then that’s a pretty big economic positive.”

In what CEO Ric Navarro said will likely be the first closing of OrthoData’s round, eight investors including non-profit venture group JumpStart (disclosure: JumpStart is an investor in MedCity Media), Akron BioInvestments Funds and six individuals backed the company with $1.1 million.

Navarro said that money will be used to make some engineering tweaks to the device, prepare it for animal studies and conduct those studies, which he hopes to begin in nine to 12 months. He anticipates the company will need another $300,000 to $500,000 more in funding to complete the studies, and expects to close on additional investments within three to six months.

Founded in 2003 by a group of Louisville researchers and Puno, the company was moved to Ohio partly to take advantage of the state’s hospital network, where Navarro said the company has already developed relationships. It’s setting up shop outside of Cleveland in Akron.

Previous to this round, it’s been funded by investments from Queen City Angels, Kentucky Seed Capital Fund, Kentucky Science & Technology Corporation and Commonwealth Seed Capital Fund.

[Photo from OrthoData]

“It’s rather like purchasing a high-end digital camera and being satisfied with photos taken through a dirty lens,” said CEO Wayne Poll, a laparoscopic surgeon who turned his idea into a company called Minimally Invasive Devices in 2006.

Now the company has just raised a $9 million Series B that will allow it to establish a direct sales force, expand manufacturing and develop new products. Canaan Partners led round, and Charter Life Science, a VC firm that has invested previously, also participated.

During a laparoscopic surgery, there are multiple ways the image the surgeon sees can become obscured. Fogging of the lens can occur during the cold laparoscope’s initial insertion into the abdominal cavity, for example, and debris or smoke from other devices used in the procedure may collect on the lens, impeding the vision of the surgeon.

MID makes a clear, disposable sheath that fits over the laparoscope and produces a continuous “air curtain” that keeps the lens free from debris and fog during surgery. It also makes an FDA-cleared biocompatible wash that can clear the end of the laparoscope while it’s in position, in case debris should end up on the lens. That, in theory, should save surgeons time and reduce the hassle of having to remove the scope to clean it.

Poll said that in a recent study of 100 consecutive surgical cases using the product, the company only saw two removals of the laparoscope for cleaning.

The last time the Columbus, Ohio company raised money was in 2010, when it rounded up $1.5 million to launch FloShield. It was cleared by the FDA in 2008 and was previously distributed through a deal with medical device maker CareFusion.  But that deal is over, and after exploring a few other alternatives, Poll said the company thought it would be best to create its own direct sales force. With this financing, he said, the company will hire about 10 more additions to its 21-person staff, including sales personnel, a regulatory director and a VP of sales, which it has already hired.

In addition to ramping up sales of FloShield, MID is also working on a companion product for the robotics market that will improve vision and eliminate problems with smoke during robotic surgeries, Poll said.

Past funding for MID has come from Cincinnati’s Queen City Angels, Columbus’ Ohio TechAngels, as well as Charter Life Sciences and Reservoir Venture Partners.

Active negotiations between health insurer Anthem Blue Cross and Blue Shield and Cincinnati hospital group UC Health over reimbursement rates is the latest health provider/payer dispute made public.

This time Anthem and UC health are negotiating rates Anthem pays for care its members receive from UC Health services. The current contract expires April 15.

If an agreement isn't reached, Anthem members might have to pay higher out-of-network costs for UC Health services, or find a different provider that accepts Anthem plans.

The current Anthem contract with UC Health was negotiated two years ago and included higher payment rates than the one before, according to Anthem spokeswoman Kim Ashley.

Anthem is Ohio's largest health insurer with about 3.3 million members statewide. The contract with UC Health covers about 14,000 people, the estimate of how many Anthem members have used UC Health services the past 12 months, according to Anthem.

"We'd like to clarify that UC Health chose to terminate its contract with Anthem, demanding higher reimbursement. UC Health is already the most highly reimbursed hospital system in Greater Cincinnati and they are demanding their physicians be paid more than other local physicians," said a written statement from Anthem released to media. "The hospital and physician contracts that we negotiate on behalf of our customers directly impact what they pay for their medical care."

Higher hospital reimbursement rates are reflected in insurance premium rates, affecting costs of care, Ashley said.

UC Health owns several hospitals, including West Chester Hospital in Butler County, and the doctor's group UC Physicians.

UC Health took to its Twitter page Thursday to post a statement saying it did not choose to terminate the Anthem contract. In the written statement UC Health claims the opposite, that Anthem proposed a new contract with reimbursement rates below the rates paid to other academic medical centers in the region.

"It is our hope that Anthem recognizes the level of care we provide to their members and to the region as its only level one trauma hospital...," the statement reads online. "We struggle daily with representatives of large for profit insurance companies as they often find ways to deny one of their own members' medical claims which serves the best interest of the insurance company and not its members."

Most times contract negotiations and re-negotiations transpire without disputes between the two parties, said Susan Millerick, spokeswoman for Aetna, another major Ohio health insurance carrier. Aetna has approximately 700,000 Ohio members.

"Although we do have occasions where we simply are unable to reach terms with a health care provider, we are working hard to get past an era of disputes to one characterized by collaboration." Millerick said in an email. "Increasingly, we are working closely with hospital systems to develop innovative, new reimbursement models based on value and good health outcomes vs. services provided."

UC Health and Aetna confronted a similar issue in 2011 to the one between Anthem and UC now. Aetna and UC Health had a contract that terminated January 2011, which impacted West Chester and Fort Hamilton Hospitals.

UC Health is the successor to the former Health Alliance of Greater Cincinnati system, of which Fort Hamilton was previously a member.

In August 2012, UC Health and Aetna announced they reached a new contract for coverage through July 31, 2015, that covers 165,000 patients.

Fort Hamilton was rolled into Kettering Health Network's contract with Aetna. Fort Hamilton joined Kettering Health in July 2010.

PriMed Physicians, an independent physician group with sites in Greene, Montgomery and Warren counties, had a payment dispute with Aetna in 2012 affecting about 4,800 patients. The physicians group's contract with Aetna expired Nov. 1 last year.

The parties have not reached a new agreement, said Jim Moffett, executive director of PriMed.

"This situation with Aetna is the first time we've ever gone out of network with a carrier," Moffett said.

Many affected patients stayed with PriMed, but their rates are higher, he said. Some employers also changed to other carriers PriMed is contracted with, he said.

"Aetna was uncomfortable paying us a rate we felt we needed to provide the quality of care we're committed to giving our patients," he said, noting he respects Aetna. "We feel stuck somewhat and hope that we will be able to contract with Aetna." ___

AKRON - Doctors from across the globe are getting specialty medical training via a studio tucked inside Akron Children's Hospital.

Thousands of physicians worldwide have participated in web-based continuing medical education conferences offered by GlobalCastMD.

Dr. Todd Ponsky, a pediatric surgeon who joined the staff of Children's last year, is co-founder of GlobalCastMD, which offers low-cost, virtual medical conferences to physicians throughout the United States and internationally.

On Thursday, about 1,200 doctors logged onto a secure website to watch Ponsky and leading experts from as far away as England and France share updates about treating childhood traumas.

Participants were able to chat with each other and ask questions of the experts while watching the five-hour virtual conference.

"People can call in and talk to these key opinion leaders and see like they're there," Ponsky said.

The webinar concept is a "quick and efficient" way to provide doctors worldwide with details about the latest approaches to treating patients, said Dr. Wayne Meredith, chair of the Department of Surgery at Wake Forest University and executive director of the Childress Institute for Pediatric Trauma. The nonprofit institute -- which co-sponsored Thursday's conference -- raises awareness, supports research and provides education about pediatric injuries worldwide.

Immediately after a similar conference last year, Meredith said, he heard back from a participant who said he learned techniques that saved a child's life.

"The benefits of this could be huge," he said.

Ponsky started the venture with fellow physician and lifelong friend Dr. Marc Schwachter about four years ago when he was working in Cleveland.

Doctors are required to earn continuing medical education credits to maintain their license to practice medicine.

But Ponsky noticed fewer physicians were able to break away from their busy practices and schedules to attend in-person medical conferences. So instead, he decided to bring the education to the doctors via live, interactive video conferences.

GlobalCastMD usually charges $99 per virtual conference -- an amount that Ponsky said is substantially less than the typical $600 to $700 registration fee for most onsite medical conferences.

Participants in the web-based conferences also save travel expenses and don't miss valuable days in the office or operating room, he said. Surgeons lose an estimated $3,000 in revenue for each day they're off the job.

"It really is a huge cost-savings," he said. "That's why it becomes so popular."

Dr. Fayza Haider, a pediatric surgeon at Salmaniya Medical Complex in Bahrain, has participated in 19 virtual conferences organized by Ponsky on topics ranging from urologic surgery to adolescent obesity.

In an email interview, Haider said the GlobalCastMD conferences let her learn about medical advances without traveling -- or changing out of her PJs.

Through her participation, she said, she has learned surgical techniques that she has been able to use on her patients in Bahrain.

"It gives me a chance to discuss live with the experts and interact with other attendees from all around the world," she said.

GlobalCastMD relies on hospitals and other sponsors to help pay for the costs of running the virtual conferences. Since Ponsky joined Children's, the pediatric hospital has been co-sponsoring many of the events by providing its studio, equipment and technical support.

The company isn't making money yet, but Ponsky said that's not the real goal.

"We're advancing the speed of bringing new technologies to patient care," he said.

Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/abjcherylpowell. ___

The governors of Ohio and Arkansas, seeking a way around conservative state legislators who refuse to expand Medicaid, want to insure some of their poorest residents using a market-based approach.

The federal government appears likely to allow Republican Gov. John Kasich of Ohio and Democratic Gov. Mike Beebe of Arkansas to use federal Medicaid dollars to purchase private health insurance for low-income people from the new health-care “exchanges” that will be created under the Affordable Care Act.  They plan to use the strategy to cover newly eligible adults making up 138 percent of the federal poverty level ($15,870 for an individual or $32,499 for a family of four).

Washington’s only caveat is that the states must prove that private insurance won’t be any more expensive than giving the beneficiaries a Medicaid card. Under traditional Medicaid, the government pays health-care providers directly.

If Kasich and Beebe are successful, officials in other states, including Louisiana, Florida and Texas, may opt for a similar arrangement.

“It’s a potential turning point for states that are on the fence,” said Matt Salo, director of the National Association of Medicaid Directors. “If Arkansas and Ohio can find a path through this thicket, it could give a lot of other states that have either said ‘No’ or are on the fence a reason to think again.”

The Supreme Court last June made the Medicaid expansion in the Affordable Care Act optional. For states that choose to expand, the federal government will foot the entire bill for new enrollees for the first three years. After that, the state’s share will gradually increase to 10 percent of the cost.

After last year’s elections, about a dozen Republican governors announced they would not support the expansion, while others remained silent. Most Democratic governors supported the expansion. Since then, GOP governors in Arizona, Florida, Michigan, Nevada, New Jersey, New Mexico, North Dakota and Ohio have broken ranks, approving the Medicaid expansion. But the final decision rests with their legislatures.

Extending Medicaid coverage to an estimated 17 million new beneficiaries is the health law’s primary means of reaching its goal of providing health coverage to 32 million uninsured Americans. The other method is providing tax credits to people with incomes between 138 percent and 400 percent of poverty.  The so-called “individual mandate,” which requires most people to purchase health insurance or pay a tax penalty, is expected to motivate millions more who can afford insurance to go ahead and purchase it.

In Arkansas, the number of new beneficiaries under a Medicaid expansion is estimated at 250,000 people. In Ohio, the number is 366,000.  Arkansas currently covers about 700,000 people under its Medicaid program, while Ohio covers 2.3 million.

How the plan was hatched

Beebe always has been in favor of expanding Medicaid. But GOP lawmakers in his state–whose numbers increased after the November elections—refused to go along. They told him they would only approve a market-based approach to covering low-income Arkansans.

Kasich announced his support for the expansion in February. But legislators in his state also balked at the idea of adding hundreds of thousands of people to a Medicaid program they see as deeply flawed.

Last month, Washington gave both governors a way forward by granting them tentative approval to pursue a private option.  In Arkansas, GOP lawmakers are expected to approve the strategy, said Beebe spokesman Matt DeCample, because it was their idea in the first place.

Kasich received a call from Washington right before he unveiled his proposed budget, which included a Medicaid expansion, last month. He plans to present the private option to lawmakers once he sees the details in writing from Washington, said spokesman Eric Poklar.

Is it still Medicaid?

To beneficiaries and health care providers, the strategy that Arkansas and Ohio are pursuing would look exactly like private insurance. Instead of a Medicaid card, the newly eligible adults would get a private insurance card. They also would be responsible for certain co-pays, just like private insurance subscribers. The difference is that the state Medicaid program would pay their premiums with federal dollars.

The Medicaid agency would maintain control over enrollment and could determine that certain people in the expansion group, such as those with severe chronic illnesses, should receive traditional Medicaid benefits, including home health services and long-term care.

In fact, the private option already is allowed under the federal Medicaid law, although it is rarely used. Called “premium assistance,” it is considered cumbersome by Medicaid officials because it requires the agency to find a policy with roughly the same set of benefits that Medicaid offers—or provide additional benefits separately—and it must cost enrollees no more in copays than other Medicaid subscribers pay. If it does, Medicaid must reimburse the beneficiary.

But using the premium assistance option should be less of an administrative burden in 2014, when the federal health law takes effect. That’s because insurance companies should be eager to create plans that fit the state’s existing Medicaid benefits, because it will give them the opportunity to sell policies to hundreds of thousands of newly eligible beneficiaries.

The question of cost

After the Affordable Care Act became law, the Congressional Budget Office estimated that providing Medicaid coverage to the uninsured would cost about $6,000 per year per person, while health insurance purchased on the exchange would cost about $9,000 per person. The primary reason for the gap is that private insurers traditionally pay health care providers much more than Medicaid does.

But officials in Arkansas and Ohio said they do not expect their private insurance strategy to cost the federal government significantly more than traditional Medicaid over the long term.

Medicaid experts agree. Alan Weil, director the National Academy for State Health Policy, predicted that over time the prices for private insurance and Medicaid would converge.  He and other experts argue that as insurance companies compete on the exchange and insurance risk pools grow, private insurance premiums will come down.  At the same time, adding millions of people to the Medicaid program likely will force states to increase the rates they pay health care providers in order to convince them to serve the new patients.

Better for beneficiaries

Proponents of the plan say it makes more sense than traditional Medicaid for the new expansion population: able-bodied, non-elderly adults. Unlike those currently covered by Medicaid—low income pregnant women, children, disabled adults and the elderly—almost all of these newly insured adults will be working or seeking work. As a result, their incomes may fluctuate.  If their Medicaid coverage is through a private insurer, they won’t have to find new insurance or change doctors if they begin making too much money to qualify for Medicaid, or bounce back and forth between being eligible and not eligible.

“What we are trying to create is a ladder up and out of poverty to help people make that transition from Medicaid and get into the private insurance market,” said John McCarthy, Ohio’s Medicaid director.

For many of the people in the expansion population, particularly young people with mental illness or substance abuse problems, the new health coverage is expected to rapidly change their earning ability, said Salo. “You’ll see many of them rocket out of poverty.” If their treatments are interrupted because they lose Medicaid coverage, it could send them back into a downward spiral, he said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

At HIMSS earlier this month Dr. Anil Jain, the CMIO of Explorys, a spinout from the Cleveland Clinic, highlighted some of the different analytics approaches it is offering clients as they get more involved in population health.

Descriptive Analytics This accounts for the biggest chunk of big data across industries and it tends to focus on what went wrong or assessing why outcomes are more or less than what was expected. “Most people are  pretty well covered when you think of descriptive analytics,” says Jain. One example of descriptive analytics is giving hospitals a better understanding of current assessments, like how many of its patients should have received a pneumococcal vaccine or how many diabetes patients in an endocrinology department have their blood sugar under control?

Predictive Analytics Big data is chiefly being used to identify patterns, predict how to predict future outcomes, and avoid preventable events as a way to reduce healthcare costs. Jain says the most frequently asked question, particularly from accountable care organizations is,  “‘What percent of our patients will be re-admitted?’  They are also looking at how many patients will use the emergency room.”  Explorys’ big data platform includes a tool that can score patients based on their risk profile, such as whether they have chronic conditions, so providers can develop more effective approaches to care.

Prescriptive Analytics  One of the most noticeable trends at HIMSS this year was the increasing interest in prescriptive analytics. A recent report from Gartner looking across business intelligence said that only 13 percent of organizations are using predictive analytic but even fewer — 3 percent — are using prescriptive analytics, so there is plenty of opportunity for growth and the demand is increasing.  Prescriptive analytics involves helping a provider measure and manage a patient population. For example, one tool from Explorys’ big data platform allows users to focus on patients with obesity, add a morbidty like diabetes and assess their LDL levels or other measurement to determine where they need to focus attention.

“When you have an ACO that is trying to change the cost curve it is about good data but once the data is in, most providers look at the computer screen and try to figure out what the focus should be.”

Jain likens shifting from a descriptive to prescriptive data analytics platform to the equivalent of going from a broad, fluorescent light to a laser beam focus. “We don’t bring customers on if they are not ready to address population health as a solution. Provider groups have the same end-goal in mind: How do we stay relevant as pay-for-performance models change?”

Comparative Analytics One of the most interesting ways providers can use big data is to compare their performance to other healthcare facilities. Explorys expanded into the comparative analytics market this year with its National Benchmarks platform. The platform uses comparative metrics throughout more than 92 billion clinical, financial, and operational data sets across a continuum of care. By combining clinical data with claims and administrative data, it gives insights into patterns and trends. Providers can compare their performance with a particular patient population compared with the aggregate network, made up of providers such as the Cleveland Clinic, St Joseph Health System and Legacy Health.  Patient information is de-identified and made HIPAA compliant while keeping participating providers private. For example, providers can see how the LDL levels of their patients compares with that of the network and can use different sets of criteria across age, race, geography and gender. Providers can use the information to develop insights to improve performance.

Market research has suggested that neuromodulation devices make up the fastest-growing segment of the medical device sector, forecasting some $7 billion in sales within five years. Although medical device giants Medtronic, St. Jude Medical and Boston Scientific dominate the market, there are a number of young companies working on nerve stimulation devices to treat pain and bladder control issues, and other nerve-related disorders.

One of those companies, Case Western Reserve University spinoff ConservoCare LLC, recently reached an important milestone by securing licensing options from the university to develop a nerve stimulation device that restores bladder function in patients with urinary retention or incontinence.

ConservoCare says patients with spinal cord injuries will likely be the first to benefit from its device, which comprises implantable nerve cuff electrodes, a stimulator and a wireless control unit that directs the activation of the device.

Some patients with spinal cord injury and infection experience nerve damage that affects their urethral sphincter, a group of muscles in the pelvis that control the flow of urine from the bladder. When those muscles don’t work properly, the bladder may not be able to empty properly, putting the patient at risk for urinary tract infections or kidney problems.

ConservoCare’s device uses high-frequency electrical nerve stimulation to eliminate spasms of the urethral sphincter and allow the bladder to function. Medtronic’s InterStim device works in a similar way, using electrical pulses to modulate the sacral nerves that control the bladder.

“The ConservoCare implant will provide doctors a safe, reversible alternative to destructive and ineffective treatments,” said company President Adam Boger in a statement.

As a former research assistant at Case’s Neural Engineering Center, Boger was part of the research team that developed the technology. The startup company has since been doing preclinical feasibility work on the device with Kenneth Gustafson, an associate professor and research scientist whose own lab at the Louis Stokes Cleveland VA Medical Center has been developing prostheses to restore bladder function.

In order to proceed with feasibility testing in humans, ConservoCare needs an OK from the FDA. That’s part of the startup’s plans for 2013, along with validating a screening protocol.

So far, the company has been financed by a $125K Phase I Small Business Technology Transfer grant from the National Institutes of Health, and by Case’s Translational Research Partnership with the Wallace H. Coulter Foundation. It’s based in Atlanta, where Boger is studying intellectual property law at Emory University.

 [Photo from BigStock Photos]