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At Harvard, Grad Students Form A Picket Line Over Wages, Health Care And Protections – NPR

Union members protest at Harvard University in May over an increasing number of harassment and discrimination cases. The union began an indefinite strike Tuesday, with one of its key proposals aimed at strengthening protections against harassment and discrimination. Michael Dwyer/AP hide caption

Union members protest at Harvard University in May over an increasing number of harassment and discrimination cases. The union began an indefinite strike Tuesday, with one of its key proposals aimed at strengthening protections against harassment and discrimination.

Graduate students at Harvard University began an indefinite strike Tuesday after a deadline to fulfill contract demands such as pay equity and health insurance were not met by administrators.

Negotiations between the two sides are ongoing, but the union which represents about 4,400 student workers said an agreement is not close to being met. Representatives with Harvard Graduate Students Union-UAW accused the university of neglecting several issues that students have faced for years.

The strike began on the last day of classes for the fall semester, impacting thousands of students preparing for final exams.

"Our negotiations have not yielded a fair agreement," Ege Yumusak, a Ph.D. candidate on the bargaining committee, told NPR.

"[Most] importantly, we haven't heard responses from the administration on our demands for our basic rights and protections, such as protections against harassment and discrimination, that other unionized workers on this campus have, as well as thousands of student workers across the nation," Yumusak said.

Negotiations began in October of last year, with tentative agreements being reached on several proposals. However, bargaining reached an impasse.

Harvard administrators described the strike as "unwarranted" in a statement Tuesday.

Union negotiators allege that the Ivy League university is failing to recognize the rising cost of living in the Greater Boston area. The latest proposal from university officials offered to raise the minimum rate to $15 an hour, with an 8% increase over three years for salaried student workers. However, the union said the university, with its multibillion-dollar endowment, can do better.

Grad students are also calling for the university to implement better protections from academic harassment and discrimination by establishing an independent third-party arbitrator. The proposal would not replace Title IX the federal law that prohibits gender discrimination on campus and mandates sexual misconduct investigations which union leaders said has "failed too often to be considered reliable."

Affordable health care is also on the union's list of demands. Grad students are seeking improvements to what they call inadequate dental, mental health and specialist coverage.

According to union leaders, there are also several issues the university either has refused to negotiate on or has not offered a proposal on.

Despite the disruptions during exam time, Yumusak said undergraduates are showing solidarity.

"We expect many of them to join us at the picket line," she said. "They understand that our working conditions are their learning conditions."

In addition, in solidarity with the labor action, dozens of Harvard faculty members have promised that strike participation will not have an adverse effect on their evaluation of grad students' work or academics.

Support for the strike has extended outside Harvard's campus. All 11 congressional representatives from Massachusetts, including presidential hopeful Sen. Elizabeth Warren, signed a letter Tuesday urging university officials to reach an agreement with the union.

Paolo Zialcita is an intern on NPR's Newsdesk.

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At Harvard, Grad Students Form A Picket Line Over Wages, Health Care And Protections - NPR

Cerner taps Amazon Web Services to ramp up healthcare AI capabilities, predictive technology – FierceHealthcare

Health ITcompany Cerner is deepening its partnership with Amazon Web Services to build new prediction tools and a virtual medical scribe for healthcare providers.

Cerner named AWS itspreferred cloud provider in July. At the AWS re:Invent conference in Las Vegas this week, Cerner expanded that partnership by naming AWS its preferred cloud, artificial intelligence, and machine learning provider.

"For 40 years, Cerner ushered in health cares digital age by moving medical data from paper charts and manila folders into electronic health records,Cerner CEO and Chairman of the Board Brent Shafer said during the AWS re:Invent conference Monday.

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Cerner's work with AWS will put the company at the"leading edge of cognitive data," Shafer said.

"Where were headed is taking the digital age to a new level to reduce costs, providing more insights into diseases, and giving clinicians back valuable time," he said.

RELATED:Cerner, Amazon Web Services partner on new cloud-based cognitive health platform

The Kansas City-based company will use AWSs broad portfolio of services, including machine learning, analytics, and Internet of things (IoT), to help create the "next chapter of healthcares digital age," company executives said, which will focus on advancing the patient care experience, improving the health of populations, and reducing the per capita cost of healthcare.

As part of the multi-year agreement, Cerner willmigrate its core applications to AWS and willstandardizeits artificial intelligence and machine learning workloads on the public cloud.

Using AWS' capabilities, Cerner is developing a new platform, called theCerner Machine Learning Ecosystem (CMLE), to helpdata scientists build and deploy machine learningmodels for healthcare applications at scale, the company said. The goal is to uncover predictive and digital diagnostic insights that will offer earlier health interventions.

One potential use case: Developers will be able tocreate chatbots that give patients access to their personal health records and answer patients' questions about medication, diagnoses, and medical conditions.

The health IT company is focused on developingpredictive technology to help organizations preventhospitalreadmissions and reduce healthcare waste. To do this, the company is leveraging de-identified patient data to help make early determinations of what is causing return hospitalizations.

RELATED:Microsoft, Humana ink 7-year strategic partnership to leverage cloud, AI and voice technologies

The company already is working with a post-acute healthcare provider on a project to identify patients at risk of hospital readmission. usingmachine learning applied to historical data migrated to the AWS cloud.

The collaborationis part of agrowing trendof healthcare providers, payers, and technology vendors migrating to cloud platforms offered by big tech giants. Mayo Clinic has entered into a 10-year strategic partnership with Google to use the tech giant's cloud platform to accelerate innovation through digital technologies. Insurance giant Humana and Microsoft announced a seven-year strategic partnership to usecloud and artificial intelligence technologies to build predictive solutions and intelligent automation to support Humana members and their care teams.

These technology partnerships raisesome thorny issues around connections topatients' health data.Google is facingsignificant blowback, including scrutiny from regulators and lawmakers, following news that it iscollecting personal health information on millions of patients in a partnership with Ascension.

Cerner also wants to use machine learning andvoice tools to automate medical documentation and clerical work for doctors.

RELATED:Amazon Web Services launches Transcribe Medical speech recognition service for clinicians

At the conference on Sunday, AWS announced the launch ofAmazon Transcribe Medicalas a speech recognition service for clinical documentation. Cerner plans to use Amazon Transcribe Medical's transcription application programming interface to develop a digital voice scribe. That voice toll will "automatically listento clinician-patient interactions and unobtrusively capturethe dialogue in text form," Jacob Geers, solutions strategist at Cerner said in an AWS press release. "From there, our solution will intelligently translate the concepts for entry into the codified component in the Cerner EHR (electronic health record) system," he said.

The digitization of health care has inadvertently caused an increase in documentation for physicians, according to Shafer.

"Working with AWS will allow us to capture doctor-patient interaction and integrate it directly into the electronic workflow of the physician. This new advancement will help doctors and providers spend less time filling out forms and more quality time with their patients," he said.

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Cerner taps Amazon Web Services to ramp up healthcare AI capabilities, predictive technology - FierceHealthcare

Meridian ‘hopeful’ agreement can be reached with OSF HealthCare – week.com

PEORIA (WEEK) -- OSF HealthCare recently announced it would terminate its agreement with Meridian and that the health insurance provider owes OSF "millions of dollars."

Now, Meridian says they are working with OSF on terms for a new contract and is "hopeful than an agreement will be reached," according to a press release sent Tuesday by Meridian.

"In the meantime, our members continuity of care remains our number-one priority. In the event we are unable to reach an agreement, we have a comprehensive process in place to transition our members to alternative providers within the MeridianHealth network," according to the release.

On Monday, OSF said Meridian owes millions of dollars to the Peoria-based health care provider "millions of dollars for outstanding claims for services provided over the past five years."

OSF's notice of termination said the agreement would end December 15.

We are unfortunately at a standstill with Meridian because for years they have failed to honor the most basic components of our agreement and will not come forward to resolve outstanding accounts, said Randy Billings, OSF HealthCare senior vice president of population health in the press release by OSF Monday. We are concerned for Meridian members, which is why we contacted the Illinois Department of Healthcare and Family Services and Meridian members to make them aware of the situation.

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Meridian 'hopeful' agreement can be reached with OSF HealthCare - week.com

‘An Arm And A Leg’ Podcast Explores The Cost Of Health Care In America – WUWM

Leading up to the 2020 election, Americas unusual approach to health care is on full display. The hot-button issue is a consistent talking point for both Democrats and Republicans since it has a huge impact on all American citizens.

Health care costs are prohibitively expensive, sometimes costing thousands of dollars for a quick trip to the emergency room, as many have experienced. These stories were part of the inspiration for the podcastAn Arm and a Leg, which showcases the horror stories and hard-fought victories of people dealing with Americas health care system.

Dan Weissman is the host and executive producer of the podcast, which premiered its third season in December. The fourth episode of the third season comes out on Thursday and deals with the hidden costs of emergency room visits.

"This is a long struggle and the cavalry is not coming."

"One of the things that I ended up thinking about, especially as we had completed two seasons, is that this is a long struggle and the cavalry is not coming," says Weissman.

Lake Effects Joy Powers spoke with Weissman about the impact and stories of health care costs in the U.S.:

Dan Weissman, host and executive producer of "An Arm & A Leg" podcast, speaks with Lake Effect's Joy Powers.

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'An Arm And A Leg' Podcast Explores The Cost Of Health Care In America - WUWM

Give it 5 stars: How doctor ratings affect your health care | TheHill – The Hill

Consider a fantastic experience at a restaurant with delicious food, timely customer service, and amazing ambiance.A diner may feel compelled to give that business a five-star rating on Yelp. It exceeded expectations and the restaurant can benefit from the power of a positive online review.

Now consider a visit with a physician.What would make it a five-star experience? And how would excellent service be defined in the medical setting?

As a physician, my goal is always to deliver effective and empathic health care to all of my patients. My goal is not to receive a high rating. Due to bias, subjectivity and other motivations, the random online patient ratings system is a hinderance, not a reliable guide, to good health care.

For many Americans, the end of the calendar year means they have already met health insurance deductibles and out-of-pocket maximums. This can make medical services less expensive and lead patients to search online for new physicians. However, in deciding on a doctor, patients need to be cautious not to confuse customer satisfaction with evidence-based, patient-centered care.

When making decisions about their health, patients are acting increasingly like typical consumers, who value online ratings. According to a 2018 study from NRC Health, 92.4% of consumers use online reviews to guide most of their ordinary purchasing decisions. The survey revealed that 59.9% of patients say theyve selected a doctor based on positive reviews, and nearly the same percentage (60.8%) of patients say theyve avoided doctors based on negative reviews.

These trends have huge implications for the quality of health care in the U.S., since patient ratings depend on often-inaccurate and potentially biased patient perceptions, rather than on more objective measures of good medicine.

Research shows that patient ratings tend to be biased against female and minority physicians. A 2018 study in the Womens Health Issues journal showed that women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone.

Another 2019 study in Health Equity found significant difference in patient satisfaction scores between underrepresented and white physicians.

Additionally a 2018 paper in the Journal of General Internal Medicine shows the different expectations that patients have for female and male physicians. Female patients tend to seek more empathic listening and longer visits, especially with female physicians. As a result, patient satisfaction with female physicians is subjected to gendered stereotypes and expectations with hidden rules for appropriate behavior.

Even if this implicit bias is overlooked in physicians, online reviews for products and services are hardly reliable.

Recently the skin care brand Sunday Riley settled with the Federal Trade Commission after the company was accused of posting fake reviews of their products on Sephora's website for two years.Thirty percent of Amazon product reviews also were found to be falsified by Fakespot, which analyzes online ratings for accuracy.

But the rippling effects of a fake review of body lotion pales in comparison to fake reviews of physicians, who deal with life and death.

In spite of this, the NRC study showed that 83 percent of patients trusted online ratings and reviews more than personal recommendations. Yet patient reviews on heavily trafficked sites, such as Vitals.com, Healthgrades.com, and WebMD.com are not vetted for accuracy.There is no verification that reviews are even written by actual patients.

This means that anyone an angry former employee or a grumpy neighbor can tarnish a physicians online reputation and sway potential patients with the click of a button.Conversely, there is nothing preventing associates of physicians from posting fake positive reviews.

Due to federal privacy laws, there is little recourse for physicians who are faced with negative online reviews. Unlike other businesses, physicians cannot respond to comments posted online because it violates patient privacy to simply acknowledge someone is a patient.This leaves doctors particularly vulnerable to personal and professional attacks.

When a Miami plastic surgeon attempted to sue two patients earlier this year for what he described as inaccurate reviews, he received negative press and additional negative reviews (that may or may not have been from actually patients).

Perhaps most importantly, though, high patient satisfaction scores have been linked to worse care.Motivation to achieve a high rating can influence doctors to prescribe unnecessary treatments and order unwarranted tests. Patients can use the threat of a poor online rating to leverage their requests.

A 2018 study in JAMA reported that telemedicine patients who received an antibiotic for a respiratory tract infection (e.g. a cold) gave high ratings.This is concerning since respiratory tract infections are usually viral and rarely warrant antibiotic use, which can lead to dangerous outcomes for patients.

Recently a Washington state physician sued her former employer, Kaiser Permanente, alleging the way the company used patient satisfaction scores hurt her career and incentivized doctors to over-prescribe painkillers. Evidence shows that patient satisfaction has played a role in the opioid epidemic.

This intense focus on patient ratings is a factor contributing to physician burnout, which also negatively affects patient care. Many doctors are under pressure to see more patients with shorter appointment times, but still maintain excellent customer service.

Patients may not know or understand that a physician may be running late not because she is rude, but because she was comforting a patient with a new cancer diagnosis.Its hard to imagine that this empathetic doctor deserves a poor online rating, but there is nothing preventing this result.

The consensus from physicians themselves is clear: there is an active petition with over 40,000 signatures to remove online ratings from Yelp and Healthgrades.com.

To be sure, checks and balances on physicians are undoubtedly important. While physicians take an oath to do no harm, no industry is free from bad actors. If in doubt, see Dr. Death podcast for an extreme example of this malpractice. Monitoring by state medical boards and hospital quality assurance committees are traditional ways to ensure patient safety.

When seeking medical care, patients can view online reviews with the understanding that they can be flawed, biased and subjective. Patients deserve the best healthcare possible and need to understand good ratings do not always lead to good doctors. Save the stars for the restaurants, not the physicians.

Lisa Ravindra is an assistant professor of Internal Medicine and a primary care physician at Rush University Medical Center in Chicago. She is a Public Voices fellow through The OpEd Project.

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Give it 5 stars: How doctor ratings affect your health care | TheHill - The Hill

Brits freak out when told the price of health care in the United States – Boing Boing

Brits freak out when told the price of health care in the United States / Boing Boing

"So if you're poor, you're dead." That's what a woman in the U.K. said when she was told the price of health care services in the U.S.

No doubt many people in the U.S. do die from the high price of health care, but the ones who survive but can't pay their bills are likely to be sued by the hospital.

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Brits freak out when told the price of health care in the United States - Boing Boing

Rosen: Warren ‘tripped on the third rail of health care’ – CNN

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Rosen: Warren 'tripped on the third rail of health care' - CNN

Lower number of people covered leads to higher rural health insurance premiums, study finds | The Source – Washington University in St. Louis Newsroom

Small risk pools may contribute to the challenges faced by private insurance plans in rural areas, in which case risk reinsurance, or insurance for the insurer, is a potential policy solution, finds a new study from the Brown School at Washington University in St. Louis.

A health insurance risk pool is a group of individuals whose medical costs are combined to calculate premiums.

A lot of our prior work on market-based insurance has shown that premiums tend to be higher in rural areas, and there is anecdotal evidence, often put forth by insurers, that a lack of health care providers is a factor in making insurance more expensive, said Abigail Barker, research assistant professor and author of Effect Of Population Size On Rural Health Insurance Premiums In The Federal Employees Health Benefits Program, published Dec. 3 in the December issue of the journal Health Affairs.

Insurers are sometimes required to contract with certain providers in order to satisfy network adequacy standards, but this research suggests that a more important factor is likely to be the low numbers of lives covered in a particular place, said Barker, who is faculty lead for data and methods at theCenter for Health Economics and Policyat the universitys Institute for Public Health.

The model controls for provider availability and various other possible explanations, and I find that additional enrollment is the factor most associated with lower premiums, she said. This makes sense because insurance is fundamentally about spreading risk, and it relies upon having large numbers of people in a given risk pool in order to work well.

Using data from the 2013-16 Federal Employees Health Benefits Program, Barker focused on premium and enrollment data for state-specific plans which offer insurance policies and set premiums at the regional level.

In nonmetropolitan counties, she found that each additional plan enrollee was associated with a 10-cent lower per capita biweekly premium, whereas this effect was trivial in metropolitan counties.

Low health care provider counts were not associated with higher premiums in nonmetropolitan areas, nor was the degree of insurer competition an important predictor of premiums, she said. However, there was substantial correlation over time, which suggests that some variables may be viewed less as sources of premium variation and more as influencing long-term premium levels.

Barkers current work for the Rural Policy Research Institute focuses on understanding how markets can be successfully integrated into the health care sector, using the Affordable Care Act and Health Insurance Marketplaces data as well as Medicare Advantage data to inform rural health policy.

Barker will present her findings Dec. 4 during an eventat the National Press Club in Washington, D.C.

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Lower number of people covered leads to higher rural health insurance premiums, study finds | The Source - Washington University in St. Louis Newsroom

63% Say U.S. Health Care Has Huge Problems and Thats an Improvement – Yahoo Finance

Heres a nugget of good news: Nearly two-thirds of Americans surveyed by Gallup say that the U.S. health care system is in a state of crisis or has major problems. Yes, thats good news because Gallup says its one of the least negative assessments since it started tracking the issue in 1994 and the lowest since 2002. Over the last 25 years, the average share of Americans who rate the health care system as being in crisis or having major problems has been 69%.

Of course, the results are clouded by partisan differences in perception of the health care system. Republicans negative views have dropped significantly since hitting a peak of 80% in 2016, the last year of President Obamas second term.

The bottom line: Americans' perceptions of the state of the U.S. healthcare system have been steady, with between 60% and 70% assessing it as having at least major problems, Gallups Justin McCarthy says. This has been consistent across four presidencies with differing approaches to healthcare policy.

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63% Say U.S. Health Care Has Huge Problems and Thats an Improvement - Yahoo Finance

Readers sound off on health care after 9/11, airline fees and traditional church services – New York Daily News

Through funding from the federal CDC World Trade Center Health Program, NYC Health + Hospitals has three Word Trade Center clinics that provide comprehensive medical and mental health services to individuals affected by the tragedy. Eligible New Yorkers include those who lived, worked, or went to school or day care in Manhattan south of Houston St. or in northwest areas of Brooklyn, between Sept. 11, 2001, and July 31, 2002; anyone who was present in the dust or the dust cloud on 9/11; and, people who worked as a cleanup worker or performed maintenance work in the disaster area between Sept. 11, 2001, and Jan. 10, 2002.

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Readers sound off on health care after 9/11, airline fees and traditional church services - New York Daily News

Healthcare: In service of the people – MedCity News

In the age of consumerism, chronic disease, and technological innovation, the future of patient-centered healthcare will be very different from todays experience. That is a good thing.

Healthcare is a service. Transformative methodologies deployed for decades in other service industries will be adopted, albeit evolved, into healthcare. And by far, the foremost service trend across all sectors is heightened personalization and greater choice expressions of brand empathy with the customer.

The future of healthcare lies in authentic empathy for the individual patient healthcares ultimate customer and cultivating long-term relationships with brands based on trust and value.

CustomerAt the recent HLTH conference in Las Vegas, there appeared to be some confusion around identifying healthcares ultimate customer. Speakers intermixed consumer and patient throughout their talks. It raises a question, How about person? A talented patient engagement leader exclaimed, Our patients are just like the real people in the community. News flash: They are the real people in the community.

This muddling reflects the perceptual difficulty healthcare faces as it tries to adapt to a modern continuous engagement model. The old idea that patients are event-driven phenomena requiring treatment at a hospital on the hill is fine for acute illness and injury. But it does not work for conditions that individuals live with continuously. Todays most pressing health issues overwhelmingly skew toward chronic disease prevention and management which requires a much more cooperative and participatory care and service paradigm. You probably will not need to see an endocrinologist at a big medical center tomorrow if you join your neighborhood diabetes prevention program (DPP) today: People require both kinds of healthcare delivery and they need to be treated as people just like any other industry selling services.

BrandThe future face of healthcare also requires contemplating brand and its role in service delivery. The incentive structures, technologies, and care requirements of our system traditionally encourage shining temples of exemplary care where glitzy dcor, classical statuary, and a hotel-like experience convince you where you should have your surgery.

Beyond the fanciest building approach to drawing customers, health systems have not contemplated the lifetime value of the people they engage preferring, more typically, a distinctly transactional outlook. Our engagement and evaluation tools reflect this, and few large systems have an engagement plan that matches the shine of their new hospital building.

On the other end of the spectrum, a company like BMW can tell you the long-term value of all its customers. This Customer Lifetime Value (CLV) is a measure that drives the automakers decision-making around marketing, sales, product development, service, and more. The underlying logic is to get you started with a 3 Series, upgrade you to a 5 Series, and ultimately shepherd you into an MClass, SUV, or 7 Series. BMWs goal is to be your preferred car provider through all the stages of your driving life.

Conceptually, CLV traces back to the late 80s, when marketing had a revolution in data-driven analytical approaches to better business insight. The work helped justify spending early to forge a customer relationship and fostering profit growth over time. CLV heuristics are obviously rooted in general business sentiment the idea that its good to keep a customer is not new. Yet advancement in data-based spending and profitability models supporting long-range customer engagement strategy has transformed our entire retail experience and most service segments. And it should transform future healthcare delivery as well.

This model has further matured as companies like Amazon and Google articulate the value of investing to perpetuate customer loyalty acceptable losses today incurred as a pathway to steady profits tomorrow. At the core of this analytic mindset is a very simple concept: empathy.

EmpathyIn some respects, you cannot find a more empathetic profession than healthcare. But healthcare is also a business that needs to change with the times. If you build it, they will come, is not a strategy for a healthier population or a healthy healthcare system. The goal should be to cultivate deep empathy with the core customer, delight where possible, support consistently, and always to help in the most appropriate way. Thats how todays service-based businesses succeed.

Understanding the evolving marketplace for health and care means also understanding:

The traditional consolidation that has driven large system creation does not adequately address the current needs of the market. We still require hospitals and state-of-the-art acute care facilities, but a fast-changing world is cause for expanded patient/customer empathy. Take, for instance, stroke care: Funds deployed on having two, stroke centers in close proximity could be reallocated toward a single full-service center and increased localized engagement with potential stroke victims on blood pressure management, adherence to blood-thinning treatment, or caregiver and extended family education to ensure more timely response to a stroke. Thinking about less hospital-centric and more everyday-life-inclusive care models that orient around the individual to keep that person healthy and ensure they are getting the help they most need in each moment and that they feel they are being well-served is incumbent upon the future brands and businesses of healthcare.

Doctors, too, will have to evolve how they think about their interactions. But if they lead this charge in new collaborations, they can ensure practice follows a scientific and meaningfully appropriate methodology. Consider this: How many people are asked by their doctor what their top three health goals are? Or what they really hope to get out of consuming healthcare? Have you ever been asked how the system can best help you? For me, I hope to feel as well as I did last year, be able to pick up my kids, exercise with and explore the world with my family. I also want help in doing that. This has nothing to do with a diagnosis list, but it has everything to do with healthcare. It means managing expectations in the face of a very complex service. It means using technology to engage me in thoughtful and empathetic ways. It doesnt have me sitting in waiting rooms unless absolutely necessary. It instills a sense of trust that support is there, helping me live my best life and keeping me well. Thats the future of healthcare.

Photo: kieferpix, Getty Images

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Healthcare: In service of the people - MedCity News

Opinion: Metrics to deliver five extra productive healthy years – Healthcare IT News

The challenge to deliver five extra years of healthy productive life in England is far more likely to succeed if the financial metrics that drive health and care are also aligned in mainstream practice.

The factors that will drive and accelerate healthy productive ageing are multifactorial and lie within and without the present health and care systems.Within the healthcare continuum, the financial metrics that drive the NHS also need to adapt and change to the new reality of making prevention of disease and maintenance of healthy productivity of the citizen a core key outcome.

The transformation of the current NHS is further fuelled by an increased understanding that health and care need to deliver more productivity per unit cost and also deliver service with measurable improvements in outcomes, rather than solely in activity, for citizens. Furthermore, they are driven by the long-term unaffordability of the present models of delivery, exacerbated by ageing and multi-morbidity of citizens.

To accomplish this reimagined new health and care system, a holistic view of the individual, including the non-health determinants, needs to be captured in the design of patient-centred care delivery and the fact that the only real option for delivering this is via digital transformation offers a real opportunity to capture appropriate data points to drive and monitor the new system.

There is emerging consensus internationally that new health and care systems need to be capitated, personalised, and value and population-based.From Europe to the Americas to the Middle and Far East, systems are in transition to new models of care.These new capitated models are favoured by payers in that they seem to offer better financial control, as well as offering advantages over the existing activity-based models,as they tend to value long-term individual outcome above units of activity as well as truly incentivise the prevention of ill health and the promotion of well-being.

Managing health and care systems is particularly complex.As live, complex, adaptive systems, they are made up ofmyriad moving parts and the probability of producing unexpected consequences through tinkering of a few sentinel metrics is high.

Outcome metrics are not an exact science and we are in the foothills of our understanding of how best to drive them.There is no simple formula and the fact that one outcome inevitably affects another makes the design of metrics particularly challenging,which is why they are a continuous work in progress.

Using financial metrics to encourage health care systems to shift their emphasis from activity to outcome cannot occur in a single step without significantly increasing the already considerable pressure on delivery systems, but is achievable by a more nuanced and staged approach.

Thus, an approach which may be worth considering is utilising a process which encourages the transition to a more preventative population health-based to be effected over a number of years.Whilst there could well be debate around the pace this change needs to be effected over, and the percentages which need to be allocated to prevention as against activity, the most pressing action now is stating this will be the direction of travel the NHS will be taking for the foreseeable future as what would immediately benefit the NHS is purposefully stating that a shift in the financial metrics from the present activity-based ones is being made as part of its long-term plan,and describing the optimal end state as one which would encompass both activity and outcome.

With such a complex delivery system made up of a multitude of players, all working through the fundamental shifts associated with digital transformation, changes in processes (like enabling interoperability and streamlining activities) also need to be encompassed in order to deliver financial predictability,enabling payments to be normalised on a year to year basis. The optimal approach must encompass the capitated, personalised, value and population-based systems we aspire to deliver in the pursuit of universal health care provision, and thus include both personalised outcome measures as well as activity and progress indicators.

The NHS by 2030 will be deployed onto a population which may well be very different to the one today.It will have become older and with the advent of a more personalised public health offering to individuals via precision health and enabled digital connectivity, the citizen will be much more activated.

When the NHS five-year view was published in October 2014, what was presented was a vision not a plan. The assumption was that the plan would immediately be followed by the details around implementing outcome-based population based financial drivers.The same could be said for the NHS long-term plan published in January 2019, where there is promise, but no timescales as to how the payment systems are to be altered and at what pace.

The NHS in England has to balance the loosening of its centralist culture and make its offerings fit the various diverse demographies it serves, and do this in practice, whilst remaining a corporate national body.The historical approach that it has perfected, to drive the system through metrics which look to assure a national agenda over a local one, inevitably will lead to metrics and subsequent delivery of care which are an approximate fit everywhere and a perfect fit nowhere.

In terms of deployment, what could be achievable without destabilising existing provision would be a cumulative substitution of an increasing percentage over the first three years.This would achieve the 25% change of the existing activity metrics which drive the system to achieve the changes required.Thus, in the case of the total core income for NHS hospitals, 5% in year one, 7.5% in year 2 and 12.5% change in year threewould achieve the first major step by having a quarter of all the financial drivers pointing towards prevention.As regards to primary care, the same pace and methodology would apply.In this case, the challenge is selecting metrics which are relevant to the served population.The adoption of primary care networks, with their populations of at least around 40,000 makes this more achievable.

The new outcome-based metrics to drive prevention and better outcomes could be developed over a period of years in an iterative process.

Whatever the metrics selected, the overriding factors to be taken into consideration are the life course approach as well as adoption of newer concepts like HealthSpan.

Charles Alessi is chief clinical officer at HIMSS International. Healthcare IT News is a HIMSS Media publication.

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Opinion: Metrics to deliver five extra productive healthy years - Healthcare IT News

RSNA: New imaging, informatics products from Change Healthcare, Google, IBM, others – Healthcare IT News

RSNA's 105th Scientific Assembly and Annual Meeting, the biggest radiology conference in the world, takes place this week at McCormick Place in Chicago. Among the many exhibits of massive MRI machines and CT scanners, plenty of new IT products and vendor initiatives have been announced so far. This past week, we reported on GE Healthcare's new Edison Developer Program. Here's a few other highlights so far from the show.

Change Healthcare unveiled its new CareSelect Imaging Open Access project, which offers no-fee access to qualified clinical decision support to help healthcare providers comply with the forthcoming Protecting Access to Medicare Act.

Under PAMA, effective January 1, 2020, Centers for Medicare & Medicaid Services will require that physicians check with CMS-approved decision support mechanism before ordering advanced imaging exams for fee-for-service Medicare patients.

Change Healthcare says CareSelect Imaging Open Access offers such a CDS mechanism.

"Referring providers without decision support integrated into their EHR lack the tools needed to ensure compliance with the new layer of PAMA requirements that go into effect in January, explained Michael Mardini, CEO of Change Healthcare's National Decision Support Company.

"By providing no-fee access to our interactive, web-based, clinical decision support technology, were making it easy for providers to reference and consult against the largest collection of evidence-based, physician-authored imaging criteria currently available to achieve compliance.

Change Healthcare also announced continued growth and momentum for another of its initiatives, its cloud-native Enterprise Imaging Network, which offers imaging archive and viewer and AI-powered analytics.

Four health systems have signed on as development partners for the project, hosted by Change on the Google Cloud Platform: Bronson Healthcare, Community Health Systems Professional Services Corporation, Montefiore Nyack Hospital and University of Wisconsin School of Medicine and Public Health and UW Health, Madison Wisconsin are among the partners who will work with Change on the network which aims to enhance and optimize medical imaging data and help providers boost clinical, financial and operational outcomes.

Most cloud-based enterprise imaging technologies weren't developed specifically for the cloud but were instead drawn from legacy tech and re-platformed, Change Healthcare points out.

"This means providers arent realizing the full benefits in improved care coordination, cost realization, and reduced infrastructure complexity that true cloud-native solutions can provide," explained Tomer Levy, general manager, cloud solutions at Change Healthcare.

"From the time we first partnered with Google Cloud, weve focused on building a solution that doesnt simply replicate traditional on-premise systems, but delivers everything providers expect in an enterprise imaging serviceplus clinical and operational capabilities that are only available through a true cloud-native SaaS platform."

IBM Watson Health announced several new innovations for its imaging AI platform. As Anne Le Grand, general manager, imaging, life sciences and oncology at IBM Watson Health noted, these range from "helping clinicians to identify potential missed findings to seeing a summary view of patient records quickly, our innovative technologies are at the forefront of Watson Healths mission to help enable clinicians to more effectively respond to the worlds most pressing health challenges.

In addition, the IBM Imaging AI Marketplace was showcased at RSNA: a single-source solution designed to help simplify the complex process of finding, purchasing and deploying various AI imaging applications. The marketplace, which contains only FDA-cleared tools alongside Watson Health's own AI apps, is meant to offer a single location for procurement, accessed through IBM's iConnect Enterprise Archive.

IBM Watson also announced some new firsts. Hardin Memorial Health, for one, is the first provider to use its Imaging Patient Synopsis, which provides a summary view of patients through analytics and extracts insights from patient records to uncover underlying issues. The company has also launched Clinical Review 3.0 launched in the UK, a tool designed to analyze imaging studies and their associated reports to identify potential missed findings and facilitate more comprehensive reports.

Konica Minolta Healthcare Americas, meanwhile, is showcasing several new technologies at RSNA: analytics, data management and more. These include the KDR AU Advanced U-Arm, with Dynamic Digital Radiography. Billed as an "X-ray that Moves," the tool offers a loop of rapidly acquired, diagnostic-quality images depicting full views of articulatory mobility, helping clinicians better assess changes in relationship of bones, ligaments and other anatomical structures through full range of motion. The tech is first deployed at Emory Healthcare.

Konica Minolta is also touting its new picture archiving and communication system for specialty practices, Rede PACS. Aimed at orthopedics, urgent care and family practice, and built on the Exa Platform, Rede PACS is a web-based, zero-footprint solution that provides the features and tools needed to optimize and streamline imaging workflow.

The company is showcasing new analytics and productivity dashboards for the digital radiography, and new cybersecurity tools, such as a radio-frequency ID-based tool for secure user authentication with a unique identification that aids in HIPAA compliance.

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RSNA: New imaging, informatics products from Change Healthcare, Google, IBM, others - Healthcare IT News

Digitised records: The future is now – Healthcare IT News

The transformation of paper-based patient record-keeping practices into a fully digitiseddata asset management strategy has been a long process for many healthcare institutions. The historical legacy of paper records is often cultural as much as it is practical, and it has proved stubbornly hard to shift. As a result, the benefits of digitisation-especially seamless remote access for clinicians and the removal of costs associated with physical storage - have been slow to materialise.

But pioneering healthcare providers such as University Hospital Southampton have led by example, and now provide a blueprint for an integrated approach to digitisationto which other institutions can aspire.

University Hospital Southampton NHS Foundation Trust is a major teaching and research centre, with ambitious plans to digitiseby integrating open systems. Following the Wachter Report in 2016, it was named as one of Englands global digital exemplars with a significant difference: unlike most of the others, it has based its strategy on an integrated electronic document management (EDM) system Hyland Healthcares OnBase enterprise information platform rather than an electronic patient record suite from a single supplier.

The system went live at the Princess Anne Hospital in 2017, ahead of a subsequent roll-out to the Royal South Hants Hospital and Southampton General Hospital. While the initial focus was on cost-savings -the closure of a health records centre shared by the three organisations -the long-term strategy was to support a move from paper-heavy to paper-light working, and enable the facilities to share information with each other more easily.

Adrian Byrne, chief information officer at University Hospital Southampton, says: We wanted to start moving people away from writing notes on paper to entering information into digital systems. This fitted with our strategy of migrating from being paper-heavy, to paper-light, to paperless.

Byrne adds: In addition, the trust does not want to be dependent on just one supplier and its development path - it wants to be able to switch or add innovative products, economically.

Some aspects of the implementation project and its ongoing evolution reveal the scale of the task faced by any healthcare provider embarking on a digitisationstrategy. The trust instituted a scanning programme that will ultimately see around 15%of its historical records digitised - or 60% of those in regular use to provide care to patients who have repeated contact with the trust.

Byrne says the trusts IT systems already contain a lot of data about patients, but some key pieces of information are still held in paper-based historical records. There are two things, in particular, that you find yourself pulling records for, he says. ECGs and drawings, particularly things that people drew a long-time ago, such as an image of a congenital heart defect.

Medical staff can now access this information via OnBase, which holds content in a single, secure location, and enables it to be viewed on secure devices. Byrne says a lot of work went into the rollout model because once a patient group or department goes live with the system, its clinicians are creating information that will not be available to others until their part of the trust also goes live.

While the trusts immediate priority has been to close the Health Records Centre, the deployment of OnBase also supports further elements of its digital strategy. For example, it is becoming easier to support clinicians who need to run remote clinics, and for the acute, mental health and community trusts to share information with each other.

Byrne says: As we move away from paper notes, we have to become more agile when it comes to mobile working. At the moment, if somebody needs to run a mobile clinic in Dorset, they can take the notes; but what happens when there are no notes? We need to make sure people can work in that situation. Its also part of our regional information sharing strategy, because we can put documents into the EDM system (OnBase) and interface to them.

Byrne is a keen advocate of institutions proactively influencing system development in this case, focusing on the needs of other trusts looking to digitisewithout going down the single-supplier EPR route. He sits on the companys advisory board and says: I want to highlight the issues we see as a UK customer. For example, if you talk to US customers, its clear they are focused on the big EPR suppliers, and only interested in using EDM as an archive. They dont use it much as a forms creation system; whereas this is one of the things that we are keen to develop.

Byrne adds: Forms creation will be a large component of our paperless operation. It will mean information will be much more readily available to our clinicians. It will enable us to do some significant business change. We may also end up using it for HR and financial tasks, and take out more paper that way.

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WEDNESDAY AT 5:30: Kirkland cancer patient, others fighting Aliera Healthcare to get claims paid – KIRO Seattle

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WEDNESDAY AT 5:30: Kirkland cancer patient, others fighting Aliera Healthcare to get claims paid

KIRKLAND, Wash. - Patients are left with mountains of medical debt after they thought they signed up for health insurance, but ended up with something that wouldn't pay the claims when they got sick.

The company is called Aliera Healthcare. Washington state ordered the company to stop selling policies in Washington and the state has fined the company more than a million dollars.

But customers across the state are still dealing with the aftermath.

A cancer patient in Kirkland, Brad Fuller, said he's being forced to max out credit cards to pay for treatment because Aliera is denying his claims.

KIRO7's Deedee Sun investigates the health care company the state is calling a "scam" Wednesday night at 5:30 p.m.

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WEDNESDAY AT 5:30: Kirkland cancer patient, others fighting Aliera Healthcare to get claims paid - KIRO Seattle

Confront cyberthreats to healthcare reliably and affordably: Leverage a security operations center-as-a service – Healthcare IT News

The healthcare industry continues to have a cyber target on its back.

The inherent value of patient health records means hospitals and other healthcare organizations continually fall victim to a deluge of ransomware, spear phishing, and other cyberattacks. The costs of such assaults are substantial. These data breaches result not only in HIPAA violation fines and recovery costs, but also significant losses in community trust and patient satisfaction.

A security operations center (SOC) provides a focal point for security operations, but providing 24x7 SOC coverage is beyond the means of most organizations due to people and technology costs. Healthcare organizations face multiple challenges in proactively responding to threats. These challenges include protecting different legacy medical systems that are difficult to patch and maintain, locating and retaining security personnel, and managing with constrained cybersecurity resources.

Thats why Todd Thiemann, a product marketing director at Arctic Wolf, said healthcare organizations can benefit from investing in a security operations center (SOC)-as-a service instead of maintaining an on-premises SOC.

Creating your own SOC requires you to monitor all the telemetry from your various systems, detect and investigate anomalous activity, and remediate the security issues that you find. For larger organizations, that generally takes nine to 12 people with cybersecurity experience working 24x7, which is an expensive proposition, Thiemann said.

For smaller- and medium-sized organizations, standing up a SOC is beyond their means. But SOC-as-a-service, which provides everything required for security monitoring and related compliance obligations, offers healthcare organizations the protection they need at a more reasonable cost.

Thiemann said many healthcare organizations do not even realize that SOC-as-a-service is an option. But, he argued, this kind of service offers healthcare organizations a timely, responsive, and affordable way to manage threat risk, detection, and response. Healthcare organizations that enter into such arrangements should also expect an ongoing vulnerability management process in addition to the monitoring services that detect and respond to threats.

A good managed services team will ask about and understand where your crown jewels are and can identify the handful of systems with vulnerabilities where you need to focus disproportionate attention. And if something does occur, the security team can engage with you to resolve the issue, he said.

The right SOC-as-a-service partner, Thiemann added, can offer a personalized concierge approach that appreciates your organizations IT environment, inside and out. That team should also have the knowledge and experience to understand when a threat is truly significant so that you are not inundated with unnecessary false-positive alerts.

SOC-as-a-service is an ongoing relationship, an extension of your own internal IT team, that can help you tighten your security ship in a reliable and affordable way, he said. With a threat landscape that continues to evolve, its not a matter of if, but when youll encounter a cyberattack. SOC-as-a-service allows healthcare organizations a way to refine their security posture so they are ready for to effectively deal with whatever comes their way.

To learn more about SOC-as-a-service and how it can help protect your healthcare organization from cyberattacks, visit Arctic Wolf.

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Confront cyberthreats to healthcare reliably and affordably: Leverage a security operations center-as-a service - Healthcare IT News

What is real health care? – Lethbridge Herald

By Letter to the Editor on December 4, 2019.

Re: the Conscience Rights Protection Act, Nov. 23 Herald. What I simply read into this proposed act is to protect health-care providers from having to forward patients to other health-care providers, or institutions, when those procedures are contrary to their beliefs.

Now I have a question: are all procedures really considered health care? About eight months ago my wife and I witnessed the awesome care given in the Lethbridge hospital when a granddaughter delivered a set of awesome twins prematurely. They were loved and cared for, first in the incubator, then loving and nurturing and caring until they were able to go home with Mommy and Daddy.

Then my sad news: about three months ago my wife was hospitalized with an incurable brain tumour. First one week in the Lethbridge hospital, she received awesome loving care from doctors and staff, then one week in the palliative care unit in Taber, the love and care was awesome, then she passed into glory.

But sad to say in todays Canada, it is within our laws to snuff out life, both for the pre-born and the medical assisted in dying. If that would not be the case, then the health-care providers would not have to deny their service to anyone. So what is real health care? Yet now on a positive note, I am so thankful for the awesome care, both in the hospital and seniors homes. Thank you so much for all our caregivers.

From a Taber volunteer.

Hans Visser

Taber

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What is real health care? - Lethbridge Herald

Up to 60% of Australians will drop private health by 2030 without reform, report finds – The Guardian

Fewer than 40% of the population will be covered by private health insurance by 2030 unless reforms are made, according to a report from the public policy thinktank the Grattan Institute.

The report, led by the health economist Stephen Duckett, recommended partially deregulating premiums to allow insurers to charge younger people less than older people for the same level of coverage, but said premiums should remain regulated and should not vary by age for people 55 and over.

The system faces a death spiral younger and healthier consumers get a bad deal so theyre dropping their insurance, which means premiums need to rise, so even more young and healthy people drop out, and the cycle continues, the report, published on Tuesday night, said.

This youth exodus means the recent moderation of premium increases is likely to end, and premiums will probably return to increasing at 5% or more each year. Young peoples premiums have to get cheaper.

The report proposed a number of other reforms, including redirecting the private hospital insurance rebate towards older patients. The report also recommended that the rebate not be increased, it be withdrawn from low-coverage policies, and the extras insurance rebate be withdrawn.

Part of the proceeds should fund dental care and part should keep hospital insurance premiums for older people at acceptable levels, it said.

The chair of the Australian Health Care Reform Alliance, Jennifer Doggett, said the proposed reforms were not substantial and would merely tweak the numbers to make insurance slightly more attractive to young people.

My biggest criticism is that the paper assumes that the current system of private health insurance is a system worth saving which, in my opinion, is not the case, Doggett, a health policy analyst, said.

They dont address many of the fundamental problems with private health insurance: that it is overly complex, cost-inflationary, has high administrative costs, leads to over-servicing, is inequitable, doesnt help those most in need, and disadvantages people in rural areas although some of these issues are addressed in other Grattan papers.

For the reforms to succeed, enough young people would have to join to effectively cross-subsidise the cost of older people. Consumer behaviour in this area was difficult to predict accurately as peoples decisions about private health insurance and healthcare were not often economically rational.

The paper relies on some significant assumptions about how young people will respond to the reforms. If these are wrong, the changes are not going to have the effect they predict, Doggett said.

However, redirecting the dental component of the rebate into public dental services is a positive as this would deliver much better value although overall the removal of the rebate from ancillary services means that the out-of-pocket costs for allied health and dental services are likely to rise.

Catholic Health Australias chief executive, Pat Garcia, said deregulating premiums for those under 55 would mean junking a fundamental tenet of Australias health system. This risked increasing premiums for young people with chronic disease and mental health issues, leading to those with chronic disease dropping their private health insurance and moving into the public system.

This is the last thing public hospitals need right now.

The chief executive of Private Healthcare Australia, Dr Rachel David, said health funds were prevented from discriminating against members based on health status or claims history.

The latest report from the Grattan Institute highlighted issues of concern in the private health sector previously identified by government and stakeholders, however it failed to offer any workable solutions, she said.

While maintaining a system of community rating [which means the same service is available to everyone for the same price] posed challenges for Australias health system, it was also one of the features which helped Australia maintain its international reputation for fairness in healthcare.

Community rating underpins Australias private health insurance regulations, and changes to a risk-rated system would severely destabilise premiums for older Australians and threaten the future of fair and equitable healthcare.

Generational transfer of risk would mean a lot of Australians would have a very uncertain future.

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Up to 60% of Australians will drop private health by 2030 without reform, report finds - The Guardian

Respiratory Viruses Cling to Healthcare Workers – Infection Control Today

The clothing, skin, and personal protective equipment (PPE) of healthcare workers (HCW) are often contaminated with respiratory viruses after they care for patients, according to US Centers for Disease Control and Prevention investigators. Their conclusion, published in the December issue ofInfection Control & Hospital Epidemiology, reinforces the need for complete hand hygiene and frequent changing of PPE to prevent virus transmission.

Investigators found viruses on 31% of glove samples, 21% of gown samples, and 12% of face mask samples. In addition, 21% of bare hand samples, 11% of scrub samples, and 7% of face samples tested positive for respiratory viruses.

The data were collected from 59 healthcare workers at a 465-bed acute care academic hospital in the Chicago area who volunteered to have their skin, cloths and PPE swabbed for virus measurement. The swabbing took place from March to June 2017 and again from September 2017 to April 2018.

Investigators wanted primarily to characterize the presence and magnitude of viruses on healthcare workers after they provided routine care for patients suffering from respiratory infection and who had been placed under droplet and/or contact isolation. But they also wanted to measure the connection between how healthcare workers can contaminate themselves through faulty doffing practices.

Our findings of viral contamination on PPE, clothes, and skin of HCWs emphasize the significance of appropriate PPE use, PPE doffing practices, and hand hygiene in infectious transmission prevention via the contact route, the study states.

The 52 patient participants provided written informed consent and authorized access to use and disclose health information for the study. Investigators observed the care given to patients during a 3-hour period, typically between 8 a.m. and noon.

To our knowledge, our study is the first to evaluate the association of self-contacts by HCWs and virus contamination on their PPE and bodies, the study states.

They found an association between the number of self-contacts by HCWs with their gloves, gowns, or masks and the concentration of virus on those pieces: the more self-contacts, the more virus.

The strongest correlation identified was between self-contact with the gown (torso) and virus concentrations on a personal stethoscope, which is often draped around the neck, the study states. Investigators were unable to discern the direction of virus transfer upon contact between the healthcare workers hands or gloves and a surface, but results suggest that those contacts contributed to virus dissemination.

Investigators also said that they observed doffing practices that deviated from CDCguidelines.

Exposure modeling and quantitative microbial risk assessment should be used to evaluate the importance of the presence and magnitude of different viruses at different locations in the environment and on HCWs for occupational and patient health impact, the study states.

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Respiratory Viruses Cling to Healthcare Workers - Infection Control Today

Vaccines: A Healthcare Revolution and High Return on Investment – BioSpace

Historically, the first disease to be totally eradicated by vaccines was smallpox. This vaccine was first introduced in 1796 by Edward Jenner. He had noted that milkmaids who had caught cowpox did not catch smallpox. He lanced a cowpox lesions from Sarah Nelms, a young dairymaid and inoculated an eight-year-old boy, James Phipps, with it. The boy developed a mild fever discomfort but recovered. Two months later Jenner inoculated Phipps with a fresh smallpox lesion. The boy did not come down with smallpox.

Before 1980, the disease killed three out of every 10 people infected. It killed hundreds of millions of people worldwide before it was eradicated.

From 1966 to 1977, the World Health Organization undertook a global campaign to eliminate the disease via a worldwide vaccination program. The last known naturally occurring smallpox case was seen in October 26, 1977, in Merka, Somalia. By 1980, WHO declared smallpox eradicated.

There are two known stockpiles of variola, the virus that causes smallpoxin Atlanta, Georgia, at the U.S. Centers for Disease Control and Prevention (CDC) and the Russian State Center for Research on Virology and Biotechnology in Koltsovo, Russia.

Another human disease that has been eradicated, is rinderpest, or cattle plague, which was eradicated in 2011.

Modern vaccines have been used, and are being developed, to control, prevent or, hopefully, eradicate some diseases. They often use a weakened or dead virus or bacteria, or antigens found on their surface, to trigger a protective immune response. However, increasingly, vaccine technology utilizes other approaches to vaccinate against not only infectious diseases, but also diseases like cancer.

14 Diseases that Vaccines Control or Have Eliminated

The CDC prepared a list of 14 diseases that people have almost forgotten about, because of vaccines. They include:

Vaccine Pipeline

According to the Pharmaceutical Research and Manufacturers of America (PhRMA), there are 264 vaccines in development to prevent and treat diseases. These include infectious diseases (137), cancer (101), allergies (10), autoimmune disease (8) and Alzheimers disease (4).

Here are some recent stories about vaccines:

In May, the U.S. Food and Drug Administration (FDA) approved Sanofis Dengvaxia, a vaccine for all four serotypes of dengue. The disease, a hemorrhagic fever, is endemic in the U.S. territories of Puerto Rico and the U.S. Virgin Islands. The vaccine has a controversial history. It was pulled from the Philippine market in 2017 over safety concerns. However, it has been approved in 10 countries in Latin America and Asia where the disease is endemic. It was approved in Europe in December 2018.

On November 7, Takeda Pharmaceutical announced that its dengue fever vaccine hit its primary efficacy endpoint in its Phase III clinical trial. The trial evaluated the vaccine in 20,000 patients in Latin America and Asia.

In October 2019, 4D Pharma, based in Leeds, UK, partnered with U.S.-based Merck to develop Live Biotherapeutics vaccines. Outside the U.S., Merck & Co. is known as MSD. 4D Pharma focuses on the microbiome, the trillions of microorganisms that live in the human body. Live Biotherapeutics are a new class of medicines made up of strains of gut long-term bacteria originally isolated from healthy human donors. They are then encapsulated and administered orally, where they are selectively delivered to the gut where they can interact with the patient to exert therapeutic effects.

Under the terms of the deal, 4D will use its proprietary MicroRx platform with Mercks expertise in novel vaccine development and commercialization to discover and develop Live Biotherapeutics (LBPs) as vaccines in up to three currently undisclosed indications.

Also in October, researchers with the Washington University School of Medicine developed a technique to improve on cancer immunotherapy and vaccines. Currently, cancer vaccines and immune checkpoint therapies rely on a knowledge of MHC class I genes that activate killer T-cells. The new research looks at another group of genes, MHC class II, that activate the helper T-cells. One of Schreibers co-authors, Maxim N. Aryomov, an associate professor of pathology & immunology, developed a computer program that predicts which mutant proteins (antigens) on a tumor will specifically activate helper T-cells.

The idea of giving checkpoint inhibitors along with a tumor-specific vaccineespecially a vaccine that activates both killer and helper T-cellsis just beginning, said Robert D. Schreiber, the Andrew M. and Jane M. Bursky Distinguished Professor, and senior author of the study. But based on our study, the combination is likely to be more effective than any of the components alone. Today, when we treat a particular tumor type with checkpoint inhibitors, maybe 20% of the patients respond well. Were hoping that with a vaccine plus checkpoint inhibitors, the number of patients who respond well will go up to 60 to 70%. We havent tried that yet in patients, but thats the hope.

In July 2019, Cambridge, Massachusetts-based Neon Therapeutics announced top-line results in its Phase Ib clinical trial of NEO-PV-01, its personal neoantigen vaccine candidate. NEO-PV-01 was being evaluated in combination with Bristol-Myers Squibbs Opdivo (nivolumab) in advanced or metastatic melanoma, smoking-associated non-small cell lung cancer (NSCLC) and bladder cancer.

In all three cancer types, data showed prolonged and consistent improvements in progression-free survival (PFS) that is similar to that seen with checkpoint inhibitor monotherapy. In 27 patients with metastatic NSCLC, median PFS was 5.6 months. In 21 patients with metastatic bladder cancer, median PFS was 5.6 months. At 13.4-month median follow-up in 34 patients with metastatic melanoma, median PFS hadnt been reached yet.

The War on Antibiotic-Resistant Infections

A recent CDC report, Antibiotic Resistance Threats in the United States, 2019, found that more than 2.8 million antibiotic-resistant infections occurred in the U.S. each year, killing more than 35,000 people. In 2017, the agency found that there were 223,900 cases of Clostridioides difficile (C. diff) infections, resulting in at least 12,800 deaths.

The report underlines the importance of funding the development of new antibiotics and the effectiveness of vaccines. The U.S. government does fund quite a bit of research into anti-infectives, largely through the Department of Defense and Health and Human Services Biomedical Advanced Research and Development Authority (BARDA). Moderna, for examples, receives quite a bit of funding for its mRNA vaccines and anti-infectives programs, as well as the Bill & Melinda Gates Foundation, which invests heavily in companies working on vaccine and antibiotics research.

CARB-X is a program led by Boston University and funded by BARDA, the Wellcome Trust, the Gates Foundation and U.S. and European government agencies. Between 2016 and 2021, CARB-X plans to invest more than $500 million into vaccine and antibiotic research and has already made 44 awards totaling $126.1 million.

Vaccines provide an unusual return on investment. Not only have vaccines eliminated or minimized some of the most serious infectious diseases the world has ever known, a 2016 Johns Hopkins University study found that for every dollar invested in vaccination in the 94 lowest-income countries in the world, $16 were expected to be saved in healthcare costs, lost wages and lost productivity. Taking into consideration healthier and longer lives and the long-term burden of disability, the net return increases to $44 per $1 invested.

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Vaccines: A Healthcare Revolution and High Return on Investment - BioSpace


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