Checking Up On Health: June 4, 2013

BenitaDodd2013By Benita M. Dodd

An involved patient is a physician’s dream. But how do you engage patients, given the looming physician shortages and growing numbers of insured under ObamaCare? Enter Americans’ constant companion: the smartphone, with all its apps. A friendly, conversational Virtual Health Assistant can guide patients through medication management, motivate them to stick with their wellness routines and more, right on the smartphone. Victor Morrison blogs in NextiIT that a Virtual Health Assistant deployed via a smartphone, tablet or PC is in position to be a constant life companion and personal coach, and the “natural language” platforms are improving to the extent that Virtual Health Assistants are able to have conversations with humans across service channels and devices, understand context and deal with complex issues.

It’s all in the implementation: The federal government has issued the final rules on employment-based wellness programs under ObamaCare. The final rules continue to support “participatory wellness programs,” such as those that reimburse the cost of membership in a fitness center, provide a reward to employees for attending a monthly health education seminar and those that reward employees who complete a health risk assessment. The rules also outline standards for nondiscriminatory “health-contingent wellness programs,” which include programs that provide a reward to those who do not use or decrease their use of tobacco and programs that reward those who achieve a specified health-related goal. The final rules also will increase the maximum reward that may be offered under health-contingent wellness programs to 30 percent of the cost of coverage, a 10 percent increase from the current amount. The rules apply to plans beginning on or after Jan. 1, 2014. “The final rules also protect consumers by requiring that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness,” a news release notes. Cha-ching.

Despite sleepless nights and doubling up on diaper duty with new twins in the family, my friend Michael Cannon of the Cato Institute found time for comment after a Wall Street Journal article pointed out how employers are seeking lower-cost, bare-bones health coverage. The unintended consequences of the Affordable Care Act could end up hiking costs and hurting health-insurance exchanges: “To the extent ObamaCare’s employer mandate pushes firms to offer bare-bones plans, premiums for plans offered through Exchanges will rise. The healthiest workers will enroll in their employers’ bare-bones plans, but workers who have expensive illnesses (or with dependents who have expensive illnesses) will seek more-comprehensive coverage through the Exchanges. The influx of sick consumers will increase the premiums for Exchange-based plans. Many of these sick workers won’t receive any premium-assistance tax credits or cost-sharing subsidies because their employer’s bare-bones plan will likely satisfy ObamaCare’s definition of adequate – and because the statute forbids those entitlements in the 33 states that have declined to establish an Exchange.”

Immunotherapies treating cancer: Research released at an oncology conference in Chicago reinforces that using drugs to harness the body’s immune system to fight tumors may prolong lives for certain types of cancer. An experimental Bristol-Myers Squibb Codrug, nivolumab, helped patients with a deadly form of skin cancer, melanoma, live an average of nearly 17 months in a clinical trial. Another study showed that adding Sanofi SA’s drug Leukine to Bristol-Myers’s drug Yervoy – both of which also work through the immune system – reduced the risk of dying by 35 percent compared with Yervoy alone, among patients with advanced melanoma. Immunotherapy drugs are designed to stimulate the body’s immune system to destroy cancer cells. Source: Wall Street Journal

There goes the neighborhood: The Department of Health and Human Services is seeking public comment on elements to include in “a risk-based regulatory framework for health information technology and mobile medical applications that promotes innovation, protects patient safety and avoids regulatory duplication.” The Food and Drug Administration (FDA) Safety and Innovation Act of 2012 “requires” the FDA in consultation with the Federal Communications Commission and Office of the National Coordinator for Health IT, to propose a strategy and recommendations for the framework. Incidentally, the 2012 legislation also gives the FDA the authority to collect user fees from industry to fund reviews of innovator drugs, medical devices, generic drugs and biosimilar biologics. Because, you know, the government is all about innovation …

 May was ALS month: I came across this poignant introductory paragraph about ALS, or Amyotrophic lateral sclerosis – also known as Lou Gehrig’s disease – in an article by Steve Perrin for BioTechNow:
1,100 days. That’s the average amount of time a person survives following a diagnosis of ALS. That is because ALS is a progressive neurodegenerative disorder defined by the loss of both upper and motor neurons which in the clinic is characterized by the atrophy of nearly all a person’s muscles. These 1,100 days aren’t pretty. Each person will progressively lose their ability to speak, move or eat on their own. Most people will die from respiratory failure as the disease strips away the muscles that control the diaphragm. There is nothing forgiving about this disease. It doesn’t care how rich or poor you are or what your background is. It can take you before your 21st birthday or soon after retiring in your 60s. Make no mistake, ALS is a killer.” Read more about the research here:

A potential cure for diabetes: After finding that Type 1 (juvenile) diabetes destroys blood vessels in the pancreas as well as insulin-producing cells, scientists at the University of Missouri are developing a treatment drug called Ig-GAD2 for use in combination with adult stem cells from bone marrow. The bone marrow cells led to growth of new blood vessels. The drug stops the immune system attack, and the stem cells generate new blood vessels that help insulin-producing cells to multiply and thrive. Source: Business Standard

In Brief

Building a better thermometer: Two Japanese companies have developed a device for women to measure their body temperature, which can tell a lot about their health, body rhythm and gynecological illness. Toshiba and Rakuten ‘s smartphone-based app has an easily connected thermometer fitted with a microprocessor that measures the body temperature and sends the information directly to a smartphone. “Simply selling thermometers might not be the right way. Working together with a data service company and creating this kind of new technology will surely bring many benefits to everyone,” a Toshiba spokesperson explained.

Is ObamaCare too complicated to succeed? The New York Times asked several health policy analysts, including Michael Cannon of the Cato Institute. Read their responses here. Alternatively, judge for yourself by opening up the IRS’ ObamaCare proposed rules.

Fourth Amendment and DNA: The U.S. Supreme Court has upheld the power of government to collect and keep DNA samples from people who are arrested for serious crimes, ScotusBlog reports. Police want to expand the pool of genetic “fingerprints” to link suspects picked up for one act to others in the past. Plaintiffs cited the “unreasonable search and seizure” aspect of the Fourth Amendment.

Medicare has changed the billing codes for some diagnostic tests but did not assign codes for some novel tests that detect a combination of biomarkers. The tests without codes are not being reimbursed, discouraging investment and research into precision medicine, Scott Gottlieb of the American Enterprise Institute writes in Forbes. Some of the biomarkers’ greatest promise has been in personalizing the treatment of cancer by tailoring drug therapies to a person’s unique tumor type.

Quotes of Note

“For a month, a nonexempt individual is any individual who is alive for the entire month and is not an exempt individual for the month.” – IRS ObamaCare proposed rules, page 22 (73 pages).

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