Sunday, April 15, 2007

Clinical Innovatitons - Innovation News This Week

This snippet of stories, drawn from various news sources from April 10 to 13, affirms three of my beliefs,

1) innovation characterizes American health care;

2) the market sets limits to innovation; and 3) the private sector and government can learn from one another. Innovation's handmaiden, market risk, always lurks.
This is what Amgen, Pfizer and UnitedHealth, whose innovations got them where they are, learned this week. We also learned three phenomenon marked by individualism -HSA/high deductible plans, blogging, and free market health care in Canada, are still on the ascendancy. They too, soon or late, will reach their limits. And finally we learned that a giant government health system, the VA, can innovate and set the pace for the private sector. What follows is what the news taught us this week about innovation – its promise, its limits, and its lessons.

Don’t Put All Your Innovations in One Basket

The stock of Amgen, the world’s biggest biotech company, plunged after its two anemia drugs, Aranesp and Epogen, used to raise hemoglobin levels kidney failure and cancer patients, were reported to cause heart problems with too high a dosage. The drugs account for 50% of Amgen’s sales. (“Amgen’s Star Fades Amid Safety Questions,” Wall Street Journal, April 10)

Forcing All Your Clients into One Basket May Not Be The Innovative Thing to Do

The new UnitedHealthGroup’s policy of threatening to fine the nation’s 520,000 doctors with whom it does business if doctors don’t refer to Lab Corps, Inc, is backfiring. United is known for using its heft to negotiate cut-rate fees with doctors, drug makers, and other suppliers. Backfiring adds to UnitedHealth’s woes from its backdating stock-options scandal and its rancorous contract disputes with doctors in California, Colorado, and elsewhere (“Doctors Assails UnitedHealth’s Threat of Fines, Wall Street Journal, April 10)

Some Innovations Take it in the Throat, So Don’t Be Too Exuberant

Exubera, Pfizer’s inhaled insulin drug, sounded like a “Can’t Miss”when introduced last year. Pfizer’s message to diabetics was: Inhale and spare the needle. But after 6 months of marketing, Exubera is prescribed in only 1 out of every 500 insulin prescriptions. It’s far less popular than Junuvia, a new Merck diabetic drug, prescribed 25 times more often than Exubera. The problems with Exubera seem to be its bulky hard to use inhaler, its expense (twice those of needle-delivered drugs), and doctor fears it will damage the lungs (“Pfizer Drug for Diabetes Lags, “ New York Times, April 10, 2007)

Blogging Can Be An Innovative Path to a New Job

Among some, the blogisphere is considered the latest and greatest media innovation. Now corporate recruiters are surfing the blognet looking for talent. To make your blog recruiter friendly: include a tagline in your blog’s banner so its theme can be identified quickly, stay current on hot topics, omit personal information, submit frequent blogs, contribute to other blogs to increase search-engine rankings. Above all else, don’t clog your blog with fog or recruiters may noggin off.(“How Blogging Can Help Get You a New Job,” Wall Street Journal, April 10)

HSA/HDCPs, Consumer-Driven Care Innovations. Are Growing at a 41% Annual Clip

A periodic census by America’s Health Insurance Plans (AHIP) of U.S. health insurance carriers shows people covered by health savings accounts/high-deductible health plans (HSA/HDHPs) totaled 4.5 million in January 2007. This was up by 1.3 million from the 3.2 million figure reported by AHIP members in January 2006. This is a 41 % increase. If growth were to be sustained, HSA/High Deductible membership would reach nearly 18 million 2010 and 95 million by 2015. AHIP received participation from virtually all private health insurance carriers in the HSA/HDHP market for this census. This census doesn’t include coverage associated with health reimbursement arrangements (HRAs), which are most commonly offered in the large-group market (Center for Policy and Research, April 2007)

The VA Innovates with a System-Wide Electronic Medical Records System

The VA, under recent unremitting political attack, is finally getting some good press. Over the last 8 years, the VA has installed a universal electronic system lining its 155 hospitals, 881 clinics, 135 nursing homes, and 45 rehabilitation centers. The system permits any authorized person to view 5.3 million patient records – everything from a nurse’s note, to the result of a blood test drawn during a clinic visit, to the video of a coronary angiogram done in a cardiology lab. In the process, it has done away with paper charts – the bete noir of those who criticize the efficiency and safety of the American health system (“VA Takes the Lead in Paperless Care: Computerized Medical Records Promise Lower Costs and Better Treatment,” Washington Post, April 10.)

Canada Innovates Privately, But Now Without Moral Reservations

A private Vancouver clinic has found a way to charge patients for basic medical care. The False Creek Urgent Care Center provides diagnostic and treatment services for patients with acute but non-life-threatening ailments, such as broken bones or lacerations. The Center charges a set fee of $199, plus additional charges for some procedures.
Provincial legislation allows doctors to charge patients directly if they’re not enrolled in the B.C. Medical Services Plan. Since physicians hired by the center are from out of province and not part of the public system here, The Center believes it’s free to charge for its services. Legally, the center has a case. Private clinics have operated in Quebec for years. But according to the Times Colonist newspaper in Victoria, public values are at stake. Free, universally accessible medical care is one of Canada’s defining accomplishments. It helps shape the nation’s sense of a compassionate society.A court challenge is unlikely. The Supreme Court has already ruled that physicians -- and patients -- can make private arrangements if they find the public system unsatisfactory.
(“ Private ER legal, but Still a Concern: Doctors have the Right to Opt out of Medicare, but Two-Tier Care is a Risk to the Public System, Times Colonist (Victoria), April 13, 2007)

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