The Ohio Hospital Association is about halfway through a 124-hospital, statewide initiative to reduce sepsis mortality by 30% by the end of 2018. Data shows the initiative is working and the target is attainable.
About 1,486 lives have been saved since the Ohio Hospital Association began itsstatewide initiative to reduce sepsis deaths in 2015. A new status report details the progress that’s been made in combating the single most expensive condition in the nation’s healthcare economy. Mike Abrams, president of the Ohio Hospital Association, spoke again with HealthLeaders Media about the progress being made. The following is a lightly edited transcript.
HLM: You’re about 18 months into a three-year initiative. How’s it going?
Abrams: Our goal is by the end of 2018 to have a reduction in sepsis mortality of 30%. We’ve achieve about a 13.5% statewide reduction. I sense a real enthusiasm and a real momentum on our side. You see from the report there has been great uptake on the part of our membership.
Anytime you can make people intellectually curious about a situation, that is half the battle. We have stimulated a lot of discussion and interest in prioritizing this problem. One of the elements of that is a deep and abiding commitment on the part of hospital and health system leadership. The C Suites are committed to resolving this issue.
I always remind audiences when I speak around the state that sepsis is the single most expensive condition in the US healthcare economy. Not only is it costly in terms of human life, it’s very costly for the overall economy of our country. This is something that health systems across the country need to make sure they are prioritizing.
HLM: Are the tools to reduce sepsis already in place? Is it just about increasing awareness?
Abrams: It goes a little farther than increasing awareness, although that is a huge part of it. We have to educate the people throughout the chain of healthcare providers, whether they are licensed professionals or people who are providing healthcare in the home or people driving ambulances. It’s about increasing their awareness. This is something they need to be curious about and interested in, and know the signs of sepsis, and what to do once they’re confident that they have a patient who might be septic. Also, during the handoff period between various providers, we have to make sure each level of care is interested in whether sepsis is an issue with a certain patient.
HLM: Can you explain some of the numbers around your reductions targets?
Abrams: The target rate is 14.9% but the goal is to reduce it by 30%. We did the math the other way around. We felt like a 30% reduction was a stretch goal, frankly. It was not going to be easy. But if we reduce it by 30% that mathematically puts our new rate at 14.9%.
HLM: Are you finding that it’s more difficult to nudge the percentages down now that you’ve plucked the low-hanging fruit?
Abrams: In some ways yes because we have done a really good job of informing our providers about the three-hour bundle and educating our people that this is a race against the clock. When we look at what is next, we are in that second tier of activity. We need to bring it to that next level.
There is the technology that we are talking about that includes working with our electronic health records, and a technology called Capnography, which measures CO2 in respiration. We are piloting with CMS (Centers for Medicare & Medicaid Services) because, when they start using this a little more aggressively, it is going to be a big indicator that they may have a patient who is septic and who needs treatment.
HLM: How are you using EHRs to fight sepsis?
Abrams: At hospitals they refer to alarm fatigue, and there is a little bit of that going on with alert systems in EHRs. You have constant alerts and pop-ups and you can’t always judge which are greater and which are unlikely. We are trying to improve the alert systems in the EHRs. We are also looking at how we use big data and biomarkers. Can we use big data, for example, to show that certain patients with certain characteristics are more likely to be septic than patients with other characteristics? For example, we might learn that certain BMIs or age cohorts or other characteristics might indicate that a patient is at greater risk of sepsis.
HLM: What will you focus on in the remaining months of this initiative?
Abrams: Frankly, one thing is keep doing the things that have been working so far. We want to layer in some new initiatives like this pilot program to see if it works. We want to continue our collaboratives in an all-teach-all-learn environment, where we have people who are curious about programs that are working in hospitals. They are interested in what their sepsis data shows, and they want to learn from each other. The hospitals who are knocking it out of the park can help the ones who might be struggling.
We don’t want to stop what’s working but we do want to layer in new initiatives. I referred to the PDSA Cyclefor physicians. “Plan, Do, Study, Act.” Look at initiatives, pilot them and assess if they are bearing the results we need. If they are, work on spreading them.
Auditors found that CMS made 1.8 million adjustments to Medicare capitation payments over a three-year period and recouped nearly $3 billion that had been paid on behalf of dead people.
The Centers for Medicare & Medicaid Services was “generally effective” in ensuring that capitation payments to Medicare Advantage contractors were not made for dead beneficiaries, a federal audit found.
The Department of Health and Human Services’ Office of the Inspector General examined CMS’ payments from 2012 through 2015. The auditors found that CMS made 1.8 million adjustments to capitation payments, and recouped $2.96 billion from MA organizations for Parts A and B capitation payments that had been made on behalf of dead beneficiaries.
The federal government paid more than $616 billion Medicare Advantage payments for the three-year span examine by OIG.
CMS did not identify and recoup all improper capitation payments, however.
"As of March 7, 2017, CMS had not recouped $2.4 million associated with 1,817 capitation payments that were made on behalf of 978 beneficiaries. For our audit period, these improper payments represented .0004% of the total capitation payments made to MA organizations and .08& of the total adjustments that CMS made after receiving information on beneficiaries' dates of death," OIG said.
"We recommended that CMS recoup the $2.4 million in capitation payments made to MA organizations for Medicare Parts A and B services on behalf of deceased beneficiaries, and that CMS implement system enhancements to identify, adjust, and recoup improper capitation payments in the future," OIG said.
CMS concurred with the recommendations and said corrective actions had been implemented.
Despite increased use of online resources to inform health decisions, a new survey shows that the 75% of registered voters are not using emerging healthcare innovations such as online health records and e-prescription services.
Nearly 60% of people use online health resources such as WebMD as a substitute for primary care, according to a new survey from the University of Phoenix.
"The healthcare industry is shifting to a patient-centered model that harnesses technology to both open communication channels and create a platform for patient engagement," said Doris Savron, executive dean for the College of Health Professions at University of Phoenix. "Given this shift, it is crucial that patients not only have access to these technologies, but also view them as important resources for improving their health and overall care experience."
Additionally:
48% of the 2,201 registered voters who responded to the online poll said the rising cost of insurance would be the biggest challenge facing the healthcare industry in the next five years, with 77% of respondents indicating that prescription drug coverage and monthly premium costs were very important when selecting healthcare coverage.
Only 25% of respondents who have access to health technology use resources such as e-prescription filing services (26%), online health records (25%) and online appointment booking services (15%).
Patients have strong feelings about the qualities that clinicians should have in traditional care settings. The vast majority of Americans find it “very important” for their treatment teams to have interpersonal skills, including listening (84%), verbal communication (83%) and bedside care (71%).
"The data shows that technology is just one piece of the puzzle when it comes to patient care," Savron said. "Although new technologies are resources that we should lean on to help improve communication, interpersonal skills are the foundation for ensuring patient trust and better care."
The survey was taken in mid-August and has a margin of error of plus or minus two percentage points.
Health spending growth in August was only 4.3% higher than one year earlier, and observers say the relatively slow pace is in response to a leveling-off in insurance coverage.
Fueled by the fight over the Affordable Care Act and structural health sector changes, healthcare price growth in August rose by only 1.2% compared to a year earlier, according to Altarum’sHealth Sector Economic Indicators Briefs.
This is the lowest health price growth rate recorded in almost two years, and just slightly above the all-time low. Contributing to overall slow price growth is a historically low Medical Consumer Price Index growth rate, a possible signal of relief for healthcare consumers with substantial out-of-pocket expenditures.
The 12-month moving average of the Health Care Price Index fell to 1.8% growth after being at 1.9% for six months, dousing any expectations of a return to a 2% growth rate range in the near term. Year-over-year hospital price growth fell to from 1.5% to 1.3%, and physician and clinical services price growth fell one-tenth to .5%. Annual drug price growth fell to a 2.7% rate, its lowest reading since growing by 2.4% in December 2015.
Despite an upward revision to recent estimates, health spending growth in August 2017 was 4.3% higher than a year earlier. The moderation in spending growth is in response to a leveling-off in insurance coverage.
Healthcare job growth also remained modest, with 22,500 new jobs added in September 2017, slightly less than the 2017 average of 25,000. Slow hospital job growth in 2017 is a primary force behind the health sector growing at about three-quarters the pace of 2015 and 2016.
In August, the health share of gross domestic project fell to 18%, exceeding $3.5 trillion. Spending growth in August increased in all major categories, led by home healthcare at 6.5%. Hospital spending continues to grow slowly, at a 2.3% rate.
Anthem says its list is an in-house screening tool to identify non-emergent care in the ER, but emergency physicians say it's a violation of the prudent layperson standard and could harm patients.
Emergency physicians say Anthem Blue Cross Blue Shield has created a "secret list" that contains about 2,000 emergency department diagnoses that the insurer will not pay for.
"There are things on there like 'chest pain with deep breaths' which we know as clinicians could be pleurisy but it could be a pulmonary embolism or a collapsed lung or influenza," says American College of Emergency Physicians President Rebecca Parker, MD.
"Thousands of people die from influenza every year," she says. "It’s like looking for a needle in a haystack and patients shouldn’t have to figure out whether or not they have an emergency."
Parker says ACEP learned about Anthem’s list from its state chapters in Kentucky, Georgia and Missouri.
"Anthem has to abandon this policy. It is bad patient care. It is not the way to look at appropriate use of acute care services," Parker says, adding that Anthem’s diagnoses list violates the prudent layperson standard — which is in the Affordable Care Act and in many state laws.
Instead of denying ED claims, Parker says Anthem should improve its provider network and expanding access points for care beyond the emergency department.
"Patients need to know that their insurance will cover them when they have emergency symptoms. We don’t want patients trying to make that decision at home," she says. "I don’t want someone clutching their chest wondering if they are going to be covered by their insurance company. People will die."
Anthem Responds
Jay Moore, MD, a senior clinical officer at Anthem, says ACEP is mischaracterizing how diagnoses screening lists are used. He says about 95% of all ED diagnoses codes Anthem processes are approved automatically without review, and that only "5% or less, depending on the market" trigger a flag.
"There is no 'secret black list code' that you are automatically not covered and we aren’t going to pay for a diagnosis," Moore says. "We told ACEP several times but I think they are marketing it this way because they don’t like the policy in general."
"It’s a screening list of diagnosis code that flag that case for review," he says. "It is designed to get on top of a trend that we have seen for some time in emergency rooms. We are seeing more and more people across all payers showing up who have less-than-emergent conditions. I’m talking about things like literally athlete’s foot or a headache, and I don’t mean a migraine; things we wouldn’t consider emergencies."
In the rare occurrences when a diagnosis is flagged, Moore says, it starts a review process that considers mitigating factors.
"A nurse starts by looking at the case and they make a determination as to whether the person is a child, or if it was a weekend or holiday where an urgent care might not be open" he says. "The other check is how close a person lives to urgent care, because you could go there instead of an emergency room."
"If someone lives in the country they may not have good Internet or many healthcare providers and the emergency room might be their best option, even for something that is relatively minor. We approve those cases regardless of the diagnosis," he says.
"If none of those exceptions are met the case is forwarded to a board-certified physician. They look at all the information the hospital sends us on a claim, including the diagnoses codes," Moore says.
"If you come in with some redness on skin that you think is an infection, but the final diagnosis will be poison ivy, that would show up on our screening list," he says. "But then we see the initial diagnosis and that would tell us why that person went to the ER. That is reasonable for someone with that condition."
Moore says the list of flagged diagnoses will not be made public "because we are refining our data and we are trying to decide what codes should and should not be on the list."
"We don’t want there to be some kind of master list that we have to keep updated and provide provider notification, and since it is just a screening list we aren’t obligated to share it," he says.
Moore says Anthem has responded to ACEP’s concerns about some of the diagnoses on the list.
"ACEP got our list and it was an early copy and it has 'chest pain on breathing.' They called us and said 'did you know chest pain on breathing is on the list?' We said, 'Hey, you are right!' so we took it off the list. It is no longer on the list of screening diagnoses," Moore says. "They continue to cite that even though they know it is off the list."
Moore says the screening list is one of a number of strategies that Anthem has developed to encourage patients to access care in less-expensive venues. Those strategies include bolstering the primary care and urgent care networks, and expanding telemedicine services.
Patients are usually notified that their claim has been denied several weeks after the ED care has been administered.
"They won’t find out in the ER," Moore says. "That would require the ER to call in the information and they would be doing a pre-certification for the ER visit and we don’t want to put that administrative burden on the ER. It will slow down the ER and reduce its mission to quickly respond."
He says patients can appeal the denial of coverage, and are told before they sign up for coverage that emergency department care is only covered for emergencies.
"You can’t have it as a primary care doctor. It’s not efficient. It’s not cost-effective, and it costs everyone else on the plan a lot of money," he says. "This is not going to affect the great majority of people. This is only going to affect a small number of claims and a smaller number of patients because it tends to be the same patients who abuse the system again and again."
Deal accelerates Express Scripts shift away from fee-for-service to value-based care; establishes platform to advance medical benefits management services.
Express Scripts today announced that it will pay $3.6 billion to acquire eviCore, the privately held medical benefits management company.
"Together with eviCore,Express Scripts will be an even more powerful partner in managing costs for patients and payers, bringing us closer to our goal of becoming the nation's leading patient benefit manager," Tim Wentworth, president and CEO of Express Scripts, said in a media release.
"By further strengthening our independent model and creating numerous opportunities for growth, the acquisition of eviCore will deliver value for our clients, patients, providers, and shareholders," Wentworth said.
The deal is subject to regulatory approval, but is expected to be completed by the end of 2017.
"The greatest opportunity to improve healthcare is by reducing wasteful spend and overutilization while delivering quality outcomes," said eviCore Chairman and CEO John Arlotta. "Together, eviCore and Express Scripts will be uniquely positioned to tackle these problems."
Bluffton, SC-based eviCore contracts with health plans and commercial clients to manage medical benefits for 100 million people in areas that include radiology, cardiology, musculoskeletal disorders, post-acute care and medical oncology. The company has approximately 4,000 employees and will operate as a standalone business within Express Scripts.
St. Louis-based Express Scripts, the nation’s largest pharmacy benefits manager, said the acquisition provides "an attractive entry point into a growing market."
"Today, pharmacy is an industry with approximately $400 billion in annual spend. Healthcare spend represents nearly $3.4 trillion. Medical benefit management is a large and growing market with more than $300 billion spent annually in the areas eviCore manages today," the company said. "Establishing a cornerstone platform in this market will enable Express Scripts to build a uniquely comprehensive suite of solutions, with significant opportunities for cross-selling to both client bases."
Express Scripts said the cost containment capabilities and expanded client base achieved in the acquisition "will create an even more powerful partner for our clients, fully aligned with the interests of patients and payers."
"This will further differentiate Express Scripts and position the company to take advantage of the transition to value-based care and the increasing demand from payers for a more comprehensive set of service offerings and solutions," the company said.
eviCore investors include General Atlantic, TA Associates, and Ridgemont Equity Partners.
Hospital patients who had good dining experiences were also more likely to provide optimal ratings for overall food quality than patients whose expectations were not met, study finds.
Patients don’t expect hospital food to taste good, and in that respect they are often not disappointed.
However, they place value on service-related elements of the meal, such as order accuracy, timeliness of delivery and staff courtesy, according to a new report from Press Ganey.
Those patients who had good dining experiences were also more likely to provide optimal ratings for overall food quality than patients whose expectations were not met, according to the study, which included data from 9,734 respondents over a three-year period from 2014-2016.
“We found that patients know that hospital food isn’t going to be that great. They expect it,” says James Merlino, MD, president and CMO, Strategic Consulting, Press Ganey.
“What is really important to them is the accuracy of the order and the friendliness and ability of the team; the perception that the food service workers are part of the larger team,” Merlino says. “That was the significant finding that came out of the quantitative research that was backed up in the focus groups we did. Patients are willing to forego the fact that the food isn’t that good. But they want it to be accurate. When they ask for something they want it to be right.”
“This suggests that it’s a modicum of control that patients have,” he says. “Patients give up all control in this submissive hospital environment, except for this little bit of control over their daily life.”
Merlino identified four target areas for improving hospital food services:
Food service should be a pleasurable inpatient experience. “You may not need to invest a lot of money to change the food, but invest in training so that your people understand that this element of the hospital stay is important to patients,” Merlino says. “Some of that training could be raising awareness for the people in food service who are working at the bedside."
Teamwork makes a difference. “We’ve done extensive work on the importance of teamwork at the bedside across all areas,” he says. “The patient wants to see people working together to make sure the order is being delivered in a team fashion.”
Meal ordering and service is important to patients. “Look at the processes for order accuracy and drilling down for why that fails and how you can improve the process to make sure that the orders coming to the patients are what they asked for,” he says.
Special diets require special attention. “Working better together through teamwork and communicating effectively at the bedside gives patients a better understanding of why they are on a special diet they may not like, which will impact their perception across other areas,” he says.
Taking action to improve food services and presentation doesn’t take a lot of investment, Merlino says, but it does require hospitals to relook at how they’re delivering the product.
“Overall, the ability to drive teamwork and create a better experience for meeting patients’ needs at the bedside is also going to impact your reputational scores as an organization,” he says.
The Press Ganey research was conducted in conjunction with Compass One Healthcare.
Rideout Health is a non-profit community health system based in Marysville, CA, with an acute care hospital, clinics and ancillary services located throughout Yuba and Sutter Counties.
Adventist Health has reached an affiliation agreement with Marysville, CA-based Rideout Health that should be finalized in early 2018, the two non-profit health systems announced.
Financial terms were not disclosed.
“We are excited to welcome Rideout Health to the extended Adventist Health family,” Adventist Health CEO Scott Reiner said in a media release. “We are confident that this affiliation will have a positive impact on patients and the broader Yuba City/Marysville community; we intend to grow the market with a focus on whole-person care and access to expanded healthcare options.”
“Under the affiliation, Rideout and Adventist will enter into a ‘membership substitution’ agreement,” Adventist explained in an email exchange with HealthLeaders Media.
“Before the agreement, the local community was the sole member of Rideout Health, but now Rideout will be substituting Adventist Health into that role as a nonprofit organization,” Adventist said. “Adventist Health will take responsibility for all the obligations and trust of the community’s asset. When it substitutes, it becomes part of Adventist Health’s obligated group, which in essence backs up all the financing and debt that the organization has had.”
Adventist said “it’s still too early to tell” if there will be leadership changes at Rideout. “Once the paperwork is submitted, the attorney general will have about three and a half months to approve the deal or deny it,” the health system said. “Adventist will not take over operations until after that occurs. In the meantime, Adventist plans on working through a transition plan and conducting an assessment to see what the local organization’s needs are and will eventually make its recommendations on potential changes.”
The existing Rideout board of trustees will remain intact, but there are plans to add new members from Adventist. There are no plans to displace Rideout employees.
Rideout Health is comprised of the 219-bed Rideout Regional Medical Center, an acute care hospital; the Heart Center at Rideout; Rideout Cancer Center, which is affiliated with UC Davis Health; outpatient clinics and a host of ancillary services including: senior living services located throughout the Yuba-Sutter County.
“Through affiliation with Adventist Health and our efforts together, we will continue to advance our mission of delivering exceptional healthcare to our family, friends and neighbors,” said Rideout Health board chair, Janice Soohoo Nall.
Roseville, CA-based Adventist Health includes 19 hospitals, more than 280 clinics, 13 home care agencies, seven hospice agencies and four joint-venture retirement centers along the West Coast and Hawaii.
More granular analyses of performance on specific medical conditions and procedures would make Medicare's hospital compare program's Star Ratings system more effective, says one observer.
For a second time in four months, the Centers for Medicare & Medicaid Services has delayed publishing revisions to its Star Ratings, which means the hospital comparison tool may not be available to the public until next year.
Rita Numerof, an author and veteran healthcare observer and consultant, believes CMS should use that extra time to reconsider some of the shortcomings of the Star Ratings system. She spoke with HealthLeaders Media about some of those challenges, and how CMS can improve the measures. The following is an edited transcript.
HLM: What needs to happen to make Star Ratings better?
Numerof: We need to make the information accessible and it has to be user friendly. The more there is scrutiny from experts around minutiae that delays the general public getting access to important information related to the performance of these hospitals, that is a problem. That is a delay tactic and it is not in the public interest.
When payment requires hospitals to focus on quality and outcomes they were able to get their act together and do it. Any industry would prefer having little to no oversight. We need a focus on transparency, quality, real accountability across the continuum and information that is made available to the consumer so that they can make meaningful choices about what is important to them.
HLM: We hear a lot of complaints about the weight given to patient experience.
Numerof: Patient experience is important, but it is not the same thing as the quality and safety of the care that I receive, and the ability of that institution to make sure that they do not have a surgical site infection, etc. Both are important, but to lump them together could really cloud the so-called quality of that particular institution.
HLM: There have also been criticisms that the Star Ratings are too broad for the needs of many consumers.
Numerof: Star Ratings gives a directional view to a patient of the quality of that institution based on a number of legitimate dimensions. However, consumers need to have access to more detailed information with regard to how that institution performs, not in a generalized way, but in a specific way associated with a specific condition.
If I am going to get hip or knee replacement, I want to know how these institutions compare with regard to volumes and outcome rates and patient satisfaction for that particular condition. The overall hospital quality five-star rating program was intended to give an overall view, but that is different from giving specific insight about performance in a particular surgical procedure.
HLM: Does Star Ratings sufficiently account for patient mix?
Numerof: You hear industry insiders talking about how their patients are different, especially from academic institutions and safety net hospitals. There are calculations and risk stratification scores that are applied so that those organizations get compared with each other and we do take into account in the measures severity of patients’ conditions.
Last year hospitals were concerned that their coding was not accurate. That was why their scores were not as good because the risk stratification that should have been applied to their patient population which would have enabled them to do better in Star Ratings was not captured appropriately.
That led to some serious changes on that institutions’ part, where they had to make sure they had the right data in the records they were reporting to CMS. That is not a problem of CMS and the Star Ratings. That is a problem of coding accuracy on the part of that institution. We shouldn’t be curtailing public reporting of legitimate safety and quality issues because of the complexity of reporting to take into account risk.
HLM: Why doesn’t CMS provide those specifics?
Numerof: The short answer is that it’s very political. There is enormous pushback from industry insiders, the American Hospital Association as an example, and various other organizations who have been very resistant to any kind of public reporting of quality or cost. This goes back decades.
HLM: You’ve called for a more forceful role for The Joint Commission. Please explain.
Numerof: The Joint Commission acts on behalf of CMS because CMS has allowed the accreditation process by this separate organization to stand for a CMS review. If you talk to The Joint Commission they say “We can’t force organizations to change. We are voluntarily engaged with them. They pay to be part of The Joint Commission review process.”
The Joint Commission and the industry can’t use its accreditation in promoting an institution on the one hand, and then if they get deficiencies, can’t say “we aren’t going to public report that. We are only going to publicly report the accreditation.” It can’t go both ways.
HLM:Do you anticipate any major changes to Star Ratings in the coming months?
Numerof: I expect some tweaks. There will be a focus on some of the statistical analyses, but you are not going to please all the people all the time with regard to this. There is discussion today about normalization of the data sets to avoid extremes in the data, to have better distributions. I would argue that in something like this you would want to highlight problems and not lop off extremes. You don’t want to get rid of them. You want to learn from them.
It’s a problem with statistics. The “average” is a statistical artifact. It doesn’t really exist. It’s something that we do to make sense of the data set. It’s like you’ve got one foot in a bucket of boiling water and the other foot on a block of ice. On average you are really comfortable.
The cutting edge technique is still a few years away from the marketplace, but it could have the potential to greatly expand the applications for prescription drugs and the way they are delivered.
University of Michigan researchers are working on a technology that can print pure, precise doses of prescription drugs onto various surfaces, which the developers believe could enable on-site printing of custom-dose medications at pharmacies, hospitals, and physicians’ offices.
The technique can print multiple medications into a single dose on a dissolvable strip, microneedle patch or other dosing device. Researchers believe it could make life easier for patients who must now take multiple medications every day.
Max Shtein, professor of materials science and engineering at U of M, is leading the research. He spoke with HealthLeaders Media about the potential for the new technology. The following is a slightly edited transcript.
HLM: How soon will we see this technology in the market place?
Shtein: We think that possibly within five years you might be able to see some applications of this technology. There are different bottlenecks associated with Food and Drug Administration approval, depending on the medications and the indications and the conditions you are trying to treat.
Normally FDA approval for any new medication or process for making a medication takes a while. There are certain conditions for which very few treatments are effective and those gets fast-tracked through the process. There are some possibilities for things to go a little faster. There are also possibilities for using this technology in research in the drug discovery and validation stages. We think that it’s going to be finding applications pretty soon, within five years.
HLM: Are you looking to focus on a particular field of study?
Shtein: Oncology is a very interesting area in part because the medicines can be quite expensive, the treatments can be quite complex, and oftentimes there are certain characteristics of the medication for treating cancer that make it difficult to get the medicine to the cancer, to maintain a regime that people are going to be willing to go through.
There are a lot of possibilities in treating cancers locally, but there is no way to deliver the medication locally, aside from painful injections and even that is an issue because the medicine doesn’t dissolve well. We have worked with a couple of compounds that are used for treating cancer, and we showed that we can enhance these solutions. Toxic solvents aren’t needed for getting it into the system. We demonstrated in a petri dish and there is a lot of promise, but you won’t know how it will work in a living system until you do those studies.
HLM: Does this technology have the potential to disrupt how pharmaceuticals are delivered?
Shtein: We don’t aim to disrupt. That is not our goal. What want to provide a better way of doing things and hope there is a more natural migration of interest from the old crummy way of doing it into this new better way of doing it.
From a standpoint of a person needing something that is uniquely tuned to their body, metabolism, genetic condition or whatever, it is going to be super easy to do that. If you have a course of action that requires a dozen different drugs or compounds and you have to take a dozen pills on a complicated daily schedule, and for half of the drugs the amount is too large and for the other half it is too small, that’s pretty hard.
With our techniques you should sidestep all of that. You print exactly what the person needs. You can do it in a pharmacy or maybe at a doctor’s office or maybe distributed manufacturing thing going on to make that possible. Thinking about it in those terms, all of a sudden it opens possibilities for prescribing medicines in a totally different way.
HLM: Should the shareholders at CVS or Walgreens be nervous?
Shtein: This could be an opportunity for them too. They might have a bunch of people in back now who are counting pills and mixing solutions when they could be providing a lot more value if they could personalize the medicine even further.
There is a big trade off in the pharmaceutical industry and healthcare that personalization is expensive and completely at odds with manufacturability and scalability. If you want to make something cheap it has to be all the same. That goes against the idea of personalization. With this approach you break this trade-off. There is no dilemma. There is no longer an either/or situation. You can get personalization and ease of manufacturing.
HLM: Who owns the rights to this?
Shtein: The University of Michigan has the rights to the technology, but we are in conversations to see what the best way to proceed would be.
HLM: What should we be looking for as this technology progresses?
Shtein: We need input from people who are out there working with specific ailments and conditions who are developing treatments. In particular, folks are working to develop data bases based on electronic medical records that allow a very intelligence physician or a deep-learning algorithm to learn what each patient needs and translate that to formulations.
We want to find conditions that are very difficult to treat using existing techniques where people could look at our study and get inspired to say ‘Could you help us with this compound delivered in this particular way to treat this condition?’ if we could work with those people we could get a cure to that population sooner.
HLM: Can this technology be used remotely?
Shtein: When you need something specific you can have a set of instructions and a cartridge or series of cartridges and this thing makes it on demand. Rather than transporting boxes of pills all over the place, it is a much more elegant way to do it.
HLM: What other uses do you foresee for this technology?
Shtein: Doing diagnostics to help people avoid acute conditions and reduce the cost of healthcare. This technique may help with that. We can deliver so many different compounds on a small area extremely precisely. That can be used for diagnostics.
For example, let’s say you’re allergic to something but you don’t know what. Right now the best you can do is go to a hospital or an allergist who is going to stick pins in your skin with all these different allergens. They do it on a grid and see how you react. You have to kill your entire day to find out. Well, if we can do the same test on an area that was smaller than one-inch, we could do it mail a patch to you that you put on and then the patch gets the information automatically, I just saved you a whole day.
That’s worth a lot. You reduce the inconvenience, you increase the precision with which it is done, and in a smaller area you can test a lot more allergens. You have to release these things in very small quantities because otherwise you can trigger a bad reaction. Well, this technique allows you to put a lot of different compounds into a small area and release small amounts. It’s compact and you can easily ship them. There is that potential.
HLM: What’s next?
Shtein: Our main thing is developing technologies that are ultimately going to help people. We are not just playing in the sandbox in isolation, so the faster we can do it the better.
