Category Archives: Feature

Obamacare Lives On, For Now…

This morning, the Supreme Court of the United States ruled that individuals who purchase health insurance through the federal government’s exchange will continue to be eligible for tax subsidies.

This King v. Burwell ruling came after months of political upheaval and planning for the aftermath of the court decision. An estimated 87 percent of individuals who enrolled through healthcare.gov are receiving subsidies. If the plaintiff had won the case, more than 6.4 million people would have lost the subsidies and faced an average premium rate increase of 47 percent, according to the RAND Corporation. The Urban Institute estimated that by using the available subsidy, a typical single person earning below 200 percent of the poverty level spends 4.1 percent of their annual income on insurance. Without the subsidy, it would take 30 percent of that person’s income to keep the insurance.

The case revolved around four words in the Affordable Care Act (ACA): “established by the state.” The plaintiff argued that this means the law prohibits the federal government from providing premium tax credits and cost-sharing reductions to residents who live in states that did not establish their own state health insurance marketplaces. Thirty-four states do not have state-based exchanges.

Today, Justice Roberts wrote in the ruling that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them” and that the law must be read with its intent in mind.

The White House went on record multiple times that it did not have a contingency plan to restore subsidies if the Supreme Court ruled against the administration.

If subsidies were shut down, analysts predicted a classic “death spiral.” Insurers would suddenly have a risk pool filled with high-need, high-cost people, after having priced their 2015 premiums based on a balanced pool containing both healthy and sick people. Many insurers might leave the market, and remaining plans would be forced to absorb disproportionately high-risk customers from any exiting insurers, as they’re required to do under the individual mandate.

The insurance and hospital industries are hailing the rule for creating a “more stable” future. Share prices soared, with several hospitals hitting all-time highs. Democrats on the Hill announced the ruling as a win for America while many Republicans made it clear they will not give up their efforts to repeal the law. Presidential candidates on both fronts released statements and took to Twitter to share their views.

Rand Paul posted that “this decision turns both the rule of law and common sense on its head,” while Hillary Clinton tweeted, “Yes! SCOTUS affirms what we know is true in our hearts & under the law: Health insurance should be affordable & available to all.

Although there will continue to be hot rhetoric from Republican presidential candidates, this suit has been widely regarded as a “final test” for the ACA. It is highly unlikely that the ACA will have to face another legal challenge of this magnitude in the courts. The other controversial provision, the individual mandate, was upheld by the Supreme Court in 2012.

It appears the ACA is the law of the land – here to say forevermore… unless there is a total Republican sweep of Congress and the White House in 2016. Then the fun begins again.

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Framing the Conversation on Dying in America

As a semi-typical middle schooler cramming for the Spelling Bee, my favorite thing about words was that they had both connotations and denotations. Denotations may be the dictionary definitions the announcer gives out, the ones I begrudgingly memorized, but the connotations were the ones that mattered. As more states look at end-of-life care and more articles crawl up the newsfeeds, I find myself thinking about how the words we use interchangeably are often masquerading as synonyms to further complicate already-complicated issues.

Dying is never easy. The ethics of physician-assisted dying is nuanced on both sides. Proponents argue for a right of self-determination; if we hold to our rights on living the way we want to live and receive healthcare to maintain our living capabilities, it only seems natural to receive help from the medical system to spend our last days in a dignified manner. For some people, this is much too simplified. Patients can feel pressured by families, psychological disorders, pain, financial problems, and the feeling that they are too burdensome on others. There is the possibility of developing into a weapon against the disabled community, or growing into a system of injustice against seniors.

At the same time, who can deny a terminally ill patient the right to remove himself from pain? The right-to-die and slippery slope arguments are complex, balanced on a multitude of factors that range from gender and economic variables to geographic location and religion.

How does this complexity relay itself to a world of click-baiting headlines and 140 characters? Not easily.

When the subject was “Dr. Death,” the enigmatic pathologist Jack Kevorkian who helped over a hundred patients die, the media was not as divided. Dr. Kevorkian often broke his own rules and many reports on both sides of the debate questioned whether his patients were even terminally ill. His “mercy machine” was dubbed the “death van” and his legacy remains exceptionally controversial. But activist and patient Brittany Maynard brought a different light.

“Brittany Maynard, because she’s young, vivacious, attractive, a newlywed, has a dog, and is a very different kind of person from the average middle-aged or older person who has to confront issues about terminal illness, changes the optics of the debate.”

According to bioethicist Arthur Caplan, her story grabbed the attention of a new generation. Her video went viral, blogs on both sides erupted and Twitter was all ears. Her courage and background captured imaginations and emphasized the relevance of the conversation to a broader audience. But it didn’t make it any less complicated.

Take the headlines in themselves- “physician-assisted suicide” is the key phrase that garners the most media hits, but supporters might prefer “physician-assisted death” or “aid in dying.” The “Death with Dignity” movement, discussions on the “End-of-Life Option Act” and organizations like “Compassion and Choices” remove the seemingly problematic connotation of “suicide.” Implicit within the understanding of that word is the notion that it is wrong; the person making this decision needs intervention, even involuntary psychiatric treatment but not drugs for dying. Those who attempt suicide are not generally seen as people making conscious decisions. Thus, their rights of self-determination are overstepped by a moral medical system that saves lives. The “end of life option,” on the other hand, highlights the autonomy each patient has in deciding how to die. The implication is that just as we plan for each stage in our lives, we should make informed choices on death as a natural extension of life.

When asked about allowing doctors to “end the patient’s life by some painless means,” a grand majority (70%) of Americans were in favor of allowing doctors to hasten a terminally ill patient’s death. But when asked about doctors helping a patient “commit suicide,” only 51% were supportive.

A 2013 Gallup poll is the perfect example of how much word choices say. There is no question of reaching an easy consensus on the issue, but framing the debate? That can be an important conversation to reduce noise. Dying vs. Suicide, Murder vs. Mercy, Choose vs Commit – the issue brings to light the myriad ways in which those who spark conversation in society direct the debate.

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Getting to the Point of Precision Medicine

The Twitterverse was aflutter during President Obama’s State of the Union (SOTU) address. According to social media listening tool Sysomos, there were approximately 2.1 million #SOTU- related mentions on Twitter during the one hour speech covering a wide range of economic, social and health care related topics. What’s more interesting, First lady Obama hosted a health data scientist who’d once worked for Google, IBM and now with the U.S. Digital Service. Presumptuously, the health care industry expected an announcement about advancing the role of health IT and interoperability among the provider community. Instead, what we heard was President Obama calling for an increased focus on research and development in “precision medicine” projects – a fledgling, and important, industry sector within the disease and molecular diagnostic community.

Specifically, the President’s agenda aimed at “using digital and genomic data to develop highly targeted disease treatments. The proposal would invest in ‘precision medicine’, an innovative field that provides healthcare professionals with tools, knowledge and treatments to tailor care to a person’s unique characteristics — such as their genetic makeup,” according to The White House blog.

As stated in The White House Release, “recent advances in genomics and digital data have produced powerful new discoveries about health and disease that have made it possible to design highly effective, targeted treatments for cancer and other diseases.” Obama’s proposal “will engage patients and healthcare providers in delivering this new era of medicine.”

Precision medicine has been a movement afoot that re-coined ‘personalized medicine’ to ‘precision medicine’, a new term to give the concept a fresh start by medical academia and health tech industry. Essentially, it is using the same knowledge we have gained by mapping the human DNA to use but with more advanced technologies. Either way you slice it, precision medicine, or personalized medicine 2.0, combats the 20th century ‘one size fits all’ mindset to drug therapy, and applies the data extrapolated  from genome mapping into more effective medicines to help speed up patient recovery, stave off diseases, and advance new drug discovery.

According to Dr. Lakdawalla of the National Pharmaceutical Council, whose organization’s primary mission is to improve quality of care and control costs by driving public and private research in comparative effectiveness, or ‘patient-centered outcomes research’ (PCOR), claims “there are new methods and economic analysis of data that allows researchers to estimate individual effects of drugs. We can look at 100,000 people’s information and compare two different treatments and figure out what each treatment is going to do to the individuals as if they were on each drug at the same time.”

However, even with these advances in mind, the health care community is still having difficulty putting actionable data to use. According to Dr. Lakdawalla, “there are many struggles within the health care community – among medical academia, researchers, providers and insurers – to meet the needs of the entire population and the individual by getting the right therapy to the right person at the right time.“

While the health tech and biogenetic forces continue to evolve their methodologies to support the advancement of patient-centered outcomes, The Myth of Average: Why Individual Patient Differences Matter outlines practical methods that can help identify patient diversity. What it boils down to is that patients today should be having an informed conversation with their health care provider (HCP), but patients are simply not aware of the right questions to ask their HCP in time of need. There should be an informed discussion among the physician and patient to decide on the best treatment based on the patient preferences and their personal response to certain drugs.

In order to advance precision medicine and make a tangible difference in patients’ lives, we must focus on developing a practical approach that begins with educating patients on the right questions to ask their HCPs, and empowering HCPs to factor in their patients’ individual needs when discussing their treatment options.

It is safe to say that in the end, regardless of political affiliation, we all want what President Obama called for in his address, “to cure diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.”

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It’s here! The 2015 Freshman Healthbook for the new class of the 114th Congress

Includes analysis of healthcare positions; identifies potential health policy leaders

Fellow healthcare advocates, consider this an early holiday gift from us at TogoRun. Today we released our second “Freshman Healthbook,” a free advocacy resource that analyzes the healthcare priorities of newly elected members of the 114th Congress with a specific focus on issues such as the Affordable Care Act (ACA), medical innovation, children’s health, mental health, Medicare, physician reimbursement, reproductive rights and veterans’ health.

The first edition profiling the 113th freshman class was downloaded more than 2,000 times by reporters, lobbyists, advocates and healthcare organizations. The TogoRun team has been working tirelessly since before the election to uncover the previous voting records, public statements, personal health experiences and other “fun facts” about the 2015 freshman class.

Highlights from the 2015 Freshman Healthbook include:

  • Health policy positions of the 114th Congressional freshman class, which includes five with direct healthcare experience.
  • 10 freshmen to watch as the potential new healthcare power players.
  • Comparisons to the 113th freshman class such as political make-up, diversity and gender.
  • Freshmen with an appreciation of medical technology’s value.

TogoRun’s top 10 “Ones to Watch” for the 114th Congressional freshman class are:

SENATE
Shelley Capito (WV-R)

HOUSE
Rick Allen (R-GA-12)
Buddy Carter (R-GA-1)
Barbara Comstock (R-VA-10)
Debbie Dingell (D-MI-12)
Robert Dold (R-IL-10)
Tom Emmer (R-MN-6)
Seth Moulton (D-MA-6)
Jon Moolenaar (R-MI-4)
Mark Takai (D-HI-1)

This resource is insightful, helpful, and frankly, a fun read for anyone who works on or around Capitol Hill. I dare say…not even just for healthcare people. This year we included additional interesting profile factoids that might offer great fodder for the season’s Beltway cocktail party.

TogoRun will release a 2.0 version of the Freshman Healthbook in January 2015 that includes committee assignments and additional information provided to us or uncovered from new publically available information. We welcome all feedback and input, email me at a.woodbury@togorun.com.

Download the 2015 Freshman Healthbook today and get ready to dog-ear some pages.

Anne Woodbury

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To Tweet or not to Tweet: Europe’s digital conundrum

Twitter-BirdFor most pharmaceutical companies in Europe, the use of Twitter verges on an existential crisis. With social media regulations that vary from country to country and language barriers to overcome, companies often find themselves asking, ‘Why do I need Twitter and what value can Tweeting bring?’

Why do I need Twitter?

When you look at what pharmaceutical companies have flocked to Twitter, the majority of the tweets are coming out of the United States. As one of only two countries (the other being New Zealand) that is allowed to advertise directly to the consumer, the U.S. tends to throw caution to the wind when considering the use of social media channels such as Twitter. Whilst the tweets tend to be quite corporate in nature – covering items such as press releases, company overviews and CEO blog posts – the appeal of this format is obvious. It gives companies the opportunity to control their message and disseminate news directly to their followers for a fairly nominal cost.

On the flip side, if European pharma should try this tactic, the price could be much more significant.  Individual countries in Europe have restrictions in place to stop direct-to-consumer advertising. That, combined with the threat of considerable fines, may be more risk that companies are willing absorb. A well-known global pharmaceutical company found this out the hard way when it was reprimanded for tweeting about two medications in 2011. Though the company escaped without a fine, the decision in the UK by the Prescription Medicines Code of Practice Authority (PMCPA) set a cautious tone, instilling fear that even the slightest mention of a drug can result in a public rebuke.

Companies are now bound by the following PMCPA guidance on digital communications:

“If a company wanted to promote a medicine via Twitter it would have to ensure that if the medicine was prescription only, the audience was restricted to health professionals only.”

In a medium like Twitter, this is simply not possible.

What value can Tweeting bring?

Pharmaceutical companies have a lot to gain by using a channel like Twitter.  The apparent limitation of being unable to advertise could slipstream the companies into a more concise role. Rather than delivering details of their corporate environment, they stand to help patients better manage their disease and improve their profile by becoming thought leaders within a disease area. By improving the dissemination of information in the health environment, pharmaceutical companies stand to gain from an educated audience who are able to more easily recognize their symptoms.

‘To be or not to be’ – this is an allusion of a choice. With the equivalent of 8,123 copies of War and Peace tweeted every day, Twitter has become one of the most valuable business resources available today. The pharma industry has a lot to lose by sitting on the sidelines.

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