As Walmart Buys Online Retailers, Their Health Benefits Suffer

In little more than a year, Walmart has spent nearly $4 billion acquiring e-commerce companies with thousands of workers. Last month, many learned that their potential out-of-pocket costs for medical expenses would increase in 2018 at a rate far exceeding the overall rise in health care costs — reaching thousands of dollars in many cases.

Health care benefits tend to be harder to come by in retail than in any other industry, with just over half of all retail employees eligible for company plans, versus more than 90 percent in manufacturing, according to a survey this year by the Kaiser Family Foundation. Retail workers also opt into their company plans at a far lower rate than any other industry’s workers, possibly suggesting that the insurance is not very attractive or affordable even when companies do offer it.

The abstract to the KFF survey reads:

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer practices. The 2017 survey included more than 2,100 interviews with non-federal public and private firms.

...The 2017 survey includes information on the use of incentives for employer wellness programs, plan cost sharing, and firm offer rates. Survey results are released in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs.

What used to be employee-based insurance, and I'm sure you hope to have such insurance in your own workplace, is no longer affordable by many employees.

Banner Health hits snags migrating two hospitals from Epic to Cerner EHR

As I continue to read your blogs and comment on your second drafts, I came across this article in Healthcare IT News (from a Kaiser News link).  It speaks to many issues we discussed, including how difficult it is to switch to new EHR systems, and that long lines persist even in the US (and not just Canada).   The picture posted on the article should look familiar.  I love this quote.  It masks the real issues underfoot, don't you think?

While EMR implementations are always challenging, our specific challenges have included issues with slowness and workflow delays that have caused longer than normal patient wait times.

The short article chalks it up to implementation issues that will soon be remedied.  "Banner’s chief clinical officer John Hensing, MD, told the Arizona Star that the Cerner migration has thus far been a 'painful period,' but added that performance degradation can happen when switching to any new application because transitioning systems is a complex undertaking."

Really?  So we can expect smooth sailing soon?

Watch the Backstory of the American Opioid Story

I posted the reading in D2L and in an earlier post on this blog about the Sackler family from the New Yorker article (and we heard from Steven May who is also mentioned in this article).    Here is a link to the video of the backstory from Patrick Radden Keefe, the author of the story.  It is pretty grim for a 6-minute video.

Watch this video on The Scene.

More on Purdue and the Sackler Family

Regarding the question regarding the board of directors at Purdue.  In the New Yorker article from the end of October about Sackler family, it starts like this:

Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative, at Brandeis University, has worked with hundreds of patients addicted to opioids. He told me that, though many fatal overdoses have resulted from opioids other than OxyContin, the crisis was initially precipitated by a shift in the culture of prescribing—a shift carefully engineered by Purdue. “If you look at the prescribing trends for all the different opioids, it’s in 1996 that prescribing really takes off,” Kolodny said. “It’s not a coincidence. That was the year Purdue launched a multifaceted campaign that misinformed the medical community about the risks.” When I asked Kolodny how much of the blame Purdue bears for the current public-health crisis, he responded, “The lion’s share.”

Although the Sackler name can be found on dozens of buildings, Purdue’s Web site scarcely mentions the family, and a list of the company’s board of directors fails to include eight family members, from three generations, who serve in that capacity. “I don’t know how many rooms in different parts of the world I’ve given talks in that were named after the Sacklers,” Allen Frances, the former chair of psychiatry at Duke University School of Medicine, told me. “Their name has been pushed forward as the epitome of good works and of the fruits of the capitalist system. But, when it comes down to it, they’ve earned this fortune at the expense of millions of people who are addicted. It’s shocking how they have gotten away with it.”

Read more... 

Pulitzer Award on Opioid Abuse in West Virginia

Here is a series of articles related to our topic this week. Rather than add it to our readings, I thought we could comment here. Click on the author and Gazette-Mail link for access to the three articles. I'll post some thoughts below.  But you can do the same.

INVESTIGATIVE REPORTING

Photo

Mr. Eyre (pronounced AIR), 51, won the award for a series of articles about the opioid abuse epidemic in West Virginia. Mr. Eyre, the paper’s statehouse reporter, began his multipart series with these words: “Follow the pills and you’ll find the overdose deaths.” It took Mr. Eyre years to acquire the documents most important to his reporting, and he did it “in the face of powerful opposition,” according to the Pulitzer citation. A lawyer defending a drug wholesale company said that it was vital to protect crucial court records “from the intrusive journalistic nose of the Gazette-Mail.”

The series uncovered how small towns of 392 people were devastated from opioid overdoses.  Look at the data, read the series, and comment.  Follow the link:

Eric Eyre, The Charleston Gazette-Mail

Opioids: Last Week Tonight With John Oliver (HBO)

I saw this last year (Oct. 2016), and maybe you did, too.  The language is explicit, and views of addicts and what they do to get their drugs.  But it's relevant to our week of Pharma and Addiction conversation.  He interjects his strange humor as he gets to the main points, which are important, especially Purdue's marketing of OxyContin.

Personalized Diagnostics

Here is another example of what we talked about today: Personalized Diagnostics, which is the result of research to create drugs to treat a large variety of cancers. After all, cancer is not a single disease, it is a collection of diseases.  Every cancer is different because it is caused by a different mutation. BRCA1 gene mutation primarily causes Ovarian cancer while KRAS gene mutation primarily causes Colo-rectal cancer. But it is more complicated that.

A single gene can have mutations in thousands of different places. Some mutations have shown no effect in cancer development, whereas other specific location mutations wreak havoc on the body.  For example, take a look at the below image. Though BRCA1 mutation causes Ovarian cancer, specific location mutation in the same gene can result in other forms of cancer. Similarly, mutations in genes other than BRCA1 can lead to Ovarian cancer.

What does this information mean?

This means that there is an astronomical number of mutation combinations possible, and we are barely scratching the surface of targeted cancer therapies.  For simplicity, say MutationA responds to Drug1 and MutationA has no response for Drug2, we can then say that Drug1 is the preferred treatment for MutationA. This means that there is potentially lot of trial and error to understand which drug works for which mutation.  Cancer research institutes have been collecting this information for a long time, with thousands of records of medical literature for cancer and its treatments. Yet we have more to work towards better targeted therapies.

Finding the gene is inefficient

Though we may have information on the best recommended therapy for a cancer, targeted therapy would mean that we need to understand the composition of the cancer. The current scenario involves the oncologist conducting a tumor biopsy followed by a single gene mutation test. Once the mutation is understood, the oncologist relies on his/her expertise or references current medical literature for the best targeted treatment. This would mean hours spent on combing through information.  Then, we have to ask, is this the best possible scenario?  What if the single gene sequencing reveals no mutation and the tumor is caused by another gene?  Gene sequencing is expensive, now which single gene mutation test should the oncologist order?  Even if sequencing a gene is affordable, running tests one gene at a time to find the mutation can be costly for the patient's life, as time is of the essence when dealing with cancer remedies. 

Making cancer treatment personal

Personalized Diagnostics can help overcome the inefficiency faced by care providers today. I'll give a brief overview:

A collaboration between IBM Watson, Quest Diagnostics, and Memorial Sloan Kettering has facilitated in the development of the Comprehensive Cancer Test called OncoVantage™. Each organization is responsible for delivering an integral component of Personalized Cancer Diagnostics. A simple diagram below shows the role of each player.

With OncoVantage™, oncologist are able to run mutation analysis for 34 genes at the same time for a considerably reduced cost. Additionally, the oncologist saves time with the report being presented with the latest medical literature referencing all the mutations identified in the tumor.

Quest Diagnostics

OncoVantage™ is a $3,000 test using the latest genome sequencing to analyzing mutations in 34 genes in one complete sequencing from a sample of the tumor biopsy. The mutation analysis along with the complete sequencing report is shared with IBM Watson.

IBM Watson

Using advanced computing power, Watson cross-references the mutation analysis with the medical literature. Its advanced cognitive system is able to present a weighted analysis for each mutation observed and present a comprehensive report.

Memorial Sloan Kettering

MSK is one among the many partnership with cancer research institutes that IBM Watson has leveraged to fight against cancer. MSK with 130 years of excellence dedicated to cancer has a real-time functioning database for cancer research called OncoKB. This vast repository provides data which include treatment methods and its effectiveness.

Oncologist can now download this report to make informed decisions. The report also provides current clinical trials which aids the oncologist to recommend programs which the patients can participate.  Saving time and offering a precise treatment comes from an enhanced diagnosis. Personalized Diagnostics still has a long way to go, but this collaboration shows us the promise of the future of targeted therapies, not just for cancer, but potentially all diseases.