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‘It’s All about Med Adherence’: Atrius Health’s Dr. Steven Strongwater Discusses Accelerating Change in Healthcare—and Cracking the Code on Improved Care at Reduced Cost (Part 2)

Posted By John W. DeWitt, Wednesday, September 26, 2018

“A lot of non-value-adding costs need to be cut out of the chain,” asserted Steven Strongwater, MD, CEO of Atrius Health, in his thoughtful and data-packed presentation during the ASAP Leadership Forum meeting on opening day of the September 24-26, 2018 ASAP BioPharma Conference in Boston. When it comes to prescription drugs, for example, “it’s all about med adherence. The problem is very practical. In New York, there are ten thousand homeless children. How compliant are they going to be with their asthma meds? Instead they go to the emergency rooms.”

The urgency of reducing soaring US healthcare costs while improving outcomes is a constant mantra for Strongwater and Atrius Health, which serves 720,000 patients in the state of Massachusetts with 1,300 clinicians and 825 physicians across 32 clinical sites in over 50 specialties. The non-profit accountable care organization (ACO) generates about $2.1 billion in revenue and is the top-ranked ACO for quality of care in both New England and nationally.

Regarding the challenge of prescription and therapeutic adherence, there are of course many factors and interdependencies involved, from drug costs and prescription protocols to care models and patient behavior, all of which means you need to ask, “What’s the full delivery chain?” His ask of the biopharma partnering execs in the room was specific: “How will you not only sell [pharmaceuticals that help patients], but also help us manage down the total cost of care?”

One biotech executive immediately responded that “drug companies care a lot about adherence—we talk about it every day.” Dr. Strongwater replied, “We don’t hear it—but if that’s the case, there are 560 ACOs who’d be interested in working on this with you.” (Strongwater describes ACOs as groups of providers that collectively accept responsibility for overall spending and quality outcomes for attributed beneficiaries. There are 561 ACOs nationwide as of May 2018.)

Stuart Kliman, CA-AM, partner at Vantage Parners, introduced Dr. Strongwater and moderated the leadership forum discussion. At this point, he interjected with an example of a company that is taking a holistic approach to adherence, commenting that “we should be thinking about adherence as a total solution—are we in the drug business or the solution business? And what is that [total solution] going to look like?” Which of course begs the money question: Which organizations in the life sciences and healthcare space are going to invest in holistic delivery solutions?

“We on the front lines do not have the R&D budget to study this,” Dr. Strongwater noted. “This is basic lab research funded through grants, mainly NIH [National Institutes of Health]. Operations research around adherence, compliance—there’s no funding stream to do this kind of delivery-at-the-front-end work. And we really do need help.”

Strongwater spent a slide discussing the frontlines challenge of compliance in diabetes—providing another thoughtful illustration of the entangled drivers of rising healthcare costs. He offered a case example of “a 48-year-old woman who weighs 200 pounds, has two children, and works as a medical secretary making $45,000 a year. She has diabetes and hypertension—but can’t afford her insulin on a regular basis.” Atrius has an analytics tool that can predict, with 80 percent accuracy, the likelihood of a high-risk patient requiring hospitalization—but a doctor probably wouldn’t need that tool in this all-too-common scenario for diabetes patients. “About half of diabetics skip care because of the cost of drugs and 45 percent cut back on treatment. Insulin costs spiked eight percent last year,” he added, noting that insulin price has nearly tripled since 2002 and that three manufacturers control the insulin market.

Strongwater then described one way Atrius is tackling the cost challenge for its diabetic patients—“an initiative within Atrius to switch to lower cost test strips.” With 80 percent utilization, this initiative will save Atrius itself nearly a million dollars a year. Patients still pay their usual copay, but get a free new meter and, if they pay out-of-pocket, they will be able to pay less for their strips.

Stay tuned for more about the ASAP Leadership Forum discussion—including Dr. Strongwater’s analysis and recommendations for collaboratively cutting healthcare costs—as well as the ASAP Media team’s onsite coverage of the 2018 ASAP BioPharma Conference. 

Tags:  accountable care organization  Atrius Health  Dr. Steven Strongwater  Healthcare  healthcare reform challenge  improving outcomes  Stuart Kliman  therapeutic adherence 

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‘We’ve Already Transitioned to Value-Based Care’: Atrius Health’s Dr. Steven Strongwater Discusses Accelerating Change in Healthcare—and Cracking the Code on Improved Care at Reduced Cost (Part 1)

Posted By John W. DeWitt, Tuesday, September 25, 2018

What’s on the leadership agenda today for biopharmaceutical alliance executives? How about collaborating to reduce drug costs, suggested Steven Strongwater, MD, to a group of about 20 life sciences alliance executives who participated in an ASAP Leadership Forum meeting and workshop session facilitated by Stuart Kliman, CA-AM, partner at Vantage Partners. The group met in a closed-door session the first afternoon of the September 24-26, 2018 ASAP BioPharma Conference in Boston.

Healthcare spending in the US is “something like $3.3 trillion, or $10,000-plus per person per year. It’s approaching 18%, and heading north of 20%, of GDP [gross domestic product]. A lot of this is driven by drug costs,” said Dr. Strongwater, who is president and CEO of Atrius Health, a non-profit accountable care organization (ACO) that employs 6,800 medical professionals and serves 720,000 patients in eastern Massachusetts. Atrius, with 1,300 clinicians and 825 physicians across 32 clinical sites in over 50 specialties, generates about $2.1 billion in revenue and is the top-ranked ACO for quality of care in both New England and nationally.

“Things are in rapid, accelerated transition right now, with all of these vertical and horizontal mergers like CVS-Aetna, Cigna and Express Scripts, WalMart and Humana. … Digital health is a major transformational force,” he added, flashing a chart showing the explosion, in number and size, of digital health deals since 2011. (Average deal size today approaches $18 million, and 2018 likely will see nearly 700 digital health deals worth a cumulative $8 billion, according to the Rock Health Funding Database.)

“There’s so much money in the healthcare space. Everybody wants in because it’s almost 20% of the economy, and costs are continuing to rise,” said Dr. Strongwater in setting the stage for his discussion of reform strategies and cost-reduction collaborations.

Today, “it’s a terrible disadvantage to be in a fixed model [of reimbursement],” he continued. “I would argue that we’ve already transitioned to value-based care.” He cited a comment by Troy Brennan, CVS’s chief medical officer who will remain on board after the merger. “He says 80% of what is offered at the primary care office will be offered at CVS. Companies like CVS believe they can disrupt the doctor-patient space. They are a serious competitor—with free parking too,” Dr. Strongwater noted to chuckles around the room.

Patients seeking better care at a lower cost are the core change driver—a “consumerism explosion,” said Dr. Strongwater, adding that “patients are looking for more empowerment” and “at the end of the day, consumers will always win.” Today, “patients are booking office appointments like airline seats” using digital solutions. “They want faster quicker access for less money,” he added, citing as an example the emergence of “clearinghouses for cheap MRIs” and rapidly growing demands by Massachusetts and other state governments for pricing transparency.

Of course, reimbursement lies at the center of the healthcare reform challenge.

“How we are paid for healthcare defines the kind of care that is provided,” Dr. Strongwater said. “I will say that again: how we are paid defines how care is provided.”

Stay tuned for more of the ASAP Media team’s coverage of the ASAP Leadership Forum and other sessions at the 2018 ASAP BioPharma Conference. 

Tags:  Atrius Health  Dr. Steven Strongwater  Healthcare  healthcare reform challenge 

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Dr. David Williams to Keynote 2017 ASAP BioPharma Conference Focused on Accelerating and Fine-Tuning Collaboration in Life Sciences and Healthcare

Posted By John W. DeWitt and Cynthia Hansen, Wednesday, September 13, 2017

As see in PR Newswire... 

The Association of Strategic Alliance Professionals (ASAP), the world’s leading professional association dedicated to the practice of alliance management, partnering, and collaboration, announced the theme and programming for the 2017 ASAP BioPharma Conference Sept. 13-15, “Accelerating Life Science Collaborations: Better Partnering, Better Outcomes,” to be held at the Royal Sonesta Boston, Cambridge, Mass. This year’s conference theme delves into maximizing the value of partnering in life sciences.

“Partnering has been essential to long-term asset development in the life sciences for decades. This has never been more apparent than it is today, especially across the expanded partnering network of the healthcare ecosystem,” commented ASAP President and CEO Michael Leonetti, CSAP. “Patient-centric healthcare, personalized medicine, and new technologies teamed together in the healthcare system are creating new ways to leverage important innovations, which lead to positive outcomes for patients. This year, the ASAP BioPharma Conference will bring together the world’s leading practitioners and experts on partnering in the life sciences to share their perspectives on innovating in this highly complex ecosystem.”

Wednesday morning, Sept. 13, begins with a series of professional development workshops focused on enhancing participants’ alliance management capabilities. . The full conference program kicks off later in the afternoon with a keynote address by Dr. David Williams will take place at 5 p.m. Dr. Williams is chief scientific officer and senior vice president for research, Boston Children's Hospital, and president of the Dana-Farber/Boston Children's Cancer and Blood Disorders Center. His research laboratory has been the recipient of continuous funding by the National Institutes of Health (NIH) for 31 years, since 1986.

“Williams is an exceptional leader who has fostered a collaborative portfolio of successful partnerships at Boston Children's, making it one of the best children's hospital systems in the U.S. today. He has extensive clinical and research experience having investigated, co-investigated, or sponsored extensive clinical trials in the area of gene therapy for blood, immunodeficiency, and neurological genetic diseases,” said Leonetti. “Looking at what BCH has accomplished through its partnership efforts, it is clear Dr. Williams understands and has achieved extensive accomplishments through business and scientific collaboration in healthcare. We are privileged to have him as a keynote speaker—and his talk should be a great way to kick off a great conference program.”

Click here to read the full press release.

Tags:  2017 ASAP BioPharma Conference  Boston Children's Hospital  Collaboration  Dr. David Williams  Healthcare  Life Sciences 

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ASAP BioPharma Conference Keynoter Dr. Sam Nussbaum: ’An Industry under Siege Must Take on a Different Social Contract’

Posted By John W. DeWitt, Wednesday, October 5, 2016

A couple of weeks ago, renowned physician Dr. Samuel Nussbaum—who served as chief medical officer for Anthem through 16 years of dramatic change in the healthcare industry—took the stage at the Sept. 7-9, 2016 ASAP BioPharma Conference in Boston with a big grin, twinkling eyes, and an embrace of new ASAP Chairman Brooke Paige. Paige introduced Dr. Nussbaum and noted that speaking in Boston was a homecoming for “America’s Physician,” who trained in internal medicine at Massachusetts General and then in endocrinology at Harvard. Indeed, Nussbaum, who is now strategic consultant for EGB Advisors, paid homage to the Boston and Cambridge, Mass., area’s medical science history and still-expanding potential for academic partnerships.

“One only has to go a few blocks west of here to see where Merck began to work with Harvard; Novartis has a research center near MIT in Cambridge,” Nussbaum noted. Then he turned serious. “It’s great to be here,” he began, “but it’s also an extraordinary time in healthcare, an industry, a space, under siege. It’s no longer fully understandable to say we discover, we cure, we make health better for the world. One has to take on a different social contract … and drive collaboration.”

Nussbaum echoed Dickens’ famous description of the Elizabethan era in England.

“We live at a time which is unprecedented. It’s the best of times, because we are in an age of unprecedented advances in medical technology and human science, yet it’s the worst of times, because we have a healthcare system in the US and around the world that doesn’t provide access for everyone. The state of public health is not a focus; the quality of medical care doesn’t keep pace with the science. Looking back to halcyon days, we had a great healthcare system [in the US] and research leading to some of the most extraordinary advances in healthcare. Yet we have storm clouds on the horizon.”

Nussbaum discussed a variety of driving forces vs. restraining forces

  • Breakthrough science vs. affordability for government and private payers
  • Personalized medicine vs. reputation issues
  • Technology, big data, bioinformatics vs. value-based payment models, bundled payment
  • Patient-centered outcomes and clinical design vs. impact of consolidation

He juxtaposed several triumphs of modern medicine with what has become a key factor in recent news coverage of the pharma industry and in the run-up to 2016 US presidential election.

“Cardiac death rates dramatically reduced. Antiviral drugs transform HIV into a chronic illness vs. a killer. And screening and better drugs improve cancer survival. But there is anger, there is outrage,” over high-profile drug price increases in the US and lack of access in other places in the world. “Why are people so angry? Because they can’t afford, and as nations, we can’t afford, the cost of healthcare,” he said. “Over the last decade, the average US family wage hasn’t changed much—from $49,309 to $53,800. Why the movement to Sanders or Trump? Capitalizing on outrage.”

He further explained the context of this outrage—and why expanded coverage (in Massachusetts and across the US under Obama’s Affordable Care Act) hasn’t been the cure-all for healthcare in the US.

“Massachusetts was the first state to have universal coverage. It was done under ‘Romney Care,’ similar to ‘Obamacare,” he said. The problem? “In Massachusetts, healthcare costs went up $5.1 billion and everyone applauded that type of access. But look what happened to other essential services: public health spending down 40 percent; mental health spending down 33 percent, etc.” In other words, Nussbaum explained, “We stole from what are called the social determinants of health. We know that education and housing leads to better health and better health outcomes,” while costing less. In other words, prevention costs much less than the healthcare cure.

“More importantly,” Nussbaum continued, “we are not using our $3.2 billion wisely—30-40 percent of healthcare spending is wasted on unnecessary services, administrative costs, prices, fraud. This is what we have to contend with. That’s why it is about collaboration, why it is the focus of the Obama administration, and of private business, to introduce reforms.”

Don’t miss “Dr. Sam Nussbaum: Healing the US Healthcare System One Politician at a Time,” my colleague Genevieve Fraser’s previous blog coverage of Dr. Nussbaum’s keynote address

Tags:  Anthem  ASAP BioPharma Conference  big data  bioinformatics  Brooke Paige  bundled payment  Dr. Samuel Nussbaum  driving forces vs. restraining forces  EGB Advisors  Harvard  healthcare  Merck  MIT  Novartis  Personalized medicine  reputation issues  Technology  value-based payment models 

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‘Design in Pencil’ as You Integrate Change into the Design Thinking Process (Part Three): How Alliance Teams Build an Experience Map, Grapple with Challenges, and Iterate

Posted By Genevieve Fraser, Monday, October 3, 2016
Updated: Friday, September 30, 2016

As you work through the design thinking process and apply it to your partnerships, you are building techniques to reach a decision, and you are learning to work together. With an alliance team and two core partners, you can get at an aligned recommendation or proposal. The ideal is to brainstorm and map out the most efficient way partners can get to the most effective process to come to a proposal. Then bring the partners together and arrive at a decision. Instead of “You have your way and I have mine,” ask “What is the alliance way?”

Now participants in the “Using Design Thinking to Drive Speed, Innovation, and Alignment in Partnering” workshop are exploring how to build an experience map. At this point in the 90-minute interactive session at the Sept. 7-9, 2016 ASAP BioPharma Conference in Boston, ASAP board member Jan Twombly, CSAP, and her partner at The Rhythm of Business, Bentley University professor Jeff Shuman, Ph.D., CSAP, are leading breakout groups through the process, advising executives to:

  • Step back and focus on empathic needs using their emotional intelligence.
  • Define what the empathic needs are for the co-diagnostic partner.
  • Report back to the larger project team—scientists, governance bodies, and other stakeholders.
  • Brainstorm with the larger group in mind.
  • Accelerate the delivery process, and eliminate elements can slow the process down.
  • Separate decision making into a core group for brainstorming and a companion diagnostics partners group.
  • Question if either party has experience. If both or neither have experience, then negotiate.

It’s critically important for alliance managers to drive the process and ensure it’s actually happening. Establish a collaboration leadership team; compare the companions in a diagnostic space and find companion diagnostic partners. Define the objective of the proposal and components. Both parties should come up with a short list of partners. There should be a joint evaluation process before asking for project approval. Get feedback, and redesign the prototype loop. Bring leaders and managers together to do this. Obtain a joint alliance management agreement on a new design. Relaunch the collaboration, implement from both partners, and plan for a joint development.

  • Two groups should come together and define a shared problem or goal.
  • Identify the problems.
  • Bring back to the company collective and individual brainstorming and group feedback.
  • Finalize and propose to the steering committee.

Approach Issues with Partners—and Build Iteration into the Process

Implementation

There is a skill to defining assumptions that may turn out to be true, or not true. Engage people, and roll it out to create a social charter, and stick to it. When looking at the final piece—look to iterate. You may find you didn’t get the question right, or you may discover you didn’t understand and so-and-so needed to be brought into the process. Question: Are you delivering the design experience? Make sure you find measures that define it. Prior to the proposal being presented to governance, make sure everyone has bought in.

As part of the workshop, groups were formed and asked to identify three assumptions inherent in the process they designed. Additionally, they were asked to assess the following: What is the most critical assumption you have made, and if it’s wrong, what is the impact? 

Group responses:

  • People won’t be candid or transparent or participate in individual conversations.
  • The development team is vetting the plan properly, and it was checked for joint alignment.
  • Both teams want to work jointly and collaborate. Or do they think they know best?  
  • They assume the other company has experience, but they may not have the experience or data needed.
  • In the list of shared attributes, make sure the internal list matches up. If not, it won’t pass governance.
  • You don’t need hard data numbers to prove or disprove the assumption.

Final thoughts

ID assumptions.  Use iteration. Move forward and focus on the intended outcome.  Start the intended experience, and map backwards. All stakeholders must get their needs satisfied; if not, they will stick out their foot and stop the process. Give power to partners if you wish to engage in a productive and collaborative process.

Tags:  alliance managers  alliance teams  Bentley University  biopharma  collaboration  decision making  design thinking  healthcare  Jan Twombly  Jeff Shuman  leadership team  non-asset based alliances  partnering  partners  The Rhythm of Business 

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