Healthcare Experts Share the Latest Thinking & Insights

 

Top-Down Approach as a Solution for Diversity in Healthcare Workforce

By | Diversity & Inclusion, Healthcare Innovation | No Comments

Demographics in the United States are rapidly changing. By 2043, the nation will be “majority-minority” according to projections by the U.S. Census Bureau [1]. The nation is already experiencing this shift with minorities accounting for 98% of the population growth in large metropolitan areas [2]. This shift will have significant implications for decision-making and care delivery as the healthcare industry transitions from a physician-led model to a patient-centric model.

As the U.S. population becomes more diverse, the business case for the healthcare workforce to reflect the racial, ethnic, and socioeconomic backgrounds of the total population is compelling [3]. Such a representation is essential in addressing the barriers to healthcare access which ultimately lead to quality and culturally competent service delivery. This is also important in addressing healthcare disparities among minority communities who are often impacted by other socioeconomic factors such as income, education, and lack of insurance [4].

Despite these pronounced benefits, minorities have been historically underrepresented in the healthcare workforce. For example, in 2000, African Americans accounted for approximately 12.7% of the population but represented only 4.4% and 8.8% of physicians and nursing staff, respectively [5]. Furthermore, in 2015, only 5.7% of medical school graduates were African American [6]. This disconnect is expected to worsen due to anticipated physician shortage in the coming years, combined with lack of representation in the pipeline. The latter can be overcome by equipping these groups with preparation and resources for academic success, mentorship programs for talent recruitment, and increased awareness of healthcare opportunities [7]. Some programs, such Winston-Salem State University, have already implemented these changes into their curriculum with a commitment to expand the pipeline with diverse and qualified candidates to reduce healthcare disparities [8]. Also, state and federal policymakers are calling for training programs to encourage underrepresented students to explore health careers through academic support, financial incentive programs, and lectures and workshops supplementing the K-12 curriculum [7].

In addition, diversity in senior management positions can better serve the growing minority patient populations. This broadening would expand thought diversity at the “top” of the organization, and the benefits of this are often underestimated. According to a 2015 McKinsey report, companies in the top quartile for ethnic and racial diversity in management were 35% more likely to have financial returns above their industry mean [9]. This report further established that for every 10% increase in racial and ethnic diversity at the ‘top’, pre-tax earnings rose 0.8% [9].

Yet, minorities are disproportionately failing to attain such high-level positions, specifically at the C-suite level or the Board of Directors. In a 2013 Institute for Diversity survey, minorities represented 31% of patients nationally [10]. However, they represented only 17% of front- and mid-level management positions. These figures worsened with 14% and 12% representation at the executive and board levels, respectively [10].

Companies with diverse executive teams enforce stronger governance practices and increased successes with innovation and operations. These teams are also more likely to remain objective, challenge their conscious and unconscious biases, and apply various perspectives in decision making [11]. In addition, diverse leadership teams also demonstrate opportunities for minority groups.

With minorities’ underrepresentation, the ‘trickle-down effect’ becomes increasingly important. The leadership sets the tone, and the teams follow their example. This executive team’s behaviors and practices drive the underlying interactions between employees and consumers. Such passing down of values-based behaviors can stifle a company’s progress in the diversity of their workforce, management teams, and senior executives. The lack of diversity at this level could lead to unawareness of unconscious biases and unchallenged assumptions. As a result, their perspectives and policies would be inclined towards hiring and promoting those with similar characteristics. This would also influence the front- and mid-level management to adopt similar behaviors and practices, thus causing a domino effect. Due to lack of shared values, recruiting diverse talent and retraining a diverse workforce becomes challenging. This will have a negative impact on the organization’s overall performance. Thus, diversity initiatives must be expanded to both executive management and the workforce.

To further explore the influence of diverse leadership, CHI is organizing the 8th annual Diversity, Inclusion, & Health Equity Symposium on 6/27/18 in Chicago, which is a leading annual, collaborative event focusing on health equity and health disparities in the U.S. The symposium brings together leading healthcare professionals, executives, physicians, patient groups, patients, researchers, academics, clinical trial professionals, and diversity and inclusion advocates to discuss health equity in the life sciences and the health sectors. The symposium focuses on the latest trends, challenges, opportunities in both the marketplace and workplace, with a specific focus on how to best serve an increasingly diverse patient base. We also aim to address the broader health disparity challenges in the U.S., and the symposium equips attendees with the latest insights and ideas. Attendees will learn practical solutions, share perspectives, and meet new industry and marketplace colleagues. Visit chisite.org/dilss for more information and registration.

References:
1. U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. U.S. Census Bureau. Accessed April 17, 2018.
2. White neighborhoods get modestly more diverse, new census data show. Brookings. Accessed April 17, 2018.
3. 2015 Kelly Report: Health Disparities in America. Office of Robin Kelly. Accessed April 17, 2018.
4. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. Accessed April 17, 2018.
5. Fact Sheet: The Need for Diversity in the Health Care Workforce. Health Professionals for Diversity Coalition. Accessed April 17, 2018.
6. Diversity in Medical Education: Facts & Figures 2016. AAMC. Accessed April 17, 2018.
7. Racial and Ethnic Disparities: Workforce Diversity. National Conference of State Legislatures. Accessed April 17, 2018.
8. Improving Diversity in the Health Professions. North Carolina Medical Journal. Accessed April 17, 2018.
9. Why Diversity Matters. McKinsey & Company. Accessed April 17, 2018.
10. Diversity and Disparities: A Benchmark Study of U.S. Hospitals in 2013. Institute for Diversity in Health Management. Accessed April 17, 2018.
11. Why Diverse Teams are Smarter. Harvard Business Review. Accessed April 17, 2018.

New Partnership Could Lead to Disruptive Innovation

By | Affordable Healthcare Act, Collaboration, Data Analytics, Global Healthcare Trends, Healthcare Costs, Healthcare Innovation, Patient Engagement, Patients | No Comments

This morning, Amazon, Berkshire Hathaway, and JP Morgan Chase announced an ambitious partnership to cut health cuts and improve satisfaction for their U.S. employees. They announced plans to create a company “free from profit-making incentives,” with the goal of implementing technology solutions to simplify the healthcare system. The chief executives of all three firms noted the challenges that they are likely to face, but all the while expressed confidence that the vast resources of these corporations will help them achieve this goal. The project will be led by a team of three senior executives, one from each company, with more of the logistical news expected in the coming weeks and months.

This partnership could represent a dramatic change in the healthcare landscape. The track records of these corporations speak for themselves, and they certainly have the financial backing and corporate talent to make a huge impact in the healthcare industry. Traditional players in this industry including CVS, Cigna, Aetna, and United Health all suffered hits in the stock market potentially related to the news, pointing to the disruptive potential for this collaboration. However, much of the details have yet to be released, and any effects that this might have on the healthcare marketplace at impossible to predict at this point. It is also unclear what approach the group will use. Amazon has been rumored to venture into the healthcare space for some time now, and their strengths in logistical and data management, as well as the cutting edge technological innovations we have seen in recent years, suggest that they are primed to tackle the rising costs of healthcare delivery. However, we do not know what any solutions might look like, so we will have to wait and see what they can propose. One thing that we do know is that the complexity and regulatory challenges present in the healthcare industry in unlike any marketplace these companies have seen before, and this will certainly take some getting used to.

Also of note in this partnership is the focus on patient-centered care. Many groups, including our Center for Healthcare Innovation, have recognized that the key to containing the costs in healthcare is to give more autonomy to patients and physicians in making healthcare decisions. Technology can certainly assist patients in making more informed and cost-effective choices, as well as assist hospital systems in reducing spending but utilizing artificial intelligence and information management platforms. These are things that Amazon, Berkshire, and JP Morgan will likely focus upon.

The healthcare industry has been primed for change for some time. Amazon, Berkshire Hathaway, and JP Morgan have announced a partnership to cut health care costs and improve services for their employees, who number over 1 million. However, what they think up could have ramifications that affect all Americans. The name recognition of these players and the highly qualified executives heading the project have boosted optimism that a positive disruption to the healthcare marketplace is on the horizon.

References:
CNBC; “Amazon, Berkshire Hathaway, and JPMorgan Chase to partner on US employee health care.”

Lack of Diversity Hurts a Company’s Performance

By | Diversity & Inclusion | No Comments

To everyone that has been considering switching between Lyft and Uber, the latest news regarding diversity within these two companies may help users decide. On Jun 1st, Lyft released its first diversity report, which stabilized its top place of diversity in the industry. 42% of Lyft’s workforce identify as female, compared to Uber’s 36%. 63% of Lyft’s staff is white, 19% is Asian, 7% is Latino, and 6% is black. Although the percentages are still not matched with the composition of the population of the nation, Lyft has been doing a better job of promoting diversity and inclusion in its company than its rival Uber and the entire tech industry. Lyft also admitted that it “has a lot of work to do” in the future with diversity. Many studies show that raising diversity can improve a company’s performance. Large companies such as Twitter, Uber, and Lyft have been emphasizing their company’s diversity and inclusion to maintain the company’s positive reputation, but how exactly diversity and inclusion can affect a company’s bottom line was not sufficiently explained.

The Forbes article by James Heskett stated two findings of a McKinsey Global Institute study. The study sampled 366 companies in Canada, Latin America, United Kingdom, and the U.S., and concluded that companies lacking gender diversity tend to have lower business performance. Also, companies who maintain diverse leadership are more successful than others. The study seems to perfectly prove that lack of diversity can hurt a company’s performance. However, critics of the study argue that the sample size of 366 companies is too small of selection for some countries. Also, many potential factors are influencing a company’s financial performance, and there is no sufficient evidence showing that gender diversity necessarily accounts for much if any of the financial performance. Therefore, the result of the study is not convincible to indicate the enormous effect that lack of diversity may have on a company’s performance.

On the other hand, an earlier McKinsey study researched more than 58,000 employees of 101 organizations around the world and demonstrated that there is a huge difference in companies’ business performance between companies with at least 30% female in leadership positions and companies with no female leadership involvement. The employees in the diverse workforce gave positive feedback on work environment, values, direction, coordination, and control, which are factors contributing to the better performance of the employees and the company. On the contrary, in companies lacking diverse leadership, employees complained about work motivation, capability, accountability, and innovation, which are factors most likely leading to low company performance. Therefore, the study contained the proper size of samples and concluded that the company with at least 30% female in leadership has better business performance than the company with no female leadership.

More studies analyzing the effects of lacking diversity in a company’s performance are necessary in the future, but we cannot ignore the trend that the world, the society, and every industry need to focus on raising the awareness of diversity and inclusion since the nature of the world is diverse and inclusive.

To further explore the influence of lacking diversity in a company’s performance, CHI is organizing 2nd Annual Breakthroughs in Healthcare Diversity Symposium on 1/9/18 in San Francisco, CA. The symposium is a leading collaborative symposium for patients, patient groups, clinicians, researchers, technologists, healthcare and life science executives, and diversity and inclusion advocates to discuss diversity and inclusion in healthcare. The symposium will discuss best practices, and exchange new ideas related to making healthcare more diverse, with a specific focus on understanding how to serve underserved patient groups, including racial and ethnic minorities, women, and the LGBT community. The symposium will also focus on helping provider, pharma, and other organizations who serve patients with the latest ideas and insights on how these organizations can become more diverse and inclusive in order to best understand the unique and diverse needs of the patients they serve. Attendees will learn the newest insights and ideas, discuss practical solutions, and meet industry and marketplace colleagues. Please click here for more information.

 

References:

Guynn, Jessica. “Twitter Users Are Diverse but Not Its Staff.” USA Today, Gannett Satellite Information Network, 19 Jan. 2017, www.usatoday.com/story/tech/news/2017/01/19/twitter-diversity-2016/96749454/.

Hawkins, Andrew J. “Lyft’s Diversity Numbers Are Better than Uber’s, but Only Slightly.” The Verge, The Verge, 1 June 2017, www.theverge.com/2017/6/1/15725676/lyfts-diversity-report-ethnicity-gender-silicon-valley.

Heskett, James. “Why Does Lack Of Gender Diversity Hurt A Company’s Performance?” Forbes, Forbes Magazine, 5 Nov. 2015, www.forbes.com/sites/hbsworkingknowledge/2015/11/04/why-does-lack-of-gender-diversity-hurt-a-companys-performance/#44c24a8d2332.

Minority Patients Recruitment in Clinical Trials

By | Clinical Trials, Diversity & Inclusion, Informed Patient, Patient Engagement, Patients | No Comments

The FDA has approved 22 new drugs in 2016, and there are 31,468 patients participated in clinical trials in total. We have been encouraging patients to join clinical trials by showing patients the benefits for them and future generations. However, we should also focus on the diversity of patients in clinical trials, rather than only increasing the total number of patients. Among all the patients participated in clinical trials in 2016, 48% were female patients and 24% were patients with color, which does not correlate with the population percentages of women and people of color in the nation. According to 2010 census, there are approximately 51% women and 30% people of color in the U.S. It is evident that women and people of color are under-presented in clinical trials, which could lead to different drug effects on women and people of color. Therefore, it is essential to encourage more minority patients to participate in clinical trials.

To recruit minority patients in clinical trials, there are serious barriers that need to be addressed. According to a Forbes report, the biggest obstacle is the lack of encouragement or support from the attending physician. Many doctors are either unaware of relevant clinical trials for their patients or not spending sufficient time on each patient. In a 2000 Harris Interactive survey, 80% of cancer patients were unaware of their potential clinical trial options. Additionally, in a 2013 Zogby survey, more than 50% of patients were still unaware of clinical trials, and only a quarter of patients learned of clinical trials from their physicians. Thus, raising the awareness of the existence and benefits of clinical trials is extremely necessary. One big reason that patients are not aware of clinical trials is due to their physicians failing to introduce clinical trials to their patients. Forbes pointed out that “with the increasing pressure to see patients more and more quickly, they simply don’t have the time to engage in lengthy discussions with patients.” However, as a physician, listening to their patients, asking for patients’ needs and helping patients as much as possible is crucial. Especially for minority patients, their diverse backgrounds may require special needs from their physician. Also, the effect of the same treatment can vary enormously across different patients. Therefore, it is vital for physicians to communicate properly with each minority patient. One communicating strategy is that doctors should transfer their language to one that different patients can understand, which will help awareness amongst minority patients. Besides, during the whole process of clinical trials, patients should decide how they want to be part of any of the processes, and physician takes the significant role of guiding and suggesting their patients. Another possible reason that stop minority patients from joining clinical trials are that many patients misunderstand and believe that an experimental treatment must be better than the standard, hence, they would rather take a placebo than finding a standard treatment through clinical trials.

We are a nation of immigrants and diversity is our reliable weapon to support society’s stability. To perfect our healthcare industry, we need to raise and spread the awareness of diversity and inclusion. Physicians are encouraged to engage with their minority patients, communicate with them, and provide the best treatments and clinical trials options for them. Physicians’ efforts can not only help minority patients at present but also benefit their future generations since there are biological changes as generations live and grow in our country. In the end, building trust and communication between physician and minority patients are the keys to recruiting more minority patients in clinical trials.

To further explore the importance of increasing minority patients recruitment in clinical trials, CHI is organizing 2nd Annual Breakthroughs in Healthcare Diversity Symposium on 1/9/18 in San Francisco, CA. The symposium is a leading collaborative symposium for patients, patient groups, clinicians, researchers, technologists, healthcare and life science executives, and diversity and inclusion advocates to discuss diversity and inclusion in healthcare. The symposium will discuss best practices, and exchange new ideas related to making healthcare more diverse, with a specific focus on understanding how to serve underserved patient groups, including racial and ethnic minorities, women, and the LGBT community. The symposium will also focus on helping provider, pharma, and other organizations who serve patients with the latest ideas and insights on how these organizations can become more diverse and inclusive in order to best understand the unique and diverse needs of the patients they serve. Attendees will learn the newest insights and ideas, discuss practical solutions, and meet industry and marketplace colleagues. Please click here for more information.

 

References:

Stone, Judy. “How Can We Encourage Participation in Clinical Trials?” Forbes, Forbes Magazine, 8 Jan. 2015, www.forbes.com/sites/judystone/2015/01/06/how-can-we-encourage-participation-in-clinical-trials/#1146b57c4d0c.

Tate, Wendy. “Diversity in Clinical Trials: Recruiting Women and Minorities in Research.” Forte Research Systems, Forte Research Systems Inc., 12 Apr. 2017, forteresearch.com/news/diversity-clinical-trials-women-minorities-research/.

Sticker Shock: Are Generics the Solution to the Drug Pricing Dilemma?

By | Uncategorized | No Comments

In recent years, the media has been teeming with grim news about the soaring costs of prescription drugs. Headlines went viral regarding the high price of staying alive with insulins for type I diabetes and the abrupt price increases of life-saving heart medications Isuprel and Nitropress [1,2]. These surges not only affect new treatments but they also affect generics used to treat chronic conditions, such as diabetes and high cholesterol.

As a whole, spending on prescription drugs has been the fastest growing component of the healthcare dollar [3]. In 2016, brand-name drugs comprised only 10% of all prescriptions dispensed in the U.S., yet accounted for 72% of drug spending [4]. This triggered heated debates and highlighted the discrepancy between manufacturers’ retail prices and what consumers actually pay.

Manufacturers reported that high costs and business interests are responsible for climbing drug prices. The average industry cost to bring a prescription drug to market is $2.6 billion, largely owing to years of investment in research, manufacturing costs, subsidies, and regulatory fees [5]. Pharmaceutical companies have to recover these costs to continue operations and fund future research and development (R&D).

The government has historically granted patent monopolies lasting up to twenty years as a mechanism to incentivize innovation and research. In order to best leverage this monopoly, drug manufacturers price brand-name drugs high enough to recoup R&D and marketing costs as well as their anticipated loss of their market share upon patent expiration. This is understandable as most of these companies are managed by corporate directors with fiduciary duties to the company, a concept that has become synonymous with increasing shareholder wealth.

Furthermore, there appears to be a significant inequality between other countries and the U.S., where the majority of these costs is recovered by high prices. Countries such as Norway, U.K., and India have established price caps and are willing to decline costly medications, resulting in manufacturers subsidizing their drugs to these nations and even providing these drugs to developing nations at little-to-no charge [6].

This led to consumers voicing concerns that prescription drugs are becoming inaccessible and burdening the entire health care system. According to a recent AARP report, the annual cost for one brand name drug used to treat a chronic condition averages $5,800 [7]. This brings the annual cost of treatment for the average older adult taking four prescriptions drugs to over $26,000. These costs leave consumers looking for cheaper alternatives, particularly generics, or taking unhealthy steps such as missing appointments or decreased compliance.

Generics are a bioequivalent version of brand-name drugs that are sold after a manufacturer’s patent expires. This allows other drugmakers to enter the free market and sell the same compound at a lower price, leading to a price reduction of approximately 80-85% due to decreased R&D costs and an abbreviated process for FDA approval [8,9]. For example, they are not required to repeat clinical trials and in turn, do not pass on the high development costs to consumers.

There is a general consensus that when generics enter the market, prices are lower than their counterparts. According to many experts, reducing the cost of healthcare is synonymous with increased generic approvals [9]. In theory, this is the exactly what the doctor prescribed for the healthcare dollar. However, in practice, there is still doubt over whether generic drugs actually help consumers.

The spiraling prices for prescription drugs also stem from a battle over profitability between pharmaceutical and insurance companies, with consumers increasingly footing a larger portion of the bill [10]. Manufacturers accuse insurers of passing the costs to consumers while insurers fault costly drugs and patent protection for affecting coverage.

In the U.S., there are no regulations restricting drug prices. Manufacturers are able to determine the clinical value of a given prescription drug based on their market analysis. For example, when Turing Pharmaceuticals purchased the rights to Daraprim, they abruptly increased the price of the medication from $13 to $750 per pill due to the lack of a generic equivalent [11]. Similarly, Mylan made headlines after drastically increasing the price of the Epipen, enraging consumers by prioritizing its bottom line over public health [12].

Manufacturers then began to fund access programs where insured patients made a small co-payment for access to their product [10]. After all, ten dollars is a small price to pay for a life-saving medication. However, as the cash value of these medications remains exorbitant, they remain inaccessible to millions. In the U.K., these pricing battles between affordability and enabling innovation are not determined by the industry. Rather, they utilize a centralized advisory board to determine the true value of a drug based on its efficacy, safety, etc [13].

Another issue is that insurance companies strike back at manufacturers for high price tags with few alternatives. In the U.S., consumers pay monthly premiums to insurers in order to protect themselves from the unexpected costs of care. In terms of prescription drugs, insurers then utilize pharmacy benefit managers (PBMs) to negotiate large-volume discounts with drugmakers [14]. Manufacturers argue that these discounts should then be advanced to the patient as cost savings.

However, as for-profit entities, insurance companies balance high prices and profit margins by decreasing coverage [10]. Gone are the days of a flat fee for all prescription drugs, instead insurers are now offering greater cost sharing. These mechanisms include higher deductibles, higher premiums, tiered co-pay pricing systems, and co-insurance structures where consumers are responsible for a portion of the total cost [10].

Some insurers are even responding to these market changes by dropping coverage for certain medications. For example, in 2016, Express Scripts responded to limited leverage for price negotiations for new medications by excluding a number of common medications, such as insulin, from their discount drug program [15].

Finally, competition is the major factor in generic price inflation. That is, pricing is dependent on the price and availability of their competitors [16]. There is little argument that when generics enter the market, prices drop significantly. However, generic medications often have supply shortages, causing a rise in the price of longtime medications. For example, six companies were approved by the FDA to produce generic versions of the arthritis medication hydroxychloroquine following patent expiration [10]. As expected, prices initially dropped from increased competition but increased in recent years as some manufacturers ceased production of this older generic drug in favor of more profitable ventures [10]. Greater concerns arise that any stalls in the production cycle for the remaining manufacturers, such as difficulties obtaining the raw materials will impact the supply chain nationwide [16].

Generic medications are a critical component of efforts to hold down healthcare costs. As pricing struggles continue, consumers are looking to the government to control drug prices, insurers to shop for the best deals, and manufacturers to decrease costs. This bears the question: does the push toward generics really help consumers or simply create more problems?

To further explore the drug pricing trends, CHI is organizing the 5th Annual Healthcare Executive Roundtable on October 12, 2017, in Manhattan, New York. The Center for Healthcare Innovation’s “Understanding Value in Consumer-Orientated, Patient-Centric Era” Roundtable is an intimate, invitation-only, expert roundtable discussion for healthcare executives, key opinion leaders, and patient groups to discuss how stakeholders throughout the healthcare ecosystem can address critical issues related to healthcare value, quality, and cost. This year’s Roundtable will focus on several key market forces that affect the current state of healthcare in the U.S. Please visit http://chisite.org/roundtable/ for more information.

References:
1. Diabetic Sticker Shock: The High Price of Staying Alive. ABC News. Accessed October 6, 2017.
2. Drug Industry on Tenterhooks as Maryland Price-gouging Law Nears. Thomson Reuters. Accessed October 6, 2017.
3. Controlling Spending for Prescription Drugs. The New England Journal of Medicine. Accessed September 27, 2017.
4. The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform. JAMA. Accessed October 4, 2017.
5. Cost of Developing a New Drug. Tufts Center for the Study of Drug Development. Accessed October 4, 2017.
6. Why the U.S. Pays More Than Other Countries for Drugs. The Wall Street Journal. Accessed October 4, 2017.
7. Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans, 2006 to 2015. AARP. Accessed October 4, 2017.
8. How Expanding Generic Drugs Can Add to America’s Health Care Woes. Fortune. Accessed October 4, 2017.
9. Why Do Generic Medicines Cost Less than Brand-Name Medicines? FDA. Accessed October 4, 2017.
10. Is There a Cure for High Priced Drugs? Consumer Reports. Accessed October 6, 2017.
11. Drug Goes From $13.50 a Tablet to $750 Overnight. The New York Times. Accessed September 27, 2017.
12. Mylan Raised EpiPen’s Price Before the Expected Arrival of a Generic. The New York Times. Accessed September 27, 2017.
13. Solving the Problem of High Drug Costs. Consumer Reports. Accessed October 6, 2017.
14. Feeling the Pain of Rising Drug Prices? Blame the Middle Man. CBS News. Accessed October 6, 2017.
15. Will Your Prescription Meds Be Covered Next Year? Better Check! NPR. Accessed October 6, 2017.
16. Generic Drug Competition Equals Consumer Price Relief. RealClear Policy. Accessed October 6, 2017.

Creating Stakeholder Dialogue Around Drug Pricing

By | Drug Costs, Healthcare Costs, Healthcare Value, Informed Patient, Rising Cost, Uncategorized | No Comments

The increase in prescription drug pricing and spending has been one of main factors contributing to the high costs of healthcare in the United States. In fact, according to a 2015 report by the National Center for Health Statistics, the national health expenditure for prescription drugs made up 10.1% of the total national health expenditure that reached $3.2 trillion that year [1]. Certain measurements of drug pricing villanize manufacturers an industry with outrageous cost and spending of prescription drugs. For example, patent exclusivity, research and development efforts, and competition in the market are generally blamed for the initial price increases. However, these measurements also cause skepticism and inaccuracies, thus shining a negative light on pharmaceutical companies. Therefore, the outliers misrepresenting pharmaceutical companies and the number of failed drugs need to be addressed in order for patients to have a better understanding on drug pricing.

Two outliers that don’t represent the overwhelming amount of biopharmaceutical companies are Mylan and Turing Pharmaceuticals. In 2007, Mylan Pharmaceutical acquired EpiPen, a handheld device that injects epinephrine to an individual with life-threatening allergic reactions, and increased the price of the drug by 500% [2]. The price rose from $100 to $600 in 2008 without any justification [3]. To no surprise, the company came under fire by the media for its unethical approach. The price increase can be attributed to Mylan’s patent use which allowed them to profit off of the drug without facing competition from a generic drug for a period of time [4]. In a similar situation, Martin Shkreli, founder and CEO of Turing Pharmaceuticals, raised the price of the drug Daraprim from $13.50 to $750 a tablet overnight [5]. What were once ‘affordable’ drugs became unaffordable for the vast majority of users causing outrage and shaming for pharmaceutical companies. Again, there are outliers that don’t represent the overwhelming majority of pharmaceutical companies that are developing new and novel drugs.

According to the 2017 Edelman Trust Barometer, the trust in the healthcare industry is slowly increasing compared to last year [6]. The trust in pharma in the U.S. seems to be “neutral.” With pharmaceutical companies like Mylan and Turing, it’s understandable why Americans might not be fully invested in pharma. When pharmaceutical companies make the headline in the news, it usually is unfavorable.

Furthermore, research and development is key when it comes to developing new drugs and used as justification for drug pricing. As we know, the process of creating a drug involves a lot of trials and errors where high costs are incurred in order to satisfy regulations imposed by the Food and Drug Administration (FDA); thus, it can create opportunities to price the drug even higher than it actually cost to get it out to the market. According to the 2017 Edelman Trust Barometer, 8 out of 10 people believe the pharmaceutical industry puts profit over people [7]. In reality, pharmaceutical companies only realize 39% of initial gross drug expenditures [8]. In addition, companies like Gilead are helping subsidize the cost of its drug, Epclusa, in Australia, which will help approximately 200,000 Australians that face the challenges of hepatitis C [9]. For example, Merck created an HPV vaccination program for cervical cancer in Rwanda [10]. Despite the media’s negative coverage, several other pharma companies have partnered with organizations like the Gates Foundation and UNICEF to provide medications for the developing world [11].

Lastly, it’s critical to address the failed formularies that ultimately lead to higher pricing as these costs must be recouped. The price to develop a drug is over $500 million [12]. According to the Tufts Center for the Study of Drug Development, the cost to develop and win marketing approval for a new drug is $2.6 billion [13]. The variance in the two aforementioned distinguish by fourfold, but it’s really expensive. Aside from this statistic, during clinical research phase studies, only 25-30% of initial drugs move to phase 4 where the drug is trialed by volunteers with the disease of interest [14]. The development of a drug can take a long time, especially when it comes to illnesses like cancer or HIV. During this time, the initial fund to conduct these studies starts to deplete. As patients, we need to understand that these are factors that even pharmaceutical companies have no control over.

As we wait for a viable healthcare reform under the current administration, it’s important to push for one that restores the well-being and decreases the burden of millions of Americans. During the process, there needs to be increased dialogue between patients and providers, such as pharmaceutical companies. All to avoid situations like that of Mylan and Turing. If drug pricing continues to increase, the biopharmaceutical industry will face more scrutiny. There will be increasing tension between patients, pharmaceutical companies, and pharmacy benefit managers (PBM). It’s important for all stake holders to be open and transparent in order to resolve these issues successfully. In an ever changing environment, we must learn to understand the process in order to appropriately resolve issues plaguing our society. We are ever changing.

To further explore the drug pricing trends, CHI is organizing the 5th Annual Healthcare Executive Roundtable on October 12, 2017, in Manhattan, New York. The Center for Healthcare Innovation’s “Understanding Value in Consumer-Orientated, Patient-Centric Era” Roundtable is an intimate, invitation-only, expert roundtable discussion for healthcare executives, key opinion leaders, and patient groups to discuss how stakeholders throughout the healthcare ecosystem can address critical issues related to healthcare value, quality, and cost. This year’s Roundtable will focus on several key market forces that affect the current state of healthcare in the U.S. Please visit http://chisite.org/roundtable/ for more information.

Work Cited

[1] Health Expenditures. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/health-expenditures.htm. Accessed September 14, 2017.

 

[2] Mylan Raised EpiPen’s Price Before the Expected Arrival of a Generic. The New York Times. https://www.nytimes.com/2016/08/25/business/mylan-raised-epipens-price-before-the-expected-arrival-of-a-generic.html?mcubz=3. Accessed September 14, 2017.

 

[3] Mylan finalizes $465 million EpiPen settlement with Justice Department. CNBChttps://www.cnbc.com/2017/08/17/mylan-finalizes-465-million-epipen-settlement-with-justice-department.html. Accessed September 14, 2017.

 

[4] Mylan Raised EpiPen’s Price Before the Expected Arrival of a Generic. The New York Times. https://www.nytimes.com/2016/08/25/business/mylan-raised-epipens-price-before-the-expected-arrival-of-a-generic.html?mcubz=3. Accessed September 14, 2017.

 

[5] Drug Goes From $13.50 a Tablet to $750 Overnight. The New York Times. https://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html. Accessed September 20, 2017.

 

[6] Trust in Healthcare: Making Progress. Edelman. https://www.edelman.com/post/trust-healthcare-making-progress/. Accessed September 20, 2017.

 

[7] Trust in Healthcare: Making Progress. Edelman. https://www.edelman.com/post/trust-healthcare-making-progress/. Accessed September 20, 2017.

 

[8] Majority of Drug Revenue Not Going to Pharmaceutical Companies. The American Journal of Pharmacy Benefits. http://www.ajpb.com/news/majority-of-drug-revenue-not-going-to-pharmaceutical-companies. Accessed September 20, 2017.

 

[9] New Hepatitis C Drug to be subsidized in Australia. The Pharma Letter. https://www.thepharmaletter.com/article/new-hepatitis-c-drug-to-be-subsidized-in-australia. Accessed September 25, 2017.

 

[10] Even Pharma’s Good Deeds Are Criticized. Forbes. https://www.forbes.com/sites/johnlamattina/2013/05/06/even-pharmas-good-deeds-are-criticized/#612c29ec4cd3. Accessed September 20, 2017.

 

[11] Even Pharma’s Good Deeds Are Criticized. Forbes. https://www.forbes.com/sites/johnlamattina/2013/05/06/even-pharmas-good-deeds-are-criticized/#612c29ec4cd3. Accessed September 20, 2017.

 

[12] R&D Costs For Cancer Drugs Are Likely Much Less Than Industry Claims, Study Finds. NPR. http://www.npr.org/sections/health-shots/2017/09/11/550135932/r-d-costs-for-cancer-drugs-are-likely-much-less-than-industry-claims-study-finds. Accessed September 20, 2017.

 

[13] Cost to Develop and Win Marketing Approval for a New Drug Is $2.6 Billion. Tufts Center for the Study of Drug Development. http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study. Accessed September 28, 2017.

 

[14] Step 3: Clinical Research. U.S. Food & Drug Administration. https://www.fda.gov/forpatients/approvals/drugs/ucm405622.htm. Accessed September 20, 2017.

 

The Shift from Volume-to-Value: Innovating Payment Systems

By | Healthcare Costs, Patient Engagement, Volume-to-Value | No Comments

The U.S. healthcare system has been facing serious issues when it comes to the quality and cost of healthcare today. These issues have called for a shift from the traditional volume-based care to value-based care. One key factor driving this change is the need for patient-centered care for our current growing elderly population and those with chronic disease [1]. In addition, there is a need for a different type of payment system that won’t punish providers for focusing on keeping people healthy and avoiding unnecessary care [2]. The last factor is the current payment system contributes nothing to improving health [3].

According to a report by the Centers for Medicare & Medicaid Services, the total health spending in the U.S. in 2016 reached nearly 3.4 trillion dollars [4]. In addition, 45% of all Americans suffer from at least one chronic disease, which in financial terms turns out to be an average costs of $6,032 annually [5]. The high cost of care can be attributed to the traditional volume-based care (fee-for-service) that promotes profit over quality of care [6]. This means physicians must focus on volume of patients and getting rewarded for it. As previously mentioned, there are individuals that suffer from serious illnesses that calls for better care on behalf of the providers.

Furthermore, in order to successfully shift to value-based care, the current payment model must be changed to one that incentivizes physicians to promote better care. Physicians aren’t paid for time spent on educating their patients. However, they are paid for coordinating tests [6]. This ends up hurting patients because physicians aren’t focused on improving patient outcomes but rather making sure that they follow procedures that don’t add much value to patient engagement. The numerous tests and medicine prescriptions are illusions of high quality care. In reality, even though our health care spending is astronomical, millions of Americans are uninsured or receive care that is inadequate.

To further elaborate on the issues with the current payment system, according to a survey conducted by PwC’s Health Research Institute (HRI), fee-for-service payments make up 53% of a physician’s revenue [7]. Therefore, in the initial stages of the shift to value-based, physicians must accept a temporary loss of revenue [8]. Sure, it’s a hard pill to swallow. However, in order to see change, financial losses at the beginning stages is a reality that must be accepted. It seems that in order to create a balanced system that works for providers and patients, more financial risks have to be incurred by organizations.

In 2017, the topic of healthcare coverage has taken the spotlight under the current administration that aimed to replace the Affordable Care Act (ACA). If there ever were a better time to leverage the use of technology to help reduce certain costs, it would be a great time to do it now. As we know, the healthcare industry is a complex ecosystem where traditional thinking is favorable compared to innovative ideas. Value-based care is innovative to a certain extent and seems promising. In the end, as the health care landscape changes once again, implementing a payment model that aligns with the objectives of high quality and better care is needed.

To further explore these value-based trends, CHI is organizing the 5th Annual Healthcare Executive Roundtable on October 12, 2017, in Manhattan, New York. The Center for Healthcare Innovation’s “Understanding Value in Consumer-Orientated, Patient-Centric Era” Roundtable is an intimate, invitation-only, expert roundtable discussion for healthcare executives, key opinion leaders, and patient groups to discuss how stakeholders throughout the healthcare ecosystem can address critical issues related to healthcare value, quality, and cost. This year’s Roundtable will focus on several key market forces that affect the current state of healthcare in the U.S. Please visit http://chisite.org/roundtable/ for more information.

References:

[1] From Volume To Value: Achieving Bold Change In Our Healthcare Payment Systems. Forbes. https://www.forbes.com/sites/billfrist/2016/06/30/from-volume-to-value-achieving-bold-change-in-our-healthcare-payment-systems/#65afc8f09c82. Accessed September 7, 2017.

 

[2] From Volume To Value: Better Ways To Pay For Health Care. Health Affairs. http://content.healthaffairs.org/content/28/5/1418.full#ref-1. Accessed September 7, 2017.

 

[3] Patient-Centered Care: What It Means And How To Get There. Health Affairs. http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/. Accessed September 7, 2017.

 

[4] 2016-2025 Projections of National Health Expenditures Data Released. Center for Medicare & Medicaid Services. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-02-15-2.html. Accessed September 7, 2017.

 

[5] Why Public Health Is Necessary to Improve Healthcare. National Association of Chronic Disease Directors. http://c.ymcdn.com/sites/www.chronicdisease.org/resource/resmgr/white_papers/cd_white_paper_hoffman.pdf. Accessed September 7, 2017.

 

[6] From Volume To Value: Better Ways To Pay For Health Care. Health Affairs. http://content.healthaffairs.org/content/28/5/1418.full#ref-1. Accessed September 7, 2017.

 

[7] Healthcare’s Alternative Payment Landscape. PricewaterhouseCoopers. https://www.pwc.com/us/en/health-industries/health-services/assets/pwc-hri-alternative-payments-2015.pdf. Accessed September 7, 2017.

 

[8] Patient-Centered Care: What It Means And How To Get There. Health Affairs. http://healthaffairs.org/blog/2012/01/24/patient-centered-care-what-it-means-and-how-to-get-there/. Accessed September 7, 2017.

 

Healthcare Value and Patient Engagement

By | Patient Engagement, Patient-Driven Healthcare, Uncategorized | No Comments

As of 2015, healthcare spending in the U.S. reached approximately $3.2 trillion dollars, or $10,000 dollars per person. (1.) Despite high amounts of spending, Americans have seen a decline in life expectancy by one-tenth of a year.  (2.) According to a publication in 2013 by The Common Wealth Fund, Americans had fewer physician visits with 4 per year compared to 6.5 visits for other countries in The Organization for Economic Cooperation and Development. (3.) With the rising cost and poor quality of healthcare, it is critical to analyze the intersection between healthcare value and patient engagement. (4.)

How do we define “value” in health care? The definition for this term can range from improved patient outcomes to coordination of care to patient-centeredness. (5.) However, value-based care is generally defined as safe, appropriate, and effective care at a reasonable cost. It is very important to carefully define value as we move towards value-based care. This allows customers to fully understand the type of care they are receiving. Furthermore, value-based care has emerged as a solution to address rising health care costs. This is a change from the traditional fee-for-service approach where doctors and hospitals are paid for based on the number of health care services they deliver. (6.)

What this entails for hospitals and physicians is more accountability on their part for the well-being of their patients. For example, according to the Harvard Business Review, value-based care will be about costs and patient outcomes like quicker recoveries, fewer readmissions, lower infection rates, and fewer medical errors. (7.) In addition, as we move towards this newer model, we also see an abundance of data that can be tabulated and analyzed to ensure better health outcomes for patients. (8.) If value-based care is to succeed, the need for better patient engagement becomes a key component to that success.

Patient engagement is a set of strategies that are created to keep patients connected and engaged in their own care. Today, this is facilitated through the use of healthcare technology. For example, patients can use patient portals to directly message their provider regarding any questions they have regarding their health. (9.) In addition, people have been using mobile applications on their smartphones to keep track of their health. Ultimately, they can decide whether it is appropriate to visit a doctor based on the information they have in their pocket. (10.) This trend also focuses on preventive measures since this allows patients and providers to be in direct contact.

What patient engagement ultimately allows is for patients to take charge of their health through the use of innovative methods that have become available through technology. It allows patients to avoid spending a lot of money on doctor visits that only require simple checkups. It plays a critical role in lowering the cost of healthcare for patients and ensures better quality of care. (11.) Healthcare value and patient engagement now go hand in hand because both are innovative ideas that are meant to disrupt an industry where traditional thinking triumphs. In today’s society, the need for change is only becoming inevitable.

As a new administration takes charge, the future of our healthcare system has never been so unclear. It will be interesting to see if this value-based approach can reach new heights under the new administration. As leaders in this sector await change, one can only hope that it is the change that we have long desired. It is important for healthcare leaders to advocate for an inclusive and efficient healthcare system. In the end, if we are to succeed, collaboration on both ends of the spectrum is required.  

 

Works Cited

1.) National Health Expenditures 2015 Highlights. Centers for Medicare and Medicaid Services. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/highlights.pdf. Accessed January 25, 2017.

2.) Bernstein L. U.S. Life expectancy declines for the first time since 1993. Washington Post. December 8, 2016. https://www.washingtonpost.com/national/health-science/us-life-expectancy-declines-for-the-first-time-since-1993/2016/12/07/7dcdc7b4-bc93-11e6-91ee-1adddfe36cbe_story.html. Accessed January 25, 2017.

3.) Squires D. U.S. Health care from a global perspective. The Common Wealth Fund. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective. Accessed January 25, 2017.

4.) Claxton G. Measuring the quality of healthcare in the U.S. Peterson-Kaiser Health System Tracker. http://www.healthsystemtracker.org/insight/measuring-the-quality-of-healthcare-in-the-u-s/. Accessed January 25, 2017.

5.) Blumenthal D. Getting real about health care value. Harvard Business Review. https://hbr.org/2013/09/getting-real-about-health-care-value. Accessed January 25, 2017.

6.) Belliveau J. What is value-based care, what it means for providers? Rev Cycle Intelligince. http://revcycleintelligence.com/features/what-is-value-based-care-what-it-means-for-providers. Accessed January 25, 2017.

7.) Cosgrove T. Value-based health care is inevitable and that’s good. Harvard Business Review. https://hbr.org/2013/09/value-based-health-care-is-inevitable-and-thats-good. Accessed January 25, 2017.

8.) Porter M. The strategy that will fix health care. Harvard Business Review. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care. Accessed January 25, 2017.

9.) Heath S. How do patient engagement strategies cut healthcare costs? Patient EngagementHIT. http://patientengagementhit.com/news/how-do-patient-engagement-strategies-cut-healthcare-costs. Accessed January 25, 2017.

10.) Key facts about the uninsured population. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Accessed January 25, 2017.

11.) Barnett J. United States Census Bureau. http://www.census.gov/library/publications/2016/demo/p60-257.html. Accessed January 25, 2017.

 

Diversity among Executive Leaders: An Essence for Prosperity

By | Diversity & Inclusion, Healthcare Innovation | No Comments

Diversity in the workplace helps to spark creativity and innovation. A diverse set of experiences and opinions can offer a variety of solutions to business problems. All industries need diversity to bring forth new ideas that lead to innovation, but a lack of diversity among executive leaders is still a common problem across many fields.

A study conducted by Harvard Business School interviewed 24 CEOs from around the globe who positively advance diversity in their companies and corporate divisions. All 24 CEOs forcefully affirmed the benefits of diversity and defined it as “a source of creativity and innovation.” When employees with different backgrounds and experiences collaborate with one another, they can accomplish more than they would as individuals. The CEOs praised the remarkable benefits of promoting employee diversity, but they were also disappointed with the shortage of progress on diversity in the C-suite. According to a recent report, there are only 4 African-American CEOs at the nation’s 500 largest companies. A Forbes report last year indicated that only 4.2% of the Fortune 500 firms are led by female CEOs, and 28% have just one female director. Even worse, the inequality at the C-suite level has also promoted intolerance of leaders with diverse backgrounds. Andrea Jun, the CEO of the personal-care-products firm Avon, shared her experience that she is usually the only woman or Asian sitting around a table of senior executives, and people often assume she could not be the boss. Another similar example is shared by Ajay Banga, the CEO of MasterCard, “My passion for diversity comes from the fact that I myself am diverse. There have been a hundred times when I have felt different from other people in the room or in the business. I have a turban and a full beard, and I run a global company—that’s not common.” Executive leaders with diverse backgrounds can be treated unfairly, and their contributions can often be underappreciated. In the study, Harvard Business School also distinguished leadership styles between men and women. The conclusions of the study described women as less political, more collaborative, better listeners, more relationship-oriented and more empathetic and reasonable. Therefore, as George Halvorson, the CEO of the California-based managed-care consortium Kaiser Permanente, said, when dealing with some complex projects involving multiple layers, a collaborative leader is necessary and his experience shows that more often than not the leader turns out to be a woman. Thus, we have to admit that one certain type of executive leader is not able to handle the rapidly changing market, and executive leaders with diverse backgrounds can fulfill the demands with innovation and creativity.

In the end, it is important to embrace executive leaders with diverse backgrounds. They are the talents who can create a culture based on innovation and cooperation, and also have the courage to bring forth new ideas and break the routine.

To further explore the influence of diverse leadership, CHI is organizing the 7th annual Diversity, Inclusion, & Life Sciences Symposium on 6/15/17 in Chicago. The Symposium is the leading annual, collaborative event for life sciences and healthcare executives, physicians, HR professionals, clinical trial professionals and patients, entrepreneurs, patient groups, researchers, academics, and diversity, and inclusion advocates to discuss diversity and inclusion in healthcare. The symposium focuses on the latest trends, challenges, opportunities, and best practices for implementing strategies and tactics to make these industries more diverse and inclusive, as well as understand how to better serve diverse patient groups. Attendees will learn the newest insights and ideas, discuss practical solutions, and meet new industry and marketplace colleagues. See a video at http://www.snip.ly/fxln8. This year’s symposium will include topics such as the role of coaching and mentoring in executive success, diversity and inclusion in clinical trials and research, and expanding definitions of diversity. Please visit http://chisite.org/dilss/ for more info or to register.

 

References:

Connolly, Boris GroysbergKatherine, and Boris Groysberg and Robin Abrahams. “Great Leaders Who Make the Mix Work.” Harvard Business Review. N.p., 27 Oct. 2014. Web. 24 May 2017.

Vinjamuri, David. “Diversity In Advertising Is Good Marketing.” Forbes. Forbes Magazine, 20 Mar. 2017. Web. 01 June 2017.

Wallace, Gregory. “Only 5 Black CEOs at 500 Biggest Companies.” CNNMoney. Cable News Network, 29 Jan. 2015. Web. 01 June 2017.

Zarya, Valentina. “Female Fortune 500 CEOs Are Poised to Break This Record in 2017.” Female Fortune 500 CEOs Set to Break Records in 2017. Fortune, 22 Dec. 2016. Web. 01 June 2017.

 

 

 

Need for Diversity in Clinical Trials

By | Clinical Trials, Diversity & Inclusion, Drug Costs | No Comments

Clinical trials are essential to bringing new medicines to patients. An important aspect of clinical trials is to make sure that the drug is effective for a diverse group of people. Diversity in clinical trials has recently been a key issue. There is no comprehensive way of defining diversity, as it could include gender, race, ethnicity, sexual orientation, and more, depending on the dimension from which it is viewed. Unfortunately, many clinical trials lack diversity in representation.

A diverse nation like the United States has an assortment of populations, with White Americans forming the ethnic majority. Hispanic and Latino Americans amount to 16% of the population, making up the largest racial minority1. African Americans are the second largest racial minority, accounting for 12% of the population1. Adding to this is the international community which lands in the U.S in search of opportunities. Already diverse cities are becoming increasingly mixed with immigrants from Asia, Africa, and Latin America. The U.S. is a diverse country, so why do our clinical trials not reflect the same level of diversity?

Clinical trials are an essential part of drug development. These provide a base of evidence for evaluation of a drug. Each drug needs to be tested for its efficacy, ease of application, side effects, and many other factors before being launched into the market. The average drug developed by a major pharmaceutical company costs billions of dollars to develop. In general, the drugs are not specifically designed with every racial group in mind due to the cost of production. That is why clinical trials are an important tool to determine the drug’s effectiveness on the population as a whole. The trials are performed on a sample population and researchers try to prove its statistical significance on the entire population. Hence, it is very much essential for clinical trials to be diverse to represent the population. People from diverse cultures differ among factors such as their predisposition to diseases or the environment they are exposed to. To create awareness, the FDA announced 2016 as “The Year of Diversity in Clinical Trials.” Despite an increase in awareness, the current trend is unsatisfactory. According to the FDA, African Americans represent 12 % of the U.S. population, but only 7% of clinical trial participants. Additionally, Hispanics represent 16% of the U.S. population but only 1% percent of clinical trial participants2. In a country where minorities are estimated to outnumber white Americans by 2044, the inclusion of individuals of varied races, ethnicities, ages, gender, and sexual orientation in clinical trials can help to prevent disparities in the evaluation of potential new medicines2. Clinical trials ensure top quality drugs and diversity in clinical trials should be considered to provide better treatment.

The 7th Annual Diversity, Inclusion, and Life Sciences Symposium will discuss the trends, facts, insights, and best practices regarding diversity in clinical trials. Attendees will learn the newest insights and ideas, discuss practical solutions, and meet industry and marketplace colleagues. Please visit http://chisite.org/dilss/ for more info or to register.

 

  1. Source: Wikipedia
  2. Source: Center for Healthcare Innovation – DILSS 2016 Executive Summary