Empowered Patient Podcast

Dr. Monica Perez, the Scientific Chair at the Arms and Hands Lab at the Shirley Ryan AbilityLab and Professor of Physical Medicine and Rehabilitation at Northwestern University, is focused on developing drugs and strategies for treating those with spinal cord injuries. With no FDA-approved treatment, the current standard of care is surgery and physical rehabilitation, depending upon the location of the injury and cause. The AbilityLab is conducting a clinical trial with NVG-291, which targets the body's natural inhibitors for repair, regenerates neurons in the CNS, and aims to improve connections disrupted by spinal cord injury. Exercise is also a component of this treatment to improve outcomes.   Monica explains, "The experiment we’re running today at Shirley Ryan AbilityLab is the first of its kind study because we’re using a medication that we have evidence in animal studies that actually can improve regeneration in the central nervous system and contribute at least to enhance recovery of function. This is NVG-291, a medication that targets the body’s natural inhibitors for repair. And that, in theory, is supposed to improve connections disrupted by a spinal cord injury." "We are working with NervGen Pharma, a company that provides the medication. This is an injection. Our patients receive 84 injections during the trial. This is a randomized placebo-controlled trial, so they can receive either the real medication or a placebo medication, which is followed by exercise rehabilitation. So, it’s pharmacology - the medication targets the body’s natural inhibitors of repair, aiming to enhance the repair of connections that were affected by a spinal cord injury." #SRAbilityLab #SpinalCordInjury #NervGenPharma #CNS #CentralNervousSystem #Rehabilitation sralab.org Download the transcript here

Richard ‘RJ’ Kedziora, Co-Founder, CEO, and Chief People Officer at Estenda Solutions, emphasizes that usability is critical in developing successful digital therapeutics, and industry standards and interoperability are essential for data sharing and integration. A digital therapeutic can be prescribed by a physician and reimbursed by insurance companies. It is a digital health application that has undergone clinical trials and regulatory review to prevent, monitor, or treat physical or mental health issues. The future of digital therapeutics looks promising, especially with Medicare's introduction of billing codes for prescription digital therapeutics. Richard explains, " I think of the difference between a digital health application and a digital therapeutic as the difference between supplements and medications prescribed by a physician. So as you know, there are any number of supplements on the market. Some have more evidence than less about whether or not they can prevent, treat, or monitor a specific disease condition." "Digital therapeutics, which can be prescribed, have gone through a rigorous evidencing process of clinical trials to make sure they work and have gone through regulatory review here in the U.S. by the FDA. So, they’re an elevated category of digital health applications that have been created and can make a difference in the world." "You would still download them from the app store. That’s still where you’ll get them, but the key differentiator is probably from a billing perspective. Not only does that digital therapeutic meet a higher evidence-based, clinically-driven evaluation, but the idea is that you, as a patient individual, aren’t paying for it and can be reimbursed by the insurance companies. That can make a real difference in how much money a company putting these out can invest in it and then sustain a business based on the digital health applications." #Estenda #DigitalHealth #DigitalHealthApps #DigitalTherapeutics #HealthTech #HealthcareTechnology #HealthcareIT #HealthcareInnovation #ArtificialIntelligence #HealthAI #Medtech estenda.com Download the transcript here

Oren Gilad, President and CEO of Aprea Therapeutics, focused on the DNA damage response pathway, specifically targeting the ATR protein. ATR is a master regulator of DNA replication and is hyperactive in cancer cells, making it a potential Achilles heel for cancer therapy. By inhibiting ATR, cancer cells can be selectively targeted, while normal cells can tolerate lower levels of ATR activity. Synthetic lethality is applied when two genetic mutations are combined, leading to cell death, specifically in cancer cells. Aprea is conducting clinical trials for their targeted treatments, focusing on solid tumors with defined genetic mutations. Oren explains, "DDR, the DNA damage response pathway, is the broader terminology for the regulation of DNA synthesis. In order for cancer to grow, cells have to duplicate. In order for them to duplicate, they have to replicate their DNA. So what happens is that cancer cells get into this DNA replication phase very early and prematurely, causing a single-strand DNA to be exposed which then activates the ATR pathway, where in normal cells, this pathway is very tightly regulated. The normal cell is not going to enter this phase and start DNA replication before the environment is ready because it’s a very fragile phase of the cell cycle." "Double-strand DNA is a very stable molecule. It is found in mummies, it survives heat, and it survives freezing. When a double-strand DNA molecule is opened, the exposed single-strand DNA can easily break. That’s where ATR comes into play, it protects and responds to single-strand formation. A cancer cell is hyper-sensitive to ATR inhibition, which we identify as the Achilles heel of cancer. Our work showed that normal cells can live with a reduced level of the ATR activity, so it makes it a good target for cancer therapy." #ApreaTherapeutics #CancerTreatment #TargetedTherapy #Oncology #Cancer #SyntheticLethality #DNADamageResponsePathway aprea.com Download the transcript here

Dr. Marcy Carty, President and Chief Medical Officer of myLaurel, emphasizes the need to change the model where hospitals are the safest place for medical care. MyLaurel's acute care services include pre-hospital care to prevent emergency room visits, care-at-home to help patients get discharged earlier, and post-hospitalization care to smooth the transition. They work with primary physicians and other care providers to ensure a coordinated approach and use technology in the home to perform monitoring and diagnostics overseen by medical professionals and responders who can provide in-person and virtual visits. Marcy explains, "In the past, our health systems have looked at volume. I was a chief medical officer at a hospital, and I remember my CEO saying, "How many heads and beds can we get?" And so the system’s really driven towards reducing risk and putting people into hospitals, assuming that it’s the best place to be cared for. At myLaurel, we challenge that and work with communities to say, "How can we change that paradigm and bring the care to someone at home where they can sleep in their own bed, where they can hold all the power in their decision-making and ensure their goals of care are really incorporated into the care plan?" We want to change the paradigm that hospitals are the safest place to be and bring that care home, where I would say most people we talk to want to be cared for." "In general, myLaurel focuses on elderly or frail or people with complex medical conditions. What that means is our average patient is in their eighties, our average patient has about 13 medications, and our average patient has six or more chronic conditions. They generally represent the top 10% of patients for a health plan, accountable care organization, or physician group." #myLaurel #AcuteCare #InHomeCare #HospitalatHome #ObservationatHome mylaurelhealth.com Download the transcript here

Dr. Waqaas Al-Siddiq, the CEO and Founder of Biotricity, focuses on remote patient monitoring for heart health with HeartSecure, the three-channel wearable device that collects continuous ECG data. This device provides a more comprehensive view of the electrical activity of the heart compared to other wearables like smartwatches and can help identify potential cardiac issues, especially those that are intermittent and asymptomatic. Used by cardiologists and now available as a home-based diagnostic, this technology is a tool to screen those with risk factors such as high blood pressure, diabetes, sleep apnea, and obesity.  Waqaas explains, "When we talk about wearables, we have to understand what those wearables are collecting. A typical watch, like an Apple Watch or Samsung Watch or these kinds of devices, collects data through a PPG, which is really looking at light refraction and basically looking at your pulse rate. Based on skin tone, it will have varying results. Based on how tight you are wearing the band, it will have varying results."   "The second problem and why the cardiac issue is the number one killer and why it's the silent killer is most of these issues are intermittent, and most patients are asymptomatic. So if you don't feel the symptoms, you could take that 30-second ECG all the time, and you may never catch it because many times, these issues happen while we're sleeping. They're happening early in the morning." "The reason people are passing away is because many of these patients are screened is because when they are put on a monitor, sometimes you'll collect data on a patient for 24 hours a day for seven days. You'll not find the issue, and suddenly, you extend the monitor to day ten, and you'll find it on day nine. So how can you hold a device or a watch continuously for 24 hours, let alone continuously for nine days? And that's your challenge. That is why wearables are great awareness drivers. They're great tools if you've already been diagnosed and you're trying to manage your condition, but incredibly, incredibly blunt instruments when it comes to figuring out what your issue is." #Biotricity #HeartSecure #HeartHealth #Preventative #HeartDisease #HealthyHeart #SelfCare #HealthyLifeStyle #HealthTestatHome biotricity.com Download the transcript here

Bill Padula, PhD, Assistant Professor of Pharmaceutical and Health Economics, and Dr. David Armstrong, professor of surgery and Neurological surgery, are both at the University of Southern California and are concerned about wound care and the impact of potential changes in Medicare reimbursement of skin substitutes. They discuss the importance of skin substitutes in chronic wound care and their effectiveness in reducing amputations and hospital readmissions. With current advancements in wound care,  there is an emphasis on the need for education and advocacy to ensure that Medicare understands the value of skin substitutes and their potential for improving patient outcomes. David explains, "The skin substitutes we are talking about have been really helpful over the past, maybe at least the last decade, maybe even the last two decades, and especially over the last few years. We’ve seen now in some studies from our group and others that we can not only reduce amputation, but we can also reduce hospital admission and emergency department admission for these patients. So it’s a really exciting time. And so that’s on the positive end. On the not so positive end is that there have been some changes, and I’m sure Dr. Padula can talk about this. That may limit our access to it as clinicians, which is concerning certainly for the patients that I’m having right across the hallway." Bill elaborates, "Up until recently, Medicare hasn’t put a lot of governance on reimbursement for skin substitutes, and physicians have been using them autonomously with the patient to treat non-healing chronic wounds. We see from the data that these skin substitutes work best when applied on a patient every one to seven days in a wound clinic, like what David Armstrong runs here at the University of Southern California. Medicare wants to change the reimbursement pattern and reduce reimbursement so that it would be impossible to get reimbursed for more than ten applications of a skin substitute in twelve weeks. So, that reimbursement system makes it impossible for providers and patients to follow parameters for use and improve the likelihood of healing a chronic wound." #SkinSubstitute #Medicare #CMS #ChronicWounds  Keck School of Medicine at USC Download the transcript here

Gretchen Case, Managing Partner at The Wilshire Group a boutique healthcare revenue cycle consulting company that helps healthcare clients streamline workflows and processes. They work with hospitals, physician groups, and other providers to optimize their investment in technology and improve patient outcomes. Gretchen points out the various aspects of revenue cycle management, which include insurance benefit verification, explanation of costs, and identification of financial support. The middle revenue cycle includes the codification of clinical data and coordination with insurance companies and electronic health records. The third phase is the billing and payment.   Gretchen elaborates, "Some of the automation I’ve seen over the last several years has been designed to query the documentation and come up with suggested codes, called computer-assisted coding. And there is a lot of that in play. I think it expedites things and it makes things more efficient. I don’t know of anybody who’s just flipped that button and left it behind and not continued to monitor and manage it." "There’s also movement right now around what we call a single path. That’s just one way of saying it, but it’s about coding the professional and the technical at the same time. What does that mean? The physician’s procedure charge and the technical is what the hospital is going for that technical component of the services. And a lot of times, we share codes. So, if you’re going to be coding the physicians and getting her bill out the door correctly, you might as well be coding the hospital one at the same time. So there are definitely developments there, but I haven’t seen anything. Just completely automate it and step away." #TheWilshireGroup #RevenueCycleManagment #RCM #Hospitals thewilshiregroup.net Download the transcript here

Lynn Carroll, the Chief Operating Officer at HSBlox, focuses on payer-provider collaboration to mitigate risks related to the transition from a fee-for-service model to value-based care. Care coordination is critical to this model to reduce duplicative and unnecessary services and low-value providers by effectively sharing patient data. They are seeing an emphasis on high-cost categories, diagnostics, and disease management to rein in costs and improve patient outcomes. Lynn explains, "At HSBlox, we have built a platform for payer and provider collaboration around these types of arrangements, particularly for onboarding different types of alternative payment model contracts, bringing together the care continuum to align primary care with specialty care because primary care can’t go alone in achieving success under value-based programs. A significant amount of spend, particularly under the total cost of care programs, is driven by specialty utilization." "We have built a platform that allows for multi-participant programs that enable the sharing of data and the movement of funds across these different alternative payment models. The purpose of the platform was to provide the infrastructure that would allow these programs to flourish and accelerate the pace of the end game for value-based administration."  #alternativepaymentmodels #carecoordination #contractmodeling #healthoutcomes #patientengagement #permissioneddataexchange #populationhealth #referralmanagement #reinbursementmodels #riskbearingproviders #ValuebasedCare #VBC HSBlox.com Download the transcript here    

Dave Kerwar is the CEO and Co-Founder of Inbound Health, a hospital-at-home organization that offers an advanced primary care model for patients who would typically go to the emergency department and a secondary care model for post-acute patients who would typically go to a skilled nursing facility. With virtual care enhanced by data analytics, remote sensors, and on-site visits, Inbound Health's model has shown lower readmission rates than traditional facility-based care.   Dave explains, "We help health systems launch and scale advanced care models delivered from the home. So our flagship care model is a hospital-at-home model where we’re typically taking patients who are presenting in the emergency department or have been inpatient for less than 24 hours and who could otherwise receive the totality of their hospital stay from the comfort of their home. In that model, what we do is we bring forward the care model, so basically, the care pathways for how to care for those patients."   "We bring forward a technology and analytics platform to remotely care for those patients, monitor those patients, and manage all the logistics around the care that needs to be delivered. We bring forward the virtual care team, which is made up of virtual nurses and physicians who provide the care and oversee the patient 24/7 and the in-home care. Nurses, therapists, and community paramedics go into the home." "We have to manage a lot of the supply chain in these models. We bring forward durable medical equipment, home-based labs, home-based imaging, home infusion, transportation, and things like that. We manage the ability to provide that supply chain into home-managed care services. Often, these models are not a standard reimbursement structure with the payers, so we create that reimbursement structure with the payers on behalf of our health systems."   #InboundHealth #HospitalatHome #Medtech #DigitalHealth inboundhealth.com Download the transcript here 

Michelle Clavecilla-Chan, Director of Behavioral Health at MVP Health Care, and Amanda Conway, Chief Growth Officer at Aptihealth, have partnered to expand access to mental health services for MVP customers. Aptihealth provides virtual behavioral health services that connect patients to comprehensive mental health and substance abuse support. Through their digital platform and behavioral health provider network, MVP customers have options for integrated care that remove traditional access barriers and provide virtual visits to engage this high-need population. The partnership focuses on serving complex patient populations with conditions such as psychosis, bipolar disorder, ADHD, and personality disorders with personalized care plans. Michelle explains, "MVP provides coverage for all lines of business, including commercial Medicare, Medicaid, Child Health Plus, and Essential Plan enrollees. We provide all of the healthcare needs of our customers, and our mission is to improve our customers’ health and provide peace of mind to our customers by helping them access quality healthcare that meets their needs. Our mission is also to create healthier communities through innovation and collaboration, which is why we’re excited to partner with Aptihealth."   Amanda elaborates, "Aptihealth is a virtual behavioral health provider. We work with payers in value-based care arrangements to provide comprehensive services for behavioral health patients. We focus primarily on complex, high-acuity patient populations, which is unique to our virtual model, and we integrate within the communities that we serve to be a key stakeholder in the overall care of the patients we treat."  #MVPHealthCare #Aptihealth #MentalHealth #DigitalHealth #AccessToCare MVPHealthCare.com Aptihealth.com Download the transcript here