Zolinza (Vorinostat) to fight HIV/AIDS?

David M. Margolis, MD at University of North Carolina is approaching the fight against HIV/AIDS using a novel approach. He's testing the Merck cancer drug Zolinza (Vorinostat). Given that Zolinza blocks HDAC, it could push out latent HIV hiding in infected cells. Sounds interesting, doesn't it? Let's wait to see what ends up happening.

Thanks to BusinessWeek for the interesting story.

How much effort (and money) should we spend to extend the life of dying cancer patients?

I'm reading BusinessWeek Magazine and the cover story is titled, "Lessons of a $618,616 Death." The story is about a man named Terence Bryan Foley who died of metastatic kidney cancer after being treated aggressively with the latest and greatest in medical technology. From the perspective of public health and population health management, some could make a compelling argument to say that end-of-life-care is contributing greatly to our current health care crisis. However, how do you know where to draw the line? How can an insurance company deny payment for medical treatment that may extend life?

When I used to work in the hospital, I remember wondering if certain cancer patients should simply be placed on hospice. It's such a difficult thing to talk about because every family member and every patient may have different values and goals in life. For some, their goal is to extend life as long as possible, even if it means additional suffering. Others would rather maximize their quality of life, even if that means a shorter duration on life.

The BusinessWeek story brought back many memories of working in the Intensive Care Unit (ICU) and seeing very sick cancer patients struggling for their lives. It brought back memories of patients who simply chose hospice and died peacefully with their family members around. It brought back memories of family members grieving. It's difficult to care for dying cancer patients. This is where the art of medicine really needs to shine. This is where compassion needs to come through.

Concierge disease management

The concept of concierge medicine may not be new, but what about concierge disease management? The problem with traditional disease management or DM is that patients often get lost and they don't end up receiving the personalized level of care that they need. Why? Because it would be much more expensive to deliver that level of care.

I'm currently reading an article in BusinessWeek magazine titled, "Take Your Meds, Exercise—and Spend Billions" (click here to read that story)

There are many people who don't believe that traditional disease management programs are cost-effective. Given recent advances in technology, I'm sure that disease management programs can become much more effective and robust. There are mixed opinions when it comes to the topic of traditional disease management with health coaches and financial incentives, but what about exploring the idea related to concierge disease management? We probably don't have much data on that type of concept, but I'm sure it would make a tremendous impact on patient outcomes if people could afford such services. Unfortunately, the reality is that few people would be able to afford such boutique services, so you'd be left with clients who are from the "rich and famous" or elite upper class of society.

Shifting health care costs

According to a recent story on BusinessWeek, the heavy costs of health care are shifting more towards employees. Employers will need to pay more to provide health insurance, but the burden will increase significantly more for employees. I suppose it will also really depend on how much your employer currently pays. Will your company start paying a smaller percentage of your health insurance premiums?

According to the story titled, "Health Costs: Steeper Still," we have seen employers' health care costs rise 149% since 2000. 175 million people are covered by private employers.

Perhaps the role of wellness and disease management programs will need to be re-evaluated. If a public option becomes available, I wonder if that will also include some type of wellness program. What percentage of health plans will offer formal wellness and disease management programs in 3 years? What about in 5 years?

Technology is making it more easy for patients to learn ways to improve their health and wellness. There are many personal health record (PHR) services that are freely available. Consumers can get educated about certain diseases by reading articles on reputable websites. There are web-based health programs that can guide patients to live a healthier lifestyle. Advances in mobile technology are also contributing to health and wellness initiatives.

Healthcare reform and jobs

How will healthcare reform initiatives impact the job market in the United States? I think many people are anticipating a boom in the health information technology (health IT) sector. That's to be expected, considering how the American Recovery and Reinvestment Act of 2009 (ARRA) focuses tremendously on the role of health IT (or HITECH) in healthcare reform. Will healthcare reform boost employment? Improved health should raise productivity. What about the "pay-or-play" mandate on employers? They must either offer benefits or pay a fine.

There are some other perspectives to consider when we think about healthcare reform. Catherine Arnst writes in BusinessWeek about how healthcare reform may spur employment. She cites MIT economist Jonathan Gruber (an MIT alum who also studied at Harvard, but we won't hold that against him) for the Small Business Majority. Professor Gruber estimtaes that if reform doesn't occur and small businesses are spending over $2 trillion on healthcare over the next decade, then this may lead to a loss of 178,000 jobs in 2018.

A remedy for health-care costs?

BusinessWeek has a very interesting article titled, "The family doctor: a remedy for health-care costs?" Will it ease the healthcare burden if we make primary-care physicians the center of America's health system? Perhaps the next question is, "what does it mean to make the PCP the center of the health system?"

This article starts with the line: "The primary-care doctor is gaining new respect in Washington." So many medical students have no interest in primary care. Are they not getting the right type of exposure to the world of primary care? Perhaps they are disillusioned and they don't fail to see the benefits of being a primary care provider (PCP).

Lately, there has been much talk about healthcare reform, electronic health records (EHRs), and the Patient-Centered Medical Home (PCMH). Can the medical home model actually save $67 billion a year? That reflects a 5.6% savings on healthcare costs. IBM's Director of Health-Care Transformation Dr. Paul H. Grundy led IBM to start the Patient-Centered Primary Care Collaborative. I think many people are curious to see how the medical home model will impact healthcare costs in these large corporations. If only 27% of physician practices qualify as a medical home, then what type of impact are we expecting to see?

Cloud Computing and Healthcare

BusinessWeek has an article about Cloud Computing in the June 15th edition. It calls it Cloud Computing 2.0 and there's a little column in there titled, "A Sharper Eye on Patient Care." It describes how OptumHealth (a UnitedHealth Group Company) is using eSync to gather medical information and alert clinicians and patients if a problem is detected. These types of automated reminders are not difficult to generate as long as you have the right algorithms that are driven by evidence-based practice guidelines. According to this article, 20 million patients will be served by eSync medical technology.

In my former life, I worked for a company that has now been acquired by OptumHealth. There, we employed automated messages that were tailored for individuals who have various types of health conditions. As the world of electronic health record (EHR) soars over the next few years, we will see more employ decision support, automated messages, and more data integration. At the end, will we see improvements in public health? I'm hopeful that we will. Companies (and the government) are counting in reduced healthcare costs.