Contest Seeks Innovations To Benefit Aging Population

Ecumen and Mojo Minnesota have teamed up to launch an international contest that seeks innovative products and services to benefit the growing aging population.

by Rebecca Omastiak

August 12, 2013

Local organizations Ecumen and Mojo Minnesota are seeking both high- and low-tech solutions to benefit people as they grow older.

Ecumen—a Shoreview-based nonprofit senior housing and services provider—and Mojo Minnesota—a Minneapolis-based cooperative consisting of entrepreneurs, venture capitalists, angel investors, business advisors, and engineers—recently launched their inaugural AgePower Tech Search contest, inviting individuals, startups, and established companies to submit new products and services that are ready to be tested among the senior population.

The two partners said they are looking for functional prototypes that demonstrate a real-world purpose and are positioned for investor interest and commercial success.

“We’re not seeking ‘ideas’ or ‘concepts,’” Ecumen spokesman Eric Schubert told Twin Cities Business. “The submitter must be working to commercialize the technology within the next 12 months with the focus of having a broad, positive impact in life quality, profitability, job creation, and community engagement.”

Ernest Grumbles, co-founder of Mojo, told TCB that “this is not a traditional business plan contest.” Rather, he said, it’s an opportunity for innovators to “road test” their technologies.
 

After completing a screening process, Ecumen and Mojo plan to select roughly four finalists who will gain access to field-testing and feedback. Test environments include Ecumen’s in-home and clinical care settings, assisted living communities, and physical rehabilitation centers.

 

Mojo said it will lend its expertise to help finalists actualize their market potential.

In exchange for the resources Ecumen and Mojo offer, the partners receive a small equity stake (Grumbles said the working figure is 3 percent) in the finalists’ products or services.

“This search fits the sweet spots of both organizations in terms of innovation, collaboration, and helping move Minnesota forward,” Schubert said.

Since the contest opened in July, it has received 10 submissions from locations as diverse as Israel and Ireland. Schubert described one submission as a workplace collaboration tool intended to keep track of work flow and documentation among care givers; another submission outlines a community networking platform and search tool to make senior services easier to find, he said.

Products and services for the aging population represent a Minnesota market in which there is a lot of “low hanging fruit,” Grumbles said.

“There’s a whole system devoted to medical and life care in Minnesota,” he added, referencing institutions such as Mayo Clinic. “[The state] is nationally recognized for social support and old age life improvement.”

“The world’s only growing demographic is people 60-plus,” Schubert added. “It’s our country’s fastest-growing population cohort. And Minnesota has so many attributes to lead in this space.”

Using data from a 2012 United Nations report, Ecumen and Mojo said that approximately 900 million people in the world are over the age of 60 and by 2050, that number will have grown to 2.4 billion. Ecumen President and CEO Kathryn Roberts said that growth represents an opportunity to improve the aging population’s quality of life.

Schubert said the contest taps into a need for near-term care solutions for the aging population by linking human ingenuity with technology.

“Our desire is that AgePower helps locate, optimize, and launch products that link with human skill to make lives better and are commercially viable,” Schubert said. “It’s a vehicle for helping open the door to Minnesota as a global hub for innovation for longevity and wellness.”

The AgePower Tech Search contest is open to applicants until October 31. Interested candidates can apply here.

Ecumen, which recently celebrated its 150th anniversary, owns or manages 55 independent-living and assisted-living communities, as well as 17 health care centers. It operates in 35 cities in Minnesota, Idaho, Nebraska, North Dakota, Tennessee, and Wisconsin. It reported $138 million in 2012 revenue and employs 3,952—3,800 of whom work in Minnesota.

Last May, Twin Cities Business cited Ecumen as an example of a business that is successfully using mentorship programs. Click here to read the story.

Mojo Minnesota, which was founded in 2010, is a cooperative of 13 individuals that mentors entrepreneurs and garners federal and state support for local startups. 

Colorado for-profit ERs next to Starbucks: convenience and controversy

POSTED:   07/30/2013 12:01:00 AM MDT
UPDATED:   07/30/2013 12:30:59 AM MDT

By Michael Booth
The Denver Post

Dr. Ron Price examines Olga Thein at a First Choice emergency room in Colorado Springs last week (. Hyoung Chang, The Denver Post)

BLOG: DAILY DOSE

The Daily Dose prescribes an enriched mix of news, features, consumer issues and in-depth followups to The Denver Post's coverage of medicine and health care.

COLORADO SPRINGS —Here at a tidy suburban shopping strip, in the parking lot near a tanning salon, a Starbucks and a cupcake shop, is a fierce new battleground for precious health care dollars.

First Choice is a gleaming, stand-alone emergency room built like a drive-through dry cleaners, set in an affluent neighborhood to signal convenience to consumers — and to rake in profits for private investors.

There's no towering hospital attached at the back, no helicopter pad, delivery rooms or surgery suites. But a doctor is always here, they handle hangnails to heart attacks, and regulators allow First Choice to charge high ER prices no matter how trivial the ailment.

"The hospital ER system right now is overburdened," said Andrew Jordan, chief marketing officer for First Choice.

"We're the ultimate fix-it shop," senior vice president Heather Weimer said. "We want to fix you and send you up or down to the next level."

But critics say free-standing ERs are creating and distorting demand, not just filling it.

"What they're doing is driving up the cost of medical care," said Dr. Vince Markovchick, an emeritus professor of emergency medicine and author of the manual "Emergency Medicine Secrets." Free-standing ERs can charge four or five times what an urgent-care center or clinic charges for common problems such as stitches, abdominal pain or sprains.

For-profit ERs are siphoning patients with insurance from urban hospitals that need the money to subsidize charity care, Markovchick and others said.

"They play the numbers of being in the right ZIP code," said Dr. Richard Zane, emergency department chair at University of Colorado Hospital.

Zane said he expects First Choice to build up to five more ERs in Colorado, and other for-profit competitors will likely follow — none of them good for the system, he added.

This First Choice ER on Powers Boulevard is the inaugural outpost for a company that has blanketed Texas with the controversial concept and now has sights on Colorado. With 16 other ERs around Houston and Dallas, First Choice is also renovating a site in Arvada to open early next year.

Nonprofit hospital systems also have entered the "freestanding" game, with Banner Health and University of Colorado Health building stand-alone ERs near each other's territory in Greeley.

Insurance companies — which spend time these days trying to keep people out of expensive ERs if they don't belong there — and other critics don't like the trend. When beds and exam rooms expand, customers tend to fill them whether they belong there or not.

"There's some truth to it that if you build it, they will come,"

First Choice Emergency Room, on Powers Boulevard in Colorado Springs, is the company's first facility in Colorado. Such free-standing ERs are praised for treatment but criticized for high charges. (Hyoung Chang, The Denver Post)

said Dr. Elizabeth Kraft, chief medical officer for Anthem's Blue Cross insurance in Colorado. "There's a learning curve on the patient's part, and they may get a bigger financial hit than they were expecting."

Insurers encourage ailing consumers to think twice by boosting penalties for using the ER. Federal rules guarantee insurers will pay for medically necessary ER visits, but they have some freedom to share costs with the patient.

Anthem, for example, has co-pays of $150 to $300 for ER visits, versus $10 to $75 for the same treatment at an "urgent care" or other primary doctor's office.

Frustrating the health experts is what simple, nonemergency ailments ERs commonly attract: "allergic rhinitis," in other words a runny nose from pollen; headaches; and physicals for summer camps.

"At least half of the patients seen in most busy ERs could be safely taken care of in a lower- cost, urgent-care setting," Markovchick said.

First Choice executives say they have no more interest in keeping a patient who doesn't belong there than a hospital-based ER. They say First Choice refers non-emergency patients back to their family doctor, if they have one, and frequently writes off charity care.

Under state law, and because it's the right thing to do, First Choice doctors say, every patient is given a medical screening by a physician before any questions are asked about how they are paying.

On a recent weekday in Colorado Springs, Olga Thein was brought in with chest pains and a history of heart illness. Dr. Ron Price spent 45 minutes with her, took labs that were done in minutes and determined she was not having a heart attack and offered a prescription. Price said he was calling her cardiologist to report the incident and the tests.

The nurse on duty, Erica Miller, said she has worked at all the Colorado Springs ERs, and is doing far more patient care and less bureaucracy at First Choice than at the other locations.

"I'm feeling like a nurse instead of a computer technician," she said.

State law requires all licensed ERs to have a transfer agreement with a full hospital, and First Choice contracts with both Memorial and Penrose-St. Francis in Colorado Springs. Ambulances do not come to First Choice — all traffic is self-directed; a contracted ambulance is parked outside the front door for emergency transfers to hospitals.

None of the ERs are official trauma centers, as only hospital ERs can receive that designation, a First Choice spokeswoman said.

First Choice cannot bill Medicare or Medicaid because federal rules require an ER to be part of a full hospital system to get paid. That leads to the criticism from Markovchick and others that the for-profit ERs are only after high-paying private insurance.

"The way you make a profit is you avoid anybody who can't pay," Markovchick said.

First Choice employees reject that assumption, saying they always give the care needed to the patients who arrive. Thein, for example, was a Medicare and Medicaid patient, and when she walked out the door on the arm of a friend, her bill was written off.

Researchers on costs in health care tend to hedge when addressing whether for-profit ERs are exploiting gaps or listening to consumer demand.

"Free-standing emergency departments, like a lot of other players in the health care marketplace, tend to go where the well-insured patients are, not necessarily where the need is," said Emily Carrier with the Center for Studying Health System Change in Washington, D.C. "But that's not the same thing as saying that the need isn't there."

Consumers are responding to something they want from the inviting new ERs, other analysts note. Other pieces of the health care system might do well to figure out what that is and try to deliver the same service in a less-costly way.

Patients who don't have a regular doctor or who like knowing a clean, well-lighted place will take them in at 9 p.m. Friday, for example. Primary-care doctors can provide some of that with night and weekend office hours, access to e-mail or texted advice, and other techniques, Anthem's Kraft said.

"Meeting patients where they're at, which is kind of a new concept," Kraft said.

Michael Booth: 303-954-1686, mbooth@denverpost.com or twitter.com/mboothdp

Read more: Colorado for-profit ERs next to Starbucks: convenience and controversy - The Denver Post http://www.denverpost.com/news/ci_23756641/colorado-profit-ers-next-starbucks-convenience-and-controversy#ixzz2aWZEbUjM
Read The Denver Post's Terms of Use of its content: http://www.denverpost.com/termsofuse
Follow us: @Denverpost on Twitter | Denverpost on Facebook

Accountable Care Organizations And Innovation: A Changing Landscape

---

June 28th, 2013 

by Erin Bartolini

As Accountable Care Organizations take the country by storm, too little attention is being paid to how the new incentive structure of ACOs is sharply altering the landscape of health care innovation.

ACOs, even at this early stage, are changing the innovation paradigm, creating new opportunities for some sectors and new challenges for others. For payers and providers, ACOs have opened the door for innovative new payment and care delivery models. But at the same time, there are new pressures on the biopharmaceutical and medtech industries to demonstrate the value of their innovations in ways not required in the past.

Here are some of the emerging lessons and concerns about ACOs and innovation that were raised during a series of multi-stakeholder roundtables hosted by NEHI in Massachusetts and Washington, DC.

Transitioning From Broad-Based Innovations to Targeted Solutions

The use of global budgets has allowed providers to shift their focus from volume and intensity of service to a broader more comprehensive view of health. As a result, ACOs have begun to invest in innovations and services that were previously under-reimbursed or not reimbursed at all: prevention and wellness, chronic disease management, and behavioral and mental health. This shift towards patient-centered care is driving industry to develop solutions that help ACOs achieve these new population-health goals. They are doing this by developing tailored solutions that incorporate prevention strategies, behavioral changes, genomic factors, and home-based or community-based interventions that get to the underlying factors of a patient’s health.

Interestingly, in many cases it is clinicians who are driving these changes from the bottom up, rather than ACO leadership dictating practice reforms from the top down. Once physicians become part of an ACO model, they typically look for ways to redesign the way care is delivered in order to stay within their global budget. As a result, clinicians are now taking the lead in creating new clinical protocols, developing ways to track patient outcomes, measuring cost savings, and leveraging other practitioners as part of the care team.

Emerging Patient Engagement Technologies

With patient engagement a new focus of ACOs, industry innovators are actively investing in new ways to help ACOs achieve this goal.   For instance, there has been a marked increase in the adoption of telehealth and mobile health technologies that can bridge the communication gap between patients and providers outside of the doctor’s office or the hospital room. There is now a real business case to invest in many of these technologies when considering their cost relative to the total medical expense for a patient, rather than relying on fee-for-service reimbursement. Home telemonitoring for heart disease patients, for example, can seem expensive to purchase — costing as much as $1,000 per device — but if it can help avoid a $10,000 hospital readmission, the investment may make financial sense for an ACO.

Similarly, the biopharmaceutical industry is striving to extend its reach and its value by offering consumer-based tools that help educate and engage patients across the continuum of care. For instance, Johnson & Johnson recently purchased the consumer-based business HealthMedia to create coaching tools to help patients navigate the health care system, better engage with their providers, and learn what symptoms they should be looking out for.

Payers are also exploring technologies that can help patients seek appropriate care for their symptoms. Aetna, a national health plan, recently invested in the mobile application iTriage that allows patients to query their symptoms, identify appropriate providers and care settings for their treatment, and determine what services are covered by their insurance plan. This mobile technology even allows patients to print out directions to see their provider of choice. Aetna has shown that when patients are empowered with this information, they are much more likely to seek appropriate care and choose an in-network provider.

Increasing Use Of Evidence Based Medicine And Clinical Guidelines

Because ACOs are taking on whole or partial financial risk for their patient populations, they are now looking more closely at which drugs, devices, technologies, procedures, and patients require the most resources and are reviewing the clinical evidence to determine appropriate care. In some cases, global payment models have already shown a change in the utilization of some therapies and technologies on the market today. For example, early results from Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract, a commercial ACO-like payment model, show that the use of high-tech radiology and imaging services has declined significantly while preventive care has improved overall,  including some forms of cancer screening, when compared to fee-for-service payment models.

Steward Health Care System, a pioneer ACO in Massachusetts, streamlined the use of anesthetic agents across their chain of hospitals after recognizing that one of three anesthetic agents being used was four-times more expensive than the others. After reviewing the evidence, Steward decided to use the more costly drug only in instances where the evidence supported its use.

Paying closer attention to the evidence also applies to the adoption of new innovations. Many ACOs have created committees and review boards to assess the evidence and ultimately decide if and when new drugs or devices should be used. These review boards are evaluating new products and writing clinical guidelines based on safety, effectiveness, patient-centeredness, regulatory compliance and cost-effectiveness. Partners HealthCare System, another pioneer ACO in Massachusetts, has a “Center for Drug Policy” where physician leaders review newly FDA-approved therapies and write clinical guidelines for appropriate use.

Due to these changes in the marketplace, the biopharmaceutical and medtech industries are adjusting by generating evidence earlier in the product development process. Not only are they generating clinical and sometimes cost-effectiveness data earlier, they are also exploring partnerships with payers and providers to better understand the long term impact and outcomes of their products. These partnerships allow manufacturers to gain better feedback data on their products in real time rather than having to conduct additional clinical studies that can be costly and time consuming.

The Challenge for Innovators

Despite the new opportunities offered by ACOs, many questions remain about the impact of ACOs on innovation, including:
.

• Will ACOs disincentivize the use of new technologies in cases where the clinical or financial benefits accrue outside of the window in which an ACO would calculate savings?   Innovators are understandably concerned that an ACO may favor a less expensive therapy over a more costly alternative despite its potential long-term benefits that may be unclear when a product first enters the market.
• Will ACOs incentivize the use of Part D therapies that are excluded from the ACO’s global budget over Part B therapies that aren’t? What will this mean for patients and their access to innovative and appropriate therapies?
• How will academic research be supported and subsidized in the new ACO environment?  If academic medical centers are forced to compete with other providers on cost alone, the fear is that the funding stream for academic research may decrease significantly.

These questions deserve close attention by health care leaders, policymakers, patient groups and innovators so that all sectors can better work together to make ACOs a success. In the meantime, the continuing challenge for biopharmaceutical and medtech innovators is to develop products that help reduce the total medical expense for patients and/or improve quality as defined by ACO quality measures.

A simple formula for how innovators can best survive in the new ACO world comes from Health Economist David Cutler of Harvard University: “In any industry that works well, the firms that do extremely well are the one that create value. They’re not the ones that are the cheapest or the highest quality at all cost. They are the ones that focus on how do I create value. Do that and you win.”

http://healthaffairs.org/blog/2013/06/28/accountable-care-organizations-and-innovation-a-changing-landscape/