Pharmaceutical Commerce - March/April 2013 - (Page 8)

Top News Leading EHR vendor, athenahealth, will buy Epocrates, mobile drug info provider, for $293 million Outcomes research will get a boost from an Optum/Mayo Clinic collaboration Step is one of the first toward consolidation of electronic health providers and information publishers Optum Labs will run analytics on millions of claims and clinical records to find improved outcomes Representing a 22% premium over Epocrates’ current stock price, the proposed acquisition fills two critical gaps in the business plans of both companies, according to Jonathan Bush, athenahealth CEO: “For Epocrates, it will fill the need for a broader revenue stream, and for us, our need is access [to physicians] and market share.” Epocrates is one of a handful of companies that provide edited, tailored drug information to physicians; it claims access to 330,000 physicians, or roughly half the US profession. Athenahealth (Watertown, MA), on the other hand, is one of dozens if not hundreds of IT companies providing electronic-health or medical records systems that are moving at a fairly rapid clip into doctors’ offices and healthcare systems. (It is regarded as one of the leaders, at least of cloud-based applications, with a claimed 38,000 providers in its network, and is growing at a 30% annual clip.) One of the biggest hurdles to broader use of EHRs, however, has been the broad range of vendors and lack of interoperability among them. During an analysts’ presentation announcing the acquisition, Bush mentioned that Epocrates has a “Our strategic research alliance with Optum Labs will leverage what we believe to be the largest combined source of clinical and claims information, providing a more comprehensive picture of patients’ diagnoses, progression of diseases, comparative treatments and outcomes,” said John Noseworthy, M.D., CEO of Mayo Clinic (Rochester, MN), in announcing the undertaking. According to press reports, Mayo will bring more than five million clinical records, going back 15 years, while Optum (a healthcare analytics part of the insurer UnitedHealth Group, based in Minneapolis) will bring claims records of 100 million patients spanning 20 years. Together, using the latest “big data” analytics techniques, the partners will attempt to gain insights into optimal treatments, variations in care and comparative effectiveness of therapies. (See Pharmaceutical Commerce, Nov/Dec 2012, p. 6, for more background on comparative effectiveness research.) Unlike the outcomes research being developed at HHS, however, Optum Labs will be free to look at cost effectiveness of therapies as well. The collaboration is based in Cambridge, MA, and is open to participation from academic institutions, life sciences companies and commercial and government payers. large database of patient records, and athenahealth has millions of patient records of its own. Both, with proper HIPPA constraints, can provide market insights to pharmaceutical companies (and health systems). Epocrates has offered a variety of engagement options for pharma marketers. As more and more physicians become employees of healthcare systems (rather than independent practitioners), and as healthcare systems apply more constraints on physician access, getting access to prescribers is a growing challenge for pharma marketers. By getting drug information from Epocrates into the “digital workflow” (Pharmaceutical Commerce, Nov/Dec, p. 1) of these physicians, the hope is that a more effective communication channel to prescribers is developing. Epocrates’ management was aware of this trend, but the company backed off from developing its own EHR offering in early 2012, and its stock had been sliding during most of last year. One of the questions yet to be resolved is whether Epocrates’ ownership by an EHR vendor will make it less accessible to physicians using other EHR systems. Social media and medication adherence: Theory and promise are way ahead of results Lack of quantitative clinical results and FDA regulatory uncertainty leave unclear benefits for this $300-billion problem Medication adherence today is like walking down a long, quiet hallway, opening a door and finding a raucous party going on, with the partygoers all enthusiasts of applying social-media and mobile-health (mhealth) techniques to this longstanding problem. There’s a lot of buzz and excitement— but the jury is very much out whether it will make a difference. Two newer entrants in this buzz are the MediSafe Project (out of Haifa, Israel), and Abiogenix (Cambridge, MA). Both come out of the growing stew of organizations using novel startup technologies like crowdsourcing to ramp up. MediSafe is an iOS (Apple)/Android app, available for free download, that combines a smartphone (conventional telephony is also in the works) with a cloud-based database system. According to Omri Shor, CEO, the app creates an ecosystem of care providers (such as family and friends) that share notifications of when a patient has taken their medications, and can act as support and reminders for missed dosages; texting and callbacks can be programmed for the patient as well. Pills can be identified, even by photos compared to a stored database, to confirm the right meds. That’s the patient-facing aspect, says Shor. A healthcaresystem and pharma-facing part collects usage patterns and demographics to provide insights into patient habits. Shor says that this is done in a HIPPA-compliant manner. Discussions are ongoing with several pharma manufacturers to sponsor the application. Abiogenix is going the hardware route, having developed what it calls the uBox, a day-by-day pillbox loaded with communications-enabled electronics to transmit usage patterns to the “circle of care” of a patient—again, friends and family. Based on company literature, targeted customers (besides individual patients) include healthcare systems, and clinical research organizations conducting trials. While healthcare providers and the pharma industry spend millions annually funding medication adherence, these organizations have followed their own path. MediSafe has been supported by the Azure Accelerator program, organized by Microsoft in support of its Azure cloud service. Abiogenix is one of the awardees of Healthbox, a Boston group that provides venture funding and incubator support. It has also gone the crowdsourcing route, offering varying price points at (the support page is located here). Mixed results Medication non-adherence’s cost to the US healthcare system has been estimated at more than $300 billion by Express Scripts (in its 2011 Drug Trends report), and a global missed-revenue opportunity for the pharma industry alone of $188 billion by Capgemini. CVS Caremark has just publicized a study it sponsored (published in the J. of Managed Care) looking specifically at social media tools for supporting adherence. “Leveraging a patient’s existing social contacts and networks… could be both an effective and cost-effective way to help improve adherence,” according to Dr. Niteesh 8 Visit our website at March | April 2013 Choudhury, of Brigham and Women’s Hospital and Harvard Medical School, after participating in the meta-analysis of 50 adherence studies the authors had collected. But the details of the study—which the authors say is a qualitative analysis limited by the small scale of each study and problems inherent in observational data—did not clearly endorse social media or social networks. “While specific types of social support were associated with varying levels of adherence, the strength of the effect of each type has not been clearly quantified,” they conclude, calling for more study of the subject. The clearest message was that “practical support”—such as transporting patients to pharmacies to pick up meds, or helping with medication administration— provided the best benefits. Interestingly, some of the studies evaluated found a negative implication for friends and family involved in medication adherence. MediSafe and Abiogenix are by no means the first to apply mhealth to medication adherence. There are hundreds of reminders, schedulers and drug-identification apps in the Apple Store or at Google Play. Remedy Health, which taps into 150 million readers and website visitors annually, has had the MyRefill Rx app available for more than a year; Jim Curtis, chief revenue officer at the company, says that it has been downloaded 8,000 times for use with one drug (Novartis’ Diovan, a cardiovascular therapy)—which is a promising but not revolutionary result. Apps from healthcare providers, pharmacy chains and others show downloads in the tens to hundreds. Some of the pharma industry hesitation about mhealth is to be expected; the industry is still cowed by FDA regulators who watch what efforts take place, but have been unable to issue clear guidance on acceptable mhealth practices. The FDA Safety and Innovation Act passed last summer stipulated that FDA will issue such guidance—but the deadline is January 2014.

Table of Contents for the Digital Edition of Pharmaceutical Commerce - March/April 2013

Pharmaceutical Commerce - March/April 2013
Top News
Brand Marketing & Communications
Supply Chain/Logistics
Information Technology
Manufacturing & Packaging
Legal & Regulatory
Meetings and Editorial Index

Pharmaceutical Commerce - March/April 2013