For our latest After Hours interview, Traci Thompson, MD, MBA, chief medical officer, Humana Healthy Horizons of Florida, discusses her drive to improve health equity in underserved east Tampa, with AJMC® Associate Editor Matthew Gavidia.

Learn About Managed Care Experts' AFTER HOURS Pursuits

For our latest After Hours interview, Crystal Denlinger, MD, FACP, chief scientific officer, NCCN, discusses how how she rekindled her love for sailing during the pandemic, with AJMC® Associate Editor Matthew Gavidia.

Learn About Managed Care Experts' AFTER HOURS Interests

Human papillomavirus (HPV) infection is more common among people with 

 (SLE) than the general population, and the virus can play a role in the onset or worsening of the autoimmune disease.

Yet, the most common method for preventing HPV infection—vaccination—may in some cases trigger SLE for certain patients, according to a recent report.

 in the United States since 2006; initially, it was approved for girls and women, and then it was broadened to include males. Uptake, however, has lagged, compared with other parts of the world, such as in 

, where it is credited with a 92% reduction in HPV types responsible for almost 75% of cervical cancer.

International Journal of Rheumatic Diseases

 involved a single case at Peking Union Medical College Hospital and a series of similar cases in which patients developed SLE following HPV vaccination. The authors said the cases show it is important to assess patient risk when considering vaccination. They said the pathogenesis of SLE is complex and is believed to be related to genetic factors and epigenetic and environmental factors.

“The suggested age for HPV vaccination coincides with the age of high SLE incidence, making the relationship between the HPV vaccine and SLE incidence a notable concern,” they wrote.

In this case, a 31-year-old female reported a rash on her hand and forehead 1 week after HPV vaccination. The rash went away on its own, but it reappeared 2 months later after she received a second dose of the vaccine. In addition to the worsening rash, she also had fever, arthralgia, hair loss, and a poor appetite.

After laboratory tests, she received an SLE diagnosis and was given methylprednisolone and hydroxychloroquine, which led to improvement.

The investigators conducted a literature search of various databases for articles from January 2006 to March 2021 and identified 11 similar cases in which HPV vaccination was linked with SLE onset and laboratory data were available. In most cases, the investigators said, symptoms appeared 4 to 5 months after the second vaccination dose.

“Common clinical manifestations were fatigue, fever, arthralgia, and myalgia, with minimal involvement of vital organs,” they wrote. However, they added that there were 2 cases of lupus nephritis and 2 cases of central nervous system involvement among the group.

“Patients typically show autoantibodies for various factors in laboratory tests, including ANA [antinuclear antibodies], anti-dsDNA [anti–double-stranded DNA], and anti-SSA [anti-Ro antibodies], antiphospholipid antibodies, and hypocomplementemia,” they wrote.

In just over half of the cases, the investigators said, patients had a prior history or a family history of autoimmune disease.

All of the patients “showed rapid remission with glucocorticoid and immunosuppressive therapy and remained stable during several months of follow-up,” they said.

The investigators emphasized that clinicians ought to take a detailed personal and family history before recommending young women get the HPV vaccine. In cases where there is a history of autoimmune disease, genetic testing can be used to help clarify the patient’s risk for SLE or related diseases.

“A pre-immunization assessment of autoantibody and HLA [human leukocyte antigen] status will be a marker for at-risk individuals,” they said.

More research is needed, they added, to better understand exactly who is at highest risk of developing SLE or another autoimmune disease after HPV vaccination. Such data could result in better guidelines as to which patients are good candidates for vaccination and at which doses, they said.

They also noted that the European League Against Rheumatism recommends the vaccination for patients with rheumatic diseases in adulthood and patients with SLE during adolescence.

Allison Inserro contributed to this story.

He N, Leng X, Zeng X. Systemic lupus erythematosus following human papillomavirus vaccination: a case-based review. 

. Published online August 10, 2022. doi:10.1111/1756-185X.14404

Articles

A new case report highlights the potential benefits of risk assessment for women with a family history of autoimmune diseases, such as systemic lupus erythematosus (SLE), who are considering the human papillomavirus (HPV) vaccine.



New Report Highlights Rare Cases of SLE Onset After HPV Vaccination

 I’d like to pivot a little bit and talk about the populations that are most at risk for developing CKD because it builds off the great information we’ve had this far. As we focus on education, targeting unique patient populations, it’s important to understand who has the most risk. Dr. Feldman, you have a lot of expertise here, and you hit on it earlier, but do you mind reminding us and the viewers what the populations are that are most at risk for developing CKD?

 I’m going to pivot off what Dr. Agarwal said, and looking at the end-stage renal population, which is our costliest population, and it’s the reason why we need programs like this. The burden of most of those patients are African Americans or Hispanics, and if you go back and look at the population at risk, African Americans are 12% of American population. In New Jersey, where I am, most of the patients I’m seeing are African Americans and Hispanics. The patients that develop CKD, diabetes, and obesity with the comorbidities that we discuss are predominantly overrepresented, African Americans and Hispanics, compared with Caucasians. The problem is identifying the patients early, getting them on treatment, and with disparities care. We need to bring them into our offices and get them on guideline-directed therapy to prevent worsening kidney function, worsening complications of diabetes, heart failure, coronary disease. These are the patients we need to look at, follow, and get very aggressive with in order to bring them in and prevent them from ending up on dialysis or needing a renal transplant, which is cost quite costly. As part of our ACO [accountable care organization] in New Jersey, we have 400–600 patients on dialysis. We are overrepresented in New Jersey. It costs $100,000 a year for a patient on dialysis. Dr. Agarwal could tell you what it costs in Indiana, but it’s much less in other states. It’s about $70,000. There’s the burden also with these patients developing heart failure and multiple admissions to the hospital. It’s the comorbidities of heart failure, end-stage renal disease, coronary disease that is most costly and can be prevented with the current types of therapies that we now have available.

 I love how you brought up that we’ve got to be really thoughtful in how we’re treating these patients. Early intervention, managing the comorbidities, that’s going to give these patients the best chance at great outcomes, but also managing total cost to care. And Doctor Feldman I think that’s something that you have a unique perspective on, being involved in the ACO and bringing in that economic burden as well as clinical burden as you as one of the treating physicians.

Videos

Dr Feldman describes the populations that are most at risk of developing CKD.

Populations That Develop CKD

 Program titled, Population Health Management of Chronic Kidney Disease. I am Dr. Ryan Haumschild, director of pharmacy at Emory Healthcare, and the Winship Cancer Institute. Joining me today for this virtual discussion are my colleagues: Dr. Jeffrey Feldman, nephrologist in the Atlantic Health System; Dr. Rajiv Agarwald, Professor of Medicine at Indiana University School of Medicine; Dr. Bertram Pitt, cardiologist and professor of internal medicine at the University of Michigan; and Paul Sapia, population health strategy principle at Humana. This panel discussion adds to the conversation from our previous 

 discussing the implications of chronic kidney disease in type 2 diabetes. Today, our panel of experts will discuss the population health burden of chronic kidney disease, explore the relationship between chronic kidney disease and cardiovascular disease, and lastly review unmet needs and additional considerations in the treatment of chronic kidney disease. Thank you, and let’s begin.

Let’s first start talking about the population health burden of chronic kidney disease. I want us to describe the difference between the population health burden and then the economic burden of this disease. As we get started, I’m going to pivot to Dr. Feldman. Dr. Feldman, what are the patient characteristics associated with chronic kidney disease? As in age, gender, race, comorbidities. Give us a little bit of context there as you’re describing the patient population.

 Good morning, everybody and thank you for inviting me to this distinguished panel. I've been in practice for many years, and over the last several years, the burden has increased in chronic kidney disease. It does not know any age, gender, race, ethnicity. It crosses various population types. It doesn’t care about COVID-19 or politics or anything like that. As I’m an adult pathologist, I do inherit a few pediatric patients, but most of our patients are in their early 20s and span up to 90s. I’ve had patients who come to me with chronic kidney disease with hypertension and, as Dr. Agarwal will hopefully get into and we’ll discuss, even though we have moderate EHR [electronic health record], the patients’ never had a urine analysis. If they did, it was many years ago. We see significant numbers in elderly people and that pretense systemic disease like chronic chromium nephritis or multi systemic disease with vasculitis or myeloma, but the predominance of patients are really patients with the comorbidities of metabolic syndrome, cardiometabolic syndrome with diabetes, hypertension, dyslipidemia, and atrial fibrillation. As they age, they develop worsening chronic kidney disease. Again, this occurs all across the population, race, and ethnicity and age, and it’s more of a problem in our aging population. It gets older, particularly with the increasing rate of diabetes. Right now, between the ages of 21 and 75, there’s about 35 million diabetics. Most of them are type 2. A significant amount have obesity with hypertension. Heart failure is big now, with over 6 million patients, and chronic kidney disease appears to have about 37 or 38 million adult patients. That’s where we stand currently, and we need better, earlier detection and treatment as we’ll discuss hopefully later on.

 Thanks for giving that great overview because I think it’s so important for people to understand the characteristics and how CKD really affects all, especially those with comorbid disease. As we talk about prevalence I want to defer to my expert, Dr. Agarwal, to really give us an overview. What is the incidence and prevalence of CKD in the United States population? If you could, please talk about what the estimated prevalence by stage is.

 That’s a great question. I’m going to cite the Centers for Disease Control that has done a lot of work in this area. The statistic that is usually cited is more than 1 in 7 Americans have chronic kidney disease. That is 15% of the US adult population, or 37 million people, that are estimated to have CKD. What is surprising is that as many as 9 out of 10 adults with CKD do not know that they have chronic kidney disease. Even if you are talking about stage 4 and 5 kidney disease, about 2 out of 5 are with severe CKD and do not know, which is surprising. When people come to me, they say, “How do you know I have kidney disease? I don't have any problems urinating. I don't have any problems with any blood in my urine.” Many people don't recognize that it is the detection of albuminuria, or low EGFR, that is responsible for making a diagnosis. For the majority of the patients, you can have polycystic kidney disease in the absence of albuminuria and not just kidney disease, or you could have other special kinds of kidney disease. The majority of the people will have either albuminuria or low EGFR, or the combination of the 2, which will define CKD. If you look at the data from the National Health and Nutrition Examination survey, NHANES, and analyze the prevalence by stage, most patients have albuminuria as the defining reason for their kidney disease. This is especially true in people with type 2 diabetes. Stage 3 kidney disease would be a bulk of the kidney disease that comes to medical attention because very few people get their urine even when they have diabetes. Stage 4 kidney disease is < 0.5%, and there are 600,000 or so patients who are on dialysis. They would be end-stage kidney failure and are undergoing dialysis or have received kidney transplant. That’s the burden. Normally, there are 750 million people with chronic kidney disease. If you look at the US prevalence, it is 37 million. You have < 5% of the kidney disease patients in the United States and 95% outside the United States.

 That’s a great overview. It’s a reminder of the impact of this disease on a lot of patient populations. I like how you stratify by the different stages because I think it’s helpful. There are different needs based on those different stages in which patients fall.

Jeffrey Feldman, MD, and Rajiv Agarwal, MD, MS, provide an overview of chronic kidney disease (CKD) and its prevalence.

Getting to Know CKD

Julia is an associate editor of The American Journal of Managed Care

since 2022 after receiving her Bachelor's degree at Rutgers University–New Brunswick in English and Creative Writing.

Physically inactive adolescents were more likely to have worse 

 quality and more heart rate variability than those who had regular physical activity, according to a study published in 

. This reduction in sleep quality could have implications for cardiovascular health in this age group.

The cross-sectional study included adolescents of both genders. Adolescents were invited to participate after a parent or guardian gave informed consent. All participants were split into 2 groups based on sleep quality: good or poor. They were then further divided into subgroups: active good sleep quality (AGSQ), sedentary good sleep quality (SGSQ), active poor sleep quality (APSQ), and sedentary poor sleep quality (SPSQ).

Participants’ heart rate variability was obtained with a 12-lead electrocardiogram device. Blood pressure was also assessed. The International Physical Activity Questionnaire was used to record physical activity and the Pittsburgh Sleep Quality Index was used to assess sleep quality.

There were 352 adolescents who enrolled in the study, and they had a mean (SD) age of 15.8 (0.24) years. Most of the participants enrolled were girls (62%), 210 participants had good sleep quality, and 142 participants had poor sleep quality. The subgroups were divided, with 123 in AGSQ, 87 SGSQ, 36 APSQ, and 36 SPSQ.

The researchers found that participants in the SPSQ group had a higher mean (SD) systolic blood pressure (SBP) compared with AGSQ and SGSQ (119.4 [2.0] vs 112.8 [1.1] and 112.2 [1.24], respectively). The APSQ and SPSQ groups also had a higher mean (SD) diastolic blood pressure (DBP) compared with AGSQ (69.5 [0.8] and 68.8 [1.4] vs 65.3 [0.7]).

The investigators also examined several measures of heart rate variability, including root mean square of successive differences between normal heartbeats (RMSSD), pNN50, and SD1. There was a difference in the mean RMSSD between the SPSQ group and the AGSQ group (44.39 [5.29] vs 53.92 [2.75]). For pNN50, the SPSQ group had a significantly lower mean level than all of the other subgroups. There was a significant difference in SD1 in the nonlinear analysis, where SPSQ was less than APSQ (32.37 [3.72] vs 41.31 [1.89]). 

An analysis of the frequency levels of the heart rate variability spectrum also demonstrated significant differences in all parameters. The low frequency percentage in the SPSQ group was higher than the AGSQ group (49.08 [2.79] vs 41.12 [1.45]) and the APSQ group was higher than the SGSQ group (49.66 [1.59] vs 44.21 [1.70]). The high frequency percentage was lower in the APSQ group compared with the AGSQ group (50.33 [1.52] vs 58.87 [1.45]).

The investigators summarized that the representative variables of the parasympathetic nervous system were at worse levels in the SPSQ group than in all other groups.

There was also a significant difference in SBP in female adolescents between the AGSQ group and SPSQ and APSQ groups (108.2 [1.4] vs 118.6 [2.5] and 116.3 [1.4]).

There were some limitations to this study. The investigators did not perform polysomnography to evaluate sleep in the adolescents and did not utilize other questionnaire tools, meaning that other comorbidities like insomnia and parasomnias could not be evaluated in this study.

“A physically active lifestyle could decrease the harmful effects of poor sleep for some variables involved with cardiovascular control,” the researchers concluded.

Soares NJS Jr, Dias-Filho CAA, Ferreira AC, et al. Sleep quality and regular physical activity in reducing cardiac risk. 

 Published online August 3, 2022. doi:10.1007/s11325-022-02688-x

A study found that adolescents who were more physically active had better sleep quality and heart rate variability than those who were sedentary.

Physical Activity Linked With Better Sleep Quality, Heart Rate Variability in Adolescents

 enter different markets around the globe, payers and practices will need to consistently evaluate the economics of covering biosimilars and take a stance on whether to support their adoption.

Both payers and practices can play a big role in encouraging biosimilar adoption, and health care institutions that have already begun pushing for more biosimilar use, such as Emory Healthcare, have seen substantial savings.

On this episode of Managed Care Cast, we speak with Ryan Haumschild, PharmD, MS, MBA, the director of pharmacy services at Emory Healthcare and the Winship Cancer Institute. Haumschild is also an Advisory Board member for The American Journal of Managed Care® and its sister site, 

®. The interview took place at the The Institute of Value-Based Medicine® (IVBM), hosted by Emory Healthcare, on July 18 in Atlanta, Georgia. Haumschild was chair of the event and gave a presentation on the current pharmacoeconomics of biosimilars and his predictions for how the market will develop in the future.

The episode discussed how the pharmacoeconomics of biosimilars have evolved and different strategies that health care institutions can implement to reap the benefits of biosimilar savings.

We also talked about how stakeholders can collaborate to promote biosimilars and how technology can be used to assist this mission.

Listen to the interview above or through one of these podcast services:

Podcasts

On this episode of Managed Care Cast, Ryan Haumschild, PharmD, MS, MBA, from Emory Healthcare and the Winship Cancer Institute, explains the evolution of biosimilar pharmacoeconomics and the different strategies that health care institutions can implement to reap the benefits of biosimilar savings.

How Health Care Institutions Can Leverage Biosimilars to Generate Savings

Members from independent oncology practices gathered to discuss value management, theranostics, clinical trial access, innovations in pharmacy at the Quality Cancer Care Alliance (QCCA) Summer 2022 National Leadership Summit, held August 10-12, 2022, at The Bell Harbor International Conference Center in Seattle, Washington.

With a focus on “Harnessing Innovation in Independent Community Oncology,” the summit included panels on topics such as the shift from the Oncology Care Model to the Enhancing Oncology Model and CAR-T cell therapy.

To kick off the meeting, Sibel Blau, MD, president and CEO of QCCA, led a panel on integrating innovation into independent community oncology. Joining Blau to share how their practices are innovating in the field were:

Alti Rahman, practice administrator at Oncology Consultants

Beth Page, COO, director of compliance at Cancer Specialists of North Florida

Frank Senecal, MD, director of oncology at the Franciscan Healthcare System, Northwest Medical Specialties

Justin Floyd, DO, president of Cancer Care Specialists of Illinois

According to Rahman, value and impact are 2 main factors of innovation.

“If you don’t value it, you won’t change it,” he said, noting that change must start at the top with alignment of values between an organization’s management and executive board, because value management is needed at all levels and in all aspects of an organization.

Further, work structure, whether there is an established team focusing on the issue, and what resources are being invested to create this innovation all determine how much value is put into the innovation.

“It's not something that you're looking at generating an ROI [return on investment] out of,” Rahman emphasized. “It is something that you invest in in order to create stronger foundations and roots in what we're doing in community practice.”

His second point was, “If you can’t measure it, you can’t change it.”

Based on this, it is important for the organization to set a clear goal within its limits, as well as understand the magnitude of the issue at hand and how the innovation’s impact is being measured.

Rahman explained that the job of the provider starts in the middle of the patient’s journey after receiving a diagnosis. However, the provider needs to not only focus on how to make things move efficiently at an operational level, but also think about the patient’s journey so far and how their life is affected after treatment.

Rahman pinpointed prior authorization as an area in need of overhaul; he said it adds unnecessary time to the process of getting treatment to patients. To address this, Oncology Consultants looked into how the time was being spent and invested in automation, reducing the turnaround from 20 minutes to 11.8 minutes.

Additionally, after filtering through which parts of the process were deemed to not add value, including redundancies and repetitions, the overall authorization process went from 2 to 3 days down to 1 day between when the physician ordered the therapy and when the prior authorization was approved by the payer.

“As we look at our organization, we have to continuously assess what we're doing and then review the capacity for change and improvement throughout as a culture of innovation,” Rahman closed.

Page expalined theranostics, which are a precision therapies that combine therapeutics, diagnostics, and nanoscience. This type of treatment uses 1 radioactive drug to identify and diagnose a malignancy, and another to deliver therapy for the malignancy and any metastatic tumors.

By comparison, traditional radiation only targets 1 disease site, which makes radiation less effective for patients with metastatic tumors. Radiation can also damage healthy tissue surrounding the malignancy.

Theranostics available at Cancer Specialists of North Florida include lutetium Lu 177 vipivotide tetraxetan (Pluvicto), lutetium Lu 177 dotatate (Lutathera), and radium Ra 223 dichloride (Xofigo). Data presented at the QCCA Summit show Lutathera and Xofigo result in more than $8000 and $2200 in average profits per injection, respectively.

Page emphasized the importance of operationalizing this therapy correctly, stressing that practices that fail to set up the correct system risk losing all profit.

To avoid this loss while also minimizing waste and improving the patient experience, Page explained that Cancer Specialists of North Florida has a team that meets the same day every week. This team includes 1 member who handles scheduling, 1 part-time nurse who stays in the room with the patient for 6 hours to avoid pulling a nurse from the clinic’s chemotherapy floor, and 1 imaging tech who is with the patient for around 30 minutes to administer the doses.

This team also moves between sites on different days of the week, but always consists of the same members on the same schedule.

Blau added that standard operating procedures are being developed to help practices build these teams.

According to Page, the global theranostics market is estimated to grow 9.6% annually through 2028, reaching a value of more than $123 billion. Primary factors driving this growth are the increase in prevalence of cancer and other chronic illnesses, and growing investments in biological research. At the same time, this trajectory could be impeded by challenges surrounding the regulatory landscape and a lack of reimbursement policies.

Clinical trials for this therapy are ongoing, with phase 3 trials happening at Telix Pharmaceuticals for TLX591, which is estimated to reach commercialization in the next 12 months. Additionally, a phase 4 trial at Zionexa is being initiated for Cerianna.

Most CAR T-cell therapy programs are available through hospital settings, especially in metropolitan areas. In the northwest United States, according to Senecal, this means many patients eligible for the therapy that are referred to a limited number of centers have to wait longer to access it.

“The result of that is there is oftentimes a 2 month, 3 month waiting list for getting patients into therapy,” Senecal explained. “In addition, the rules and regulations from Fred Hutch [mean] patients need to stay in Seattle after they receive their therapy, so patients are making a commitment to stay for a pretty prolonged period of time.”

Senecal is also the founder of the South Sound CARE Foundation (SSCF), which aims to increase access to clinical trials and cancer research closer to patients in the South Sound region, and provide residents with cancer treatment options such as CAR T-cell therapy that are otherwise unavailable in their area.

Topics for ongoing trials through SSCF include blood cancers, breast cancer, genitourinary cancer, and quality of life.

SSCF also has a number of Compassionate Use trials for physicians and providers, designed for patients that are no longer responding to standard of therapy.

“These are individual ‘trials’ in which the FDA and pharmaceutical companies work together to provide access to drugs shown effective for specific tumor traits, but not available through other sources,” the 

 explained. “The South Sound CARE team coordinates the process for our patients, facilitating the applications and locating potential Compassionate Use programs within pharma willing to partner to provide drug free of cost to patients.”

According to Floyd, providing specialty drugs to patients has several challenges, including high costs, variable half-lives of drugs, and access to specialty infusion staff. Additionally, many patients have limited access to cancer care, especially if they are older in age, live in a rural area, or live in a smaller, vulnerable, or generally underserved population or geographic location.

On top of this, patients are sometimes unable to keep their appointments due to travel, poor health, and various other reasons.

Floyd also noted that, while Cancer Care Specialists of Illinois (CCSI) has been operating successfully for 30 years, he realizes the care design model is geographically challenging.

To overcome these obstacles, CCSI created a “first of its kind” mobile pharmacy, a pharmaceutical compounding vehicle that is not a licensed pharmacy but helps to deliver cancer care to patients by providing on-site chemotherapy medication compounding.

Issues with wasted drugs has also become a large problem in pharmaceuticals, both environmentally and financially. Chemotherapy drugs can be very expensive, and if they are transported to a center and then no longer needed, they must be disposed, contributing to both a waste in resources and high health care costs.

With the mobile pharmacy, the chemotherapy medication is not mixed until the patients are seen at the hospital and an exact prescription is made, saving valuable medical resources while reducing cancer care’ environmental footprint.

It also has led to financial savings, with Floyd noting waste savings of $664,248 in 2020, $804,833 in 2021, and $278,722 so far in 2022.

Finally, Floyd suggested that compounding drugs on site can improve patient access to clinical trials because they are no longer required to travel to a central hub for investigational drugs.

Value management, theranostics, clinical trial access, and a mobile pharmacy are major innovations being integrated into independent community oncology highlighted at the Quality Cancer Care Alliance Summer 2022 National Leadership Summit.

QCCA Panel Highlights Expansion of Innovation at Independent Community Oncology

Matt Dickson is a versatile leader with strong operational management experience and expertise providing IT, product, and process solutions in the health care industry for nearly 25 years. Prior to joining Stericycle, Matt served as vice president of data analytics for Conduent Payment Integrity Solutions, a global business process outsourcing company with more than 85,000 employees in 40 countries. While at Conduent, Matt built predictive models to identify overpayments for health care payers leading to a 60% increase in identification rates.

Prior to his time working with Payment Integrity Solutions, Matt worked in several other verticals and horizontals at Conduent where he led storage and database teams, which reduced storage expenditures by 85% in his first year. Matt also served as vice president of strategic operations where he won an award for product innovation of the year.

Matt is a graduate of Northern Illinois University and completed a master’s degree at Southern New Hampshire University where he won the Outstanding Student Award for having the highest GPA of graduating students in their respective major while earning his advanced degree in data analytics.

Patients have come to expect their health care providers to deliver the same level of convenience they experience shopping online with consumer brands that lead the charge in driving personalization, choice, and loyalty. With increasing patient expectations, innovative patient engagement solutions are a 

. Patient engagement solutions provide incentive and ability to 

 in a way uniquely appropriate to the individual. Barriers and misconceptions about patient engagement persist, however. Here are 6 myths that are preventing provider organizations from committing to patient engagement solutions, debunked:

Myth #1: Patient engagement solutions have an “unclear” benefit for patients

Patient engagement solutions have many clear 

, the most valuable being better patient outcomes. According to the Agency for Health Research and Quality (AHRQ), patient engagement has a 

 on emotional health, symptom resolution, functioning, pain control, and physiologic measures such as blood pressure and blood sugar. These solutions help providers to engage patients by helping them stay informed of their care options, adhere to treatment plans, increase education, and experience less friction during the care journey.

A good patient engagement solution encourages patients to take informed actions related to their health care journey by providing them with the tools they need to easily connect for care, ask questions, remind, and reengage. For example, in a 2021 patient engagement 

 conducted by Stericycle Communication Solutions, 71% of respondents said that multiple reminders help them keep track of appointments. The platform should take this a step further and allow the patient to ask directions or for other important information easily via texting to help them adequately prepare for the appointment. This reduces the chance a patient might miss their appointment or need to reschedule due to being unprepared. These solutions are directly responsible for shepherding patients on their journey to much-needed care, improving health outcomes over time.

Myth #2: Patient engagement solutions have an “unclear” benefit for providers

From the provider perspective, patient engagement solutions help to optimize providers’ schedules, reduce no-shows, and aid in increasing revenue. The most effective solutions activate patients and encourage them to take the next step in their care journey, potentially adhering to treatment plans long term. Those next steps include everything from scheduling and attending additional appointments, seeing a specialist via referral, getting an MRI within the hospital system, or attending a class to learn how to manage their diagnosis—all actions that bolster patients’ long-term health outcomes.

By leveraging tools to encourage and help patients take these steps, providers can acquire new patients and encourage existing patients to stay within the health system, optimizing revenue, reducing no-shows, and filling out provider schedules. Upon implementing one such solution, 

, a Missouri-based health system, saw a 72.5% increase in urgent care visits scheduled online, along with 100,000 additional visits in 1 year vs the previous year. Beyond revenue, growth, and retention, patient and family engagement can improve multiple aspects of hospital performance such as quality, safety, patient outcomes, and employee satisfaction, according to a 

Myth #3: Patient engagement solutions are not HIPAA compliant and secure

Health Insurance Portability and Accountability Act (HIPAA) concerns are the go-to excuse among health care’s slowest adopters. To a point, these detractors are right to be cautious, because health care’s 2-way communication and data flow among a multitude of users and end points requires rigorous cybersecurity and digital hygiene practices. But patient engagement solutions that are worth their salt vigilantly meet and exceed the legal and ethical obligations to keep patients’ data and privacy secure.

There are many best practices when it comes to security, but the most critical features include utilizing 2-factor authentication to access sensitive information, ensuring data is encrypted in transit and at rest, and implementing a rigorous entitlement review process that ensures people only have access to information that is required for them to do their job—not broad access to sensitive data. It’s also important to keep personal health information off less secure channels. This information should be securely housed and encrypted but still easily accessible through gated links for only authorized users.

Myth #4: Patient engagement solutions are not available as “off-the-shelf” tools

Although this may have been truer in prepandemic days, innovation and integration of engagement tools have proliferated in the industry in the last 2 years. Not only do standardized off-the-shelf tools exist, but they are also relatively straightforward to plug into a health system’s existing technology ecosystem, tying into the electronic health record as a single source of truth. Additionally, health systems have the option for deep customization through configuration if standard off-the-shelf tools don’t suit their system’s needs. Configuration also allows for personalization without requiring additional staff to write the code.

With engagement options as diverse as their patient populations, health systems can meet their patients where they are to effectively activate them on their care journey. These engagement options include multilanguage and multichannel communications, such as email, live voice calls, text messages, web chats, and online scheduling. Natural language processing and cognitive search, among other artificial intelligence and machine learning integrations, can enhance the versatility of these solutions as well.

Myth #5: Patients don’t care about online scheduling

"Healthcare 2030: The consumer at the center"

 report by KPMG, 58% of millennials and 64% of Gen Xers value online booking and would switch providers to do so. Not only do patients care, but they will health care “shop” to find providers who offer the convenience of online scheduling. Additionally, a recent 

Stericycle Communication Solutions survey

 highlighted that patient friendly scheduling (via patient engagement solutions that integrate both online and live human call options) drives overall patient satisfaction and access. Online scheduling options—and the patient engagement solutions that leverage them—allow for the level of customization that addresses language barriers, long wait times, and more to improve patient satisfaction.

Myth #6: Patient engagement is one-size-fits-all

Patient engagement is important, but it’s time to focus on patient activation. According to the 

, patients with greater activation have better health outcomes. While patient activation is a subset of engagement, it requires patients to have the right tools, information, and confidence to adhere to their health care journey. With patient knowledge and comfort in 

, a one-size-fits all approach will leave some patients behind. Additionally, the pandemic had a dramatic impact on delayed care, with as many as 

 due to fear of COVID-19 exposure. The effect of delayed care on early detection and intervention has had dire consequences for some patients and potentially caused preventable deaths.

It’s not enough to just implement a patient engagement solution. To increase patient activation, health care providers should focus on tailored outreach designed to meet patients where they are and improve their willingness and ability to take actions to manage their health. Choose a solution that allows you to personalize content, context, cadence, and channel. Then build a prescriptive outreach plan that empowers patients and encourages activation. Offer education sessions and other classes to improve health literacy, make it easy to connect for information by offering support in multiple channels, communicate frequently with health and practice information, and make engagement convenient and easy.

Health organizations that drag their heels on patient engagement will find it difficult to retain patients against their more tech-friendly health care competitors and the big technology companies making forays into the health care sector. Big box retailers and tech giants have an edge in the engagement, personalization, and convenience departments, making them formidable opponents when it comes to giving patients what they want.

Health system executives would be wise to dismiss these 6 myths and find the right patient engagement partner for them to get started now, because their patients aren’t going to wait. Patients are ready to engage meaningfully in their care—they just need the invitation and clear access point to do so. With modern patient engagement solutions, it’s easy for health systems and providers to extend that invitation before someone else does.

Patient engagement solutions facilitate active care participation, but several myths persist that hinder their adoption and implementation.

Contributor: 6 Myths to Avoid About Patient Engagement Solutions

Hearing Aids to Be Available Without a Prescription

 hearing aids to be accessible over the counter as early as this fall, which will make hearing loss treatment more accessible and potentially less expensive. The rule will apply to patients 18 years and older who have mild to moderate hearing loss and to air-conduction hearing aids, which are worn behind or inside the ear. The FDA has given numerous requirements of the OTC hearing aids, including that all hearing aids need user-adjusted volume and a lower maximum sound output to avoid patients overamplifying.

FDA Receives Reports on Faulty Philips Devices

 more than 48,000 reports of faulty Philips respiratory devices and ventilators between May and July, which have resulted in 44 deaths. This number is twice the number of reports the FDA received in more than a year, until April. This comes 1 year after Philips 

 their products in June 2021, in which Philips aimed to repair and replace the devices for most of their patients by December 2022.

HHS Approves 12-Month Postpartum Medicaid Extension

 a 12-month extension for postpartum Medicaid and Children’s Health Insurance Program (CHIP) coverage in Hawaii, Maryland, and Ohio. This move can allow up to 34,000 people annually to get Medicaid and CHIP coverage for a full year after their pregnancy. With his approval, and previous state approvals, 318,000 Americans are estimated to be eligible for 12 months of postpartum coverage in 21 states and Washington, DC. An estimated 720,000 people nationally would benefit if all other states adopted this option. Currently, Medicaid covers 42% of all births in the nation.

A new FDA rule will allow hearing aids to be purchased without prescriptions; the FDA has received more than 48,000 reports of faulty Philips respiratory devices between May and July; HHS has extended postpartum Medicaid in Hawaii, Maryland, and Ohio.

What We're Reading: OTC Hearing Aids; Respiratory Devices Failing; Postpartum Medicaid Extended

Laura is the vice president of content for The American Journal of Managed Care

) and all its brands, including The American Journal of Accountable Care

, Evidence-Based Oncology™, and The Center for Biosimilars

, since 2011. She also oversees Managed Healthcare Executive

She has an MA in business and economic reporting from New York University. You can reach her at 

Results from DESTINY-Lung01 have shown promising progression-free survival and overall survival with ongoing research that may lead to a future FDA approval, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

At ASCO this year, there were critical findings about treatment of HER2-low breast cancer with trastuzumab deruxtecan. Is this an area of exploration in HER2 lung cancer, as well?

Yes, definitely. It's actually a very exciting area of active investigation for patients with advanced non–small cell lung cancer. We know that HER2 mutations identified on NGS [next-generation sequencing], it's an actionable mutation, at least so far, in the studies that have been done. We see HER2 mutations in about 1% to 2% of patients with nonsquamous non–small cell lung cancer.

We have results from the DESTINY-Lung01 trial that looked at T-DXd [trastuzumab deruxtecan] in patients with HER2 mutations advanced non–small cell lung cancer. And in their initial cohort of patients, it really showed that there is significant activity of this agent in patients with advanced non–small cell lung cancer with HER2 mutations. They demonstrated a response rate of about 50%. And overall, really promising progression-free survival, as well as overall survival.

There are some toxicities associated with this agent. Overall, well tolerated, but the main reason for treatment discontinuation in this agent has been pneumonitis. So, I think really understanding some of the toxicities is key. There are ongoing studies also to explore the right dose of T-DXd. And this may lead to an FDA approval for us in the future. The NCCN [National Comprehensive Cancer Network] guidelines has actually already incorporated this in their guidelines as an emerging biomarker.

HER2-Low Lung Cancer an “Exciting Area of Active Investigation,” Says Dr Ticiana Leal

Insurance reimbursement for teleophthalmology services is not consistent among populations, and only recently received a boost due to flexibilities allowed during the pandemic, said Parisa Emami-Naeini, MD, MPH, assistant professor of ophthalmology at University of California, Davis, and vitreoretinal surgeon and uveitis specialist at UC Davis Eye Center.

Your study of remote retinal imaging during the pandemic found “inconsistent insurance coverage for teleophthalmology services.” Can you explain what that means?

We did a regression analysis and adjusted for all the baseline characteristics of the beneficiaries, and we found that insurance reimbursement of teleophthalmology services was lower among older individuals—individuals aged 65 years and older—beneficiaries with Medicare Advantage plans, enrollees with lower household income, and African American individuals. This was interesting to us, because a lot of these individuals, like older individuals or racial minorities, are the ones who actually benefit the most from these services. And lower reimbursement of services among these individuals means that these beneficiaries cannot use these services as often as the other beneficiaries or the other enrollees.

By the end of 2020, insurance coverage for remote retinal imaging had largely returned to prepandemic levels. When the public health emergency ends, do you expect to see a further decline?

At the beginning of the pandemic, a lot of the restrictions in telehealth were lifted to encourage social distancing and decrease the number of nonessential in-person medical visits. However, a lot of these changes are temporary, and will likely end later this year and after the end of the public health emergency, or PHE period, although a 151-day post-PHE extension was recently instituted on many of the telehealth flexibilities.

With the recent advancements in teleophthalmology and remote eye screenings in diabetic individuals and with improvements in quality of the cameras that we have, and also with the advancements of artificial intelligence in reading these images, teleophthalmology is here to stay. But we'll have to wait and see how insurance coverage and reimbursements will change over time.

I want to thank my collaborator and partner in crime in this study, Dr Glenn Yiu, who is a vitreoretinal surgeon at UC Davis. He's also the director of the teleophthalmology services at UC Davis.

Insurance reimbursement for teleophthalmology services is not consistent among populations and only recently received a boost due to flexibilities allowed during the pandemic, said Parisa Emami-Naeini, MD, MPH, assistant professor of ophthalmology at University of California, Davis, and vitreoretinal surgeon and uveitis specialist at UC Davis Eye Center.

Teleophthalmology Is Here Today, but Insurance Coverage, Reimbursement Will Change

 among Black women and men compared with their White counterparts, according to a new study, but the increased prevalence appears to be tied largely to social determinants of health.

Corresponding author Natalie McCormick, PhD, of Massachusetts General Hospital, and colleagues, said that gout has traditionally been associated with wealthy White men who over-consumed gamey meat, alcohol, and rich foods.

However, the investigators noted that other demographic groups are seeing increasing rates of gout and its precursor, hyperuricemia.

“Indeed, the global frequency and disability burden of gout among women have been rising disproportionately relative to gout among men, with gout among women characterized by a higher frequency of obesity and related cardiometabolic sequalae,” they wrote.

Despite such evidence, the investigators said there has been little in the way of national data on the demographic prevalence of gout in the United States.

McCormick and colleagues explained the results of their analysis of the National Health and Nutrition Examination Survey. Using data from the survey spanning the years 2007-2016, the investigators tracked rates of provider-diagnosed gout and hyperuricemia and compared them to self-reported racial demographics and body mass index (BMI) scores, as well as rates of chronic kidney disease (CKD) and socioeconomic factors.

The analysis showed that the prevalence of gout was higher in men than in women, but for both sexes the rate was higher among Black survey participants than among White participants. Out of 18,693 participants, the age-standardized prevalence of gout was 3.5% in Black women and 2.0% in White women, the study showed. For men, the prevalence was 7.0% among Black men and 5.4% in White men.

“This disparity is in contrast with data from 2 decades earlier (the NHANES III), when no differences in gout prevalence were observed between Black and White adults, and parallels a disproportionate worsening of CKDand overweight and obesity among Black adults over time,” McCormick and colleagues said.

When the investigators adjusted for socioeconomic and lifestyle factors, the disparities largely diminished. When they adjusted for all risk factors, the difference became statistically null.

The investigators said social determinants of health appear to play a role even aside from any genetic predisposition to gout. They noted that CKD, a risk factor for gout, is more prevalent in Black adults than White adults, reportedly due to the 

 risk alleles present in African American populations.

Even so, McCormick and colleagues said, “evidence suggests that racial differences in sociodemographic, lifestyle, and clinical factors play a greater role [than 

], with poorer access to health care among Black individuals also contributing.”

The authors concluded that the findings of their study not only reverse previous conventional wisdom that White men were at the highest risk of gout, but also that the shift in the demographic burden could be reduced with appropriate public health and clinical interventions.

“Culturally informed interventions designed to address adiposity and kidney disease and improve diet quality while recognizing the role of poverty in gout among women could help reduce these disparities,” they concluded.

McCormick N, Lu N, Yokose C, et al. Racial and Sex Disparities in Gout Prevalence Among US Adults. 

. 2022;5(8):e2226804. Published 2022 Aug 1. doi:10.1001/jamanetworkopen.2022.26804

The new report reverses previous research suggesting that White men who consumed large amounts of gamey meat and rich foods were most at risk.

