Tennessee, Other States More Aggressive with Medicare Reimbursement

Reimbursement for increasingly expensive healthcare treatments and long term care is an issue and states are finding more drastic solutions.  Even if property is willed, a state can still go after it to seek reimbursement of costs, or so the Tennessee Supreme Court ruled last week that the state's Medicaid program can go after the willed property of deceased patients who received long-term or nursing home care, as reported in Fierce Healthcare

The Volunteer State's High Court reversed the ruling of a lower court that the TennCare program could not seek the home of Ardell Hamilton Trigg, who had willed the home to relatives, the article noted.  The court's vote was unanimous on the matter.  Trigg had received care from the TennCare program between 2002 and 2006, when she died, according to the AP.  and incurred 22,000 in costs.

Long Term Care is a key source of bills for Medicaid.  Despite public perception to the contrary, Medicare does not pay for long term care and a provision in the recent Healthcare Reform Legislation for a funding mechanism was ruled out due to cost. Our report on this topic addresses how the industry is affected by these reimbursement challenges.http://www.kaloramainformation.com/Term-Care-Nursing-6849604/ 

New Vaccines Are On the Way

According to our latest vaccine report there may be 24 billion dollars of vaccines sold that do not exist on the market today.    What’s Next in Vaccines? Published by Kalorama Information, this report details over thirty conditions, including malaria, diabetes, Alzheimers and allergies for which there may be vaccines by 2020.  The healthcare market research publishers made its finding based on interviews and a review of products in Phase  II and III.

 Around the world, vaccine developers are investigating a large number of areas that previously would have not been considered treatable via inoculation.   These range from conditions that cause discomfort but are not considered life threatening, such as allergies and Ross River fever, to diseases that significantly increase mortality such as addiction and diabetes.

Using various novel technologies and mechanisms of action, emerging vaccines are being designed to address both infectious and non-infectious disease. They may be prophylactic, intended to prevent a disease before it starts, or therapeutic, designed to address a disease once it has become established; both types, by definition, seek to create an immune system response that will mitigate against the targeted disease.  A model assuming that vaccine candidates currently in Phase III will be commercialized in 2012, candidates in Phase II will enter the market in 2014, those in Phase I will launch in 2016 and vaccines still in pre-clinical testing will enter the market at some point, and that all are going to see some drop off, as not all candidates are approved, yields best case total sales of $24,792 million in 2020.

What’s Next in Vaccines? (Malaria, Diabetes, Alzheimer's, Allergies and 30 Other Targets in the 2012-2021 Vaccine Pipeline) provides forecasted revenues for products in development out to 2021. The report does not does not cover indication expansions of existing vaccine products, nor does it cover vaccines for which products currently exist and are widely available, but may need improvement. Development of vaccines that incorporate new production methods (such as the migration of chicken eggs to mammal, yeast or other cells) is also excluded. Cancer vaccines are excluded as Kalorama has an entire report on this topic.  More information could be obtained at http://www.kaloramainformation.com/Vaccines-Malaria-Diabetes-6985776/

Clinical Understanding of Cancer Has Changed: Reuters

Per this Reuters Article, the deeper genetic information available to oncologists today has the changed the way cancer is identified, tumors are diagnosed and treatments are prescribed.  It is no longer enough to simply identify the organ a cancer has reached and begin treatment.  The new knowledge, while increasing options to keep the disease at bay, has increased the need for genetic testing and specialized knowledge to understand results.   Per the article:   http://www.reuters.com/article/2012/06/06/us-cancer-genome-diagnosis-idUSBRE85500120120606

"Cancers that may look identical under the microscope may actually have very different genetic abnormalities, and therefore, are likely to respond to very different kinds of therapies," said Dr. Mace Rothenberg, senior vice president for oncology at Pfizer. "What is happening is a very rapid evolution in thinking - from one test on one tumor to actually doing multiple tests on one tumor sample."

The positive side is that treatments can be targeted better, the negative side is that it's harder for community hospitals and oncologists outside of major universities to keep pace.  


Kalorama's Personalized Medicine Diagnostics   is Kalorama Information's latest market research report on the industry of tests that identify molecular characteristics of cancer and treatment potential, among other applications. 

Dark Side of A Growing Market: Growing Costs in Another Market

One industry's growth can be in some cases, a severe burden on another industry's growth.  The growth of wound care devices, reported on each year by Kalorama Information in its report (our latest update will be out this month) also means more costs for nursing homes and assisted living care centers that treat the elderly who are more likely to be wounded from accidents or surgeries, and who often take a longer time healing.  

So it is illustrated in this McKinght's Long Term Care Report article.

Much remains to be learned about wounds and how best to treat them. Last year, the Agency for Healthcare Research and Quality awarded the Johns Hopkins Evidence-based Practice Center nearly half a million dollars to investigate state-of-the-art wound care. The center has been tasked with determining what's known about medications, antibiotics, dressings and surgery, and establishing strategies proven to work.
The review will focus largely on lower extremity wounds, which can be complications of leg ulcers and diabetes and be exacerbated by obesity and poor nutrition. But investigators also expect to learn more about other types of wounds, such as pressure ulcers that are seen in long-term care settings.
Across the United States, about seven million people have chronic wounds. About $25 billion is spent annually on their care, according to a study that called this a “snowballing threat to public health.”

The article has a point.  What we present in our report as a key growth time for wound care device makers, which it certainly has been for the past few years, is to public health a 'snowballing threat.'  And that suggests some of the price increases may be tamed in the near future, which will impact revenue growth.

The  reports of many healthcare market research publishers, and Kalorama even at times, tend to be unitary in focus.  Reports show charts of increasing revenues.  We are identifying a market and showing companies the growth potential for new products that they might launch in that market.

But it's critical to understand any given market to know the markets that are adjacent.  Because these are going to be the limiters on potential growth.    In our diagnostic reagent reports are complemented well by our clinical lab services report.  Growth in lab services will mean more reagent sales.  In our report on global medical devices, we take a look at the hospital market and how they are slightly recovering from the recession and the hit on their endowments but still facing payment issues and reimbursement cuts.   Here you can see that although wound care products will grow in coming years, we can't go off the charts with the growth rate because there's only so much the long term care industry and governments will pay.  A good market research effort will require many different industry reports to see the whole picture.

Even for Large Organizations, EMR Switches Can Hurt

For a small physician practice, the change to an EMR or a change of EMRs is fraught with real costs and potential productivity costs.  But EMR changes are costly as well for large organizations, as evident from last quarter's move by a major healthcare system.   Partners in Boston, MA has selected Epic for a massive EMR overall from its internal electronic medical records system to the Epic system with customizations. Partners plans to invest $600 million to $700 million in the new EHR over the next 10 years.  


As indicated in this Fierce EMR story, such a change has not been out without challenges for the organization.  EMR comes with a cost, and last quarter Partners took a 138 million dollar hit in operating income as the result of a switch.  

Kalorama Vaccine Estimates Published in Business Week

Kalorama's estimated numbers for vaccine sales are cited in an article in Business Week regarding the change in leadership at Takeda Pharmaceuticals.  The basic message: mixing a high-growth product like vaccines with high-growth emerging markets is  a winning strategy.  

The worldwide vaccines market excluding North America, European Union members and Japan, probably expanded 11 percent to $6.78 billion last year and will increase about 10 percent annually for the next five years, researcher Kalorama Information said.

Slightly higher growth than developed markets at 8-9%.  The citation is timely because Tadataka “Tachi” Yamada, the new head of Takeda, wants to direct efforts to these countries.  
Article: http://www.businessweek.com/news/2012-05-31/gates-foundation-veteran-yamada-retools-drugmaker-takeda-health

If the Device Moves, RFID Wins Out

It's great to have devices that move with a patient to offer care and monitoring.  But such devices create staff concerns.  When medical devices become mobile, when they are utilized in patient care, protecting them and keeping track of them becomes more important.  For makers of RFID, this problem means on the heavy medical asset front they can win the struggle against cheaper barcode solutions.

Some features of an RFID, identification and counting, are easily replicated on a simple barcode.  But more advanced features - location, distinguishing an authorized person from an non authorized person, are more amenable to RFID.  This is where Kalorama Information finds the higher relative cost of an RFID tag versus a standard barcode becomes important.  For some high end devices, Radio Frequency Identification technology (RFID) is used.  Medical asset tracking is one of the top areas where RFID offers  solutions for the main segments of the healthcare industry—hospitals and nursing homes, pharmaceutical manufacturers, distributors, and pharmacies. Kalorama, in its report on RFID technologies, identifies the market for RFID opportunities in the healthcare industry focusing on four
general market segments, in addition to asset tracking:
• Pharmaceutical manufacturing and distribution/blood product distribution and
tracking
• Medical staff identification and tracking and patient identification and tracking
• Medical device RFID use
• Other areas including medical documents and patient records

Medical asset tracking, however, is the largest category in healthcare, with companies like 3M and Alien in the mix.  Kalorama finds that RFID is useful when the device is valuable and mobile such as a patient monitor or infusion pumps, knowing its location is important. If it's just an inventory concern, those device tend to see barcode use.  Barcode is still used far more in hospitals than RFID due to expense.  .