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Putting Precision Medicine For Cancer At Work In America's Largest Hospital

Putting Precision Medicine For Cancer At Work In America's Largest Hospital | Healthcare and Technology news |

In one of the largest initiatives of its kind, the for-profit hospital chain Hospital Corporation of America (HCA) has embarked on a plan to molecularly profile the tumor of cancer patients, marry the genomic information to clinical data from a patient’s electronic health record, and recommend targeted therapies.

In a one-size-fits-all approach, patients who now receive a cancer diagnosis get the standard of treatment, which may or may not work. Those who fail first-line treatments are then subjected to other therapies through trial and error. “We’re seeing the light,” says Howard Burris, chief medical officer of Sarah Cannon, an arm of HCA which runs 75 cancer centers across the country and the U.K., and is heavily involved in cancer drug development. Its facilities treat more than 100,000 newly diagnosed cancer patients annually. 

Two years ago, Sarah Cannon profiled the tumor of 1,000 late-stage cancer patients to match them with the appropriate early phase clinical trial, and hopefully boost their outcomes. The results which Sarah Cannon presented at the American Society of Clinical Oncology last year, showed that up to 25% of patients enrolled in a trial based on their gene mutation. 

While promising, the project proved overwhelming in terms of tracking various clinical and genomic data. To profile cancer patients on a grand scale, patient information had to be aggregated and displayed in a way doctors can understand, to enable them to recommend the right therapy or clinical trial.

To do so, HCA reached out to Syapse, a venture-backed start-up that counts Intermountain Healthcare, University of California San Francisco, and Stanford University School of Medicine among its customers. It is deploying its software to some 60 oncologists in Nashville, Tenn., HCA’s headquarters, before expanding to other Sarah Cannon outposts in Florida and other states later this year. Through its platform, doctors will be able to measure the impact of a tailored treatment in conjunction with a patient’s history, other treatments, biopsies, side effects, and other relevant clinical information that reside in an electronic health record. “We’re collaborating with them to implement this at scale,” says Jonathan Hirsch, Syapse’s founder. 

“The real missing piece is the physician looking at the cancer patient, and determining that the patient needs to be profiled. They might think they don’t need it yet, or some don’t have the education,” says Burris.

Patients who’ve experienced a recurrence, have advanced or a hard to treat cancer will have their tumor profiled. Insurance companies typically don’t reimburse genomic profiling for newly diagnosed patients.

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Many Choose Not to Save in the Health Marketplace

Many Choose Not to Save in the Health Marketplace | Healthcare and Technology news |

Steven Norton, recovering from a severe stroke, says he is renewing the health plan he got this year through the Affordable Care Act insuranceexchange. He will pay more in 2015 — $501 a month including his federal subsidy, up from $485. But for him, continuity matters more than price, so he has not logged on to to search for alternatives.

“If it’s working, why try to fix it?” said Mr. Norton, 51.

Nancy Allman, a retiree outside Tucson, sees things differently. Ms. Allman, 64, said she was surprised to learn her exchange plan would cost $235 a month next year after her subsidy, up from $158. Overwhelmed by her choices on, she called the customer service line and received help finding a plan from a different insurer that will cost only $77 a month. The plan has a smaller network of providers, but it includes her primary care doctor, and she is in good health.

“It was like a no-brainer to switch,” she said.

Across the nation, millions of people who bought insurance through the exchange in this inaugural year of coverage under the health care law must decide by Monday whether to switch plans for 2015 if they want a new plan starting Jan. 1. If they do nothing, most of the 6.7 million people who remained enrolled as of last month will automatically be re-enrolled in their current plans or similar ones. More often than not, the premiums for those in the most popular plans will increase, according to a New York Times analysis of data from the McKinsey Center for U.S. Health System Reform.

The Obama administration is urging them to shop around, and with good reason: Many can find a better deal or at least keep their costs steady. That is especially true in states like Arizona, where the competition is robust, new insurers have entered the marketplace, and the price for the cheapest plans in many areas has dropped.

At the same time, the availability of less expensive “benchmark” plans means that the federal subsidies that help many lower-income Arizonans pay their premiums will go down, because subsidies are pegged to those plans. That means customers who stay in more expensive plans will have to pay a larger share of the price.

Another potential problem is that subsidy recipients will receive the same amount in 2015 as they did in 2014 unless they ask for a recalculation. That means some people could be required to pay back part of their subsidy at tax time.

Despite those issues, the data so far suggests that many customers are keeping what they have and not even window-shopping. As of Dec. 5, only about 720,000 customers had returned to the federal exchange serving 37 states to re-enroll or switch plans, according to the Department of Health and Human Services.

Here in Arizona, insurance agents and enrollment counselors last week reported a steady stream of customers seeking advice. But the demand has not yet been huge, they said, indicating that many enrollees may be succumbing to inertia, are willing to pay more to their keep their networks and level of coverage, or are unaware that they have a choice. About 120,000 residents of Arizona signed up for exchange plans this year, according to federal data.

“I’m concerned about the confused,” said Kathleen Oestreich, the chief executive of Meritus, a new insurer, which, after dropping its rates by 23 percent on average, is offering many of the lower-priced plans here for 2015. “That natural inclination to simply not change because it’s too much effort: How will it affect the population of low-income people in particular?”

Shanna Goldenberg of Phoenix, who works two jobs and pays $160 a month for her exchange plan, said she had no idea if her premium was going up. But Ms. Goldenberg, 27, said she would probably let her plan be automatically renewed, because the enrollment process last year was so confusing.

“I’m the kind of girl who just sticks with what’s easy,” she said in an email.

But in a later note, Ms. Goldenberg said she had discovered her plan would not be offered next year, adding: “I guess now I have to shop around again. ... If only I can figure it out this time.”

Mr. Norton, of Scottsdale, Ariz., did call on Thursday for a recalculation of his subsidy. It will drop by $30, he learned, and his portion of the premium will grow to $385 from $338.

Ms. Oestreich said those who were researching their options seemed fairly savvy about insurance. That is a big change from last year, she said, when many customers seemed baffled by the enrollment process and the policies they were buying.

“They are calling with specific questions and looking for specific products,” she said. “In many cases, they’re buying up a little bit — going to a little bit bigger network because they’ve understood the value of that.”

In other states, too, enrollment groups said that people shopping around were asking smart questions.

Brenda Cardenas, an enrollment counselor in Phoenix who helped dozens of families sign up for coverage last year, said that only about 15 had sought her help with the renewal process as of last week. Most people are picking new plans, often ones with smaller networks of doctors and hospitals, to avoid paying more, she said. For many, the switch will require finding new doctors, but Ms. Cardenas said nobody had complained so far.

“For a lot of our consumers, this is the first year they’ve had health coverage,” she said. “For them, switching to a new provider isn’t a big deal yet.”

In one case, Ms. Cardenas said, a couple learned the amount of their subsidy would drop by $66 because of the availability of new lower-cost plans that influence the calculation. They decided to switch from a Health Net plan with a large network of providers and no deductible to a Meritus plan with a smaller network and a $1,000 deductible. By doing so, she said, they will spend almost $200 less a month.

Health Net signed up 65 percent of exchange enrollees here this year, but its rates are rising by an average of 12 percent, a company spokeswoman said. Altogether, 11 insurers are selling on the exchange here for 2015, up from eight.

Leslie McGee, an acupuncturist in Tucson, also found a better deal when she went to and updated her personal information. Her income has dropped, so she will qualify for a subsidy in 2015 after receiving none this year. The premium on her current plan is increasing by 17 percent, so she is switching to a different insurer and will save $100 a month.

Ms. McGee, 60, will have higher out-of-pocket costs if she goes to the doctor, but she is gambling that she will need only preventive care, which is free.

Michelle Steinberg, 54, of Phoenix, is avoiding a 23 percent increase by switching to a less expensive plan that will not cover as much of her medical costs. Her premiums will still increase 13 percent, to $450 a month, but she said she was satisfied with her new choice, which has a lower deductible.

“I’m not averse to switching companies,” said Ms. Steinberg, who is moving from Health Net to United Healthcare.

The big question is whether people who have not yet shopped around will flock to the online exchanges by Monday in a last-minute crush — and whether those who do not will later regret it. They can switch until Feb. 15, when open enrollment ends, but their new coverage will not begin until February or March if they wait past Monday.

In Maitland, Fla., Rebecca Pando, 60, said that she was happy to do the painstaking research to find a new plan.

Her insurer, Florida Blue, is replacing her plan with one that has a substantially higher deductible: $5,000 compared with $1,300. Ms. Pando found a new plan from United Healthcare that will cost $400 a month in premiums, about $50 less than what she paid this year including her subsidy. It has a $4,000 deductible, she said, but a better choice of doctors.

“It’s pretty time-consuming and you get a little crazy,” Ms. Pando said of the shop-and-compare process. “But it certainly is better than not being able to buy insurance.”

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So Far, 6.4 Million Obtain Health Care Coverage for 2015 in Federal Marketplace

So Far, 6.4 Million Obtain Health Care Coverage for 2015 in Federal Marketplace | Healthcare and Technology news |

The Obama administration said Tuesday that 6.4 million people had selected health insurance plans or had been automatically re-enrolled in coverage through the federal insurance marketplace.

New customers accounted for 30 percent of the total, or 1.9 million.

For 2014 enrollees who took no action by Dec. 15, coverage was automatically renewed for 2015 by the federal government.

Sylvia Mathews Burwell, the secretary of health and human services, who is in charge of the federal marketplace, said she did not know how many people had been automatically re-enrolled by her department. But she and her aides suggested that the number was in the range from 2.7 million to three million.

Dec. 15 was the deadline to sign up for coverage that would start on Jan. 1. The automatic or passive re-enrollments, combined with a surge of interest among consumers just before the deadline, produced a big increase in activity in the federal marketplace. People could sign up a first time, switch to new plans, choose to extend coverage in their current plans for a year, or do nothing and be re-enrolled in the same or similar plans.

Is the Affordable Care Act Working?

In the first four weeks of the three-month open enrollment period, through Dec. 12, nearly 2.5 million people selected health plans, the administration said. In the week after that, more than 3.9 million people signed up or had their coverage automatically renewed, lifting the total to 6.4 million. The enrollment period ends on Feb. 15.

Officials said that about 35 to 40 percent of people already enrolled had returned to the online marketplace, allowing them to shop for new health plans as the administration had recommended.

“This is an encouraging start,” Ms. Burwell said, but she added, “We still have a lot of work to do.”

The administration has been more successful in signing up new customers than in changing public opinion of the health care law. Polls show that people’s views remain deeply divided, with those holding unfavorable opinions of the law slightly outnumbering those with favorable opinions.

The new enrollment numbers do not include people signing up for insurance through state-run exchanges like those in California, New York and 11 other states. Taking account of federal and state exchanges, officials said they were on track to meet their goal of having a total of 9.1 million people enrolled and paying premiums next year.

Those who go without coverage in 2015 may be subject to tax penalties that could approach 2 percent of household income for some taxpayers., the website for the federal marketplace, is working much better than last year, but the back end of the system, used to update enrollment information and to pay insurers, is still a work in progress, so federal officials often lack vital data.

As of mid-October, before the latest enrollment period began, 6.7 million people had insurance through the federal and state exchanges. But Ms. Burwell said Tuesday that she did not know how many of them were in the federal exchange, which now serves 37 states.

About 85 percent of people with marketplace coverage receive federal subsidies to help defray the cost. Critics of the law have challenged the authority of the federal government to pay those subsides for insurance bought in the federal marketplace. They contend that the Affordable Care Act allows subsidies only for people who use an exchange established by a state.

The Supreme Court is considering those arguments in the case of King v. Burwell, which the court is scheduled to hear on March 4. Supporters of the health care law, who see the litigation as a threat to subsidies for millions of people, have urged the administration to develop contingency plans.

Ms. Burwell refused to say if she was working on such plans, but said she was confident that the administration would prevail in court.

“Nothing has changed in terms of the subsidies and assistance people can get,” Ms. Burwell said. “We believe that our position is the position that is correct and accurate.”

She said she had seen no evidence to suggest that “Congress intended for the people of New York to receive these benefits for affordable care, but not necessarily the people of Florida.”

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