Health Care Current: July 21, 2015

Precision medicine: Bridging the gap between potential and reality

This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies and provides updates and insights on policy, regulatory and legislative changes.

Precision medicine: Bridging the gap between potential and reality

Twenty-six years ago, researchers announced they had discovered the gene that causes cystic fibrosis (CF).1 Just three years ago, the US Food and Drug Administration (FDA) approved Ivacaftor (Kalydeco™), the first drug to target the underlying cause of CF: a faulty gene and its protein product. KalydecoTM  is now approved for use in about 10 percent of patients who have particular genetic mutations. Though there is more work to be done to develop targeted therapies for patients with CF, the discovery of the gene and the decades-long quest for a targeted, effective treatment is a precision medicine success story.

Some diseases like CF and Huntington’s disease stem from an error in a single gene. Unfortunately, many other, more common conditions (e.g., depression, autism and schizophrenia) likely result from the interaction of several genes and other factors. These can take years to identify. And even in the case of CF, multiple therapies may need to be developed to target different mutations. As another example, because cancers are caused by multiple mutations, it has long been recognized that it is not a disease that can be treated with a single therapy. Even cancers of the same tissue or organ vary significantly in their molecular details and have different responses to treatments.

Precision medicine offers the potential for more targeted therapies – targeting treatment to positively responding patients – and reducing adverse events. A recent report from the Tufts Center for the Study of Drug Development shows that investment in precision medicine has nearly doubled in the last five years.2 Despite this growth in investment, we would be remiss to forget that targeted treatments still have to go through the rigorous and costly research and development process. And because the treatments may only be used for a small subset of patients, the return on investment is potentially reduced. It is both in spite of and because of these challenges that momentum around precision medicine is gathering like never before.

The President announced the Precision Medicine initiative in January, and funding for it is included in the President’s Budget. The 21st Century Cures Act, which includes a provision around precision medicine as well as many other ideas to spur biomedical innovation, just passed the House of Representatives this month. Finally, last month, the National Cancer Institute (NCI) launched its “precision cancer” effort (see the June 9, 2015 Health Care Current) and the American Society of Clinical Oncology (ASCO) announced the Targeted Agent and Profiling Utilization Registry.

These initiatives are exciting to track, but both the Tufts report and a recent Deloitte report, “In the face of uncertainty: A challenging future for biopharmaceutical innovation,” explain that there are still challenges to overcome in biopharma innovation. Scientific uncertainty and uncertainty around the regulatory and insurance coverage landscape continue to hinder innovation. Companies face challenges on the scientific front in the areas of biomarker identification and diagnostic test development. The report, “The current and future state of companion diagnostics,” discusses the challenge around aligning incentives of the multiple stakeholders in the area of companion diagnostics.3 Regulators and payers want to see clear evidence of safety and efficacy. With the health care system transitioning toward value-based care, providers want to select a therapy based on diagnostic testing that compares similar therapeutics against one another. Drug developers want to see compelling economic incentives for the continued investment of time and money.

Companion diagnostics offers solutions to some of these challenges: Regulators see the potential for more directed regulatory submissions with fewer adverse events based on targeted therapies, while payers see the potential for fewer unnecessary treatments. Drug developers can achieve faster time to market with less expensive clinical trials for drugs with significant revenue potential. The uptake of targeted therapies, such as Herceptin® (trastuzumab) and Gleevec® (imatinib mesylate) which require testing with companion diagnostics before they can be prescribed, demonstrates the rapid evolution of companion diagnostics and the potential that some the above-mentioned challenges can be overcome.

I am encouraged by the momentum precision medicine is gaining. Dr. Francis Collins, Director of the National Institutes of Health, remarked at the annual Biotechnology Innovation Organization (BIO) International Convention recently that medical knowledge is far outpacing treatment gain, but that the Precision Medicine Initiative will greatly enhance our ability to take precision medicine from a promise to a reality. What is most exciting to me is the collaborative ecosystem that is emerging from these announcements. Examples like the NCI’s precision cancer effort and ASCO’s initiative both illustrate what can happen when the different stakeholders come together under the shared goal of getting the right treatment to the right patient at the right time. In the NCI example, the Molecular Analysis for Therapy Choice (MATCH) trial is currently enrolling thousands of patients with intractable cancers in 2,400 clinics around the country. Ten pharmaceutical companies are providing more than 20 drugs – some that are currently on the market and others that are still in development – to be tested on different gene mutations during the first few months of the trial. ASCO’s Targeted Agent and Profiling Utilization Registry will collect real-world evidence on the outcomes of patients with advanced cancers who receive molecularly targeted drugs for uses not approved by the FDA.

Both of these large initiatives require a high level of coordination between the clinical trial networks, the pharmaceutical companies providing the drugs and the patient advocates who were engaged in the development of the trial and who will help oversee the protocols and other aspects of the study. Learnings from these initiatives could help demonstrate the power of informatics, connectivity and collaboration to spur biomedical innovation.

Currently there are around 7,000 known rare diseases. We have treatments for around 500 of them. In many ways, we are just setting out on the precision medicine path. If we can keep up this momentum, we may be well-positioned to make more ground-breaking discoveries that lead to many more cures.

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2 Personalized Medicine Coalition and PhRMA, “Biopharmaceutical Companies’ Personalized Medicine Research Yields Innovative Treatments for Patients,” 2015:
3 The FDA definition of companion diagnostic: A companion diagnostic device can be an in vitro diagnostic device or an imaging tool that provides information that is essential for the safe and effective use of a corresponding therapeutic product. The use of an in vitro diagnostic companion device with a particular therapeutic product is stipulated in the instructions for use in the labeling of both the device and the corresponding therapeutic product, as well as in the labeling of any generic equivalents and biosimilar equivalents of the therapeutic product.

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My Take

By Terri Cooper, PhD, Principal, Federal Health Sector Leader, Deloitte Consulting LLP


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Tufts: Vaccines in the R&D pipeline have tripled in the last decade

Earlier this month, the Tufts Center for the Study of Drug Development released a report on the global growth of vaccine products. Researchers leveraged data from the FDA, company reports and IMS Health sales data to understand trends in vaccine research and development (R&D), demand and sales. Vaccines have seen unprecedented growth worldwide, but challenges remain for developers. Key findings:

(Source: Tufts Center for the Study of Drug Development, “Vaccine Products in Development Have Tripled over Last Decade,” July 9, 2015; Powers, Marie, BioWorld, “Tufts: The vaccine pipeline is soaring and global sales could hit $40B by 2020,” 2015)

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Implementation & Adoption

CMS proposes updates to long-term care facility rules

Last week, the US Centers for Medicare & Medicaid Services (CMS) published a proposed rule that would revise long-term care (LTC) facility requirements for participation in Medicare and Medicaid. This marks the first review and update to LTC requirements since 1991. Since that time, there have been significant changes in this care delivery setting. These proposed changes would align requirements with updated clinical practice guidelines and reduce duplicative or unnecessary requirements.

Many of the proposed changes are intended to improve LTC facility residents’ quality of life:

CMS also proposes updates to behavioral health requirements. CMS would require facilities to ensure that they have staff with adequate skills/competencies and social support services necessary to properly care for residents with mental and psychosocial illnesses.

The agency proposes changing policies on pharmaceuticals and prescribing for LTC residents. The proposal aims to increase pharmacist engagement in care and would require pharmacists to document potential irregularities in a drug regimen (e.g. the patient’s medical record doesn’t indicate the need for a certain drug), especially when prescribing psychotropic drugs. CMS would require attending physicians to document that they have reviewed any irregularities and actions taken to address them. In an effort to reduce the unnecessary use of psychotropic drugs, CMS proposes to require facilities to prescribe such drugs only when medically necessary and to reduce doses of such drugs gradually unless clinically contraindicated.

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CMS: Cost of newly eligible Medicaid enrollees higher than expected

A recent actuarial report released from CMS found that the cost of newly eligible Medicaid enrollees was significantly higher in 2014 than previously projected. Prior estimates projected that 2014 costs for these beneficiaries would be 1 percent less than the cost of enrollees in Medicaid prior to the expansions. However, CMS found that the average cost of new enrollees was $5,517 – 19 percent greater than the average cost of earlier enrollees.

The actuaries attributed this higher cost to the fact that most states that expanded Medicaid enrolled newly eligible individuals into managed care programs, which asked for higher payment rates than for earlier enrollees. Many plans assumed the newly eligible population would be sicker than earlier enrollees. In some states, this assumption proved to be true. In other states, however, new enrollees were healthier than traditional enrollees and the rate adjustment was too high. Health plans also increased rates with the expectation that new enrollees may have “pent-up demand” for services and would use more services during their first months of coverage than traditional enrollees.

The actuaries also looked at Medicaid spending, which increased 9.4 percent in 2014, largely due to Medicaid expansion. Medicaid spending growth is predicted to slow to 6.2 percent per year until 2023. However, this rate is still markedly higher than the increase in the gross domestic product of 4.9 percent.

Background: This is CMS’s sixth annual actuarial report on the Medicaid program. The report reflects past and projected Medicaid enrollment and expenditure trends from 2013 to 2023. Although CMS has released some data on the new beneficiaries, it has not released data on managed care or enrollees’ health status before now. The actuaries acknowledge that these data are critical to accurately measure 2014 health costs.

Reaction: Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities, reacted in a blog post that the data do not reflect the true costs of newly eligible Medicaid beneficiaries. The data do not factor in that health plans with excess payments will have to pay back the states through the risk corridors program and/or minimum medical loss ratios (MLR). Under the risk corridors program, health plans that overestimated their costs must return excess payments to the state and federal governments. Health plans that underestimated their costs may receive payments from the state and federal government. In states that require a minimum MLR, health plans would return excess costs to the state and federal governments, but would not receive payments if their MLR was higher than expected.

(Source: CMS, Office of the Actuary, “2014 Actuarial Report on the Financial Outlook for Medicaid,” 2015; Solomon, Judith, Center on Budget and Policy Priorities, “New Estimate for Medicaid Expansion Doesn’t Reflect Actual Costs,” July 14, 2015)

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CMS: Premium stabilization programs benefiting consumers through low premiums and range of choices

In late June, CMS published a report on the reinsurance and risk adjustment programs after the first year of the health insurance exchanges. For 2014, CMS will pay 437 health plans more than $7.9 billion in reinsurance payments. The reinsurance program is temporary and intended to help health plans with individual members who have high medical claims costs. The risk adjustment program, a permanent program that protects health plans against adverse selection, is for health plans that enrolled sicker-than-average patients in their overall membership. CMS said health plans that enrolled more patients with HIV/AIDS and those that had more specialty hospitals in their networks and attracted more high-risk patients received risk adjustment payments.

Last week, Standard and Poor’s Rating Services published findings from its analysis of CMS’s report. The report compared the findings with projections that health plans made in their 2014 financial statements. The analysis found that CMS paid many health plans more reinsurance payments than health plans projected and that many health plans were “too optimistic” about their expectations for the risk adjustment program.

In the reinsurance program, 10 states accounted for nearly 60 percent of the payments. Nine out of ten health plans saw higher payments than what they projected earlier. On average, health plans will receive 20 percent more than they projected for 2014. The higher payments are mainly due to CMS’s increase in the co-insurance payments from 80 to 100 percent for 2014 (see the June 23, 2015 Health Care Current).

By contrast, in the risk adjustment program more than 50 percent of health plans participating in the exchanges received less than they projected for 2014. Though many health plans are familiar with Medicare Advantage’s risk adjustment program, there were many unknowns for the first year of the exchanges. Health plans could not predict with certainty either the risk profile of the new exchange members or the average risk score for the state. Both are used to make risk adjustment calculations in the exchanges. The analysis found that public health plans predicted their projected risk adjustment payments more accurately than the Consumer-Operated and -Oriented Plans (CO-OPs). On average, Blue Cross Blue Shield plans projected lower risk adjustment payments than they received.

Background: The three premium stabilization programs – reinsurance, risk adjustment and risk corridors – were designed to help health plans navigate the initial years of the health insurance exchanges. Along with a new marketplace for enrolling customers, health plans have faced a new set of rating rules and competitive environment. These factors have collided to create unprecedented uncertainty, and the premium stabilization programs exist to protect health plans and consumers during the transition. As outlined in Deloitte’s recent report, 10 percent problem: Future health insurance marketplace premium increases likely to reach double digits, previous market reforms have shown the importance of premium stabilization programs in protecting the market during times of uncertainty and in reducing the risk of adverse selection when unexpectedly higher numbers of sick people who use more services enroll in plans.

(Sources: CMS, “Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2014 Benefit Year,” June 30, 2015; Standard and Poor’s Rating Services, “Hits And Misses: A First Look At US Health Insurers' ACA Premium Stabilization Programs,” July 15, 2015)

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Lawmakers unlikely to meet July 24 deadline for budget recommendations required for budget reconciliation

Earlier this year, Congress passed S. Con. Res. 11, which established the fiscal year (FY) 2016 Congressional budget for the federal government and budgetary levels for FY2017 through FY2025. In the bill, Congress included instructions for five Congressional committees to submit draft legislation to the Senate and House budget committees that would reduce the deficit by no less than $1 billion over FY2016 to FY2025. The resolution calls for the Senate Committees on Finance and Health, Education, Labor and Pensions and the House Committees on Education and the Workforce, Energy and Commerce and Ways and Means to submit their recommendations by July 24, 2015. Many analysts believe that lawmakers will miss this deadline, however.

Though much of the Republican leadership in both Chambers has indicated they remain dedicated to using the reconciliation process to repeal the Affordable Care Act (ACA), many analysts believe it will be difficult for them to succeed in doing so. When each budget committee receives the recommendations from its respective committees, the recommendations are then combined into an omnibus reconciliation bill to be considered on the full floor. At that point, the bill would only require a simple majority to pass and there is a time limit set on debate of the bill.

Because the reconciliation process is expedited and only requires a simple majority to pass, only provisions that affect spending or revenue are generally considered. The Senate parliamentarian – the rule keeper for the reconciliation process – enforces this rule.

Though many lawmakers have indicated that Congress will likely miss the July 24 deadline, they will still have more time to work on reconciliation after the deadline passes. At this point, it is unclear when this will happen and what, if any, parts of the ACA may be included in the final bill. In total, the Congressional Budget Office projects repealing the entire ACA would increase the deficit by as much as $353 billion over the next decade.

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On the Hill & In the Courts

White House convenes stakeholders to discuss aging issues

Last Monday, the White House held its Conference on Aging. The event brought experts and advocates from around the country together to share best practices and explore objectives to support older adults. Many believe that now is a good time to employ preventive care strategies, provide proper resources for older adults and learn what health care practices can improve health and quality of life for aging individuals because the Baby Boomers are entering retirement age. Improving the supportive services accessible to the older adult population and their caregivers may be a valuable investment to keep older Americans living healthy and productive lives.

In coordination with the conference, the Obama Administration announced a number of initiatives that aim to improve quality of life for older Americans.

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House passes bill to extend Independence at Home demonstration

Last week, House lawmakers voted to approve S.971, the Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015. The bill extends the Independence at Home demonstration in Medicare from three years to five years. Independence at Home is an example of a delivery system and payment innovation approach that was called for by the ACA. The bill now heads to President Obama to sign.

According to recent estimates from CMS, the Independence at Home program saved more than $25 million in its first year (see the June 23, 2015 Health Care Current). In 2014, the participating organizations saved more than $3,000 per Medicare beneficiary. In total, nine organizations that participated in the program in 2014 qualified for $11.7 million in incentive payments because they met the program’s savings and quality goals.

Background: The ACA created Independence at Home to test a new model of payment and health care delivery to the sickest and frailest of Medicare patients. This population makes up 5 percent of the Medicare beneficiary population, but accounts for 43 percent of spending in the program. In 2012, the organizations began providing primary home care services to this fragile and expensive population to determine what cost savings and benefits in quality of care could be seen through this new model. Only practices that use electronic health records systems, remote monitoring and mobile diagnostic technology were selected for the program. CMS monitors quality and financial performance of the 17 participating organizations. Organizations that successfully increase quality and reduce spending are eligible for shared savings.

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Most home health agencies receive 3 or 3.5 star ratings in quality program

Last week, CMS published star ratings for home health agencies on Home Health Compare for the first time. These ratings are meant to help patients, caregivers and family members search and compare home health agencies. Nine of the 29 quality measures are aggregated into one performance star rating to rate home health agencies. These ratings are then published on Home Health Compare. Most home health agencies have a 3-3.5 star rating:

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House of Representatives holds hearing on Medicare Part D fraud and abuse

Last Tuesday, the House Subcommittee on Oversight and Investigations held a hearing to discuss the results of two recent US Department of Health and Human Services (HHS) Office of Inspector General (OIG) reports. The reports highlighted vulnerabilities in the Medicare Part D program. Lawmakers also examined whether CMS is taking necessary steps to maintain the program’s integrity.

The OIG portfolio report (one of the two reports that prompted the hearing) included nine recommendations to CMS. These recommendations outline measures to prevent, detect and address Part D fraud.

All of OIG’s recommendations have been in prior reports. Although CMS agrees with seven of the nine recommendations, the agency has not yet implemented any of them. CMS disagrees with the recommendation to exclude Schedule II refills in payments to plan sponsors due to potential data inaccuracies which could wrongly identify partial refills as illegal refills. CMS also disagrees with the recommendation to require plan sponsors to report their corrective actions. Dr. Agrawal testified that plan sponsors have been hesitant to publically report corrective actions due to competition with other plan sponsors. CMS has responded to this concern by allowing plan sponsors to submit de-identified reports.

The subcommittee heard from two witnesses: Dr. Shantanu Agrawal represented CMS as Deputy Administrator and Director of the Center for Program Integrity, and Ann Maxwell represented the HHS OIG as Assistant Inspector General of the Office of Evaluation and Inspections. Dr. Agrawal largely spoke to the progress CMS has made in recent years to align its policies and procedures with the OIG’s recommendations. CMS’s initiatives include the launch of the Predictive Learning Analytics Tracking Outcome (PLATO) system. Plan sponsors may use PLATO to report to CMS the actions they have taken to address potentially fraudulent prescribers and pharmacies. OIG has recommended that CMS make these responses mandatory; however, these reports remain voluntary.

Ms. Maxwell reiterated OIG’s recommendations and responded to questions from subcommittee members. Ranking Member Diana DeGette asked Ms. Maxwell if she believed CMS was doing enough to identify fraudulent actors who may have gone undetected by plan sponsors. Ms. Maxwell responded by saying that CMS has made significant progress in responding to OIG’s recommendations.

In the other report, the OIG measured drug spending and identified potential fraud in Part D. The OIG identified more than 1,400 pharmacies with questionable billing practices for Part D drugs in 2014. The OIG found that the number of Medicare beneficiaries who used opioids, which are highly addictive, grew by 92 percent (as opposed to 68 percent for all drugs). Medicare Part D fraudulent activity (e.g. billing for drugs that are not dispensed or kickbacks from pharmacy to prescriber) can negatively affect the financial integrity of the program and threaten the health of Medicare beneficiaries.

(Source: Office of Inspector General, “Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D,” June 2015; Office of Inspector General, “Ensuring the Integrity of Medicare Part D,” June 2015)

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Report finds little progress on health care price transparency across states

Though many state legislatures have discussed health care price transparency, the third annual report from the Health Care Incentives Improvement Institute and Catalyst for Payment Reform found little progress among the states. The report gave 45 states a failing grade. Only a few states – New Hampshire, Colorado, Maine, Vermont and Virginia – received a “C” or higher.

More employers are shifting health care costs to workers through co-payments and deductibles, so price transparency is more important than ever for consumers. The scores are based on whether states have passed laws that require hospitals to report price information to public websites and how well the requirements are being enforced. The score also gives states points for legislating an all-payer claims database (APCD) and using it effectively.

Progress over last year includes states like Connecticut and New York building APCDs and consumer-facing websites. Maryland is working to publish prices on health care services, and Washington just recently passed new transparency laws.

Analysis: Legal and contractual barriers exist to health care price transparency. Contractual barriers include non-disclosure agreements and anti-tiering/anti-steering or most-favored-nation clauses. Most-favored-nation clauses allow providers or insurers to mandate how pricing information is determined and/or shared through non-disclosure agreements.

According to the report, states that have been successful in increasing transparency have passed legislation that requires transparency on price information directly relevant to the patient’s decision. This includes average billed prices, charge master data and usual and customary charges.

(Source: Catalyst for Payment Reform, “Report Card on State Price Transparency Laws,” July 2015)

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Around the Country

Many states continue modifying Medicaid expansion programs

The Ohio state legislature passed a budget that requires Governor John Kasich to pursue an 1115 waiver that would require non-disabled adults on Medicaid to contribute to health savings accounts (HSAs). Though it is based on Indiana’s model, if it is approved, Ohio’s program would have stiffer penalties. In Indiana, Medicaid expansion enrollees that earn more than the federal poverty level ($24,250 for a family of four in 2015) could lose their Medicaid coverage for six months if they fail to contribute to HSAs. Ohio’s proposal would disenroll beneficiaries who do not pay, regardless of their income.

Ohio must get CMS approval for the waiver before it can go into effect. The legislature and governor both acknowledge that CMS may push back on strict HSA provisions of the proposal. The waiver would require all beneficiaries ages 18 or older, except pregnant women, to contribute 2 percent of their income or $99 into an HSA (whichever is less). Ohio is one of several states trying to change its Medicaid expansion model. Other recent examples include:

  • Arizona recently passed a law to limit Medicaid coverage to five years and to add employment requirements. CMS approval is still needed.
  • Michigan Governor Rick Snyder is seeking a waiver to cap Medicaid coverage at the federal poverty level. After four years in the Medicaid program, beneficiaries that earn above the poverty line would have to enroll in a plan on the state’s exchange or pay up to 7 percent of their income toward their health care costs to stay in Medicaid.
  • Iowa announced it intends to drop the part of its program that sent certain beneficiaries to the exchange.
  • Alaska Governor Bill Walker announced he plans to use federal dollars to expand Medicaid, supplementing with funding from the Alaska Mental Health Trust Fund Authority.

Analysis: Ohio and Arizona have already expanded Medicaid, so if the federal government denies the waivers, coverage will likely continue for newly eligible enrollees. However, in Michigan, more than 550,000 residents would lose their Medicaid coverage if the proposal isn’t approved. Though the Alaska proposal would expand coverage to 42,000 people, it is unclear how long the funding will last. The governor can accept federal funding on his own but without buy-in from the legislature, it is unclear where funding for administrative costs would come from in the future.

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Using social media to explore sleep disorders

Researchers from Boston Children's Hospital and Merck are using social media to learn more about sleep disorders. They published results from their recent analysis in last month’s Journal of Medical Internet Research. Insomnia and other sleep issues can reduce productivity, contribute to accidents and injury and are associated with chronic conditions such as heart disease, diabetes and depression. Sleep disorders are common and affect between 50 and 70 million Americans.

Traditional population-level research on sleep disorders has used survey methods such as the CDC’s Behavior Risk Factor Surveillance System. These methods can be time and resource intensive, do not provide real-time information and are not always generalizable to the larger US population.

This new research examined individuals’ tweets to develop a "digital phenotype," or baseline profile of how an individual struggling with insomnia or other sleep disorders interacts on social media. Results of the study suggest that patients with sleep disorders may be at higher risk for psychosocial issues.

The research team used publically available, anonymized data from Twitter to create a virtual cohort of nearly 900 active Twitter users whose tweets contained sleep-related words or hashtags (e.g., "can't sleep," "insomnia”) or the names of common sleep aids or medications. They then compared data from that cohort to those from a second group of over 900 users who did not tweet sleep-related terms.

The researchers also looked at the time of day and average sentiment (positive, neutral, negative) of each user's tweets. They then compared the profile of social media users with sleep issues compared to individuals without sleep issues. The data indicate that Twitter users suffering from a sleep disorder are less active on social media on average, but tweet more during traditional sleeping hours. The increase in negative sentiment in their tweets suggests that sleep-disordered users could be at an increased risk for psychosocial issues. The researchers noted that the findings are preliminary and observational only, and need to be studied further. However, the findings do suggest that social media can be useful for studying the patient experience and behavioral epidemiology of sleep disorders.

Analysis: Health care organizations are exploring the use of non-traditional, non-medical data, including purchasing data, medical claims, social media and web trending data, to engage consumers and be more proactive in preventing disease. In related news, another study published last week in the Journal of Medical Research shows the kind of information researchers are gathering from smartphone use to predict symptoms of depression. The small study shows the more time individuals spend on their phone, the more likely they are to be depressed. The study also made some preliminary conclusions that the more people moved throughout the day and the more variation in their routines, the less likely they were to have symptoms of depression.

While major retailers are continually learning as much as they can about their customers in order to promote specific products, the health care industry has generally lagged behind other industries in its use of data mining and predictive analytics as a mechanism to improve population health and deliver preventive care. Many consumers have concerns about wide dissemination of individuals’ medical history and lifestyle preferences. In the future, greater use of lifestyle and behavioral data and analytics may help the health care industry meet rising demands for more effective health care services, develop innovative products and treatments and achieve significant cost savings.

(Sources: David J McIver et al, “Characterizing sleep issues using Twitter,” Journal of Medical Internet Research, June 11, 2015, and Sohrab Saeb et al, “Mobile phone sensor correlates of depressive symptom severity in daily-life behavior: an exploratory study,” Journal of Medical Research, July 15, 2015)

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Breaking Boundaries

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