The 9th US-China Health Summit

 As the new healthcare reform in China enters its 10th-year journey and the Affordable Care Act (ACA) enacted nine years ago, more than 100 top representatives from both countries gathered together for this summit. In this two days summit, we talked about the modern science and technology advancement in healthcare that saves lives; we also discuss the hug threats in human survival, such as global warming, escalating medical costs, and socioeconomic instability. We then place the focus on how to provide value-based investment in healthcare, including a focus on precision medicine, digital therapeutics and valued-based insurance plan. I wrote a few sections based on the presentations at the summit, and I hope you can get a clearer idea about what is currently happening in China and the United States. 

PEAR: A Pioneer in Prescription Digital Therapeutics- talks reviews from the 9th US-China Health Summit

Speaker: Corey McCann, President and CEO of Pear Therapeutics

Writer: Christiane Zhao

"How many people in here have some knowledge about Prescription Digital Therapeutics or PDTs?" Corey McCann, the President & CEO of Pear Therapeutics, is about to give a presentation at the US-China Health Summit. He is pointing at the FDA approval report on his slides, "PDTs are at an inflexion point, and PEAR is the first PDT to receive market authorisation from the FDA to improve disease treatment. " This company just announced its FDA submission for Somryst, a Prescription Digital Therapeutic Treatment for adults with chronic Insomnia and Depression. 

“It is the first time that the product work with the patient to develop software from the ground.”, Corney continues to explain, “We post monthly updates based on real-world data. ”Since Sandoz and PEAR officially launched its FDA-approval therapy (reSET-O) for opioid use disorder(OUD) this January, the market believes it is another important signal that PDTs are entering the healthcare mainstream. 

"PDT can be view as a combination of Telemedicine, Remote Monitoring, Wearables and Health IT infrastructures," Corey explained, "The use of DPT can enhance drug efficacy, treat the untreatable, and possibly, replace drugs in some circumstances." As a subset of digital health, PDT is evidence-based therapeutic interventions driven by a high-quality software system. It is also commonly employed in cognitive behaviour therapy. The development of PDT software usually required using the machine learning method to analyse real-world data to accelerate patient-faced interventions. Although it means there will be technical challenges like data accuracy and patient privacy, the Prescription Digital Therapeutic Development is still having a much shorter timeline than a traditional pharma product development timeline.  

Corey then compared PDT with traditional molecular therapeutics. The main similarities it addressed are, both need prescriptions written by specialist and both reimbursed traditional medical pathway. He also emphasized that the use of PDT is enabling insurance companies to claim processors and patients with eligible questions. However, PDT is much different from the molecular therapeutics in terms of product updates, compliance, ongoing monitoring, data analytics and costs of goods. PDTs require marginal investment, but it can be completed much quicker within weeks or months only. Patient compliance and engagement with the application is tracked in a longitudinal term in real-time, while in the traditional case, the physician is not able to track compliance. Besides, patient-facing assessment can regularly monitor product efficacy and effectiveness. PDT support the shift from none or limited patient data collection to customisable data analysis which targets patient, clinicians, hospital network and payers. 

reSet as one of the core products in PEAR, which can be used as an excellent example to explain the implication of PDT. As mentioned above, the company released reSet & reSet-O earlier this year, and it is a 90-days prescribed cognitive behavioural therapy for substance use disorder in an outpatient treatment setting. The service is provided based on a mobile application, and digital treatment is provided based upon on the supervision of clinicians. It is connected with an associated clinical dashboard, which enables care providers to get updated information about the patients' treatment performance and outcome, including the use of the software, lessons completed, patient-reported substance use and else more. These patient-reported data can be integrated and used to compare with in-clinic data input to develop a personalised report. These real-life data will be used to support the update and building of the software. It is intended to provide partial support for the adult user only.   

“PDTs are still marked as a very innovative sector in the healthcare industry,” Corey said, “After all, it is just a piece of software, and our job is to help the integration of such software into the clinical workflow.” PDTs also experiencing many challenges like other digital health products, enabling and monitoring changes of both the behaviour of clinicians and patients is one of the obstacles for all PDT products. Also, the healthcare system and its market still need times to digest and distinguish from the health and wellbeing market. Regulator’s involvement is necessary as usual. The active participation and regulatory of the FDA makes the PDTs market became more favourable for investors. 

 It is just one of the many talks Corey gave since the company established. In the past two years, this pioneer is actively presenting in healthcare-related summits and conferences in the field nearly every month. 2018 seems to be an essential year for the company. The company has successfully raised $134 million in four rounds, two of them announced on Jan 2018 and Jan 2019. In 2nd Jan 2018, PEAR received $50 million from Series B funding as an early-stage venture; followed by that, they received $64 million from nine investment parties including Temasek Holding in Series C just less than 20 days after they received the FDA clearances in December 2018. 

"75% of the healthcare cost are lifestyles related, so mobile and digital therapeutic should be involved in this industry. " Joseph Kvedar said, Professor of Havard Medical School. PDT is targetting at conditions that are poorly addressed by the current healthcare system, and it is expected to become one of the steps which can transform the future of healthcare. Today, such kind of advanced technologies have provided many opportunities for companies and organisations to improve the quality of care and system efficiency. 

Reference: https://peartherapeutics.com/products/reset-reset-o/

Embracing “Precision” Medicine: How to improve health and be able to afford it

Speaker: Mark Fendrick, Director, Value-Based Insurance Design (V-BID) Center, University of Michigan (www.vbidcenter.org)

Writer: Christiane Zhao

The increasing medical expenditures do not only reflect the increasing pressure in accessing to care but also question the fee-for-services payment method in the United States. Such a payment method is measured based on the provider types, and it is not directly correlated with the clinical outcome. As each service is paid separately, it emphasises the quantity rather than the quality of care. A growing body of evidence concludes that increases in consumer costs lead to a reduction in the use of essential services, worsens health disparities, and in some cases, leads to higher overall costs.” Mark referred this statement from an article in The New York Times. In the setting of ‘patient-centeredness’, US consumers are paying a higher percentage of their health care. 

Mark pointed out that there is an underutilisation of high-value care persists across the entire spectrum of clinical care, and Value-Based insurance design is the main contributor to deal with the medical cost growth in this country. The adoption of such a model has created a rapid movement to targeted screening, diagnostics and therapies. 

Hundreds of public and private payers have successfully implemented Value-Based insurance design. It is essential to be well-aware that clinical services differ in the benefit produced, and the clinical benefits depend on who receives it. The high-risk groups can bring higher value in return of the services compared with the low-risk group. Through the setting of cost-sharing to encourage higher utilisation of high-value services and providers and discourage the use of low-value care. For instance, the application of USPSTF Recommendation(A set of criteria) for BRCA-related cancer services. 

“Clinician and patient incentives for precision medicine should aim to get the right service, to the right patient, at the right time, by the right clinician, at the right price.” Mark states, “Collaborations within and between the government, industry and academia is the key predictor to achieve such goals. ” Based on this, reduce the financial and non-financial barriers is another essential step to enhance the access of evidence-based services in a targeted fashion. Care providers should also consider ways that can increase population access to care, including introducing telehealth and add supplement benefits to the disadvantaged groups. 

Healthy China 2030: From Plan to Action

Speaker: YuanLi Liu, Dean, School of Public Health, CAMS & Peking Union Medical College (PUMC)

Writer: Christiane Zhao

“An ounce of prevention is worth more than a pound of treatment”, Dr Liu started with a quote said by John. B Grant. Dr Liu quickly goes through the healthcare journey of China, covered from the public health campaigns to the success of universal health insurance coverage. In 2009, China implemented its first Healthcare Reform Policies, and on November 2012, Xi became the new leaders of this country. 2016 is marked as a historical year where China held its National Health and Wellness Conference in Beijing. Both President Xi Jinping and Premier Li Keqiang attended the meeting; President Xi gave a two hours speech without a script to talk about the shift from the sick-care system to the healthcare system. In the same year, China published its health action plan called: “Healthy China 2030”. The development of such a strategical plan is not only meant to build upon on China’s own healthcare experiences but also moderated by several western models, including the Ottawa Charter for Health Promotion. 

In 2019, Healthy China 2030 is implemented.

For the first time in this country, this strategic plan is outcome-oriented, targeted social determinants of health and value proportion from both social and political determinants. There are 15 Initiatives for the Healthy China Action(2019-2030), including six initiative targeting the major determinants, and five specific targeted disease programmes and four targeted population groups. 

During the early stage of the implementation, we are still not sure which direction this public health strategic programme will go. 

“Chinese have this old saying, the sky is high, and the emperor is far away”, Dr.Liu is closing his presentation with two questions, “how can we make the local leaders act? In addition to that, how can we make people change their lifestyles?”

The U.S. Commercial Health insurance and Diabetes: What is the problem? What is the solution 

Speaker: Frank Wharam MD MPH, Division of Health Policy and Insurance Research, Harvard Medical School & Harvard Pilgrim Health Care Institute. 

Writer: Christiane Zhao

There are 59% of people in the United States had private health insurance in 2018, and 49% are employer-sponsored insurance. However, the high costs and suboptimal quality remains a significant issue to resolve. It is urgent to develop a high-deductible health plan and value-based health insurance strategies to support system efficiency and delivery of quality care to the population. If we place value and cost in scale, it was evident that high-value care & high-cost model can lead to a different direction compared with high-value & low-cost model. 

By using diabetes as an example, Frank differentiates the models by its focus of care. High valued-based & high-cost insurance models mean it will focus more on outpatient visits for acute complications and macrovascular disease testing and treatment. Such a focus means a higher out-of-pocket cost, and it leads to a considerable delay in outpatient complication visits for low-income diabetes patients. It also appears to be increasing visit to the emergency department in the hospital, and higher severity of hospitalisation stays — the overall population results in a delay of accessing care.

In contrast, the shift to a high valued based & low-cost insurance models can positively benefit the low-come groups and further reduce inequalities in the population. Such a model means it focuses more on secondary preventive tests and cardiovascular medication use. While disease monitoring remains unchanged, the medication use declines to a small degree. When the Full VBID(cost of drugs goes down), the lower-income group has over 15.6% increases in the use of their medication to control diabetes. Not to mention, both models do not affect the high-income groups statistically, in general. However, lower out of pocket cost for medication and preventive disease monitoring can lead to a higher return on investment for the population as a whole. 

Panel talks: The future of Public Health & Healthcare in the United States

Speaker: Christine Lu, an associate professor and co-director at the Precision Medicine Translational Research centre & Joe Kimura, the Chief Medical Officer at Atrius Health

Christine Lu, an associate professor and co-director at the Precision Medicine Translational Research centre, give her opinions based upon on the public health sites of Precision Medicine. "Precision is not just about using genomic; it is trying to reunite patient preference in care delivery and the outcome of care." Precision medicine is increasingly used in life; it widely appears in clinical settings and used for consumer genomic testing as well. She then pointed out three main challenges that the U.S. market is facing. First of all, there is a lack of clear evidence to support the implication of precision medicine, even though we have various use of precision medicine. We do not have enough substantial and robust evidence to show that the use of technology in genomics can make a real difference to our daily life. The reason for that is mainly because the human genome is not complete, while how to categories different genomic sequences and distinct understanding of genomic can change the output. Clinicians and patients should be more informed with the update. However, the system makes it very difficult to ensure the updates is on time before the decision-making point in the clinics. Secondly, we do not have a comprehensive policy and governance for privacy. While lots of information that are related to genomics are new and data computation is needed, we are urgently to develop the law to prevent unsuspected use of this information. Government accessed data might be used by employer or insurance companies, which can reinforce the role of discrimination in society. Lastly, the cost of genomic tests are reducing, but the variation of products is enormous. We have inequality and disparity between the quality of the test result, but we do not have an excellent solution to deal with these yet. 

Joe Kimura, the Chief Medical Officer at Atrius Health, is then picked up the talk. He said that 80% of the new practice care comes from capitation domain, which brings the concern of driving the most value from the daily practice. It is necessary to create a learning healthcare system, as we are acknowledged that we do not know the blueprint of the future of healthcare. The current healthcare system requires a long cycle time frame for the medicare givers to learn and adopt changes. Joe also pointed out that the adoption of health informatics can solve inequalities in access to care, especially in primary care.

"What is the optimal form of leadership?" Joe continues to explain, "The best primary care physician enables a patient to believe they are taking control of their health. Technology gives patients the ability to engage in their health also enables care providers to involve in the care delivery process actively." The United States is having an ageing demographics as well as a lack of healthcare staff. Therefore, we should support patients' independence in health, but also enhance the bonds between the patient and the system. Evidence-based care is an essential part of achieving this. It means the appropriate uses of technology can enable patient to know their health better, for instance, home care. It will always be difficult for care providers to adopt the changes between 20 years ago, now and 20 years later, but it is so essential to create values for access to care, access to continuous care. 

Declaimer: This article is generated based on a talk given at the 9th US-CHina Health Summit in Boston, the United States in 26th September 2019. The views and opinions expressed in this article only reflect the speaker’s opinion and does not necessarily reflect the author’s official policy or position. All rights reserved.