Power Outages Are California’s New Normal: What Of Home Medical Needs?

Fern Brown (left) and her sister, Lavina Suehead, sit in the rear of a tent on Auburn’s fairgrounds. (Mark Kreidler for California Healthline)

Fern Brown, 81, sat in the rear of a tent on the windswept fairgrounds of this historic Gold Rush town, drawing deep breaths through the mouthpiece of a nebulizer plugged into a power strip atop a plastic folding table.

Afflicted for years with asthma and chronic obstructive pulmonary disease, Brown uses the nebulizer twice a day to avoid flare-ups that can be life-threatening. It turns her medicine into a fine mist that she can inhale.

Her machine runs on electricity, and when Pacific Gas & Electric Co. cuts power in the region amid wildfire scares, as it did earlier this week, Brown must scramble to find a place where she can administer her treatment.

She knows the makeshift “resource center” she visited on Tuesday afternoon, one of several set up this week by PG&E, is not a viable long-term fix ― especially now that power outages and the uncertainty that comes with them seem likely to be a more frequent feature of California’s fire season.

“I could rent a generator. Or can you rent to own?” Brown said. “They’re expensive. But that’s probably what I’ll do. We just want to be ready for the next time.”

“That is the real travesty of this PG&E plan,” said Sandy Jay, a nurse practitioner at Santa Rosa Memorial Hospital in Sonoma County, about 130 miles southwest of Auburn. “As the dominoes fall, it’s the poor and the disabled who are the most affected by this.”

Jay supervises a program that for 20 years has sent teams of workers throughout the Santa Rosa area to bring medicine and treatment to those whose conditions prevent them from leaving home or keep them bedbound.

Without power, though, almost all of those patients need help immediately, she said. Air-pumped mattresses, used to prevent chronic bedsores, begin to deflate. Ventilators and nebulizers cease to function. Electric wheelchairs don’t respond. And many of the affected people are reachable only by landline telephones, which don’t work in a shut-off.

“It’s just kind of unconscionable,” Jay said.

Hardened by experience of shut-offs imposed by their utility company, many residents of this region ― and others up and down the state ― have concluded they must prepare for future power cuts.

PG&E confirmed that notion in an emailed statement, saying all its customers should “have an emergency plan to be prepared for any extended outages due to extreme weather or natural disasters.” The statement referred customers to PG&E’s website page on wildfire safety, adding that local county emergency offices may also offer help.

The PG&E outages that have affected some 1.8 million Californians in the past few weeks, amid nerve-wracking warnings of wind and fire, have only affirmed the company’s message.

For those with home medical needs, the quest for a durable fix takes on real urgency.

Steve Bast, who lives in a rural section of Auburn in the Sierra foothills, has Type 2 diabetes, and his insulin needs to be refrigerated. Bast has been forced to deal with previous outages, both weather-related and PG&E-driven, some lasting several days.

Now, he said, he keeps ice packs in his freezer and puts them on the insulin containers as soon as his power goes down. He then stores the medication inside a soft cooler that zips closed and goes back in the refrigerator for as long as the unit remains cold.

Bast also uses a CPAP machine for his sleep apnea, and it must be plugged in, so he says his next move is to buy a small, personal generator. He noted, however, that he would still need to find an open gas station for fuel to keep the generator running during an outage. Gas stations need electricity to run the pumps.

Then there’s the cost: A personal generator sells for between $400 and $1,000, meaning it could be out of reach for people of limited means.

PG&E’s temporary resource centers, of the type Fern Brown visited, are small, tented areas where up to 100 people at a time can power up devices of all kinds and get bags of ice, cases of water and snacks for free. The centers are set up when an area is plunged into a utility-ordered shut-off, and they close once power is fully restored to that area.

But the centers cannot solve the bigger problems.

During the last power shut-off a few weeks ago, Debrah Vitali went to check on her neighbor, 88-year-old Joan Casper. She and Casper have become close friends in their Rincon Valley neighborhood of Santa Rosa, and Vitali knows that Casper wears an emergency calling device around her neck, which she can use to alerts medics if she needs help.

The device is tied to Casper’s landline, but what neither woman realized was that the landline operated through her internet connection. When the power went out, so did the internet – and with it Joan’s ability to summon help.

“I couldn’t believe it,” Vitali said. “So we’ve just agreed as a group of neighbors to take turns checking on her, because she’d have no way to let anyone know she was in trouble.”

California’s Health and Human Services Agency this week established a nonemergency hotline (833-284-3473) to help residents find health services in their communities during a shut-off. Gov. Gavin Newsom, meanwhile, announced a $75 million fund that communities can tap to help purchase generators and other backup energy sources that would keep local emergency services going.

For people whose medical treatment begins at home, however, the solutions also need to begin there.

At the PG&E center in Auburn, Fern Brown completed her 30-minute treatment before speaking. She said that her asthma and COPD have become worse over the past couple of years and that skipping a nebulizer session is not an option.

Brown and her sister, Lavina Suehead, who cares for Brown, drove a half-hour from their home in the remote town of Foresthill to reach the resource center at Auburn’s Gold Country Fairgrounds. They said they would be seeking another solution, both for Tuesday night’s treatment and beyond.

“We’ll have to do something,” Brown said. “We’re out of power a lot.”

If Power Outages Are California’s New Normal, What About Home Medical Needs?

Peer recovery helping patients with addiction seek treatment

Before RWJBarnabas Health started its Peer Recovery Program, clinicians struggled to help patients with substance use disorder.

Physicians and nurses at the New Jersey-based system were treating patients who overdosed from opioids and other drugs but lacked the training and tools to discuss long-term treatment options after discharge. “Hospital personnel were not equipped to respond and intervene in an appropriate way to engage them and get them into treatment,” said Connie Greene, vice president of the RWJBarnabas Health Institute for Prevention and Recovery. “It was very difficult for our staff.”

It’s a problem for providers around the country. Research shows patients with substance use disorder rarely get treatment. Of the 21.7 million people age 12 and older who needed substance use disorder treatment in 2015, just 10.8% received it.

So, with support from a $1.8 million state grant in 2016, 11-hospital RWJBarnabas hired individuals in long-term recovery from substance use disorder to engage patients in discussions about seeking addiction treatment post discharge. The individuals, called peer recovery specialists, are trained on how to interact with someone in crisis as well as motivational interviewing.

STRATEGIES

Screen all patients for substance abuse disorder and alert specialists to at-risk patients.

Call patients frequently post-discharge to check in with them.

Host events for patients and families to discuss recovery experiences.

Since the specialists joined RWJBarnabas, more patients are getting help for their substance use disorders. Of the 12,859 patients the peer recovery specialists saw in the first nine months of 2019, 89.1% accepted the services and 91.4% of those patients received services post discharge.

“It really speaks to great patient acceptance” of the program, said Nancy Holecek, chief nursing officer of the northern region at RWJBarnabas.

The program did reduce readmissions, she added. Of patients seen in July and August 2019, about 1 in 7 who accepted bedside Peer Recovery Program services had a 30-day ED revisit, compared with approximately 1 in 5 who declined the services.

More than 100 peer recovery specialists are employed by RWJBarnabas. A specialist is available 24/7 at all hospitals. They are alerted when a patient has been administered naloxone or buprenorphine, or if the patient screens as a high risk for a substance use disorder such as alcohol abuse. All patients in the emergency department and inpatient units are screened by nurses.

Peer recovery specialists enter the patient’s room at a vulnerable moment in their lives but can relate to them, said Angela Cicchino, a peer recovery specialist and supervisor of the program. “(We) can say, ‘I know exactly how it feels to be in this bed,’ ” she said.

Patients are typically open to speaking with the peer recovery specialist and discussing next steps to begin recovery. The specialist then calls in a clinical navigator, who works with the patient on a discharge plan, taking into consideration their insurance and social risk factors.

Even if the patient isn’t interested in discussing recovery options, the specialist calls the patient consistently after discharge and gives them a card with contact info. “Now they know there is help out there,” Cicchino said. “Eventually something is going to happen, and if we can plant the seed, they remember us; that is really what we look to do.”

For patients who agree to get treatment after departing the hospital, the specialist calls them three times the first week, twice the second week and once a week for six more weeks. The calls then taper off to once every three months. The specialist is mainly checking in with the patient to see how their recovery is going. Once a week each hospital site also hosts gatherings for patients and their family members to discuss their experiences with recovery. Families are thankful for the program, Cicchino said.

Clinical staffers also appreciate the peer recovery specialists, Holecek said. “We didn’t have the understanding about the disease in such a deep way, we didn’t have the resources” before the peer recovery program, she said.

The grant will end in September 2020, but Greene said the system plans to keep the program going. The state has approved including peer recovery specialists as a reimbursable service in its Medicaid program, which will help with funding.

https://www.modernhealthcare.com/care-delivery/peer-recovery-helping-patients-addiction-seek-treatment

Population health tools may exacerbate health disparities

The equity of the healthcare industry’s population health management care has been called into question after researchers found that a widely used algorithm sold by Optum dramatically underestimated the health needs of the sickest black patients.

The unexpected results for Optum have put a spotlight on the entire industry, which relies heavily on programs that make predictions on which patients may benefit from additional and more comprehensive care.

Risk-prediction algorithms like Optum’s, which use cost as an indicator to pinpoint high-risk patients, are ubiquitous in the industry, said Cynthia Burghard, a research director in value-based IT transformation strategies at IDC Health Insights, a division of market research firm International Data Corp.

It’s “a really simple tool that any analytics vendor offers,” she said.

In fact, these types of algorithms analyze data from roughly 200 million patients in the U.S. each year, according to industry estimates cited in the study in the journal Science. And they’re only becoming more popular with the shift to risk-based contracts, according to Dr. Shaun Grannis, vice president of data and analytics and director of the center for biomedical informatics at the Regenstrief Institute.

“Folks want to understand where their costs are going to be,” he said. He was not affiliated with the study.

There’s nothing wrong with predicting, and proactively intervening in, care for high-cost patients. But if these tools are relied upon, they can exacerbate existing healthcare disparities.

“The overall goal of the algorithms can be very positive and helpful if directed toward improving patient health outcomes,” said Dr. Marshall Chin, a primary-care physician at UChicago Medicine and associate director of the health system’s MacLean Center for Clinical Medical Ethics. “The choice of cost reflects perhaps misplaced priorities.”

That decision to predict patients’ risk scores based on cost is what led to the racial disparities for Optum’s algorithm, which was found to assign healthier white patients the same risk score as black patients who had poorer lab results, according to the recent research published in Science. The algorithm had specifically excluded race as a variable.

The algorithm is part of an analytics tool called Impact Pro, which Optum markets as a way to help healthcare organizations identify individuals who will benefit most from population health management programs.

But the algorithm in question doesn’t predict patients’ future health conditions; it predicts how much patients would cost the hospital in the future, and used that as a proxy for who would benefit from additional care-management services. That created a disparity, since black patients generally use healthcare services at lower rates than white patients.

Annual care for black patients with chronic conditions cost about $1,800 less than that for comparable white patients, according to the study, which looked at a patient population at one unnamed academic health system using the algorithm. Essentially, that meant “healthier white patients were ‘cutting in line’ ahead of sicker black patients” to get more intensive care management, said Dr. Ziad Obermeyer, the study’s lead author and acting associate professor in health policy and management at the University of California at Berkeley.

There is a fix, according to the study authors—one that hits at the heart of the question over how to design and use clinical algorithms. Rather than having an algorithm predict how much a hospital would spend on patients, the researchers adjusted it to predict health conditions. As another alternative, they tweaked the algorithm to predict patients’ avoidable costs, rather than total costs.

“Both of those alternative algorithms actually had far less bias,” Obermeyer said. “The problem we found wasn’t anything to do with what’s going on in the black box of the algorithm. The problem was what the algorithm was told to do.” Obermeyer said the research team has been in communication with Optum to experiment with possible versions of the algorithm. Optum hasn’t commented on whether it will add the researchers’ adjustments to its product.

Optum, for its part, has stressed that its algorithm fulfills its intended purpose. A company spokesman highlighted that Impact Pro has multiple features, of which one part is an algorithm that forecasts expenditure costs. Optum’s tool also identifies gaps in care, which are often driven by social determinants of health.

“We appreciate the researchers’ work, including their validation that the cost model within Impact Pro was highly predictive of cost, which is what it was designed to do,” he wrote in an email. Optum did not respond to a request for comment on how much it charges healthcare organizations for Impact Pro.

Burghard, the analyst with IDC Health Insights, agreed. The algorithm did what it was designed to do: it “spit out a list of people based on cost,” she said.

If a hospital decides those high-cost patients are the population to target, “of course there’s bias. You miss all the people who didn’t get care, or who don’t have access to care,” she said. “To me, at this point in my musings, it’s not about the algorithm or the tool. It’s about the human decision (and how) to use that tool.”

On the surface, using cost as a proxy to predict health risk can seem reasonable—health is complex, and there’s no one variable to measure someone’s health, Obermeyer noted. But while cost may sound like a race-neutral measure on paper, there are social and historical disparities that shape it, such as, in this case, black patients generally using healthcare services at lower rates.

So even if the algorithm worked as intended, it raises ethical questions, according to Chin. “I think that healthcare organizations and hospitals have to look in their hearts and ask: What is their mission?” he said. “If you are thinking about the ultimate mission of patient care, you’ll be directed to metrics being high-quality care and the best possible patient health outcomes.”

He acknowledged that it’s understandable why a healthcare organization might decide to focus efforts on tackling high-cost patients. To truly encourage a focus on high-quality patient care, he said, the industry would need to think about realigning incentives so that patient outcomes are rewarded, rather than cost savings. “Hospitals are under a lot of cost pressures,” Chin said. “The financial margins for a lot of hospitals are small.”

A population health team at Partners HealthCare System in Boston was confronted with a decision on how to address disparities when it tested Optum’s algorithm a few years ago.

The team had mapped patients who were getting high risk scores from the algorithm, and found many were concentrated in some of the region’s wealthier neighborhoods. “That made us uncomfortable with just using the tool,” said Christine Vogeli, director of evaluation and research for population health at Partners HealthCare and a study co-author. While Partners continued to use the tool as part of its care-management program, it supplemented the algorithm’s findings with additional clinical information.

And while the system used tools like Optum’s algorithm to serve as a resource to help corral an initial list of patients who might benefit from enhanced care management, it decided primary-care physicians would be responsible for determining which patients would be offered enrollment in the program.

For the care-management program, all patients designated as high risk by Optum’s algorithm would be flagged as candidates. But they also took into account factors like whether a patient had multiple chronic conditions and their patterns of healthcare utilization, such as if they had missed appointments or frequently visited the emergency department.

Developing that process required a conscious focus on patient needs, according to Vogeli. “We’re not just interested in patients who are high-cost, we’re interested in patients who have a need for more intensive care-management services,” she said.

Partners HealthCare stopped using Optum’s algorithm to inform its care-management program earlier this year, switching to a different tool that only uses information about patient’s chronic conditions.

Even when the system had used Optum’s algorithm, only about 15% of patients designated as possible candidates for the care-management program were identified solely based on having a high risk score, Vogeli said. The program serves about 14,000 patients at a given time, the bulk of whom were flagged via Partners HealthCare’s review of their chronic conditions and healthcare use.

“Healthcare organizations need to be very savvy about how they use these tools,” Vogeli said.

https://www.modernhealthcare.com/information-technology/population-health-tools-may-exacerbate-health-disparities

Independent dispute resolution process offers best fix for balance billing

There are few healthcare policy issues as pressing as finding a solution for out-of-network, or “surprising billing,” of patients. Physicians take an oath to provide the best possible care we can—but that’s not possible when our patients are afraid of getting a surprise bill for medical costs they thought would be covered by their insurance.

Over the past 12 years insurance companies have been steadily increasing their deductibles—leaving patients on the hook for upwards of thousands of dollars before coverage even starts. In addition, insurers have sold plans without sufficient in-network care providers, also called “narrow networks.” Narrow networks, combined with high deductibles, are most often the cause of surprise medical bills.

Throughout discussions, physicians have been steadfast in their commitment to taking patients out of the middle in a thoughtful way that ensures access to care.

Successful legislation must protect patients, first and foremost. If a patient receives unanticipated out-of-network care at an in-network facility, they should only be responsible for in-network cost-sharing. This protection should apply to copays, coinsurance, and deductibles.

Patients benefit most when physicians are in-network with as many insurers as possible. Physicians are concerned legislation that encourages “rate-setting” will give insurers extra leverage to push even more providers out-of-network and profit further by shifting additional costs to patients.

An independent dispute resolution process, or IDR, however, solves the problem of surprise medical bills related to out-of-network care without disrupting the broader market, and without having to involve patients at all. IDR is a proven market-based approach that brings everyone to the table, making it an efficient and easy way for insurers and physicians to negotiate fairly and quickly, without added bureaucracy or costs.

The solution put forth by Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.), both physicians, the Protecting People from Surprise Medical Bills Act (HR 3502), would establish robust patient protections including a workable IDR. The bill currently has more support than any other pending surprise bill legislation in the House of Representatives. IDR has been used successfully in New York state, where surprise bills have been greatly reduced and the number of in-network physicians has increased, all while saving significant healthcare dollars.

Insurance can be made more patient-friendly, too. Insurance companies should be more transparent about the limits of their coverage by detailing information on everyone’s insurance card about the deductible, which can easily range into the thousands of dollars, rather than just copays, which are often less than $50. They should also make up-to-date directories of in-network providers more readily available and easier to understand.

Physician societies representing more than 300,000 physicians across multiple specialties are united in support of finding a legislative solution to solve surprise bills without impacting patient access to care. Congress is working hard to identify one, and physicians are hopeful it can be done so that patients can focus on their health needs when seeking medical care, rather than worrying about their insurance coverage.

https://www.modernhealthcare.com/opinion-editorial/independent-dispute-resolution-process-offers-best-fix-balance-billing

HLTH19: Telehealth seeks to move beyond flu, but stymied by regulations

Telehealth was supposed to be a game-changer for care delivery, but adoption has been slow and only in niche specialties. Still, company backers and optimists say tailwinds will spur the technology’s uptake in a traditionally conservative industry across myriad use cases, from follow-up visits to post-acute care.

“I think we’re past the tipping point of where virtual care becomes expected or embedded,” virtual care vendor Teladoc COO David Sides told Healthcare Dive on the sidelines of the HLTH conference in Las Vegas this week. “I don’t think you can put the genie back in the bottle.”

The industry has seen an increasing emphasis on low-acuity urgent care as a crop of symptom checkers and digitally-enabled health apps like four-year-old 98point6 and three-year-old K Health have entered the market.

But executives in the virtual care space say there’s a lot of white space to expand, including follow-up after high-acuity care like surgeries or chemotherapy, for example.

“There’s a very, very rich world that’s used for things beyond the flu or the rash,” Roy Schoenberg, CEO of privately-held telehealth vendor American Well, told Healthcare Dive. “The thirst on the side of the health system to tie these technologies together into complex care is insatiable.”

Earlier this year, American Well launched an acute care telehealth cart to allow hospital patients and their care teams to connect to remote specialists for use cases like ICU consults.

Virtual care is “an efficiency mechanism,” Sides said. Teladoc, which went public in 2015, plans to move more into primary care within the health system by using remote patient monitoring, digital therapeutics and other tools, and bring a pilot to market next year.

Both American Well and Teladoc have are moving deeper into primary care — specifically for specialty, complex and high-cost cases.

Last week, Teladoc launched Teladoc Medical Experts, a service pairing patients with high-cost, chronic needs with a doctor to help them navigate virtual and in-person care options. CEO Jason Gorevic said on the company’s third quarter earnings call Thursday the service enrolled 100,000 employees from Nationwide Insurance and UPS so far.

Just two days prior to the launch of Medical Experts, American Well created a new company called The Clinic in tandem with The Cleveland Clinic. The joint venture provides virtual access to Cleveland Clinic’s medical specialists for patients with complex conditions.

“Imagine for a second that, through technology, when that patient goes home, their home is essentially the ward of the oncology department,” Schoenberg said. “If you can be with them every day in their home and converse with them, you’re going to change people’s ability to fight cancer.

Regulatory barriers slowly ebb

The requirement that physicians get licensed for each state or jurisdiction where they plan to practice medicine has stymied adoption of virtual care nationwide.

“What we didn’t think about it, with the arrival of telehealth, if you’re a complex cancer patient in North Dakota, you have a higher probability of getting treatment that’s less advised than the treatment you’d get in one of the leading cancer centers in the country,” Schoenberg said.

That’s not to say the government is uninterested. In May 2018, the U.S. Department of Veteran’s Affairs eliminated state licensure requirements for its physicians and saw a subsequent explosion in veteran’s use of virtual care.

And CMS finalized a rule in April giving Medicare Advantage plans additional flexibility to offer telehealth benefits for people treated in their homes in 2020.

Teladoc, which has inked contracts with six insurers in MA, forecasts it’s going to be a few more years before virtual care proves its ROI and is more widely adopted in the marketplace.

Eliminating state licensing could help, experts say. Schoenberg believes national licensing for physicians could come in the next decade if interest in virtual care continues to ramp up.

But national licensure would be a “very tough road to hoe,” Ann Mond Johnson, CEO of the American Telemedicine Association, said. “Regulation and reimbursement has to support that effort.”

Fee-for-service Medicare could also expand to cover telehealth, relaxing stringent and complicated coding requirements to promote telehealth parity, though historically the Congressional Budget Office has maintained there’s no way to model the cost implications of that decision.

Indeed, evidence is still emerging about the potential for cost savings.

Injecting stronger economic incentives into the system would prompt a “real giant expansion in the delivery of remote care,” David Ryan, general manager of health and life sciences at Intel, argued.

But broad government reimbursement support is likely years away and moving “criminally slow,” according to Schoenberg. Some legislators want to move the needle. On Wednesday, a bipartisan group of lawmakers in the U.S. House of Representatives and Senate introduced the CONNECT for Health Act, which would remove geographic restrictions for emergency and mental health virtual care and in federally-qualified health centers’ and rural clinics’ use of telehealth.

However, the Trump administration is currently “kicking the can,” Schoenberg said, by stretching the risk contracts to give payers and providers the ability to provide telehealth as long as they’re taking on risk. “I think that’s chickening out.”​

But that’s not a simple ask, administration officials said. The federal government has 15 different codified definitions of telehealth across its disparate agencies — five within HHS alone — and there are 26 different offices that have accountability or authority around the service, said Ed Simcox, CTO and active CIO of HHS.

“We’re not singing across the same sheet of music,” Simcox said. “It’s a messy situation.”

And then there is Amazon

However, the free market may soon spur the government to take a renewed interest in loosening strictures on telehealth. E-commerce giant Amazon elbowed into virtual care for the first time in September with Amazon Care, a telehealth pilot for Seattle-area employees.

Fay Rotenberg Bush, president of virtual primary care company Firefly Health, called that and an “exciting accelerant” for the market.

The service includes in-app telemedicine visits with doctors and nurses provided by a Washington state clinic for urgent or preventive care, in-person follow-up visits at an employee’s home or office and at-home prescription drug delivery.

A potential commercial launch is likely years away, but if successful, Amazon has indicated it would be looking at multiple pathways to scale — and there’s room for it, given current telehealth vendors aren’t meeting all clients’ virtual care needs, according to KLAS Research.

Experts expect the e-commerce behemoth to shop for clinician and telehealth vendor partnerships if it grows the new offering, in lieu of running an expensive provider network itself. But “on-site clinics are not new. Telehealth is not new,” Peter Flesichut, SVP and CTO of NewYork-Presbyterian Hospital, said. “What is interesting is that they’re creating their own technology.”

American Well’s Schoenberg also called out Amazon’s creating of its own platform, calling it a “bold step” to recognize the technology is foundational to managing the care of its employees.

​American Well may face little threat if Amazon stepped more firmly into the market. The vendor contracts directly with health insurers and health systems like Cleveland Clinic and Anthem Blue Cross.

Purchase, New York-based rival Teladoc, however, is different. The 17-year-old company relies heavily on subscriptions paid out by insurers (accounting for revenue of almost $120 million in the third quarter) over visit fee revenue paid either by insurers or directly by patients ($18 million). Many of its clients are employers, including more than 40% of the Fortune 500.

https://www.healthcaredive.com/news/hlth19-telehealth-seeks-to-move-beyond-flu-but-stymied-by-regulations/566119/

Canadian ambassador says drug imports would not lower U.S. prices

Canada does not have a large enough supply of prescription drugs to meet U.S. demand, and importing medicines from Canada would not significantly lower U.S. prices, Ottawa’s acting ambassador told U.S. officials in recent meetings, according to a statement published on Friday.

Kirsten Hillman, Canada’s acting ambassador to the United States, said her country is “sympathetic to U.S. concerns regarding affordable prescription drugs.”

“Not only are we too small of a market, Canada cannot increase its domestic pharmaceutical drug supply to meet U.S. demand,” the statement said. “Canada remains dedicated to working with the U.S. to improve our citizens’ health and well-being, recognizing that Canada’s priority is to ensure a steady and solid supply of medications at affordable prices for Canadians.”

The statement summarized a meeting between Hillman and Trump advisor Joe Grogan on Friday, as well as discussions with other officials on Oct. 22.

It cited a 2019 study that projected that if 40% of U.S. prescriptions were filled from Canada, the Canadian drug supply would run out in 118 days. It noted that the U.S. state of Florida spends more on prescription drugs than all of Canada.

Last week, U.S. President Donald Trump called on the head of the Department of Health and Human Services, Alex Azar, to speed up the administration’s efforts to allow cheaper medicines to be imported from Canada.

Trump and Democratic rivals looking to run against him in the November 2020 election have made lowering the cost of prescriptions medicines for U.S. consumers a high priority.

The United States, which does not negotiate drug prices with manufacturers, has much higher prices for prescription medicines than most other developed nations.

In July, the Trump administration announced that it would allow U.S. states and other groups to start pilot programs importing cheaper drugs from Canada in an effort to lower drug costs.

Reuters previously reported that Canada had privately told U.S. federal and state officials that the country would not support any plan to buy Canadian prescription drugs that might threaten its own drug supply or raise costs for Canadian citizens.

https://www.reuters.com/article/us-canada-health-supplies/canadian-ambassador-says-drug-imports-would-not-lower-u-s-prices-idUSKBN1XB55E

Lymphatic system found to play key role in hair regeneration

IMAGE: GROWING HAIR FOLLICLES. view more 

CREDIT: ROBIN CHEMERS NEUSTEIN LABORATORY OF MAMMALIAN CELL BIOLOGY AND DEVELOPMENT AT THE ROCKEFELLER UNIVERSITY

Given the amount of wear and tear it’s subjected to on a daily basis, the skin has a phenomenal ability to replenish itself. Spread throughout it are small reservoirs of stem cells, nested within supportive microenvironments called niches, which keep a tight rein on this repair process. Too much tissue might cause problems like cancer, while too little might accelerate aging.

Until now, scientists were uncertain whether the stem cells themselves could instruct other stem cells to form new skin by reshaping their niche. But new research in Science, led by Elaine Fuchs, the Rebecca C. Lancefield Professor, indicates that stem cells can indeed influence tissue regeneration. The study identifies a molecular coordination tool used by stem cells to signal across niches.

The researchers also discovered a new component of the niche: a specialized type of vessel called lymphatic capillaries, which transport immune cells and drain excess fluids and toxins from tissues. These capillaries form an intimate network around the stem cell niche within each hair follicle, the study showed, thereby interconnecting all its niches.

“By turning the skin completely transparent,” says postdoctoral fellow Shiri Gur-Cohen, “we were able to reveal the complex architecture of this network of tubes.”

Hair-follicle stem cells control the behavior of lymphatic capillaries by secreting molecules that act as an on-off switch for drainage, the scientists found, enabling them to control the composition of fluids and cells in the surrounding locale and ultimately synchronize regeneration across the tissue.

“The involvement of the lymphatic system in this process is a new concept,” says Fuchs, “and might potentially provide new therapeutic targets for lymph-related conditions such as wound-healing defects and hair loss.”

https://www.eurekalert.org/pub_releases/2019-11/ru-lsf110119.php