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A Brave New World

by Stuart Michaelson

Health care advances can be measured in concrete—new or renovated medical buildings, dollars, insurance costs and medical funding—and improved, even saved, lives.

And hope.

The latter is typified by progress and career issues; another group and includes a probe used to described by officials and practitioners from 13 Philadelphia-area organizations and illustrated by optimism generated this summer at the Philadelphia College of Osteopathic Medicine (PCOM) opportunities advancement graduation.

When former U.S. Surgeon General Antonia Novello used the phrase “door of opportunity” when addressing graduates of a five-week pipeline program for Hispanic students interested in the fields of science, technology, engineering, math and medicine, hers was no mere turn-of-phrase.

PCOM, along with two of Philadelphia’s largest Hispanic- serving educational institutions, ASPIRA, Inc., of Pennsylvania Schools, and Esperanza, Inc., this year launched the academy’s summer pilot program aimed at increasing the small (about four percent, according to the Association of American Medical Colleges) number of Hispanic practicing physicians.

With instruction led by PCOM students, alumni and faculty, 35 academy pupils learned about medicine as well as educational and career sues; another group will be chosen next year for a 2017 session.

Graduation day was “moving,” says PCOM President and CEO Jay S. Feldstein, who also touts another 2016 initiative, the Primary Care Innovation Fund, which consists of a $5 million venture capital plan to stimulate innovation and entrepreneurship in such primary health care challenges as diabetes, obesity and heart disease.

Its focus, Feldstein says, isn’t just symptoms, but such health- threatening behaviors as smoking and, in the case of calorie-evaluation software, diets contributing to obesity.

Progress is no less moving for a dozen other health care leaders.

Einstein Medical Center moved forward this year with two major initiatives: the use of new technology, the MarginProbe System, to help identify cancerous cells during lumpectomies diagnosed as breast cancer; and the Pride Clinic for the LGBT community.

MarginProbe, used by Dr. Lisa Jablon, Einstein’s breast center director, uses electromagnetic waves and includes a probe used to examine the surface of removed breast tissue to help determine if it is free of cancer cells, known as negative or clean margins. Surgeons utilize this and other data to deter- mine whether additional tissue needs to be removed in order to get all the cancer cells and complete the lumpectomy.

Jablon says that since she started using the device this year, re-incision rates have decreased from 30 percent to 20 percent, but cautions that this decrease is not entirely caused by MarginProbe, and adds that it needs some improvements in terms of false positives.

The device, she says, is “expensive,” at $1,000 per case; it is not reusable. Many insurance companies, however, support it and it is “fairly cost-efficient” considering the price of potential re-operations.

The Pride Clinic, located in the Klein Building, offers obstetric and gynecologic care, including health-maintenance exams and screenings; diagnosis and treatment of pelvic floor conditions; reproductive health care; and counseling.

A social worker, Libby Parker, is on staff to provide counseling, serve as patient coordinator and conduct community outreach. Clinic medical director Dr. David Jaspan says the clinic opened in 2015 and has moved forward this year to align with an advocacy group and with Medicare coverage for gender affirmation, as well as endocrinology and plastic surgery.

Plans are under way to expand clinic hours from current once- monthly status to five days a week.

Also making new contributions in 2016 to the area-health care community is Drexel University, as Dr. Sandra Wolf’s work at the Women’s Care Center included prevention projects targeting needs of area girls and women impacted by female genital- cutting. Wolf says “our community- based and informed outreach, our clinical programs and education initiatives all will be advancing” in 2017. The project is part of a $6 million federal grant.

Federal money, in this instance from the National Institutes of Health (NIH), also helped Drexel this year in the form of an estimated $3 million grant to test therapy on 120 patients over the next five years regarding a battery-powered applicator to heal wounds (including those involving diabetes patients) with low-frequency ultrasound.

Dr. Kenny Simansky, vice dean for research and a pharmacology professor, notes another Drexel development, that of “smart fabric” to monitor the contractions of pregnant patients.

Looming large this year and next at Hahnemann University Hospital are developments in organ transplantation, where Dr. David Reich, chief of multi-organ transplantation and hepato-pancreato-biliary surgery (as well as professor of surgery at Drexel University) is involved with the HIV Organ Policy Equity (HOPE Act) organ transplants at Hahnemann and the ongoing ELAD clinical trial.

The HOPE Act, signed into law by President Obama in 2013, paved a path for select transplant centers to utilize donor organs with HIV as part of a research effort focused on safety and increasing access to care. For the first time in the United States, people with HIV can donate their organs for transplantation to HIV patients.

Reich calls 2016 an exciting year for this “trailblazing” development, and notes that close to 30 patients were willing to accept HIV organ transplants at Hahnemann (from a national total of 80); previously, trans- plants were performed on HIV-positive patients, though the trans- planted organs were not HIV-positive.

One non-medical challenge, Reich says, is the fact that many patients are unaware of the availability and success of these transplants for HIV-positive patients, while medical challenges included medication management and the availability of a pharmacist with HIV-and-transplant experience.

Reich adds that referrals have in- creased, and hopes, possibly in 2017, to use donated organs from living donors with HIV.

“It is incredible,” Reich says as organ transplants recently passed a 50-year anniversary, “what we are able to do. It is very exciting and gratifying to push the envelope and afford more people these advantages.”

Reich is also involved with the ELAD clinical trial, an investigational extracorporeal, human cell-based liver-support system designed with the proposed intent to supplement hepatic function in order to improve survival rates among subjects with liver failure.

Data from ELAD System clinical studies have shown trends that may indicate a potential for ELAD to increase survival rates in patients with liver failure. ELAD has received orphan designation in the United States and Europe for the treatment of patients with acute liver failure.

Reich is currently involved in a Phase Three clinical trial (VTL 308), with patients under 50 who have complications from hepatitis at a level not making them unacceptable for treatment.

“The liver,” he says, “has an in- credible regenerative quality. We learned, though, that older livers don’t regenerate as well.” ELAD could cure patients or support them until liver transplant is possible. Certain patients with alcoholic liver disease may be considered viable options for liver transplants, particularly those with acute alcoholic hepatitis without records of recidivism, as well as strong support from family.

Reich conceived of and recently initiated other cutting-edge research that utilizes ELAD components, with a goal of repairing imperfect organ donor livers and expanding the inadequate donor pool. His research at Drexel University and Hahnemann Hospital employs ELAD cellular treatments and newly available machines that keep livers alive outside the body longer. These perfusion ma- chines will improve transplant success as cold/preserved livers can’t be studied as successfully as live ones (and, when preserved through cold, there are greater limits in terms of transporting them, and it is hard to repair a cold-stored liver).

In a recent development, the Institute of Emerging Health Professions at Thomas Jefferson University this month received a $3 million gift from Australian philanthropists Barry and Joy Lambert to support its Center for Medical Cannabis Education and Research, which was launched in May, and will now be called the Lambert Center for the Study of Medicinal Cannabis and Hemp at Thomas Jefferson University.

The donors were inspired by the experience of their granddaughter’s fight with Dravet’s syndrome, a rare genetic abnormality that causes seizures, and for which medical cannabis provides relief.

Dr. Charles Pollack, who runs the center, says the funds will support education and research; a third center component, social impact, includes Web-based public education on medical uses of medicinal cannabis, for which he says there is much untapped potential.

All possible uses of medical marijuana, as well as hemp, are fair game, he adds, “We need to separate hype from science.”

Also promising were advancements this year at Temple University, as de- scribed by Dr. Clifford Belden, professor and chair of the radiology department at Lewis Katz School of Medicine and radiologist-in-chief for Temple University Health System (TUHS); and Dr. Gerard Criner, chair and professor of the Department of Thoracic Medicine and Surgery at Katz as well as Temple Lung Center director.

Belden notes progress in the TUHS collaboration announced in 2015 with GE Healthcare to provide higher-quality radio- logic imaging more efficiently, at lower cost.

One aspect of the collaboration, which started in July, was to reduce time spent by CT scan patients in the office, with many at Temple University Hospital having wait times cut by as much as half.

The GE collaboration, he adds, also involved Temple University Hospital, Episcopal Hospital, Jeanes Hospital and Fox Chase Cancer Center sharing information on patients’ experiences involving hospital visits and insurance issues.

Criner hails efforts to battle chronic obstructive lung disease (COPD). He will be involved next May in a scientific seminar hosted by members of a global-initiative panel for COPD; also, in 2016, the Temple Lung Center conducted COPD trials involving such aspects as adherence and beta blockers.

Criner also points to advances in tele-health focused on improving emergency- room (ER) admissions as well as reducing ER and hospital use.

Also at Temple this year: free baby boxes (functioning bassinets) to battle high infant-mortality rates among mothers who deliver at Temple Hospital.

Another noteworthy development in 2016 involved the Fox Chase-Temple University Hospital Bone Marrow Transplant (BMT) Program for patients needing bone- marrow or stem-cell transplants. The program is located on the campus of Jeanes Hospital, where a new $2.1 million BMT outpatient facility opened in February.

Slated to open early 2017 at the Fox Chase Cancer Center is Fox Chase Cancer Center Pharmacy, a retail pharmacy that will provide patients with medication on an outpatient basis. Fox Chase Director of Pharmacy Dwight Kloth and Outpatient Pharmacy Manager Jeff Karcsh say the new pharmacy will focus mainly on oral- targeted specialty chemotherapy drugs, along with other medications related to malignancy treatments.

Kloth says this service will benefit patients who must currently use specialty pharmacies, often from out-of-state. Karcsh, who will work on-site along with a pharmacist who will come on board in January, says patients will receive assistance in insurance issues as well as continuing care.

At the Rothman Institute, Dr. Alan Hili- brand, co-director of spine surgery and di- rector of the Spine Fellowship, expects ex- pansion in 2017 of Rothman’s role at Methodist Hospital, “a hospital within a hospital” where spine procedures are now performed by Rothman physicians.

Hilibrand will be active with the 2017 Methodist improvements, including physical renovations to the hospital.

He is also involved, as chair of the communications cabinet for the American Academy of Orthopaedic Surgeons, in promoting safety public-service announcements about “digital dead-walkers” who fail to pay attention to their surroundings while fixating on their cell phones.

Shriners Hospital for Children this year launched an expanded anti-bullying resource center providing public- service announcements, says public-relations manager Stephanie Byrwa. They also introduced a specialty clinic for the treatment and prevention of sports in- juries among girls and young women.

FIERCE (Female Initiative: Evaluation and Rehabilitation Care Excellence), led by Dr. Corinna Franklin, is designed to reduce injuries through a team that includes a pediatric orthopedic surgeon, a physical medicine and rehabilitation physician, a physician assistant, pediatric registered nurse, and physical therapist, all of whom are female.

At the University of the Sciences, says Dr. Andrew Peterson, dean of the Mayes College of Healthcare Business and Policy, points to plans in 2017 to begin early stages of plans for the creation of a center for addiction studies, notably opioids.

Active in health care advances this year was Steve Barsh, chief innovation officer at Dreamit. Barsh notes his company’s 2016 relationship with Blackstone Foundation, through Penn Medicine and Independence Blue Cross, through a Blackstone In- novation Grant (BIG) of about $300,000.

Also big on Dreamit’s 2016 developments: investor road shows spurring between 20 and 30 meetings, targeting the likes of Philadelphia’s Oncora Medical, which integrates radiation-oncology equipment and data.

Barsh points to Dreamit’s involvement with California-based Graftworx, which works to improve cardiovascular implants; Eko, also in California, which works on heart-monitoring; and Israel’s Medaware, which—inspired by the fatal result of a bicycle accident—makes efforts to better match patients with medications.

Independence Blue Cross this year began offering its ongoing college tuition benefit to businesses at no cost to customer groups for one year. The program, which makes it easier for patients with Independence health coverage to pay for eligible family members’ college education, provides tuition rewards to pay up to one year’s worth of undergraduate tuition at more than 350 colleges and universities.

Terry Booker, vice president of corporate development and innovation at Independence, points to Independence’s Dreamit-Penn Medicine collaboration with TowerView Health on pilot efforts to help patients using multiple prescription medicines; and its ongoing work with Radnor’s Relay in improving communications between Independence and its members.

Also high on Independence’s agenda are its design-thinking workshops, which teach students and business and health care professionals how best to tackle various challenges, including those involving health care.

“Innovation focus,” Booker says, “knows no bounds.”

A relatively new player on the area’s health-insurance block is West Conshohocken-based Tandigm Health, a joint venture between Independence Blue Cross and DaVita Health providing a network of 440 participating primary-care physicians (up from 270 in 2015).

Patrick Adams, who came aboard as president in July, touts Tandigm’s “robust health system” and its 100-plus employees (from 27 in 2015) whose “hearts are in the right place, who know we can make an impact in the lives of someone’s mom, dad, brother or sister.”

Tandigm educates patients about where to go for treatment and provides home-care programs; nurse navigators for in-person or phone assistance; mobile health tools; and coordination assistance for hospital, lab, and specialist services.

Also provided: its Quality Health Alliance (QHA), including 65 new primary care physicians from 24 independent and 15 employed practices; and 14 preferred skilled nursing facilities (SNFs).

Tandigm reports its efforts spurred 800 fewer ER visits in the past year, as well as an increase in patients reached to 100,000 from 69,000 in 2015. “Healthier people,” says Adams, “make for a better health system and a better community.”

Published (and copyrighted) in Philly Biz, Volume 1, Issue 12 (December, 2016).
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