Last summer, F1000 celebrated ten years highlighting the top literature in biology and medical research. Faculty of 1000 (F1000) is a unique online services that selects, rates, and evaluates important articles based on the opinions of global leaders in biology and medicine. Articles are selected by a peer-nominated global ‘Faculty’ of the world’s leading scientists and clinicians who then rate them and explain their importance.

Rather than a traditional journal, F1000 Research is a publishing program, which will offer immediate publication after an in-house editorial check similar to what is done by other publishers such as PLoS One before anything is sent for referee. Peer review will occur openly, post publication, with open revisioning of work including ongoing updates. Review will be a simple formal check by invited reviewers confirming that the work is scientifically sound, with commenting optional. An “approved” or “not approved” stamp with the invited reviewers’ name(s) and comments will then accompany the article. Following review, any registered reader can comment on the work and authors can respond.

F1000 Research will also encourage raw data deposition and publication. Standardized templates are being developed to permit the data and associated information to be indexed and mined, potentially for further publication credit.

The new publishing program will accept a broad range of article formats and will encourage content types that are now routinely rejected (or not even regarded as publishable by other science publishers) such as negative results, case studies, thought experiments, preliminary analyses, and incomplete datasets. Publication fees (i.e. author costs for submission) have not been announced.

The move by F1000 is timely. Recently, researchers have been boycotting one traditional publisher, Elsevier, who has been actively supporting a bill in Congress, the Research Works Act (RWA), which seeks to roll back legislation passed less than five years ago that expanded public access to taxpayer funded research by requiring all research funded by the NIH to be freely available to the public within 12 months of publication.

Commenting on the launch of F1000 Research, Vitek Tracz, Chairman and Founder of Faculty of 1000 said [2]:

The Open Access model has addressed effectively the issue of inadequate access to research findings. It did not address the major issues around communicating the research finding: the delays in access, the inadequacies of peer review, and the complexities of data publishing. It is up to collaboration between researchers and publishers to come up with a solution, and we are determined to be a part of it.

Many questions remain as F1000 Research is readied for launch. Rebecca Lawrence, F1000 Director of New Product Development, invites those working in the bioresearch community, institutions, funders, data centres and repositories, and data mining and informatics groups to join in open discussion and debate about the outstanding issues via the F1000 Resarch RSS feed or Twitter @F1000Research.

References

1. F1000 Research – join us and shape the future of scholarly communication. F1000 Research. 2012 Jan 30.
2. Faculty of 1000 introduces a novel Open Access publishing venture: F1000 Research. F1000 press release. 2012 Jan 31.

• Selventa Receives Patent for Method to Identify Biomarker Profiles

  Selventa, a biomarker discovery company that enables personalized healthcare through the stratification of patients based on disease-driving mechanisms, recently announced a US patent that relates methods and techniques that facilitate discovery of biomarkers, thus aiding in the development of predictive and prognostic diagnostic tests for therapeutics targeting complex multi-factorial diseases.

• Biomarker Discovery: Moving Diagnostics to the Forefront of Medical Research

  Increasing emphasis is being placed on biomarker discovery as the key to advancing personalized medicine.

• FDA Clears Critical Diagnostics Presage ST2 Assay for Patients with Heart Failure

  Critical Diagnostics is a U.S.-based biomarker company focused on optimizing patient care in cardiovascular diseases, such as heart failure.

• SciClips Launches Cancer Biomarker Database

  The success of personalized cancer therapeutics relies on the development of companion diagnostic assays that can identify the most appropriate cancer patient, tumor type and disease state. To address this need, SciClips, a Wisconsin-based open innovation platform company that enables scientists and researchers to collaborate and share research and ideas, recently launched a cancer (oncology) biomarker database.

• The Bill & Melinda Gates Foundation to Fund Biomarkers of Gut Function for Global Health

  The Bill & Melinda Gates Foundation is currently seeking letters of inquiry for the grant program Biomarkers of Gastrointestinal (Gut) Function and Health.

The recall affects select bottle packaging configurations from retailers of Excedrin and NoDoz products with expiration dates of December 20, 2014 or earlier and Bufferin and Gas-X Prevention products with expiration dates of December 20, 2013 or earlier, in the United States.

The issue arises from manufacturing problems at the company’s Lincoln, Nebraska facility. Novartis voluntarily halted production at the plant on December 19th, 2011. The FDA has cited the Novartis plant for quality control problems over the summer 2011 [2]. Among the 13 FDA inspector observations, Novartis officials have failed to adequately investigate 166 complaints of foreign tablets in bottles since 2009. On Monday, January 9th, FDA officials warned that some of Novartis’ over-the-counter medications may have accidentally been packaged with opiate products manufactured and packaged for Endo Pharmaceuticals, which are made at the same facility [3].

No related adverse events have been reported as a result of these issues. U.S. Consumers are being asked to either destroy or return unused product identified in the recall to Novartis Consumer Health Inc. Information on the affected bottle sizes, and related expiration dates are available at www.novartisOTC.com.

The Novartis recalls come just over six months after Johnson & Johnson recalled over 40 products due to what was believed to have been contaminating breakdown products from a fungicide used to treat wooden pallets on which empty product containers were stored.

References

1. Novartis Consumer Health Inc. voluntarily recalls certain over-the- counter products in the US while Novartis Group strengthens quality standards across all manufacturing sites. Novartis media release. 2012 Jan 8.
2. Novartis Consumer Health, Lincoln, NE 483 issued 7/8/2011. U.S. Food and Drug Administration. Accessed 2012 Jan 9.
3. Endo Pharmaceuticals Opiate Products by Novartis Consumer Health: Public Health Advisory – Potential Safety Risk. U.S. Food and Drug Administration. 2012 Jan 9.

Would you like to win two free books, two magazine subscriptions and a Webicina T-shirt? To enter the giveaway, simply subscribe to the Highlight HEALTH Network email updates.

As the year draws to a close, let’s take a look back at the top stories readers were interested in for 2011. We’ve compiled two top ten lists of the most-viewed stories for the year, one as measured by the absolute number of page views and the other as measured by the average number of page views per day posted.

To get an idea of the underlying theme for the top ten lists, here’s a tag cloud of terms taken from the news stories that made the cut:

Top Biomedical Research News Stories for 2011

According to the Pew Internet and American Life Project, 80% of internet users have searched online for information about health. To see what’s been frequently viewed on Highlight HEALTH, we’ve calculated the top stories for the year using two measures, either by the highest absolute number of page views for 2011 or by the average number of page views per day (7 out of 10 overlap both lists). Each story indicates an article number (we published a total of 115 stories in 2011) and number of views.

Top 10 stories by highest absolute page view for the year

1. Crizotinib: Another Step Towards Personalized Cancer Care
   (article #11; 6,671 page views)

   Three research studies in a recent issue of the New England Journal of Medicine highlight the therapeutic potential of crizotinib, a drug that blocks fusion proteins of anaplastic lymphoma kinase, a signaling molecule that can regulate cell growth.

2. Clarian Health Becomes Indiana University Health
   (article #5; 5,469 page views)

   On Monday, January 24, 2011, Clarian Health, the second largest health organization in Indiana, officially changed its name to Indiana University Health.

3. Grey Weather, Grey Mood: Cortisol Levels May Underlie Seasonal Affective Disorder
   (article #13; 5,449 page views)

   A recent study finds that the cortisol response to awakening is reduced in people with self-assessed seasonal affective disorder.

4. Flu Vaccine for the 2011-2012 Season Approved
   (article #62; 5,302 page views)

   On Monday, July 18th, 2011, the FDA said it had approved the formulation for the 2011-2012 vaccine.

5. Neti Pot Deaths Spark Tap Water Warnings
   (article #113; 5,078 page views)

   There have been two neti pot-associated deaths in Louisiana recently, both of which were caused by infection with the “brain-eating amoeba,” Naegleria fowleri.

6. New Strategic Plan for NIH Obesity Research Seeks to Curb Epidemic
   (article #35; 5,063 page views)

   To combat the obesity epidemic, the National Institutes of Health is encouraging diverse scientific investigations through a new Strategic Plan for NIH Obesity Research.

7. President Obama Resists Cuts to Biomedical Research Funding
   (article #16; 4,648 page views)

   While making cuts and freezes in many areas of government, the 2012 budget President Obama recently sent to Congress seeks an increase in funding for biomedical research at the National Institutes of Health (NIH).

8. Daily Aspirin May Reduce Cancer Risk
   (article #9; 4,419 page views)

   A recent report published in The Lancet claims that at least 75mg of aspirin every day can also reduce the risk of developing many different types of cancers.

9. Health Literacy: Key for Managing Personal Health
   (article #2; 4,341 page views)

   Health literacy: what is it, why is it important, and what is being done to increase it and create a health literate society.

10. Easter Seals Living With Disabilities Study
    (article #1; 4,011 page views)

    Most of us take everyday adult life for granted; we have a place to live, access to transportation and the opportunity to live independently. But what happens if you’re one of the millions of adults living with a developmental disability in this country?

Top 10 stories by average number of page views per day

1. Neti Pot Deaths Spark Tap Water Warnings
   (article #113; average: 725 page views/day)

   There have been two neti pot-associated deaths in Louisiana recently, both of which were caused by infection with the “brain-eating amoeba,” Naegleria fowleri.

2. Supplemental Vitamin E and A, Worth The Risk?
   (article #115; average: 118 page views/day)

   A recent research summary published in The Medical Letter On Drugs and Therapeutics may help consumers and practitioners to wade through the conflicting information on supplements, as many supplements have both risks and benefits associated with their use.

3. Flu Vaccine for the 2011-2012 Season Approved
   (article #62; average: 32 page views/day)

   On Monday, July 18th, 2011, the FDA said it had approved the formulation for the 2011-2012 vaccine.

4. Celebrating Five Years of Highlight HEALTH, Prize Pack Giveaways
   (article #108; average: 21 page views/day)

   Some events are special and meant to be observed. Here at Highlight HEALTH, we’re coming up on one of those events: our 5 year anniversary! To celebrate this milestone and to give something back to our subscribers, for the next three months we’re holding a prize giveaway.

5. Crizotinib: Another Step Towards Personalized Cancer Care
   (article #11; average: 20 page views/day)

   Three research studies in a recent issue of the New England Journal of Medicine highlight the therapeutic potential of crizotinib, a drug that blocks fusion proteins of anaplastic lymphoma kinase, a signaling molecule that can regulate cell growth.

6. New Strategic Plan for NIH Obesity Research Seeks to Curb Epidemic
   (article #35; average: 19 page views/day)

   To combat the obesity epidemic, the National Institutes of Health is encouraging diverse scientific investigations through a new Strategic Plan for NIH Obesity Research.

7. Grey Weather, Grey Mood: Cortisol Levels May Underlie Seasonal Affective Disorder
   (article #13; average: 17 page views/day)

   A recent study finds that the cortisol response to awakening is reduced in people with self-assessed seasonal affective disorder.

8. Clarian Health Becomes Indiana University Health
   (article #5; average: 16.1 page views/day)

   On Monday, January 24, 2011, Clarian Health, the second largest health organization in Indiana, officially changed its name to Indiana University Health.

9. President Obama Resists Cuts to Biomedical Research Funding
   (article #16; average: 15 page views/day)

   While making cuts and freezes in many areas of government, the 2012 budget President Obama recently sent to Congress seeks an increase in funding for biomedical research at the National Institutes of Health (NIH).

10. Tips for a Healthy Thanksgiving
    (article #104; average: 14 page views/day)

    Some easy science-based tips to ensure not only a delicious turkey but a healthy Thanksgiving.

Thanks for reading and Best of Health in the coming year!

Thanks to all of our readers for helping make 2011 a great year.

Happy holidays from the team at Highlight HEALTH!

Walter Jessen, Diana Gitig, Kirstin Hendrickson and Faith Martin.

To celebrate this milestone and to give something back to our readers, for the next three months we’re holding a prize pack giveaway.

Highlight HEALTH launched back in late December 2006 and from the very beginning focused on the science of health, reporting on research, providing background and analysis, and explaining how research results affect you, the healthcare consumer. To compliment Highlight HEALTH, we launched the Highlight HEALTH Web Directory six months later. By the end of 2007, The Highlight HEALTH Network was born. We’ve been growing and improving ever since (if you’re interested in new ideas impacting health and medicine, check out the recently relaunched Highlight HEALTH 2.0).

To celebrate five years of biomedical research reporting at Highlight HEALTH, from now through the end of February 2012, we will be giving away four prize packs every other Saturday, starting on January 14th.

Five Years of Highlight HEALTH: the Prize Packs

Here at Highlight HEALTH, we promote advances in biomedical research and offer background/analysis on scientific studies so that readers can understand how new treatments and emerging research could affect them. We also encourage health literacy to improve health self-management. We’ve carried these same themes over to our prize packs. In celebration of five years of Highlight HEALTH, each of the four prize packs we’re giving away consists of the following:

A one-year subscription to ResearchSaves Magazine. The Foundation for Biomedical Research’s quarterly biomedical magazine ResearchSaves showcases medical and scientific breakthroughs with foundations in animal research and strong human interest elements. All articles are submitted by universities, nonprofits and companies across the country. Each magazine also includes a full-length DVD, poster or educational program.

A one-year subscription to NIH MedlinePlus magazine. NIH MedlinePlus brings the latest and most authoritative information from the National Institutes of Health (NIH) to patients and their families and to other health care consumers. The magazine presents you with the best in reliable, up-to-date health information and the latest breakthroughs from NIH-supported research.

A paperback copy of Don’t Cross Your Eyes … They’ll Get Stuck That Way by Drs. Aaron Carroll and Rachel Vreeman of the Indiana University School of Medicine. The ultimate myth-busting collection of quirky and curious facts about your body and health. With a perfect balance of authoritative research, breezy humor, and snappy, easily-understandable takeaways, Don’t Cross Your Eyes … They’ll Get Stuck That Way is a must-have for physicians, parents, mythbusters, and anyone interested in quirky medical information.

A hardcover copy of Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care by Dr. William Hanson, Professor of Anesthesia and Critical Care and the Chief Medical Information Officer at the University of Pennsylvania School of Medicine. In Smart Medicine, William Hanson brings to life the fascinating true world of doctors and nurses, examines how the multifaceted medical system has evolved, where it’s going, and reveals the revolutionary changes that will soon be sweeping through the medical community.

A Webicina T-shirt (e-patient style shown; a web-savvy physician style is also available). Webicina.com is the world’s first and only free service that provides curated medical social media resources across 80 medical topics in over 17 languages. Their mission is to let empowered patients and medical professionals access the most relevant social media content in their own languages on a customizable, easy-to-use platform for free.

Five Years of Highlight HEALTH: Enter to Win

To enter the giveaway, simply subscribe to The Highlight HEALTH Network email updates using the form below. Our email updates are one of the easiest ways to stay on top of everything here at Highlight HEALTH. You’ll only get an email when there’s new content. If you’re already a subscriber, send us a note with your email address and we’ll include you in the drawings.

Entries must be in by midnight EST on the Friday preceeding the prize drawing. Four drawings will be held every other Saturday: January 14, January 28, February 11, and February 25. Good luck!

Bonus: Use the buttons below to “Like” on Facebook and/or tweet on Twitter — if you’re one of the prize pack winners, we’ll add a surprise gift!

Research has shown that, following a large meal, less tryptophan will reach the brain than on an empty stomach. The real culprit is the types and quantity of food you’ve eaten. Blame your sleepiness instead on high-calorie, high glycemic index foods.

Here are a few easy science-based tips to ensure not only a delicious turkey but a healthy Thanksgiving.

Defrost safely

If your Thanksgiving turkey is frozen, when you defrost it keep the outside of the bird below 41 degrees Fahrenheit (5 degrees Celsius). Pathogens such as Salmonella or Campylobacter don’t grow below that temperature. You can do this by putting the bird in cool water or the refrigerator.

If you go the route of the refrigerator — likely the easier of the two options — note that it can take additional time to thaw. According to the U.S. Department of Agriculture (USDA), it takes about 1 day for every 4-5 pounds [1]. If you thaw your turkey this way, be sure to catch any drippings under the turkey so you don’t contaminate ready-to-eat foods like apples or lettuce.

Don’t wash that bird

Running a raw turkey under the faucet doesn’t remove bacteria. In fact, doing so can spread pathogens around the kitchen. Splashing water can aerosolize bacteria and carry them around the room. Instead, wipe the turkey with a paper towel to remove foreign debris.

With all that cooking going on in the kitchen, make sure you keep track of your knives and cutting boards. Anything that’s touched raw meat needs to be washed with soap and water to prevent cross-contamination — that includes your hands and the countertop. If you’ve thawed your turkey in water, be sure to clean the sink with soap and water to remove any bacteria.

Cook your stuffing separately

The USDA advises against stuffing the turkey [1]. Instead, cook your stuffing outside the bird. Stuffing can easily become contaminated with Salmonella from inside the turkey. In addition, thick breading can interfere with moisture migration and cause the turkey to cook more slowly. This makes it even more difficult to get the breading hot enough to kill bacteria without overcooking the turkey.

If you decide to stuff the bird anyway, be sure to use a food thermometer. The center of the stuffing needs to reach a safe minimum internal temperature of 165 degrees Fahrenheit (74 degrees Celsius). Let the bird stand 20 minutes before removing the stuffing and carving.

The perfect turkey

Why does meat get dry when it’s overdone? As meat is cooked, heat flows in and denatures (meaning unfolds) proteins. Once unfolded, the proteins no longer wrap around water molecules in the cells and stick together, making the meat tougher.

The challenge with cooking a turkey is that it has two different kinds of meat. White breast meat is very different from dark leg, thigh and wing meat.

Muscular dark meat is reinforced with connective tissue, tendons and ligaments, all of which are abundant with a protein called collagen. Softening dark meat takes hours of roasting to turn the collagen into gelatin that moistens the meat. In contrast, white meat doesn’t have much collagen and is abundant in myosin and actin proteins. White meat becomes tender after myosin breaks down, occurring at a lower temperature than what is required to break down the collagen in dark meat. This is the reason why it’s common to have a turkey with moist dark meat but dry white meat; the white meat has been overcooked.

To avoid this, you could prepare the turkey parts individually and cook them to the optimal texture and temperature. Another option is to start out with the breast section cooler than the rest of the bird. This can be accomplished by placing an ice pack on the breasts while the bird is thawing or for about a half-hour prior to cooking. This will allow the different meats of the turkey to cook more evenly. You’ll have to add 15-30 minutes to the cooking time to ensure the white meat is fully cooked. Remember that a whole turkey is safe cooked to a minimum internal temperature of 165 degrees Fahrenheit (74 degrees Celsius) throughout the bird.

One last thing to consider is basting. Many people baste their turkey with hot juices right from the roasting or drip pan. However, pouring very hot liquid over white breast meat causes it to cook faster. You can baste legs and wings with the hot liquid right from the pan, but let the juices cool down before you baste the breast. This will help maintain some moisture in the meat, add flavor and keep the turkey cooking properly.

Give thanks

People typically give thanks during the holiday for family, food and home. But did you know that research has found that expressing gratitude is also good for your health?

Scientists have shown that being grateful affects an individual’s health in a positive way. Grateful people report having a heightened sense of well-being, greater optimism and improved life satisfaction [2-4]. Not surprisingly, writing letters of gratitude also has positive psychological and physical benefits.

Have a safe and healthy Thanksgiving!

References

1. Food Safety of Turkey … from Farm to Table. U.S. Department of Agriculture. Accessed 2011 Nov 22
2. Froh et al. Counting blessings in early adolescents: an experimental study of gratitude and subjective well-being. J Sch Psychol. 2008 Apr;46(2):213-33. Epub 2007 May 4.
   View abstract
3. Froh et al. Measuring gratitude in youth: assessing the psychometric properties of adult gratitude scales in children and adolescents. Psychol Assess. 2011 Jun;23(2):311-24.
   View abstract
4. Emmons and McCullough. Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life. J Pers Soc Psychol. 2003 Feb;84(2):377-89.
   View abstract

Breast cancer accounts for nearly 1 in 3 cancers diagnosed in U.S. women [2]. In October 2010, the National Breast Cancer Coalition (NBCC) called for a vaccine for breast cancer with a deadline of 2020. Almost a year later, GE’s healthymagination initiative has also focused on breast cancer with a target of 2020.

Modeled after GE’s ecomagination challenge, which resulted in over 5,000 submitted ideas and $134 million in investments and partnerships by GE, the new healthymagination challenge focuses on improving early detection of breast cancer at the molecular level. GE’s first healthymagination Challenge is an open call to action for oncology researchers, businesses, students, and healthcare innovators. Through the Challenge, GE and its venture capital partners will award up to $100 million to fund the best ideas to improve breast cancer diagnostics. The are several goals to the Challenge:

1. Improve early breast cancer detection and allow for more accurate diagnosis
2. Better understand tumors associated with triple negative breast cancer, which is less responsive to standard treatments and is typically more aggressive
3. Better understand the molecular similarities between breast cancer and other solid tumors

Jeff Immelt, CEO and Chairman, GE, said [3]:

We envision a day when cancer is no longer a deadly disease. When you add our cutting edge cancer detection technologies to the innovative ideas of our new partners, it’s a powerful formula for tackling cancer and helping doctors and researchers improve care.

In partnership with O’Reilly Media, the effort will also feature a special focus on data (CEO and founder, Tim O’Reilly, is an advocate for using data science to spur innovation). A series of code-a-thons or “data challenges” will be held to engage the data science community in finding new applications for breast cancer data.

To enable analysis and further accelerate innovation, GE is also investing in the development of a first-in-kind “super database” that will consolidate clinical, pathology, therapy and outcomes data. The database will be available in collaboration with leading cancer research organizations, as well as NGO and government groups, starting with relevant cancer data from GE’s Medical Quality Improvement Consortium (MQIC); Clarient, a cancer diagnostics and GE Healthcare Company; The Premier healthcare alliance; and the U.S. Department of Health & Human Services.

In addition, Immelt also said that GE will invest $1 billion over the next five years on research and development programs to expand its suite of advanced technologies and solutions for cancer detection and treatment. At the September event, GE presented several new technologies:

1. GE SenoCase, a new concept in mobile mammography that will deliver breast cancer screening capabilities to millions of women around the world who lack access to existing screening options
2. GE PET Tracer, a new Positron Emission Tomography (PET) tracer technology in development that will inform doctors if cancer treatments are working, very early in the course of treatment, by measuring new blood vessel formation in tumors
3. GE SenoBright Contrast Enhanced Spectral Mammography (CESM), a technique that helps radiologists localize a known or suspected breast cancer lesion

Lastly, GE announced a three-year partnership with Susan. G Komen for the Cure to forge first-in-kind programs that bring the latest breast cancer technologies to more women in the United States and around the world. Initially, these programs will run in Wyoming (one of the most rural states in the U.S.), Saudi Arabia and China.

GE will publicly track progress against this cancer initiative at healthymagination.com.

References

1. GE Launches New Commitment to Accelerate Cancer Fight: Integrated Tech Portfolio and Collaboration with Doctors and Researchers to Deliver Better Care to 10M Patients by 2020. GE reports. 2011 Sep 15.
2. Breast Cancer Facts & Figures 2011-2012. American Cancer Society. Accessed 2011 Nov 17.
3. GE and Partners Aim to Speed Fight Against Cancer, Starting with Breast Cancer. Healthymagniation press release. 2011 Sep 15.

Anna Barker’s TEDMED talk last year focused on the history of The War on Cancer, her projects within the National Cancer Institute, and where research is badly needed. TEDMED is a three day annual conference where cutting-edge science and technology leaders “connect, understand and inspire” to advance the art of health and medicine with new ideas, the latest science and innovative technology. Barker’s talk provides a brief history on The War on Cancer and an overview on a number of cancer programs initiated over the last decade. Check out Anna Barker’s talk below.

References

1. World Cancer Report 2008. International Agency for Research on Cancer. World Health Organization. 2008.
2. Cancer. World Health Organization. Accessed 2011 Nov 1.
3. Global Economic Cost of Cancer. American Cancer Society. 2010 Aug 16.
4. Anna Barker joins ASU to lead Transformative Healthcare Networks. ASU News. 2011 Aug 31.

What is an Accountable Care Organization (ACO)?

An Accountable Care Organization (ACO) is a group of health care providers (doctors, hospitals, etc.) that work together to arrange all medical care for their patients. The general idea behind ACOs is that by establishing a continuum of care among providers who have incentives to focus on primary and preventive care, costs can be contained.

By allowing for care coordination and evidence-based care, healthcare systems and health professional performance will achieve significant quality improvements. Promoting preventive medicine in order to avoid costly acute episodes, especially as they relate to chronic disease, elder care, and within health disparity communities, will lead to better health outcomes for patients.

What’s wrong with healthcare today?

The problem with healthcare today is that patients are getting each part of their healthcare separately. Patients see primary care physicians for basic treatment, specialists for specific care, hospitals for tests, etc. An ACO brings all the components in the healthcare chain together. Imagine the Cleveland Clinic or the Mayo Clinic where care is highly coordinated. In an ACO, if you need a specialist, lab work or medication, it all comes from the same treatment team. An ACO also gives patients more time with doctors and less shuffling between offices filling out forms. By design, an ACO provides more efficient healthcare, is less prone to errors, and controls costs better than the traditional system.

And there is definitely an emphasis on cost control. ACOs will fundamentally change how doctors and hospitals get paid. ACOs will make providers jointly accountable for the health of their patients, giving them strong incentives to cooperate and save money by avoiding unnecessary tests and procedures.

For some, however, the picture isn’t all rosy. In a policy paper published by the Heritage Foundation, Why Accountable Care Organizations Won’t Deliver Better Health Care — and Market Innovation Will, Rita Numerof, Ph.D. argues that ACOs will most likely exacerbate the very problems they set out to fix, concentrating power in just a few organizations, allowing them to become “too large to fail” [2]:

Such a system undermines competition and entrepreneurship—the bedrock of innovation and job growth in this country. There is no evidence that supports the use of untested, complex organizational structures to improve quality of care and reduce costs. Creating incentives that focus on achieving higher quality of care, not quantity of medical procedures; providing choices to patients; and allowing real competition among health insurance providers is what will truly transform the health care system.

Judy Feder and David M. Cutler, senior fellows at the Center for American Progress, see things differently. In their report Achieving Accountable and Affordable Care, Key Health Policy Choices to Move the Health Care System Forward, they discuss how to deliver better healthcare quality at lower costs by promoting physician-led organizations [3]:

The Affordable Care Act highlights the potential role that physician-led organizations can play in reducing the unnecessary and costly use of the hospital through better primary care and care management. By mobilizing their skills and taking charge, physicians can call the shots in distributing the substantial savings that can result. Physicians can also encourage hospitals to compete for, rather than count on, their referrals, and thereby promote better quality at lower costs.

In markets with a single dominant hospital, however, it may be difficult to foster this competition. But forming ACOs should not become an excuse for promoting hospital consolidation by encouraging hospitals to capture physicians and foreclose rival hospitals. If physicians are able to take the lead in establishing care management organizations, then they will be far better positioned to capture savings than if hospitals are in control.

To encourage physicians to actually take the lead, ACO quality performance benchmarks and rewards for good care should emphasize health care delivery changes that depend on physician engagement in better care. Reducing preventable hospital admissions or readmissions should be a key quality metric, emphasizing the avoidance of ambulatory-care-sensitive use of hospitals in emergency settings or as an inpatient.

Will new ACO regulations help with healthcare costs?

Although some people believe that bringing doctors and hospitals together economically will make them too powerful, ACOs stand to dramatically reduce the number of tests that patients have to take, amounting to hundreds of millions of dollars in savings.

Medicare’s traditional fee-for-service payment system pays doctors and hospitals by the test and procedure. ACOs wouldn’t do away with fee-for-service but would create savings incentives by offering bonuses when providers keep costs down and meet specific quality benchmarks. The focus will be on prevention and careful management of patients with chronic diseases.

If patients show they like this new system, we could see a fundamental change in the American healthcare system.

References

1. Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations. Office of the Federal Register. Accessed 2011 Oct 25.
2. Numerof, R. Why Accountable Care Organizations Won’t Deliver Better Health Care—and Market Innovation Will. The Heritage Foundation. 2011 Apr 18.
3. Feder J and Cutler D. Achieving Accountable and Affordable CareKey Health Policy Choices to Move the Health Care System Forward. Center for American Progress. 2010 Dec.