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Guest J.F.,Health Catalyst | Guest J.F.,University of Surrey | Watson H.G.,Royal Infirmary | Limaye S.,York Teaching Hospital NHS Foundation Trust
Clinical Therapeutics | Year: 2010

Background: Warfarin is the most commonly used oral anticoagulant in the United Kingdom. Indications for its long-term use include recurrent venous throm-bosis, prosthetic heart valves, stroke prevention in atrial fibrillation, valvular heart disease, and prosthetic heart valve replacement. Objective: The aim of this study was to estimate the cost-effectiveness of using prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for emergency warfarin reversal in patients with a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. Methods: Mortality estimates associated with managing an intracranial, gastrointestinal, or retroperitoneal hemorrhage were obtained from published studies after a systematic literature search. Estimates of health care resource use pertaining to managing warfarin-treated patients after a life-threatening hemorrhage were provided by 11 consultant physicians with experience in warfarin reversal. These published clinical outcomes and clinician-derived health care resource use estimates were used to construct a decision model depicting the treatment patterns and associated resource use attributable to current management of a hypothetical cohort of adults undergoing emergency warfarin reversal as a result of an intracranial, gastrointestinal, or retroperitoneal hemorrhage in the United Kingdom. The model only considered direct health care costs borne by the secondary care sector of the National Health Service, and not those borne in the community (with the exception of the cost of stroke rehabilitation) and estimated the cost effectiveness of using PCC compared with FFP to reverse the anticoagulant effects of warfarin, from the perspective of the National Health Service, at 2007-2008 prices. Results: The cost of warfarin reversal was estimated to be ≤15% of the total cost of managing a patient after a life-threatening intracranial, gastrointestinal, or retroperitoneal hemorrhage. The cost per life-year gained with PCC was estimated to range from £1000 to £2000, depending on hemorrhage type (ie, intracranial, gastrointestinal, or retroperitoneal). The cost per quality-adjusted life-year gained with PCC was estimated at £3000 or less depending on hemorrhage type. Conclusion: PCC appeared to be a more cost-effective treatment than FFP for the emergency reversal of warfarin, from the perspective of the UK National Health Service, in this model analysis. © 2010 Elsevier HS Journals, Inc.


Rosenthal E.L.,University of Texas at El Paso | Brownstein J.N.,Centers for Disease Control and Prevention | Rush C.H.,Community Resources | Hirsch G.R.,Office of Community Health Workers | And 4 more authors.
Health Affairs | Year: 2010

Community health workers are recognized in the Patient Protection and Affordable Care Act as important members of the health care workforce. The evidence shows that they can help improve health care access and outcomes; strengthen health care teams; and enhance quality of life for people in poor, underserved, and diverse communities. We trace how two states, Massachusetts and Minnesota, initiated comprehensive policies to foster far more utilization of community health workers and, in the case of Minnesota, to make their services reimbursable under Medicaid. We recommend that other states follow the lead of these states, further developing the workforce of community health workers, devising appropriate regulations and credentialing, and allowing the services of these workers to be reimbursed. ©2010 Project HOPE - The People-to-People Health Foundation, Inc.


Hodin R.M.,Health Catalyst
Generations | Year: 2013

As more than twenty states work to develop new demonstration projects aimed at better integrating care for people dually eligible for Medicare and Medicaid, the involvement of consumers and advocates in their design, implementation and oversight is critical to making the projects a success. In this article, the author discusses how consumers and advocates in several states have shaped the projects to date and offers recommendations for continuing to engage consumers over the course of the three-year demonstrations. Copyright © 2013 American Society on Aging; all rights reserved.


It’s snowing this time of year along the Wasatch Front, a patch of connected cities spreading from Ogden to Provo, that some in Utah refer to as the “Silicon Slopes.” But this part of the Rockies isn’t just turning out large amounts of fluffy, white stuff, it also seems to be producing a strong herd of unicorns, or startups worth at least $1 billion on paper. Four of these fabled creatures popped up along the Wasatch this last year, including Omniture founder Josh James’ business intelligence platform Domo. There’s also Pluralsight, Qualtrics and InsideSales – with several more “soonicorns” in the ready. Utah has seen the most economic growth in the nation for the past two years, with tech leading the charge. But many of these tech startups had to show profitable growth before venture capitalists would even give them the time of day. The community has a strong history in the tech industry – Utah is the birthplace of Omniture, WordPerfect and Landesk; Pixar co-founder Ed Catmul and Atari co-founder Nolan Bushnell both graduated from the University of Utah; several colleges and universities in the area churn out advanced engineering degrees in the hundreds every year; and Utah is fairly affordable and comes with a built-in well-educated workforce that likes to stay put – yet most of Utah’s startups launched without the ability to bring in venture funding. a culture of delayed gratification around building a business with strong fundamentals,” said Aaron Skonnard, CEO of Pluralsight, an educational technology company based in Farmington. His team went almost nine years without taking outside investment. “M Because of this, Utah has “ost businesses in Silicon Valley wouldn’t have had the patience to do what we did.” The lack of capital availability forced these businesses to have a greater focus on their business fundamentals on day one.  “All of us had the discipline of how to run a company profitability,” said Dave Elkington, CEO of Provo-based InsideSales.com. But at this point, the region has no trouble attracting venture capital. Sequoia convinced Qualtrics founder Ryan Smith to take $70 million in Series A funding a few years ago. It has since pulled in $220 million in venture capital and is now worth just over $1 billion. Smith and Skonnard agree on several points, including the discipline these startups needed early to become profitable first. “There are four or five founders that are sitting on businesses that have a long runway because they were disciplined early on,” Smith said. But Smith also thinks these Utah tech companies are seeing success after sticking with it for a long time. “If all the [Utah] unicorns sell out then it will just continue to be what it’s been, Smith told TechCrunch. “WordPerfect could have been the game changer but they sold in 1992. What if they never sold?” Many of the state’s nascent unicorns have been at it for well over a decade before reaching the valuations we see at present – much longer than Snapchat or Pinterest. Data obtained by TechCrunch from the National Venture Capital Association shows that nearly $700 million was invested in the region in the first three quarters of this year. And those venture investors who have bet on Utah tech are likely to see some significant returns. Educational technology company Instructure went public last month and Domo, Pluralsight and InsideSales.com are all getting close. It’s likely that there will be several tech IPOs coming out of Utah in 2016. “I’ve seen incredible growth in the ecosystem in Utah,” said  Josh Coates, CEO of Instructure. There are “half a dozen really exciting technology companies in Utah right now that are getting ready to access public markets.” Smith tells us Qualtrics is also gearing up to go public in the next year or so. “The signs are all there. We’re already acting like a public company anyway,” he told TechCrunch. And there are still more startups flying under the radar but possibly worth looking into. Entrata, a property management software solutions business, might not be as seemingly sexy as an Airbnb or Uber, but the company has a $100 million revenue run rate with zero VC backing – it’s entirely bootstrapped. Others such as Health Catalyst, a Utah startup attempting to bring paper health records into the digital era, is getting closer to unicorn status this year with a half a billion dollar valuation at the moment. Much of the $165 million raised so far comes from a mix of Utah and outside venture capital – including from Sorenson Capital, the largest venture capital firm in the state with more than $1 billion in its coffers. Much of Utah’s successes also happen to be from enterprise – an industry that has a much harder time getting attention from media and thus investors unless it turns a considerable profit or gains a high valuation. “You don’t get the Snapchat type growth or the Amazon type growth [with enterprise]. You just don’t,” Smith said. “But once some of our investors see one company in Utah they love to jump into another.” Venture capital firm Accel has poured $70 million into Qualtrics so far. Accel has also invested in the Utah-based flash memory company Fusion-io. “Almost every major Silicon Valley investor has now seen what’s happening [in Utah],” added Elkington. Because in Utah, said Skonnard, “our startup culture rewards companies that are built to last.”


News Article | May 8, 2015
Site: techcrunch.com

Editor’s note: Promod Haque serves as senior managing partner at Norwest Venture Partners, focusing on systems and IT infrastructure, healthcare IT, software and services. As technology permeates nearly every aspect of our lives, it has become an increasingly political topic. On one hand, Washington and Silicon Valley have seemingly never been closer with recent visits to the Valley by President Obama, new cybersecurity legislation, news at RSA that the Department of Homeland Security plans to open an office in the Valley, as well as the surge of Silicon Valley veteran hires in Washington. On the other hand, the two power centers continue to tangle on basic approaches to fostering innovation. This conflict was clearly illustrated when Yahoo, Google and Facebook chose not to send their CEOs to the security summit Obama hosted at Stanford University earlier this year. But despite the hurdles, the stage is set for a historic opportunity in which effective policy and regulations can be enacted without hindering technology market innovation. It will take the concerted effort of both players to make it happen, but a simple collaborative approach can get it started. The cybersecurity and healthcare technology sectors are frequent battlegrounds for policy makers and technologists. Cybersecurity has quickly become a focal point for government and policy discussions within the United States, and was recently labeled a national emergency by the President. And for good reason: constant infrastructure probing, the attack on Sony and even attacks against the White House are suspected to be nation-state driven. But even with the cybersecurity’s new, elevated stature, both officials from government agencies and Silicon Valley businesses are voicing their opinions on information sharing and encryption from opposing sides. The rift is evident in the language found in the proposed amendments to the Computer Fraud and Abuse Act (CFAA), which could put many white hat security researchers and their methodology under legal scrutiny if approved. It’s the equivalent of taking the scalpel from the surgeon and asking them to conduct an operation. Already, security researchers are concerned about the legal implications. In healthcare, regulatory policies and technology advancements are also increasingly at cross-purposes. This is particularly concerning as initiatives like Obamacare pick up traction and our healthcare IT infrastructure, powered by companies like Health Fidelity and Health Catalyst, catch up to the rate of innovation. There needs to be careful consideration for how and when regulations come into play. Recently, the FDA decided not to regulate technologies that transmit, store or display information from healthcare devices; and it did the same for mobile medical applications. In some cases, this decision makes perfect sense; however, there is a subset of devices in which smart regulation is needed. Think about how the FDA regulates prescription medications that have a direct impact on health but keeps its hands off multi-vitamins and supplements. In the same vein, devices like Telcare that affect key aspect of health like regulating blood glucose levels should be guided by policy, but  ‘wellness’ apps that track fitness activities should not be subject to regulation. It’s about laying down the right rules with the right advice instead of taking a hands-off approach that could actually muddy the waters of progress. To close the gap between the Valley and Washington, an effective method of collaboration needs to be leveraged in a joint venture that aims to make policies and adhering to them a seamless and pain-free experience. It can start with something as simple as having tech meetups in Washington, where tech professionals can communicate their needs and concerns on relevant legislation affecting their particular fields. And on the other end, technology companies could do something as easy as adding more people with policy backgrounds and governmental understanding as consultants to ensure the governmental mentality is not entirely forgotten. To illustrate, in the case for cybersecurity, many policy makers want more privacy protection, businesses think there is enough because it still allows them to collect enough customer data to optimize user experiences, and researchers think they’re being hobbled with legislation that criminalizes their daily jobs. No one is pleased, putting a wrench in the policy-making process. But perhaps with the input of researchers and other technology experts, the government could be better aware of what’s going on in the space and change how it forms and implements its policy in order to produce the optimal decisions. It’s the same in the case of healthcare technology. Adding regulation would weed out the imitators from the tech businesses that are actually delivering actionable results, but it should not be overbearing. Washington and Federal agencies need to become better aware of what products need to be certified and regulated, versus those that simply deliver a cool “wellness” experience for the user. In short, there needs to be better communication and understanding between the White House and Silicon Valley. There are already signs of this mentality, as exemplified by tech meetups at the White House and Obama’s string of Silicon Valley hires for new administrative roles like chief data scientist, chief digital officer, and director of IT. But it’s time we really rethink our approach and ensure that the technology market has the opportunity to innovate and grow.

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