Sometimes ideas for academic research can come from the unlikeliest of places. Like out of your earbuds.
Hilal Atasoy, assistant professor in the Department of Accounting at the Fox School, was hardly expecting to discover a subject that would lead to years of study while listening to a podcast, but that is exactly what happened.
“I was listening to a story about a cancer patient,” says Atasoy. In addition to being physically and emotionally difficult, having cancer can be costly. The patient explained that during her treatment she had moved and had to change hospitals and doctors several times because of her relocation and other reasons.
“She was saying how difficult it was to keep transferring her tests, results, procedures, and other records. She had to go through this ordeal again and again,” recalls Atasoy. Finally, the patient landed at a hospital with a good electronic health records (EHR) system, and she didn’t need to go to any extra trouble or expense anymore.
That got Atasoy thinking. Since the HITECH Act of 2009 made the migration of patient information from paper files to electronic health records mandatory, many studies have investigated whether this shift actually benefits hospitals, as electronic health records systems are costly to implement.
The results of previous research, particularly around healthcare costs, have been inconclusive. Studies point to the likelihood that costs actually go up—not down—as electronic health records systems are put into practice, at least for the individual hospital in question. But Atasoy’s research looks beyond the adopting hospital to the region surrounding it. “The question we’re asking in the study is whether the impacts of the electronic health records go beyond the adopting hospital.”
It’s common for someone to have a dermatologist at one hospital, get a mammogram at a different hospital, and see a primary care doctor affiliated with a yet a third institution, especially if that person lives in a city. When you factor in the costs at not only the individual hospital that adopted EHRs but also the costs at surrounding hospitals where there are shared patients, Atasoy has found that there is a marked cost-saving benefit after all. Estimates suggest that if one hospital in each area adopts an EHR system, it would add up to a net reduction of $18 billion in healthcare costs nationwide.
To conduct her research, Atasoy relied on several data sets. “We tracked information about the adoption of electronic health records systems at almost all the hospitals in the U.S. from 1998 to 2012,” she says. She also used Medicare data, census data, and HIMSS data (a dataset that comprises information about EHR use across the country). Atasoy and her team used statistical analysis software to interpret the numbers and come to their conclusions about the costs and benefits of EHR beyond the walls of any one hospital. Her research was published last year in the journal Management Science.
Atasoy notes that implications for her research extend beyond the healthcare sector. “It shows the importance of connections across different organizations. Businesses might be connected, for example, through shared customers,” she says. “Obviously, the firms are focused on their customers and their purchases and all the information they have on their customers right within their business, but there are many organizations that share customers or share suppliers. They have these connections.”
Her work on hospital-level data led into her current research, which focuses on patient-level data and seeks to identify the cost and quality of care benefits that could come with the widespread sharing of EHR between health institutions. “We’ve learned that only 20 percent of doctors use electronic health records, and what we’ve seen suggests that there are significant benefits to patients when doctors do use them,” says Atasoy. This seems to be especially true for patients living with chronic conditions such as cancer, diabetes, or heart disease.
Atasoy hopes her research will help spark a discussion about the value of hassle-free information reciprocity at hospitals, something that, on a policy level, she believes needs to be incentivized. Just as she began to look at the bigger picture, viewing hospitals regionally as a group and not individually, viewing a patient’s multi-year health journey and not just a single procedure, she hopes hospital administrators will zoom out, too.
“One big problem with healthcare in the United States is that it’s very fragmented,” says Atasoy. Her work reveals that a hospital isn’t an island and that the free flow of information will ultimately benefit everyone’s bottom line.
This story was originally published in On the Verge, the Fox School’s flagship research magazine. For more stories, visit www.fox.temple.edu/ontheverge.
Victor H. Gutierrez-Velez never expected his work to lead him to the topic of public health. His expertise lies in remote sensing science, analyzing data such as satellite images. “Every day, numerous satellite images are taken,” says Gutierrez-Velez. And the information drawn from these images has both academic and commercial applications.
For example, satellite images can help prescribe management, fertilization, irrigation, and other activities in precision agriculture, according to Gutierrez-Velez. They can help the insurance industry assess risks related to flooding or other natural disasters, or to verify crop insurance complains. Satellite imagery can allow energy companies to pinpoint the ideal location for solar panels. And this kind of data, it turns out, can even come in handy when it comes to fighting certain diseases.
To that end, partnering with colleagues with expertise in biology and public health, Gutierrez-Velez, assistant professor in the College of Liberal Arts, has recently been drawn to an unlikely research subject: mosquitoes. Specifically, the tiger mosquito (scientific name: aedes albopictus). What’s so interesting about this tiny, blood-sucking bug?
“It’s worrisome. They can spread the Zika virus and other dangerous diseases,” says Gutierrez-Velez.
In 2016 when the Zika pandemic caught his interest, mosquitoes dominated the headlines. Once thought to be limited to tropical and subtropical regions, the tiger mosquito had expanded its territory into most continents. Climate change plays a role, but these mosquitoes are also particularly aggressive. They’re among the 100 most invasive species in the world. In the 1980s, they were first spotted in the U.S. in Texas. Today, they reach as far north as Connecticut. Their presence in Pennsylvania remains an ongoing public health concern.
For his project, a recipient of the Office for the Vice President of Research‘s Targeted Grant Program and supported by the Data Science Institute housed at the Fox School, Gutierrez-Velez decided to look at multiple datasets, including climate data, information gathered from sampling for the presence of the tiger mosquito, land cover data, and census information. Gutierrez-Velez believes that with these and other datasets as inputs, machine learning and advanced algorithms can be used to predict the locations of tiger mosquito populations in advance of the season.
One of the most interesting possible findings of this research is that the tiger mosquito is less of a rural dweller than previously thought. “What we’re finding contradicts conventional wisdom about where these mosquitoes live. They are becoming domesticated animals. They prefer to be where lots of humans are living closely together—in cities. Because they love our blood,” says Gutierrez-Velez.
Scientific curiosity led Gutierrez-Velez to census data, which is not necessarily an obvious source of information to predict the presence or absence of a small flying bug. “If they feed on humans, human behavior should have something to do with it,” he says. And it does seem like including this data makes for a more accurate prediction about where the mosquitoes will go next.
Gutierrez-Velez’s ultimate goal for the project is to perfect a reliable working model that can be used to predict the upcoming mosquito season. Knowing that a particularly bad mosquito season is about to start will give officials the opportunity to plan in advance.
For example, the most affected areas can be targeted for treatment before the problem becomes unmanageable. Residents could be strongly cautioned in advance of the season to deal with housing-related conditions, such as places that collect standing water, which act as mosquito breeding areas. In the event that mosquitoes are spreading Zika or another virus, these protections could even save lives.
“There’s a lot we can do if we have a model that can say, ‘Hey, it’s going to be a bad year for mosquitoes, get ready,’” says Gutierrez-Velez.
This story was originally published in On the Verge, the Fox School’s flagship research magazine. For more stories, visit www.fox.temple.edu/ontheverge.
It’s the moment every woman dreads: A routine breast self-examination during an otherwise relaxing shower ends in the panic-inducing discovery of a lump.
Often, what happens next is a long, harrowing journey through a combination of biopsies, surgery, chemotherapy, and radiation. While it’s true that, thanks to advancements in screening and treatment, more and more women survive breast cancer, it’s also true that 80 percent of breast cancer cases have already advanced to an invasive stage at the time of diagnosis.
Today, just 20 percent of breast cancers are identified at the earliest stage, when treatment is most effective and the five-year survivorship rate hovers near 100 percent.
Carlos Barrero, MD, and Oscar Perez-Leal, MD, assistant professors in the Pharmaceutical Sciences Department at Temple University’s School of Pharmacy, wants to change all that. “I believe we can invert those numbers so we’re discovering 80 percent of breast cancers at the very earliest stage,” he says.
The research Barrero and Perez-Leal are conducting may represent a major breakthrough in breast cancer screening. Their work could lead to a simple routine blood test that detects breast cancer sooner than ever before for more women. To do this, Barrero and Perez-Leal are working on identifying a set of biomarkers for breast cancer, a specific signature of early-stage breast cancer detectable in a blood sample.
Their work on this project received funding through the Office for the Vice President of Research’s Targeted Grant Program, and the team is currently in the process of securing additional funding from the National Institutes for Health, and the National Cancer Institute. Perez-Leal is also using the knowledge gleaned from his master’s degree from the Fox School’s Innovation Management & Entrepreneurship program to turn the idea into a feasible product.
Though mammograms are a recommended cancer screening for women age 40 and older, only 65 percent of women over 40 have had one in the past two years, according to the Centers for Disease Control.
“Many women avoid mammograms because they can be uncomfortable, and because of the hassle of needing to make a separate appointment. If screening for early-stage breast cancer became a part of routine blood work, more women would be screened regularly,” says Barrero. That would likely result in more early diagnoses, more effective treatment, and ultimately more long-term cancer survivors.
Through systems biology, advances in mass spectrometry technology that allow the detection of very low concentration of proteins and metabolites, and the availability of large public datasets from thousands of breast cancer tumors, Barrero and Perez-Leal can move this cutting-edge work forward. “Most research of this kind starts with analyzing the blood sample. We start by analyzing the data,” says Perez-Leal. It’s a fresh approach to a longstanding problem.
The researchers start by looking for specific proteins secreted by breast cancer tumor cells across many thousands of samples drawn from breast cancer tumors. The team is searching for a signature set of proteins that can be detected in very low amounts. A vast data set and formidable computing power are essential for finding the precise biomarkers that could, in five to 10 years, lead to the blood test. Recently upgraded mass spectrometry equipment at Temple’s School of Pharmacy allows him to carry out this innovative research.
The promise of this research extends even beyond the hopes of early detection into the possibility of new, more effective medicines to battle breast cancer. Going forward, biomarkers are likely to be an increasingly hot topic for those in the pharmaceutical industry, which represents a significant part of the U.S. economy. Biomarkers such as these are often used as a reference point in drug development; when the biomarkers diminish or disappear in blood tests, it’s evidence that the new drug is working.
Current treatments for breast cancer are effective, but they come with their own health risks and side effects, some of which lead to different health challenges years after patients have recovered from cancer. The identification of these biomarkers would also mean that, in addition to early intervention, a breast cancer patient could get a form of personalized medicine, which is another area of potential business growth for the pharmaceutical industry. For patients, that might mean fewer side effects and complications down the line.
“It’s rare to find a scientist with a business background,” says Perez-Leal. He praises the Innovation Management and Entrepreneurship program with helping him take an idea, establish a business plan, and pitch to investors. “The research community should continue to focus on finding solutions and products to real problems.”
Clearly, breast cancer is a real problem, as the most common cancer among women: one in eight will face a diagnosis in her lifetime. But if Barrero and Perez-Leal succeed, it will be a game-changing advance. Many more women will be diagnosed in cancer’s earliest stages, receive more personalized treatment, overcome the disease, and lead long and healthy lives.
This story was originally published in On the Verge, the Fox School’s flagship research magazine. For more stories, visit www.fox.temple.edu/ontheverge.
Americans are growing older—and their caretakers need to decide the best and most cost effective way to care for them.
Since 2011, nearly 77 million baby boomers have become eligible for Medicare. For the elderly and those suffering from chronic diseases, home healthcare (HHC) is a convenient and cost-effective solution that avoids the necessity of receiving care through hospitals and nursing homes.
HHC meets an important demand in the healthcare system. Experts have found that close to 90 percent of Americans wish to spend their final time at home. But how does the care HHC providers deliver compare to that of larger health institutions?
Last year, In collaboration with investigators at the University of California at Irvine, Dr. Jacqueline Zinn, professor in the Fox School’s Department of Risk, Insurance and Healthcare Management, has received a five-year grant from the National Institute of Health to investigate the cost effectiveness and quality of care provided by home healthcare agencies.
Over the last decade, the home healthcare field has seen dramatic increases in patients, care providers, and spending. The New York Times reported that individual states spend close to $200 billion of their own funds on Medicaid, making it the second biggest item within their budgets.
As projections continue to rise and healthcare technology advances, patients should be aware of their care options.
“What we don’t know is whether or not the technologies that lead to additional growth impact the quality of care delivered,” said Zinn. “In other words, do larger facilities have better quality associated with growth? What is the optimal [home healthcare] agency size with respect to cost and quality? These are the questions we hope to answer.”
Home healthcare not only includes rehabilitative care after surgery, but hospice care and palliative care, which is dedicated to relieving people’s physical and emotional symptoms after facing life-threatening illnesses.
“Healthcare is on track to become 20 percent of the GDP,” said Zinn. “That means one in every five dollars generated by the U.S. economy will be in the healthcare sector.”
Alongside her fellow researchers at the UC Irvine, Zinn aims to discover valuable insights for patients, government, and health institutions, and home healthcare agencies alike by learning more about this under-researched field.
Are you interested in the intersection of healthcare and business education? Read our article, “Why More Surgeons and Health Professionals Are Pursuing MBAs” and learn more about Fox School Research.
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Combatting Abuse in Digital Medical Records
October 16, 2017 //
Healthcare in this United States is a lightning rod for debate. As Congress grapples with the future of the Affordable Care Act, the American people face uncertainty in medical care and costs.
To improve the efficiency, quality, and cost-effectiveness for patient care, hospitals have increasingly turned digital, using Electronic Medical Record (EMR) systems to store and share patient’s medical history. However, as the use of EMR systems increased, so did reported healthcare costs.
Since the adoption of the physician coding systems used to store and update EMRs in 2009, Medicare has experienced an estimated $380 million increase in reimbursements per year. Medicare accused hospitals of “upcoding,” or illegally overstating patients’ diagnoses and treatment, in an effort to receive a higher reimbursement. A 2012 study showed that hospitals in Utica, NY, and Nashville, TN, increased its patient reimbursement claims by 43% and 82% respectively after adopting EMR systems.
In response to this drastic surge in reimbursements, the Centers for Medicare and Medicaid Services conducted a pilot program, the Recovery Audit Program, from 2004 to 2010. Researchers at the Fox School partnered with researchers at McGill University to study how this audit program has been able to reduce illegal Medicare reimbursement claims, thus lessening the financial burden on American taxpayers.
The initial goal of implementing EMRs was to lower costs by reducing medical errors, over-testing, and re-admissions. But the findings of Dr. Kartik K. Ganju of McGill and Drs. Hilal Atasoy and Paul Pavlou of Temple University, confirmed that the adoption of the coding system is associated with an increase in Medicare reimbursements, particularly in the case of for-profit hospitals.
The research found an average of $217,745 in inflated reimbursements to Medicare per hospital per year, and even higher costs (nearly $370,000 in overages) at for-profit hospitals. After finding $693 million in overpayments by Medicare in six pilot states, the audit program was adopted nationwide in 2010.
The researchers looked into this “trillion-dollar conundrum” and found that the audit program successfully combated upcoding by using default templates and by identifying and removing cloned records of old patient that were erroneously copied into a new patient’s medical chart. After the audit became nationwide, the study found that it had corrected up to $2 billion in incorrect claims; yet for-profit hospitals were still reporting high reimbursement fees than their nonprofit counterparts.
The bottom line? While EMRs have enhanced coordination and information sharing, they also make it easier to report expensive and potentially inappropriate healthcare expenses.
As the first successful evaluation of the Recovery Audit Program, the researchers praise the work that has been done, but warn that stronger oversight by the government is still needed to combat ever-increasing costs, especially at for-profit hospitals.
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RMI student wins AAMGA white-paper research contest
September 13, 2016 //
Molly Belmont, a Risk Management and Insurance student from Temple University’s Fox School of Business, has been selected as the winner of the 2016 American Association of Managing General Agents (AAMGA) Student White Paper Research Contest.
A junior, Belmont won the AAMGA competition’s Technology and Wholesaler category for her paper, “Internet of Things Insurance, Opportunities, and Threats.”
In her paper, Belmont focused on three distinct areas – the connected home, the connected car, and the connected self – and discussed benefits and potential flaws in the collection of data through the Internet of Things IoT.
“While these devices can help insurance companies price better premiums and lower risk, and can also better educate the consumer and help them identify exactly what they’re paying for, there is a cyber risk involved with these devices that most companies didn’t necessarily consider,” said Belmont, a native of Malvern, Pa. “These systems can be hacked and create unforeseen dangers.”
Belmont said the paper was the culmination of more than one month’s work, during which time she utilized more than 20 sources. She said it was the first writing competition in which she’s taken the top prize. Belmont credited Fox School Assistant Professor Storm Wilkins with the encouragement to enter the competition.
For her winning entry, Belmont will receive a scholarship totaling $1,000; an all-expenses-paid trip and registration for the 90th AAMGA Annual Meeting, to be held May 22-25 at the JW Marriott Desert Ridge Resort in Scottsdale, Ariz.; an opportunity to shadow an AAMGA member during his or her meetings at the conference; and publication of her paper in the May issue of Wholesale Insurance News magazine, which is distributed to more than 1.4 million insurance professionals in more than 40 countries globally.
“I’ve been looking into the schedule of events and the networking opportunities available at the conference,” said Belmont, who this summer will serve as a benefits intern in the Philadelphia office of Arthur J. Gallagher & Co. “I wasn’t expecting to win, so it’s a big thrill.”
Read about the 2015 research contest winner, Hayley Leather.
Study: Investments in Commercial Operations Can Improve Pharmaceutical Business Performance
June 4, 2014 //
Pharmaceutical companies would improve sales revenue by investing in commercial operations that promote business innovation, employee engagement, organization alignment, and ensure a reasonable ratio between district sales managers and frontline sales representatives, according to Fox School of Business research.
The study was commissioned by TGaS Advisors, a benchmarking and advisory services firm, and division of KnowledgePoint360®, a global leader in communications, information and workflow services to healthcare professionals and the pharmaceutical and biotechnology industries.
“We focused on factors likely to impact pharmaceutical sales because data for this area are more robust, but the value of investments in sales operations should be read as a proxy for a broad range of commercial operation functions,” said George Chressanthis, the professor of healthcare management and marketing at the Fox School of Business who led the study team with Eric Eisenstein, assistant professor of marketing, and Fox PhD student Patrick Barbro.
According to Chressanthis, this is the first such independent research study on the effects of qualitative versus quantitative measures of commercial operation functions on business performance. Internally reported data from 26 pharmaceutical companies were analyzed for the period 2005-2011 and was complemented with qualitative survey data on commercial operations’ cultural attributes assessed by strategic account executives at TGaS Advisors.
The research team was given complete access to their database, with all analyses, findings, and recommendations independently developed of TGaS Advisors. All company specific data elements and names in the research were kept confidential, in keeping with contractual obligations, but did not affect the course the analysis.
The research showed that three factors within a company’s commercial operations organization are particularly important in determining U.S. business performance:
- Commercial operations’ cultural attributes, specifically innovativeness and responsiveness, which drive employee engagement and organizational alignment, are critical. These attributes are most powerful in affecting sales when working synergistically and in concert with quantitative investments in commercial operations support.
- Company scale and spending to support sales professionals that allow for more products to sell and leverage specialized commercial operations functional support for sales representatives to be more effective in their role.
- The number of sales representatives whom district sales managers supervise has a direct bearing on their ability to provide necessary levels of sales force effectiveness activities such as coaching, mentoring, on-the-job training, and managerial support to representatives, which in turn has a quantifiable impact on business performance.
The findings suggest that executives can significantly improve commercial performance by investing resources to:
- Create stronger alignment between functions and foster a culture of commercial innovation, organizational alignment, agility, and urgency. Quantitative investments in commercial operations will yield sub-optimal returns without the right structure of cultural attributes to support these business activities.
- Support improvements in sales professionals (i.e., through information, systems, business processes, training, etc.).
- Ensure an optimal number of sales representatives reporting to each first-line sales manager.
The Fox School research team has presented study findings at the following conferences: Pharmaceutical Management Science Association Annual Conference in May 2013 (Bonita Springs, Fla.), International Health Economics Association 9th World Congress in July 2013 (Sydney, Australia), and the American Marketing Association Summer Marketing Educators’ Conference in August 2013 (Boston).
Further insights from the study can be found by reading, “What Aspects of Commercial Operations Impact Pharmaceutical Company Business Performance?” and TGaS Advisors’ “Reflections on a Research Study Conducted by the Temple University Fox School of Business,” both available at www.tgas.com.