Minnesota Physician cover stories

august 2017

Past cover stories

The value of Medicaid

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Opioid Prescribing Improvement Project

A safety net for children

 

By Kelly Wolfe

 

Imagine you’re pregnant and you unexpectedly go into premature labor, delivering your baby two months early. While you have health care coverage through your employer, you discover upon discharge from the hospital that your insurance won’t cover the 24-hour nursing care your baby will require, nor does it cover the equipment or medications your infant will need to survive. Thankfully, your child is eligible for Medicaid and you can now access these services.

 

Quality reporting

The importance of accounting for social conditions

 

By Paul Kleeberg, MD, and Phil Deering, BA

 

Like many Minnesota physicians, Dr. Lynne Ogawa first saw her Minnesota Statewide Quality Reporting and Measurement System (SQRMS) outcomes toward the end of the last decade. At the time, the family practice doctor saw patients at the Fremont Clinic, located in the heart of North Minneapolis.

 

Why just retire?

Consider physician emeritus

 

By Michael J. Weber, JD, and Nancy Lee Nelson, JD, MPH, RN

 

If you are like many other Minnesota-licensed physicians, you might be unaware of the option to retire as a “physician emeritus.” To retire as a physician emeritus, a physician has to complete a short application with the Minnesota Board of Medical Practice.

 

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives.

 

The Minnesota Adult Abuse Reporting Center

Protecting the vulnerable

 

By Commissioner Emily Piper, JD

 

An older adult woman living in northern Minnesota was at her most vulnerable—recovering from surgery after a stroke—when she became the victim of financial exploitation by her own daughter.

 

The CARES Model

A way to engage your patients

 

By Archelle Georgiou, MD

 

Sixty-two percent of Americans say they want to deliberate with their physician about their treatment options. And, to help make the right choices, consumers have been armed with an array of health information sites, symptom checkers, cost calculators, and provider quality scores and report cards.

 

Minnesota Prescription Monitoring Program

Important updates responding to an epidemic

 

By Barbara A. Carter

 

In a recent survey conducted by the American Medical Association, in which 44 of the 49 state prescription drug monitoring programs (PDMP/PMP) responded there was a 180 percent increase, between 2014 and 2016, in the number of physicians’ and other health care professionals that had registered for an account with a PDMP/PMP.

 

Regenerative Medicine:

Efficacy, Economics, and Evolution

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Recognizing Minnesota physician volunteers

Regenerative Medicine Minnesota

Transforming the future of health care

 

By Jakub Tolar, MD, PhD, and Andre Terzic, MD, PhD, FAHA

 

We have grown accustomed to the medical miracles—antibiotics to combat infection; transplantation to replace failed organs; and biologics to control high cholesterol, rheumatoid arthritis, or psoriasis—that have transformed patient care. Despite remarkable advances, many serious health problems resist conventional medicine and surgery, causing suffering and shortening lives. To address the growing unmet needs in an aging population, regenerative medicine brings together the next generation of technologies to provide hope for patients suffering from chronic lifelong diseases such as heart failure, cancer, or diabetes. Biomedical engineering, stem cell science, genome editing, and acellular repair have all contributed to achieving regenerative outcomes across degenerative disorders (e.g., multiple sclerosis, amyotrophic lateral sclerosis [ALS], Alzheimer’s disease), offered alternative solutions to address the lack of organ donors (affecting more than 100,000 Americans each year), or ameliorated prognosis in debilitating conditions aggravated by malfunctioning tissues (e.g., joint deterioration). In short, regenerative medicine offers a healthier, more functional future for millions of people who currently have no treatment options.

 

Operating rhythm

On May 16, 2014, the Minnesota State Legislature took a leap of faith into the future and funded a 10-year Minnesota Regenerative Medicine Act to promote “regenerative medicine research, clinical translation, and commercialization” across the state. The Legislature allotted $4.5 million to be awarded in the first year and $4.35 million each year thereafter. To fulfill the requirements of the bill, a Board was formed of five representatives who brought experience from private industry, regenerative medicine research, clinical translation, commercialization, and medical venture financing. As steward of this initiative, the Regenerative Medicine Minnesota (RMM) Board reviewed ongoing state initiatives—for example, the California Institute of Regenerative Medicine (CIRM), the largest regenerative medicine program in the U.S. The RMM Board also considered the State of Minnesota as a unique home for this endeavor. Minnesota has a remarkable history of medical innovation, biotechnology invention, and a population encompassing those who have access to the most advanced health care and those who are frequently underserved. Accordingly, RMM strives to improve the health of Minnesotans by promoting and advancing regenerative medicine research, education, industry, and delivery to patients. RMM proposed to fund the cutting-edge discoveries that underpin the development and dissemination of potentially life-saving products, while cultivating the build-out of the production pipeline and the education of patients and caregivers, so that once ready, regenerative medicine therapies can be distributed throughout the state.

 

On Nov. 6, 2014, RMM (originally known as Minnesota Regenerative Medicine), released a business plan. Shortly thereafter (on Nov. 14, 2014), requests for proposals for research grants; education grants; scholarships; patient care grants; biotechnology/biobusiness development grants; and a website development and maintenance contract were distributed statewide.

 

Science

Research is the largest part of the program, and 25 projects have been funded over the initial three years for a total investment of just under $9 million. Grants were awarded based on independent scores from experts in regenerative science from outside the state of Minnesota. In the first year, grants were divided by organ system. Thereafter, they were classified into research types: 1) discovery science, 2) translational research, and 3) clinical trials. Given that research projects require considerable infrastructure and multidisciplinary teams, it was not unexpected that the majority of proposals came from and were awarded to investigators at the University of Minnesota and Mayo Clinic. In an effort to balance the research portfolio with investigators from all stages of professional development, recent emphasis has been on early-career investigators. Of note, out-of-state reviewers have been consistently impressed both by the high quality of the proposals and the forethought of the Minnesota Legislature.

 

Business

The second largest part of the program centers on manufacturing and development and funds 22 projects with about $2.6 million. It supports development in Minnesota of the capacity to produce scalable and standardized regenerative therapies in accordance with Current Good Manufacturing Practices, so that qualified facilities exist to produce both cellular and non-cellular therapies for clinical use. Ensuring advanced manufacturing capabilities positions Minnesota at the forefront of the regenerative industry. This piece is critical to attracting new business to the state and creating new jobs, while expediting the production at scale of cost-effective, ready-to-use regenerative products. Enhancing the readiness of the state to serve as a hub for advancing regenerative enterprise is a stated priority in the years to come.

 

Education

The third largest focus of the program is education and outreach, funding 44 initiatives at just over $2 million. Initially, plans used funds to train and retain university students in regenerative medicine projects in Minnesota through a scholarship program and to fund education programs for students in grades 3 through 12. Once the request for proposals was released, it quickly became apparent that there was enormous interest and potential for education programs at all levels, so the competition was widened to expand the learner base.

 

The education programs have been a major success for RMM for several reasons. Teaching students about regenerative medicine and health care careers educates families, not just participants. Education programs have been the best vehicle to expand the reach of RMM throughout the state. Many teachers are used to working collaboratively, so they spontaneously began creating networks, pooling curricula, and sharing resources. After the first year, the programs were so successful that the Board felt that the most effective use of funds was to discontinue supporting individual students and to instead help develop programs that supported groups of students. We have had programs that train veterans for laboratory careers using an accelerated “bootcamp” approach. We helped to expand the successful Scrubs Camp program that prepares middle and high school students for careers in science and medicine. Several programs work with communities to build an interest in regenerative medicine through activities based in Native American culture. A number of additional programs work with medical students to specifically interest them in regenerative medicine research and/or practice. In the past year, the grade levels were changed to kindergarten and above, thereby including students at every level of education in the state. RMM also attended the annual Minnesota Education Association meeting and had an article in the Minnesota Science Teachers Association Newsletter to help spread the word about the availability of funds and support.

 

Adaptability

One of the key guiding principles behind the program has been to evolve in an iterative manner, learning from growing experience in the field and responding to state needs. The initial steps of RMM, along with experiences from others, have informed how best to adapt and enrich the program each year to maximize the impact on stakeholders. In this context, the Board’s vision has remained steadfast, yet the process and programs are nimble and under constant review to find ways to improve them and ensure early adoption of regenerative solutions that address patient needs.

 

Patients

For RMM, success of the program is measured in lives improved, so patient care delivery is key to overall success. Other markers of success—job creation, student engagement, and clinical trials—have touched lives, thereby further supporting the ultimate goal of the program of improving the health of all Minnesotans. As other subprograms gain momentum, RMM will increasingly focus on care delivery.

 

To foster this growth, it will be critical to partner with health care providers across the state who can identify and recruit patient populations that would benefit from clinically proven safe and effective regenerative therapies. Some examples of how patient care delivery funds could be used include: 1) developing the capacity of smaller clinics to participate in clinical trials (building out trial management, creating dedicated registries, and supporting multi-site analytics to ensure state-wide competitiveness); 2) providing equipment and infrastructure to increase access to inpatient and outpatient regenerative therapies; and 3) enhancing affordability of regenerative treatments through coordinated and sponsored patient-centric programs.

 

The future

There are undoubtedly many other ways to extend the reach of RMM. The program depends on input from medical professionals, scientists, paramedical staff, scholars, industry, government, and the community around the state to help identify them. Future directions include activating and expanding science-driven patient care delivery statewide; continuing to redesign and improve the website (www.regenmedmn.org), which is our primary communication and outreach tool; and reworking the biobusiness/biotechnology grant application and review process to amplify impact on state bioindustry. RMM will continue to champion this exciting future and develop its programs to match the interest in health care empowered by advances in medical science.

 

Jakub Tolar, MD, PhD, is the executive vice dean of the Medical School, director of the Stem Cell Institute, and a distinguished McKnight Professor of Pediatrics at the University of Minnesota. He is co-chair of the Regenerative Medicine Minnesota Board.

 

Andre Terzic, MD, PhD, FAHA, is the Michael S. and Mary Sue Shannon Director at the Mayo Clinic Center for Regenerative Medicine; the Marriott Family Professor in Cardiovascular Medicine; and the Marriott Family Director of Comprehensive Cardiac Regenerative Medicine at Mayo Clinic. He is professor of medicine and pharmacology; chair of the Discovery-Translation Advisory Board; and director of the National Institutes of Health “Cardiovasology” Program. He serves as co-chair of the Regenerative Medicine Minnesota Board.

Minnesota Physician Publishing Inc. © 2017