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Bailey Amber

Vial and syringe with a vaccine

Clover Biopharmaceuticals, a clinical-stage firm developing a Covid-19 vaccine with potential manufacturing and distribution advantages over other vaccine technologies, has raised $230 million as it prepares to advance its lead candidate into pivotal testing.

Chengdu, China-based Clover said Tuesday that it expects to start a global Phase 2/3 clinical trial for its vaccine candidate, SCB-2019, in the first half of this year. The company added that it has already started planning for the production of potentially hundreds of millions of vaccine doses.

The Clover Covid-19 vaccine is protein-based. SARS-CoV-2, the virus that causes Covid-19 infection, is an enveloped RNA virus—the outer coating is dotted with spike proteins that bind to a receptor on the host cell. These spikes are trimeric, meaning they’re formed by three proteins.

Using its Trimer-Tag technology, Clover developed a trimeric spike protein that resembles the one found on the outer envelope of the novel coronavirus. The vaccine uses an adjuvant, an ingredient that boosts immune response, supplied by Dynavax Technologies.

As a protein-based vaccine similar to many of the vaccines developed for influenza, shingles, and hepatitis B, Clover said production can use manufacturing processes that are already well established. The company added that this production can be rapidly scaled up to large quantities.

Another advantage of the Clover vaccines are the temperature requirements. The company said its vaccines and adjuvant should be stable for long periods at refrigerator temperatures of 2 to 8 degrees Celsius. At room temperature, Clover has said its vaccines are stable for at least two months. Those temperature and storage requirements stand in contrast to messenger RNA vaccines, which must be distributed frozen and stored at temperatures well below what medical-grade freezers can achieve. Last week, Pfizer and BioNTech asked the FDA to approve a change in the storage temperatures permitted once vaccines reach a vaccination site.

The new financing follows publication in The Lancet earlier this month of peer-reviewed results from an early-stage test of two Clover Covid-19 vaccine candidates. The 150-patient study showed that the vaccines were well tolerated and safe. Both vaccines also induced neutralizing antibodies at levels comparable to or higher than those found in the blood of those who have recovered from Covid-19.

Clover said that its research includes vaccines that could address multiple variants of the novel coronavirus. In addition to supporting its Covid-19 vaccines, Clover said the new capital will support plans to advance multiple programs into human testing later this year. Other vaccines in the Clover pipeline include programs for rabies and influenza. The company also said it plans to expand its manufacturing and capabilities.

GL Ventures and Temasek both led the Series C financing. Oceeanpine Capital, OrbiMed, and Delos Capital also invested. Clover said it has raised more than $400 million in the past year.

Clover also has financial support from the Coalition for Epidemic Preparedness Innovations (CEPI), which has committed to finance development of the company’s Covid-19 vaccine candidate up through licensure with a total investment of $328 million. Some of that cash will fund the global Phase 2/3 study. If the Clover vaccine is shown to be safe and effective, it would be distributed through Covid-19 Vaccines Global Access, or COVAX, the World Health Organization’s initiative to ensure equitable vaccine access throughout the world.

Public domain photo by Flickr user Alachua County

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As 2021 dawned and vaccine distribution has picked up, many people had one overarching question on their minds: how and when will they get vaccinated.

At the same time, providers have had to grapple with another question:  how to best approach for this historic, monumental task.

For Stamford Health in Connecticut, the way forward was clear: Leverage existing partnerships with the city of Stamford, community organizations and the state to distribute the much-anticipated vaccines.

The health system has been sharing data and information with the city of Stamford throughout the pandemic, including positivity rates, hospitalizations and other key metrics, said Kathleen Silard, CEO of Stamford Health, in a phone interview. Stamford Health and the city worked collaboratively to set up testing sites, and in the last few months, they also worked together to set up vaccination sites — including one at an old hospital on Stamford Health’s campus.

“The collaboration [with the city] really is to pool our resources, because we know, together we are better,” Silard said.

The health system began vaccinating healthcare workers, first responders and other eligible essential workers on Dec. 17, when the state was in Phase 1a of its vaccine rollout. Back on Jan. 18, it began vaccinating people older than 75 and recently added those older than 65 to the list, as part of Phase 1b of the rollout.

So far, the health system has administered around 27,000 vaccines, and is averaging between 750 and 930 doses a day, Silard said. But Stamford Health has ambitious plans to increase this number three-fold.

The health system is planning to open a new, much larger, site around March 1, which will enable the provider to administer up to 3,000 doses a day, she said.

But getting shots in people’s arms is not without its challenges.

Vaccine availability has been one of the biggest hurdles the health system has faced, but working closely with Connecticut Gov. Ned Lamont and his team has helped the system get the doses and resources it needs, Silard said.

Aside from uncertainty with vaccine availability that has since receded into the background, Stamford Health is tackling a more intractable problem: vaccine hesitancy and health inequity. Both present a formidable barrier to its 3,000-a-day vaccination goal.

To help combat vaccine hesitancy, Stamford Health is conducting outreach programs, including setting up panels with people who have already received the vaccine to talk about their experience, Silard said. The system is also participating in Stamford Mayor David Martin’s weekly Zoom calls to further educate the public on the vaccine.

The Covid-19 pandemic shone a harsh light on existing health disparities in the country, with people in minority racial groups and low-income populations most likely to get the disease and die from it.

Stamford Health has put together a task force, which includes health system members, city officials and members of community health organization Vita, to ensure that vaccines are being administered in an equitable manner, said Silard.

In addition, the health system is partnering closely with the National Association for the Advancement of Colored People and Building One Community, an organization that works with the undocumented community, to focus vaccine administration efforts on underserved populations.

Building One Community has developed a great deal of trust with a population that is typically hesitant to use healthcare services, said Dr. Anka Badurina, executive director of the organization, in a phone interview.

Through the pandemic, the organization has been working to ensure immigrant and underserved communities are included in response efforts — from testing to, now, vaccination.

One of its main areas of focus has been helping the elderly in these communities get registered for vaccine appointments, Badurina said. Those currently eligible often don’t have access to the internet or an email address, which is typically required for registration. Building One Community, which has interpreters on hand, helps them with the process.

Further, the organization helps organize transport to vaccination sites.

“Stamford Health partners with organizations like Building One Community [because] you have to go to those that have a trusted voice in the community,” Badurina said. “They are the ones that know where the community is and know exactly what the community is lacking.”

With the help of its community partners Stamford Health has established a “No Barriers” day, where members from minority groups and under-resourced communities can come to a vaccination site without an appointment, get registered and get vaccinated, Silard said. No individuals are asked about their immigration status or other questions that might keep people from coming to get vaccinated.

Stamford Health wants to eliminate any traditional barriers to vaccination to ensure that the largest swath of eligible individuals can get vaccinated, Silard said.

“We see [vaccine administration] as our moral, ethical responsibility to help fight this deadly disease,” she said.

Photo: LarisaBozhikova, Getty Images

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The Covid-19 pandemic has affected every sector of our society and requires coordinating a broad coalition of assets to contain it. The response includes multiple federal and state government agencies, thousands of hospitals, and a broad swath of commercial manufacturing capabilities and supply chains. We saw this coordination and collaboration early on with personal protective equipment and ventilators, and we see it again as we ramp up vaccine distribution.

To coordinate an effective response, it is critical to integrate disparate data types from multiple domains and sources, something that has been a long-standing challenge in health care. Obstacles include government agency budget structures that don’t incentivize data sharing and legacy databases that create barriers to data integration. The commercial sector also brings the challenges of competition and proprietary systems. Even seemingly simple questions, such as how many ICU beds are available in a community, are maddeningly difficult to answer in near real time. While well-branded and user-friendly websites provide impressive updates on case counts, emergency operation centers have found it challenging to integrate that data with bed availability, hospitalization projections, work force data, supply chain data, mitigation interventions, social determinants of health, and other key data elements that allow for effective planning and response.

In addition to the public health challenges, new care delivery models have underscored the need to better integrate data to deliver care for chronic diseases. The pandemic has accelerated the adoption and use of telehealth. But again, tools, sensors, apps, and devices are often deployed on disparate data platforms that make it cumbersome for patients and providers to integrate data in a meaningful fashion.

The pandemic illustrates the need for better data integration to improve management of this crises as it continues to impede the everyday care of patients.

Lessons learned from defense and intelligence communities
The health industry lags behind other commercial sectors in its adoption of data management and open-source innovations. The health community can learn a great deal about data management from defense and intelligence agencies, which must integrate vast amounts of data from disparate systems to create a common operating picture to support life and death decisions for warfighters.

The 9/11 attacks demonstrated that data gaps can be deadly. The 9/11 Commission Report revealed that information that could have prevented this tragedy was scattered across several different intelligence agencies’ databases. Following the Commission’s critique, the intelligence agencies adopted low schema data “lakes” that could accommodate multiple “streams and rivers” of disparate data and allow for easier integration. Think of these data systems as giant spreadsheets, with each cell containing an entry item. With automated meta-tagging, each cell of information can be correlated with any other item of data to reveal patterns that would otherwise have gone undetected. These data platforms also enabled the accumulation of massive data stores that optimize advanced analytics and artificial intelligence. Intelligence agencies also benefited from security protections at the individual cell level that enhanced data security, an important feature to consider as health information increasingly comes under cyberattack.

The intelligence community also embraced open source tools and open architectures for these data systems. Open source allows the rapid development of new tools at lower cost. Open architectures avoid costly and stagnating vendor lock, and it enables the adoption of new best-in-class tools and capabilities as they are often developed by small niche firms and start-ups

While novel 15 years ago, many of these innovations have been avidly adopted in the commercial sector. However, the same cannot be said for the health domain. That said, there are notable exceptions that are bright spots on the health care landscape.

Advana: Uniting disparate systems and users on a common platform
Advana, a Department of Defense (DoD) data platform, pulls together more than 200 business systems across the DoD and makes data discoverable, understandable, accessible, and usable for advanced analytics for more than 17,000 users across the Army, Navy, and Air Force who need to make decisions about mission readiness, contracts, supply chain logistics and more. The platform has helped the DoD coordinate its Covid-19 response by enabling the easy integration of a wide range of data, including case, bed, supply chain, readiness, and financial data, to inform critical health care decisions. The open architecture platform supports multiple projection models and analytic tools, which allows the DoD to validate findings in a way that would not have been feasible with a single approach.

Advana faced many of the data integration obstacles familiar to health care IT leaders: non-standard interfaces, duplicate data and systems, legacy technologies, and a history of different units pulling their own data for decision making. To integrate disparate data from spreadsheets, application programming interface (APIs), database dumps, and data warehouses from across the enterprise, Advana streams data feeds, automatically categorizing, tagging, and transforming them into a common data model to improve enterprise level analytics.

Preparing for the next health crisis
The value of big data in health care is clear but unless we can integrate and correlate disparate types of data, we can’t realize the benefits. The data challenges of the Covid-19 response illustrate this issue. The seams between government agencies, health systems, and departments within the same organization create chronic barriers to data sharing. Few organizations manage more data than the defense and intelligence agencies, and as with health care, their decisions often have life and death consequences. For critical decisions, they have developed effective strategies to create a common operating picture through robust data integration. As we continue to respond to this pandemic and prepare for the next crisis, the health care community should learn from these mission critical organizations.

Editor’s Note – The author is a Department of Defense consultant.

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COVID-19 has interrupted vital supply chains, driving up the costs of materials and forcing developers to build and sell more cautiously

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Paul Fitzpatrick, broker of record at Home Group Realty Inc., has noticed a change in the types of buyers making inquiries at his Guelph, Ontario–based offices. A lot more of them are coming from the Toronto area, and many are interested in a very particular type of product: a newly built detached home.

“Two years ago, they would not have considered moving this kind of distance from the GTA,” Fitzpatrick says, referring to the Greater Toronto Area. But now, with interest rates near record lows and work-from-home arrangements more available than ever before, something has shifted. Fitzpatrick says his volume of inquiries from buyers based in the region has doubled during the pandemic.

A new intensity of consumer desire for single-family homes, stimulated by forces unleashed by the COVID-19 pandemic, has put the low-rise home development industry in something of a double bind: it’s being flooded with buyers at a time when developers are especially ill-equipped to meet increased demand.

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That’s because the COVID-19 pandemic has interrupted vital supply chains, driving up the costs of materials and forcing some low-rise developers to build and sell more cautiously than they have in the past.

“We’re not selling as many presale homes as we normally might, because we have no guarantees on material supply,” says Sue Wastell, president of Wastell Homes, a housing developer based in London, Ont. that specializes in single-family communities. “We’re being a lot more cautious going forward. We’re not releasing too far into the future.”

The construction of new homes in Canada’s suburbs and exurbs is never a quick or easy process. Even in normal economic times, Canada’s housing developers are constantly at odds with municipalities and provincial governments over planning permissions for new residential communities. “We already had a shortage of supply well before the pandemic,” says Kevin Lee, president of the Canadian Home Builders’ Association. “It was probably the biggest issue driving up housing prices in our largest urban centres.”

But the pandemic has added a new set of complications to the supply side of the new-home market.

I’ve gone out and bought skids of garage door openers, because where they’re manufactured in Mexico they had to close for COVID

Sue Wastell, president of Wastell Homes

Although residential construction has continued throughout the pandemic, new health and safety practices have hampered the process of building homes. Tradespeople can no longer work shoulder to shoulder. “We’re separating various crews so that there’s very little chance of spread happening among people on site,” says Al Libfeld, president of Tribute Communities, a Pickering-based developer that builds both low-rise single-family homes and condo towers. “It has slowed down construction to some degree.”

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Lockdowns have also caused some municipal permitting offices to operate more slowly than they ordinarily would. Developers report delays in flows of building and planning permits, which they say has created additional drag in the construction pipeline.

One of the most vexing virus-related challenges for builders has been getting — and paying for — vital construction supplies.

Some wood products have more than doubled in price. Photo by Bloomberg

Essential items such as windows and doors have become scarce as home builders in Canada and the United States attempt to keep up with strong buyer demand on both sides of the border. “We’re buying products and having them stored, where we’ve never done that before,” Wastell says. “I’ve gone out and bought skids of garage door openers, because where they’re manufactured in Mexico they had to close for COVID. I’ve already sold 60 homes that include a garage door opener. We’re thinking much farther ahead than we’ve ever done before.”

But the biggest material concern for low-rise builders is wood. Single-family homes are usually framed entirely in timber, which means they require several times the amount of wood, per unit, that would normally be used in the construction of a taller, multifamily building.

Lumber prices, apparently buoyed by increased demand for home renovations and construction during the pandemic, have surged. Some wood products have more than doubled in price. The random lengths composite, a broad measure of lumber price performance, was trading at US$983.80 per thousand board sheets, up around 118 per cent higher from the same period last year.

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Valérie Gonzalo, a spokesperson for Lowe’s Companies, Inc., told the Financial Post that increased demand and decreased supply has had an impact on the availability of products to consumers.

“Dealing with COVID-19, several suppliers (including lumber, building materials, windows, doors and appliances) were forced to limit their production as they had to reduce the number of employees in their plants to be compliant with the health measures in effect and deal with longer lead times for parts supply,” Gonzalo said.

Developers typically pre-sell properties months or years before the actual start of construction. Now, they’re left to perform an uncertain calculus. If they pre-sell a home today, will future increases in material costs erase their profit margins before they even begin to build? With lumber prices fluctuating so wildly, it’s impossible to know.

“We definitely need to be more cautious,” says Mike Taylor, vice president of business development at Granite Homes, a low-rise housing developer based in Guelph. “One of the things we need to be careful about is not selling too far in advance. You have so much demand right now, you want to supply the market and sell units. But if you do that, all of a sudden your closing dates are getting much later, and there’s increased risk.”

Despite the industry’s pandemic-related challenges, Canada’s overall amount of single-family home construction activity has not diminished. Canadian single-detached housing starts in 2020 were up six per cent over 2019. But the pace of sales of new-build houses during the pandemic has been so quick that buyers, in some cases, have fewer properties to pick from.

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Whatever new-build houses are available for sale are tending to fetch high prices. Photo by David Bloom / Postmedia

In the Greater Toronto Area, there were just 1.8 months of low-rise inventory remaining at the end of December, according to statistics compiled by Altus Analytics. Toronto-area buyers of new single-family homes haven’t faced such tight inventory conditions since early 2017. In Vancouver, single-family new-build inventory stood at 3.5 months.

Buyers who are put off by inventory problems in the new home market currently have nowhere else to turn, because resale markets are in similar shape. A February analysis by RBC Economics found that Canada’s nationwide resale housing inventory is now the lowest on record, at just 1.9 months.

Whatever new-build houses are available for sale are tending to fetch high prices. Statistics Canada’s New Housing Price Index — which tracks the sale values of detached, semi-detached, and townhouse properties — was up 4.6 per cent year over year in December, the largest monthly year-over-year increase since 2008.

Those rising prices may prove to be a saving grace for low-rise developers whose margins are being squeezed by increased material costs. “If you didn’t have that kind of balancing effect on the pricing side, I think it would be a bigger challenge that it has been,” Taylor says.

In-depth reporting on the innovation economy from The Logic, brought to you in partnership with the Financial Post.

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When IBM first launched its Watson Health unit in 2015, it had to live up to a grandiose vision. The company’s AI creation, popularized by its win on Jeopardy!, was pitched to oncologists as a tool that could comb through medical literature and cancer patients’ health records, detecting patterns that they could not.

Reports later found that it fell short of those claims, and in some cases, offered ‘unsafe and incorrect’ suggestions. Now, IBM might be considering selling its Watson Health unit, as it focuses more on its cloud computing business, according to the Wall Street Journal. Citing anonymous sources, the Journal reported the health unit brought in $1 billion in revenue and isn’t currently profitable.

IBM declined to comment on the report, and it’s not clear who would buy the company. But it’s another example of a high-flying healthcare effort that might have tried to do too much all at once, and a case where marketing overtook the science.

Other tech behemoths have also stumbled in their much-vaunted plans to disrupt healthcare. Haven, a joint venture between Amazon, JPMorgan Chase and Berkshire Hathaway to combat rising healthcare costs, dissolved as the three companies pursued their own efforts.

Part of the challenge is that it’s difficult for these large companies to move quickly, while in the same span, dozens of startups are bringing their own solutions to market.

“There’s a contextual dynamic that large companies will by definition not move as quickly as early-stage innovative companies,” said Michael Greeley, co-founder and general partner with Flare Capital Partners. “A product roadmap that a big tech company might set for the end of the year, by the time committees meet and budget, the year has gone by.”

Two years ago, IBM started winding down sales of Watson for Drug Discovery to pharmaceutical companies, because it wasn’t yielding big enough financial returns. Before that, the general manager of the division also stepped down for a different role at the company.

Facing declining revenues, in an investor call last month, the company’s new CEO, Arvind Krishna, said he was looking to redefine IBM’s future as a cloud platform and AI company.

“This is where we are focusing the bulk of our efforts, time and investments,” he said.

Over-hyped and under-delivered

With the way IBM had marketed Watson for Oncology, “There was clearly always a mismatch in the reality and the promise of what they were going to bring to market,” Greeley said.

More time would have been needed to get closer to that goal. Building AI tools for healthcare requires a huge amount of high-quality data that can be hard to get, and complicated to analyze.

“To date, there’s been far more heat than light,” wrote David Shaywitz, founder of health-tech advisory firm Astounding HealthTech. “There’s a lot of complexity to health data that requires domain expertise to understand, and just sticking a lot of values in a data lake or data swamp and then setting algorithms loose on it hasn’t proved especially productive to date.”

Despite that, Shaywitz still remains optimistic that AI will have a role in medicine in drug development in the future. He pointed to Flatiron Health as an example of one startup that has done well – it was acquired by Roche in 2018 for $1.9 billion.

He said that success relies on the ability for health and tech experts to collaborate as equal partners,  something that’s “vanishingly rare” at big tech, biopharma and healthcare companies.

 Whatever happens with Watson, Greeley still doesn’t see tech companies’ interest in healthcare waning anytime soon, as Amazon wades into the prescription drug market and Google tries to woo more health systems with cloud partnerships.

“I think we’re seeing renewed intrigue by consumer tech, the Googles and Facebooks of the world,” he said. “I think because healthcare is such an important part of the economy, they will continue to be active with acquisitions.”

Photo credit: Getty Images, wigglestick

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Pfizer and BioNTech are asking the FDA to approve a change that would permit storage of their Covid-19 vaccine within a temperature range found in medical-grade freezers.

To be clear, this proposed change doesn’t eliminate the need for ultra-cold temperatures as the vaccine moves throughout the supply chain—temperatures that require specialized equipment. Those storage requirements are a barrier to its distribution because not all facilities have equipment that can achieve the required temperatures. What Pfizer and BioNTech are proposing is that when the vaccine reaches its destination, such as a hospital or pharmacy, it could be stored for up to two weeks at (relatively) warmer freezer temperatures.

The FDA granted emergency use authorization to the messenger RNA vaccine, named Comirnaty, last December. According to the product’s label, the vaccine must be stored in ultra-cold temperatures between minus 112 degrees and minus 76 degrees Fahrenheit (minus 80 degrees and minus 60 degrees Celsius). At those temperatures, the vaccine can last up to six months. Pfizer ships the vaccines in specially designed containers that can be refilled with dry ice every five days. Those containers can serve as temporary storage for up to 30 days.

The vaccine can be stored at refrigerator temperatures for up to five days. Pfizer and BioNTech are asking the FDA to approve an additional option to store the vaccine at minus 13 degrees to 5 degrees Fahrenheit (minus 25 degrees to minus 15 degrees Celsius) for two weeks. That range would put it closer to the storage requirements for the mRNA vaccine from Moderna. The temperature range Pfizer and BioNTech are proposing would be in addition to the five days at refrigerator temperatures that is currently permitted under the authorization.

“If approved, this new storage option would offer pharmacies and vaccination centers greater flexibility in how they manage their vaccine supply,” Pfizer CEO Albert Bourla said in a prepared statement.

Pfizer and BioNTech are proposing the additional temperature option based on new data about their vaccine’s stability. The data span from the earliest clinical trials up to batches currently in production.

Messenger RNA vaccines are a new technology that employ a snippet of genetic material from the novel coronavirus. This mRNA serve as a blueprint that a cell’s protein-making machinery use make the characteristic spike protein found on the surface of the novel coronavirus. That protein is what triggers an immune response and confers immunity.

Though mRNA vaccines are administered at room temperature, they must be kept at ultra-cold temperatures in the supply chain because mRNA is fragile. The extremely cold temperatures keep the components of the vaccine from breaking down. As mRNA companies study the storage data they have for vaccines, they are getting a better understanding of how long these vaccines can last at certain temperatures. Last November, Moderna released data that it said supported storage of its vaccine at refrigerator temperatures for up to 30 days.

Temperature requirements can be a barrier to the distribution of the vaccine to rural areas, which may not have facilities with appropriate freezers. In that regard, the Johnson & Johnson Covid-19 vaccine is seen as offering an advantage. In addition to requiring only a single shot (both authorized mRNA vaccines require two), the J&J vaccine can be stored at standard refrigerator temperatures. An FDA advisory committee is scheduled to hold a hearing about that vaccine on Feb. 26.

Photo by BioNTech

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Expect a record-breaking year for Canadian real estate

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Royal Lepage CEO Phil Soper speaks with Financial Post’s Larysa Harapyn about how we can expect a record-breaking year for Canadian real estate.

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The journey toward achieving interoperability in healthcare needs to now move beyond data exchange, and instead, focus on data management.

This is the opinion of a panel of experts who gathered at the all-virtual Health Datapalooza and National Health Policy Conference Thursday to discuss one of healthcare’s most hotly debated concepts: interoperability.

The healthcare industry has come a long way with regard to interoperability, especially with the new rules proposed by the Department of Health and Human Services, set to take effect April 5. These rules aim to provide patients with unprecedented access to their data.

But the healthcare problems of today require solutions that support data management, and not just data exchange, said Claudia Williams, CEO of California-based Manifest MedEX, at the Health Datapalooza conference.

The industry has focused on enabling the basic exchange of health records between providers and made great progress, but the connective tissue that enables data management — including matching and cleaning data — is lacking, she said. And it’s the smaller providers that are being left behind.

“In California, a slim share of the health delivery systems, mostly the big health systems, have hundreds of people doing this work, and safety net providers and small Medicaid plans and others really are stuck with just being able to pile up CCDAs [consolidated clinical document architecture] or maybe not even process CCDAs at all,” she said.

There needs to be policies and strategies enacted at the state and federal levels to create an infrastructure that has more to do with the management of data than with health record exchange, Williams said.

While policy actions are necessary, there also needs to be more alignment between the needs of the providers on the ground and the health IT technology and capabilities available today, said Dr. Farzad Mostashari, CEO of Bethesda, Maryland-based Aledade, during the panel discussion.

Through Aledade, which operates accountable care organizations in partnership with more than 800 primary care practices, Mostashari has experienced that disconnect firsthand.

“What EHRs do today have nothing to do with what I need,” he said. “Well, not nothing, but they really don’t fill the thermometer of what I need to do for population health.”

It is costing Aledade millions to map, match and translate EHR data, he added.

Looking ahead, care quality measurement needs to be automated within the EHR and providers should get free access to information that is already mapped in accordance with data standards, Mostashari said.

The technical tools needed to push interoperability forward already exist, but the regulatory landscape needs to catch up, said Donald Trigg, president of North Kansas City, Missouri-based Cerner, during the session.

The government is now both the biggest healthcare regulator in the country and the biggest payer. This means it is in a unique position to use health IT certification and provider reimbursement to help create the interoperability architecture that is necessary for the coming decade, Trigg said.

“I’m still an optimist,” he said. “And I think that Covid and this administration will be an accelerant for the next wave of meaningful data exchange.”

Trigg’s advice for the new administration’s HHS is to tackle the inter-agency complexity that exists at the federal level.

Coordination between agencies like the HHS, Federal Trade Commission and Food and Drug Administration is necessary. This means, it will be important to create clarity around the inter-agency landscape and data management so that the healthcare industry can innovate and do more, Trigg said.

Photo: LeoWolfert, Getty Images

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High demand has put upward pressure on housing prices for scarce waterfront properties

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Bidding wars are to be expected when buying a house in a big city market, but now they have spilled beyond even the suburbs to otherwise calmer, more remote areas, known as peri-urban regions.

The pandemic-driven outward migration of households from central parts of the city to the towns forming the extended urban boundary has generated quite a lot of hype. Nowhere is this hype more visible than the cottage country surrounding the Greater Toronto Area (GTA).

It used to take months to sell a cottage before COVID-19 hit. Now, such homes are being sold within days, sometimes even hours, of being listed. Offer nights and multiple bids are the new norm, and they have delivered both unexpected riches to many cottage country sellers and loads of disappointment for outbid buyers.

Real estate professionals in the famed Muskoka region north of Toronto initially panicked when the lockdown in March 2020 shut things down. However, a once-in-a-lifetime turnaround in housing markets took place within weeks. Cottage country realtors have not been this busy in years and there are no signs of a sharp slowdown on the horizon.

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The demand for cottage country dwellings has increased for two reasons. The first is the rise of working from home or teleworking, making it possible for knowledge economy professionals to live and work from spacious residences near nature and water. Even if they can only partially work from home, they can trade in their urban dwellings for a cottage and a pied-à-terre in the city for the days when they must visit work.

Second, it is not apparent when vacationers may board a plane for trips abroad. A holiday within commuting distance is the compromise, which has increased the demand for vacation properties near urban centres.

Cottages are being sold within days, sometimes even hours, of being listed.
Cottages are being sold within days, sometimes even hours, of being listed. Photo by Getty Images/iStockphoto

In remote towns where multiple bids were once unheard of, the new norm involves offer nights that turn housing markets into an auction of sorts, where the bidders are at a unique disadvantage since they do not know what others have already bid. The fear of missing out kicks in, and some end up bidding outrageous amounts that they would otherwise not have if the other bids were not kept secret.

Kevin Ali, the broker of record with Zolo Realty, is all too familiar with the hyperactive housing markets in Ontario’s cottage country. He noted that a recently listed house in Severn, some 165 kilometres north of downtown Toronto, received more than 70 offers. The two-bedroom dwelling sold within four days and for almost twice the list price.

But there is more driving the hype than just the pandemic-driven demand for recreation properties.

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One factor is the chronic undersupply of decent waterfront properties. The number of buyers seeking such properties far exceeds the number of dwellings listed that meet the necessary criteria. Another factor is that some sellers are listing their properties at prices far less than comparable sales to attract buyers. The waterfront property in Severn was strategically priced at less than $400,000 to attract attention — and it did.

Of course, that’s anecdotal evidence of the demand, but let’s look at the empirical evidence to see whether this cottage country gold rush is due to a shift in market demand, or is merely because there isn’t enough housing available.

We asked the Canadian Real Estate Association (CREA) to provide custom tabulations showing how sales activity changed once the initial restrictions on mobility and assembly were relaxed in May 2020. We specifically focused on the cottage country markets to the north of the GTA, namely the Barrie District, Kawartha Lakes, Muskoka and Haliburton.

These markets rebounded in July 2020 with unprecedented high levels of sales. But there is a catch. The housing markets near Toronto have been struggling since early 2017, when the Ontario government introduced the foreign homebuyers’ tax and new rental regulations. The bump in July 2020 sales, therefore, seems large relative to the sales since 2017.

Prior to 2017, cottage country housing markets had been steadily growing since the Great Recession, with sales in 2015 and 2016 reaching new heights. For example, sales in Kawartha Lakes in June 2015 were higher than those recorded in July 2020.

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What is different now is that a larger pool of prospective buyers has jumped into the market, competing for even fewer properties. The relatively high demand has put upward pressure on housing prices in cottage country.

CREA’S Composite House Price Index (HPI), an estimate of average housing prices that controls for housing quality and size, shows that housing prices in Simcoe County, also north of Toronto, accelerated faster during 2020 than they did in the GTA. Similarly, the growth in housing prices in Barrie, another area north of the GTA, was faster than that in urban centres to the south.

Cottage country housing will continue to attract city slickers in large numbers while the pandemic-related uncertainty remains. As a result, bidding wars will continue to be fought for scarce waterfront properties.

Once more housing is made available by prospective sellers, who have been patiently watching the markets from the sidelines, cottage country markets are likely to return to calmer conditions to match the serene and tranquil environments that distinguish them.

Murtaza Haider is a professor at Ryerson University. Stephen Moranis is a real estate industry veteran. They can be reached at the Haider-Moranis Bulletin website hmbulletin.com.

In-depth reporting on the innovation economy from The Logic, brought to you in partnership with the Financial Post.

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health insurance, Obamacare

A rise in insurer participation in the Affordable Care Act individual marketplace indicates that payers are anticipating a fruitful year ahead. The installation of a new president and ongoing Covid-19 pandemic appear to be driving this trend.

Over the past year, insurer participation in the ACA individual marketplace has grown and benchmark premiums have declined, according to a new analysis by the Robert Wood Johnson Foundation. The total number of insurance offerings sold on the marketplace is now 9,144, which is about 75% of the 2015 record high.

This suggests that insurers are anticipating increased enrollment as a result of federal policy changes and the impact of the Covid-19 pandemic, said Katherine Hempstead, senior policy adviser at RWJF and author of the analysis, in an email.

“The Biden administration has been emphatic about its commitment to the ACA marketplace,” she said. In particular, the administration has committed to preserving and expanding health coverage to help Americans during the pandemic.

In his American Rescue Plan, President Joe Biden called on Congress to subsidize continuation health coverage through the end of September and to expand and increase the value of the Premium Tax Credit. The latter move will help lower or eliminate health insurance premiums and ensure enrollees will not pay more than 8.5% of their income for coverage.

Further, Biden recently reopened the HealthCare.gov insurance markets for three months to enable Americans to sign up for coverage amid the ongoing pandemic.

Though these policy changes are temporary, there is a commitment on the part of the administration to try to make them permanent, Hempstead said.

Drilling down into participation among major insurers, Hempstead found that Anthem, UnitedHealth and Cigna currently comprise about two-thirds of the national commercial offerings on the individual marketplace. Centene, which dominates the Medicaid managed care organizations category, made its largest single-year increase, nearly doubling its marketplace offerings from 2020 to 2021.

In addition, participation by newcomers like Oscar and Bright Health has grown steadily. Bright Health is now in 10 states, and Oscar is in 19.

Another key analysis finding is that states that have yet to expand Medicaid saw increases in insurer participation. Increased participation in the ACA individual marketplace was particularly focused in Florida, Georgia, North Carolina and Texas, where the number of offerings increased by almost 50% in the last year.

“This is where the greatest number of uninsured people live, so it is the biggest opportunity for membership growth,” Hempstead said.

Looking ahead, it is clear that insurers are hopeful that a significant expansion in healthcare coverage is due, and they see the ACA marketplace as an increasingly important part of the coverage landscape, according to the analysis.

Photo: BrianAJackson, Getty Images

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