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If you’re looking for a job, it’s important to know how to write a cover letter especially if you’re looking for assistance from an IT recruitment company.

A cover letter, sometimes called an introductory letter, is a formal letter that you send along with your resume to an organization that is looking to hire you.

Its purpose is simply to illustrate your capabilities and strengths, to emphasize upon your qualifications and accomplishments, and to let the hiring manager know who you are and what you hope to bring to their organization.

Unlike an application, a cover letter allows you to introduce yourself to the potential employer, offer context to your accomplishments and qualifications, explain your motivation for entering the organization, and perhaps best of all – explain your ambition.

You can’t underestimate the power of this initial letter.

In fact, a badly written or poorly worded cover will not only be a waste of time but also will most likely be disastrous for any opportunity you may have.

When you’re looking for how to format a cover letter, there are certain things to remember.

First, keep in mind that the letter’s appearance – in terms of its overall structure and formatting – is actually more important than what you may think.

You should not only look for the right format for the letter, but also the right type of font. Using a Times New Roman or Arial font, for example, won’t really do you much good. In fact, these types of fonts are a poor choice – they are hard to read, aren’t eye-catching, and will thus likely draw negative attention to you and your work.

The next step is to ensure that your job description and the rest of the cover letter to fit together in a logical fashion.

As with your resume, where your keywords should be part of your headline, your keywords should also be part of your introductory paragraph.

Start off by introducing yourself briefly, then giving a brief overview of how you can best help the company obtain the person’s stated goals.

You could also indicate how your skills can meet their needs.

Your next paragraph should be the meat of your professional cover letter – this is where you get to show off your talents, your strengths, and why they should choose you over all the other candidates.

However, it is important to realize that your paragraph doesn’t need to be overly written, just clear, concise, and to the point.

Your cover is a means to an end; it should give the employer a clear idea about what he/she is getting when he/she invests their time and resources into you. It is important that you sound professional, but at the same time passionate.

Finally, your third paragraph is where you make your pitch as a professional.

Here you need to be sure not to sound like you’re too attached to the job; mention how things have been going in your recent career, how things are going now that you are seeking a different position, or anything that shows how you will fit into the organization perfectly.

If you have experience with the company in question, then you can use it here.

But, as a general rule, keep this brief and focus more on the job that you are applying for. Focusing on past experiences is great when trying to convince the hiring manager that you are capable of doing the job, but you want to tailor everything you say to the job description of the role and pick out as many similarities to your current role as possible.

You have now learned how to write a cover letter example.

Now it’s time for practice! Start off by writing a short personal one page resume cover, then add to it throughout your job application process.

Stick with one format – one that will allow you to compile all your data, including your contact information, accomplishments, and any images (for portfolio uses only, try not to include a photo of yourself) or links you may want to include.

Cover letters are not difficult to write, but they are perhaps one of the most important parts of your job application.

Take your time, follow these simple steps, and you will increase your chances of finding a job substantially compared to those who apply for the same job without having written one.

If you’re looking for a recruitment company in Milton Keynes within the IT industry, you can get in touch with an IT Recruitment Company and discuss your options.

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There are more issues associated with missing teeth aside from the cosmetic issues it brings. At Tennessee Valley Oral Surgery, we take time to explain to our patients the effects of a missing tooth on their daily life. This includes changing the way they chew foods and how they talk, slowly losing interest in the foods they love, and of course, the chances of saggy cheeks and lips due to the absence of tooth root that secures the jaw.  Fortunately, if you are looking for the best solution to a missing tooth, our dental implant service is what you need.

Stop your search for the “best dental implants near me.” Visit our clinic and talk to our experts to learn about your options. Here are the signs you are a candidate for dental implant service:

·         You have missing or chipped teeth.

If you have a missing tooth and want to bring back your jaws’ natural look and security, a dental implant is your best choice. A dental implant replaces the teeth, allowing you to eat, talk, and live your life the usual way.

·         Dentures aren’t fitting properly.

Dentures are the most common option for missing teeth, but many people complain of discomfort and pain when the dentures are not fitted well. On the other hand, dental implants remove these problems because of their ability to function just like normal teeth. They stay in place so you will not suffer from gum irritation and discomfort, no matter what you chew.

·         You have an infection.

Infections are usually due to periodontal diseases, injury, and other causes. If the infection got bad enough and ruined the tooth’s integrity, you can decide to undergo dental implants and restore the beauty of your oral health. Dental implants will replace your natural teeth and save you from the pain of infection and more serious problems associated with it.

·         The jaw bone is deteriorating.

Chances of jaw bone deterioration are high if you have missing teeth for a long time. Dental implants can fill in the missing teeth and help stop further recession of the jawbone. Over time, it provides additional security in the jaw and brings it back to its normal structure.

·         The face is sinking in.

Missing teeth for a long time can cause your face to sink in, giving you a cave-in appearance that doesn’t look very natural. This is usually due to bone loss from the missing teeth. A dental implant promotes bone growth that naturally lifts the jaw and gives you a more youthful appearance.

Best Dental Implants Near Me

Tennessee Valley Oral Surgery offers advanced dental implant services to preserve your facial structure and provide a permanent solution to your missing teeth. We also offer a range of oral and cosmetic procedures that we can perform to keep your oral health in tip-top shape:

Oral Procedures. Our oral procedures include dental implants, wisdom teeth removal, extractions, and other oral surgeries, impacted teeth solution, anesthesia, oral head and neck pathologies, facial inquiry, trauma surgery, and bone grafting. These important procedures are done by our qualified, skilled, and licensed in-house and referring doctors with years of experience in the field.

Cosmetic Procedures. Our cosmetic procedures at Tennessee Valley Oral Surgery include non-surgical brow lift with fillers and Botox, surgical brow lifts, blepharoplasty, latisse, cheek filler injections, mentoplasty and genioplasty or chin reduction and augmentation, kybella or double chin treatment, Botox cosmetics, restylane, injectable filler, mole removal, scar removal and revision, lip filler and lip wrinkle reduction, full facial wrinkle reduction, wart and skin tag removal, and ear and earlobe procedures. We are dedicated to helping you achieve a youthful glow and a healthy, younger, and more engaged appearance.

The greatest responsibility of a maxillofacial surgeon and our office is protecting your health while providing the care you need, functionally and cosmetically. All our dental services are at the most affordable costs, and we even have available financing options to help the cost that your insurance may not. Schedule your appointment or visit our clinic to learn more about your options. Our friendly professionals are always ready to help you with your needs. Call us!

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Like any other industry, the dental industry possesses its very own set of accounting and tax rules that need to be complied with. If your plan is to start a career in dentistry or are already providing healthcare services as a professional dentist, it is best to search for the services of a professional accounting firm.

As a practitioner of dental services, taking care of the patients should be the first priority but, managing the accounting and bookkeeping can also intervene sometimes and can be considered a priority as well. Due to this, it is imperative to choose the appropriate dental CPA firm. A good accounting firm should provide dental practice accounting services to free hardworking dental practitioners from back-office duties in order fot them to be able to concentrate on working with patients.

An experienced CPA organization offers reliable accounting services tax reduction planning to sustain all kinds of dental practices, such as family dentistry, as well as oral surgeons and also orthodontists. A good service will take care of the responsibility of maintaining the accounts meticulous and precise. Nevertheless, the client should also make sure to always be in control when it comes to finances. The detailed financial reports a good accounting firm offers should empower its clients to effortlessly supervise matters such as cash flow and accurately trail expenses in order for the practice to function smoothly and maximize revenues. Another important aspect that should be taken into consideration is employing benchmarking to evaluate the client’s practice by comparing it to others and shed light on the point where improvements need to be made in order to bring more value to the business in question.

When talking about taxes, a good accounting service recognizes that less is more so it creates a comprehensive tax planning strategy in order to lower tax liabilities for the dental practice. Additionally, at tax time, the firm should also use every deduction available to be certain that the clients acquit the lowest amount of tax allowed by current regulations.

What expenses can be claimed by dentists for tax-related purposes?

•           The costs of goods purchased for reselling or consumption purposes (such as filling materials, vaccinations, or even mouthwash)

•           Staff costs such as wages and salaries

•           Rent, rates, power, and insurance costs

•           Travel costs inquired for business purposes

•           Repair and maintenance of property and equipment

•           Phone, fax, stationery, and other office costs

•           Advertising and business entertainment costs

•           Bank interest and other loans

•           Bank, credit card, and other financial charges

•           Accountancy, legal, and other professional fees

•           Other business expenses

•           Trading and property allowance

The qualities of good dental accounting services

•           Availability-A good accounting service understands the significance of a client’s time

•           Knowledge and expertise- A good accounting service is picked based on experience in the domain of expertise

•           Online facilities- A good accounting service implements an online portal in order to enable the clients to upload and complete accounting details

•           Transparency- A good accounting service offers transparency in its fee structure

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A new health IT partnership aims to improve clinical data quality and thereby increase the volume of data available for care quality measurement.

The partnership will combine Chicago-based Apervita and Farmington, Connecticut-based Diameter Health’s expertise to provide payers, providers and other healthcare stakeholders with access to clean clinical data for value-based care delivery, said Rick Howard, Apervita’s chief product officer, in an email.

“The healthcare industry has no shortage of data, but the way it’s leveraged continues to be a challenge for both quality measurement and for supporting value-based contracts,” he said.

Apervita provides stakeholders with the infrastructure necessary to develop value-based care models.

Per the new partnership, the company’s quality measurement and value optimization solutions will leverage Diameter Health’s Fusion engine to clean healthcare data in multiple formats, including clinical, claims, behavioral health and laboratory data, Howard explained.

The clean data can be used to glean performance insights that are needed to develop value-based contracts between providers and payers.

Diameter Health’s technology ingests raw — that is, poorly formed, unstructured or incorrectly coded — health information from EHRs, labs and aggregators, and automatically normalizes, re-organizes, deduplicates and summarizes the data, said a Diameter Health spokesperson in an email. The technology identifies data quality errors early in the ingestion process, which makes data sharing more efficient.

“We are thrilled to be a critical and foundational component to Apervita’s platform by delivering clean, normalized, and enriched multi-source clinical data to their customers, empowering providers, payers and other healthcare stakeholders to improve quality and deliver value,” said Eric Rosow, CEO of Diameter Health, in a news release.

Healthcare data is proliferating as the industry becomes more digitized. Telehealth and remote patient monitoring services, in particular, grew exponentially amid the Covid-19 pandemic. And the data generated by these services also grew.

In addition, wearable health technology, like glucose monitors and the Apple Watch, are becoming more widely used to track patient diagnostics and encourage patient engagement, Howard said. This provides even more data for the healthcare industry to contend with.

“As the volume of healthcare data continues to grow, so will the need to have technology that normalizes the data so that it can be used to support quality measurement, value-based contracts and analytics,” he said.

Photo: Dmitrii_Guzhanin, Getty Images

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Breast cancer cells

Athenex’s lead drug candidate, an oral formulation of the chemotherapy paclitaxel, is intended to bring patients comparable, if not better, efficacy and fewer side effects than the intravenous version. But the company now faces questions about the drug’s safety in the wake of an FDA rejection.

Buffalo, New York-based Athenex announced the rejection of the cancer drug Monday. According to the company, the regulator recommended the biotech conduct a new clinical trial in metastatic breast cancer patients. The agency also suggested the company take steps to mitigate the drug’s toxicity.

Shares of Athenex fell sharply after the FDA rejection was announced, and closed Monday at $5.46 apiece, down nearly 55% from Friday’s closing stock price.

Paclitaxel, also known as Taxol, is a widely used chemotherapy for treating breast, ovarian, and lung cancers. Intravenous dosing of the drug can cause adverse reactions. To mitigate those effects, cancer patients are given steroids and antihistamines prior to dosing of the chemotherapy. Other side effects of intravenous paclitaxel include nerve damage, hair loss, and neutropenia, which is an abnormally low level of a type of white blood cell called neutrophils. Those side effects may reduce how much of a dose of the chemotherapy a patient can receive.

Athenex’s version of paclitaxel is given in combination with another drug, encequidar. According to the company, this compound blocks a protein in the intestinal wall that limits the absorption of chemotherapies. In results of a Phase 3 study testing Athenex’s oral paclitaxel in patients with metastatic breast cancer, the company reported its drug met the main goal of showing statistically significant improvement in the overall response rate compared against treatment with the IV version of the chemotherapy.

The company also reported that its drug can reach levels in the blood comparable to IV paclitaxel, and for a longer period of time. The company said in securities filings that this capability may translate to a better clinical response to the therapy. In the 402-patient Phase 3 study, Athenex observed a higher tumor response rate along with lower incidence and severity of nerve problems compared to IV paclitaxel.

Athenex said that the agency’s complete response letter cited the risk of an increase in problems related to neutropenia in the oral paclitaxel arm compared with the group treated with the IV formulation. The FDA also expressed concern about how the results of the study primary endpoint were evaluated under blinded independent central review, a group of independent physicians. According to Athenex, the FDA said there may have been “unmeasured bias and influence” on the review.

Speaking on a conference call, CEO Johnson Lau said the company was “surprised and extremely disappointed” by the FDA’s rejection. The neutropenia concerns cited are a known risk of paclitaxel, he said. Lau added that the review remained blinded, was conducted by independent radiologists, and the regulator had not issued any formal warnings flagging problems at the imaging lab.

The FDA’s recommendation that Athenex conduct another clinical trial specified that the study should include patients more representative of the U.S. population. Rudolf Kwan, the company’s chief medical officer, said on the call that none of the clinical trial sites were in the U.S. But he added that the company had discussed the clinical trial design with the regulator, and the single study, as proposed by the company, was understood to be sufficient to support approval if the results were positive.

Lau said that the company plans to request a meeting with the FDA to discuss the letter and clarify the scope of the new clinical trial needed to address the agency’s concerns.

“Whether it requires the whole study be done in U.S., we’ll have to clarify in the meeting,” Lau said.

Though Athenex has a pipeline of clinical-stage cancer therapies, company currently generates most of its revenue from the sales of generic injectable products. In 2020, it reported more than $105 million in product sales, a 73% increase over 2019 sales. In its financial report of fourth quarter 2020 and full-year results, Athenex attributed the revenue increase to growing sales of specialty pharmaceutical products used to treat hospitalized Covid-19 patients. As of Dec. 31, 2020, Athenex had $86.1 million in cash and $138.6 million in short-term investments.

Photo by American Cancer Society/Getty Images

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The FDA has authorized Johnson & Johnson’s Covid-19 vaccine for emergency use, adding a third vaccination option—one that comes with storage and distribution advantages.

The regulatory decision followed the review of an FDA advisory panel, which voted unanimously on Friday to recommend authorization of the vaccine. J&J said it has begun shipping its vaccines to the federal government, which will manage distribution. The company expects to deliver enough vials for the vaccination of more than 20 million people in the U.S. by the end of March, ramping up to 100 million vaccinations by mid-year.

The J&J shot joins the messenger RNA vaccines developed by Moderna and partners Pfizer and BioNTech as the only authorized Covid vaccines in the U.S. The mRNA vaccines must be transported and stored at ultra-cold temperatures well below temperatures of typical medical freezer equipment. However, vaccination sites now have a little more flexibility in how they can store mRNA vaccines. Last week, the FDA approved a request from Pfizer and BioNTech to permit storage of their vaccine at pharmaceutical-grade freezers for up to two weeks.

The J&J vaccine can be transported and stored at refrigerator temperatures, making it a better option for rural areas or vaccination sites that don’t have the specialized freezer equipment required to store the mRNA vaccines. It has the additional advantage of being a single shot, unlike the mRNA vaccines that are given as two doses weeks apart. A single shot avoids the challenges of getting people to return for a second injection.

“The potential to significantly reduce the burden of severe disease, by providing an effective and well-tolerated vaccine with just one immunization, is a critical component of the global public health response,” Paul Stoffels, J&J’s chief scientific officer, said in a prepared statement. “A one-shot vaccine is considered by the World Health Organization to be the best option in pandemic settings, enhancing access, distribution and compliance.

The J&J vaccine uses a virus to fight a virus. The company’s Janssen subsidiary takes adenovirus, which causes the common cold, and engineers it so that it cannot replicate and does not cause illness. This engineered virus becomes the vehicle that transports into cells a piece of DNA from SARS-CoV-2, the novel coronavirus. Cells use that genetic material to make the spike protein found on the surface of SARS-CoV-2. Those proteins spark the immune response that leads to immunity. This vaccine technology, which J&J calls AdVac, is the basis of the company’s Ebola vaccine, which was approved by the FDA in 2019.

The FDA authorization for J&J’s Covid vaccine was based on results from a global, placebo-controlled Phase 3 study that enrolled nearly 44,000 volunteers. Those participants were followed for a median of eight weeks. The main goal of the study was to evaluate the first occurrence of moderate-to-severe Covid infection with the onset of symptoms after 14 days, and then after the 28-day mark.

Overall, the J&J vaccine was about 67% effective in preventing moderate-to-severe or critical Covid infection after two weeks. After 28 days, the vaccine was about 66% effective at preventing infection. The FDA added that the J&J vaccine was about 77% effective in preventing severe or critical illness two weeks after vaccination. After 28 days, the vaccine was 85% effective in preventing severe or critical illness.

The most common side effects reported from the studies were pain at the injection site, headaches, fatigue, muscle aches, and nausea. The FDA said these side effects were mostly mild to moderate and lasted for a day or two. J&J does not yet have enough data to determine how long protection from the vaccine lasts. The studies conducted to date also do not show whether the vaccine stops people from transmitting the virus. As part of the emergency authorization, J&J must continue to collect data about its vaccine and report and serious adverse events.

The J&J vaccine is given as a 0.5 mL intramuscular injection. The vaccine is shipped in vials, each containing five doses. The company estimates the vaccine will remain stable for two years stored at minus 4 degrees Fahrenheit (minus 20 degrees Celsius). At refrigerator temperatures in the range of 36 to 46 degrees Fahrenheit (2 to 8 degrees Celsius), the company says the vaccine can be stored for up to three months. The company will deliver the vaccine with the same cold chain currently used to ship its other medicines.

The federal government will manage the allocation and distribution of the J&J vaccine according to guidelines set by the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Johnson & Johnson said that it plans file an application seeking a formal FDA approval later this year. The company is also seeking authorizations for its vaccine in other markets.

Photo: Esben_H, Getty Images

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The U.S. is one step closer to making available another Covid-19 vaccine after a panel of experts voted unanimously Friday to recommend emergency use authorization for a shot developed by Johnson & Johnson.

The independent panel, comprised of mostly physicians, voted 22-0 to support the vaccine with no one abstaining. These votes aren’t binding on the FDA, but the agency often follows the recommendations of its panels. A decision could come as early as this weekend. The two Covid vaccines currently cleared for emergency use received their authorizations the day after their respective advisory panel meetings.

The Johnson & Johnson vaccine would offer an alternative to the ones currently available from the Pfizer and BioNtech alliance, and Moderna. Those messenger RNA vaccines must be distributed and stored at ultra-cold temperatures, then thawed before use. Those shots are given as two doses, weeks apart. The J&J vaccine can be kept at refrigerator temperatures. Another key difference is that the J&J jab requires a single shot. Together, those features will make the J&J vaccine easier to distribute to more people in more places through distribution channels that are already in place.

Panel members expressed support for the J&J vaccine, saying that the safety and efficacy data supported its authorization. But panelists also cautioned the public against picking vaccine favorites.

“It’s important that people do not think one vaccine is better than another,” said Cody Meissner, an infectious disease expert and professor of pediatrics at the Tufts University School of Medicine. “There is no preference for one vaccine over another and all vaccines work with what appears to be equal safety and equal efficacy as of this time.”

Emergency authorization is not the same as an approval. Federal law permits the FDA to allow marketing of unapproved medical products for emergency situations, such as a pandemic. Authorizations only last for the duration of the emergency. These authorizations can also be revoked if new data show that the product is not safe or effective. Stanley Perlman, a professor in the departments of microbiology and immunology at the University of Iowa, said that while the clinical studies to date have produced data about the vaccine’s safety and efficacy, it would be “nice to have more.”

The J&J vaccine may be new, but compared to the mRNA vaccines, the technology behind it has bit of a longer track record. J&J vaccine makes it using its AdVac technology, the same platform that produced the company’s Ebola vaccine, which the FDA approved in 2019. The technology takes the virus that causes the common cold and modifies it so it doesn’t cause illness. That engineered virus is the delivery vehicle that ferries into cells a snippet of genetic code for the novel coronavirus’s spike protein. The genetic material serves as the blueprint from which the body’s cells produce spike proteins. The immune system responds by producing antibodies to those proteins, conferring immunity.

The clinical data to date for J&J Covid vaccine covers 44,000 adults from all over the world. In Phase 3 data reported in late January, the vaccine was 66% effective overall in preventing moderate-to-severe infection, 28 days after vaccination. Furthermore, the vaccine showed 85% efficacy in preventing severe disease, and showed complete protection against Covid-related hospitalization and death, also measured at day 28.

Those marks look inferior to the greater than 90% efficacy demonstrated in mRNA vaccine trials. But cross-trial comparisons are difficult and can be misleading because trials have different designs and different goals. Also, the mRNA studies were conducted earlier in the year when there were fewer variants circulating. Public health experts have said that if those vaccines were tested under current conditions, their efficacy rates might be lower, too.

Plans are already underway to gather more data about J&J’s shot, including a study of the vaccine in children and teens. Johan Van Hoof, the global head of the infectious diseases and vaccines for J&J’s Janssen subsidiary, told the advisory panel that a clinical trial testing the vaccine in those 17 and younger is expected to begin this spring. He also said that the company is assessing how the vaccine responds to variants of the novel coronavirus.

Shortly after Friday’s meeting, the FDA issued a statement saying that it would “rapidly work” with J&J toward finalization and issuance of an emergency use authorization. The agency added that it has notified federal partners involved in the allocation and distribution of vaccines, so that they are ready.

Photo: Getty Images, Sezeryadigar

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On the heels of a coordinated care agreement with Anthem, St. Louis-based Mercy is partnering with another health insurer.

On Thursday, the health system announced it was entering into an agreement with Louisville, Kentucky-based Humana to expand patient access to virtual health resources.

Per the new agreement, Humana’s Medicare Advantage members who are patients at Mercy facilities and physician practices will gain in-network access to Mercy Virtual. Staffed with more than 300 clinicians, Mercy Virtual offers 24/7 telehealth services, including virtual primary care at home.

In addition, the agreement links provider reimbursement to quality of care, shifting the payment model for Mercy physicians from fee-for-service to value-based compensation.

“Mercy is committed to working with our communities to improve healthcare while also reducing the total cost of care,” said Shannon Sock, Mercy’s executive vice president, chief strategist and CFO, in a news release. “Strong payer relationships, like this one with Humana, will help in our long-term journey to provide more seamless care for our patients. Together we can make a real difference for patients, which is especially critical during this pandemic.”

The new agreement brings together an insurer with a sizeable membership and a vast healthcare organization.

Mercy includes more than 40 acute care, managed and specialty hospitals, urgent care locations, imaging centers and pharmacies, as well as 4,000 primary and specialty care clinicians in Arkansas, Kansas, Missouri and Oklahoma. And, as of January, Humana’s Medicare Advantage membership totaled more than 4.8 million.

“This agreement unites two organizations striving to offer care that is more accessible, personalized and coordinated — a commitment that is more important than ever right now,” said Jeremy Gaskill, Humana regional Medicare president, in a news release.

The news of the partnership between Humana and Mercy comes just a few weeks after the health system entered into a cooperative care agreement with Anthem. That partnership includes a closer alignment between clinical care and reimbursement as well as increased data flow between Mercy and Anthem.

As the healthcare industry moves toward value-based care, provider-payer partnerships that aim to improve care quality have become more popular.

For example, at the end of last year, Salt Lake City-based Intermountain Healthcare and UnitedHealthcare established an accountable care organization with the goal of improving care coordination and health outcomes for the payer’s Medicare Advantage members. In another instance, Butler Hospital, a mental health facility, partnered with Blue Cross & Blue Shield of Rhode Island to reduce hospital readmissions.

“If either a payer or provider is looking to fill a gap and expand optionality of services for partners or members, these types of innovative partnerships are beneficial because they provide both parties an opportunity to quickly refine and build versus recreating the wheel,” said Nick Donkar, PricewaterhouseCoopers’ health services deals leader. “This strategy enables a win-win solution in short order.”

Provider-payer partnerships will likely continue into the future to help both entities fill gaps as they think about improving care in a virtual environment, he said.

Photo: Gerasimov174, Getty Images

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Gaining insights into social factors affecting patients’ lives can be used to augment healthcare delivery in a big way.

That’s according to Dr. Courtney Lyles, an associate professor at the University of California San Francisco, who helped create an expansive social determinants of health-focused data visualization platform. She discussed the platform and its development at the Workgroup for Electronic Data Interchange’s The Quest for Health Equity virtual conference on Feb. 23.

The platform, UCSF Health Atlas, was released last April. Focused on California-based data, it is designed to enable researchers to explore neighborhood-level characteristics and see how they relate to health outcomes. It also includes data on Covid-19.

“It’s pretty clear, and Covid has made it even more clear, that health is really impacted by place,” said Lyles, who is also co-principal investigator of the UCSF Population Health Data Initiative. “Where we live, including our physical and social environment, directly influences health outcomes.”

The interactive platform includes more than 150 social determinates of health variables at different levels of granularity down to the census tract level, which includes between 1,200 and 8,000 people. The platform draws from several sources including the American Community Survey from the Census Bureau, CalEnviroScreen developed by the California Environmental Protection Agency and the California Department of Public Health.

But one of the main challenges of developing a platform like this is deciding what publicly available data to include from the massive trove that is available, said Lyles.

To create Health Atlas, UCSF relied heavily on the Health People 2020 framework created by the Office of Disease Prevention and Health Promotion. This framework helped the UCSF team think through five domains of social factors, said Lyles. These domains were:

  • Demographic characteristics
  • Socioeconomic factors
  • Community characteristics
  • Neighborhood characteristics
  • Health and healthcare indicators

The UCSF team then went in and selected useful variables within each of the five domains. For example, within the community domain, the team selected individual variables like language and foreign-born status as well as wider variables like population density and household composition — that is, people living in households with children versus single-adult households versus seniors living alone.

“Thinking about those variables has really been interesting,” said Lyles. “[It allowed us to] think through what matters for population health and health equity risk.”

Combining all this data on an interactive map enables researchers and clinicians to drill down into granular data on any one variable, and also compare different variables, she said.

UCSF has gone a step further and made it possible to link that social determinants of health data with its EHR data. For example, UCSF combined the two to gain insights into racial disparities in hypertension outcomes. Eliminating this disparity was a pre-Covid goal for the health system, Lyles said.

First, the team extracted every single address that existed within UCSF’s EHR, and then they geo-coded those addresses onto latitude and longitude. They assigned census tract identifiers to those geo-coded addresses so that they could be linked out to the publicly available datasets. Finally, they gathered clinical and demographic data for patients with hypertension receiving care within the system.

By combining all this the system was able to track hypertension patients by race, neighborhood and socioeconomic status in San Francisco on the map and compare these variables with health outcomes, Lyles said. They found that Black patients are concentrated in certain neighborhoods, and they’re struggling with hypertension control.

“This is not showing us something that perhaps we didn’t know already about structural disparities in care or structural disparities in our society,” Lyles said.

But it does show the urgent need for including place-based strategies in health systems’ disparity reduction and quality improvement programs.

“When you put it out there in a visual display, it actually gives you even more impetus to think about neighborhoods you want to target, or [places where] you might think differently about your interventions moving forward,” she said.

Photo: GarryKillian, Getty Images

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AppliedVR’s program includes a feature for users to go through guided breathing exercises, which are visualized in a 3-D nature scene. Photo credit: AppliedVR

For the past six years, AppliedVR has been distributing VR headsets to hospitals to see if it could help reduce pain and anxiety during what for many patients can be a stressful experience. Now, the digital health startup is testing its platform to see if it can have a similar effect in a home setting.

The Los Angeles-based company shared the results of a pivotal trial showing its VR program was effective in helping people manage chronic lower back pain at home. The results of the randomized controlled trial, published Wednesday in the Journal of Medical Internet Research, showed that users reported a 42% reduction in pain intensity, though the study had certain limitations.

“We were ecstatic with the results we got,” CEO Matthew Stoudt said in a phone interview, adding that he plans to make a submission to the Food and Drug Administration this year.

“Our long-term vision has always been, how do we bring this into the home?” he added. “Ultimately, we are a doctor-prescribed payer-reimbursed model. We’re focused on building a body of evidence.”

Last year, AppliedVR got Breakthrough Device designation from the FDA after publishing results showing early successes in using its program to help people manage fibromyalgia and lower back pain at home. The designation could help accelerate the company’s pathway through the FDA and, thanks to a recent regulatory change, could even lead to a short path to Medicare coverage.

The most recent study tested whether the digital program was effective in reducing lower-back pain for people that went through an eight-week program. Unlike some other virtual programs, it’s focused less on physical therapy exercises and more on cognitive-behavioral therapy for pain management.

Called EaseVRx, the self-guided course walks users through pain education and guided breathing exercises with a nature scene that responds to their breathing. For example, wind blowing in the background might calm as a user slows their breath.

“We’re trying to help people acquire key pain management skills, and the way we can enhance learning and encoding of information is to provide rapid biofeedback in an immersive environment,” said Beth Darnall, AppliedVR’s chief science advisor, who co-authored the study.

Separating immersion from intervention
The double-blind study was also designed to answer questions from the FDA on how much of the therapeutic effect was from merely wearing a headset versus interacting with AppliedVR’s program. To test this, the company created a “sham” VR program that consisted of 2-D nature scenes, designed to hold users’ attention but without a specific therapeutic effect.

While the intervention group reported their average pain intensity decreased from 5.1 to 2.9 after eight weeks, the control group saw a more modest decrease, from 5.2 to 4.

“It’s exciting that we substantially exceeded the effect of the sham,” she said.

Participants that used EaseVRx also reported reductions in pain interfering with their activity, sleep, mood and stress levels.

Study limitations
That said, the study still had some significant limitations. An important one: The vast majority of the 179 adults who participated were white, female and college-educated, representing a narrow demographic.

Since the study was not linked to medical care, all data were self-reported, other than participants’ use of the VR headset. Because of this, “…there was no ability to confirm pain diagnoses or analgesic prescription information,” according to the paper.

About 90% of users stuck with the program, which Stoudt attributed to years of work to make the headset easier to use.

In addition to seeking FDA clearance, AppliedVR plans to build a system into the headset that would capture users’ breathing rate, so that no other devices need to be connected for them to receive feedback while going through the program.

“We have a ton of scars on our back from a lot of things we’ve done wrong in terms of sending devices into the home,” he said. “Ease of use is going to be the biggest barrier to ultimate adoption.”

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