Obesity, ACOs, and the "Lung on a Chip": RTI Health Research in the New Decade

"We are giving patients a meaningful voice in how medical technologies are evaluated"

RTI's health researchers kicked off the 2010's with two striking, and seemingly contradictory, findings. First, a 2011 study found that states spent upwards of $15 billion per year, from Medicare and Medicaid funds, on medical treatment for obesity-related conditions. And second, a survey conducted that the same year found that low-income Americans were scavenging from dumpsters, selling blood, and turning to crime to feed themselves in the tough economic climate after the bursting of the Internet bubble.

In 2012, with funding from the Defense Threat Reduction Agency, RTI began working with UNC-Chapel Hill to develop a sophisticated model that closely emulates the human lung. This 3-D in vitro cell culture—or "lung on a chip"—uses human cells to provide better information about how the human body responds to natural and bioengineered pathogens, and also to avoid pitfalls due to the physiological differences between animals and humans. This project was one of the first forays into "organ on a chip" technology, which is currently being pursued by research institutions worldwide.

In 2016, RTI's 20 years of work with Accountable Care Organizations (ACOs)—which create incentives for health care providers to voluntarily work together to deliver high-quality, coordinated care to patients while reducing costs—resulted in a groundbreaking announcement by the Center for Medicare and Medicaid Services (CMS). As the ACO initiative matured, CMS found, an increasing number of ACOs successfully generated savings above their minimum targets. In 2015, for example, 31 percent of Shared Savings Program ACOs generated savings above minimum savings targets, compared to 28 percent in 2014 and 26 percent in 2013, and ACOs that reported quality in both 2014 and 2015 improved on 84 percent of the quality measures reported in both years—results suggesting that ACOS delivered higher-quality care to more and more Medicare patients each year.

In 2016, RTI Health Solutions collaborated with the Medical Device Innovation Consortium to determine the benefit and risk tradeoffs Parkinson's Disease patients were willing to make for a potential new therapy, and to use that information in designing a clinical trial. This project represented the first time that patient preferences regarding benefits and risks had been used as an explicit means to set significance levels in a clinical trial design.

"This work represents a unique opportunity to make significant advances in three key areas - giving patients a meaningful voice in how medical technologies are evaluated, incorporating preferences into key product-development decisions, and demonstrating the value of patient input into clinical study design," says Brett Hauber, senior economist and vice president of Health Preference Assessment at RTI, who spearheaded RTI's part in the project.