Intermountain Trustee AN EMAIL BRIEFING FOR INTERMOUNTAIN HEALTHCARE TRUSTEES October 2019 INTERMOUNTAIN INITIATIVES Civica Rx’s first medication goes to patient at Riverton Hospital Drug costs less than half of what it had before The first medication produced by Civica Rx was given to a patient at Intermountain’s Riverton Hospital in early October. The drug, vancomycin, an IV antibiotic that’s been in short supply for years, costs less than half of what it had before. Drug shortages, specifically involving life-saving medications used in hospitals, have been affecting patients all over the country, which is why Intermountain joined with more than 40 health systems, representing more than 1,000 hospitals in 46 states, to form Civica Rx as a nonprofit drug company that will provide generic medications to hospitals at a fraction of the cost. “This is great news for patients in Utah,” said Dan Liljenquist, Intermountain’s senior vice president and chief strategy officer, as well as head of the board at Civica Rx. “Some drug manufacturers have been widely criticized for unwarranted and arbitrary price increases and for creating artificial shortages of vital medications for patients. These activities have resulted in some generic drugs increasing in cost by more than 1,000 percent in just a few months for seemingly no reason. Civica Rx aims to fix this problem.” Intermountain alone anticipates savings of more than half a million dollars over the next year by purchasing medication through Civica, Liljenquist said, and more savings are expected in the years to come. Vancomycin is only the first of many affordable drugs Civica will release. The company expects to announce the availability of another 15 products before the end of the year, including another powerful antibiotic called daptomycin that will be available shortly. Participating hospitals can expect to receive orders of vancomycin before the end of the month and daptomycin soon after. Another 40 medications are planned for release next year. Caregivers develop new cardio-oncology program Program designed for cancer patients at risk for heart problems Intermountain’s Cardiovascular and Oncology Clinical Programs have developed a new cardio- oncology program to help people who undergo cancer treatment and face increased risk of developing heart problems or who already had heart problems before their cancer treatment. Some cancer treatments, including radiation to the chest and certain types of chemotherapy, may increase the risk for heart disease. Heart complications can occur during cancer therapy or may develop decades after treatment. The Intermountain Cardio-Oncology Program team includes cardiologists, oncologists, and radiation oncologists who collaborate to provide comprehensive, coordinated care for people with cancer. The project was championed by cardiologist Mike McCulloch, MD, and oncologist Margaret Van Meter, MD, and was led by Heather Rayburn, vascular lab director at Intermountain Medical Center, Colleen Roberts, executive clinical director for the Cardiovascular Clinical Program, and Melissa Banner, RN, cancer services nurse director for the Oncology Clinical Program. The committee working on the project included imaging cardiologists, medical and radiation oncologists, education partners, communication partners, and data manager and analysts from both clinical programs. One of the most important services provided by the new program is consultations before cancer treatment begins to help assess a patient’s risk for heart complications, especially for people who have a history of, or risk factors for, heart disease. Cardiologists can make recommendations to oncologists to minimize potential heart toxicity from cancer treatments. Additionally, during and after cancer treatment, the team can provide a plan for monitoring heart function, evaluate symptoms that might suggest heart problems, and manage any heart complications that may arise. “It’s important to note that most chemotherapy medications don’t usually affect the heart,” said Dr. Van Meter. “The risk of heart problems is related to which chemotherapy medications are received, and the risk with those medications is higher for patients who are over age 60 or have other pre-existing conditions that affect the heart, such as such as high blood pressure, high cholesterol, or obesity.” Intermountain is one of only a handful of healthcare networks in the nation that currently offers a cardio-oncology program to patients and physicians. Currently, the Cardio-Oncology program is available at Intermountain Medical Center and LDS Hospital. Intermountain is working to expand the program across the system. UPDATES AND FEATURES Statewide suicide awareness campaign to launch Campaign meant to engage every level of Utah’s community A $2 million campaign to change stigmas about mental health in Utah was announced in September by officials from Intermountain Healthcare and government and community leaders. “We’ve all had a personal journey with this issue,” Lt. Gov. Spencer Cox said at a news conference outside the State Capitol. “All of us have been impacted in some way, whether it’s family members, friends, loved ones, or people in our community who’ve been impacted by suicide. And so while we recognize that the government can’t solve all of our problems, there’s a critical role for government to play in this space.” The campaign will launch in mid-2020 and is meant to engage every level of Utah’s community, Lt. Gov. Cox said. It will include content on TV, radio, print, social media, and other outlets. In addition to $1 million contributed by the Utah Legislature, private sector donations for the campaign came from Intermountain Healthcare, The Church of Jesus Christ of Latter-day Saints, doTERRA co-founders Greg and Julie Cook, Rocky Mountain Power, University of Utah Health, the Utah Shooting Sports Council, and about $25,000 from individuals who made donations through their tax returns. “We hope this campaign will advance and modify attitudes and social norms to demonstrably reduce suffering and save lives,” Lt. Gov. Cox said. Mikelle Moore, Intermountain’s senior vice president of community health and chief community health officer, said the issue of suicide prevention is so large it takes an entire community to address. “We need faith leaders and concerned businesses and schools to all work together if we’re going to make an impact and truly prevent every suicide,” she said. More than awareness will be required to truly make changes, but awareness is a good place to start, Moore said. “I think awareness is the first step, including understanding the warning signs and knowing our suicide rates are high. And yet, that awareness doesn’t translate into something that makes a difference in the outcomes. We can each be more conscientious about looking for warning signs and locking up firearms so someone in a crisis doesn’t have access to them in our homes or in our friends’ homes,” she said. “Every single death by suicide is preventable,” Lt. Gov. Cox said. “All of these deaths of despair are preventable, but it’s going to take all of us working together.” Congress praises work to prevent suicides by firearms Intermountain’s Community Health program director speaks at hearing Intermountain’s work to prevent suicides involving firearms was featured at a recent congressional hearing in Washington, D.C. The U.S. House of Representatives Ways and Means Subcommittee brought together public health experts from across the country to discuss the consequences and costs of gun violence. Morissa Henn, Intermountain’s Community Health program director, testified about the link between suicides and firearms and presented what Utah is doing as a model for the nation. During her presentation, Henn spoke about how firearm deaths account for half the suicides in the U.S—and 85 percent of the suicides in Utah. “We know that reducing access to lethal means for those who are at risk of suicide is a proven, effective tool for prevention,” Henn told the subcommittee. “Suicide rates decline sharply when there’s time and distance between people at risk for suicide and access to firearms.” A coalition of different groups in Utah are collaborating on suicide prevention and lethal means reduction, Henn said. “We’ve been fortunate to join a coalition of health professionals, gun owners, and other stakeholders who are working together to prevent firearm suicides in Utah,” she said. “Building productive, trusting relationships with gun owners on suicide has connected the data with culturally-relevant messages regarding access to firearms.” She shared examples of approaches used by Utah’s suicide prevention coalition, including training to help clinicians intervene with high-risk patients, research related to firearms and suicide, Utah’s Safe Harbor Law, and a new $2 million media and education campaign that addresses the issue of suicide and how reducing lethal means access can save lives. “While we don’t fully know whether the interventions in individual states like ours impact suicidal behavior, the short-term wins have created momentum,” said Henn. “We’re optimistic that such efforts, at scale, will ultimately contribute to reductions in suicide rates.” Lawmakers in the hearing said they were impressed to see meaningful results from Intermountain’s work in Utah. “Listening to this entire conversation really brings it home,” said Rep. Jackie Walorski from Indiana. “I’m really impacted by the fact that you’re actually talking about a community that has brought shareholders to the table, with gun owners and health professionals coming together to talk.” Henn said at the hearing, “By moving outside of our comfort zones we’ve been able to find a common denominator: We’re all universally horrified there are so many gun deaths, and we all want our loved ones to be safe. We’ve found a level of trust with different groups, including gun owners, because neither side has a monopoly on grief from losing a loved one. It doesn’t matter how you feel about the issue of guns or whether you own guns, there’s that common horror.