Stem cell therapy could offer new hope for defects and injuries to head, mouth

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Health insurers offer patients the option of paying extra for higher-priced care

When consumers and employers pick health plans, some increasingly are being offered a trade-off these days: They can get a hefty break on their premiums if they agree to pay more out-of-pocket when they use certain high-cost providers in their network or if they cut those providers out of their network altogether.

Blue Cross Blue Shield of Massachusetts this year introduced a "Hospital Choice Cost-Share" option. It tacks on extra charges when patients get certain services at 15 hospitals that the insurer says have higher costs than other providers. Patients pay an extra $1,000 for inpatient care or outpatient surgery at one of these hospitals, for example, and an extra $450 for high-tech imaging services.

Among the hospitals on the high-cost list are Harvard teaching hospitals Massachusetts General and Brigham and Women's in Boston as well as UMass Memorial Medical Center in Worcester.

Small businesses and individual policyholders who choose the new option can expect their premium increases to be reduced by half, to about 5 percent, says Jay McQuaide, a senior vice president at the insurer. "We believe our members can get the same quality of care in the lower-cost, high-value category," he says.

A report last year by Massachusetts Attorney General Martha Coakley found that although the prices negotiated between hospitals and insurers for services varied considerably, there was no correlation between higher prices and better quality of care.

Insurers say that businesses and individuals are increasingly interested in so-called "narrow" or "select" or "preferred" network plans. Like the BCBS of Massachusetts option, insurers generally first evaluate providers based on quality benchmarks. Those that meet standards are then segmented based on cost. Depending on the plan, pricier providers either don't make it into the network or are placed in tiers with higher out-of-pocket charges for consumers who use them.

Thomas Lee, a physician and the network president for Partners HealthCare, an integrated health-care system founded by Massachusetts General and Brigham and Women's hospitals, doesn't argue that people have to pay higher rates to get good care. Products such as Blue Cross's hospital choice option push providers to become more efficient, he says. "I don't think that's a bad thing."

The potential downside, he says, is that more-expensive hospitals often use the higher payments to subsidize less lucrative services, including burn units and pediatric mental health. When the market puts pressure on those higher payments, "what inevitably happens is that institutions look at what they're subsidizing and ask whether they can keep this going," he says.

That's a valid argument, but only up to a point, says Ha Tu, a senior health researcher at the Center for Studying Health System Change. "The difference in rates is not nearly explained by the subsidization of less profitable services or the teaching mission," she says.

For patients, the potential downside is that they may lose access to their doctors if they or their employers choose a plan with a narrower network. A doctor who only has admitting privileges at one of the higher-cost hospitals might not be a good choice for someone with the new Blue Cross plan, for example.

"The biggest thing is to educate consumers so they know what they're getting into," says Suzanne Curry, policy coordinator at Health Care for All, a Massachusetts-based consumer advocacy group.

In Minnesota, some people insured through HealthPartners have been getting an education in the new trade-offs. Last year the insurer introduced a network called Perform, which had only one difference from its other products: It excluded the Mayo Health System and its vaunted Mayo Clinic in Rochester. If any of the 34,000 customers in the Perform network want to include Mayo, their premiums could increase by up to 20 percent, says Andrea Walsh, executive vice president at HealthPartners.

Is it worth it? It depends on the situation. Barbara Gurstelle's older sister, Sally, died several years ago at age 50 after struggling for years with von Hippel-Lindau syndrome, a rare genetic disorder that causes abnormal blood vessel growth. Mayo Clinic doctors were the ones who finally were able to diagnose her illness. Over the years she received treatment elsewhere, but she returned to Mayo every so often for a workup. "It really contributed to her understanding of the disease," says Gurstelle, who lives near Minneapolis.

On the other hand, as a principal at a mid-size IT consulting firm who has taken part in trying to find affordable health insurance for the company, Gurstelle says she might be willing to accept Mayo as an out-of-network provider if the cost differential was big enough.

Her employees might agree. "Over time, employees faced with high out-of-pocket costs have become more willing to trade off some choice of providers for cost savings," says Tu.

Besides, networks aren't everything. "Most people want the option to go to Mayo, but if [a disease is] that bad a thing, you're going to find the money to go there anyway," Gurstelle says.

This column is produced through a collaboration between The Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail questions@kaiserhealthnews.org.

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New materials offer solutions to energy production challenges

New materials will have a central role in many of the energy applications of the future. For instance, inexpensive and environmentally friendly thermoelectric materials will be capable of converting waste heat into electricity in both homes and factories in the future.

Nearly all of the new inorganic materials being developed at the Aalto University School of Chemical Technology involve energy - its production, transfer, or storage - in one way or another. New superconductors, as well as materials used in lithium ion batteries, solid oxide fuel cells, and oxygen storage, among other things, are being developed at the laboratory of Academy Professor Maarit Karppinen.

Other interesting projects are the thermoelectric materials being developed at the laboratory, which are capable of extracting electrical energy from waste heat originating from various sources. In future visions these materials will be producing energy in places such as the walls of homes, solar panels, car exhaust pipes and the heat exchangers of power plants. They can also be used as sources of electricity in mobile devices or in cardiac pacemakers, for instance.

'Thermoelectric materials can be used in both small consumer applications as well as large industrial institutions in the production of electricity from waste heat', Karppinen says.

Common to all of the materials developed in the laboratory is that they are based on oxides, which do not damage the environment. Also, they contain inexpensive and easily-available materials, such as zinc, titanium, and iron, instead of costly precious metals.

Hard work and pure coincidence

Karppinen's laboratory engages in pioneering basic research in which the goal is the development of completely new materials. The application point of view is always in the background, but it is not necessarily the primary consideration.

'We try to find compounds and entire families of materials that nobody else in the world has managed to produce yet', she says.

She says that in addition to persistent research , coincidence has had an important role in the work.

'A new material that has been developed into a superconductor has sometimes proven to be a good thermoelectric material, and vice versa. A new kind of cobalt oxide which was supposed to be a promising thermoelectric material proved to be uniquely suitable for the storage of oxygen.'

This is possible because the materials being researched are typically mixed oxide materials which can be used for a number of different applications. 'The materials that I have studied have remained similar over the years, but the variety of their applications has kept growing', Karppinen says.

She studied oxide superconductors already for her doctoral dissertation, which was completed in 1993. After that, she went to Japan, to the Tokyo Institute of Technology, where she spent a total of ten years. In the last five years of this period she served as an assistant professor.

'We continue to cooperate closely. Japan is one of the main players in the development of oxide materials.'

An open-minded approach produces results

The application of different methods of synthesis is a key part of the practical work of a laboratory.

'To find something completely new, it is necessary to have the courage to experiment with production methods that nobody else has ever tried before', Karppinen explains.

For instance, her laboratory has produced oxide materials under ultra-high pressure - in the same kinds of conditions that turn graphite into diamonds. Another important method is atomic layer deposition, or ALD, in which materials are produced as thin films, one atom at a time.

'Some materials will only become stable when they are made in thin film form', she says.

Half of the approximately 20 researchers in Karppinen's laboratory produce materials in the form of thin films, and the other half produce them as powders. Researchers have also used ALD technology to produce new types of hybrid materials combining organic and inorganic layers of atoms.

However, it will be a long time before the materials will have commercial applications.

'Closest to it are thermoelectric materials. They have a very wide range of potential applications', she observes.

Karppinen's role model is Professor John Goodenough of the University of Texas at Austin. At the age of 90, he is still continuing his long career as one of the most important researchers in his field. In the late 1970s he and his small research group developed a lithium ion battery which was taken into commercial production by Sony in 1991.

Karppinen says that this is typical of the time frame from the discovery of a new functional material to its commercialisation.

'Significant discoveries do not necessarily emerge in big laboratories alone. We also have possibilities for practically anything', she says.

Provided by Aalto University

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Versatile ceramics offer new directions for emerging applications

(Phys.org) —Research into a versatile class of material, the MAX phases, with a large variety of potential high-temperature and low-friction applications by Dr. Miladin Radovic, his group, and collaborators was featured on in the April 2013 issue of the American Ceramic Society Bulletin.

The cover of this issue showed micrograph of MAX phases by materials science and engineering student Liangfa Hu. Radovic is an associate professor in the Department of Mechanical Engineering, where he was named a Herbert H. Richardson Fellow, and is on the faculty of Materials Science and Engineering.

Carbides and nitrides with a layered structure, MAX phases and offer the ability to finely tune materials properties according to the article, "MAX Phases: Bridging the Gap Between Metals and Ceramics."

"MAX phases are elastically stiff, good thermal and electrical conductors, resistance to chemical attack, and have relatively low thermal expansion coefficients. Mechanically, they are relatively soft, and most are readily machinable," according to the article by Radovic and Drexel University's Michel W. Barsoum.

MAX phase materials can be fabricated as bulk materials, powders, porous foams, and thin films, and offer high temperature stability, thermal and shock resistance, crack-healing capabilities, damage tolerance, good machinability, and exceptional oxidation resistance, they lend themselves to high-temperature applications, such as heating elements, gas burner nozzles, and industrial die inserts, high-temperature foil bearings, glove and condom molds, and dry drilling of concrete.

Provided by Texas A&M University

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