FDA approves new targeted breast cancer drug


WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.


The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.


Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.


"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."


Cobleigh helped conduct the key studies of the drug at the Chicago facility.


The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.


The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.


Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.


FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.


Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.


FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer


Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.


Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.


Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.


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Las Vegas Strip Shooting Suspect ID'd












Las Vegas police identified a suspect today in a shooting on the strip that caused a Maserati to hit a taxi and burst into flames, killing three people.


Ammar Harris, 26, has been named a suspect in the Thursday skirmish that killed three people, including rapper Kenny Clutch.


The altercation between Harris and Clutch, 27, whose legal name was Kenneth Cherry Jr., is believed to have originated in the valet area of a Las Vegas hotel, police said.


Police said Harris fired several rounds into a Maserati that was being driven by Cherry as both vehicles continued northbound on glitzy Las Vegas Boulevard.


The rapper's expensive sports car careened out of control after he was shot, slamming into several cars, including a taxi. The impact caused the cab to burst into flames, killing the driver, Michael Boldon and a female passenger. Witnesses said it looked like the car exploded.


"He was a number one guy," Carolyn Jean Trimble, Boldon's sister, told ABC News.








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"I looked out my window and I could see one vehicle down here on the corner of the intersection totally engulfed in flames," witness John Lamb told ABC News.


Boldon, 62, and his passenger, who has not yet been identified, were both killed, as was Clutch.


Timble said her brother loved driving his taxi around Vegas.


"He came to live with me in Las Vegas last year to help take care of our mother, and the first day he got here he said, 'I have to get a job.' The second day, I came home from work, and he said he got a job," she recalled.


"He says, 'You'll never guess what it is,' and I said, 'what,' and he said, 'taxi cab driver,' and we both fell out laughing," Trimble said. "He loved that job. He never complained. He'd come home and tell me stories about what happened, who he picked up."


Boldon was a single father who raised a 36-year-old son and was a new grandfather. His grandson was named after him, Trimble said.


"Of all the people to take from this earth," she said. "But I guess the Lord needed him."


A passenger in the Maserati was hit and sustained only a minor injury to his arm. Clutch died at University Medical Center.


His father, Kenneth Cherry Sr., expressed his grief for the loss of his son while speaking with ABC News.


"This is something you never really, really ever want to experience as a parent, to lose a child before you go," he said.


Harris is described as 5-foot-11 and 180 pounds. Anyone with information is asked to contact the Las Vegas Metro Police Department's homicide division.



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Hollande wants proper labels on meat meals






PARIS: France's president said Saturday he wanted to see proper labelling of meat in ready-made meals to avert a repeat of the scandal over horsemeat being passed off as beef.

"I want there to eventually be mandatory labels on the meat contained in prepared meals," Francois Hollande said while visiting an agricultural show in Paris.

"Until then, I will support... all initiatives for voluntary labelling" so that "consumers know the origin of the products they are consuming, especially meat."

A vast food scandal erupted in Europe in January after horsemeat was initially found in so-called beef ready-made meals and burgers in Britain and Ireland. It has since spread as far as Hong Kong.

French firm Spanghero has been at the heart of the scandal after it allegedly passed off 750 tonnes of horsemeat as beef, with the product eventually finding its way into 4.5 million "beef" products sold across Europe.

-AFP/fl



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Hyderabad blasts: CCTV image may provide breakthrough

HYDERABAD: The probe into Thursday's twin blasts, which killed 16 people and injured over 100, gathered momentum with the police scanning the image of a suspect captured on CCTV camera.

The investigators are scanning the images recorded on a Closed-circuit television (CCTV) camera mounted on a traffic signal near the blast site in Dilsukhnagar, police sources said.

A man believed to be in his early thirties was seen reaching the place on a bicycle with a bag hung to its carrier a few minutes before the blasts.

He was seen reaching the area at 6.38pm, 10 minutes before the blast at Anand Tiffin Centre in front of Konark theatre. The second blast took place at 7.01pm a few meters away. The bombs at both the places were planted on old bicycles.

The surveillance camera installed in front of Dilsukhnagar bus station captured the image of the suspect. However, as his face is not clearly visible, the police are taking the help of experts.

Though the CCTV camera is focused on the vehicles moving on the main road and not towards the corner where the blast occurred, the image of the suspect on bicycle could prove a vital clue in the investigations, sources said.

The police Friday announced a suitable reward for anyone providing information about the suspect. Cyberabad police commissioner D. Tirumala Rao said the identity of the person would be kept a secret. He said the reward could be anywhere between Rs.5 lakh to Rs.20 lakh depending on the investigations.

Meanwhile, the condition of eight of the injured remained critical. The injured are undergoing treatment at seven hospitals including state-run Osmania Hospital.

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FDA approves new targeted breast cancer drug


WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.


The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.


Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.


"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."


Cobleigh helped conduct the key studies of the drug at the Chicago facility.


The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.


The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.


Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.


FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.


Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.


FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer


Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.


Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.


Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.


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Cyberattacks Bring Attention to Security Reform











Recent accusations of a large-scale cyber crime effort by the Chinese government left many wondering what immediate steps the president and Congress are taking to prevent these attacks from happening again.


On Wednesday, the White House released the administration's Strategy on Mitigating the Theft of U.S. Trade Secrets as a follow-up to the president's executive order. The strategy did not outwardly mention China, but it implied U.S. government awareness of the problem.


"We are taking a whole of government approach to stop the theft of trade secrets by foreign competitors or foreign governments by any means -- cyber or otherwise," U.S. Intellectual Property Enforcement Coordinator Victoria Espinel said in a White House statement.


As of now, the administration's strategy is the first direct step in addressing cybersecurity, but in order for change to happen Congress needs to be involved. So far, the Cyber Intelligence Sharing and Protection Act (CISPA) is the most notable Congressional legislation addressing the problem, despite its past controversy.


Last April, CISPA was introduced by House Intelligence Committee Chairman Mike Rogers, R-Mich., and Rep. Dutch Ruppersberger, D-Md. The act would allow private companies with consumer information to voluntarily share those details with the NSA and the DOD in order to combat cyber attacks.






Peter Parks/AFP/Getty Images







The companies would be protected from any liabilities if the information was somehow mishandled. This portion of the act sounded alarm bells for CISPA's opponents, like the ACLU, which worried that this provision would incentivize companies to share individuals' information with disregard.


CISPA passed in the House of Representatives, despite a veto threat from the White House stemming from similar privacy concerns. The bill then died in the Senate.


This year, CISPA was reintroduced the day after the State of the Union address during which the president declared an executive order targeting similar security concerns from a government standpoint.


In contrast to CISPA, the executive order would be initiated on the end of the government, and federal agencies would share relevant information regarding threats with private industries, rather than asking businesses to supply data details. All information shared by the government would be unclassified.


At the core of both the executive order and CISPA, U.S. businesses and the government would be encouraged to work together to combat cyber threats. However, each option would clearly take a different route to collaboration. The difference seems minimal, but has been the subject of legislative debates between the president and Congress for almost a year, until now.


"My response to the president's executive order is very positive," Ruppersberger told ABC News. "[The president] brought up how important information sharing is [and] by addressing critical infrastructure, he took care of another hurdle that we do not have to deal with."


Addressing privacy roadblocks, CISPA backers said the sharing of private customer information with the government, as long as personal details are stripped, is not unprecedented.


"Think of what we do with HIPAA in the medical professions; [doctors do not need to know] the individual person, just the symptoms to diagnose a disease," Michigan Gov. John Engler testified at a House Intelligence Committee hearing in an attempt to put the problem into context.






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Syrian opposition says Assad cannot be part of deal


CAIRO (Reuters) - The opposition Syrian National Coalition is willing to negotiate a peace deal to end the country's civil war but President Bashar al-Assad must step down and cannot be a party to any settlement, members agreed after debating a controversial initiative by their president.


The meeting of the 70-member Western, Arab and Turkish-backed coalition began on Thursday before Syrian Foreign Minister Walid al-Moualem is due for talks in Moscow, one of Assad's last foreign allies, and as U.N. mediator Lakhdar Brahimi renews efforts for a deal.


After an angry late night session in which coalition president Moaz Alkhatib came under strong criticism from Islamist and liberal members alike for proposing talks with Assad's government without setting what they described as clear goals, the coalition adopted a political document that demands Assad's removal and trial for the bloodshed, members said.


A draft document seen by Reuters that was circulated for debate said Assad cannot be party to any political solution and has to be tried, but did not directly call for his removal.


"We have adopted the political document that sets the parameters for any talks. The main addition to the draft is a clause about the necessity of Assad stepping step down," said Abdelbasset Sida, a member of the coalition's 12 member politburo who has criticized Alkhatib for acting alone.


"We removed a clause about a need for Russian and U.S. involvement in any talks and added that the coalition's leadership has to be consulted before launching any future initiatives," he added.


Still, the agreement marked a softening of tone by the coalition because previously it had insisted that Assad must step down before any talks with his government could begin.


In an indication that Syria's strongman remains defiant, Brahimi said Assad had told him he will remain president until his term ends in 2014 and then run for re-election.


Brahimi told al-Arabiya television he wants to see a transitional government formed in Syria that would not answer to any higher authority and lasts until U.N.-supervised elections take place in the country.


"I am of the view that U.N. peacekeepers should come to Syria as happened in other countries," Brahimi said.


BOMB, AIR STRIKES


The opposition front convened in Cairo on a day when a car bomb jolted central Damascus, killing 53 people, wounding 200 and incinerating cars on a busy highway close to the Russian Embassy and offices of the ruling Baath Party.


Syrian state television blamed the suicide blast on "terrorists". Central Damascus has been relatively insulated from the 23-month conflict that has killed around 70,000 people, but the bloodshed has shattered suburbs around the capital.


In the southern city of Deraa near the border with Jordan, activists said warplanes bombed the old quarter for the first time since March 2011, when the town set in a wheat-growing plain rose up against Assad, starting a national revolt.


A rebel officer in the Tawheed al-Janoub brigade which led an offensive this week in Deraa said there were at least five air strikes on Thursday. The Syrian Observatory for Human Rights said 18 people were killed, including eight rebel fighters.


Coalition member Munther Makhos, who was forced into exile in the 1970s for his opposition to Assad's father, the late President Hafez al-Assad, said supplies from Iran and Russia were giving government forces an awesome firepower advantage.


"It would be surreal to imagine that a political solution is possible. Bashar al-Assad will not send his deputy to negotiate his removal. But we are keeping the door open," Makhos said.


Makhos is the only Alawite in the Islamist-dominated coalition. The Alawite sect, an offshoot of Shi'ite Islam which accounts for about 10 percent of Syria's population but makes up most of the intelligence apparatus and dominates the army and the political system, has generally remained behind Assad.


With Alawites feeling increasingly threatened by a violent Sunni backlash, Alkhatib, a cleric from Damascus who played a role in the peaceful protest movement against Assad at the beginning of the uprising in 2011, has been calling on Alawites to join the revolution, saying their participation will help preserve the social fabric of the country.


Alkhatib's supporters say the initiative has popular support inside Syria from people who want to see a peaceful departure of Assad and a halt to the war that has increasingly pitted his fellow Alawites against Syria's Sunni Muslim majority.


But rebel fighters on the ground, over whom Alkhatib has little control, are generally against the proposal.


The Syrian Islamic Liberation Front, which represents armed brigades, said in a statement it was opposed to Alkhatib's initiative because it ignored the revolt's goal of "the downfall of the regime and all its symbols".


"We are demanding his accountability for the bloodshed and destruction he has wreaked. I think the message is clear enough," said veteran opposition campaigner Walid al-Bunni, who supports Alkhatib.


Alkhatib formulated the initiative in broad terms last month after talks with the Russian and Iranian foreign ministers in Munich but without consulting the coalition, catching the umbrella organization by surprise.


Among Alkhatib's critics is the Muslim Brotherhood, the only organized group in the political opposition.


A Brotherhood source said the group will not scuttle the proposal because it was confident Assad is not interested in a negotiated exit, which could help convince the international community to support the armed struggle for his removal.


"Russia is key," the source said, speaking on condition of anonymity. "We are showing the international community that we are willing to take criticism from the street but the problem is Assad and his inner circle. They do not want to leave."


PLAY FOR RUSSIA


Russia hopes Alkhatib will visit soon in search of a breakthrough. Bunni said Alkhatib would not go to Moscow without the coalition's approval and that he would not be there at the same time as Moualem.


"In my opinion Alkhatib should not go to Moscow until Russia stops sending arms shipments to the Assad regime," Bunni said.


Formal backing by the coalition for Alkhatib's initiative gives it more weight internationally and undermines Assad supporters' argument that the opposition is too divided to be considered a serious player, opposition sources said.


Coalition members and diplomats based in the region said Brahimi asked Alkhatib in Cairo last week to seek full coalition backing for his plan, which resembles the U.N. envoy's own ideas for a negotiated settlement.


One diplomat in contact with the opposition and the United Nations had said a coalition approval of Alkhatib's initiative could help change the position of Russia, which has blocked several United Nations Security Council resolutions on Syria.


The diplomat said only a U.N. resolution could force Assad to the negotiating table, and a U.N. "stabilization force" may still be needed to prevent an all-out slide into a civil war.


"Brahimi has little hope that Assad will agree to any serious talks," the diplomat said. "Differences are narrowing between the United States and Russia about Syria but Moscow remains the main obstacle for Security Council action."


(Editing by Paul Taylor and Mohammad Zargham)



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"Argo" vs "Lincoln" in knife-edge Oscars race






HOLLYWOOD: Ben Affleck's Iran hostage drama "Argo" goes into Oscars weekend a whisker ahead of Steven Spielberg's presidential "Lincoln", but the race is one of the most unpredictable in recent memory.

Veteran director Spielberg, bidding for his first best picture Oscar since "Schindler's List" in 1994, tops the nominations with 12 nods -- but "Argo" has cleaned up in Hollywood's awards season so far, despite having only seven.

Although he started the season two months ago in front, Spielberg may have to settle Sunday for the best director award -- one that Affleck cannot beat him to, having not been nominated in the category, in a perceived snub.

But again here there could be an upset, with rivals including Taiwan-born Ang Lee for "Life of Pi", David O. Russell for "Silver Linings Playbook", or even Austrian dark horse director Michael Haneke for Cannes-topping "Amour",

One near-certainty Sunday is that "Lincoln" star Daniel Day-Lewis will be named best actor, a record third for the British-Irish actor after wins in 1990 for "My Left Foot" and in 2008 for "There Will Be Blood".

The diffident Day-Lewis, known for his meticulous preparation -- he spent weeks in a wheelchair before playing Christy Brown in "My Left Foot" -- has been modest despite repeatedly taking the stage for acceptance speeches.

"Members of the Academy love surprises, so about the worst thing that can happen to you is if you've built up an expectation," he said, after winning the Screen Actors Guild (SAG) best actor award last month.

"I think they'd probably be delighted if it was anybody else," he added.

For best actress, the early favourite was Jessica Chastain, playing a CIA agent hunting Osama bin Laden in "Zero Dark Thirty", but the clever money is now on Jennifer Lawrence for her turn in "Silver Linings Playbook".

Lawrence, star of the "Hunger Games" blockbuster franchise, has won praise for moving out of her comfort zone as mixed-up widow Tiffany to Bradley Cooper's recovering bipolar Pat, in the romantic comedy with an edge.

The best supporting actress race is more open, although Anne Hathaway is probably still the frontrunner for her heart-wrenching turn in musical adaptation "Les Miserables", which is also nominated for best picture.

The most unpredictable race of all is perhaps for supporting actor, with Hollywood legend Robert De Niro tipped by some for playing Cooper's father in "Silver Linings Playbook".

But strong rivals in the category include Austrian Christoph Waltz as a white bounty hunter who frees Jamie Foxx's black slave in Quentin Tarantino's blood-spattered "Django Unchained", as well as Tommy Lee Jones in "Lincoln".

On the foreign front, the clear frontrunner is "Amour", which won the Palme d'Or at last year's Cannes Film Festival for its heart-wrenching portrayal of an elderly couple coping with encroaching physical and mental illness.

Its French female lead, Emmanuelle Riva, could even cause an upset in the best actress category, some critics believe. If she did, she would be only the sixth performer to win an Oscar in a language other than English.

Riva, who will be 86 on Sunday, is coincidentally also the oldest ever best actress nominee, and up against a shortlist including the youngest ever nominee, nine-year-old Quvenzhane Wallis for "Beasts of the Southern Wild".

"Amour" is also among the nine films nominated for best picture, although it is not seen as a favourite there.

On a more colourful note, the best animated feature contest is widely seen as a battle between Scottish-themed princess adventure "Brave" and "Wreck-It Ralph", about a video game villain fed up with being the bad guy.

The fast and fun movie pays subtle homage to generations of computer games, in a feel-good story appealing to both mainstream cinema-goers and hard-core animation filmmakers at the Academy of Motion Picture Arts and Sciences.

-AFP/fl



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Govt has casual approach on terror: BJP

NEW DELHI: Accusing the government of having a casual approach on the issue of terror, the BJP said that it has "failed" to take effective steps to prevent blasts in Hyderabad.

"The government's response is not adequate to the burning issue of terrorism. Government is taking it in a casual and usual manner," BJP leader Venkaiah Naidu told reporters outside Parliament on Friday.

"This is a very serious issue. Series of bomb blasts are happening and especially in Hyderabad and the government is unable to take any effective step. Information in received that National Investigation Agency had mentioned Hyderabad, Bangalore, Maharashtra and other areas where there is possibility of such blasts," he said.

The BJP leader said NIA had given this information two days ago which was confirmed by Home minister Sushilkumar Shinde himself.

"It is a serious issue and the government is not prepared to discuss the issue. We want MPs to express their views and then home minister should give his statement."

Criticising Shinde for going to Hyderabad on Friday, Naidu said, "The home minister should have gone to Hyderabad yesterday itself after the incident and should have come back in the morning today. Government is ignoring Parliament."

The BJP leader charged, "The home minister is changing his stand very often. First he said there were intelligence reports on possible terror attack and later said there were no specific inputs."

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APNewsBreak: Govs to hear Oregon health care plan


SALEM, Ore. (AP) — Oregon Gov. John Kitzhaber will brief other state leaders this weekend on his plan to lower Medicaid costs, touting an overhaul that President Barack Obama highlighted in his State of the Union address for its potential to lower the deficit even as health care expenses climb.


The Oregon Democrat leaves for Washington, D.C., on Friday to pitch his plan that changes the way doctors and hospitals are paid and improves health care coordination for low income residents so that treatable medical problems don't grow in severity or expense.


Kitzhaber says his goal is to win over a handful of other governors from each party.


"I think the politics have been dialed down a couple of notches, and now people are willing to sit down and talk about how we can solve the problem" of rising health care costs, Kitzhaber told The Associated Press in a recent interview.


Kitzhaber introduced the plan in 2011 in the face of a severe state budget deficit, and he's been talking for two years about expanding the initiative beyond his state. Now, it seems he's found people ready to listen.


Hospital executives from Alabama visited Oregon last month to learn about the effort. And the U.S. Department of Health and Human Services announced Thursday that it's giving Oregon a $45 million grant to help spread the changes beyond the Medicaid population and share information with other states, making it one of only six states to earn a State Innovation Model grant.


Kitzhaber will address his counterparts at a meeting of the National Governors Association. His talk isn't scheduled on the official agenda, but a spokeswoman confirmed that Kitzhaber is expected to present.


"The governors love what they call stealing from one another — taking the good ideas and the successes of their colleagues and trying to figure out how to apply that in their home state," said Matt Salo, director of the National Association of Medicaid Directors.


There's been "huge interest" among other states in Oregon's health overhaul, Salo said, not because the concepts are brand new, but because the state managed to avoid pitfalls that often block health system changes.


Kitzhaber persuaded state lawmakers to redesign the system of delivering and paying for health care under Medicaid, creating incentives for providers to coordinate patient care and prevent avoidable emergency room visits. He has long complained that the current financial incentives encourage volume over quality, driving costs up without making people healthier.


Obama, in his State of the Union address this month, suggested that changes such as Oregon's could be part of a long-term strategy to lower the federal debt by reigning in the growing cost of federally funded health care.


"We'll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn't be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," Obama said.


The Obama administration has invested in the program, putting up $1.9 billion to keep Oregon's Medicaid program afloat over the next five years while providers make the transition to new business models and incorporate new staff and technology.


In exchange, though, the state has agreed to lower per-capita health care cost inflation by 2 percentage points without affecting quality.


The Medicaid system is unique in each state, and Kitzhaber isn't suggesting that other states should adopt Oregon's specific approach, said Mike Bonetto, Kitzhaber's health care policy adviser. Rather, he wants governors to buy into the broad concept that the delivery system and payment models need to change.


That's not a new theory. But Oregon has shown that under the right circumstances massive changes to deeply entrenched business models can gain wide support.


What Oregon can't yet show is proof the idea is working — that it's lowering costs without squeezing on the quality or availability of care. The state is just finishing compiling baseline data that will be used as a basis of comparison.


One factor driving the Obama administration's interest in Oregon's success is the president's health care overhaul. Under the Affordable Care Act, millions more Americans will join the Medicaid rolls after Jan. 1, and the health care system will have to be able to absorb the influx of patients in a logistically and financially sustainable way.


The federal government will pay 100 percent of the costs for those additional patients in the first three years before scaling back to 90 percent in 2020 and beyond.


"There are a lot of governors who are facing the same challenges we're facing in Oregon," Kitzhaber said. "They recognize that the cost of health care is something they're going to have to get their arms around."


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