Greater collaboration among health care stakeholders is considered one of the most effective solutions for improving clinical outcomes and reducing costs. Two recent developments affecting the practice of medicine — precision medicine and home genetic testing — will require stakeholders to talk to each other more than they ever have before.
President Barack Obama announced his precision medicine initiative in his State of the Union address in January. He subsequently requested $215 million in funding for the initiative in his fiscal 2016 federal budget proposal. Four weeks later, the personal genetics company 23andMe said the FDA approved its first direct-to-consumer genetic test, a home genetic test for Bloom Syndrome.
The timing of the announcements is unrelated, but the subjects of each are connected. The federal government and President Obama in particular have been very interested in medical advances and health care innovation. At the same time, consumers’ interest in their own health has never been greater. The convergence of interests lies behind both announcements.
Precision medicine and home genetic testing share another characteristic: The potential to dramatically change the traditional relationship between patients and providers and between payers and providers.
Precision Medicine Will Bring Patients and Providers Closer Together
Let’s start with the relationship between patients and providers. Historically, a patient doesn’t feel well and goes to the doctor or hospital for care. The provider makes an initial diagnosis based on knowledge, experience and diagnostic test results. The provider decides on a course of treatment based on evidence-based medicine protocols developed for all patients who have comparable symptoms and test results. More and more, this process includes the active use of clinical decision support tools.
Precision medicine takes that process to the next level by making diagnosis and treatment decisions specific to individual patients and specific to components of a patient’s disease based on molecular and genetic diagnostic tests performed on individual patients. With better information, providers can determine more explicitly the course of treatment that will work best on that specific patient based on his or her genetic makeup. That is the heart of precision medicine.
Interestingly, as scientific and precise as that process is, it will take subjective and personal relationships to make it work.
Take the patient-provider relationship. Patients with more serious health problems are beginning to expect customized treatment plans and not simply what’s best for most patients with the same clinical presentation. At times, providers must be able to effectively communicate to patients that certain treatments just won’t work for them.
Physicians must also anticipate that patients will begin arriving at their office with the results of a home genetic test. Patient access to online medical information has already affected the patient-provider relationship, often challenging the physician’s expertise. Home genetic test information will only magnify that dynamic.
Nevertheless, at the same time, precision medicine and home genetic testing are wonderful opportunities to draw patients and providers closer together. That’s the direction we hope it takes as both sides obtain more information. Sharing information and discussing treatment decisions that produce the best possible clinical results and health outcomes is a win-win for everyone.
When I was a practicing internist, that’s what happened with my patients who checked their blood pressure at home. Those who did were more compliant with their blood pressure medication and other interventions because they saw positive results and were provided with real data that we could share and discuss.
Payer-Provider Collaboration Needed to Share Precision Medicine Benefits
Precision medicine and home genetic testing will alter the payer-provider relationship, too. The first thing a payer wants to know is whether a particular molecular or genetic diagnostic test is reliable and, therefore, worth paying for as a covered health benefit. Does this test distinguish one treatment option from another? What are the test’s false positive and false negative rates? Are the test results correlated with treatment options and health outcomes? Are there a sufficient number of qualified clinicians available to interpret the results? In essence, is this test ready for prime time?
Assuming a molecular or genetic diagnostic test is reliable and relevant, the second question a payer asks is, “Isn’t all this additional testing going to cost a lot of money?” The answer is often yes. Molecular or genetic diagnostic tests can be quite expensive.
The total cost of a test must be understood in the context of the total cost of treatment. Before spending $100,000 or more on chemotherapy, it is helpful to know that a particular cancer is likely to respond. If a $2,000 test can determine whether a patient will respond to that course of treatment, then that’s money well spent. If the same test determines that a patient won’t respond to that course of treatment, that’s $100,000 not wasted on treatment that offers no clinical benefit to the patient.
On the other hand, how much money will be saved when a screening test identifies hundreds or perhaps thousands of people with a particular problem — and treatment for the problem starts when symptoms have not even surfaced yet?
Payer-provider collaboration is essential to answering all those questions. Providers — and I’m talking test vendors and clinical labs that perform the tests here — must be able to communicate the usefulness and reliability of their tests and their testing procedures to payers, ensuring scientific and clinical acceptance of their tests as well as securing reimbursement.
Payers, in turn, must be able to share suitable information with hospitals and doctors to use in their clinical decision making. One of the greatest barriers facing precision medicine and home genetic testing is getting everyone on the same page — getting clear, actionable information into the hands of the people who need it most: Patients and physicians. Provider-payer collaboration can help make that happen.
In the end, two of the latest technical advances in the practice of medicine — precision medicine and home genetic testing — will require the softer, less technical skills of communication and collaboration to make them work. I’m confident patients, providers and payers are up to the task.