Wendy Whittington M.D. Physician Executive Dell Services
Tailoring Precise Treatment to Individual Needs Can Improve Outcomes and Reduce Waste
There is much enthusiasm these days around precision medicine, and it’s very exciting to see effective individualized care delivered to patients based on their genomic information. I can’t understate the importance of giving the best care possible and avoiding potentially toxic treatments for patients by knowing that a particular medication may or may not be effective for that individual. This science is growing rapidly and many patients stand to benefit from it.
Think of the exponential benefits we might see if we were to layer a personalized element onto this young but already successful field. If my patient’s genomic make up is such that drug X is the scientifically obvious choice to shrink her tumor, but drug X needs to be taken in a precise fashion that will never work with my patient’s lifestyle and diet, then I have more work to do.
Wouldn’t it be powerful if we could layer lifestyle and other factors on top of our scientific knowledge to really get it right? That’s the idea behind shared decision making, in which patients and their doctors together weigh the pros and cons of treatments and craft plans of care that meet the individual needs of each patient. As we amass medical data, our understanding grows of how patients’ outcomes are affected by various treatments. Combining this knowledge with genomic data and individual patient preferences holds great promise for better outcomes.
While some consider personalized and precision medicine synonymous, I would argue that personalized medicine is a broader term and will continue to expand in breadth, including the incorporation of shared decision making.
President Obama clearly meant “precision medicine” in its purest form when he announced a $215 million biomedical research effort earlier this year. This includes collecting genetic data on a million Americans with the hope of gaining insights into the causes of diseases and how to treat them. The initiative’s bipartisan support indicates a readiness to move forward with this tangible science.
Regardless of semantics, both precision and personalized medicine, with shared decision making, are very good for individual patients. But is it good for keeping populations healthy and controlling healthcare costs? I think it can be.
First Step: Get a More Complete View of Each Patient
To give the most specific, patient-directed treatment, we need to know more about our patients than we do now. We will need to know things like how often our patients are eating burgers and fries, what their social networks are like and how they spend their free time. Too intrusive? Patients are increasingly willing to share personal details if that data can be used to improve care. In a recent NPR poll, 68 percent of 3,000 people surveyed would be willing to share personal information with researchers and doctors. Other surveys have had similar results, and the younger the respondents, the greater the willingness to share.
Vast amounts of personal information is being shared on social media, and in this era of big data, there is a reasonably good chance that we have the technology to be able to pull this resource into a medical decision-making matrix. We now have massive amounts of data about patients that, in the past, we wouldn’t have considered relevant.
An Opportunity to Improve Care and Lower Costs
According to the Institute of Medicine’s 2012 Report, “Best Care at Lower Cost,” we wasted 30% of the $2.5 trillion spent on healthcare in 2009— about $765 billion. About $210 billion was in unnecessary services (services used too frequently, defensive medicine and unnecessary use of high-cost services), $130 billion was in inefficiently delivered services (medical errors, uncoordinated care and inefficient operations) and $55 billion was in missed prevention opportunities.
It is too early to really know the true cost benefits from utilizing personalized precision medicine, but it is reasonable to assume that there is waste to be avoided. On a small scale, both the system and the individual will save money by avoiding a situation where a patient fills an expensive prescription but doesn’t comply with the medication dose and timing. If a personalized plan can target a medication regimen that the patient will follow, we can avoid waste and likely get a better outcome. With waste in excess of $765 billion, even a small fraction of avoidance is very helpful
Predictive data analytics can be used to further refine care and, as the cost of aggregating and combing all of this data decreases, we’ll be able to incorporate this tool into standard clinical care. If healthcare providers can target specific treatments based on a patient’s genomic make up, personalized with added knowledge about that patient’s diet, habits, socioeconomic status, and more, we will waste less time and money on ineffective treatments. So personalizing precision medicine can help improve outcomes and reduce healthcare costs.
Using the Data to Benefit All
While we are at the task of aggregating all of this data on our patients, we can put it to uses beyond targeting treatment for a single individual. We can begin to identify patients at highest risk for exacerbation of chronic diseases, inappropriate visits to emergency rooms, failure to get appropriate screening tests, vaccines and so on.
We have long heard that the U.S. has the best healthcare in the world, a claim that is belied by the health of our population and our total spend. The promise of combining precision medicine, personalized medicine, shared decision making, and data analytics gives me great hope that we may soon be able to live up to that claim. Individualizing care, minimizing waste, and focusing on keeping populations healthy can all be achieved with this combination of tools
Wendy Whittington, M.D. (firstname.lastname@example.org), is a physician executive, healthcare and life sciences at Dell Services.