As these two seemingly unrelated “buzzwords” emerge and evolve, is it possible they co-exist to achieve optimal value-base medical care? How can the pharmaceutical industry thrive in a healthcare market focused on these concepts?
Over the past decade, the U.S. healthcare system has been enduring a dramatic evolution as it shifts from volume-based to value-based medicine. Simultaneously, healthcare costs continue to rise steeply. With costs on track to go from $2.9 billion ($271.1 billion in Pharma Industry) to $5.2 trillion by 2023, the entire system is under intense pressure to deliver better outcomes and find more cost-effective solutions.
In 2008, a Health Affairs article concluded that improving the U.S. healthcare system required “simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capital costs of health care.” The development of this “Triple Aim” essentially propelled the concept of population health.
The realization that a healthier overall population will maximize patient satisfaction and minimize resource consumption has driven the emphasis on population health management. The shift to population health is a messy one as organizations navigate and adapt to a new systemic approach.
While there are numerous definitions of population health, Rita Numerof offers one with the most current application. She writes that population health is “focused on managing the health of a defined population by providing the right intervention for a specific patient at the least costly point in the care continuum.”
The goal of population health management is twofold: 1) better health, better outcomes at a lower cost and 2) keeping patients out of acute care setting to keep costs low.
In order for population health management to achieve its goal, populations need to be specified. The specification of a population ideally should go beyond geographic location or even enrollment in a health plan. Factors such as socioeconomics, disease states, and health habits come into play.
As the 2008 Health Affairs article pointed out, “Only when the population is specified does it become, in principle, possible to know about its experiences of care, its health status, and the per capita costs of caring for it.”
Genomics in medicine arose in the mid-1980s as “the study of all of the nucleotide sequences, including structural genes, regulatory sequences, and noncoding DNA segments, in the chromosomes of an organism.” In 2003, the U.S. Department of Energy and NIH completed the Human Genome Project. The initial hope of the project was to pinpoint specific genes that cause common diseases. However, scientists have discovered a complexity of genes with multiple genes interacting and different factors affecting gene expression.
Used interchangeably, the concepts of precision medicine and personalized medicine arose from advances in genomics. The aim of precision medicine is to customize healthcare, with decisions and treatment tailored to each individual patient.
In 2013, the FDA published Paving the Way for Personalized Medicine: FDAs Role in a New Era of Medical Product Development. The FDA defines personalized medicine as “the tailoring of medical treatment to the individual characteristics, needs and preferences of each patient.” This article points out that “advances in a wide range of fields from genomics to medical imaging to regenerative medicine, along with increased computational power and the advent of mobile and wireless capability and other technologies, are allowing patients to be treated and monitored more precisely and effectively and in ways that better meet their individual needs.”.
As genomics evolves, so does the concept and promise of precision medicine. The information learned through genomics is transforming healthcare. With the implications on treatment of disease and promotion of wellness, the belief is that genome-based medicine – precision medicine — is the future of healthcare.
Integration of Population Health & Precision Medicine
Ideally, population health and precision medicine will work in tandem to improve healthcare outcomes while containing costs. The Healthy People 2020 initiative states the “genomics topic area and objectives for 2020 reflect the increasing scientific evidence supporting the health benefits of using genetic tests and family health history to guide clinical and public health interventions.”
While most of the benefits in genomics to this point have focused on individual benefit, evolving scientific findings can positively affect the health and well-being of populations.
“Public health genomics” is an emerging field that “assesses the impact of genes and their interaction with behavior, diet, and the environment on the population’s health.” Information culled from relationships between genetic traits and diseases across populations will allow for targeted, population-based interventions and result in health promotion and disease prevention in populations.
Many health organizations are now working on collaborations that build on the promise that precision medicine will boost the ability to manage and optimize the health and wellness of the populations treated.
Integrating precision health and population health has the potential to increase understanding of disease, improve public health, reduce health disparities, and, in the end, greatly decrease healthcare costs.
Implications for the Pharmaceutical Industry
Pharmaceutical companies have an opportunity to thrive in the rapidly evolving healthcare market. There are several implications for the industry adapting to an approach that integrates population health and precision medicine.
- Addressing the needs of the current healthcare market – demonstrating a deep understanding of provider issues and clearly showing how pharma provides value both clinically and economically.
- Contributing to value-based medicine – developing drugs based on precision medicine potentially offers a preventive approach to treatment and a decrease in the trial and error that exists for current drug treatment protocols. Many diseases have genomic expressions that can guide clinical decisions and define populations before diseases present.
- Strengthening partnerships with providers – a CAHG study found that 90% of physicians want to know more about precision medicine and over 70% would like to learn more about it from pharmaceutical companies. Only 20% claim to receive information about precision medicine from pharmaceutical companies.
- Contributing to the care continuum – developing strategic relationships with providers through the offering of drugs that cost-effectively prevent, manage and treat disease.
- Accelerating drug research lifecycle – Clinical trials can potentially be conducted more efficiently as genomics allows researchers to identify or disqualify patients and better collect patient response to drugs. Adding fuel is the recognition that precision medicine allows for earlier diagnosis of patients, advancements in the field of genomics, and high-level support such as President Obama’s Precision Medicine Initiative.