Personalized Medicine – Can Its Full Benefits Be Realized If We Continue To Have Access Problems?‎

Much is being penned about the potential of personalized medicine and its promise of ‎better care for ‎individuals, according to this contributor.

OPINION -- Personalized healthcare is made possible in part by the ability of the healthcare ‎provider infrastructure ‎to work in tandem with an individual in a patient-centered cross-‎collaborative team model. The idea is ‎to focus on the patient and his or her care.  For ‎example, if a patient has diabetes, monitoring his or ‎her condition is important, along with ‎ensuring that the patient adheres to the applicable dietary, ‎medicaL and exercise regimen. ‎Today, this might be best accomplished utilizing mobile health ‎‎(mHealth) applications, whereby ‎certain of a patient’s vital signs may be transmitted through ‎telemedicine to the patient’s ‎healthcare team. The patient may receive reminders to take his or her ‎insulin, submit vital ‎signs, and when to come in to visit with a clinician. The patient also might access ‎educational ‎materials about his or her condition, side effects of medication and track his or her ‎condition.‎

Social media can be employed as a support group and an educational resource.  For ‎example, by ‎participating in social media sites where others of like maladies are participating, ‎one can “discuss” ‎certain issues he or she is having with others who might be in a similar ‎position. One might be better ‎able to locate resources he or she needs, and even learn of new ‎developments and advancements in ‎treatments, side effects, and other things before one’s ‎physician learns of them, but certainly before ‎these developments are in published research ‎studies.‎

The field of genomics makes it possible to further manage one’s healthcare.  By ‎identifying one’s ‎genetic makeup, clinicians can work toward a specific care management plan, ‎predict certain things ‎that might happen to an individual, and might even be able to design a ‎specific drug regimen for the ‎patient.  ‎

Much of the incentives for personalized medicine are made possible by the changing ‎nature of our ‎healthcare system. That is, as we move from fee-for-service payments to ‎payments for quality and ‎cost-effectiveness, there is a greater incentive to embrace ‎personalized medicine. When healthcare ‎providers and systems, such as Accountable Care ‎Organizations (ACOs) and Coordinated Care ‎Organizations (CCOs) can benefit financially by ‎providing better quality care in a more cost-effective ‎manner, they begin to employ more ‎cross-collaborative healthcare team models. Such models assist in managing the care of their patient populations. Not only is it important to provide ‎timely ‎healthcare interventions when needed, but it also is important to manage the ‎chronic ‎conditions of a system’s population and the individual needs of the most costly patients. ‎Personalized ‎medicine can result in better outcomes at lesser costs. With ACOs, CCOs, and like ‎models, much of the ‎financial benefits of personalized medicine can be realized by the ‎healthcare providers and hospital ‎systems.‎

The technology is here in many respects, although the lack of interoperability of many ‎electronic ‎health records (EHRs) continues to be a barrier. Many patients now even have ‎access to their personal ‎healthcare record (PHR) which they can use in helping to manage their ‎care. Substantial strides have ‎been made toward making personalized medicine available for ‎many.  ‎

We are working toward interfaces to improve interoperability, embarking on certain ‎cloud based ‎solutions to facilitate access to patient’s healthcare information and ‎condition by healthcare ‎providers and patients. However, the lack of access to certain ‎healthcare providers may well stymie ‎comprehensive efforts in personalized medicine.  A case ‎in point: as an individual with dual healthcare ‎coverage and a third supplemental plan, I ‎thought I would have no problem accessing a particular ‎specialty physician. I had contact ‎information for two of them. The earliest that I might be able to get ‎in to see one of them was ‎in 4½ months, and this was not in a rural area. It would be most ‎unfortunate if many of ‎the potential gains in healthcare that might be realized through personalized ‎medicine are not able to be realized because of the lack of access to certain healthcare providers.‎

Many newer physicians are choosing to work less hours. Many older physicians are ‎choosing to retire ‎and not take Medicaid patients. Last week, when I was in Seattle, I met with ‎a local physician who has ‎a concierge medical practice; that is, his members pay a fee for ‎access to him, and I understand he ‎does not bill insurance, and does not take Medicare or ‎Medicaid payments. Clinicians pursuing this ‎path also are not accessible to many of us, thus ‎further reducing the number of physician hours ‎available. There has not been the expansive ‎growth in medical schools and medical residencies in the ‎last 20 or more years as there has ‎been in law schools.‎

It would be quite ironic and unfortunate if the very advances in medicine, including ‎those in the ‎personalized medicine space, that might help make it possible to stem the rising ‎costs of health care, ‎might not be realizable, in part, because we have not addressed the access ‎problem.‎

‎ Paul R. DeMuro JD, CPA, MBA, MBI, Schwabe, Williamson & Wyatt, PC, National Library of Medicine, Post-Doctoral Fellow in the Ph.D. Program with Oregon Health & Science University.

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