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