Combining Precision Medicine and Precisions Diagnostics to Improve Outcomes

By Matt Phillion

Precision medicine and precision diagnostics are inherently linked, equal parts of a single, continuous system. And yet many organizations still treat them as separate steps, which can cost organizations time, money, and improved outcomes.

Bill Kerr, MD, co-founder and CEO of Avalon Healthcare Solutions, believes the industry is at an inflection point, where diagnostics are no longer just inputs for care decisions but are actively shaping the quality, timing, and value of care. This can:

• Enable earlier, more accurate diagnoses that guide care right from the start
• Allow for smarter test selection to reduce waste and close critical gaps in care
• Offer faster clinical decision-making for better outcomes and patient experiences
• Offer better alignment between diagnostic insights, treatment pathways, and value-based models

“I’d argue we’ve been using the phrase ‘precision medicine’ for way too long,” says Kerr. “It was originally just precision diagnostics and didn’t have any implication on the therapeutic decisions. We might be able to analyze your cancer and say you have these mutations, but you’d have the same chemotherapy treatment.”

We were able to say we knew what the diagnosis was, but it didn’t impact the type of treatment, Kerr explains. But as drugs come to market that target mutations that offer a much more targeted, better treatment, they can have fewer or less impactful side effects while having an even greater impact on the cancer.

“So with precision medicine, we finally have a reason to that precision diagnosis because you can make decisions about the treatment. It’s very exciting,” he says.

There are a few challenges that come along with this shift, Kerr explains.

“First, we know it can take almost 20 years to get a new treatment for patients adopted across the entire healthcare system,” he says.

The other challenge is one of logistics.

“When you’re doing analyses on something like a tumor, most tumors are biopsied and the surgeon or radiologist gets a piece of tissue, looks at it under a microscope, and determines if you have cancer,” says Kerr. “They then refer you to an oncologist. They can’t send the tissue off to a lab for a mutation analysis because the hospital owns the tissue. The pathology group has to release the tissue and let you send it to the lab to do a mutation analysis. Those are specialized labs and not something a hospital is ordinarily going to run.”

This siloing of care can create roadblocks to reaching that precision treatment decision.

“It’s very common,” he says. “And we understand the oncologist feels pressure to make a treatment decision because you’re in their clinic, and yet they feel hamstrung on getting the tissue sent for the analysis you need.”

Complexities in ordering treatments

There are a few ways that reaching that precision treatment can run into stumbling blocks, Kerr explains.

“Money matters in healthcare, so you have to follow the money,” he says. “Some of these newer therapies are pills prescribed by the oncologist but dispersed by the pharmacy. As opposed to routine chemo, which may be infused by the oncologist in their office and they make money off of that.”

Kerr uses the example of lung cancer because it’s a more mature cancer in terms of therapies targeting mutations. Non-small cell lung cancer, the kind more frequently found in non-smokers, is on the rise, especially in women between 40 and 60.

“There’s a dozen mutations that have drugs that target them,” says Kerr. “The national standard is that any time you take out tissue you should send it for mutation analysis. But 30% of patients do not get that. We’ll see biopsy results but never a mutation analysis.”

Part of that, Kerr explains, is that oncologists are under pressure to begin treatment. Oncologists can’t get ahold of the tissue sample and so they begin chemotherapy because they know how to give it.

“Then, of the two thirds who do get mutation analysis, 40% get the wrong drug based on the analysis,” says Kerr. “That’s harder for me to understand. It’s easier to understand when they have a mutation and routine chemotherapy is administered, because it’s convenient, or even lucrative for the oncologist. But when they have a mutation and they don’t request a targeted drug that’s harder to understand. Some results are hard to interpret, and in my opinion, labs focus on running the tests well, but they don’t focus on making the results easy to understand.”

Advancements in precision diagnostics

Meanwhile, precision diagnostics continue to evolve.

“We’re getting better and better at taking blood and finding you’ve got DNA floating inside it, and some of that DNA comes from the cancer,” says Kerr. “We can spin that sample down and use PCR testing, the same technology used to test for mutations.”

One upside to this is that oncologists are able to start this testing process with a blood draw in their office rather than dealing with the logistics of requesting tissue samples, Kerr notes.

“It’s called a liquid biopsy. It gives the oncologist greater control over the situation, and the labs that do this have done a good job of trying to make the results easier to interpret as well,” he says. “We’ve been focusing on bringing those labs into networks and getting those tests covered. The goal is to make it easier to do the right thing.”

We know there are clinical silos, Kerr explains. But technology is emerging that bridges the gap between those silos and knocks down some of those barriers.

“We need to find ways to get that information into EHRs, which is an interesting question,” he says. “I don’t want to overuse the phrase interoperability, but this data is out there and the electrons can communicate it between systems, but while hospitals tend to use something like Epic, outpatient practices don’t, they use Athena or something like that. We’re debating if we need to play a role between shuttling information between those two systems.”

More targeted therapies have downstream impacts that can help incentivize organizations beyond the patient experience: Lower side effects, and therefore less time in the hospital leads to lower cost of care as complication rates go down, Kerr notes.

“This creates an economic incentive that maybe motivates people to do this data-sharing themselves,” he says. “Routine chemotherapy suppresses the immune system, and the most common reason for cancer patients to go to the ED is a fever, in order to make sure they don’t have an infection. If you avoid this by giving these better drugs or treatments it can save money. The hope is that we can prove these economic synergies that can ultimately lead to better outcomes, reduced cost of care, and seeing those silos agree to stop siloing.”

Getting technology like liquid biopsies more evenly adopted puts the oncologist more in control of the tests they order and the decisions they can make.

“I think this is a big step to bridging the silo gap,” Kerr says.

The harder question is how to get hospitals to more routinely send out their biopsy materials. It might be easier to introduce new slab testing that they can get accustomed to acting on, Kerr explains.

“Oncologists draw blood every time you’re in the office, so wadding a test is pretty straightforward,” he says.

This isn’t just about treating one condition—it’s tapping into new science.

“It’s not just DNA we’re finding,” Kerr says. “You can look at proteins to help determine if you’ve had a concussion based on what’s found in your bloodstream. What we’re finding out about blood and what we can find about the other organs in your body—it gets easier and easier to measure organ function or mutations in DNA, in proteins. Blood is easy to access.”

The next few years should be an interesting time for evolution in care, Kerr says.

“We’ve proven these liquid biopsies should be covered. It’s got to be paid for,” he says. “We need to have folks educated on access to they know how to add that to blood draw tests.”

It’s not just an option for cancer patients, Kerr notes. Immunologists, gastroenterologists, rheumatologists and more can make strong use of this type of precision diagnostics and precision medicine.

He’s also confident that the associated technology is getting better at sharing information to enable clinicians to pair lab results with recommended guidelines. Emerging AI options as a tool to comb through outputs and guidelines to help physicians focus on the patient will also help open the door to these types of treatments.

“There are some silos that get their revenue in a certain way that will have to shift—those that draw revenue from ED visits, oncologists who will administer less chemotherapy,” says Kerr. “But net/net, the revenue will be going back through the system. We’ve had precision testing for a while now, but now we have precision medicine that’s matching up the tests with treatment options. I’m optimistic but we can’t wait 20 years to get it deployed.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.