Precision Medicine: Integration May Be Closer Than You Think

This article first appeared on Health Leaders Media, July 12, 2017.

By Philip Betbeze

Precision medicine is, ironically, an imprecise term.

As it is often used today, the phrase suggests that precision is novel to the practice of medicine, and to many, it means incorporating sophisticated genetic testing into its practice.

The term can even suggest that there are now possibilities of miracle cures that were never possible before.

Sometimes healthcare organizations encourage that attitude through their marketing and advertising, but to a degree, that kind of thinking more represents hype than substance.

And while genetic testing and the information it can provide can help better tailor treatment options for individual patients, especially in cancer care, experts say healthcare executives and clinicians must be careful not to encourage false hope among vulnerable patients and their families.

Yet in a time of rapid evolution of more precise and tailored treatment options, executives and clinicians are charged with divining the difficult calculus between the possible and the practical in their precision medicine organizational structure and service offerings.

In reality, precision has always been the goal of physicians as medicine has evolved over the past couple of hundred years, says Robert Mennel, MD, director of the Baylor Precision Medicine Institute in Dallas.

“In some areas we’re there. We have well-accepted tests for certain diseases that, if you’re not using them, I would consider to be malpractice in many situations,” he says.

However, even top-level academic medicine is still quite far away from being able to look at an individual’s whole genome and predict a therapy for every disease.

“But the promise of precision medicine is there, and medicine 10 years from now is going to be quite different than it is now,” he says.

One area where genetic testing is ready for prime time is in noninvasive prenatal testing, says Scott A. Beck, administrator of the Center for Individualized Medicine at the Mayo Clinic in Rochester, Minn.

“Uptake has been phenomenally fast with one of the first widespread applications of whole-genome technology: noninvasive prenatal testing,” he says. “Many women can now avoid amniocentesis. That’s a step forward for patients. It’s much less invasive and much less risky. We’ll see more of those over time.”

Another area where genomics is finding its way into therapy is cancer care, says Eddy Yang, MD, deputy director of the Hugh Kaul Precision Medicine Institute at the UAB School of Medicine in Birmingham, Alabama.

“There are targeted therapies available based on genomic findings, and we do find patients that have excellent outcomes with them,” he says. “At present, it is a small percentage of the cancer population that benefits.”

Precision medicine is developing fast, and opportunities are vast for organizations to incorporate it into their service lines.

However, because the demand for genetic and molecular testing currently outpaces reimbursement mechanisms, executives must consider how these diagnostic services will impact their cost and revenue structure—and their competitiveness—under various models.

It’s not an easy task.

“We work with 1,700 health systems with sophisticated lab operations, and our research suggests that anywhere from 30% to 40% of the tests may be the wrong test, over-ordered, or the right test that doesn’t get used in the right way downstream,” says Matthew Hawkins, president at Sunquest Information Systems in Tucson, AZ.

“So we’re big believers in the concept of diagnostic medical teams, especially in an anatomic pathology setting.”

Indeed, teamwork among clinicians is critical as precision medicine evolves. It must become cross-disciplinary and cross-functional in the form of the clinician partnering with the informatics experts, the information technology experts with the infrastructure team, and the oncologists partnering with the genetic counselor— thus breaking down traditional silos.

View the complete HealthLeaders Media Roundtable report: The Impact of Precision Medicine on Healthcare Business Growth Strategies.