Customizing healthcare: How a new approach to diagnosis, care, and cure could transform employer benefits in a postreform world

1 | 2 | 3 | 4

pg. 4

Touchpoint 4:

Medical proving grounds

Advances in medicine are resulting in new medical testing grounds where patients can receive better care. Through collaboration and investment, some regions are making themselves medical proving grounds for a new generation of medicine that customizes care to the individual. That trend also represents a new type of medical tourism. Just as France is known for wine, and Switzerland for watches, biomedical centers are building global reputations in the new biological sciences. While medical tourism represents a small slice of overall delivery, medical proving grounds will attract patients, researchers, and providers looking for faster cycles from bench to bedside. Almost half of health leaders surveyed said they thought medical tourism would increase by 2015. However, while the previous trend in medical tourism was built on low cost, the new one will focus on the value that consumers place on coordinated research and care systems.

While medical tourism represents a small slice of overall delivery, medical proving grounds will attract patients, researchers, and providers looking for faster cycles from bench to bedside.

Another promising proving ground focuses on individual patients to create value centers around personalized medicine. The goal is to pair pharmacogenomics (the use of drugs for only those patients whose biologies will respond to them) with corresponding diagnostics in order to test for the biologics biomarkers that reveal whether a patient will respond to a given biologics treatment. In this way, biologics and a companion diagnostic (1) are used through clinical trials—involving only patients with the biologies to respond—and (2) are approved on parallel tracks. However, realizing the full potential of biologics will require a consolidated effort among all players shaping their development, including venture capital firms, pharmaceutical and large biopharmaceutical companies, drug regulators, and payers. (For a more detailed discussion of personalized medicine, see Personalized medicine.)

Governments that want to capitalize on centers of research and care for personalized medicine will need to reenergize drug development with the same vigor as other innovations, such as energy exploration and the build out of renewable energy generation. Increased government backing is one component. For example, the US stimulus funding in health information technology could build a vast electronic bioinformatics database at a time when phase III clinical trials in the US are estimated to cost $135 million to $270 million.11

The days of the winner-takes-all model in healthcare research funding may already be over, with the blockbuster drug model on the wane and US stimulus funding possibly facilitating a revived role in public financing. The onus of paying for basic research and drug development may well move to consortia of players.

In the realm of personalized medicine, employers are beginning to take an active role. They are becoming educated about the science and benefits of personalized medicine, consulting with experts and institutions at the forefront of advancing the new science. They’re also beginning to work with pharmaceutical and diagnostics companies to maintain current and accurate information on the clinical efficacy of personalized-medicine tests and treatments and then use the information to inform benefits policies and coverage decisions. At the same time, they’re working with insurers in the analysis of claims data so as to identify unmet needs that personalized medicine could address. And they’re looking at redesigns of reimbursement models that would focus on pay for performance.

Touchpoint 5:

Care-anywhere networks

The last touchpoint demonstrates how information technology is redefining access to healthcare. In this new model, mobile EHRs, telecommunications, and in-home and implantable devices will reduce the need to visit hospitals, nursing homes, and physician offices. No longer will people have to leave the comfort of their own homes for basic services, because virtual visits of all kinds will be available right at their fingertips. For example, using special wireless thermometers to take a child’s temperature and electronically transmit it to the doctor can spare some sick kids a doctor’s visit.

Wireless services that connect to all of a patient’s monitoring and safety devices have proved to be major accelerators of care-anywhere networks right now. For example, electronic intensive care units whereby physicians and nurses reach out to home-based patients via remote command-and-control centers are already in use. In addition, the development of cutting-edge devices continues. Currently in clinical trials in the US, Proteus Biomedical exemplifies the wave of the future. Proteus uses ingestible monitors that sense and record when a patient takes one or more microchip-enabled drugs. The technology runs on an electric charge generated by the patient’s stomach acid.

It’s reasonable to predict that increasing the distribution of service delivery via electronic health tracking will not only make the healthcare system more efficient but also make life easier for patients and their families. Ironically, though, the current payment structure raises a major barrier to the use of remote monitoring devices despite these advantages. But there is encouraging news on the funding front. Government financing around the globe is migrating from funding brick-and-mortar hospitals to funding virtual access points, broadband networks, and telemedicine. Here, too, employers can make their voices heard to support funding, adoption, and coverage of technology-based advancements. For example, they can start by looking at how their companies’ benefits plans handle home care via monitoring devices.

Additionally, it’s important to recognize that care anywhere is not only about remote access between physicians and patients. It can—and should— begin right in the workplace. Realizing the benefits of wellness initiatives, many employers are now embarking on wellness campaigns in the workplace. They are implementing wellness initiatives by establishing onsite clinics and fitness centers, holding health fairs, and offering reduced-cost gym memberships and weight-loss and smoking-cessation programs as benefits plan options, along with compelling incentives that encourage participation.

Spanning the entire spectrum: A new mind-set and approach

Employers are increasingly recognizing that their healthcare costs—private insurance premiums, absenteeism, workers’ compensation—amount to more than a cost center. Those costs are also investments that can be differentiators in the competition for talent.

While many companies have begun exploring wellness programs or work-site clinics, the impending transformation to customized care cuts across everything they do and everything they know. The transformation requires a whole new mind-set and a whole new approach to the designing of strategies and benefit plans.

The transition to patient-centered care will not be easy. Creating and sustaining the benefits stemming from the new model will require long-term strategies, cross-industry collaborations, and technical expertise.

Before companies can determine how best to position themselves to capitalize on the new health model, they must first understand how it will alter health services, treatments, performance metrics, payment, outcomes, and incentives. Many industry stakeholders—including self-insured employers—are now reassessing their roles, relationships, and priorities in light of impending change.

11 PwC, Pharma 2020: The Vision, 2008

1 | 2 | 3 | 4

pg. 4