Wednesday, April 7, 2010

Health Reform Lays Groundwork for New Era of Personalized Medicine and More Patient-Centered Health System

Embedded in the Health Reform package are some lesser known provisions that increase emphasis on prevention, positive health outcomes, better coordination of care and comparative effectiveness research that includes personalized medicine, paving the way for a new era of individualized care in a more patient-focused health system. Personalized medicine and patient-centered care will transform health care institutions by 2020, according to a new report by PricewaterhouseCoopers' Health Research Institute: Healthcast: The Customization of Diagnosis, Care and Cure (registration required for free download).

The report finds that between now and 2020, health systems will turn from reactive medicine to proactively understanding and supporting individuals in managing their own health. Many health systems say they deliver patient-centered care, but this research found only pockets in which this is evidenced. Health organizations remain too focused on their own organizations, not what’s best for the patient. Patient-centered care takes health systems out of their comfort zones, forcing them to integrate people, technologies and organizations that are not part of their current routines.

The analysis found that healthcare is playing catch-up to adopt innovations and trends in consumerism from other service industries such as automotive, retail and entertainment. It concludes that healthcare needs to become more adept at customizing health solutions to consumer-centric attributes and segmenting consumers beyond health status or disease group, looking at economic status, personal preferences and cultural barriers to change.

The report also outlines five areas where health systems can customize care and better engage individuals in managing their health.
  1. Coordinated care teams: Consumers want coordinated care. Integrated care networks that share information, care and accountability for patient outcomes are likely to become models for the future.
  2. Fluent navigators: Individuals lack the knowledge and skills they need to navigate the health system and understand their choices. In a patient-centered health system, there will be a growing need for consumer advocates beyond friends and family. PricewaterhouseCoopers sees the role of healthcare-fluent navigators being played by pharmacists, community workers and possibly the emergence of a new professional field much as financial planners emerged with the rise of consumer-directed investing.
  3. Patient-experience benchmarks: In a patient-centered health system, more attention will be paid to understanding and meeting consumer expectations. Many health systems already are tracking and publicly reporting on patient-centric metrics of care, such as cleanliness, wait times and physician satisfaction, allowing patients to make more informed decisions.
  4. Care-anywhere networks: The definition of access is being redefined by telehealth, wireless mobile devices, remote monitoring and new care delivery models that move care from hospitals, nursing homes and physicians' offices and into patients' homes, which increasingly are wired with networked devices.
  5. Medical proving grounds. Through collaboration and investment, some regions and other countries are positioning themselves to be medical proving grounds, or centers of excellence in medical innovation and care as a way to attract patients, researchers and providers looking for the shortest path to access and innovation.
Three key issues will force a change in today’s health model:

• Rising chronic diseases among young and old
• Technology-enabled mass customization
• Understanding of genetic, behavioral and socio-economic factors on health

Both young and old consumers are developing chronic diseases in record numbers, leading to an explosive consumption of resources that is driving up spending and creating liabilities for future generations.
Diseases that were once fatal are now chronic, which has brought extended life, but also extended spending. Most countries have not analyzed health spending by disease because of the siloed way in which they disperse funding and collect data. However, the rise in chronic disease is spurring health leaders to look across sectors at causal relationships of spending. For example, the World Health Organization’s Global Burden of Disease collects data that compares the impact of disease by country. While aging is often cited as a key driver of health spending, there is a growing concern that spending is increasingly spurred by generations of children facing costly chronic disease. For example, in Australia, respiratory diseases are the second highest driver of health spending. More than one-fifth of Australian children under age 16 have been diagnosed with asthma. On the other end of the age spectrum, neurological diseases, such as Alzheimer’s, show the fastest growth rate in Australia, estimated to increase more than 50% between 2003 and 2023. (See Figure 1.)
Figure 1

Another area is:
Technology is leading healthcare into a new era of “mass customization,” following other industries such as auto manufacturing, media and entertainment.
The results clearly demonstrate global trends in valuations of health systems’ attributes based on age and sex. The population aged 50 and over value high quality and personal attention, whereas younger populations value low cost and health education and wellness. Variations in valuations by sex were even more significant—men ranked high quality and personal attention above women, and women vastly preferred low cost and access compared to men. Response patterns by individuals also indicate a recognition that trade-offs between attributes occur, e.g., high quality over access, low cost over personal attention. (See Figures 2 and 3.)

And third factor identified is:
Chronic diseases are associated with social, economic, genetic and behavioral factors that are largely unaddressed by today’s medical delivery system. The delivery system must interface more effectively across society and with individuals regarding these factors to prevent, detect and manage diseases.
As Figure 4 shows, health leaders believe that individuals should play a larger role in managing their health. But they also believe that individuals need support and tools to do so: “The main responsibility for the prevention of disease falls on the citizens, with clear directives and adequate assistance from government agencies,” said Karam Karam, M.D., the former Lebanese minister of health.

Watch the video of Kelly Barnes: Challenges industry faces when diagnosis, care and cure are customized

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