Looking Forward: A CMO's Perspective on Healthcare Changes to Watch in 2016

January 21, 2016

Looking Forward: A CMO's Perspective on Healthcare Changes to Watch in 2016

Mapping the Genome

There’s so much happening in healthcare right now, it’s hard for me to narrow the important things to pay most attention to in 2016. Here are the top 5 changes in healthcare on my radar to track this year:

1) Co-architecting a new healthcare delivery system. 

Changing the current healthcare system to become more patient-focused and operationally efficient (i.e. more affordable, accessible and higher quality) is demanding closer partnership between payers and providers. As an example, one innovative approach that is incenting all parties to align more closely is the patient-centered medical home model, which is delivering higher quality patient care at lower costs. The medical home model enhances accessibility to physicians by providing comprehensive care at convenient onsite/near-site locations and via direct access 24/7 by phone or email. The approach is quickly gaining in popularity because of its high value to organizations in helping to systematically improve population health through evidence-based clinical processes and outcomes-based metrics while driving healthcare cost savings.

2) Genomics – gene mapping. 

The field of population genetics has changed dramatically with the recent advances in gene sequencing and screening technologies. This scientific work has been facilitated by the expanding field of genomics, which uses large databases for the purpose of studying genetic variation across many different organisms. 

The DNA sequence of the entire human genome was initially deciphered through The Human Genome Project (HGP). This project sequenced the DNA of each human chromosome from end to end, determined the DNA sequence of every human gene, and mapped the precise location of every human gene to a particular region of a human chromosome. After the study’s completion, researchers began to pinpoint locations within the genome that varied among individuals.   

In addition to the HGP, the HapMap Project focused its attention on mapping genetic variants in human populations worldwide. Through this project, researchers have begun to learn which variations are most common in certain regions of the world. This information will help explain human origins and disease risks as well as how they relate to environmental conditions. The HapMap database has also helped foster a new type of research in personalized medicine called the Genome-Wide Association Study (GWAS), which studies people with and without a particular disease. Scientists can use this information for comparisons between diseased and non-diseased groups of individuals to help determine which genetic variants co-occur with disease symptoms. With this information, statistical analyses can be used to help predict whether a certain gene is associated with a specific disease so individuals who may be at risk can be identified.

More recently, pharmacogenomics studies have aimed to better understand the genetic variations that influence individual response to drugs. According to the American Medical Association, knowledge of whether or not a patient carries any genetic variations can help physicians individualize drug therapy, decrease the chance for adverse drug events, and increase the effectiveness of drugs. Currently, research in this area is focused on genes encoding either metabolic enzymes that can alter a drug’s activity or defective structural proteins that result in an individual’s increased susceptibility to disease.

3) Direct to consumer advertising of prescription drugs may be ending. 

Direct to consumer (DTC) started in the early 1990s when drug manufacturers began targeting consumers to encourage their involvement in making health decisions. Since then, DTC advertising has become a popular promotional tool for many drug manufacturers.

This past November the American Medical Association’s House of Delegates voted to support a ban on DTC drug and medical device advertising – in response to the concern that marketing costs are adding to “escalating drug prices” and promoting demand for products but not educating consumers.

The U.S. Food and Drug Administration (FDA), which oversees the advertising of prescription drug products, had previously completed a physician survey to better understand how DTC prescription drug promotion affects the patient-doctor relationship. This survey along with two consumer surveys, also conducted by the FDA, showed that 58% of the respondents strongly agreed that the ads make the drugs appear better than they really are. Currently, the FDA is deciding on whether advertising rules need to be changed to ensure better consumer understanding of prescription drugs’ risks and benefits.

4) Physicians-in-training gaining knowledge in population health. 

Physicians-in-training are now learning about population health and clinical systems of care in school. This knowledge will help newly practicing physicians improve the health of their individual patients and communities. Their understanding of the connection between clinical and public health systems is critical to achieving improvements in overall population health in the U.S.

According to an Institute of Medicine Report Brief released in 2007, the committee made several recommendations for additional content areas for physician training in public health principles and practice at both the undergraduate and graduate levels. They recommended that every graduate medical education program should include relevant public health concepts and skills as well as employ faculty with appropriate public health training.

5) Advancement of medical informatics.  

Health and biomedical informatics, which includes information ranging from complete health records for individual patients to the sharing of data about disease outbreaks globally, are critical to the betterment of people’s health.  Population health requires systems engineering approaches to redesign care practices and integrate local, regional, national, and global health informatics networks. The future of informatics used on a personalized level rests on the development of a new system of distributed computing tools that will collect authorized medical data about people and store it securely with a network designed to help deliver quick and efficient care.

For example, the increased use of electronic health records (EHRs) is allowing more data to be captured from physician-patient interactions. In 2014, a pilot study was undertaken as a collaborative effort between IBM, Epic and Virginia Health System/Carilion Clinic to identify patients at risk for developing heart failure. The results were achieved through predictive modeling of data from Carilion Clinic’s EHRs, including “unstructured” data such as clinician’s notes and discharge documents (often not analyzed). The pilot applied content analytics and predictive modeling to identify at-risk patient with an 85% accuracy rate and identified another 3,500 patients that would have been missed with traditional methods. In the words of Steve Morgan, MD, Chief Medical Information Officer, Carilion Clinic, “We’ve learned that predictive analytics insights from both structured and unstructured data is imperative to meet our goal of improving patient care at lower costs”.

I hope these important changes in healthcare encourage you to think more about these advancements and how they impact patient care. If you’d like to discuss any of these topics, follow me on Twitter @jennybajajmd.

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