How precision health is transforming care coordination strategies: Q&A with hc1's Brad Bostic

Faced with escalating costs of care and administrative requirements that take away from their patient face time, providers are turning to precision health technologies to adopt more proactive and personalized care strategies.

The shift to using data analytics and remote monitoring technologies to better track patients' health over time is emerging as a new way to curb costs because it allows providers to catch patients' conditions and illness before they escalate.

Here, Brad Bostic, CEO of hc1, discusses how precision health is changing healthcare today, from medication delivery to lab testing and COVID-19.

Editor's note: Responses have been lightly edited for clarity and length.

Be sure to check out the Becker's Healthcare & hc1 Precision Health Virtual Summit Nov. 17-18 to hear exclusive interviews and sessions with industry experts as they discuss the challenges and opportunities around value-based care and precision health in today's healthcare landscape. You can register for this free virtual event here.

Question: What do you see as the key challenges we are facing today in healthcare?

Brad Bostic: We have an extremely stressed, very finite base of caregivers in healthcare today who want to do their best job in general to take care of patients, but there just aren't enough hours in the day. This is especially true when you layer on the demands that come with all the more recent data entry requirements. I know a lot of folks that practice healthcare feel like they spend half their time interfacing with a computer instead of with patients, so that strain on the time that is available in a day is significant. Coupled with that, we've had some significant escalation in costs in healthcare.

The scarcity of time and the pressure on costs together create a pretty difficult situation and ultimately that's where we need to be focused. Moving forward on healthcare globally is how we can enable the very valuable individuals who are there to deliver care and interface with patients with the insight they need to deliver that care really precisely and effectively. When you look at how siloed the data is, it compounds this challenge. For example, if you have a given individual who sees multiple different physicians for chronic conditions and they're on many different medications, they're being tested in various different places with lab and other diagnostic techniques. The provider ends with an even bigger problem from a time management and care delivery perspective because not only do you not have enough time already as a caregiver, but now you're dealing with very incomplete information and trying to bring together all the information from all these different siloes is nearly impossible. Even if it could be done it would take so much manual effort, so it just doesn't happen very often.

Q: How is precision health changing care delivery?

BB: Healthcare has evolved over time with an incentive model that has a heavy emphasis on volume, where you have a fee-for-service type of delivery model. This has led to a one-size-fits-all approach to healthcare. With the advancement of diagnostic techniques including genomic testing, we've now become quite aware that while the one-size-fits-all approach can reduce clinical variation and makes sense in certain cases, it doesn't make sense across the board to treat every single individual the exact same way, because you won't get to the best outcome doing that. For example, 20 percent of people will fail their cholesterol medication because they have a unique genetic mutation that makes it so they can't metabolize the medication or they're an ultra rapid metabolizer. However, we prescribe to people in a manner that assumes everybody is exactly the same. You have these kinds of issues where across the board people are not getting better because they're being treated with a blunt instrument approach versus a precise instrument approach.

Precision health is changing care delivery across multiple different facets ranging all the way from the old trend toward the quantified self where you're measuring and monitoring activities through a biometric watch band or a smartwatch to construct a much more accurate view of you; that's at the consumer level. Moving more into the care delivery world, precision health has had a huge impact on oncology for the better. We have gotten much smarter at analyzing all the way down to the unique genetic mutations to determine who can benefit from what treatment most effectively. Roughly about 5 percent or fewer of the patients in a given health system are oncology related, so there is this other 95 percent of patients who are not necessarily benefitting from precision health and really should have that opportunity. What we see happening here is this enlightenment occurring across the board with caregivers, and health plans for that matter, where they're realizing that if you can start zeroing in on how to optimally diagnose people sooner by using the most advanced diagnostic tests with an emphasis on lab testing, there's also an opportunity then to tailor the medication therapy for that individual in a holistic manner so you're not overprescribing them with lots of different physicians that are conflicting with each other. You're not causing harm with the medications that are being prescribed, and you're ensuring that those medications are going to work all the way down to the genetic level. That gives you the opportunity to deliver mass precision health versus the very finite cohort focused on oncology.

Q: How is precision health changing behavioral healthcare delivery?

BB: A lot of the behavioral and mental health testing for medications has gotten more precise, but using genomic information, and in this case with an emphasis on optimized prescribing through pharmacogenetic testing, is a huge opportunity to advance precision health for the massive base of otherwise underserved or ignored patients who could be harmed or could be failing their medication. You can also really zero in on how you optimally diagnose by making sure that every patient gets the right test as soon as possible. There are about 40 percent of patients who don't receive all of the testing that they should receive, and so there's an under utilization of the diagnostic tools that are available to the lab. Powering up every provider to the highest possible level of insight on exactly what the diagnosis is based on doing the right testing and exactly what the right prescription is all the way down to your unique genetic mutations, eliminating the conflicting medications and continuously tracking that patients are staying on the medications that are going to work best for them. Those are the ways that we see this precision testing and prescribing one-two punch that we see precision health becoming a more widespread mass market application or mass personalization, which is building on a lot of success that has been seen in smaller cohorts like oncology but spreading that precision health value across the entire expanse of all patients.

Q: What must happen today in order for precision health to get diagnosis closer to the onset of disease when it matters most so treatment and therapies can be even more effective for patients?

BB: First of all, you have to have advanced analytics that zero-in based on a wide array of data points brought together in a common patient profile that can identify who those individuals are that have the highest risk for having issues with their health. When those people are identified, engage them in an approach to lab testing that isn't just the one-size-fits-all trial-and-error model of saying: 'We'll just run this panel or that panel,' but actually having a very precise approach to the testing that you're going to run on every single individual who does fall into these higher risk categories. In some cases, it's ongoing testing. For example, you might see somebody who comes in for their physical every year and other than that doesn't have a lot of engagement with healthcare because they're seemingly healthy. However, their kidney function might be creeping in a bad trend line, but it's still within a normal range for anyone given test results. With the kind of advanced analytics available, you can have this system automatically detect those very subtle trends that ultimately give you the opportunity to treat that individual so they never end up on dialysis. That's a specific example where if you have the analytical insights and the prompts that can inform these caregivers of individuals who have these otherwise silent risk factors, you can engage proactively and create a huge increase in health and well being while concurrently dramatically reducing the cost of healthcare. And those are the kinds of things that we need to do.

Q: From your perspective, how are health system leaders balancing the transition from fee-for-service practices while ushering in value-based ones?

BB: There are certainly health system leaders who are just clenching their fists onto every bit of fee for service they can and attempting to pretend like there isn't a need to change; there's no doubt we see those kinds of people. With that said, we also see some outstanding health systems that we work with across the country who have really come together and brought the health plan and the care delivery leadership together to say, 'What can we do to meaningfully reduce the cost of delivering care, while at the same time improving outcomes? Or at a minimum staying at a level of quality that is no worse than where we are with the fee for service?' We see some health systems that really lean in and establish a clear value-based contracting vehicle with their health plan. In some cases, these health plans are owned wholly or in part by the actual health system. In other cases, it's more of a joint venture kind of arrangement through an agreement with a third party health plan. But, these really progressive leaders that get it are creating very clear measurements that the caregivers and staff can work toward, and they know that when they hit these certain measures they receive a bonus for delivering outstanding care within a cost level that is acceptable.

A good example of where you can do this is with respect to the rampant misprespcribing problem that occurs within health systems. We do analyses on major populations of hundreds of thousands of people, and we consistently find that more than 20 percent of the people who are on multiple medications are on medications that conflict with each other, that are harmful to that patient or may actually not even work for the patient based on their genetic mutations. This is a major problem, and those more progressive leaders that are engaging in and embracing the move to value based care, they realize and understand that if you fail medications, you end up with very bad, very expensive outcomes. In the U.S., more than 120,000 deaths per year occur from people taking medications as prescribed; we have hundreds of thousands of people who are dying every year because they're taking medications as prescribed. That tells you that we've got a fundamental issue that really needs to be fixed. Imagine that your mother, friend or grandparent were to die, and it was because they were taking the medication that they were told to take and it literally ended in a fatality. This is really not OK in this day and age.

From our perspective, these individuals and leaders who are moving into more of the value-based paradigm are incredibly good at executing on initiatives that make healthcare costs less not by stripping out services that patients need but by adding intelligent delivery mechanisms that allow them to personalize care and ultimately make people healthier. For example, if you're executing on a precision testing and prescribing program that ensures that all of the hundreds of thousands of people that are under a value-based health plan arrangement are getting on the optimal medications that are continuously monitored for potential health issues using effective diagnostic testing, you end up with this much healthier population that costs a lot less. This can result in the savings of tens of millions of dollars a year by keeping people healthy. Those are the things we're seeing these really strong leaders that are moving into value-based care executing on.

Q: What impact are COVID-19 and the upcoming election potentially having on healthcare in the United States from your perspective working with labs and health systems?

BB: If we separate the political from more of the practical ... from a practical perspective, the COVID-19 pandemic has certainly reshaped the healthcare industry and it will forever be changed. There's a realization now that a lot of the cutting of investment into certain testing capacity in the name of efficiency has created vulnerability. Moving forward, I think we'll see that we're more apt to be supporting investment in lab and health systems that would be ready to respond if there's a pathogen that presents itself like the SARS-CoV-2 virus has presented itself.

The majority of labs clearly have shifted the bulk of their focus toward providing testing capacity for COVID-19. They've had to retool their instruments and get access to the supplies and reagents they need to do that testing, and that's been a very painful process that has exposed that, from a supply chain perspective, we really didn't have the slack to be able to ramp up as fast as we would like. There's certainly a lot of innovation going on related to diagnosing the presence of the virus and also the presence of the antibodies for people who have been recently exposed and they no longer have the virus present. Downstream though the antibodies actually tend to wane in terms of their presence in the system, so it's actually a T cell related response that would keep you protected from severe consequences due to infection. I think there will be some testing capabilities developed that will go all the way down to that level to know, 'OK, this person even though they're not showing antibodies, their body has a T cell response that indicates they've had the virus and it knows how to defend itself from reinfection or at least keep it to a minimum.'

I'd say on the treatment side, much like polio where people were exposed to that virus and there was no vaccine and they might get better but they'd end up with long-term issues like the loss of strength in a given extremity that lasts for life. I think we have the same potential issues like how polio brought on but that relate to respiratory, pulmonary and all these other issues that we're hearing about and starting to study, I think that COVID-19 changes the game because we're going to need to be much more effective at this continuous monitoring and management of the individuals who have been infected.

Q: How will COVID-19 potentially affect treatment therapies and medication development?

BB: We are going to start to get a lot smarter; we already are getting a lot smarter about what medication therapies work for individuals who have been exposed and who have contracted the COVID-19 virus. Ultimately we have years and decades of research in antiviral medications, which was largely brought about by the HIV virus. This gives us a big advantage now today because we have a lot of anti viral capability. We will be much better prepared for sensing and responding to potential pandemics because of advancements in upfront diagnosing capabilities via very sensitive and specific testing. It's like when radar was first developed; it was this new capability to see potentially hours in advance that you've got a threat coming in a war. Initially though, people didn't really trust it and so they would just ignore it and then they get bombed to smithereens even though they saw a couple hours ahead of time that there were bombers coming in. I think we then said, 'Well, this radar thing is no joke.' We need the same thing with COVID-19 and with other potential pathogens where you start seeing these things show up in different pockets of the world. We need an automatic way to be warned and be able to sense and respond and start driving the things that you can do to contain these pathogens, rather than letting them spread and then being in this years-long mitigation effort that has obviously created a lot of pain.

COVID-19 will change the face of healthcare and how we manage health in the U.S. in a way that is analogous to how 9/11 changed the way we manage security with travel. It changed it forever. It's been 20 years since 9/11, and we are still going through the same kind of security process at the airports and looking into people's risk factors. Then we came up with TSA pre-check, which ultimately gave a more streamlined approach for people who were looking to travel and had the kind of qualifications or attributes that would make them low risk. I think looking forward at COVID-19 and its impact, it's very much the same sort of thing except for in this case, we're dealing with security versus this invisible threat of pathogens, and we're realizing that we're more vulnerable than we thought. We need the most effective way to screen, monitor, manage and take action to keep us safe.

Q: How has the new category of Precision Health Insight Networks (PHIN) played a role during this pandemic to support healthcare professionals?

BB: There has been a huge investment by all government, individual health systems and even health plans into these EHR systems and other data management systems that are designed to make it more possible to document the activities that occur in healthcare during a patient journey, encounter or series of encounters. Those systems, while they made data digital that maybe existed before in paper, they really haven't done anything to solve for the broader lack of connectivity among different islands of data that continues to pervade U.S. healthcare. Now you just have a whole bunch of different organizations that have spent hundreds of millions, or billions, of dollars to put in place these databases that are underneath their EHRs that still don't really share a common view and they don't really get a longitudinal representation across multiple different locations on what's going on with populations or with individual patients. 

Precision Health Insight Networks have brought about this new era of insight that can be gleaned from data when there's a secure cloud overlay of connectivity that brings together all of the key data points that can, in a scalable way, be brought together to generate an awareness of where there's risk and then drive action to go address that risk. Specific to the pandemic, there's the hc1 national Precision Health Insight Network capability that's connected to more than 22,000 lab testing locations and is able to bring together this massive amount of insight in real time that's covering roughly half of all of the testing for COVID-19 in the U.S. And we're talking about not a week or month later, we're talking about literally real time serving up as results are generated what the risk is in a given micro community down all the way to a population clusters of about 100,000 people across the entire U.S. – you can see what the presence is of the virus and whether it's accelerating or decelerating and then ultimately use that to inform decisions like safe back-to-work programs or safe travel or being able to safely attend a sporting event or go back to your university. All of these things can be made possible in a much more systematic way through Precision Health Insight Networks, because unlike the sort of traditional approach to health technology, which is very siloed and very much focused on trying to automate things inside a given health system or hospital, Precision Health Insight networks bring things together at scale across the entire country so you can deliver on the critical insight, analytics and solutions needed to sense and respond to risks and then drive action in order to make people healthier and safer.

Q: I understand that hc1 has a virtual Precision Health Summit planned for November 17-18 with Becker's. Who should attend and what will they learn at the event?

BB: Executive leaders who are looking to navigate this new world of healthcare, which was already moving to value-based models and already had a big need to bring together otherwise siloed data into these common Precision Health Insight Networks. These executives have now been exposed to what it's like to lead in the midst of a pandemic and also with an overlay of some strange political times that are leaving a lot of people uneasy on where things are going. Those kinds of executives who are really paying attention and want to position their integrated delivery network, health system and health plan strategies for success not only in the coming year but really over the next 10 years, should attend this event.

We're going to be digging in and talking about specific examples and strategies to deliver on precision health capabilities in a way that's very profitable in this new era of value based care. We'll also certainly talk about where the fee-for-service model fits into the equation because you'll never fully do away with that. C-level executives and their key leaders who are tasked with creating these strategic plans that allow them to at scale make people much healthier, while in parallel, significantly reducing the cost of delivering care, this is the conference for you.

To register for the free Precision Health Virtual Summit, click here.

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