Here Dr. Brian Patty, MD discusses the current landscape for Precision Medicine and Value-Based Care.
Editor's note: Responses have been edited for clarity and length.
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Question: What is the benefit of value-based care?
Dr. Brian Patty: The cost of healthcare in the US is almost double that of any other industrialized country. And yet, our outcomes are near the bottom of that same group. Why is that? I believe one of the leading factors is the current predominance of our fee-for-service payment model. In that model, our incentives are misaligned.
In a fee-for-service model, when you break it down, the sicker our patients are, the more we get paid because their utilization of high-cost services goes up: hospitalizations, procedures, ER visits, and medications. On the other hand, in a value-based payment model, the healthier we keep the population of patients under our control, the more we get “paid” (actually, the less we spend of the lump-sum payment we received). We are not incented to keep patients healthy in a fee-for-service model; in fact, we are dis-incented! In the current fee-for-service model, we get paid little to nothing for preventive care, and that same preventive care reduces the patient’s utilization of the high-cost services that keep us afloat!
Value-based payment models incent us as providers to keep people healthy because the healthier they are, the less they “cost.”
Q: What is preventing the transition to value-based care?
BP: There are a myriad of factors preventing the adoption of value-based care, from confusing payer contracts to lack of organizational knowledge of care management and population health, to insufficient size to manage risk, to insufficient data and tools to effectively manage patients at the point of care, and the list goes on. I want to focus on the tools needed at the point of care, specifically the tools needed to practice evidence-based precision healthcare.
Q: Where does precision medicine fit in the transition to value-based care?
BP: I believe this is where organizations can truly bend the cost curve. Evidence-based precision care combines the practice of medicine based on the latest evidence combined with genomics and social determinants of health to get to a truly personalized plan of care for every patient. We need to get beyond the notion that genomic testing is only for the 5% of the very sickest patients; that notion grew out of the days when genetic testing cost thousands of dollars. In today’s market, genomic testing for precision health costs only a few hundred dollars. The potential cost avoidance down the road more than justifies this up-front cost. Whether it is understanding a patient’s poly-genomic increased risk for disease or knowing which medications they are unable to absorb or metabolize and therefore need increased doses or a different therapy. The FDA recognizes over 120 pharmacogenetic associations for which current data supports a change in management or a potential impact on safety, and the list is growing. With universal genomic testing, we will know so much more about our patients in advance. We will no longer be waiting for diseases to manifest or playing trial and error with medications and medication doses. With an understanding of a patient’s genomic and social makeup, we will be able to test more precisely, diagnose more precisely, and treat more precisely, eliminating the waste of today’s predominant wait-and-see trial-and-error costly approach to care. Driving down the cost of care is the way to win at the value-based care game, and value-based care, therefore, aligns healthcare’s incentives toward a lower-cost, higher-quality healthcare system overall.
Q: So, what are the tools needed?
BP: We need to integrate data into the care team workflows that can alert them to the need to adjust doses or change therapies based on the patient’s genomic makeup, lab data, social determinants, and the medications they are on. A good example is hc1’s PRx Advisor, which ensures a patient’s unique genetic profile is taken into consideration alongside other clinical lab data, medications, lifestyle and health profiles. This tool can evaluate a panel of patients, rate them based on a risk score and evaluate potential changes in therapy to lower that risk, again, all based on genetic makeup, lab data, and lifestyle. This allows the care team to quickly optimize medical management for and entire population of patients. Similar tools could be imbedded into the provider’s workflow to alert them that a patient might benefit from genomic testing based on their current medication regimen or on a new medication being prescribed. Of course, if the patient already had genomic testing done, this would speed up the time to optimal therapy – saving time and money for both the patient and the care system, and accelerating and improving outcomes.