For most health systems, delivering personalized care at scale is not yet a reality.
At York, Pa.-based WellSpan Health, Timothy Switaj, MD, is working to change that. As vice president and chief population health officer, he is leading efforts to build a strategy for personalized care, which in turn will further advance population health outcomes.
Delivering personalized care at scale, he said, comes down to having a comprehensive strategy across three key areas: access, patient experience and clinical innovation.
For starters, health systems should work to meet patient expectations around modality to ensure they are able to access care in the way that is most convenient for them. On this front, WellSpan is using patient data to understand and act on trends related to when they seek care and the method of delivery.
“Much of our population has a lot of other demands on their time,” Dr. Switaj said. “Trying to fit them into a 9-to-5 schedule Monday through Friday is not always what’s going to be accessible or desired. We also know that, generationally, there are differences in how people want their care delivered. Some are happy with virtual care as the primary method, with in-person only as needed. Others are OK with a mix, and then some really just want that in-person care experience.”
When it comes to personalizing the patient experience, focusing on operational efficiency and simplifying clinician workflows can go a long way, he said. This includes equipping physicians with tools such as ambient documentation and care pathways.
“If we can make clinical processes more efficient by supporting our providers with tools like artificial intelligence at the point of care, clinical decision support and back-end automation, we can give them more time to talk to the patient — not just about clinical concerns, but about who they are and what matters to them as a person.”
Integrating evidence-based clinical pathways can be especially useful in primary care, where clinicians are managing a large panel of patients with a variety of conditions.
“There’s a lot of work that can be done to solidify and bring home evidence-based guidelines, taking them and putting them into a care path — whether it’s direct in the EHR, or an AI-driven clinical decision support tool,” Dr. Switaj said.
“I see it as augmenting providers because the degree of medical knowledge out there is growing exponentially every day; drugs are growing exponentially day over day and there’s no way anyone — especially in primary care — can keep up with all of it. Giving them tools they can use to help them down the pathway is incredibly important. It’s also important on the referral side so that we make sure that we utilize specialty access as efficiently as possible.”
WellSpan is also using quantitative clinical risk scores to better understand complexity and patient needs both on an individual and population level. While there are a number of risk scores available, most account for utilization patterns and clinical data, such as diagnoses, the number of prescriptions and the number of specialties in which a patient is receiving care. WellSpan is working to eventually leverage clinical risk scores to predict patient demand, Dr. Switaj said.
On the clinical side, WellSpan is building a strategy to scale the use of genomics, which involves utilizing data on patients’ genes to determine which specific treatment is the best path for them.
What’s really exciting is the work that’s occurring in the genomics and precision medicine space, where you’re actually able to individualize the treatment plan for certain conditions,” Dr. Switaj said. “By looking at people’s genes and seeing what they are going to respond to, we can get treatment right the first time and save patients from having to go through multiple medications and save them money.”
Genomics is gaining traction in areas such as behavioral health and cardiometabolic disease, where gene-drug interactions can influence how patients respond to antidepressants and antiplatelet therapies. Two years ago, WellSpan partnered with Helix to build a foundation for integrating pharmacogenomics into care delivery, starting with a research effort to sequence 100,000 patients’ genes for CDC Tier 1 conditions — a list of inherited disorders that includes certain cancers and cholesterol disorders considered high priority for genomic screening because early detection can lead to effective treatment and prevention.
Most hospitals remain in the early days of this work. To get to a place where genomics is fully integrated and scaled, Dr. Switaj said health systems will need a dedicated team and clear strategy to understand clinical use cases and navigate insurance coverage. Ongoing education for front-line clinicians will also be essential.
‘There’s a lot of education that needs to be done with our clinical teams on precision medicine and what it can do to help them in practice,” he said.
Looking ahead, Dr. Switaj sees genomics and precision medicine becoming part of health systems’ broader population health strategy to support early risk identification and targeted interventions.
“There is definitely a path in the future where you can conceive of genomics and precision medicine being part of a comprehensive population health strategy for pre-disease screening so that you can lower people’s risk factors of potentially getting the disease in a targeted fashion,” he said.
