Precision Medicine’s Mid-year Checkup

Last week the White House announced $55 million in awards to four medical centers across the country to advance the President Obama’s Precision Medicine Initiative (PMI). The end goal is to build a database of 1 million people including their genomic data that will serve as the basis for researching targeted therapies. Last week’s cash infusion kick starts that program.

One of the 2016 predictions talked about precision medicine emerging as the new cutting edge for healthcare providers. An announcement of funding is a great first step, but it’s too early to say if this prediction rings true.

Providers are practicing precision medicine today in isolated pockets and outside the scope of the PMI, but these are rare cases. The majority of healthcare follows traditional best practices, which involve treating all patients as average rather than unique.

Does this prediction have a chance of being realized by the end of 2016? Doubtful. The current level of funding will accelerate the already fast-moving field of precision medicine, getting it out of the lab and into the clinic, but the journey from seed funding to actual practice generally takes more than six months.

The same prediction that prematurely identified precision medicine as a 2016 trend also said that population health management will move from buzzword to daily practice. That half of the prediction is coming true – in a manner of speaking. To understand how population health management is already with us, and to see how precision medicine fits intersects population health, it’s worth reviewing this diagram from the Institute for Health Technology Transformation:

Population health is a six-step cycle that involves segmenting a patent population, providing targeted care, and measuring the outcome. Each of the six steps can be the focus of improvement, but doctors need to do a good job on each step in order to make a population health strategy effective.

Precision medicine is mostly about the “manage care” step of the cycle. A precision medicine approach to managing a patient’s care involves taking their circumstances, other health issues, demographics, and even genetic information into account when prescribing a treatment. By selecting the best treatment for each patient, it’s possible to improve health outcomes, measured in the next step in the population health cycle.

Precision medicine is not at odds with population health or a replacement for population health; it is complementary and synergistic and provides a way to improve one of the six facets of the population health cycle.

Measuring outcomes is the part of the cycle that is most mature. Any doctor participating in a quality program or risk-sharing agreement with Medicare, Medicaid or a private payer is required to submit quality measures for their patients. Often, these measurements impact reimbursement.

In conjunction with measuring outcomes, payers have also done a good job of defining populations, identifying care gaps and stratifying risks. There’s still room for improvement on these and the other steps of the cycle, especially around patient engagement.

Version 1.0 of population health management is here and gradual refinement will occur over time.