At SplashX: the challenges of shifting to precision health

The environment and incentive structure can both stand in the way of making precision health work

Last week, Vator held a salon, SplashX Invent Health - Precision Health, co-hosted and co-produced by our awesome partner, HP, where we took a deep dive into precision health. 

Precision health is a relatively new term that encompasses the move toward tailored and personalized medicine vs a one-size-fits-all approach, but with the emphasis or inclusion of disease prevention and detection vs treatments. For precision health to work it requires a lot of new data, which will then by used to personalize treatment to that particular patient.

The space is what co-moderator Archana Dubey, Global Medical Director at HP, called "version 3.0 of medicine," with version 1.0 being book-based, version 2.0 being evidence-based and now 3.0 being personalized healthcare. 

(NOTE: Save the date, our next salon is on Vitality - Healthy lifestyle as a drug, a look at wellness and prevention and behavioral change as the prescription to better health. JOIN us on December 13 at HP's headquarter in Palo Alto. Get Early Bird tickets or become a member).

Later on in the event, during the panel where we gathered entrepreneurs and healthcare experts, she asked about the challenges that come with that shift, and what potentially stands in the way. 

"What are the challenges that you’re noticing as we’re shifting from a conventional way of evidence based medicine, which is more about control trials, to starting to personalize to patients?" she asked.

Damon Hostin, CEO of Precision Medicine Alliance, answered first, saying that one of the biggest challenges has to do with the current incentive structure of healthcare in the U.S., especially given how different it is from the rest of the world. 

"When I was working on steam powered sequencers at Celera, back with Craig Venter ages ago, we never imagined you could have population genomics as a portion of assessing risk. So it changed everything when the democratization of the data came about and then the beginning to understand wellness as a drive in healthcare. The U.S. healthcare market is very different, of course, it is bizarre. I was just in the U.K. looking at population methods of managing wellness because it is capitated type model for many systems. So if you prevent an illness, the total system benefits," he said.

"I think the biggest issue is shifting from very high acuity care, which is typically the job of the hospital, into population management. So to get the top line boards to understand that a lifetime of risk management is actually worth more than intervening in late stage, highly complex disorders is better. There are some exceptions, but there is a cultural shift towards who provides care and why they do it. And there are ways you can find these beachheads and I do think that consumerism is vastly important in connecting the two worlds, but they are different worlds right now. So insurance coverage, core evidence, are major, giant blocks. Others are just the organizational psychology of change in healthcare."

Hostin's answer was reiterated by Atul Butte, Priscilla Chan and Mark Zuckerberg Distinguished Professor at UCSF, who noted the increasing costs, and the lack of incentive by anyone in the healthcare system for them to go down. 

"One complexity of precision medicine and precision health is increasing costs. I think whether it’s in the healthy or mild disease, let’s say diabetes, or heavy impact disease, let’s say cancer and chemotherapy, the costs are certainly going up," he said.

"We can spend a lot of time talking about who’s job is it to make sure costs aren’t going up. I can’t point to anyone in the United States who’s job it is to make sure costs aren’t going up right now. I would really have to argue the extreme opposite, that there is nobody who wants costs to go down, except for patients and small businesses, which are strangely not at the table, because they’re not still organized and I would not agree payers are the way to organize companies right now."

Dubey then turned to James McCarter, Head of Research at Virta Health, a company with a mission of reversing type 2 diabetes, to answer the question about the challenes, since diabetes, she said, "is a chronic disease that has acuity to it."

"In Virta Health you’ve got a condition where there’s a lot of hand holding about doing what a lot of people have tried for type 2 diabetes, and which truly is a big cost for a large population in the U.S. What are the challenges you’re seeing and how are you addressing that successfully? What are your success factors?" asked Dubey. 

He responded that diabetes is a problem that actually can't be solved by genomics, but instead by changing the patient's living environment. 

"I’m also an adjunct profession of genetics at Washington University School of Medicine in St. Louis and have a background in genomics, but I would posit that what we’re trying to solve here is not a genetics question," he said. 

Diabetes is a disease, he noted that has increased nine fold in a generation, while obesity has tripled in the same time frame. So, even though some people might be vulnerable to diabetes or insulin resistance, the problem is much larger than that.

"That’s not a change in our genetics, that’s a change in our environment, our food environment, our mobility, everything about the way in which we live our lives, has changed. So I think that, as precision medicine thinks about how to solve diabetes, don’t think about solving it from a deep dive into the genetics, think about solving it by addressing phenotype," he said, noting that Virta has been able to reverse type 2 diabetes, and has been able to help keep people healthy for years at a time, through its platform. 

"We’re working with our patients on that long-term, sustained, behavior change. One of the ways that we’ve done that, one of the barriers that we’ve overcome, and it was a fundamental business decision and business model decision, was rather than trying to provide that intervention through the primary care provider, we partner with the primary care provider to provide them information but we actually built a full stack company. So it’s our own medical record, it’s our own software, it’s our own data science, underlying our own providers who are physicians and health coaches that are Virta employees. And the idea is to use the technology to give those care providers super powers, so that they’re in touch with the patient 24/7 through their smartphone, as opposed to intermittent visits."