Preventive healthcare represents a massive opportunity for the health of society and our economy. Stopping the onset of illness is the holy grail of healthcare transformation and sustainability.
Emerging preventive care solutions as either proactive or predictive:
Proactive care solutions stratify at-risk individuals based on known algorithms and ensure that preventive action is taken to intervene well before the onset of symptoms, let alone illness.
Predictive care solutions leverage cutting-edge technologies and sophisticated machine learning data algorithms to not only stratify risk but even predict risk and intervene even further upstream.
The main focus area for proactive care is to stratify individuals based on key risk factors for chronic disease. In Western society, four key risk factors directly lead to the fair share (>90%) of chronic disease:
- Tobacco use
- Alcohol consumption
- Physical inactivity
- Unhealthy eating
Add to this the panacea of mental illness, including depression, anxiety and sleep disorders.
Notably, all four key risk factors are modifiable, which means that one can introduce proactive interventions to help individuals modify their behaviour to reduce these, and therefore reduce the onset of chronic disease.
Predictive care solutions take things a step further, intervening much earlier upstream. Often, these technologies rely upon genetic testing to help determine susceptibility to disease years or decades before the disease might manifest itself.
These technologies can also be used after diagnosis to prevent worsening of the patient’s condition and to guide treatment to avoid adverse events. Technological developments are furthering this concept; with the increased collection of personal health and lifestyle data, the advent of big data, and improved analytics, we can generate better insights earlier. This will allow us to “anticipate issues with unprecedented precision,” pinpointing behaviours to avoid and actions to take before risk factors even arise. (1)
Who will lead the shift to proactive and predictive healthcare?
The shift to a proactive and predictive care model will be led by established health incumbents and startups. Both groups are uniquely positioned to facilitate this shift. The incumbents by design have their processes embedded and systematized to allow them to provide health services at scale. However, incumbents are system-centred and thus face challenges in adapting their business models to be truly patient-centred and preventive. Startups are agile and lean and can provide innovative health solutions to target specific unmet needs.
“Insurers must consider the benefits of improved customer
awareness of individual health risks. Engagement in preventative
lifestyle and medical interventions specific to their known risk
factors must be acknowledged in risk-stratification processes.
Prospective occupational interventions designed to maximize
function and partial capacity should disease manifest should also
be a future consideration.”
“Genetic testing leaves some excluded from Life Insurance”…or does it?
What if your doctor offered genetic testing as a way to keep you healthy?
If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people, the answer is yes. But such information is not commonly part of routine primary care.
For patients at Geisinger Health System, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal to eventually extend the offer to all 3 million Geisinger patients.
The test will look for mutations in at least 77 genes that are associated with dozens of medical conditions, including heart disease and cancer, as well as variability in how people respond to pharmaceuticals based on heredity.
“We’re giving more precision to the very important decisions that people need to make,” said David Feinberg, Geisinger’s president and CEO. In the same way that primary-care providers currently suggest checking someone’s cholesterol, “we would have that discussion with patients,” he said. “ ‘It looks like we haven’t done your genome. Why don’t we do that?’ ”
Wendy Wilson, a Geisinger spokeswoman, said that what they’re doing is very different from direct-to-consumer services such as 23andMe, which tests customers’ saliva to determine their genetic risk for several diseases and traits and makes the results available in an online report.
“Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan to prevent that predisposition from occurring. We are preventing disease from happening,” she said.
Geisinger will absorb the estimated $300 to $500 cost of the sequencing test. Insurance companies typically don’t cover DNA sequencing and limit coverage for adult genetic tests for specific mutations, such as those related to the breast cancer susceptibility genes BRCA1 or BRCA2, unless the patient has a family history of the condition or other indications they’re at high risk
1. Public Health Ontario & Cancer Care Ontario. Taking Action to Prevent Chronic Disease: Recommendations for a Healthier Ontario. 2012. Accessed March 15, 2016, from https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=125697
2. Harvard Business Review. Predictive Medicine Depends on Analytics. 2014. Accessed March 21, 2016 from https://hbr.org/2014/10/predictive-medicine-depends-on-analytics/
Dr Brett Gerrard MD