Precision Prediction in Healthcare: The New Vista for Leaders
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We’ve always been fascinated by the future. As a futurist, understanding and projecting trends, building scenarios and drawing out implications comes with the territory. But most people would like to know what’s around the corner, especially if it’s something they know they will enjoy or will need to prepare for. Is healthcare any different?
That’s where people’s attitudes differ. Some want to know if, for example, there’s something they can do to avoid a problem and secure greater healthy longevity. Others prefer to keep their heads in the sand, facing up to problems only when unpleasant symptoms drive them to the doctor.
Science is in the process of sharpening this choice.
The Scientific Leap: Combining Genomes and Routine EMRs
Recent papers, such as the study by Sarah Urbut et al in Nature (July 15, A Bayesian framework for longitudinal EHR and genetic discovery), point the way to a very exciting future. Combining genomic information with routine data collected in EMR data integration can create a "signature" containing probabilities of what future conditions an individual is likely to contract in the coming years. Obviously the power of this is greatest where early intervention can make a major impoact.
On a smaller scale, and without the need for genomic analysis, a company I co-founded, Metadvice, is able to detect or predict as-yet undiagnosed disease, notably heart failure, through predictive health analytics.
These developments will enable patients, supported by clinicians, to make lifestyle changes, take preventive therapy, and undergo regular targeted check-ups to reduce or eliminate the risk of future diseases. Wonderful as all this sounds, it presents real opportunities and challenges to healthcare leaders in both health systems and in the life sciences industry.
Health System Leadership & Payor Dilemmas
Transitioning from reactive care to risk management requires overcoming three key operational hurdles:
Shifting from a Disease Treatment Focus to Health Maintenance Systems: Clinicians need bandwidth to manage future risks rather than just respond to present problems. Moving away from a "disease system" requires new technology tools such as those above, alongside updated incentives and rewards for clinical staff.
Balancing Risk Communication: Leaders must guide clinicians in balancing the benefits of highlighting future risks with the possibility of creating patient worry and stress when probabilities are seemingly low or timescales long.
Navigating Insurance Disclosures: Health insurance leaders face ethical questions regarding whether future risks should be disclosed by applicants. While genomic information remains embargoed via voluntary agreements in many regions, emerging tests in proteomics and multi-omics carry significant predictive power. Payors must also resolve how to handle reimbursement for early tests that identify and reduce future risks rather than leading to the treatment of acute episodes.
Precision Prediction and Prevention in Life Sciences
Does precision prediction in healthcare represent a threat or an opportunity for life sciences? As is often the case, it is both:
Precision Diagnostics: Diagnostic tests linked to forecasting future disease will find a market if patients and providers believe they are actionable. This concern historically held back tests for future Alzheimer's, for example, but we now have emerging therapeutics alongside evidenced lifestyle interventions and so we will see such tests make headway commercially, not just scientifically.
R&D and Strategic Partnerships: As disease prevention becomes of increasing interest to clinicians and health systems, therapeutics leaders will need to steer organisations into new waters. Are companies ready to invest in clinical trials to reduce chronic inflammation and delay chronic conditions based on surrogate endpoints? Partnering with diagnostics and digital health firms to reveal at-risk populations take biopharma into unfamiliar territory.
Regulation: These developments test the current regulatory frameworks. We see ‘healthy longevity’ therapies forced to prove their worth on sometimes rather exotic (but regulatorily recognised) age-related conditions, Surely it is time that impact on the aging process itself can command regulatory support, based on biomarkers developed in conjunction with progressive regulators themselves. Which brings us to:
The Role of GLP-1s: GLP-1 receptor agonists continue to surprise us with risk-reducing capabilities in chronic inflammation, perhaps ushering in this new era for biopharma companies and regulators.
Politicians have woken up to the power of prevention. While prevention is easy to articulate in speeches, funding health systems for prevention involves complex political choices. Health system and life science leaders must now shift emphasis from advocating ever-more sophisticated interventions for late-stage acute disease to technologies and policies that could make many such diseases a thing of the past.
