Personalized Medicine and Value-Based Care

Stephanie GingerPatient-centered Care, Value-based Care

How is personalized medicine impacting oncology? A panel at AJMC’s recent Patient-Centered Oncology Care Conference explored this topic. Payer, diagnostic, and advocacy representatives shared their perspectives in this discussion.

What is personalized medicine?

The panelists all agreed on a definition for personalized medicine: tailored, targeted therapies based on each individual patient’s needs. One panelist commented that personalized medicine leverages diagnostics to prescribe the right therapies, but it also integrates patient values, history, and circumstances into the process. The latter is what differentiates personalized medicine from precision medicine.

Challenges in personalized medicine

One of the main goals of personalized medicine is delivering a better patient experience. But therein lies a challenge: even if a physician prescribes the right therapy for a patient, they must consider the other factors that could impede access to this therapy. Barriers to access include lack of reliable transportation and other social determinants of health. It can be challenging for payers to regulate and reimburse for this level of care.

Another challenge is connecting the science back to the patient. Payers and diagnostic companies want to ensure providers have access to the information they need to deliver the highest quality, least toxic, and most effective patient care. This can be extremely complicated in personalized medicine. Collaboration between payers and diagnostic companies is needed, as well as standardization and integration of data collection and clinical decision support at the provider level. We’ll also need to be open to changes like accepting real world data regarding efficacy in the absence of controlled clinical data.

The shift to value-based care

The panelists agreed that we need a system that focuses on value, not cost, to identify the most effective treatment option for a particular patient. The panel also noted that if a value-based care program focuses too much on cost at the expense of patient values, real world evidence, and shared decision making, then it’s not truly meeting the goals of value-based care delivery.

However, with the avalanche of new therapies and diagnostics, it can be challenging for payers determine what a test or treatment is worth. And the panel noted that for the Medicare-age population there is very little data available to understand the best way to care for them. Data silos and the pace of innovation are significant challenges to succeeding in this shift to value-based care.

To deliver personalized medicine in a value-based world, the panel encouraged all stakeholders to work together to find the best solution – patients, providers, diagnostic companies, payers, employers and technology companies. Collaboration can help create a better (and not just different) healthcare system.

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