Institute For The Future

PMWC Preview: Personalizing Health Systems

Health Horizons researchers will be attending the 2013 Personalized Medicine World Conference here in Silicon Valley, January 28-29. In the run-up to the conference, we’ll be talking with some of the scheduled speakers to preview their talks at the event. (For more information on the conference itself, please visit the PMWC 2013 conference website.)

As part of this series, we spoke with two people addressing the challenge of personalizing medicine in the context of large-scale health systems: Dr. Robert Jesse of the Veterans Health Administration and Dr. John Mattison of Kaiser Permanente. Though we talked with the two doctors separately, there was a lot of overlap during the interviews. They’re both innovative individuals within innovative organizations, but beyond that, their visions for personalized medicine, and a better health system in general, have much in common. When we hear the word personalization, we tent to think about fragmentation—for instance, more precise targeting of prescription medications to individuals. But both Mattison and Jesse talked about integration as the key to better, more personalized care. That is, integration between the health care system and determinants of health that have traditionally been outside of the system’s purview. They both agree, (as do we) that what really determines health is not just clinical encounters, but rather, as Mattison puts it, what happens “in the 99.995 percent of our lives that we lead outside of our healthcare institutions—where we live, eat, work, study, play, and worship.”

Mattison sees the future of medicine as one in we’ll have evidence-based, personalized interventions that go beyond the biomedical. Just the way many are working to personalize prescription medications to a person’s biomarkers, Mattison envisions entire approaches to health that are equally tailored to the individual.

Mattison also says that open data will be a big part of making this happen. He mentions Open mHealth, an open source initiative developing a set of open APIs, which would not only allow apps to generate and use sharable data across platforms, it would create data that could be used to evaluate the efficacy of interventions of all kinds, (including those at the level of social networks and environment). In aggregate, this data would paint a picture of which kinds of approaches works best for different types of people, even to the level of the individual.

Jesse also spoke of personalizing medicine as being about more than just pharmaceuticals.  

“The simplest way I can put it is we’re trying to change currency of healthcare from being about the encounters to being about relationships,” Jesse said of the kinds of changes the VHA is pursuing. “You have to know the patient to create the environment in which a patients becomes the owners of their care… We’re the invited guests to that process.”

This kind of patient driven approach—Dr. Jesse also says that the VHA prefers the term “patient-driven” care, instead of “patient-centered” because the latter is an artifact of a view of the patient that is grounded in the perspective of the health care system—inherently acknowledges a person’s entire ecosystem of well-being risks and resources. The VHA, however, is in a better position to act on that knowledge than private health care providers are. They have no financial incentive to generate revenues through procedures, office visits, or hospital stays, and they the people they provide care to are generally do not switch health care providers frequently, meaning they have no disincentive to provide preventative care. But beyond that, they are already much more integrarted into their patients lives than other health care providers could hope to be.

“One of the really elegant things about the VA system is that we don’t just provide healthcare, we provide a broad base of lot of social services that are necessary to engender good health,” Jesse says. “Transportation, education, housing… we have a lot of resources within the larger [Veterans Administration] system.

“The way the VA works now, is really the foundation for what an [Accountable Care Organization] truly is.”

As an integrated system, Kaiser enjoys some of the same advantages as the VHA and this has made it something of a model health care organization, with Mattison and others from Kaiser being invited to consult for the U.K.’s National Health Service.

“Our founders gave us an extraordinary gift of being able to think and act holistically,” Mattison says. “We have a huge community benefit program run by Ray Baxter and we invest heavily in our community services.”

But he also acknowledged that there are broader policy issues that need to be addressed to truly improve community health.

“We make implicit tradeoffs as a society that need to be made more explicit,” Mattison said. “We’re currently investing more in incarcerating people in prison than in the health of our communities.”

Join us at PMWC for more from Dr. Jesse, Dr. Mattison and many others!