Precision medicine improves outcomes and lowers costs

This is the first in a series.

Precision medicine is one of the most promising and novel approaches to controlling excessive healthcare costs and providing a meaningful benefit through improved disease diagnosis, treatment and prevention. The concept, which benefit brokers and advisers should be talking about with their employer clients, essentially involves getting the right treatment or drug to the right patient — at the right time, for the right price. 

Precision medicine goes beyond personalization. The real focus is on understanding patients' biology, and genetic and genomic data to make more precise decisions about their disease and treatment. This methodology allows providers to establish specific treatment strategies based on each patient's data. 

Precision medicine is rooted in several early medical discoveries dating back to the turn of the 20th century. It was advanced by the 2003 completion of the Human Genome Project and is now starting to gain traction in oncology and other areas, such as rare or neurological and autoimmune diseases, with the help of innovative digital health and machine learning-enabled solutions. Layered on top of that is an ability of diagnostic technologies to better understand biology and design solutions that are tailored to each individual's treatment needs.

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What makes it so compelling is that we're talking about saving lives and improving the quality of life as part of establishing a culture of caring. This will resonate with employees in one of the tightest labor markets ever where it's challenging to attract and retain talent. So employers and their advisers really need to start thinking about how they will individualize solutions that draw people into their workforce, and precision medicine certainly checks that box. 

But there's also a more practical reason to embrace this emerging field of medicine. Somewhere between 30% to 50% of diagnoses and treatments are incorrect, coupled with plenty of data on adverse events. Forrester estimates that about 30% of treatments are ineffective and 10% cause harm. Considering the significant challenges faced when an employee or a family member is diagnosed with a hard-to-treat or serious illness, the data tools that precision medicine makes available could streamline the number of necessary treatments, as well as speed access to the right treatments.

For example, in autoimmune diseases, patients are often treated with tumor necrosis factor inhibitors like Humira. These drugs account for about $40 billion in pharma revenue annually. One of the more prevalent diseases treated with these drugs is rheumatoid arthritis. These drugs have been shown to work in only 33% of patients, and it can take six to 12 months to determine efficacy. It is estimated that they account for about $300 billion in retail prescription spend. Approximately, $200 billion is wasted!

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The same thinking can be applied to cancer diagnoses. There are many diagnostic tests now that help refine therapeutic choices for treating different types of tumors. Standard paths of treatment often trigger more adverse events. These adverse events add up, and thus, often prevent subsequent access to the best treatment. Precision medicine provides faster access to the right diagnostics and treatments across a wide range of diseases that would have a huge positive impact on outcomes.

This market is growing rapidly and employers need to pay attention to emerging opportunities and challenges. In five of the past six years, precision medicines accounted for more than 33% of the drugs approved by the FDA annually. Cancer is not the only disease that has seen such progress. This is also true of rare diseases and other complex diseases. While these therapies offer the potential for improved outcomes, it is critical to identify the right patients for the right treatments at the right time. 

When people are confronted with a serious diagnosis, it's important to determine whether a diagnostic test or precision medicine approach are available to provide them with more information about the disease and care options earlier in their treatment journey. Thankfully, there are innovative solutions now available that help guide patients, but many doctors and patients aren't familiar with them. So it's important for brokers and advisers to educate their employer clients about the many benefits of precision medicine for the employee populations they serve. 

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Many of these hard-to-treat serious illnesses, while representing only 5% of an employer's population, now account for more than half of healthcare spend. It is anticipated that this number will continue to grow. It is possible to use precision medicine approaches to align incentives more effectively and create significant cost savings. In fact, it is estimated that with new technologies that have advanced the science of cell and gene therapies, the cost of treating complex and rare diseases by 2030 is estimated to be greater than $1 trillion.

As a pioneer in precision medicine for more than 20 years, I have seen the significant impact this approach can have on patient care, quality of life and life expectancy. For employees and their family members suffering from cancer, as well as complex and rare diseases, precision medicine offers viable, cost-effective treatment strategies. For the first time, employers have an opportunity to seriously reshape quality, outcomes, cost of care, and patient and provider experience.