Precision Medicine & Health Insurance Business Model - - PowerPoint PPT Presentation

Precision Medicine & Health Insurance – Business Model Disruption?

What’s in it for us,

• the citizens
• the patients
• the insured

Anke-Peggy Holtorf, PhD, MBA, Health Outcomes Strategies, Basel, Switzerland www.health-os.com

Why do countries or insurance companies pay for healthcare?

Healthy Disease Severe Disease

• Work
• Earn Money
• Support family
• Spend money
• Support national

economy

• Work ?
• Earn Money ?
• Spend money on

healthcare

• No Work
• No Money
• Need support from family
• Sell property
• Poverty for whole family
• Bad for economy

Three basic goals of a health care system: (1)keeping people healthy, (2)treating the sick, and (3)protecting families against financial ruin from medical bills

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The insurance (or gov’) pays for what the doctor decides that the patient needs

Healthy Disease

+

Insurance

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Minimizing Cost Maximizing Health Outcomes

Increasingly, patients request influence … on the care they get

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• https://www.youtube.com/watch?v=4SOK8CA6mQk (English) https://www.youtube.com/watch?v=XIrrZKLvhug (German)

https://www.youtube.com/watch?v=zVXLGCxhp2k (French)

The Role of Patients in Healthcare Decisions

Future (?): Patient Focus

The HC team supports patient in making the preferred choice Clinical trials measure patient relevant

• utcomes

Healthcare quality is defined by the outcomes (patient) Data / Information is owned by the patients

Traditional: Clinical Focus

The doctor decides on

• ptimum

therapy Clinical trial measures are determined by research Healthcare (HC) quality defined by healthcare professionals Data / Information is owned by professionals & HC industry

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Why more value with Precision Medicines ?

Maximum Effect Minimal effect Adverse Effects

Targeted product Non-specific Product Efficacy +/- Safety +/- Effectiveness +/- Price +/- Efficacy é Safety é Effectiveness é Price é (high investment for ‘small’ population)

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Marker or Algorithm

Treatment versus Prevention

– When is the best moment to ‘invest’ in healthcare?

Healthy Disease Chronic Disease

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Issues with Early Diagnosis (e.g., Genomics):

• actionability (clinical or other interventions available)
• perceived impact (impact of a positive result
• n quality of life)
• disease risk (chance of getting a disease),
• uncertainty (reliability of results)

Consumerism in Healthcare

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(Predictive) Diagnostic information will be

• Increasingly available
• At decreasing prices
• Consumers will increasingly take control à genomic tests, liquid

biopsies, metabolomics etc.

• Patients will increase pressure on payers
• For early therapy
• For innovative medications –which may only work in select

populations.

• Questions to payers
• Which diagnostic tests (tools) should be funded (and which not)?
• Which medication / therapy will be funded that is used as a

consequence of consumer testing?

• What are the benefits of knowing / treating early versus

increased short term pressure on budgets?

Insurances (be) Prepare(d)

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• https://www.fiercehealthcare.com/technology/unitedhealth-optum-ventures-250m-venture-capital-finance-digital-health?

Contact

BaselArea.swiss Adjunct faculty at the University of Utah, Pharmacotherapy Outcomes Research Center Salt Lake City, Utah, USA

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Visit our website www.health-os.com and have a look at our Edu-Clips on

• What is Value?
• How is Health-Economics used in Healthcare?
• Generics & Bioequivalence
• …. And others in future