Paul Keckley and Howard Underwood of the Deloitte Center for Health Solutions present what they call the Healthcare Reform Pyramid in a recent article. It's a graphic representation of the goals we need to pursue in order to reform our outmoded healthcare delivery system while reducing costs (see: Reducing Costs While Improving the U.S. Health Care System: The Health Care Reform Pyramid). Their illlustration is worth some attention.
As one might expect, the base layer is healthcare information technology (HIT). This will not come as a surprise to any reader of this blog. The second layer toward the top is labeled comparative effectiveness/ evidence-based medicine. The third is coordination of care with a special focus on the Primary Care 2.0 Model, also called the Medical Home. The pinnacle of the pyramid is healthcare consumerism with emphasis on CDHPs (consumer-driven health plans), transparency, PHRs (personal health records), incentives, and value.
The Medical Home is defined by the Wikipedia in the following way:
The basic premise of the medical home concept is continual care that is managed and coordinated by a personal physician with the right tools will lead to better health outcomes.
I have a particular interest in the notion of Comparative Effectiveness in the healthcare delivery process. The Deloitte article provides the following explanation of this concept (boldface emphasis mine):
Building on the HCIT [healthcare information technology] foundation, the Comparative Effectiveness focus may be implemented as a means to shift incentives from doing more things to doing right things that are evidence-based and cost-effective. An important feature of this domain is continued investment in funding three to seven new personalized therapeutics/companion diagnostics annually. The advantages of personalized medicine in tandem with comparative effectiveness and HCIT could achieve NPV savings as high as $140 billion over 10 years.
I have blogged about this idea of Comparative Effectiveness in two previous notes (see: Moving Resources from the Therapeutic to the Diagnostic Silo; Biomarkers Used to Assess Treatment Efficacy), referring to it as therapeutic efficacy. The idea that I put forward in this note is that we can reduce unnecessary and inappropriate drug therapy using lab test monitoring and, in so doing, we can shift resources from the therapeutic silo to the diagnostic/monitoring silo as well as reduce the overall cost of healthcare. The Deloitte authors arrive at the same conclusion based on their phrase: doing right things that are evidence-based and cost-effective.
One key element in the effectiveness monitoring of the emerging biotech drugs, as emphasized in the pull quote above, is companion diagnostics. These are lab tests, often developed in tandem with the development of a biotech drug, that can select the patient candidates for the drug as well as assess the ongoing effectiveness of treatment with the drug. These decisions are determined by the genetic characteristics of a
tumor, in the case of chemotherapy, and/or the
genomic/proteomic characteristics of the patient being treated. The topic of companion diagnostics has been extensively covered in previous notes.
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