Precision Medicine and the Pursuit and Promise of a Sustainable Healthcare Ecosystem


by Gregg A. Masters, MPH and Douglas Goldstein

The unsustainable trajectory of the U.S. healthcare spend, including decades of variably labeled and marginally effective government and private sector efforts to restrain its apparently insatiable appetite is no surprise to many of us who’ve been in the policy and execution dance over time.

From the HMO Act of 1973 to the passage of the Affordable Care Act in 2010 with substantial reliance on the incremental transformation of a volume driven fee-for-services ecosystem via Accountable Care Organizations (ACOs) the health policy landscape is littered with failed efforts to restrain costs, improve outcomes and enable access.

Perhaps the boldest and most ‘on the come‘ in terms of potential contribution (see: ‘The Precision Medicine Initiative Cohort Program – Building a Research Foundation for 21st Century Medicine’) to remedy the cost, quality and access conundrum was launched January of 2015 during the State of the Union address by now former President Obama under the heading of the Precision Medicine Initiative (PMI), to:

‘… gather health-related data from 1 million or more people living in the United States, over many decades, to accelerate research and improve health. The program will be open to people both healthy and sick, from all communities, to reflect the rich diversity of the country.

 

Participants will have opportunities over many years to provide data about themselves that will help researchers learn more about how individual differences in lifestyle, environment, and biological make-up can influence health and disease. By taking part, participants can learn more about their own health and contribute to an effort that will advance the health of generations to come.’

President Obama proposed an initial budget of $215 million dollars for fiscal year 2016 to better understand the mechanisms of disease and pave the way for the realization of ‘precision medicine’ and to ‘lead a new era of medicine’.

While the bulk of PMI’s goal are forward leaning, It’s important to note that the Veteran’s Administration (VA) has to date collected genomic data from over 400,000 veterans and is actively exploring how to effectively communicate with and engage their members, patients and constituent communities.  There is an extensive collaboration between NIH and VA relative to discovering the ‘secret sauce‘ of motivating and supporting people to manage chronic conditions smarter.

Since its rollout the promise for and uniquely granular expression of PMI’s distributed footprint has emerged through a tapestry of participating organizations including leading academic institutions to innovative healthcare delivery systems supported by best-in-class technology platform vendors. The macro footprint of the PMI effort, recently re-branded as the ‘All of Us Research Program‘ includes the following core program components:

While principally a research effort designed to move us from ‘shotgun medicine‘ to ‘targeted therapeutics‘ – and thus better outcomes and health for ALL Americans The PMI/All of Us effort is an unique research program from NIH in that is designed to be “bi-directional.”  NIH has defined a program that shares results and implications of combination of genomic information with user generated data with social and environmental and medical record data.   All of Us Research Program is designed to have people share their DNA and more (e.g. data from their Fitbit, AppleWatch or other wearable) so that actionable knowledge can be put in the hands of the person and family to improve their health status.

The All of Us Research Program intends to enable NIH to take a quauntum leap in improving the health and well-being of all Americans. With the accumulating knowledge of the intersection of ‘omics’ with people’s activities of daily living and environmental social factors there will be a HIGH likelihood of a direct impact on healthcare delivery to improve known chronic issues of cost, quality, and access directly or indirectly based on deep interaction and engagement with the participants.

The purpose of this first in-a-series of articles is to dive under the hood of this ambitious effort and get to know the principal players and layers in the emerging partner ecosystem including enabling mission critical technologies.

The defacto master curator of the program is the National Institutes of Health (NIH), and the Office of its Director in particular. At the ‘participant technologies center‘ layer we have somewhat of a stealth play in form of Vibrent Health selected ‘as the technology platform for the Participant Technology Center’. Vibrent Health is led by Praduman Jain (aka ‘PJ’) Chief Executive Officer under the watchful eye of its Board including Robert Wah, MDGlobal Chief Medical OfficerCSC, a core ecosystem partner and key participant in the All of Us Research Program.

On Vibrent Health’ standing, no less than digital health evangelist, best selling author, researcher and practicing cardiologist Eric Topol, MDDirector at Scripps Translational Science Institute weighs in on PMI/All of US, and the Vibrent Health team as follows:

‘This is the most far-reaching medical research initiative in the history of the United States, so for us at Scripps to get to work again with Praduman Jain and his remarkably talented team at Vibrent Health, we’re set up for a truly exciting and transformative collaboration.’

More from the Vibrent Health website:

Vibrent’s evidence-based B2B2C technology infrastructure called Adaptive Platform for Personalized Engagement enables longitudinal data collection, engagement and insights. This infrastructure is supported by the three pillars of technology, science and customer support, each of which continuously improves through a process of “measure-learn-iterate”.  Such an approach enables adaptability and personalization to ensure long-term success of population level programs.

The Platform is scaled through Software as a Service (SaaS) delivery model and utilizes best practices of dissemination and implementation science that balance innovation with robustness and scalability. Specific functionality includes mobile and web apps, interactive informed consent, assessments, surveys, passively sensed data, wearables and wireless devices data, teachable moments, interventions, reminders, schedules, motivational interviewing, notifications, customized monitoring, feedback loops, coaching, alerts, temporal data integration, visualization, analytics, machine learning (IBM Watson) and reporting of individual and group level measures and outcomes.  APPE adheres to the highest standards of federal data security, privacy and trust principles.

We are pleased to note that PJ will joining us on ‘This Week in Health Innovation: LIVE From #HIMSS17‘ on Tuesday, February 21st, 2017 at 11:30AM Eastern time. The complete line-up of guests will be posted to Health Innovation Media shortly.

Next in this series, we’ll profile Scripps Translational Science Institute, followed by CSC.

 

 

 

 

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