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? Disease Severe Disease Healthy Work • No Work • Earn Money • No Money • Work ? • Support family • Need support from family • Earn Money ? • Spend money • Sell property • • Spend money on • Support national Poverty for whole family • healthcare economy 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 12. Dec 2017 BaselArea.swiss 20

The insurance (or gov’) pays for what the doctor decides that the patient needs Insurance Healthy Minimizing Cost Maximizing Health Outcomes + Disease 12. Dec 2017 BaselArea.swiss 21

Increasingly, patients request influence … on the care they get • https://www.youtube.com/watch?v=4SOK8CA6mQk (English) https://www.youtube.com/watch?v=XIrrZKLvhug (German) https://www.youtube.com/watch?v=zVXLGCxhp2k (French) 12. Dec 2017 BaselArea.swiss 22

The Role of Patients in Healthcare Decisions Traditional: Clinical Focus The doctor Clinical trial Healthcare (HC) Data / Information decides on measures are quality defined is owned by optimum determined by by healthcare professionals & HC therapy research professionals industry Future (?): Patient Focus The HC team Clinical trials Healthcare Data / Information supports patient measure patient quality is defined is owned by the in making the relevant by the outcomes patients preferred choice outcomes (patient) 12. Dec 2017 BaselArea.swiss 23

Why more value with Precision Medicines ? Maximum Effect Marker or Non-specific Product Algorithm Efficacy +/- Minimal effect Safety +/- Effectiveness +/- Adverse Effects Price +/- Targeted product Efficacy é Safety é Effectiveness é Price é (high investment for ‘small’ population) 12. Dec 2017 BaselArea.swiss 24

Treatment versus Prevention – When is the best moment to ‘invest’ in healthcare? Disease Chronic Disease Healthy Issues with Early Diagnosis (e.g., Genomics): • actionability (clinical or other interventions available) • perceived impact (impact of a positive result on quality of life) • disease risk (chance of getting a disease), • uncertainty (reliability of results) 12. Dec 2017 BaselArea.swiss 25

Consumerism in Healthcare (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? 12. Dec 2017 BaselArea.swiss 26

Insurances (be) Prepare(d) • https://www.fiercehealthcare.com/technology/unitedhealth-optum-ventures-250m-venture-capital-finance-digital-health? 12. Dec 2017 BaselArea.swiss 27

Contact Adjunct faculty at the University of Utah, Pharmacotherapy Outcomes Research Center Salt Lake City, Utah, USA 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 • BaselArea.swiss 12. Dec 2017 28