Dilemma for Hospitals and Health Systems: Finding the Productive Middle Ground in the Precision Medicine vs Population Health Debate

While a recent report suggests expanding or initiating precision medicine efforts is imminent among health systems, some worry that precision medicine may take away from population health. The task for hospital and health system leaders is to determine a complementing balance of both efforts

A report from the Center for Connected Medicine demonstrates just how early we are in the evolution of precision medicine. The report, titled "Top of Mind for Top Health Systems 2020," is based on in-depth interviews with 70 health system leaders representing 65 unique health systems. The interviews were conducted by the healthcare-focused research firm KLAS; most of the respondents held the title of Chief Information Officer (CIO).

KLAS asked the leaders about the level of precision medicine deployment at their hospital or health system. Just 12% reported high maturity (meaning their initiative was live for an average of 4 years, and they had an average of 8 use cases). Moreover, 38% reported low maturity (live for an average of 1 year with 2 use cases), and 31% said they had not yet deployed. The remainder (19%) reported moderate maturity (live for an average of 3 years with 3 use cases).

The KLAS report notes that "interest in [precision medicine] is high, and a majority of health systems plan to expand current efforts or begin initial deployment" (emphasis is ours). So KLAS had found that expanding or initiating precision medicine efforts is imminent.

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A debate has been brewing over how precision medicine works for or in opposition to population health initiatives. Sandro Galea, MD (above), of the Boston University School of Public Health recently discussed the natural tension between individualized treatment and efforts that target broader, social concerns. (Photo copyright: Boston University School of Public Health.)

Some are wary, worried that such an effort takes away from more impactful efforts, particularly population health initiatives. "There's a real concern that [precision medicine] is a distraction from more fundamental approaches that we can take, and that we know will generate population health," Sandro Galea, MD, Dean of the Boston University School of Public Health, recently told Modern Healthcare (subscription required).

Galea describes a natural tension between individualized treatment and efforts that are broader, preventive, and that target social concerns. Galea noted that he has conducted research (not yet published) showing that, since 2009, research papers covering personalized, individual, or precision medicine represent 0.3% of all published research. Meanwhile, population health studies make up just 0.1% of the mix. Galea went on to tell Modern Healthcare that precision medicine could be viewed as a "distraction from other work."

We don't see it that way. Population health and precision medicine findings should dovetail to improve outcomes in a much more impactful way than if either initiative operated in its own silo. We were glad to see that others agree.

Muin J. Khoury, MD, PhD, Director of the Office of Genomics and Precision Public Health at the Centers for Disease Control and Prevention (CDC), is cited in the same Modern Healthcare article. He notes that while genomics might be the more attention-grabbing component of precision medicine, the field is also comprised of the same health data and social factors that fuel population health studies. "We're going to use all the information, including genomics, to improve the health of the population."

Kaveh Safavi, MD, Senior Managing Director for Accenture's global healthcare business, put it another way in the article. As results of precision medicine and population health studies continue to emerge, the evidence they produce will naturally become a part of care. "It's not something that hospitals get to choose to participate in or not," says Safavi. "It's ultimately an evolution of science."

That is not to say that hospitals and health systems are merely along for the ride. We recently sat down with two precision medicine experts to discuss the key underpinnings of a successful precision medicine program. Jordan Seth Laser, MD, Associate Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Elke Nelson-Nichols, PhD, Director of Strategic Initiatives at the ECRI Institute, were unified in their view that the place for hospitals and health systems to start is by defining what precision medicine means for their organization, and then prioritizing it.

"Ask yourself which social, environmental, and other determinants of health your precision medicine program will need to address in order to best meet the needs of the population you serve--and ultimately improve outcomes," they wrote in a Precision Medicine Institute white paper. For hospitals and health systems in urban areas, the focus might be on cancer, whereas rural systems might home in on chronic diseases.

The bottom line: It is not about picking sides--population health or precision medicine; rather, it is about how both can improve outcomes in the community your system serves.

You can download the PMI white paper, "Setting the Foundation for a Best-in-Class Precision Medicine Program," here.

-Dean Celia

Related Information:

Center for Connected Medicine

Top of Mind for Top Health Systems 2020

Precision Medicine and Pop Health Combined Can Improve Care

Sandro Galea, MD

Muin J. Khoury, MD, PhD

Kaveh Safavi, MD

Jordan Seth Laser, MD

Elke Nelson-Nichols, PhD

Setting the Foundation for a Best-in-Class Precision Medicine Program

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