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How will the trends toward concierge health, wellness programs, personalized medicine, and patient centric medicine affect the future of healthcare in the US?

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Personalized Medicine
Health Insurance
Wellness
Patient Centricity
Wearables
Ed Addison
5 months ago

18 answers

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All this will make healthcare more expensive and less affordable and accessible.

Karel Petrak
5 months ago
Wow. I have been working a long time in this field, and I think the complete opposite. perhaps a healthy debate would shed light on why you think this? - Ed 5 months ago
Variations are costly - not a thought - a fact in any industry - Dr. David E. 3 months ago
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I am in support of Karel Petrak. I can imagine costs may go up, but how unique is that viewpoint? No one has mentioned outcomes. Personalized medicine is designed to reduce/eliminate side effects, overdosing ($$) or ineffective drug prescriptions ($$). Yes, it will cost us a lot to pursue that end, But as we reach that goal, costs should go down and outcomes improve.

Tom Hayhurst
5 months ago
Personal medicine - no economies of scale - Variations are costly - Dr. David E. 3 months ago
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Randy, 'let's be more specific on the "change" in investment. From enzyme or antibody based drugs and tests to MDx? Recombinent DNA based drugs? CRISPR technology?

Tom Hayhurst
5 months ago
To date, I believe that CRISPR has only isolated 4 actionable genes; so don't beleive all the genomic hype any time soon. More-over, if the general popular just walk-ed more and consumed less - diabeties and onesity rates, etc., would plumment. Remember KISS and that "deus ex machina" is not a balm for all problems. - Dr. David E. 5 months ago
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Personalized Medicine, Wellness, and Patient Centricity initiatives have their merit by focusing individuals' attention on healthy living, lifestyle, safe practices of nutrition, physical activities, etc. However, as such they do not change the healthcare system. It is up to physicians and insurance business to change their ways. Physicians need to adjust not to carry out unnecessary procedure (e.g., imaging, etc.), prescribing drugs on the basis of promotion rather than data, etc. Insurers will need to find ways of motivating clients to benefit from increased profits insurers will get as a result of lower cost of health spending, etc. As it happened in dental care decades ago, emphasis must be on disease prevention.
The Government could do more by taking measures to improve health of the population by stopping unhealthy practices such as smoking tobacco and marijuana, limiting consumption of alcohol, sugar, saturated fat,etc. Is it really necessary to promote sugar and caffein-loaded soft drinks? Concepts are good, but effective actions and not just words are needed.



Karel Petrak
5 months ago
Walk more - eat less - avoid moral hazards - Dr. David E. 3 months ago
Now dental care is mostly private pay - Dr. David E. 3 months ago
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OK. Let me add. A  movement in which, I quote, “networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners” will need to elaborate on their plan of action to achieve it. Similarly, stating that “Personalized medicine, precision medicine, or theranostics is a medical model that separates people into different groups—with medical decisions, practices, interventions and/or products being tailored to the individual patient based on their predicted response or risk of disease” is not very different from what “medical arts” have been doing to date. Stating that products will be “tailored to the individual patient based on their predicted response” is a wishful thinking lacking tools of implementation.

Karel Petrak
5 months ago
I'd like to see a broader discussion as I could not disagree more with your definitions and prognosis - Ed 5 months ago
I too disagree but do agree with ED - Dr. David E. 3 months ago
What was described was NOT personalized or genomic medicine for 1. - Dr. David E. 3 months ago
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Specific trends toward concierge health, wellness programs, personalized medicine, and patient centric medicine have been around for many years but it is the aggressive consumerism movement coupled with employer plan sponsor cost trend concerns that have tipped the balance to affect the future of U.S. healthcare. Coupled with an antiquated IT system, this has invited in outside firms to fill gaps in performance and/or transform care that delivers efficient and less costly care with same or better outcomes.


Having not transformed or moved in advance of those key trends, health plans (carriers, etc.) and PBMs now find themselves behind the curve being replaced by outside solution providers.

Randy Vogenberg, PhD
5 months ago
concierge health, wellness programs, personalized medicine, and patient centric medicine = totally different concepts - Dr. David E. 3 months ago
PS: Patient Centricity is a MISNOMER - It is PAYER centricity - Dr. David E. 3 months ago
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Change in investments not necessarily more investment would be required.
It has been demonstrated for more than 25 years that such goals are achievable - costs flatten or go down while outcomes improve.

Randy Vogenberg, PhD
5 months ago
True for a market based economy, but healthcare is NOT - Dr. David E. 3 months ago
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Tom: that was exactly my point when I asked about what is meant for this discussion by the term Personalized Medicine, Patient Centricity, etc. For example, there is much glib talk about Precision Medicine but very little thought has been given to the fact that such medicine will need Precision Drugs. In this context, doing the same as before but calling it “nano” will not cut it. Let’s be more focused and specific in this discussion.

Karel Petrak
5 months ago
Agreed - Dr. David E. 3 months ago
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Boutique Medical Practices – Not a New Wave of the Future Anymore! 

Briefly, a new-wave boutique, or concierge medical practice business model requires an annual retainer fee for personalized treatment that includes amenities far beyond those offered in the typical practice. And, as doctors may not accept Medicare patients for two years thereafter, there is no going back to the economic oasis if the model doesn’t pan out.

Rather, patients pay annual out-of-pocket fees for top tier service, but also may use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams.   

Typical annual fees can range from $1,000 to $ 5,000 per patient, to family fees that top $20,000 a year, or more. The concept, initially developed for busy corporate executives, has now made its way to those desiring such service; and although the masses have been slow to accept the new business model; it has been accelerating after passage of the PP-ACA and large deductibles.

Any thoughts?

Dr. David E. M
5 months ago
Creative packages may be able to be offered where the retainer plus catastrophic medical insurance costs less than today's comprehensive medical insurance. To be determined, but as medical insurance skyrockets, there is a value crossover. - Ed 5 months ago
Of course. Exactly what I do; as well - Dr. David E. 3 months ago
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HHS

“It is incumbent on every American to take control of their health care, to seek out high value care from providers who are competing for their business, to demand their health-care information and to make decisions that will lead to better, healthier lives,”

the Trump administration appointee said in a keynote address at the Wharton Health Care Business Conference at the Union League in Philadelphia

-SEEMA VERMA

Any thoughts?.

Dr. David E. M
3 months ago
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MORAL HAZARD

Moral hazard is a situation in which one party gets involved in a risky event knowing that it is protected against the risk and the other party will incur the cost.

Dr. David E. M
3 months ago
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Re: US is not a democracy - David E. Marcinko 37 

Once again, you are wrong.
From https://www.washingtonpost.com/news/volokh-conspiracy/wp/2015/05/13/is-the-united-states-of-america-a-republic-or-a-democracy/?utm_term=.c49a90a8ab56&noredirect=on

“I often hear people argue that the United States is a republic, not a democracy. But that’s a false dichotomy. A common definition of “republic” is, to quote the American Heritage Dictionary, “A political order in which the supreme power lies in a body of citizens who are entitled to vote for officers and representatives responsible to them” — we are that. A common definition of “democracy” is, “Government by the people, exercised either directly or through elected representatives” — we are that, too.

The United States is not a direct democracy, in the sense of a country in which laws (and other government decisions) are made predominantly by majority vote. Some lawmaking is done this way, on the state and local levels, but it’s only a tiny fraction of all lawmaking. But we are a representative democracy, which is a form of democracy.

And indeed the American form of government has been called a “democracy” by leading American statesmen and legal commentators from the Framing on.”

Karel Petrak
3 months ago
NOPE - A TEACHING MOMENT: The US is a constitutional republic - Thank you - Dr. David E. 3 months ago
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These are not my definitions but taken from official organizations involved in the movement. It is always useful to start with definitions of items one is to discuss. Please, let me have your definitions of Personalized Medicine, Patient Centricity, and Wellness.

Karel Petrak
5 months ago
Patient Centricity = payer centricity - Dr. David E. 3 months ago
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Another glib statement that has been made in connection with personalized medicine is that it will reduce drugs’ side effects; however, it has not been explained how this will be done. Most specific drugs we have - monoclonal antibodies (often approved by the FDA as “targeted drugs”) are certainly NOT free of side effects; in fact, quite often these side effects are serious and life threatening. The reason is that mAbs are specific to a molecular target BUT NOT to the disease / disease cells. One way to reduce, perhaps eliminate side effects would be to identify moleculpar targets UNIQUE to the disease to be treated. Until we have that knowledge, the idea is a “pie in the sky”’!

Karel Petrak
5 months ago
The reduction ion side effects comes from the precision medicine concept. Instead of one drug per indication, there are multiple drugs per indication and biomarkers are used to determine which is best for you. The reduction in side effects comes theoretically from this - choosing a better drug for you rather than a random one for you - Ed 5 months ago
Could you, please show me / direct me data that validate this approach? E. G. , for drugs that have been examined this way. Thanks. - Karel 5 months ago
It's prospective common sense.. Retrospective analysis not possible because it's fairly new, but clearly happening in the drug discovery world. Mainstream skeptics will not stop innovators from advancing the state of the art. - Ed 5 months ago
However, in drug development, approval and usage, "prospective common sense" needs to be validated by data, Of course, you are entitled to your opinion. - Karel 5 months ago
Thanks to all - Dr. David E. 3 months ago
GLIB - Dr. David E. 3 months ago
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Ed: Just as I thought.. However, in drug development, approval and usage, common sense needs to be validated by data. As it is, this is just your opinion against mine.

Karel Petrak
5 months ago
Meaningless - Dr. David E. 3 months ago
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Re: Trump administration appointee statement

In my view, each individual should take care of their health - be active, eat adequate and balanced diet, not abuse his/her body (e. g., by the use of drugs, smoking, alcohol, etc., be positive, maintain a balanced mental state, etc.

In democracy, governments are elected “by the people, for the people”.

It is not clear in what sense the terms “health care” and “health-care” are being used by Trump-administration appointee.
By Oxford Dictionary definition, “healthcare” is “The organized provision of medical care to individuals or a community.” In this sense, it is clearly a government responsibility to provide a healthcare platform to meet the needs of general population. In addition, it is also government responsibility to ensure that population lives in a clean and safe environment, has access to facilities to maintain their health, and be provided with clear and validated information about healthy eating etc. (such that is not tainted by commercial interests).

Karel Petrak
3 months ago
US is not a democracy - Dr. David E. 3 months ago
PLEASE - there were more drugs deaths last yeat than MVAs - Dr. David E. 3 months ago
DDs = totally avoidable = bad human behavior - Dr. David E. 3 months ago
There is no law or government that can prevent stupidity. - Dr. David E. 3 months ago
So, what is your solution? - Karel 3 months ago
Stupidity? Are you looking down on the masses from your elevated position? Very nice. How about education? Or is that again not for the masses? - Karel 3 months ago
Walk more - eat less - avoid moral hazards - Dr. David E. 3 months ago
Not too difficult for anyone - or is it? - Dr. David E. 3 months ago
YES = those that pursue MHs are STUPID. - Dr. David E. 3 months ago
Let me repeat - Dr. David E. 3 months ago
YES = those that pursue MHs are STUPID. - Dr. David E. 3 months ago
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Karel Petrak
3 months ago
Those that pursue MHs are STUPID - Dr. David E. 2 months ago
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To: NOPE - A TEACHING MOMENT: The US is a constitutional republic - Thank you - David E. Marcinko

You like to preach, don’t you?But enough of this futile exchange.

Eugene Volokh of the UCLA School of Law notes that the United States exemplifies the varied nature of a democratic republic—a country where some decisions (often local) are made by direct democratic processes, while others (often federal) are made by democratically elected representatives.[3] As with many large systems, US governance is incompletely described by any single term. It also employs the concept, for instance, of a constitutional democracy in which a court system is involved in matters of jurisprudence.[3] etc , etc.

Karel Petrak
3 months ago
Approval seeking behavior is not attractive. - Dr. David E. 3 months ago

Have some input?