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

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.

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?

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.

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.

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.

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.

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.

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?

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?.

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.

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.”

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.

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”’!

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.

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).

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.