What is Personalized Healthcare?

“Personalized healthcare” leverages an individual’s medical history, diagnostic testing, circumstances, and the continually increasing knowledge of genetics to tailor medical treatment and preventative care efforts. With more medical data available across different populations, clinicians can better determine targeted plans for specific patients. Personalized healthcare may also be referred to as “personalized medicine” or “precision medicine.”

Traditional treatment approaches have relied on trial-and-error methods influenced by statistical averages.

Until more recent technological developments, any patient-unique knowledge that clinicians might have referenced likely relied upon self-reported family histories and monitoring for suspected predispositions. Today, data-driven by DNA sequencing and other genetic research contributes to the largest store of information clinicians have ever had.

If personalized healthcare sounds unfamiliar, don’t be surprised. A 2018 survey commissioned by the Personalized Medicine Coalition (PMC) and GenomeWeb revealed that 66% of Americans had never heard of it. Of those who had, only 13% felt informed on the topic. Despite limited awareness, survey participants overwhelmingly expressed interest in the last question.

What Does Personalized Healthcare Mean?

Personalized healthcare represents a substantial advancement in patient care approaches and efficiency across all medicinal fields. Targeted treatments set up patients for healthier recoveries and easier ongoing health management, providers for more effective patient education and foster care, and payers for paying fewer reimbursements.

If continual medical advancement can be described as “standing on the shoulders of giants,” then personalized healthcare currently represents a stepladder for today’s tallest person alive.

What Does Personalized Healthcare Mean for Patients?

Only 1% of survey participants responded negatively when learning about personalized healthcare, whereas 67% responded positively. Personalized treatment can provide patients with more information, resources, and treatment decisions—empowering them with greater control over their own care management and removing barriers to healthier lifestyles.

The Duke Center for Personalized Health Care describes their approach to precision medical services as a “comprehensive evaluation of the entire person,” which “includes all of the areas of your life that impact your health, such as nutrition, personal relationships, stress, exercise, and your mind-body connection. It also means that your health care team works well together to address your health goals.”

Patients are growing excited at the possibilities:

• Healthier recoveries – Care approaches optimized by the proliferation of medical data and individual patient discovery lend themselves toward more effective, longer-lasting results.
• Higher confidence levels in their clinician’s chosen treatment – Treatment is driven by extensive medical and DNA data collected across various population groups as well as patients’ personal diagnostics and sequencing. These levels of personalization should help decrease patient stress, minimize the discomfort and side effects from rounds of testing and attempted treatments, and instill belief in a prescribed care plan that targets their health concerns.
• Better treatment and recovery support – When their healthcare providers possess greater insight into successful treatment methods and their individual needs, patients can receive tailored supplementary care. Aside from their primary treatment, patients may benefit from services such as specific dietary consultations, physical therapy, and support groups for the best health outcomes.
• Increased patient engagement and assistance with ongoing health efforts – The best method of addressing potential health risks is preventative care. Proactive management helps keep predispositions from becoming conditions and conditions from becoming worse. Easier management fosters engaged patients while improved tracking technologies (e.g., biometric data, monitoring blood sugar results over time) keep them informed.
• Potential reduction in insurance costs – As patients continue with their preventative care plans and proactive health management, they should see a financial advantage. Healthier patients are less likely to require more corrective procedures or chronic disease treatments later in life, decreasing their medical costs over time. Data, tracking, and personalization can also let patients “prove” their health for better insurance rates.

What Does Personalized Healthcare Mean for Providers?

Personalized healthcare presents a healthcare provider with the opportunity to administer individually optimized treatments and care. Providers can help more patients through personalization—and benefit from the accompanying revenue. The expanded care services and provider benefits that personalized healthcare offers include:

• Access to more patient data – Clinicians can make more insightful care decisions when consulting vast collections of data analyzed across different population segments.
• Faster patient recoveries – When providers eliminate the time-consuming process of treatment trial-and-error, they help patients recover their health while recovering their own valuable bandwidth and resources. One less visit for Patient A allows Patient B to receive their care faster. Successfully targeting treatment opens scheduling availability for sophisticated technologies (e.g., MRI machines) and specialists.
• Expanded care offerings and partnerships – Identifying successful treatment and supplementary care opportunities allows providers to add staff and offer additional health services. If growth isn’t a priority, providers can develop mutually beneficial partnerships with others in complementary medical fields.
• Greater fulfillment — Unfortunately, career fulfillment doesn’t keep the lights on. However, personalization helps contribute to happier patients. Precision care’s potential efficiency increases would allow clinicians to help more people. Those who feel cared for are more likely to advocate a specific provider to others. Personalization presents more opportunities for providers to love their careers and drive revenue.

What Does Personalized Healthcare Mean for Private Payors and Public Programs?

Private insurance companies run on risk. Patients’ health profiles become less risky and their care needs less expensive as their access to preventative care and more effective treatments increases.

While the bottom line isn’t as operationally critical for public programs—such as Medicare and Medicaid—personalized healthcare can help decrease expenditures, freeing funds for more services and initiatives. Private payors and public programs stand to reduce reimbursement expenses by streamlining individual patient treatment with targeted care:

• Less trial-and-error – When clinicians must conduct trial-and-error approaches to identifying covered treatments, insurance companies must reimburse providers for the failed attempts. While personalized healthcare treatments for smaller patient groups may be more expensive than one round of trial-and-error, target care helps eliminate successive rounds of discovery.
• Preventative medicine reduces long-run costs – Personalized, preventative medicine helps prevent the larger reimbursements incurred by corrective procedures and chronic disease treatment. Proactive monitoring, access to medical technology and information, and easier self-care enable patients to realize healthier lives and reduce healthcare costs. The CDC estimates that 90% of the U.S.’s $3.8 trillion in healthcare expenditures is spent on mental health and (preventable) chronic conditions.
• Private payors can expand coverage – As personalized healthcare continues to incorporate new technologies, treatments, and procedures, payors can increase coverage and provider options. If preventative care reduces the reimbursements for reactionary treatment, then less expensive services become more feasible. Greater in-network coverage can attract more members, further spreading risk amongst pools.
• Public expenditure relief – Any reduction to Medicare and Medicaid expenses opens healthcare opportunities. Public programs can reallocate existing funds to new programs and initiatives designed to promote, support, or personalize healthcare services even more.

Personalized Healthcare and Pharmaceutical (or other Medical) Companies?

The benefits of personalized healthcare extend beyond those providing, receiving, and paying for services. Pharmaceutical, medical supply, and medical software and technology companies all benefit from new business opportunities.

The 2018 PMC and GenomeWeb survey states that 25% of the FDA’s new drug approvals is designed to personalize treatment for smaller patient populations. Supporting a personalized healthcare infrastructure will require developing new procedures, diagnostic tests, drugs, research, software platforms, machines and implements (e.g., imaging, medicine delivery), and more.

Personalized healthcare also opens up healthcare careers and employment opportunities as providers meet the demand for (or experiment with) new care services.

Challenges to Successfully Adopting Personalized Healthcare

Although personalized healthcare can benefit everyone across the industry, continued advancement must contend with some substantial obstacles. Most importantly, personalized healthcare represented a paradigm shift within American health services from a “one-size-fits-all” model designed for reactionary care to a diverse collection of targeted treatments aimed at prevention.

Personalized healthcare’s most substantial challenges include:

• Aversion to higher costs per treatment – Payors may avoid covering personalized healthcare treatments due to the higher expected costs of servicing smaller patient populations. However, personalized care helps reduce a patient’s overall reimbursement costs by helping prevent more expensive or severe treatments.
• Patients’ data concerns – 44% of survey participants worried that extensive data collection would lead to privacy, security, and discrimination issues. Aside from protecting their medical records, participants carried concerns that insurance companies or their employers might use their personal data to restrict or deny coverage. However, the Genetic Information Discrimination Act of 2008 makes such actions illegal.
• Healthcare infrastructure — Supporting personalized healthcare requires a comprehensive restructuring of the American healthcare system. The network of professionals and services necessary to meet every patient’s individual need still requires patients knowledgeable of care and service offerings, providers who can identify and build targeted treatments, and payors willing to expand their coverage.

Despite these challenges, people want to explore the possibilities after learning about personalized health planning. 82% of survey participants expressed interest in additional information, and 67% believe their insurance should cover personalized healthcare upon learning more.

Exploring the Benefits of Personalized Healthcare

If you are a healthcare provider looking to see what personalization you can provide to your patients, PayrHealth is here to help. With over 25 years of experience as the leading outsource solution for managed care, our team can assist with analyzing your current payor agreements to find personalization opportunities or renegotiating their inclusion. Contact us today!

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