Diagnostics, Patient Engagement, Payers

CONVERGE: Population medicine has been a spectacular failure, but payers are hindering innovation

Susan Hertzberg, Boston Heart Diagnostics CEO said although genomic sequencing holds a lot of promise beyond cancer treatment, "right here, right now, we have not optimized or used fully what's available."

A CONVERGE panel discussing precision medicine included a regulator, a physician and research scientist who also teaches and the CEO of a diagnostics company. I thought it was a pretty well-rounded group although our patient advocate Emily Kramer-Golinkoff of Emily’s Entourage couldn’t attend for personal reasons. But in an interview later in the day, Boston Heart Diagnostics CEO Susan Hertzberg said it could have used one more critical player essential to making crucial improvements towards personalized medicine possible — a payer.

Herzberg pointed out that there’s a disconnect with payers that currently reimburse for best practice guidelines and the limitations of current population medicine. Half of the people who suffer a heart attack have a normal LDL cholesterol level or they might have a standard lipid panel.

She also expressed some frustration with the focus on genomics in personalized medicine. “The idea of what is personalized or precision medicine is a lot broader than genomics…Biomarkers that are non genomic have far more value than genomic data [currently] and are far more direct in treating patients and we shouldn’t forget about that.

“The big elephant in the room is this: What is the innovation pathway forward if we don’t have outcomes data? Without that data how will we get paid for what we do?” She said the big question is how will we get innovation into the market if payers don’t reimburse for it.

She added: “Heart attacks kill people every year and we still have issues of figuring out who is at risk and trying to find the right [single drug] or combination drug cocktail.”

Boston Heart Diagnostics approach involves doing personalized cardiovascular disease assessments through a series of diagnostic tests, identifying relevant biomarkers and doing risk assessment, and developing a treatment regimen that includes combines drugs and lifestyle changes. It also emphasizes presenting its test results in context so more patients can better understand them.

One of the issues that came up in the panel was a reminder that poor medication adherence can be a complex issue and it’s not just a health literacy, memory or financial issue. Some people have a bad reaction to certain medications but payers may be unwilling to reimburse for alternative treatment options.

“Population medicine in heart disease has been a spectacular failure.” Not something you’d expect to hear from a woman who sits on the board of their local American Heart Association chapter, but she described the push for people to know their cholesterol number as “a pathetic disaster.” If you know your cholesterol is 280, so what?

“The promise of what can come from sequencing the genome and what we can we derive from that will change the world, but right here and right now, we have not optimized or used fully what’s available right now,” Hertzberg said.

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