During a talk Wednesday hosted by the Duke Healthcare Policy Forum, Chancellor Emeritus Ralph Snyderman explained the benefits and challenges associated with personalized medicine, which seeks to identify a patient's medical risk and take preventative action at an early stage.
Snyderman served as chancellor for health affairs at Duke and dean of the School of Medicine from 1989 to 2004 and is now the James B. Duke professor of medicine. At the event, he emphasized how the transition to personalized medicine may play out in future policies. A thorough implantation of such a strategy could revolutionize patient outcomes, he noted, adding that recent advances in biotechnology are steadily bringing personalized medicine into the forefront of clinical practice.
"We have the ability to analyze thousands of proteins in the body, 2,500 metabolites and various other things that bring the capability to bring medicine from purely the pathophysiology of disease to developing an approach which understands not only disease but also understands health and the factors that lead to disease," he said. "Then based on that, to practice medicine in a far more, specific, predictive, personalized and precision way."
Snyderman—who was been called the “father of personalized medicine” by the Association of American Medical Colleges and is the current director of the Duke Center for Research on Personalized Health Care—also touched on the University's role in the birth of the field through its research on both health care policy and delivery.
He explained that his work in preventative medicine began during his tenure as the chancellor when he challenged clinical faculty to develop strategies that could be both cost-effective and beneficial for patients. Clinicians at the Advanced Heart and Lung Failure Clinic came up with a solution that was particularity effective and innovative, he said.
"The approach was to take patients with congestive heart failure and give them an intense education about their disease, give them a health care coach," Snyderman said, adding that patients were also extensively monitored for changes in weight or general health.
Within two years, the group with the personalized plan had an almost 50 percent reduction in medical costs, he explained, going from roughly $23,000 per patient to $14,000. He noted that the clinical outcomes were also extremely positive.
Snyderman said that the cardiology group’s initial experiment attracted much attention across the health care community. Further research revealed Duke’s initial findings to potentially have broader applications—a greater investment into patient education could not only reduce costs but also improve patient outcomes across the board.
However, the Duke Health system soon began to feel a financial strain from this personalized approach, an observation that eventually led to its discontinuation, he explained.
"I distinctly remember my chief financial officer coming in and telling me 'Ralph, I want you to understand something. We have saved almost 50 percent of the expenses for each patient. But the Duke University Health System is losing money, we cannot afford to do it,’” Snyderman said.
Since patients began to fare better in terms of their cardiovascular health, fewer checked in for an extended hospital stay. Snyderman noted that inpatient care is often one of the main contributors to a hospital’s financial margin.
He added that although the experiment at Duke Hospital was ultimately unsustainable, current dialogue around health care policy could pave the way for a long-term implementation of preventative care in the United States.
Policy experts such as Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy, have demonstrated the benefits of a “capitation” payment model, Snyderman explained. In this system, groups such as Duke Health—referred to as accountable care organizations—would be allotted a fixed sum of money by insurance providers based on the relative sizes of their patient populations. This differs from the current system, in which the insurance company gives the providers money based on the procedures they use to treat the patient.
"This is, in a sense, taking the insurance risk from the insurer and putting it on the provider, but creating a system where the provider is incentivized to deliver better, more rationalized cost-effective care,” he said.
Snyderman also said that implementing personalized medicine could shift the relationship between health care providers and their patients. The most obvious result would be a greater responsibility on patients to maintain a cleaner lifestyle based on their health risks, he noted.
“Any new model of health care to prevent or eliminate a chronic disease requires not only detection and monitoring and sometimes intervention with medications," Snyderman said. "It also involves the engagement of the individual."