Laura T. Housman, MPH, MBA October 17, 2018 Personalized Medicine in 2018: Seizing Opportunities and Overcoming Barriers to Implementation in Practice Laura T. Housman, MPH, MBA October 17, 2018

Thanks for the opportunity to share my thoughts with you this evening. The views and opinions expressed in this presentation are solely mine and do not represent official policy or position of Access Solutions Consulting or of its clients. Access Solutions Consulting provides strategies and solutions for all areas of healthcare commercialization, reimbursement and access support ©2018 Housman

Five challenges in implementing personalized medicine into practice Education and awareness Patient empowerment Value recognition Infrastructure and information management Ensuring access to care Pritchard, D., Moeckel, F., Villa, M. S., Housman, L. T., McCarty, C. A., & Howard L McLeod, H. L. (2017). Strategies for integrating personalized medicine into healthcare practice. Personalized Medicine, 14 (2), https://doi.org/10.2217/pme-2016-0064

Ever-growing number of free, online educational resources for patients and consumers

A screen-captured market supports patient engagement ©2018 Housman Source: https://www.imshealth.com/files/web/Global/Services/Strategy%20&%20Management%20Consulting/IMSCG-Consumer-Driven-Testing-WhitePaper.pdf

Demand for innovative services in healthcare is exploding In 2017, 32% of consumers had at least one health app on their smartphones or tablets. ©2018 Housman Source: http://www.clinicaltherapeutics.com/article/S0149-2918(17)31007-X/fulltext

Types of genetic testing Clinical genetic tests are ordered by healthcare providers. Clinical genetic tests are sometimes ordered to diagnose a disease, assess the likelihood that a treatment will be effective, or determine whether a treatment or dosage will cause a severe side effect. Forensic genetic tests are usually ordered by law enforcement or a court. The result of a forensic genetic test is used to determine a person’s identity, often at a crime scene or the scene of an accident. Educational/Informational genetic tests can be ordered directly by an individual. The results of an informational genetic test are returned directly to the individual who ordered it and can be used to gain a better understanding of one’s ancestry or how one’s individual genetic traits influence behaviors, such as exercise and diet. Genetic health risk information may be included in the results of educational/informational genetic tests . By examining our genetic sequence, we can estimate our comparative risk of getting certain health conditions. In process: Guide to consumer genetic health risk testing, Personalized Medicine Coalition working group 2018

Retail and online access to genetic testing is burgeoning ©2018 Housman

CDC Blog: “Think Before You Spit!” “With improved technology and plummeting prices in the coming decade, we could see an expansion of DTC testing for personal genomic information” October 10, 2017 at 1:36 pm Informative. In this era of too much information sharing, it is good to be clear about what exactly you are asking for, expecting in return and who will have access. I am just considering testing for genealogical information, but this brought several issues to my attention that had not occurred to me. Always better to be well informed about all sides of an issue….(excerpt) December 25, 2017 at 1:50 am I received health risk assessment information from a DTC several years ago and have found it quite useful. Knowing that I was at higher risk for 2DM, I have been more careful of weight and diet. Knowing that I was at higher risk for macular degeneration, I’ve not skipped eye examinations and won’t…(excerpt) December 17, 2017 at 1:34 pm I’m not sure how much I trust personal genomic DTC companies rigor in regards to testing. However, if someone does get this done they need to see a genetic specialist to discuss their test and the results. The average PCP does NOT have enough genetic education to be able to interpret the test results….(excerpt) ©2018 Housman https://blogs.cdc.gov/genomics/2017/04/18/direct-to-consumer-2/

“Direct to Wallet” Emphasis is on getting a test or device into the market without waiting on payment from traditional reimbursement channels such as private or governmental payors. Here, the ordering physician can either be the patient's own treating physician or can place the order for the patient as a contracted staff member of the laboratory or manufacturer.   Payors have already been in wallets for newer testing innovations… Co-insurance Co-payments Deductibles 30-50% patient contribution in some cases ©2018 Housman

Third party physician and genetic counseling networks support Direct to Wallet offerings ©2018 Housman

Key points to consider Personalized medicine is now consumer initiated and physician ordered.  Technological and scientific advances in personalized medicine have outpaced its adoption in practice.  Patients and consumers can now take their own actions given the genomic marketplace.  What happens when population health meets personalized medicine? What conflicts can arise?   Where is all this data going? Massive data base of 1 million people being developed – whose data is it? Who owns it? What happens to it – what can it be used for (both good and bad)?

Thanks! Let’s keep the conversation going @LauraHousman lthousman@asc-access.com Laura Housman