NC Biotechnology Center | September 5, 2019
Thomas Edison once famously remarked that “to invent, you need a good imagination and a pile of junk.”
The sequencing of the human genome two decades ago provided the “pile of junk” from which medical researchers imagined a more personalized approach to medicine – one that uses genetic, lifestyle and environmental data to develop individualized ways to treat and prevent illness.
Progress is never as quick as experts hope, but precision health is really accelerating now as we better understand how people’s genetic makeup and other factors impact their wellbeing. That information can be used to determine the best treatment options, with the fewest side effects, at the lowest cost.
As the science around precision health advances, new challenges arise. How do you measure the personal and economic value of particular treatments, for example? How can precision medicine be more broadly integrated into everyday healthcare? How should insurers determine reimbursement?
These topics and more are gaining increasing attention for North Carolina, with partnerships, panel discussions and planning sessions involving a wide range of constituents.
Imhof spearheads precision health initiative
Behind the scenes and occasionally conducting the ensemble of participants you’ll usually find Sara Imhof, Ph.D., the North Carolina Biotechnology Center’s senior director of precision health.
A former senior analyst in health care for the U.S. Government Accountability Office in Washington, D.C., among other roles, Imhof joined NCBiotech in September 2016. Her role includes overseeing the North Carolina Precision Health Collaborative, a public-private coalition working to ensure the state’s leadership position in the fast-emerging sector.
As an example of her activities, Imhof will moderate a precision health panel discussion November 8 at the University of North Carolina at Chapel Hill’s Kenan-Flagler Business School’s “The Business of Healthcare” event. That panel will include:
- Art Swanson, vice president of product management for Optum Health. Optum is a unit of the world’s largest health insurer – United Health Group;
- Lori Orlando, M.D., MHS, associate professor of medicine in the Duke Center for Applied Genomics & Precision Medicine; and
- Gabriela Lavezzari, Ph.D., MBA, senior director of U.S. R&D policy and scientific affairs with GlaxoSmithKline.
Moderated panel at BIO International Convention
Imhof had also worked with Swanson and two other precision health experts when she organized and moderated a panel at the 2019 BIO International Convention in Philadelphia in June. Besides Swanson, that panel included:
- Hannah Mamuszka, founder and CEO of Alva 10. It’s a Boston-area firm that works with payers and biotech companies to find data-driven ways to improve healthcare delivery and reduce costs; and
- Nichole Fitzpatrick, Ph.D., product manager for Pittsburgh-based Highmark Health’s VITAL Innovation Platform. The program encourages early use of healthcare technologies that have received regulatory approval but are not yet covered by insurers.
Those panelists discussed real-world applications of precision health and provided a glimpse at what a more individualized approach to medicine can mean for patients, providers and insurers in the future.
Mamuszka focused on the value of diagnostics, using rheumatoid arthritis, ulcerative colitis and other inflammatory diseases as an example. Typically these conditions are managed with anti-TNF drugs, which are only effective in about 30 percent of cases. The trick is to know which third of the affected population will benefit.
Her company, Alva 10, has developed a diagnostic test to flag the 70 percent of patients unlikely to respond favorably to anti-TNF therapies. These individuals then can move to other protocols that have a better chance of success.
“The important thing is to spend our healthcare dollars on treatments that improve patient care,” Mamuszka said. “Not on those that don’t make a difference.”
Fitzpatrick manages Vital Innovation, a test-and-learn platform that can help propel new health solutions into the marketplace by providing the ideal environment for producing evidence. One project under her watch evaluates the ways precision health can reduce the risk of drug/gene interactions. Using pharmacogenomics (the study of how genes affect a person’s response to medicines), Vital conducted an in-depth review of approximately 13,000 patients taking five or more medications. It flagged close to 300 cases for further evaluation. Of those patients, 60 percent changed dosing, timing or the types of drugs they were taking.
Fitzpatrick stressed the importance of clinician involvement in the evaluation process and to produce true real-world evidence. “Both providers and patients needed to be educated,” she said. “And it was important to find a clinician to drive the process forward.” Her company continues to evaluate the economic benefits of the initiative.
Swanson stressed the value of easy-to-understand, individualized data in making the best medical decisions for patients. “ “If you can’t get the information to clinicians in a way that makes it accessible, you’re not going to make progress,” he said. “To realize the potential of precision medicine will require partnerships that share clinical, genetic and other data across multiple providers and even health systems.”
In summing up the panel discussion, Imhof highlighted the potential of precision health.
“It’s changing the way we deliver healthcare,” she said. “We’re just beginning to scratch the surface to realize the full value of precision health, both to patients and to society as a whole. The revolution is underway, and discussions like this remind us of the progress we’ve made and the opportunities that lie ahead.”