Precision Medicine v. Accountable Care: A Faux Choice?

By Gregg A. Masters, MPH

Whether you call it personalized medicine or as Eric Topol MD prefer’s ‘individualized medicine’ or even via the possible conflation of the two c/o the President @BarackObama ‘Precision Medicine’s’ initiative (see fact sheet here), it strikes me that we may need an emerging business model glossary to make sure we’re comparing, contrasting and discerning health reform and clinical practice innovation correctly.

Precision Medicine Fact Sheet

Further considering the difficulty in separating healthcare innovation or clinical practice transformation/re-engineering from political spinmeisters and their ideological agenda’s, it’s vitally important to gain a grasp of the range of conversations now in play under a ‘big tent’ of widely variable practice in health[care] innovation circles.

It’s tempting to dumb down the debate by assigning those ventures in the ACO or accountable care derivative play space to ‘tweaks at the margin’ of business as usual medicine, while reserving the more promising frontier represented by precision medicine as a life sciences and biotechnology fueled new breed of medicine enabling us to walk away from the business as usual burning platforms required by the current financing and delivery of care paradigm.

A few articles will help with the discernment and formation of a common taxonomy of accountable care and precision medicine practices – which I will use to include both personalized and individualized medicine.

In Specialist Doctors Head for Exit as U.S. Shifts Payments we revisit the perennial dispute between cognitive vs. procedural medicine specialists and the relative embrace or resistance of ‘bundled payment’ as a transitional practice to value (vs. volume) based medicine. Disorganized medicine has a history of ‘circling the wagons’ and shooting in to solve differences. Unfortunately, the current developing divide between primary care specialists and their sub-specialty peers will likely continue this tradition of internecine warfare.

InPrecision medicine takes genetic mapping to the next level Florence Comite, MD (@comiteMD) an endocrinologist turned precision medicine evangelist unbundles the biotech and genomic medicine fueled promise of this emerging field.

And at Will patients pay for Personalized Medicine? Rob Wright (@RfwrightLSL) dips into the ‘follow the money’ question given the continued practice (now somewhat codified by the ACA via a metals designation of plan type) of cost shifting from health plans to patients/members the increasing burden of health benefits coverage.

Finally perhaps tangential though relevant to the conversation is the recent ruling in the Massachusetts Attorney General v. Partners Healthcare litigation where the delivery system merger is being challenged as anti-competitive. Fueled by accountable care strategy roll-outs (formerly ‘managed care’), market trends and the ACA, consolidation is one of the key themes likely to influence both the alchemy and market conditions under which both of these models will continue to evolve before before their inevitable convergence into a sustainable health[care] ecosystem.

Yes, we do live in ‘interesting times’.




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  1. Gregg Masters
    FEBRUARY 26, 2015 AT 5:54 PM
    Well done, especially the context for ‘insanity’.

    Completely agree with the emerging parameters (things we need do) you’ve laid out to scale and focus the challenge of ‘doing things differently’.

    Yet, I quibble only with the fact that ‘report card’ of this MSSP ‘shift’ (physician integration/alignment with entity mission, and the cultural, workflow process re-engineering, including the de-siloing of third party payment incentivized traditional health care delivery sites) is somewhat of a ‘O, G & E’ (organization, governance and equity) chicken dance.

    In other words via a series of gross movements over time we’ll likely witness the purposeful refinement of enabling physician culture and associated staff and MLP workflow processes to more accurately target and support the ‘cost reductions’ required to ‘win’ at this game. In the chicken dance metaphor, the subject is not quite clear what he or she did to earn the reward (truth admitted by several MSSP players at august meetings of ACOs). Perhaps not an exact metaphor, the picture works for me – but only in organizations committed to learning how to act differently.

    Attributing specific actions to ‘success’ or ‘failure’ at the equivalent of the top half of the first inning in this game is a tad pre-mature. Chance, or the low hanging fruit of payment formulas may be more of a determinant of success or failure than a mission of ‘purposeful behavior change’.

    Great piece! May I re-post with attribution on @ACOwatch?

    And if so Inclined, might we schedule you on ‘This Week in Accountable Care’ a 30 minute live Internet radio show:

    Gregg Masters

    1. Randy Williams, MD
      FEBRUARY 27, 2015 AT 4:26 PM
      Gregg, thanks for posting your comment. I think you are right about not judging winners and losers until we’ve played more than an inning of the game. Your analogy points to an important point that we think is being lost on the ACO movement. Namely, as an industry, we can’t afford to go into the 9th inning tied 0-0…no one will show up at that game!

      So the key question we’re trying to push ACO leaders to explore in the “first, second, and third innings” is “How do we score runs?” The point is this: by knowing the strike zone and understanding what kind of pitch is being thrown.

      At the risk of beating up the analogy, ACO leaders need to be a bit smarter and a bit more willing to learn from others, rather than just stepping into the batter’s box and swinging at every pitch. There are PROVEN paths to success, and the first year ACO results DO point to those paths. As does the 7 year experience of 10 “precursor” ACOs in the CMS Physician Group Practice Demonstration.

      Pharos had the unique opportunity to partner with 2 of the 10 organizations, for what I would consider several seasons of training in the minor leagues. In my next post, I’ll share more about what we learned; but to be sure, scoring a win as an ACO requires the right focus and the right approach, not just swinging at the pitch, or worse yet, not swinging at any pitches until late in the game!

      Cheers, and looking forward to chatting live very soon.

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