Navigating the Conflict of Personalized Medicine vs Population Management

Population health is a method that looks at the total costs of care, focuses on the prevalent chronic diseases, and, additionally, examines the various social determinants of health of an entire community. However, Burton F. VanderLaan, MD, FACP, medical director of Priority Health, explained that precision medicine, specifically in precision oncology, seeks to do just the opposite by employing variation and individualizing treatment rather than standardizing it.

It’s this fundamental challenge between both paradigms that VanderLaan and fellow panelists Joseph Alvarnas, MD, director of value-based analytics for the City of Hope, and Kavita Patel, MD, economic studies fellow and managing director of the Brookings Institution, came together to discuss at The American Journal of Managed Care’s 4th Annual Patient-Centered Oncology Meeting. The discussion was moderated by Dennis P. Scanlon, PhD, professor of health policy and administrator and director of the Center for Health Care and Policy Research at The Pennsylvania State University.

“Some of the specific challenges and things that I think need to be addressed first of all … I think payers are going to definitely have to reevaluate the evidentiary basis that they use to determine coverage policy,” VanderLaan said. “I think plans are going to have to become a little more comfortable with the notion of variation because when you’re individualizing therapy, that’s going to become a given.”

From a metric standpoint, Alvarnas said that the measures that exist today are problematic in that they don’t transfer over from one method to the other. Because of a rapidly evolving technological world, the metrics simply can’t keep up in a way to continue to effectively evaluate care. However, creating a form of communication—or a sort of language—that’s both transparent and transcendent in which the physician can spot good care, but also recognize when care is mismatched, is a formulation that he believes can help reconcile the tension between population health and precision medicine.

Patel added that concepts like increasing drug costs, the volatile or the variance around costs in general, and the conundrum regarding how standard benefits are defined all play into the issue of reconciling population health and precision medicine methods.

“Those are all the reasons that when you get to something like oncology, personalized medicine, then you get to precision medicine, that it becomes quite honestly too difficult to legislate,” Patel said. “So I would almost say that the challenge for this audience, this community, stakeholders like the 3 of us that are up here, is how can we deal with the fact that we’ve got a really basic infrastructure that’s very much outdated?”