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How precision medicine and austerity will change health care

Here is how Prof Antony Rosen, vice dean for research at Johns Hopkins, sees precision medicine in its broadest sense changing the business model in a world where more and more payors are imposing arbitrary ceilings on what they pay providers.

Note first that, for Rosen, precision medicine is about measuring with an open and inquiring mind everything from molecules and genes to social outcomes. In fact today , while genomic insights are key, he thinks a focus on the genome alone misses important opportunities. “There is so much focus on the genome, but insights from social determinants, patient-reported outcomes, and basic physiological measures of wellness can impact health outcomes today.”

So we asked what does that mean in a world like Maryland, Johns Hopkins home, where the state has imposed a cap on increases in health expenditure of 1.5-2pc a year on health systems as a mechanism to restrain growth of health care costs?

For Rosen it must push hospitals to start working out how to do stuff more effectively. Take rehabilitation after surgery. Johns Hopkins found that measuring mobility before and after surgery enabled it to predict outcomes and particularly who really needed physiotherapy and who didn’t. Rosen says: “We could immediately see a group of physically active patients who got better with minimal input. For them intensive physio was unnecessary. Moving from a model where all patients automatically get the same package, whether they need it or not, to one that is tailored to individuals or groups generates colossal savings”

He sees the future then as one where teams of clinicians deploy similar measures to maximise outcomes routinely working with teams, including data engineers and social scientists. He stresses that this should be seen as a creative process powered by wonder. There is a danger that we simply have too much data and too many tools. The trick is to find the right data.

That needs to happen fast. In aggregate in 2018, the per capita medical expenditure on healthcare times population in the United States was $1 trillion more than the next highest healthcare spender in the OECD. Rosen says that figure is nearing $2 trillion today.

As our readers know, governments in Europe such as France and the Netherlands are also capping hospital expenditure. To survive hospitals in Europe and globally are going to have to innovate in a similar way.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.