During her presentation at CANCERSCAPE, Kavita Patel, MD, MS, senior fellow at the Brookings Institution (Washington, DC), explained that, to physicians, personalized medicine doesn’t seem like something you have to learn how to do. “I always felt like I was already doing it,” she explained. In cancer, personalized care has always been considered the standard of care.
Dr Patel noted that physicians are currently practicing precision medicine by participating in CME programs, keeping up with the latest literature, attending conferences, and familiarizing themselves with NCCN guidelines. All of these activities are necessary for ensuring that physicians are equipped to make the best treatment decision for each individual patient. Yet, none of these activities are considered to be explicit quality measures. Therefore, rather than assessing the patient’s outcome as a quality measure, Dr Patel suggests that the quality of the “algorithm,” or the cognitive process used to arrive at the treatment decision, be evaluated as a measure of quality.
Dr Patel, who is serving as an advisor to the White House on its Precision Medicine initiative, clarified that precision medicine and personalized medicine seem to be used interchangeably as far as the White House is concerned. On a practical level, these terms have come to mean conducting molecular screening, putting data in a registry, and sharing information with colleagues. Although most physicians are already prioritizing these initiatives, their efforts have been inhibited by inefficient and cumbersome electronic health record systems and inadequate reimbursement models. In order for these hurdles to be overcome, there needs to be greater alignment between physicians, patients, and payers.
Dr Patel also encouraged health care providers in the audience to think about how they are positioning themselves with regards to value-based care. Dr Patel noted that value is often defined in terms of the Triple Aim (improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care) or in terms of cost divided by quality. But the precise definition of value depends most on who is defining it. Therefore, if clinicians don’t want to be told what value is, she argued, they shouldn’t wait for the government to decide on a definition; instead, physicians themselves must decide on the measures and metrics used to quantify value and advocate for those to policymakers. Dr Patel used Tesla automobiles as an example of a product that the government subsidized because they were convinced of its value. She noted a current vacuum of leadership for similarly defining value in the oncology space.
Dr Patel also pointed out the inherent conflict between defining value and quality on a population-health level and efforts to make care more personalized. She argued that measures of quality should be specific to the clinical population at hand rather than being applied to broader patient populations for whom such measures are meaningless.
She concluded that the mission of most physicians is to treat every patient like a randomized controlled trial of 1, to achieve the best quality of life possible, and to extend the patient’s life for as long as possible. If physicians are able to do these things, they will have achieved the goals of personalized medicine.
