Future of Diagnostics: The Convergence of Data, Tech and Therapeutics

GE Ventures former CEO Sue Siegel and Section 32 Managing Partner Mike Pellini discuss the four aspects of health care coming together to advance diagnostics in ways never before possible.

Key Takeaways: Diagnostics in health care have historically fallen short compared to other sectors in terms of both spending and research. However, increased demands regarding personalized medicine, predictive measures and early identification of disease are pushing the industry to enable new breakthroughs in diagnostic science.

By Michaela Katz

Today, there is a huge disconnect between diagnostic spending and the health care industry’s reliance on the tools and findings. At the same time it’s becoming increasingly clear that diagnostics will only become more important, if not strategic, in the massive shift toward value-based care.

“Two percent of the spend goes toward diagnostics — and it fuels 70% of the spend on the decisions made from it,” said Sue Siegel, CEO of GE Ventures and Chief Innovation Officer of GE in an interview at the Health Evolution Summit.

This balance clearly doesn’t make sense but, fortunately, things are beginning to change.

“Diagnostics used to be about the today, and diagnosing disease, and now we’re moving into a world where it’s all about potentially diagnosing something…where there might be no action ability, or prediction. And there’s power to that,” Siegel noted.

What’s driving this opportunity to make diagnostics a more valuable part of the equation?

“There’s an emergence of data, the utilization of data, the mining of data in a way that we’ve never really been able to do until this point in time,” said Mike Pellini, MD, Managing Partner of Section 32 and Chairman of Foundation Medicine in the same interview.

Data is just one piece of the equation. Another is the emerging technology that enables new capabilities every day and not just for diagnostics or health care but for every industry.

“We have data, we have technology, we have diagnostics and we have therapeutics, and all four of these pieces are coming together in a way that we’ve never seen in our lifetimes or, frankly, anyone’s lifetimes,” continued Pellini.

It is clear that acknowledging the value of and increasing investment into diagnostics will have a large impact. This increased emphasis will allow for the application of predictive analytics, will decrease spending for unnecessary treatments and lead to earlier and better treatments of serious and life-threatening diseases.

Beyond its impact in the clinical setting, diagnostics will have far-reaching effects in areas key to the changing health care ecosystem.

“Diagnostics drives personalized medicine,” Pellini said. “Diagnostics are the linchpin to success in personalized medicine. Diagnostics are the linchpin to even value-based care.”

Siegel emphasized the importance of the potential role of diagnostics in achieving value-based care, “With the change into fee for value and what’s happening in the health care system, diagnostics has to play a role that is much more powerful than it’s had a chance to play in the past.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

The Health Evolution Interview: CMS Head Seema Verma

Centers for Medicare and Medicaid Services Administrator Seema Verma and Health Evolution CEO Julie Murchinson took to the stage at the last Health Evolution Summit for a wide-ranging conversation about a number of today’s most pressing topics. 

In this Health Evolution Interview, they discussed Verma’s life prior to CMS, her biggest surprise when joining the agency, how she manages to lead substantive and sweeping changes while the White House and others are working to repeal the Affordable Care Act, and efforts to unleash innovation and the power of consumers.  

Murchinson: We’re thrilled to have you here. And I want to start with just the personal you. You’re near the top of the most influential list in the industry. So where do you come from? What’s your journey so far? 

Verma: I started my career working on the front lines in a public hospital. That shaped a lot of my thinking about health care because you’re seeing government run programs, you’re seeing the quest of a public hospital trying to be innovative, trying to compete with private players and you’re also seeing patients, very vulnerable patients, and the difficulties and the issues that they face. So it was a great experience for me because it was looking at the health care system from a lot of different vantage points. 

Then I went on to work with states and helped them craft policies and innovative ideas. In my work as a consultant, when I ran my own consulting business, the great part about that was being able to work with all different parts of the health care sector. Not only working on the state government side, but hospital systems, the private sector or technology firms. Some of the neat things that I got to do as a consultant were designing health care programs and also working all the way through implementation. Getting legislation passed, working with CMS on waivers, and actually sitting there with the IT vendors discussing exactly how this was going to work from an operational perspective. 

Murchinson: Once you got to CMS, then, what was the biggest surprise? 

Verma: When I first came to CMS, people said “these programs are so big.” I had one person say to me “it doesn’t even make sense.” We were very short staffed in the beginning, and so I essentially was clearing everything across the whole agency. So I’ve gotten to work with everyone.

For me, it makes a lot of sense that the agency is structured the way that it is between Medicaid and Medicare and the exchanges and also now with CMMI. We are running programs that have the same problems and the same issues and they’re all rooted in how we address health care costs. If we’re solving that, we’re helping Medicare, Medicaid and the exchanges. The challenge of the agency now is not only running these programs but, because they’re so large, we have an impact on the entire health care system.

Murchinson: So the magnitude of CMS is one thing. When you get into where we’re headed toward spending approaching $3 trillion, I hear you’re adding 10,000 members a day, the drum beat around Medicare for All is really rising. So talk a little bit about the trajectory and what you’re doing … 

Verma: So you’re right, it’s 10,000 every single day. The other challenge that we have is people are living longer. If we look at the number of people that are 85, that number is almost going to double by 2050. So it’s people living longer and more people are on the program as their needs change. That’s not sustainable. The implications for the country in terms of our role in the entire world is impacted by that. So if we look at what we’re doing at the agency, everything is sort of centered around how we make care more affordable, more accessible, and make sure that we have high quality care.

That’s nothing new. We’ve been hearing that for many years. I think our approach has been a little bit different. One area that we’re really focusing on is empowering patients. For years we’ve been regulating everybody, hospitals, doctors, pharmaceutical companies. We really haven’t unleashed the power of the consumer in healthcare. So we’re doing a lot of work around that. 

Seema Verma CMS

The second area is unleashing competition. When you have competition, you are creating basically the ambition for providing more low-cost quality care. Without competition there’s no incentive around innovation. 

The other piece is focusing on how we unleash innovation across the whole system. It starts with simple things like making sure once the FDA approves a device or medication, that we’re doing a good job of making sure that it is accessible to our patients. 

We’re working on those issues. This is an area that I think isn’t very sexy, but it’s regulatory relief. 

Murchison: With Medicaid and job requirements you’ve been a hot button. But I’ve watched you take what you did in Indiana and take a different approach at CMS to state reform and how you think about enabling waivers and enabling different relationships between the federal government and states. Can you talk a little bit about what that looks like?

Verma: Before I came to CMS I negotiated between states and CMS. What I learned going from state to state is that states are the laboratories of innovation coming up with great ideas. They know what’s going to work best in their health system. Every health care delivery system is a little bit different. The issues in Montana are very different than the issues in New York City or New York state. So you can’t have a one size fits all approach with states paying for these programs. In the Medicaid expansion population it’s only 10 percent but in a lot of the other areas of the program they’re paying sometimes up to half. Yet in terms of decision making, they really don’t have any control in the program. It’s a very ‘mother may I?’ system where they’re basically asking us to approve routine changes. It’s almost a cultural change.

We want to be able to say ‘we’re here to get you where you want to go’ as opposed to being a barrier to innovation. 

In terms of work requirements, what I will say on that is we are responding to state requests. There are states saying ‘we want to help the people living in our state rise out of poverty and find a pathway out’. Anybody that’s worked in Medicaid knows that a lot of those individuals, they don’t want to be there. People don’t want to receive government assistance. They want to be independent. They need help and they need more than an insurance card. Having a job and having the dignity of work could have a very positive impact on health outcomes. So I think the whole notion of waivers is around experimentation, testing innovative ideas. We need to try to do things differently. We need to try to end poverty and try different techniques and to not allow innovation, I think, is a tremendous disservice to the people that we serve. 

Murchinson: Can you share how you’re managing CMS, given Trump’s intention to eliminate the ACA? 

Verma: First of all, it’s our job to implement the law so that’s what we’re doing. I think it’s really born out of concern that things aren’t working the way that they should. I agree that we have provided coverage to people that can’t afford coverage and that’s a good thing. But we also have tremendous problems where premiums have gone up by over 100 percent. And I can’t think of a single thing that I buy that has gone up over 100 percent. We’re seeing a lack of competition in markets where even the year before 50 percent of counties only had one choice of health care plan. We’re seeing millions of people that have left the exchanges that are not subsidized and can’t afford anything. So there are still many challenges that remain. What we’ve tried to do is figure out how can we stabilize the market. Unfortunately, without Congress’s help, there’s not a lot that we can do, but we’re trying to figure out what we can do to stabilize. This year for the first time rates were actually lower, there wasn’t a double digit rate increase and, in fact, we actually saw a decrease. 

The next Health Evolution Summit takes place April 1-3, 2020 in Laguna Niguel, California.

AI Redefines Health Care Roles

Siemens CEO Bernd Montag discusses the promise of AI to deliver high-value care, redefine roles in health care and increase humanity in medicine

Reducing Unnecessary Spend

Landmark CEO Nick Loporcaro shares his take on the importance of reducing spending in health care, aligning incentives and addressing pressing needs.

Ancestry CEO on Re-imagining the Consumer Experience

Margo Georgiadis discusses Ancestry’s work to better understand the patient journey one person at a time.

Key Takeaways: Growing interest in DNA and genealogy has led companies like Ancestry to up their consumer engagement game by looking to Google, Apple and other examples.

By Michaela Katz

Across the country, individuals are increasingly requesting access to and detailed analysis of information about their DNA and companies like Ancestry, 23andMe and myriad others have risen to meet that demand.

As companies providing meaningful information about DNA, genealogy and personal and family history become more commonplace, lessons are emerging from their work to clearly understand individual’s unique journeys and needs.

“What makes companies successful is this obsession with the customer and customer centered innovation,” said Ancestry CEO Margo Georgiadis, during an interview at the Health Evolution Summit. “What technology really enables is the re-imagination of the consumer experience.”

She pointed to her former employer Google’s razor-sharp focus on getting users the information they want effectively and quickly with a simple, clean search page and function, and Apple’s work to simplify complex tasks so they are as easy as possible, as just two examples.

“When you really obsess about that job you do for consumers,” she said, “that’s where the magic happens.”

In health care, Georgiadis believes that magic will take the shape of advances that enable providers to routinely deliver personalized advice and assistance.

“We don’t treat people by understanding who they are and what that journey is that they’re on. If we change that mindset, we would get far better outcomes from consumers and help them to be more engaged in the experience,” she said. “I think about it as you have the consumer and you have the provider. Those experiences can be enabled so that both sides can be more effective and more efficient.”

What else does the future promise for the world of DNA analysis and the health care industry at large?

“Machine learning and AI truly can transform our ability to suggest and assist.” Continued Georgiadis, “You can unlock possibilities as never before. Things that are possible now with technology just a few years ago were not scalable.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

Cambia CEO: Healthcare Needs to be Radically Focused on Consumers

Mark Ganz on making consumer needs a company priority and what that means at Cambia.

Key Takeaways: Across the health care industry, companies are working to better address consumer needs and create a better experience. This focus on the customer is pushing for personalized health care experiences, better stewardship of patient data and addressing consumer needs before they arise.

By Michaela Katz

Consumers are increasingly demanding a better health care experience—one that matches the consumer-focused aspects of other industries, notably retail. As such, it is crucial that health systems and plans understand the importance of making consumer-driven changes.

“When I became CEO I couldn’t believe how out of step health care was with all other aspects of my life and the lives of the people we serve,” said Cambia CEO Mark Ganz in an interview at the Health Evolution Summit. “You would think something that was so personal and so important would be the most consumer-focused industry. And yet, it’s the least.”

But what does it mean to be consumer-focused in health care?

There’s not one correct answer. Generally, however, it includes efforts to make health care a better, easier to understand experience for each individual and put the consumer at the center.

“It’s all about personalizing the experience and recognizing that when you talk about populations in healthcare, N equals 1. Or 1 plus the caregivers and family around them,” said Ganz. “People don’t want to be told what to do. They want to be offered options.”

Another big consideration in the push to consumer-focused health care is the use of patient data. Many organizations currently act as if once data is collected patients relinquish control of their data. If anything, the opposite is true.

“We are stewards of their data and everything we do needs to be built around how does that data flow to them and with them when they go on their journey,” said Ganz.

Ganz added that Cambia is making strides in its efforts to radically focus on the consumer, but its journey isn’t done and, it won’t be done alone, which is why the company partnered with Blue Cross and Blue Shield of North Carolina earlier this year to improve patient experience.

“There’s an alignment of values and vision and we both want to change the world,” said Ganz. “I think what we can do for consumers together versus what we could do separately is very, very compelling.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

North Carolina leading the charge to ‘buy health’ for its citizens 

CEOs are making their business models work to embrace the state’s forward-looking agenda to invest $650 million in social determinants and other new ways of driving down costs. 

Key takeaways: North Carolina’s emerging systematic approach to aligning various public and private health organizations to change business models is a great example of how social determinants are starting to reshape not just care delivery but also ways the system interacts with other industries, in this case housing, education, food and nutrition.

By Tom Sullivan

Private and public health care executives in North Carolina are putting forward an agenda to move quickly toward value-based care.

With $650 in federal and state funding, later this year the state’s Health and Human Services department will transition its entire Medicaid population to managed care plans. That involves 18 percent of the state’s 10 million people, and 40 percent of its children.

The initiative includes Medicaid, Medicare and commercial health care organizations that are beginning to align around the broad notion that they can allocate resources to essentially purchase better health for state residents by incorporating social determinants into its overall strategy to both improve value and drive down costs.

Cohen explained in an interview with Health Evolution that Patrick Conway, CEO of Blue Cross Blue Shield North Carolina is moving the commercial space in the same direction. Cohen and Conway, it’s worth noting, are former CMS colleagues. She served as chief operating officer and he was deputy administrator.

“We want to buy health and that means doing things differently, putting different programs in place,” said Dr. Mandy Cohen, the state’s Health and Human Services Secretary. “We’re starting that work. This is a sea change, not an overnight process.”

But what precisely does it mean to buy health?

For starters, the people in healthcare have to be in what Cohen described as “a bit of a different business,” that factors in various aspects of people’s lives, including jobs, housing, community violence, and other social determinants.

“When really thinking about driving toward value you kind of have to know: What do we value?” Cohen explained in the below interview, conducted earlier this year at the Health Evolution Summit. “In North Carolina we value health — and not just health care.”

It’s not as simple as paying for more care services and, instead, state officials have to be very specific about aligning resource allocation closely with what they want to accomplish. That’s why North Carolina HHS considers various levers at its disposal, notably economic benefits, early childhood education services, food and nutrition to drive better population health.

“We’re going to use up to $650 million not just to buy more health care, but to buy some of those things underlying health,” Cohen said.

[Read Health Evolution’s in-depth interview with Dr. Mandy Cohen about the state’s work with social determinants of health.]

Among many social determinants, Cohen learned that providing new carpets and air filters to asthmatic children, as just one example, could keep them out of the emergency department.

“I don’t want to pay for an emergency room visit,” Cohen said. “I want to pay for a new carpet.”

Getting to that future state of value-based care that keeps North Carolinians healthy instead of in the hospital, however, will take considerable investments by hospitals, insurers and the state itself.

“There’s investment needed to help folks change. You can’t just expect it. Hopefully we can overcome those barriers together,” Cohen said. “It’s hard so let us help invest in that infrastructure change that’s needed.”

Watch more episodes of the Health Evolution Interview Series. The next Health Evolution Summit is scheduled for April 1-3, 2020 in Laguna Niguel, California.  

Depoliticizing Medicaid

Paul Tufano, Chairman & CEO of AmeriHealth Caritas, examines misconceptions and the vicious cycle of Medicaid and how Medicaid can be depoliticized.

Driving Change in Post-Acute Care

Neil Borg, Managing Director, Head of Corporate Finance of Ziegler, and Tracy Bahl, EVP, Health Plans of CVS, examine how to drive change in post-acute care, integration and aligning incentives for the right economic models.