Use of EBM/PM In Concierge Medicine

The Concierge Medicine Assembly, Atlanta, GA | Legal Session

“This is where Concierge Medicine really sets itself apart,” says Catherine Sykes, CEO/Publisher of Concierge Medicine Today at their annual 2016 Concierge Medicine Assembly held in Atlanta, GA.

At Evidenza, We Are Concerned About Four Key Areas Growing In Precision Medicine, It’s Application & Use Inside Concierge Medicine. Those Areas Include:

  1. The Use and Appropriate Medical Application of Evidence-Based Medicine (EBM) in Concierge Medicine …
    (READ MORE about here ‘Official Position Statement’ …)
  2. The Use and Appropriate Medical Application of Whole Genome Sequencing AND Analysis in Concierge Medicine …
    (READ MORE about here ‘Official Position Statement’ …)
  3. The Use and Appropriate Medical Application of Health Analytics in Concierge Medicine …
    (READ MORE about here ‘Official Position Statement’ …)
  4. The Use and Appropriate Medical Application of Pharmacogenomics in Concierge Medicine …
    (READ MORE about here ‘Official Position Statement’ …)

Evidence Based Medicine

The core purpose of Evidenza’s EBM Solutions is finding and delivering relevant evidence (found in clinical trials) to both concierge medicine physicians and their patients.  For over 10 years physicians with private medicine practices have been relying on EBM to find and deliver evidence that would help them identify the best therapies for their unique patient population.  Many patients who are members of concierge medicine practices expect their primary doctors and/or their specialists to rely on real evidence to make the best recommendations on their behalf.  Thus many private medicine patients/members also rely on these technologies to provide the same evidence services when they get diagnosed with a medical problem.

Concierge Medicine promises high-quality service and high-quality care.  To fulfill the promise of providing the “highest quality of care,” physicians need access to the best evidence available for any medical problem.  Concierge Medicine doctors who use evidence from clinical trials are more likely to identify the best drug or device or specialist for any unique medical condition.  Relying on training, experience, referral networks, review articles, seminars, standards of practice is not enough.  Physicians who merge their expertise with an analysis of the data found in clinical trials are in the best position to find the best therapy.

What used to be nearly impossible for physicians to do in the past is now easy to accomplish.  Now physicians can use EBM to answer any medical question with real evidence.

Dr. Todd Feinman, is the Founder and CMO of DOCTOR EVIDENCE, is on the Evidenza Steering Committee and was a Concierge Medicine Assembly Faculty Member (2015, 2016 & 2017).

“Personalized application of evidence-based decisions should be the norm, and our company provides the technology to access the most up-to-date, patient-specific evidence for a given therapeutic area or intervention, so that physicians and patients can decide together the most effective course of treatment,” says Feinman. “Concierge doctors, known to be innovative and patient-centered care, are in a unique position to take advantage of the growing number of personalized data resources matched to patient profiles and preferences, including the Doctor Evidence technologies, to improve patient care.”

Evidenza’s EBM Solutions works with Concierge Medicine doctors and their patients to make sure they are getting all the relevant evidence that will answer any framed question.  Here is short list of projects done on behalf of private medicine doctors and their patients:

  • Finding surgeons with the best survival rates for prostatectomy for localized prostate cancer.  And comparing the survival rates to watchful waiting.
  • Determining rate of cancer secondary to metal hip replacements.
  • Rate of colon cancer detection by screening colonoscopy in asymptomatic patients.
  • Stroke, MI and death rates for different statin drugs.  And compared to placebo.
  • Flu Vaccine efficacy for healthy adults
  • And hundreds more

The entire process includes:

  • Framing question with both patient and their physician by email and/or phone
  • Finding and retrieving all the relevant studies (including relevant evidence found in unpublished resources as needed)
  • Analyzing the data and creating a custom report that is sent to patient/physician.
  • Modify project as needed based on analysis done.
  • Informed decision made by patient with their physician
  • Finding best specialists as needed that provide “best therapy” identified by the evidence (i.e.: Surgeons who perform nerve sparing prostatectomy and have their own outcome data)

Health Analytics

Outcomes-based scoring is quite complex. The data on readmissions and patient mortality inside a hospital require no subjective interpretation, the data on complications however, is not as clearly documented. This is due to recording complications that require individual judgment. Coders, healthcare professionals and their patients may differ in their interpretation of events. As a result, complications may be recorded differently across facilities (or even by different coders within the same facility). Furthermore, even if codings were consistent, the codes themselves do not always separate a mild complication (like a simple infection) from a serious one that requires greater medical attention (like sepsis). Therefore, a time-tested, peer-reviewed methodology to account for complications must be integrated into Surgery Quality Scores.

Read More About the Methodology …

Concierge Doctors Can Now Refer Their Patients to Qualified Surgeons Based on Actual Medical Outcomes

A new partnership equips Concierge and Direct Primary Care physicians with a tool to refer patients to Top Surgeons with a 4-year track record of exceptional performance.

A 2016 survey by CMT found that current surgeon referral methods lack any type of objective outcomes-based information. In fact, no respondents reported using actual data, with one-third replying that the primary way they choose a surgeon for their patients is based upon the opinion of a colleague who stated that the surgeon was good.

“We are happy to bring MPIRICA’s innovation of outcomes-based quality scores to our readers,” said Catherine Sykes, Founder/CEO of Evidenza. “Now Concierge Physicians [and their patients] can use data to confidently support their decisions when recommending a quality surgeon and facility nationwide.”

The MPIRICA Quality Score is easy to understand and actionable, with a risk-adjusted and rigorous methodology. A score from 600 to 800 represents an excellent demonstration of care for a given procedure. Scores less than 600 but more than 400 represent fair care, while anything below 400 indicates substandard historical performance. This new service and information can be easily accessed here. Information about the methodology behind the score can be found at www.MPIRICA.com/methodology.

Whole Genome Sequencing

Use of Whole Genome Sequencing in Concierge Medicine
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Click Here to Order Test Kit(s) …

Concierge Medicine Today issued a statement of support, noting, “Genetic technology has reached the point where the cost of conducting comprehensive genetic testing [ie. Whole Genome Sequencing] for hundreds of preventable diseases at a single time is now affordable,” said Catherine Sykes, CEO and Publisher of the national trade publication. “After years of thoughtful consideration, careful research and review, countless hours of dialogue with various physicians and technology companies, we encourage Concierge Medicine Physicians to make personal genomic data information available to patients so that they can start to understand their makeup, learn more about their individual genome and predictors, and begin to use these insights to improve their lives.”

Genetics usually refers to the study of individual genes and their role in disease or inheritance. Genomics refers to an individual’s entire genomic make-up. Genomics looks at the genetic sequence of genes, and their structure and function as well as the interactions between genes. An easy way to think about genetic testing is to compare it to a book, because genetics is truly our Instruction Manual of Life and genetic testing is simply a way to proofread each person’s Instruction Manual for potential typos, according to Sequencing.com.

The accuracy of whole genome sequencing is quickly improving and the cost is quickly dropping. Within the next couple of years, this technology will most likely be widely used by Concierge Physicians in the daily clinical care of their patients.

The Concierge Medicine Physician can, should [and currently is] acting as the informed fiduciary, shepherding the patient treatment process so as to make informed decisions with actionable data, together, with their patients. Advanced DNA research and whole genome sequencing have powerful applications, says trade publication, Concierge Medicine Today. Companies see Concierge Physicians as the ideal delivery model, allowing people to learn more about their DNA and make informed, data-driven decisions under the direction and support of their involved [Concierge] physician, to live a healthier life.

“The genetic revolution has already begun, and it is having far-reaching effects on healthcare right now,” said Brandon Colby, MD and author of Outsmart Your Genes. “Our knowledge of how to use this information is increasing at an exponential rate. What this means is that we can now start to integrate genetics into our everyday lives. With comprehensive genetic testing, we launch an innovative strategy against disease, attacking it before it even manifests. Genetic testing, therefore, provides a new counter-offensive in our war against Alzheimer’s, cancer, heart disease, and many other diseases that have plagued our civilization for centuries. This is the most exciting, and potentially groundbreaking, medical development of this century.”

“The data, however, should be owned by the patient. Their Physician can help direct them on how to apply the information contained in WGS to maximize its benefits,” states Michael Tetreault, Editor of Concierge Medicine Today. “Patients need the ability to securely store, use, and understand genetic data.”

Concierge Medicine Today advises this should be accomplished through physician involvement and technology that integrates genetic data into software applications [apps]. Software apps are now available that analyze genetic data and transform the data into actionable information that can have a real impact on health.

Colby notes, whole genome sequencing allows him to “cast a wide net” by generating a tremendous amount of genetic data. He then uses apps at Sequencing.com that analyze the data and provide straightforward reports focused on relevant, actionable findings. He also noted that there are five questions you [patients and physicians] need to ask in order to assess the quality of the outcomes data: (1)  The credibility of the laboratory doing the testing; (2)  What types of diseases are included in the test; (3)  How thoroughly does the test actually evaluate risk for each of the diseases; (4)  Whether the information is provided in a way that makes it actionable; and (5)  Will the results be delivered in a format that is straightforward and easy to understand?

At the Louisville Innovation Summit (October 2015), former White House CTO, Aneesh Chopra outlined his vision for a future of healthcare managed by “information fiduciaries.”

“We are essentially undergoing the most entrepreneurial period in healthcare history,” Aneesh Chopra told the crowd at the Louisville Innovation Summit. In his keynote speech, From Innovation to Integration: Understanding the interdependence on people and data, Chopra presented his vision of the future of healthcare. That future, Chopra explained, is dependent on the careful management and integration of data into patient care. Chopra envisions a future where “each and every one of is given a valet key to their data.” The valet key, Chopra said, is not unlike how Netflix determines your user preferences. These valet keys can be distributed to patients. “They can be handed to an entity that the patient trusts to organize and manage their healthcare.

The third piece of the future of healthcare, Chopra said, is about managing options. He envisions a system where patients will have advisors, acting in their interests, to help them figure out their best plan. “I see the rise of an entirely new job description that doesn’t exist in health care,” Chopra said. With all the choice we have, we will need what he calls an “information fiduciary”—a person to entrust our data with, who can offer help making smarter decisions. “Which plan should I choose? Which primary care doctor?” asked Chopra. “What’s missing today from our delivery system is this muscle of being able to interpret and organize and advise individuals. We need someone to connect the dots.” [1]

Within a couple of years, Concierge Medicine Today understands genome sequencing will most likely be widely used by [Concierge] physicians in the daily clinical care of their patients. Currently available in academic medical centers, this advanced healthcare decision support tool provides the ability to predict and prevent disease and, if disease manifests, personalized therapies tailored to each patient. Due to decreasing costs and better understanding about how this information can be made actionable, this technology is now accessible to Concierge physicians.

“If I were to ask you to describe how you picture your life in ten years, chances are you could paint a fairly clear picture,” says Tetreault. “DNA data with the continuous interaction and direction of a [Concierge] physician ushers in a healthcare utopia. In this way, it simplifies decision making using data, not practice.”

“Anything that moves us toward the realization of better outcomes using data and evidence-based medicine gets a green light by Concierge Medicine Today” says Publisher, Catherine Sykes. “Whole Genome Sequencing used by Concierge Doctors empowers them to move purposefully in a predetermined direction on behalf of their patients. Our observation is that physicians and patients without clear vision are easily distracted. They have a tendency to drift from one ailment, prescription, problem or activity, to another. Without Concierge Physicians at the helm, there is no relational, financial, or data-driven compass that will appropriately impact a person’s life. Consequently, Physician surveys are finding that they are often making insurance-based decisions almost entirely on a patient’s insurance plan coverage (56%), decisions which can rob patients of their health, lifestyle and dreams.”

“What would happen if a physician were to begin speaking to a patient’s future potential rather than their past performance?” adds Colby. “Where the practice of medicine may fall short, a story is often found in our DNA that will provide clarity. Instead of waiting for sickness to occur, the clarity provided by a patient’s DNA can empower a Concierge physician to create a personalized plan for optimizing each patient’s health and longevity.”

Sykes concluded by saying, “Concierge Medicine Today believes that having your whole genome sequenced provides access to information that can empower people to improve their long term health and wellness. We support the use of Whole Genome Sequencing within Concierge Medicine programs and believe knowing more about your DNA will allow you to take steps towards living a healthier life.”

[1] http://www.techrepublic.com/article/chopra-health-care-is-about-to-get-a-lot-more-entrepreneurial-data-will-improve-personalized-health/

Pharmacogenomics

 Concierge Medicine Today supports Concierge Medicine Doctors in working with pharmacists and pharmacogenomic companies to develop clinical decision support tools that will assist and guide prescribers in the use of pharmacogenomic information. Concierge Medicine Today further supports them in preparing and distributing materials for patient education and beginning to frame institutional guidelines for pharmacogenomic implementation inside local hospitals and specialty offices.

Concierge Medicine Today (CMT) Issues Statement of Support For Use and Application of Pharmacogenomics Inside Concierge Medicine

“Comprehensive Pharmacogenomics is a powerful healthcare innovation. Concierge Medicine provides the ideal delivery model for the future of predictive medicine,” says trade publication, Concierge Medicine Today. “Used under the guidance and application of a Concierge Physician, these tests can have a predictive effect on patient treatment outcomes, find adverse interactions and help to manage prescription dosages. Comprehensive screenings with more than 50 well-established pharmacogenomic genes in a single, cost-effective test can provide medically actionable and clinically relevant data, allowing Concierge Physicians, to make a more informed and thoughtful treatment recommendation for the health and well-being of each patient. Concierge Medicine Today strongly supports use of this innovative testing.”

2016-cmt-logoNOVEMBER 8, 2016 | ATLANTA, GA – Concierge Medicine Today issued a statement of support for the use and appropriate application of Pharmacogenomics under the guidance and direction of a Physician. “Pharmacogenomics aims to predict how individual genetic variability impacts drug absorption, metabolism and activity,” said Catherine Sykes, CEO and Publisher of the national trade publication. “Concierge Medicine Physicians are the ideal delivery mechanism for this comprehensive testing.”

Pharmacogenomics is the combination of pharmacology and genomics. It involves the study of genetic variations that influence an individual’s response to specific drugs. Pharmacology is the part of science that studies how drugs work. Genomics is the study of a person’s genome including the interactions of those genes with each other and with the person’s environment. Just as decision aids now alert prescribers that the patient takes a supplement that may interact with a prescription, these tests would alert the physician and prescriber that the patient is a poor metabolizer of a particular drug. While one pharmacology treatment approach may work well for one individual, the same approach may not be effective or may cause adverse drug effects in other patients. The implementation of pharmacogenomics helps physicians make informed treatment decisions. This can lead to better patient outcomes by decreasing adverse drug events and by increasing the effectiveness of drugs using data, research, science and the analysis and interpretation of the data by a licensed Physician.

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The notion of individual genetic variability has long been accepted and promoted within both the scientific community and the healthcare industry. Advances in molecular testing, and completion of the mapping of the human genome, in particular, give credence to the fact that patients respond differently to medications based upon their individual genetic makeup. Such advancements brought about the concept of personalized medicine, the practice of using an individual’s genetic profile to guide decisions for the prevention, treatment, and diagnosis of disease. Correspondingly, a major problem in the managed care industry is the variability of drug efficacy from patient to patient. While some patients complain about lack of effectiveness, other patients suffer from adverse drug events (ADEs). Personalized medicine has the ability to alleviate the burden of individual genetic variability and the resulting varied drug responses across different patient populations. Patient non-adherence to medications as prescribed is a significant economic burden; the resulting estimated annual healthcare costs are close to $3 billion in the United States.[1] The benefits of pharmacogenomics testing to patient adherence are frequently overlooked. Patients fail to take their medications for a number of reasons, such as the general sense that the medications do not work and anxieties related to the possible side effects listed within drug labels. For the non-adherent subset of the patient population, pharmacogenomics testing can serve as positive reinforcement and incentive for patients. Pharmacogenomics test results provide personalized, actionable facts for patients.

“Pharmacogenomics is breakthrough, next generation science which allows Physicians to target an individual with the very best personalized therapy based on their own genetic information,” said Zeil Rosenberg, M.D., Vice President, Medical Affairs, Admera Health. “What was science fiction 10 years ago is here today, thanks to major advances in medicine and information sciences. With an increasing thirst for information by patients, this knowledge translates in clear and immediate clinical benefits.”

admera_health_laboratory_photoConcierge Medicine Today cautions that in order to make this information actionable for patients, a Physician must fully integrate pharmacogenomics into system-wide prescribing practices. After years of thoughtful consideration, careful research and review and countless hours of dialogue with various physicians and companies, we recommend Concierge Medicine Physicians begin to make personal genomic data information and tests available to patients. However, the type of test matters. There are a number of offerings in the marketplace with more to come in the years ahead as these tests become more mainstream. Comprehensive screenings with more than 50 well-established pharmacogenomic genes in a single, cost-effective test will be able to provide medically actionable and clinically relevant data, allowing Concierge Physicians and their patients to make more informed and thoughtful treatment decisions.[2]

“This is an important next step in medicine,” said Sykes. “It is critical that patients and their advising Physician(s) begin to learn more about a person’s individual genome. Medical science is advancing more rapidly than we’ve ever seen, outpacing what a Physician can possibly know about adverse drug interactions based on genotype. There are tests available and becoming increasingly more affordable that determine how patients will respond to drug therapy for a number of therapeutic areas, including psychiatry, pain management, and cardiology.”

Patients need only to be tested once, as genetic information does not change over time. Therefore, genetic testing results have lifetime utility. As hospitals roll out pharmacogenomics programs in the coming years, patients will likely undergo tests for genetic variants known to play a role in the metabolism of a drug their Physician plans to prescribe.

As genetic testing becomes less expensive, more accessible, and generally, more common, Mark Dunnenberger, PharmD, Director of the Pharmacogenomics Program at NorthShore University HealthSystem in Evanston, IL. envisions in the near future that many patients’ medical records will already include a patient’s raw genetic data.[3]

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“We need to build a system that allows us to pull out what we need at the moment that we need it and make clinical recommendations,” Dunnenberger said. “That changes the question from ‘Should I test you for this or for that?’ to ‘Let me go find that piece of data.’ That’s going to be really powerful if we build the informatics tools to support that.”

Pharmacogenomics is also integrating into EMRs. The NorthShore University HealthSystem is among just a handful in the nation which focuses exclusively on pharmacogenomics. NorthShore, with three hospitals, is the very first group to achieve Stage 7 on the HIMSS Analytics EMR Adoption Model. [4]

The American Medical Association (AMA) recently said of Pharmacogenomics, “Pharmacogenomics has the potential to provide tailored drug therapy based on genetically determined variation in effectiveness and side effects. This will mean:

  • More Powerful Medicines – Pharmaceutical companies will be able to produce therapies more targeted to specific diseases, maximizing therapeutic effects while decreasing damage to nearby healthy cells.
  • Better, Safer Drugs The First Time – Recovery time will go down and safety will go up as the likelihood of adverse reactions goes down or is eliminated, altogether.
  • More Accurate Methods Of Determining Appropriate Drug Dosages – Current methods of basing dosages on weight and age will be replaced with dosages based on a person’s genetics –how well the body processes the medicine and the time it takes to metabolize it.[5]

 Concierge Medicine Today supports Concierge Medicine Doctors in working with pharmacists and pharmacogenomic companies to develop clinical decision support tools that will assist and guide prescribers in the use of pharmacogenomic information. Concierge Medicine Today further supports them in preparing and distributing materials for patient education and beginning to frame institutional guidelines for pharmacogenomic implementation inside local hospitals and specialty offices.

Concierge Medicine Today encourages Concierge Medicine Physicians and the provider community to work with local pharmacists to lead the clinical application of pharmacogenomics. Collaborating together, as part of a safe, effective, and cost-efficient medication practice. Furthermore, to prepare all Concierge Medicine Physicians and staff to provide Pharmacogenomics testing and recommendations, Concierge Medicine Today calls on more State Associations, colleges of pharmacy and the Board of Pharmacy Specialties (BPS) to include curriculum about this growing field.

“What would happen if Physicians were able to begin making treatment recommendations based upon a patient’s genotype?” notes Sykes. “Concierge Doctors are in the habit of spending an inordinate amount of time with their patients, many of whom have significant and serious health concerns. What would happen if we intentionally connected [Concierge] physicians with new scientific technologies that could enable them to deliver more high precision treatment recommendations and provide more accurate prescribing to their patients? We aim to find out.”

Finally, Concierge Medicine Today believes, as do pharmacy organizations, that pharmacogenomics is primed for continued growth.

About Concierge Medicine Today

Concierge Medicine Today (CMT) is a news organization and the Concierge Medicine industry’s oldest national trade publication for the Concierge Medicine and Membership Medicine marketplace. Its web site is the online destination for businesses, consumers, physicians, legislators, researchers and other stakeholders to learn about the history of this industry, various business aspects of the marketplace, trends, breaking news and more that drives the conversation that Concierge Medicine and free market healthcare delivery is creating on a national and international level. For more information, visit: http://www.ConciergeMedicineToday.org

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