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Integrating Genomic Medicine into Patient Care with Trish Brown, MS, CGC

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Presented at the Personalized Medicine World Conference 2010

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Integrating Genomic Medicine into Patient Care with Trish Brown, MS, CGC

  1. 1. Integra(ng  Genomic  Medicine  into   Pa(ent  Care   Presenter:    Trisha  Brown,  MS,  CGC  
  2. 2. DNA  Direct  Overview   Our Mission: To bring the power of personalized medicine to patients, providers, and payors – reducing health risks, preventing disease, and better targeting therapies
  3. 3. Agenda   •  Personalized  Medicine   –  What  is  it?   –  Barriers   •  Integra=ng  Genomic  Medicine   –  DNA  Direct’s  Solu=ons   –  Physician/Pa=ent  Educa=on  &  Decision  Support   –  Payors,  Humana   –  Hospitals,  El  Camino  Genomic  Medicine  Ins=tute   –  Pa=ent  Compliance  Programs  
  4. 4. Personalized  Medicine  
  5. 5. Barriers  to  Personalized  Medicine   •  Lack  of  healthcare  provider  knowledge   –  90%  of  MDs  surveyed  want  to  use  gene5cs,  but  only  40%  are  comfortable  ordering  a  gene5c  test,  and  63%  have  limited  or  no  access  to  experts   •  Lack  of  Experts   –  Gene5c  Counselors:  MS,  cer5fied  professionals  who  assess  risk  and  educate,  <2,400   –  Clinical  Gene5cs:  MDs,  provide  gene5c  diagnos5c  and  therapeu5c  management,  <500   Trinidad, et al 2008, Sources: Washington G-2 Reports Advisory Services’ 2008 Molecular Diagnostics Survey, internal analysis, LabCorp study
  6. 6. There  are  only  a  liPle  over  500  gene=cists  and  2400  gene=c   counselors  who  see  pa=ents  in  the  U.S.   Ratio of geneticists to population by state As a result, 0 geneticists who see patients (4) genetics is pushed 1M - 3M per geneticist (11) to the PCP, who is often not prepared 500K - 1M per geneticist (22) for genetics <500K per geneticist (14) 6 Source: ACMG, 2007 & NSGC 2009
  7. 7. Barriers  to  Personalized  Medicine   •  No  evidence  yet  that  PM  has  a   significant  impact  on  common,   chronic  disease   –  Affects  >50%  of  the  US  popula5on,  and  accounts  for  ~75%  of  the  total  healthcare  spend   •  Adop=on  of  standards  into  clinical   prac=ce  can  lag  by  over  a  decade   –  In  one  study,  only  32%  of  eligible  women  had  her2  neu  tes5ng   –  Across  studies,  only  30-­‐55%  of  eligible  pa5ents  are  prescribed  warfarin   Balas & Boren, (2000) Yearbook of Medical Informatics pp 65-70 Phillips, K (2008) JAMA 300(21):2542-44, Partington, et all (2007) Thrombosis Research 120, 663–669
  8. 8. Barriers  to  Personalized  Medicine   •  Pa=ent  non-­‐compliance   –  Only  20-­‐30%  of  people  recommended  to  have  colon  cancer  screening  do  it     –  30%  of  people  with  adenomatous  polyps  do  not  return  for  follow  up  colonoscopy   –  By  6  months  of  therapy  ini5a5on,  up  to  55%  of  people  stop  taking  their  cholesterol  medica5ons   Siddiqui et al Alimentary Pharmacology & Therapeutics. 2006;24(11):16 23-1630, Inadomi Journal of Gastroenterology and Hepatology 23 (2008) Suppl. 2; S198–S204, JPMorgan MedCo 2010, presentation http://phx.corporate-ir.net/External.File? item=UGFyZW50SUQ9MjYzNDR8Q2hpbGRJRD0tMXxUeXBlPTM=&t=1
  9. 9. Integrating Genomic Medicine •  “In order for personalized medicine to progress as many US researchers want it to, it will require a more focused commitment from better informed federal agencies, smarter collaborations across public and private sectors, bigger studies and bolder science, and intelligent changes in the healthcare system overall” -Francis Collins, January 2009
  10. 10. DNA Direct Solutions Proprietary Technology National Call Center Architecture Unique + of Genetic Experts to Genetics Guidance & Decision Support for Genomic Medicine 10  
  11. 11. Access  to  Experts  
  12. 12. Physician  Educa=on   Secure portal to access comprehensive tools and resources Preauthorization wizard Latest news and updates on tests and technology CME sessions and forum for physicians
  13. 13. Pa=ent  Educa=on   Genomics 101 developed for consumer audience Clinical Decision support tools to help understand test appropriateness Multimedia videos and testimonials as a learning tool Immediate access to genetic experts
  14. 14. Pa=ent  Decision  Support   Customizes content based on family and medical history Integrates video to share patient stories and perspectives Enables exploration of various decision options Explains possible next steps based on test results
  15. 15. Gene=c  Guidance  Programs   Payors  -­‐  Humana   Prior-authorization system & call center for molecular diagnostics Helps physicians find the right test for their patient at the right lab Genetic counselors available to physicians and patients to answer questions about tests
  16. 16. Genomic  Medicine  Ins=tute     Physicians  –  El  Camino  Hospital Refer patients to genetic counseling Web-based clinical decision support and tools Key specialty area overviews and guidance for testing CME education and Training
  17. 17. Genomic  Medicine  Ins=tute     Physicians  –  El  Camino  Hospital Test Appropriateness Questionnaire Test background and use Clinical guidelines and evidence Controversies and references
  18. 18. Genomic  Medicine  Ins=tute     Pa5ents  -­‐    El  Camino  Hospital Literacy level appropriate Comprehensive content to inform the lay person Call to action: contact physician or learn about genetic counseling
  19. 19. Genomic  Medicine  Ins=tute     Pa5ents  –  El  Camino  Hospital Easy-to-understand result interpretation Next steps and actions Personalized message from physician Letter for family and support physicians
  20. 20. Tes=monials   “Just wanted to let you know that I really enjoyed this great experience in learning about such breakthrough technology, and was amazed how it can help human beings' fundamental but also complex health issues be answered” -El Camino Patient “Instead of referring my patient to another center and making them wait weeks to get in, I can get the information I need and refer patients to DNA Direct for immediate help.” -El Camino Physician
  21. 21. Decision  Support  Tools     Payors,  Providers,  Medical  Centers,  Labs Over 600 users in a small pilot in 40 practices, patients and physicians very satisfied.
  22. 22. Pa=ent  Compliance  Programs   Payors,  Employers,  Medical  Centers,  Labs   •  Stool  DNA  Colon  Cancer   Screening  Program   –  Large  US  employer  distributed   kits  to  50+  year  old  employees   at  health  fair   –  DNA  Direct  provided   educa5on  as  needed,  and   followed  up  with  employees  to   help  them  return  kits   –  Return  rate  increased  by  40%  
  23. 23. Integra=ng  Genomic  Medicine  Into  Pa=ent  Care     Pre / Post Test Phone Decision Support Counseling Physician Consultation
  24. 24. Thank  You!   trish@dnadirect.com  

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