Preventive Precision Medicine: How a Population-Level Approach to Genomics could change the Future Burden of Chronic Disease

This is part 3 of a 3 part series on how employers can leverage genomics for healthcare cost control and more.

If 2018 was the year for the concept of genomics and precision medicine to gain the attention of employers and plan members, then 2019 may be the year that this new approach to health and healthcare cost control gains traction and a place at the benefit design table.

blog_part 3Applications to leveraging the information in our own DNA are available to guide healthcare providers towards more precise cancer treatment regimens and more accurate medical prescribing practices.  All with the goal of improved outcomes, lessened or eliminating side effects, and producing value beyond dollars saved.  Yet, not everyone will benefit from these precise tools. Cancer is still a rare occurrence, increasing in frequency later in life. While pharmacogenomics covers between 80-85% of the medications prescribed in the general US population, not everyone uses one of those medications.

There’s one more perspective to precision medicine and genomics that may have a population-wide impact on health outcomes and future burden of disease.  Genomic testing is being leveraged for entire employee populations (and at least one state-wide public health initiative) as a means of identifying modifiable health risks and identifying future high cost conditions in a population.  These tests are not covered by most health insurance carriers; instead they are being directly marketed to employers as the next-level, differentiator in health and welfare benefits.  The benefit lies in the early identification of modifiable risk. Particularly the risk of developing insulin-resistance, diabetes, obesity, heart disease, hypertension, or high cholesterol.

This population-wide, preventive approach to genomic testing has tremendous potential for understanding future risk burden in a group of people.  This moves beyond understanding the geographical regions that contributed to hair color or body build. Preventive precision medicine identifies genetic markers and specific sequences in an individual’s DNA (or genetic code) that indicates a predisposition for a chronic medical condition.  This information can be particularly motivating towards needed lifestyle changes or compliance with preventive care visits for those individuals who are essentially ‘well’ and not actively participating in their own health or an employer’s wellness program.

However, these tests are not diagnostic for the conditions. As science advances and we are able to better link previously unrecognized gene sequences with certain disease states. We may be able to diagnose chronic or high risk conditions years before they manifest.  We’re not there yet, and we may never get there as we have yet to prove that the presence of these ‘silent’ DNA codes are a guarantee of disease.  Although testing for cancer specific genes and those DNA changes that can increase the risk of Alzheimer’s do exist, they are not part of these population-focused preventive genomic tests.  The focus is on identifying future burden from common conditions that can be prevented by lifestyle or behaviors—such as exercising more, keeping weight ideal and eating a balanced diet.  The concept of Epigenetics has demonstrated to researchers that you can turn the expression of certain genetic codes ‘on or off’ based on stressors in the environment, lifestyle, or nutrition.  Thus, the combination of a preventive genomics scan with a fully holistic wellbeing program could be the critical pieces to solving the employer healthcare cost control puzzle.

As mentioned in previous blogs related to genomics and precision medicine, we can anticipate that the costs of genomic testing will decrease as its applicability increases and becomes the standard of practice. The preventive genomic scans mentioned in this article are less than $200 a person, and only need to be run once in a lifetime, but are limited to a finite number of conditions, most of which are actionable and can be prevented through lifestyle and behavior modification.

Thus, preventive precision medicine is not a silver bullet, but don’t let the shiny aspects of this potential solution blind you—the future of achieving the triple aim of healthcare might just be in our DNA.