How Inova Hopes to Reinvent Health Care

Inova is betting that personalized medicine + big data can transform health care.

Inova is betting that personalized medicine + big data can transform health care. Illustration credit: Richmond Times-Dispatch

Published this morning in the Richmond Times-Dispatch.

As Republicans and Democrats brace for a battle royal over Obamacare and what might replace it, they would do well to pay heed to an important experiment south of the Potomac.

In Congress the debate centers on who pays for health care and how costs can be shifted to someone else — a zero-sum game. At Inova Health System, the dominant health-care provider in Northern Virginia, the focus is on improving peoples’ health at lower cost by practicing medicine differently. If Inova is successful, everyone wins.

The plan at Inova’s Center for Personalized Health, located across the road from Inova’s flagship hospital in Fairfax County, is to draw upon diverse data — electronic health records, user-generated data (such as fitness trackers and other wearable devices), family history, social milieu, and a patient’s genetic and biochemical make-up — to develop wellness and treatment strategies tailored to the individual.

“Take a cancer drug that’s effective 30 percent of the time,” says Todd Stottlemyer, CEO of the center. “A better way to understand it is that the drug is 100 percent effective for 30 percent of the people who possess certain genes or proteins.”

If physicians can target the treatment to the patient’s unique biochemistry, they can avoid giving drugs that don’t work. That leads to better health for the patient and saves society a lot of money.

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Inova is building its Center for Personalized Medicine on the old Exxon-Mobil corporate campus, and adapting it for use as a medical research center. Construction is underway there for the Schar Cancer Institute, a multidisciplinary institute where precision medicine will be practiced.

The Inova Clinic will provide genomic testing and consultations. Other centers, institutes and incubators will conduct research, crunch data and, hopefully, spin off new business enterprises. Meanwhile, the Center has already begun recruiting national-caliber scientists.

Many other medical colleges and research centers around the country are doing similar things. What sets Inova apart is not just treating disease but keeping people well in the first place.

Let’s say a 48-year-old woman has breast cancer. Here’s how Stottlemyer sees things working: Physicians will want to understand her genetic make-up. They’ll want to know the biomarkers of the particular type of cancer she has. They will design a treatment, based upon the unique facts of her case, that will target the biomarkers and offer a higher probability of success than conventional approaches.

But the work doesn’t end there. What if the woman’s daughters have the same genetic markers? Should they screen more aggressively? Should they have mastectomies before getting the disease themselves? Inova will have genetic counselors trained in interpreting the scientific data and then walking patients through the complex decision-making process. Says Stottlemyer: “We want to empower good, informed choices.”

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Inova will draw upon Northern Virginia’s strength in information technology. Harnessing so-called “Big Data” will help researchers and practitioners gain insight into not only individual patients but entire demographic groups.

The Center will cobble together health records, family histories, genome sequences, and sociodemographic statistics, and then compare the data against its database that houses more than 10,000 genome sequences from 134 countries of birth around the world.

The nonprofit health system is sinking hundreds of millions of dollars of its own money into the Center — acquiring the Exxon-Mobil building, funding venture capital, setting up the institutes and centers — and supplementing it with state dollars, philanthropic dollars, and funds from corporations and academic partners.

Late last year, Inova inked a $112 million deal with the University of Virginia School of Medicine allowing U.Va. medical students to participate in the discovery and commercialization of treatments for cancer and other diseases.

Stottlemyer sees the launch of a new center of research and innovation as a booster shot for Northern Virginia’s economy, which is still staggering under the impact of sequestration-related cuts in defense spending. Building bridges to U.Va., Virginia Tech, and Virginia Commonwealth University should provide a stimulus to downstate economic development, too, he says.

But the ultimate justification for a nonprofit enterprise like Inova to spend millions on an initiative like the Center for Personalized Health is to help the people of Northern Virginia and the commonwealth to enjoy better health at lower cost. When the center opens for business next year, health teams will disseminate insights from the center’s research to Inova hospitals throughout Northern Virginia.

The U.S. health care system is organized around treating people when they get sick, not keeping them well. “It’s a transactional system,” says Stottlemyer. Doctors and hospitals get paid only when they conduct a test or procedure or other service. “We’re trying to change the game.”

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7 responses to “How Inova Hopes to Reinvent Health Care

  1. Here’s some interesting fact data: (numbers approximate and vary according to source)

    Employer Provided – 156,000,000
    non-group – 21,816,500 (Obamacare + open market insurance)
    Medicaid – 62,384,500
    Medicare – 43,000,000 ( number is low, others say 55,000,000)
    Va/Tricare/Military – 6,422,000
    Uninsured – 30,000,000 (includes undocumented)

    Total – 320,000,000

    from kff.org – Health Insurance Coverage of the Total Population

    and this from Centers for Medicare and Medicaid):
    NHE – national health expenditures

    NHE grew 5.8% to $3.2 trillion in 2015, or $9,990 per person, and accounted for 17.8% of Gross Domestic Product (GDP).

    Medicare spending grew 4.5% to $646.2 billion in 2015, or 20 percent of total NHE.

    Medicaid spending grew 9.7% to $545.1 billion in 2015, or 17 percent of total NHE.

    Private health insurance spending grew 7.2% to $1,072.1 billion in 2015, or 33 percent of total NHE.

    Out of pocket spending grew 2.6% to $338.1 billion in 2015, or 11 percent of total NHE.

    https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html

  2. An interesting and worthy perspective. Until I got to this line:

    “What sets Inova apart is not just treating disease but keeping people well in the first place.”

    So, you have an advanced medical center in one of the nation’s wealthiest areas. At the same time, conservatives want to deny medical insurance such as Medicaid to poor people in less wealthy areas. How can they stay well in the first place without expanded Medicaid and if ACA is ripped by the GOP with no replacement coming?

    Using new techniques and methods to screen patients is just great, but will it only benefit the rich?

    • I’m pretty sure Inova wants to benefit more than the rich. Bringing down the cost of medical care benefits everybody, but no one more so than lower-income folks who have the least disposable income to apply to health care. The reason health care insurance is so unaffordable is that the underlying cost of health care is out of control. Public policy has focused on spreading the pain. That hasn’t worked out so well. It’s time to figure out how to drive down costs and improve outcomes.

  3. We’re not going to get very far as long as most folks who have health insurance have no clue how their own health care works and are opposed to paying for others who do not have it.

    The truth is that most on employer-provided currently have essentially a 40% tax credit while the replacement folks are talking about a $2500 tax credit but that don’t matter because the folks who have the 40% credit don’t think it will apply to them and instead only to those who don’t have it.

    Try to get a years’ worth of health insurance with $2500.

    The current lie going around is that ObamaCare has failed because it is is too expensive and has too high deductibles.

    What’s not said is that it not only does not deny pre-existing conditions – it has no lifetime caps.

    The “replacement” is said to still allow – pre-existing conditions and will lower deductibles but will reinstitute lifetime caps so that effectively once you hit those caps – you are effectively out of insurance – and if really sick – will go broke from the bills no longer covered.

    The question is – will people being sold on the idea of the “replacement” see and understand what reinstituting the lifetime caps will mean?

    I give Innova credit – but give demerits to anyone including the RTD who cite Innova as having a solution/approach to the bigger insurance problem.

    Innova is figuring out how to make money – from those who can pay. They are no more going to want those who are deathly sick can’t pay than the man in the moon.

    Apparently no self respecting Conservative wants to admit and acknowledge that every other industrialized country on earth – has a system that works better than ours … for less money and people live longer.

    All you have to do is say socialism and that’s it… ANY “solution” is better even if the Conservatives cannot come up with anything real – just a bunch of PR platitudes like “patient-centered” and ” free market”…

    but one of the most telling things is that few if any actually know how ObamaCare is actually funded… right now.. It’s amazing..

    😉

    • Apparently no self respecting Conservative wants to admit and acknowledge that every other industrialized country on earth – has a system that works better than ours … for less money and people live longer.

      Oh, conservatives will admit this readily. We just disagree on why this is so, and what the remedy is.

      • well that would be fine and dandy if you had a REAL PLAN!

        All ya’ll have is make-believe ideology and all ya’ll are doing is misleading the public as to what you REALLY want to do.. of which there are no successful models on the planet…!!

        health insurance does not “work” like other insurance where the insurer gets to decline to insure anyone who is more of a risk than they want to accommodate. The way they handled this prior to the ACA was annual and lifetime caps… and denial of those with pre-existing conditions.

        What the ACA did that blew this up was not let denial of pre-existing AND no lifetime caps.

        But that was not only for Obamacare, it was for ALL insurance including employer-provided.

        The ONLY way that “works” is in EVERYONE has insurance and pays into the system.

        If you “break” any of these – the whole thing will collapse.

        that’s the way it HAS TO WORK – in every other industrialized country n earth… everyone pays for their entire life and everyone is covered.

        I’d LOVE to hear from Conservatives an HONEST INJUN “plan” instead of the propaganda and disinformation and just outright untruths that has been going on for 8 years.

        To this point – all we have is lots of “ideas” and not a whole heck of a lot of anything else except for the stealth idea of reinstituting lifetime caps which is going to blow up when folks find out that’s what the Conservatives have in mind.

  4. What amazes me is that “Conservatives” SHOULD KNOW that insurance without govt rules would allow the insurance companies to not only turn down those who are too much a risk but it would also mean insurance companies would price the insurance according to things like age, medical history, etc.

    Not only for non-employer-provided but ALSO TO INCLUDE employer-provided – which is NOT the way the employer-provided actually works today – not because the employer has “negotiated” with the insurance company but instead the Govt law known as HIPPA – actually promulgates these “rules” that require insurance company to not only cover all employees regardless of age or medical history but also to charge everyone the same price for self or family – with no surcharges for age or medical history.

    Ironically, that’s NOT how ObamaCare works which DOES allow the insurance companies to increase premiums for increasing age.

    That’s NOT “free market” health insurance yet many who have employer-provided believe that ObamaCare is what is causing their premiums to go up instead of the Govt-imposed rules that everyone has to be covered and for the same price.

    If employer-provided actually worked according to most Conservatives philosophy of letting the market decide – not the govt – a large number on employer-provided would be paying far more for their insurance if it was priced according to age and medical history.

    How many Conservatives are advocating for this?

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