The dots are finally connecting to the future of medicine.

Pricing and payment is going to be a big topic for healthcare starting in 2021. If you didn’t catch the 60 Minutes interview about the Sutter Health case yet, add it to your to-do list.

The main issue is the rising cost of healthcare without a noticeable improvement in medical outcomes or service. Every time this issue comes up, capitation comes up as the solution.

I likened capitation to a game of hot potato because we have been passing the medical risk around the industry without an effective way to manage it.

That may change soon. The dots are finally connecting for the future of medicine and healthcare payment.

Lifespan


I read an article several years ago about David Sinclair’s research. He’s a professor at Harvard Medical School and author of the book, Lifespan.

The article predicted that by 2020 a pill would be available to help to slow your aging. Sounds too good to be true but according to Dr. Sinclair, the pill may already exist. He’s currently experimenting with a diabetes drug and getting promising results.

Reportedly, part of the challenge for researchers is that the US doesn’t recognize aging as a disease because it effects everyone. That could change in 2022 when physicians are required to use the ICD-11 codes for patients with age related conditions.

Once researchers get the data, they will also get the NIH funding needed to advance their research. Australia is currently leading because their regulatory policies for medical benefit are broader than the US.

Health for All


There is an initiative underway at the World Health Organization [WHO] called Health for All. The initiative looks beyond traditional healthcare to the public health spend of developing countries. The goal is to improve the wellbeing of individuals rather than just providing access to healthcare. The population health initiatives in the US are similar.

Mariana Mazzucato, Professional Economist and Founder/Director of their Institute for Innovation and Public Purpose has recently joined the WHO. In her book, The Value of Everything, Dr. Mazucato challenges most of our current economic theories including the typical arguments for how drugs are priced.

A new method for pricing drugs is needed because biotech is going to change how, when and where we get medical treatment in the near future. Given her involvement in the WHO, we’ll likely see a change in pricing methodology soon.

Illumina Startup Forum


I participated in the Illumina Startup Forum recently and listened to leading and emerging biotech executives. They are very optimistic about their progress and almost giddy with the funding available to the industry post Covid.

The future of medicine is reportedly rapid tests done at home with use of current technologies [x-ray, ultrasound, MRI and CT] when needed to confirm a result, therapeutics that are personalized to your genome and products that rejuvenate your body. Companies are already conducting clinical trials.
 

Preventing Aging


Preventing aging will be the game changer. Dr. Sinclair likens the products that will be used to rejuvenate your body to the process of rebooting your computer when programs start running slow.

Being able to reboot our cells doesn’t mean that we will live forever, but it does mean that we will live longer and more importantly, with a higher quality of life until death.

We need to start challenging our current thoughts on aging and start adjusting our societal norms. Look to the US political and supreme court representatives as an example. Many are in their 70’s and 80’s and still going strong.

Clinical Trials

There are new companies emerging to engage more physicians in clinical research. I didn’t fully appreciate the issue when this topic was presented on an Innovator MD call. There’s a process for sharing best practices and other information between hospitals and physicians.

However, when Bryce Olsen spoke to the Illumina Startup Forum about his cancer experience and the current standards of care that failed him, the issue became more clear. A one size fits all approach isn’t sufficient now and clinical trial information isn’t being shared widely within the physician community.

Bryce worked around the system to have his genome sequenced and got into a clinical trial that resulted in a personalized medicine. He has since founded an organization called SequenceMe.org to help others direct their care.

Capitation

Biotech companies are interested in taking the risk for the effectiveness of their products. Sharing the medical risk with them makes sense given their future role, profit margins and access to capital.

Capitation contracts may finally become more than just a game of hot potato.