Personalized Medicine: The Future Has Arrived

What if a simple blood test could predict your future? It’s a very real possibility, thanks to personalized medicine, also called precision medicine. Under this model, each patient’s medical care is completely customized and tailored to his or her DNA makeup.

It sounds like something out of a sci-fi movie set decades in the future, but personalized medicine is very much a modern concept. In 2013, actress Angelina Jolie made headlines after DNA testing revealed she had a defective BRCA1 gene. Doctors told her that having the gene meant she had an 87% chance of developing breast cancer. Jolie opted for a preventative double mastectomy.

Jolie has remained cancer free, although it’s impossible to say whether she’ll stay that way. Personalized medicine can’t predict a person’s medical future with 100% accuracy, but it can help doctors identify potential roadblocks in their patients’ futures and develop treatments to target those roadblocks.

This model is also potentially a game-changer for pharmaceuticals. Using DNA would allow doctors to more accurately identify the prescriptions that are appropriate for a patient’s specific genetic makeup, rather than using the expensive trial-and-error system that so many patients endure currently. Many Americans have stories about spending months or years taking pricy medications that have miserable side effects and ultimately don’t work. By prescribing the right drug the first time, doctors could spare their patients from lengthy, expensive and painful medical ordeals.

Personalized medicine is potentially a life-saving game changer for patients. But what does it mean for self-insured employers?

It could be very good news. As the saying goes, an ounce of prevention is worth a pound of cure. Paying for the testing that’s used in personalized medicine could prevent catastrophic claims down the road.

Say an employee covered under your plan is beginning treatment for cancer. He/she undergoes genetic testing that helps his/her medical providers identify a gene mutation, allowing them to quickly tailor his/her treatment plan to target the cancer cells effectively. That early intervention could not only save the employee’s life, but also save the insurer from spending tens of thousands of dollars on treatments that won’t work for someone with that mutation.

In short, this medical model has the potential to be a win-win for self-funded insurers and employees alike. Employers stand to cut costs substantially both for premiums and pharmacy benefits. Catching medical conditions before symptoms start – or at least, before a condition advances from treatable to life-threatening – is in everyone’s best interest.

Science keeps advancing. Make sure your insurance strategies evolve too, to keep costs down without sacrificing coverage. As always, contact us with any questions.

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In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.