Preventive health goes mainstream – a pipedream?

Regular health monitoring promises to improve outcomes and reduce costs – so why does it remain niche and elitist?

By Alistair Fleming

A recent article in Forbes, describes how Forward - a California-based start-up, is shaking up the healthcare market with a radical vison for a new patient care model.  Founder, Adrian Aoun, has realized a vision of a doctor’s office as a ‘constantly-learning’ Apple store where critical patient data is automatically recorded and processed prior to the patient engaging with the doctor, in a service costing $149 a month.  Aoun says he is looking to change the model of primary healthcare from a ‘once and done’ to an ongoing relationship between patient and health care provider.

In practice this would mean, as visitors enter the clinic, they are given a full body scan measuring a myriad of different parameters. This may be supplemented by blood and genetics test.  The data is then fed into Forward’s artificial intelligence algorithms so that by the time the patient enters the examination rooms their data, and potential implications are ready to be reviewed and manipulated in conjunction with the doctor.

It would seem self-evident that regular (or continuous) holistic health monitoring is beneficial. After all, we do it with our cars, our boilers, and our finances. With the explosion in low-cost wearable monitors and the increasing accessibility to multimodal scanning technologies, the time may be right for Forward. Alongside this, and something we are very aware of through our work at Sagentia, is that there is a huge appetite for improving the user experience throughout healthcare. Forward’s launch goes a long way to addressing this on the front line.

In order for initiatives such as this to become mainstream, however, we need to be able to prove that preventative measures do actually reduce overall costs of care. The value equation is currently played out on a case-by-case basis. Cancer screening is one of the more high-profile examples. Early detection is paramount to best outcomes, yet the cost of screening programs is significant. In some cases, value has been demonstrated e.g. breast and cervical cancers. In others, the societal benefit is less clear-cut. In a healthcare system of finite resource, is that dollar better spent catching some cancers early, or treating others more effectively.

A little girl is at the doctors office for a check up. A nurse is sitting with them and talking to the mother.

Preventive health programs need to consider the negative impact on healthy populations as well. Some screening approaches expose participants to small, but not insignificant, additional radiation which can itself increase risk of cancer. Meanwhile, even the more sensitive tests, will exhibit false positives and negatives which can either expose perfectly healthy individuals to the stress of additional tests or provide false reassurance.

Part of the attraction of Forward’s approach is that by combining a suite of screening and monitoring methodologies, it could be possible to identify not one, but a raft of potential diseases, and, particularly with the inclusion of genetic tests, to stratify clients by risk category and thereby tailor the screening approach to the individual.

Returning to the economic question, however, this is all well and good for those willing and able to pay for this service. For the rest of us, the challenge for insurers and for guidance bodies, such as NICE in the UK, is to find a way to assess benefit, now not just for single tests, but across multiple tests and conditions.

Right now, we are still struggling to make the sums work and so the benefits of Forward’s capabilities are therefore likely to be reserved for private individuals with the wherewithal to pay (whilst acknowledging Forward is also opening access to a group from under-served communities).  This is unlikely to change for quite some time.

That said, the author has long felt that the secret to uncovering the root causes of many chronic conditions is to know more about the patient's lifestyle and history. On that basis, the knowledge and data which will be built up by companies like Forward will be immensely valuable and, through aggregation, will extend well beyond the immediate benefits to the individual. A set of holistic, contextual data has the potential to unravel complex cause and effects and in doing so could help shape social change.

Whilst some way off, as the pendulum swings toward prevention, then the true value of developments such as these may well prove to be far greater than the cost of servicing the individual. Healthcare could enter an enlightened age indeed.

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