Integra(ng  Genomic  Medicine  into  Pa(ent  Care  

Presenter:    Trisha  Brown,  MS,  CGC  

DNA  Direct  Overview  

Our Mission:

To bring the power of personalized medicine to patients, providers, and payors – reducing health risks, preventing disease, and better targeting therapies

Agenda  

•  Personalized  Medicine  – What  is  it?  

– Barriers  •  Integra=ng  Genomic  Medicine  

– DNA  Direct’s  Solu=ons  – Physician/Pa=ent  Educa=on  &  Decision  Support  – Payors,  Humana  – Hospitals,  El  Camino  Genomic  Medicine  Ins=tute  – Pa=ent  Compliance  Programs  

Personalized  Medicine  

Barriers  to  Personalized  Medicine  •  Lack  of  healthcare  provider  knowledge  

–  90%  of  MDs  surveyed  want  to  use  gene5cs,  but  only  40%  are  comfortable  ordering  a  gene5c  test,  and  63%  have  limited  or  no  access  to  experts  

•  Lack  of  Experts  –  Gene5c  Counselors:  MS,  cer5fied  professionals  who  assess  risk  and  educate,  <2,400  

–  Clinical  Gene5cs:  MDs,  provide  gene5c  diagnos5c  and  therapeu5c  management,  <500  

Trinidad, et al 2008, Sources: Washington G-2 Reports Advisory Services’ 2008 Molecular Diagnostics Survey, internal analysis, LabCorp study

6

There  are  only  a  liPle  over  500  gene=cists  and  2400  gene=c  counselors  who  see  pa=ents  in  the  U.S.  

0 geneticists who see patients (4)

1M - 3M per geneticist (11)

500K - 1M per geneticist (22)

<500K per geneticist (14)

Ratio of geneticists to population by state

As a result, genetics is pushed to the PCP, who is often not prepared

for genetics

Source: ACMG, 2007 & NSGC 2009

Barriers  to  Personalized  Medicine  •  No  evidence  yet  that  PM  has  a  significant  impact  on  common,  chronic  disease  – Affects  >50%  of  the  US  popula5on,  and  accounts  for  ~75%  of  the  total  healthcare  spend  

•  Adop=on  of  standards  into  clinical  prac=ce  can  lag  by  over  a  decade  –  In  one  study,  only  32%  of  eligible  women  had  her2  neu  tes5ng  

– Across  studies,  only  30-­‐55%  of  eligible  pa5ents  are  prescribed  warfarin  

Balas & Boren, (2000) Yearbook of Medical Informatics pp 65-70 Phillips, K (2008) JAMA 300(21):2542-44, Partington, et all (2007) Thrombosis Research 120, 663–669

Barriers  to  Personalized  Medicine  

•  Pa=ent  non-­‐compliance  – Only  20-­‐30%  of  people  recommended  to  have  colon  cancer  screening  do  it    

– 30%  of  people  with  adenomatous  polyps  do  not  return  for  follow  up  colonoscopy  

– By  6  months  of  therapy  ini5a5on,  up  to  55%  of  people  stop  taking  their  cholesterol  medica5ons  

Siddiqui et al Alimentary Pharmacology & Therapeutics. 2006;24(11):16 23-1630, Inadomi Journal of Gastroenterology and Hepatology 23 (2008) Suppl. 2; S198–S204, JPMorgan MedCo 2010, presentation http://phx.corporate-ir.net/External.File?item=UGFyZW50SUQ9MjYzNDR8Q2hpbGRJRD0tMXxUeXBlPTM=&t=1

Integrating Genomic Medicine

•  “In order for personalized medicine to progress as many US researchers want it to, it will require a more focused commitment from better informed federal agencies, smarter collaborations across public and private sectors, bigger studies and bolder science, and intelligent changes in the healthcare system overall”

-Francis Collins, January 2009

DNA Direct Solutions

Proprietary Technology

Architecture Unique to Genetics

National Call Center of Genetic Experts +

Guidance & Decision Support for Genomic Medicine

10  

Access  to  Experts  

Physician  Educa=on  

Secure portal to access comprehensive tools and resources

Preauthorization wizard

Latest news and updates on tests and technology

CME sessions and forum for physicians

Pa=ent  Educa=on  

Genomics 101 developed for consumer audience

Clinical Decision support tools to help understand test appropriateness

Multimedia videos and testimonials as a learning tool

Immediate access to genetic experts

Pa=ent  Decision  Support  

Customizes content based on family and medical history

Integrates video to share patient stories and perspectives

Enables exploration of various decision options

Explains possible next steps based on test results

Gene=c  Guidance  Programs  Payors  -­‐  Humana  

Prior-authorization system & call center for molecular diagnostics

Helps physicians find the right test for their patient at the right lab

Genetic counselors available to physicians and patients to answer questions about tests

Genomic  Medicine  Ins=tute  Physicians  –  El  Camino  Hospital  

Refer patients to genetic counseling

Web-based clinical decision support and tools

Key specialty area overviews and guidance for testing

CME education and Training

Genomic  Medicine  Ins=tute  Physicians  –  El  Camino  Hospital  

Test Appropriateness Questionnaire

Test background and use

Clinical guidelines and evidence

Controversies and references

Genomic  Medicine  Ins=tute  Pa5ents  -­‐    El  Camino  Hospital  

Literacy level appropriate

Comprehensive content to inform the lay person

Call to action: contact physician or learn about genetic counseling

Genomic  Medicine  Ins=tute  Pa5ents  –  El  Camino  Hospital  

Easy-to-understand result interpretation

Next steps and actions

Personalized message from physician

Letter for family and support physicians

Tes=monials  

“Just wanted to let you know that I really enjoyed this great experience in learning about such breakthrough technology, and was amazed how it can help human beings' fundamental but also complex health issues be answered”

-El Camino Patient

“Instead of referring my patient to another center and making them wait weeks to get in, I can get the information I need and refer patients to DNA Direct for immediate help.”

-El Camino Physician

Decision  Support  Tools  Payors,  Providers,  Medical  Centers,  Labs  

Over 600 users in a small pilot in 40 practices, patients and physicians very satisfied.

Pa=ent  Compliance  Programs  Payors,  Employers,  Medical  Centers,  Labs  

•  Stool  DNA  Colon  Cancer  Screening  Program  – Large  US  employer  distributed  kits  to  50+  year  old  employees  at  health  fair  

– DNA  Direct  provided  educa5on  as  needed,  and  followed  up  with  employees  to  help  them  return  kits  

– Return  rate  increased  by  40%  

Pre / Post Test Decision Support

Phone Counseling

Physician Consultation

Integra=ng  Genomic  Medicine  Into  Pa=ent  Care    

Thank  You!  

trish@dnadirect.com