Have you ever considered what an indictment the show “Breaking Bad” is on the American healthcare system? A show about a guy who gets cancer and has to sell meth to pay for it? And that fact that pretty much no one in America thought that was a far-fetched thing to do?
Gritty tele-drama realism aside, the American healthcare system is indeed a bloated commodity. One so big that federal money once earmarked for education and national defense measures is increasingly headed to pay off growing bills in order to keep the system from caving in on itself.
So what can save this elephantine system from ballooning costs? According to Michael Christman, president and CEO of the Coriell Institute in Camden, two things — Obamacare and genetics.
Christman will be the keynote speaker at the Princeton Chamber’s 2015 Healthcare Symposium on Tuesday, September 22, beginning at 7:30 a.m. at Rider University’s Bart Luedeke Center. Two panel discussions follow the keynote. The first, “Hiding in Plain Sight: Behavioral Health in the Workplace,” will feature Jerry Hampton of Primepoint; Ruth Kaluski from the Career Connection Employment Resource Institute; and Matt Verdecchia of EAP+Work/Life. The second, “Here to Stay: The ACA,” will feature Christine Stearns of Gibbons P.C.; Bill Rue of Rue Insurance; and Ryan Petrizzi of Amerihealth.
A CEO roundtable discussion will feature Richard Freeman, president and CEO of Robert Wood Johnson Hospital in Hamilton; Darlene Hanley, president of St. Lawrence Rehabilitation Center in Lawrenceville; Vince Costantino, chief administrative officer of St. Francis Medical Center in Trenton; Al Maghazehe, president and CEO of Capital Health in Hopewell; and physician, author, and former NBC chief medical correspondent Nancy Snyderman. Cost: $75. Visit www.princetonchamber.org.
Christman grew up in Seattle, interested in becoming a scientist like his father. He earned his bachelor’s in chemistry from the University of North Carolina at Chapel Hill in 1981, but developed a keen interest in biology during graduate school at the University of California, Berkeley. He earned his Ph.D. in biochemistry and genetics there in 1985 and then did his postdoctoral fellowship in molecular genetics at MIT from 1986 to 1990.
Christman served as a professor and founding chair of the Department of Genetics and Genomics for the Boston University School of Medicine. He served as its chair from 2001 to 2007, when he joined Coriell.
The eight years since Christman took over at Coriell have, he admits, become the stuff of science fiction. Eight years ago, the idea of using genetics and genomes to figure out how to treat patients was still wavering in a futuristic fantasy world. But genetic research has come a long way and, more importantly gotten cheaper.
Now if only doctors could start accepting it.
How genomics are changing healthcare. Think about what happens when you go to a hospital. A doctor examines, he diagnoses, he maybe orders a test or two, and he prescribes medicine. If it all works, things are great. You get to go home and carry on with life as you’ve always known it.
The problem, Christman says, is that even the biggest and best medicines out there only work in about half the patients who take them. For some in the negative half, the meds just don’t work. For others, they make things a lot worse.
This leads to readmittance to the hospital, which bloats costs, Christman says. However, the Affordable Care Act heavily penalizes hospitals that readmit the same patient for the same condition within 30 days of discharge. This, he says, puts the onus on hospitals to get treatment right the first time, or face hefty fines.
Genomics factors into this because knowing a person’s genetics will tell doctors what medicines are more likely to work from the outset, Christman says. Rather than playing the odds that a popular drug will work, more personalized care becomes the norm. Coriell has been working on personalized medicine for years (U.S. 1, March 7, 2012.)
Moreover, the cost of doing a genetic screening has come way down. The Human Genome Project ran a single genome from 1998 to 2003, at a cost of $3 billion. These days, Christman says, the cost of running a genetic screening is less than an MRI, which, according to a 2014 report by Medicare, averages out to a little more than $2,600. And the genetic screening is a far better and broader diagnostic tool than an MRI, he says.
So why don’t doctors embrace it? Well, some do. Particularly newer and younger doctors, who are now learning about genomics as part of medical school, Christman says. The trouble comes from the twin facts that doctors are not genomics experts and do not know how to read these results — and shouldn’t have to, Christman says — and from the incredibly human tendency to stick with what you know.
“A lot of doctors say, ‘I’ve been a doctor for 30 years, and I’ve treated all my patients without this,’” Christman says. But this, he says, will change. Think of it like text messaging: A lot of older people wonder why you don’t just call somebody, and younger people have made it their preferred method of communication.
Insurance, Obamacare, and a nice cottage industry. The benefit of genetic screenings to the patient is obvious. Better, more personalized care leads to faster recovery and better health. This, in turn, will lead to less need for expensive care options over time.
In addition, the ACA, despite its controversies, will bring down medical costs, Christman says. Actually, he’s found that it already has. The problem with uninsured people is that when they need medical care, they often skip their primary care doctors to go to emergency rooms, which are ethically obligated to treat them, whether these patients can pay or not.
Paying for benefits, one way or another, Christman says, has kept taxpayers from having to cover the costs of uninsured people who can’t pay their own bills.
Why does medical care cost a lot of money? One answer is insurance companies. “We have 2,300 insurance companies in the U.S.,” Christman says. “Germany has one.” And Germany has almost none of the high-price-tag drama hat we have, because there “they have you for life,” he says.
In the U.S., we change insurance providers every few years. Companies do not even offer long-term contracts, Christman says, because they know they’re going to change rates. This forces businesses to shop around as the cost inflates. Even at Coriell, a medical entity, he says, providing benefits to almost 130 employees is one of the largest expenses. On the other hand, countries with single-source providers, like Germany, are vested in your longterm health and can, he says, make rational decisions about healthcare and the payments for it.
No, Christman doesn’t think the idea of a single, national insurance provider will ever fly in America, but that doesn’t mean he doesn’t support it. So instead, it is up to hospitals and doctors to keep people healthy, for their personal benefit and for the monetary incentive — because no matter how idealistic healthcare might sound, it’s a business and it has a lot of money to manage.
Genomics being the future as Christman sees it will likely lead to a boom in the practice of providing support for genetic testing results. Remember, doctors aren’t genomics experts and shouldn’t have to be. But someone needs to be, and Christman foresees a potentially huge cottage industry of professionals who can read the results of a genetic test and help doctors understand them.
“It’s not a panacea,” he admits. “There is no one answer.” For one thing, a doctor might know something about a patient that a genetic screen won’t show, like maybe the patient has only one kidney and would not be able to handle a certain medicine that the screen would suggest is a good one.
The important thing, Christman says, is that genomics is a powerful tool that’s long overdue. “It does sound a little space age,” he says. “But it’s not some futuristic thing anymore.”