Latest / CareTalk: Healthcare. Unfiltered. / Getting Real About Personalized Medicine w/ Jim Wallace, CEO & Author of Precision Medicine

Transcript

Getting Real About Personalized Medicine w/ Jim Wallace, CEO & Author of Precision Medicine · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to Care Talk.
• 0:08
  John: America's key resource for incisive debate on healthcare, business, and politics.
• 0:13
  John: And today we have my old friend, Jim Wallace, to talk a lot about what's going on in pharmacogenomics and how our we can take our disconnected healthcare system, connect it with technology and innovation, and accelerate the changes we all wanna see in healthcare.
• 0:31
  John: Welcome, Jim.
• 0:33
  Jim: Hey, John.
• 0:34
  Jim: It's good to see you and, uh, I like being, uh, characterized as your old friend.
• 0:40
  Jim: Um, and we have known each other for a long time in this case.
• 0:43
  John: It's true.
• 0:43
  John: Yeah, it's true.
• 0:47
  Jim: So thank you.
• 0:48
  Jim: It's good to, good to be here.
• 0:50
  John: Uh, Jim and I went to business school, uh, gosh, almost 30 years ago and
• 0:55
  Jim: yeah,
• 0:56
  John: and after some mishits in other industries found that.
• 0:59
  John: Uh, with both and both with a slightly military background that healthcare was a target rich environment
• 1:05
  Jim: Yes.
• 1:05
  John: For care.
• 1:07
  John: Connection and innovation.
• 1:08
  John: And so Jim, maybe you could start by talking, uh, how, how you got into healthcare in the first place as a former aviation officer in the Army.
• 1:18
  John: If I, if my recollection is correct.
• 1:20
  John: Yeah,
• 1:20
  Jim: no, that's a, that's a good, uh, good question.
• 1:22
  Jim: Um, it wasn't something I really sought.
• 1:25
  Jim: Um, I was a combat pilot in the army and then I.
• 1:29
  Jim: I joined you at business school, um, when the world was a much safer place.
• 1:34
  Jim: Um, graduated, went, you know, started at Bain and Company.
• 1:38
  Jim: Um, one of our clients was, you know, Baxter, uh, triol at the time.
• 1:43
  Jim: So I had some initial exposure there.
• 1:45
  Jim: But after my Bain experience, I started as the head of strategy at, at Anthem, which at that time was a single state Blue Cross Blue Shield licensee.
• 1:55
  Jim: And so just applying kind of what.
• 1:58
  Jim: You and I learned about competitive strategy.
• 2:00
  Jim: We created the, uh, strategy to merge the plans together and ultimately create the, you know, anthem elements that we see today.
• 2:10
  Jim: What I think is the second largest, um, the hydro headed
• 2:13
  John: monster of the for profit blues.
• 2:16
  John: That is, that is, that is as big as any plan except Save United.
• 2:20
  Jim: Yeah.
• 2:21
  Jim: It's, uh, that's right.
• 2:23
  Jim: And uh.
• 2:24
  Jim: It's taken a completely different path from UnitedHealthcare too.
• 2:27
  Jim: I mean, UnitedHealthcare is the behemoth, right?
• 2:30
  Jim: Um, with Optum, Elance took a, a little bit different path, but that was my exposure.
• 2:39
  Jim: Uh, I was there for a number of years, uh, through the first several iterations of, um, of merger and, uh, and, and, and acquisition.
• 2:49
  Jim: But then I left, uh.
• 2:52
  Jim: To start a merchant bank, after I saw what was missing in healthcare, I actually left to start a merchant bank that invested in innovation in healthcare.
• 3:01
  Jim: Uh, developed a number of technologies that really, uh.
• 3:07
  Jim: Really leveraged the applied math, that was my background, an undergraduate background, um, in projecting care costs and getting in front of those.
• 3:18
  Jim: Uh, grew that to about a half a million dollars.
• 3:20
  Jim: Ended up selling that and then I.
• 3:20
  Jim: Uh, took an entire left turn and went to SpaceX for a couple years.
• 3:26
  Jim: I was the head of business development, um, uh, with Elon at SpaceX, um, in the 2011 2012 time period.
• 3:35
  Jim: As
• 3:35
  John: you look up into the sky.
• 3:36
  Jim: Yeah.
• 3:37
  Jim: Yeah.
• 3:37
  Jim: And realize how far we've come in that industry as well.
• 3:41
  Jim: But then I came back after, uh, we assembled a good manifest of launches, um, came back to healthcare, to the care delivery side.
• 3:49
  Jim: I was the.
• 3:50
  Jim: Head of Ameri Plus, it was a business unit of AmeriLife Group, which is the largest, uh, distributor of Medicare products in the country.
• 3:58
  Jim: And, you know, we had about 1400 hospitals in the network, uh, 65,000 physicians.
• 4:05
  Jim: And that's where I really realized, I saw claims data coming through and you get a, just a laser focused lens on what's outta control here and what can you do to do about it.
• 4:17
  Jim: And that eventually led me to.
• 4:20
  Jim: Pharmacogenomics and the four drivers of precision medicine.
• 4:23
  Jim: And once I really looked under the, the hood and understood how revolutionary genomics was,
• 4:33
  John: step back a second.
• 4:34
  John: And you know, not everybody, um.
• 4:37
  John: Makes the logical leap between insurance space, banking and genomics.
• 4:43
  John: But rather than go backwards, let's, let's explain what pharmacogenomics is and, and what the promise has been of that for a bit.
• 4:52
  John: 'cause you know, you really have now spent a fair bit of time there.
• 4:55
  Jim: Sure.
• 4:56
  Jim: Uh, pharmacogenomics is just the, the application of one's unique genetic makeup, your DNA.
• 5:05
  Jim: Understanding what that is and how it in, how it impacts how you, uh, metabolize drugs.
• 5:13
  Jim: Well, it turns out that's pretty important.
• 5:15
  Jim: In fact, medication failure accounts for about 16% of wasted dollars in the $4 trillion US healthcare economy.
• 5:25
  Jim: Um, 250,000 people.
• 5:29
  Jim: Per each year from medication failure, that's completely avoidable.
• 5:34
  Jim: And a hundred percent of human beings have some, uh, difference in their DNA that, uh, prevents them from fully metabolizing a drug.
• 5:44
  Jim: So if you know that you can avoid, uh, you know, recurrent hospital admissions, uh, doctor visits, there are some classes of drugs that with certain ethnicities.
• 5:54
  Jim: Actually aggravate conditions.
• 5:56
  Jim: And that really fascinated me, both from a finance perspective, the insurance and banking, but also from a care delivery perspective.
• 6:04
  Jim: And so,
• 6:05
  John: so, and, and contextually here, everybody who's sick is likely on a pill or some, or an infusion or getting some form of pharmaceutical intervention of that massive number of, of interactions.
• 6:20
  John: Whether they're neutral, positive, or I guess just redundant where you're taking something that either helps you, doesn't help you, makes it worse, or Joe, you're paying for it and it doesn't work.
• 6:32
  John: How many of those can we diagnose and understand upfront?
• 6:37
  John: Uh, so there's a lot of problems in healthcare you can describe, but you can't make any progress on.
• 6:42
  Jim: Yeah.
• 6:42
  John: Maybe, maybe dig into like, what's, what's the, what's the possible.
• 6:47
  John: Here that we get that's actionable today for doctors and patients.
• 6:51
  Jim: Yeah, it's pretty, it's pretty astounding.
• 6:54
  Jim: 50 by, by general data, if you just Googled it or chat g PT, that, um, it would suggest that between 40 and 60% of individuals are taking some medication.
• 7:07
  Jim: That has a conflict and there are, you know, eight or nine different categories of conflicts.
• 7:13
  Jim: Drug drug interaction, adverse drug events, that type of thing.
• 7:16
  Jim: Um, in our experience, fully 53% of individuals are taking something that elevates their risk of adverse event.
• 7:27
  Jim: And so.
• 7:28
  Jim: That adverse event could just be a really bad side effect, or it could be a life or death condition that's 53% and it's not one drug.
• 7:39
  Jim: Um, in our cohort, uh, our cohorts, we tend to see polypharmacy at the four to six to eight drug level, um, being prescribed by two or three or four physicians.
• 7:55
  Jim: Fulfilled by the same number of pharmacies and none of them are talking to each other.
• 7:59
  Jim: So what we created at Decision Rx, the the founders, um, that brought me on board, uh, was a platform that really connects the dots there.
• 8:10
  Jim: Take the test, apply the analytics to your DNA, and then create a medication action plan that requires 360 degree communication and a hundred percent completion of that.
• 8:21
  Jim: So that.
• 8:23
  Jim: There's no longer anyone who's unaware of this.
• 8:28
  Jim: Uh, I mean, it's a tragedy in some instances.
• 8:31
  Jim: Uh, and so that's really, I think the leap that we made disruptively in the industry was to put those three things together in a way that is actionable and financeable.
• 8:44
  Jim: Does that make sense?
• 8:45
  John: Yeah.
• 8:45
  John: So what I think what you're saying is that every patient who's taking more than two or three drugs needs what you're selling.
• 8:55
  Jim: Yeah.
• 8:55
  Jim: And it's even deeper than that.
• 8:58
  Jim: Every human I. Will benefit from that.
• 9:02
  Jim: It's just a matter of when, so every human has some, so, so
• 9:06
  John: how, so how do you, how do you, since, to your point, we are all, we all have unique, you know, genomic presentations or proteome or, or the way our genetics interact and, and there are organic, they're changing all, all the time.
• 9:21
  John: We're, as we interact with the environment and with everything we, we consume, how do you get this product?
• 9:29
  John: Who pays for it, and how do you then
• 9:32
  Jim: use it?
• 9:33
  Jim: Sure.
• 9:34
  Jim: Um, there are point solutions out there.
• 9:37
  Jim: You can buy a test, it'll just result to what your DNA is.
• 9:43
  Jim: It won't tell you anything about it.
• 9:45
  Jim: You can buy an analytic report with or without the test.
• 9:49
  Jim: It'll tell you well.
• 9:51
  Jim: You're taking too many drugs in there.
• 9:54
  Jim: It looks like it, it looks at it, it does what PBM should be doing.
• 9:57
  Jim: Anyway, it looks at drug drug interactions and kind of the, the baseline conflicts.
• 10:02
  Jim: Um.
• 10:03
  Jim: Or you can buy a concierge pharmacy consult that will do a high class brown bag review of what you're taking, right?
• 10:10
  Jim: Um, what decision RX does is it combines all three of those and then uses an innovative funding mechanism bringing in, you know, my banking and finance background.
• 10:22
  Jim: Uh, we established a, an arrangement with Carlisle Group, uh, uh, notable healthcare investor, um, so that we can actually pay for the test upfront, no cost to the provider or the payer.
• 10:35
  Jim: And then simply out of the cost savings on the backend, that's where we achieve our revenue.
• 10:43
  Jim: Um, and that's pretty innovative.
• 10:45
  Jim: Uh, we, I did that in other industries.
• 10:48
  Jim: That's the way it was familiar to me.
• 10:50
  Jim: We just adapted that model.
• 10:52
  Jim: To healthcare finance.
• 10:53
  John: So, Jim, how does that work?
• 10:54
  John: If my, my mother's 91 years old and she's on a few things.
• 10:58
  John: Does she call a call center?
• 11:01
  John: Does she click through to a website?
• 11:03
  John: Does her, does her insurance company or her doctor reach out to her?
• 11:06
  John: How does that interact?
• 11:08
  Jim: Yeah, there's two, uh, or three primary means that the, the first, and these will be familiar to you as a veteran in the industry.
• 11:17
  Jim: Um, the easiest one to think about is.
• 11:20
  Jim: Direct to consumer, and you can go out to the Decision RX website and, and order a test kit and, and get the same product.
• 11:30
  Jim: Um, the ideal one is probably through a provider organization like an ac, an accountable care organization or a Medicare Advantage plan where you're being asked to come in and the provider is already aware of the value That kind of compresses all of the, the educational.
• 11:50
  Jim: Lift that has to occur.
• 11:52
  Jim: But the real volume way that's probably got the slowest adoption is through the payer, through a UnitedHealthcare or a Humana or an Aetna, somebody that has the same incentive to reduce the cost of care.
• 12:08
  Jim: They just have a more tangential.
• 12:11
  Jim: A relationship with a consumer.
• 12:13
  Jim: They're not really focused on the delivery of care.
• 12:16
  Jim: They're just focused on paying for it.
• 12:18
  Jim: And so getting the same pickup rate through a payer is different than if the provider saying, Hey, take this test.
• 12:23
  John: And, and maybe you could give a very specific example of your, of, of kind of what's available and how consumers interact by talking about your, your mother-in-law.
• 12:34
  Jim: Sure.
• 12:34
  Jim: Uh, I shared that story with you separately.
• 12:37
  Jim: The, um, what really.
• 12:40
  Jim: Lit the candle for me on this was, uh, and got me really diving deep into essentially the forward application of this was my 87-year-old mother-in-law, uh, was under, you know, treatment and received a blood report before her physician did.
• 12:59
  Jim: And there was enough information in that that she knew that she had to take some action on that.
• 13:06
  Jim: Well, that's occurring.
• 13:07
  Jim: Across the spectrum of interactions, you're getting that information from your wearable, your, your Apple Watch today.
• 13:14
  Jim: You're getting, you can get that information from a genomic test that says, Hey, you can't metabolize vitamin D like everybody else.
• 13:21
  Jim: So osteoporosis is gonna be a problem for you.
• 13:24
  Jim: Um, you get that from your gut biome reaction that's, you know, readily, uh, discernible in, in certain environments and cases today.
• 13:35
  Jim: Um.
• 13:37
  Jim: And now you're getting it from the integration layer, which is really big data and ai.
• 13:44
  Jim: Now big data and AI are able to proactively say, Hey, looking at your claims data, you might not even be thinking about this.
• 13:55
  Jim: But this is going to be an issue for you.
• 13:57
  Jim: That's really, now we, now we've
• 13:58
  John: been, now we've been given, you know, explicit warnings not to feed our claims data into chat GPT'cause you're never quite sure who's gonna own it, where it's gonna go.
• 14:08
  John: But it sounded like when your mother-in-law was using, was it chat?
• 14:12
  John: GPT one of is one of the tools?
• 14:14
  Jim: No, I, I'm, I think I'm the, the leading advocate of, uh, generative AI in my family.
• 14:20
  Jim: No, it was just, uh.
• 14:21
  Jim: Her, you know, accumulation of, uh, experience over 87 years that led her to realize, Hey, I need to flag this for my, for my physician.
• 14:31
  Jim: What what was astounding was that she knew that before the physician did.
• 14:35
  Jim: That's a reversal.
• 14:36
  Jim: And so I think what we're gonna see over the next, in a five years or 10 years is a really flexing around that the, the role of primary care doctors is going to change from.
• 14:50
  Jim: You know, one of care management to stage management.
• 14:55
  Jim: 'cause AI will be able to do the quarterbacking function that they've, that Marcus Welby did, you know, back in the day.
• 15:04
  Jim: And specialists will be able to intervene earlier 'cause they'll have information far before.
• 15:09
  Jim: Um, and so that's gonna make the primary care doctor more of a are are you gonna be a. Pro Prognos Tologist, who's, you know, predicting when something's going to occur.
• 15:18
  Jim: You're gonna be an in anthropologist who is actually dealing with the inception, or are you gonna be, uh, someone else who's dealing with the implementation of a chronic condition?
• 15:30
  Jim: Right.
• 15:30
  Jim: So back to my mother-in-law, she just had the information, knew something had to be done, scheduled the appointment, it, it gets done.
• 15:37
  Jim: It's changing
• 15:39
  John: care.
• 15:40
  John: How do you as a, what's, so what's your advice to patients?
• 15:44
  John: It's to not everybody's gonna be as quick and as clever as your mother-in-law
• 15:47
  Jim: to get involved.
• 15:48
  Jim: In fact, I, the, I have a book coming out from Wiley this summer, uh, on precision medicine and the personalization of healthcare, and I. You can do those things today simply by taking the test yourself or asking your provider if you can take a genomic test, uh, by wearing a wearable and paying attention to it.
• 16:09
  Jim: Um, I didn't pay attention to it until I realized how rich the data was that comes out of that by paying attention to your gut biome reaction.
• 16:20
  Jim: 'cause that has a large impact, what you eat.
• 16:22
  Jim: Determines how well you can metabolize something.
• 16:24
  John: So, so let's, but, but let's break that down.
• 16:26
  John: So if you, you can ask for tests.
• 16:28
  John: That makes sense.
• 16:29
  John: Are there tests that patients should, you'd recommend?
• 16:32
  Jim: Yes.
• 16:33
  Jim: Uh, pharmacogenomic tests would be the top of the line one.
• 16:37
  Jim: Uh, if you ask for, uh, a pharmacogenomic testing through your provider or through your payer or directly, that's going to give you the information that says you, you cannot process.
• 16:51
  Jim: An opioid or you cannot process a an SSRI for behavioral health disorders.
• 16:57
  Jim: You cannot process, uh, a statin as the of statin and drug blood thinning drugs are the biggest categories that are widely prescribed and don't work well.
• 17:06
  Jim: Um, uh, every day we get feedback from some patient who was on a statin that they couldn't metabolize, and so they had neuropathy.
• 17:15
  Jim: Um, so
• 17:16
  John: and so, so, and neuropathy often leads to problems of feeling your feet and being able to walk around, which creates all kinds of other issues.
• 17:23
  John: Okay, so that's order the test, read the test, take action on the test.
• 17:28
  John: Okay.
• 17:28
  John: You got your wearable.
• 17:30
  John: It doesn't look like your Apple Watch is on.
• 17:31
  John: I'm not gonna comment on that, but, but let's say you've got a wearable, what should you be monitoring?
• 17:39
  Jim: That probably comes down to personal preference until you understand what information is most valuable for your case.
• 17:47
  Jim: Um.
• 17:48
  Jim: In the book, we talk about, you know, weight loss.
• 17:51
  Jim: There's a lot of value that's available in the wearable, uh, with regard.
• 17:57
  Jim: But
• 17:58
  John: Jim, as, as a friend, I can tell you, whenever you bring up the book, give the title.
• 18:01
  John: So it just triggers people's, you know, you gotta constantly, it's really hard to sell books.
• 18:07
  Jim: Yeah, no, I, to
• 18:08
  John: constantly remind us what the book, the upcoming book's title is.
• 18:11
  Jim: No, I've enjoyed reading about your book, pay The People.
• 18:15
  Jim: The book is Precision Medicine, uh, ai, and, uh.
• 18:18
  Jim: The science of personalized healthcare, and it's available on Amazon and all the book outlets now.
• 18:23
  Jim: But the, um, it's really the, the, the wearable aspect of it is really more just generally health oriented.
• 18:34
  Jim: So if you're suffering from sleep disorders, the aura ring is a good.
• 18:40
  Jim: 24 7 monitor that can help adjust your sleep habits.
• 18:44
  Jim: It'll give you information about that that will change your life because if you get a good night's sleep, your whole day is better.
• 18:51
  Jim: Um, there are other, uh, more intensive things that you can measure, uh, with regard to, uh, your hearing through your Apple Watch.
• 19:00
  Jim: It can give you feedback on your noise environment for hearing loss.
• 19:04
  Jim: Um.
• 19:06
  Jim: Obviously cardiovascular health and respiratory health is, is something else that it can do.
• 19:10
  Jim: But those are more general things that just help you understand, should I be taking more steps each day?
• 19:17
  Jim: You know, should I be getting up and down more often?
• 19:20
  Jim: Those types of things.
• 19:22
  Jim: But once you take a genetic test and you understand you're gonna have an issue.
• 19:27
  Jim: With cardiovascular health in your future or you're going to have an issue, then you can start paying attention to the more discreet things that the, that the Apple Watch tells you.
• 19:37
  John: That makes a lot of sense.
• 19:38
  John: And, and, and obviously buy and read your book and share it with all your friends.
• 19:43
  John: Um, maybe, maybe just to wrap on this, what the patient should do, how, how much should they assume this is going to come from and through their doctor, and how much do they have to kind of.
• 19:57
  John: Push their doctor to make sure they're getting to the right place in terms of this more, this more sophisticated, intelligent, personalized care for them
• 20:06
  Jim: with, without sounding too gratuitous, this is the kind of breakthrough comment that I'm used.
• 20:11
  Jim: I remember hearing from you in, in business school.
• 20:14
  Jim: Um, that's the, that's the million dollar question.
• 20:18
  Jim: Uh, right now it should be the physician, but the way US healthcare is organized.
• 20:25
  Jim: It's not because it's giving the physician information that they don't have and making their current course of care look bad.
• 20:33
  Jim: Um, it should be the payer, but it's not because the payer is compensated on premium earned.
• 20:40
  Jim: If you're taking 16% out of the premium.
• 20:44
  Jim: That's harming their premium.
• 20:45
  Jim: So I'm a big advocate for, for DTC, take control of your health.
• 20:50
  Jim: That's why I wrote the book.
• 20:51
  Jim: Uh, that's, you have what you need right now, get in front of it.
• 20:56
  Jim: Um, but if you ask your physician, they'll help you.
• 21:00
  Jim: There's the, the new crop of physicians that are coming out.
• 21:03
  Jim: Medical school curricula are changing.
• 21:06
  Jim: To incorporate more genetic information in the curriculum, has a long way to go.
• 21:12
  Jim: Um, and payers, we're doing a lot of work with payers now to, to integrate that into their offering.
• 21:17
  Jim: So just be more vocal, I think is, uh, in your own course of care become, uh, more of a quarterback of your own care and don't depend on, uh, you know, somebody else to tell you.
• 21:30
  Jim: You need to get healthier.
• 21:32
  John: Does that make sense?
• 21:33
  John: I, I think it does, and I, I think I'd like to wrap there.
• 21:35
  John: I think that the responsibility to be the coach, the play collar, and at times the quarterback, I.
• 21:44
  John: A generation ago when always deferred to, um, the white coats and the senior establishment.
• 21:50
  John: Yes.
• 21:50
  John: But I think the power of you, your approach, Jim, the recommendations you're giving about personalized medicine that we will all pursue on our copies bought largely by Amazon.
• 22:01
  John: 'cause that's where all the books are sold.
• 22:03
  John: Uh, and why I am honestly really proud.
• 22:06
  John: I've always been, uh, delighted by our friendship, but I'm proud of the progress you're making.
• 22:11
  John: To make these really complex, multi polysyllabic challenges, actionable and personable through personalized medicine.
• 22:20
  John: So with that, Jim, um, thanks for joining.
• 22:24
  Jim: Thank you so much, John.
• 22:26
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