A Future Vision of Medicine from the Masters of Retina

Two forces are emerging in healthcare that could determine how quickly personalized medicine takes over: an outcomes-based system that pays drug makers only when their treatments work; and more precise diagnostic technology that utilizes artificial intelligence and telemedicine to ensure a high probability that those treatments work. That was the future vision participants on the Masters of Retina panel shared at OIS RETINA 2018 in Vancouver.

As personalized treatments and treatment algorithms emerge, moderator Jim Mazzo, global president ophthalmic devices, Carl Zeiss Meditec, challenged the panel: “Who’s going to pay for all for this?”

Pay for Performance

“There’s a high probably we’re moving into a pay-for-performance world,” says Anthony Adamis, MD, senior VP at Genentech. This means fine-tuning algorithms to truly personalize care, he explains. “You want to know at baseline a priori which is the right therapeutic to put them on, and then we will be able to command premium pricing – and then payers will pay us.”

Allergan’s chief R&D officer David Nicholson, PhD, concurs that payments for premium-priced therapies will move to a pay-for-performance model. “We will move toward more and more personalized medicine where we have good markers of which patients are going to respond to which treatments so that you’ll be giving the right drug for the right patient, and payers will pay when the drug delivers what it promises,” Dr. Nicholson says. “We will slowly but surely arrive at the state where people pay when the drug works, and they don’t reimburse when it doesn’t.”

Data Will Drive Outcomes

The challenge will be in managing larger patient populations with personalized care, and that’s where technology that improves practice efficiency will play a pivotal role, says Angelo Rago, global head, ophthalmic diagnostics, Carl Zeiss Meditec. “Data is a big part of it,” Rago says, “but we have to also remember that the image data or the current data we have today is not enough.”

Machine learning and artificial intelligence (AI) that draw on “hidden” data in electronic medical records systems will inform more robust algorithms, he says. “You’re really starting to see this data being integrated in such a way that you’re assisting the physician,” Rago adds. “You’re not making the decision for them, but you’re assisting the physician and bringing that information in a cohesive way in one view so that they can make a well-informed decision for that patient.”

Role of Telemedicine

Telemedicine will also play a key role in enabling providers to care for larger patient populations, says Calvin Roberts, MD, senior VP and chief medical officer of Bausch + Lomb. “The real breakthrough is when the patient doesn’t even have to be in the room with the doctor,” Dr. Roberts says. “The patient is someplace where they can receive this diagnostic and then, through a combination of AI to help make the diagnosis that gets reviewed by the doctor, that doctor becomes so much more efficient.”

Kfir Azoulay, VP and head of corporate strategy for Heidelberg Engineering, suggests upstream providers will play an important role in determining what patients need to see retina specialists. Potentially, optometrists, general ophthalmologists, and general practitioners will have technology that enables them to better triage patients, “so that really the patients that need to see the specialist see the specialist,” he says. Such a care network could also rely on more in-home devices, perhaps even optical coherence tomography, leading to a treat-as-needed approach to care, “instead of the current rigid system that is in place,” Azoulay states.

All of this could influence the strategic partnerships that emerge. Dr. Adamis notes that more drug and device companies could be partnering with the likes of Google to harness the power of massive amounts of data. “They’re just going to help us make the right decisions more often,” he says. Heidelberg’s Azoulay adds that the IDx-DR system that uses AI to screen for diabetic retinopathy in a primary care setting has already taken that step.

Welcome to the future.

For questions about this article, contact Richard Mark Kirkner at Rich@healthegy.com.