Thought Leaders in Healthcare IT: CareJourney CEO and President Obama’s CTO Aneesh Chopra (Part 6)

Sramana Mitra: I’m going to switch gear again to the open problems. What is your analysis of the whole gene editing and the CRISPR world? What is possible? What problems can be solved in the short, medium, and long term?

Aneesh Chopra: This is an area that will go in three directions. We’re still in R&D moving to D phase. What will we learn? The first round of applications is about cures in really low-volume but high-cost challenging areas of the healthcare sectors such as cancers. The first round of gene editing was meant to be higher cost for society to absorb on a smaller available population. We’ll see more of that unit price expense but smaller community groups for benefit.

The second path is the innovation curve to democratize some of the enabling ingredients. If possible, we’ll see many more shots on goal as the price to interact with tools falls and the resulting cost to consumers falls. The third lens is a bit more challenging. If it turns out that there’s a large population of people in the fee-for-service system that perennially end up in the emergency room, then there may be a scenario where there’s a clear signal from the market.

Sramana Mitra: What is the regulatory aspect of all this?

Aneesh Chopra: There’re regulatory aspects on consumer protection. If one is building a diagnostic or deploying an intervention, the FDA is going to play an important role already. There’s also regulatory framework on value. How does one contemplate reimbursement models as these new technologies come to life?

There was some consensus that there should be a shot clock system. Once you have been FDA-approved for an emerging technology, you’d have an on-ramp for reimbursement in Medicare for a period of time that would help fuel the evidence base to determine whether this should be scaled or limited. The last dynamic we need is observational data on quality and outcomes.

Today, we don’t have a mechanism for consumers to communicate their goals and aspirations to see whether the intervention helped. The voice of the consumer may be the regulation that matters the most.

Sramana Mitra: Very interesting. If you were to predict a timeline, when will we have a more value-based, prevention-oriented medical system with proper insurance coverage and a real adoption of all these innovations that we have kicked around?

Aneesh Chopra: To some degree, there is a financial dimension that will be the driver of some of the underlying delivery policies. That will tie to how we will keep the Medicare solvent. The current projections are that 2028 will be the year when the trust funds start to dip into the reserves for hospitals.

That will spark a question as to whether or not we double down on the move to value or whether this whole decade of experimentation will be seen as a nice-try. You either cut the price or cut the volume. That may generate the kind of demand we need. On the R&D agenda, CRISPR and the likes are more in control of their own destiny. They’ll go through the machinery of making their tools accessible in the US market. They may start at a higher price point.

Sramana Mitra: Ten years?

Aneesh Chopra: I would say five years on the value-based care flipping to be the default setting. Ten on the full potential on CRISPR and gene editing.

Sramana Mitra: Do you see gene editing impacting heart disease, cancer, and diabetes?

Aneesh Chopra: I’m not an expert enough to know what gene expression results in behavior that’s separately triggered from lifestyle choices, geographic, and social determinants. It can’t be addressed in a vacuum.

Sramana Mitra: It’s been a fabulous interview. Thank you for your time.

This segment is part 6 in the series : Thought Leaders in Healthcare IT: CareJourney CEO and President Obama's CTO Aneesh Chopra
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