health care reform

Ahead of the Curve

Challenging conventions with predictive health


Vol. 13 No. 1
Fall 2010

Return to Contents


The Well Being
Health care reform examined around the university

Health Care Reform
Key provisions from the Accountable Care Act

The Patient Protection and Affordable Care Act
Opportunity and uncertainty for academic health centers

"Among the most immediate challenges we face . . . is our communication efforts with the American public: we need to keep everyone informed about what the new law does and doesn't do, and how it will work for them."

"I'm a great believer that what medicine does best is to think about multiple causes for complex outcomes. And much of what I"ve heard over the last couple of years both in the medical science, sadly, and also in the political realm is exactly the opposite."

Ahead of the Curve
Challenging conventions with predictive health

Broadening our Lenses
Ethical reflections on health care reform

Thomas Jefferson: No Happiness Without Health

Cost Control and Health Care Reform
Defusing a fiscal time bomb

The Affordable Care Act
Will the bill improve coordination of care in the U.S.?

Health Reform Law and its Impact on Physical Therapists
Value across the spectrum of care

Placing Addiction in Historical Perspective
Health care reform and the limits of abstinence policies

Further Reading

Endnotes


The passage of the Patient Protection and Affordable Care Act (PPACA) and the heated debate it brought forth yield a powerful opportunity: to challenge conventions and to reshape health care in ways that truly improve our national health by preempting the onset of chronic disease. Achieving a healthier population not only benefits the individual, but it is critical to solving the economic and political issues concomitant with our greater health care dilemma. Emory’s Predictive Health initiative is key to addressing this opportunity.

Predictive health seeks to discover what keeps people healthy. Developed in response to the national need for a transformation in health and health care, Emory’s Predictive Health initiative aims to support individuals in taking care of their health and forestall the decline in health that leads to the need for medical intervention. This is a significant ideological shift in focus from our present disease-based health care system.

Predictive health promises to be pivotal in resolving the greater health care issue of ever-increasing spending that delivers disappointing results. The U.S. spends an unprecedented amount on health care—in terms of nominal as well as real dollars. To put this in perspective, the U.S. invests roughly 16 percent of its GDP in health care (versus 8 percent to 11 percent for Japan, Germany, or France) and maintains a higher annual rate of cost increase. Life expectancy is shorter in the U.S., and the rate of increase in life expectancy is lower than other nations. The PPACA legislation aims to help by expanding health care access to a greater population. A central question is how that health care is delivered: in a dominantly remedial model, or with prediction and preemption as a critical long-term operating component? At this time, it is the former.

The Emory Predictive Health initiative is at the core of a broader perspective on long-term solutions to health care. In this context, predictive health is far-reaching and ahead of the curve, with both an educational and a clinical/research arm working to address these challenges.

As an initial expression of the predictive health model, the innovative Center for Health Discovery and Well Being is mining the extraordinary database available from healthy individuals to establish a positive definition of health that has evidence-based predictive attributes. With the participation of more than five hundred Emory staff, the Center for Health Discovery matches cutting-edge science with a model for future health care. We are gaining knowledge from genomics, proteomics, metabolomics and bioinformatics that can define an individual’s “health fingerprint” in terms that are beyond disease identification. This can make it possible to design preemptive measures to avoid the onset of health decline not only in terms of the onset of illness, but in the realm of overall well being.

Emory Predictive Health defines a continuum of health and posits that fundamental processes—immune system function or oxidative status, for example—are at the basis of healthful functioning. The Emory toolkit for predictive health presently includes a wide range of screening assessments ranging from sleep well being to social functioning and spirituality, as well as neurocognitive health status, vascular health, and an array of health-promoting biomarkers. Innovations ranging from molecular imaging to nanotechnology can provide an unprecedented knowledge of human well being that surpasses existing disease-based categories. Advanced technology is combined with novel approaches to personal health discovery in an environment that provides individuals the tools to become proactive in caring for their personal health and well being. As a partner in personal health, Emory Predictive Health is in the forefront of transformative health care strategies.

Personal health empowerment begins with education. We have brought Emory’s substantial intellectual resources in the health sciences, social sciences, humanities, business, and ethics into the college classroom in a cross-disciplinary manner. For the past three years, students
have considered the question of health care in terms of their own futures as well as society’s. They remark that “our health care system fails to recognize that proactive means are essential for health care to be less costly” and comment that “individual preventive measures will have the greatest impact on my (personal) health future.” Our students recognize, and are almost amazed to realize, that much of their health is in their control. With training in the emerging science of health, our students are looking forward to healthier lives and are positioned to help to shape how our society creates the tools for a health-focused care system.

We live in a time of both unprecedented knowledge expansion regarding functionality of the human body and dynamic change in how that knowledge is afforded to the greater population. Technological advances ranging from bioinformatics to molecular imaging are enabling us to forecast the future and see where individuals stand in the trajectory of health to disease. This raises the possibility for intervention in the health continuum very early, before disease is manifest. Instead of health care revolving around doctors reacting to the presence and damage of disease, we are entering a time when health prediction is possible, and promoting health can preempt a considerable amount of breakdown and malfunction. Achieving this will require a fundamentally different approach, new health personnel, and changes in access, screening, and reimbursement strategies. The role of Predictive Health in this endeavor is far-reaching, and Emory is presently ahead of the curve.