Until now, providers have sought to achieve better patient outcomes and realize cost savings through a focus on care variation reduction. While efforts to reduce care variation have been broadly successful, driving improvements in the quality of standardized treatment options, they have also made it challenging to create patient-centered care options.

Advances in diagnostics, treatments, and data analysis have started to mitigate these challenges — but they have simultaneously created tension with legacy strategies that prioritize standardization.

In bespoke care, stakeholders must accept higher upfront costs in the short term, with the promise of lower long-term costs through potential cures, better management, and avoided future costs. Patients and providers also have a greater shared decision-making responsibility in bespoke care. Providers have the responsibility to ensure that patients understand the benefits of all available treatment options — and to prioritize the option that best aligns with an individual patient’s goals.

The ever-expanding number of treatment options also increases the complexity of care delivery. With a wider range of treatment options, clinicians must spend more time determining which innovations are best suited for each patient.

This new level of personalization has the potential to significantly improve the patient experience and quality of care. However, there are massive barriers preventing equitable access.

We've identified four key challenges that healthcare leaders will need to overcome to make bespoke care a reality. 

Improving access to bespoke care requires leaders to address four specific longstanding challenges: payment mechanisms, appropriate use, clinical decision-making, and data privacy.

None of these are new challenges, but the impact of not addressing them will only become heighted over time as the industry adopts more personalized care models.

There's no guaranteed path to success against any of these challenges — experimentation and innovation will be required from healthcare leaders to find the correct strategy — but a successful plan should incorporate these action items:

1. Adopt payment models that account for longitudinal benefit.

The clinical impacts of the innovations powering bespoke care are astounding — and in many cases, so are their price tags. The high cost of innovative new treatments will be the number one barrier preventing them from reaching all eligible patients. Covering these costs requires health plans to face financial, performance, and operational risks.

To mitigate these risks, stakeholders will need to look at metrics that go beyond basic regulatory efficacy and safety requirements to articulate the long-term value of high-cost treatments. The typical 12- to 18-month window is insufficient to capture the longitudinal value of many of these treatments.

Health plans, manufacturers, and providers will need to collaborate to roll out new payment models as these new metrics change the definition of value to account for long-term benefits of products that may significantly reduce the need for future medical interventions.

2.  Establish a clear and timely understanding of appropriate use.

While bespoke care empowers patients to engage in more shared decision-making with their providers, it can also increase opportunities for inappropriate use if the proper processes are not established.

Medicare spending on genetic testing increased from $470M in 2017 to $1.9B in 2021 — but these tests do not always yield valuable information to patients or providers. In a study from San Diego Naval Medical Center, a third of genetic tests ordered were inappropriate.

This explosion in testing underscores the need for both patients and providers to reach a mutual understanding of their options for testing and treatment, how much they cost, and what benefits they can expect to receive. To maximize the benefits of new technologies and products, organizations will need to hardwire appropriate use into their new care models.

3. Leverage technology to assist with shared decision-making.

The rapid advancement of innovation is making bespoke care more feasible in a clinical sense, but more operationally difficult for the physicians responsible for delivering it. 68% of clinicians report feeling overwhelmed by the treatment options available to patients, and unable to keep up with new developments and information needed to provide patients with the best possible care.

Physicians will need to leverage new innovations in clinical decision support to allow them to focus less on determining which technologies they should use, and more on what products, people, and processes will lead to the best outcomes for their patients.

4. Safeguard patient data to build trust.

Bespoke care requires massive volumes of patient data to be shared with a variety of stakeholders — and patients need to be able to trust that healthcare providers, digital health companies, health plans, and any other organizations who can access data can also keep it secure.

To establish trust, patients will need a thorough understanding of why their data is being collected, what it is being used for, and how it is being kept private. Healthcare stakeholders will need to codify, implement, and follow strict guidelines for handling patient data to keep this trust.

For patients with the financial means, bespoke care is already a reality. Moving forward, the challenge for healthcare leaders will be to redefine the care delivery landscape by following the imperatives mentioned above to mitigate issues around cost, appropriate use, clinical decision support, and data privacy.

Every sector has its own role to play in this process. To learn how health systems, health plans, life science companies, suppliers, and other health system partners will need to respond to enable bespoke care at scale, read our take on the four imperatives for the future of healthcare innovation.

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