AXA Next Lab, the innovation hub of AXA Group (a worldwide leader in global insurance and asset management), recently hosted its 7th InsurTech event in San Francisco. These gatherings support AXA Lab’s ongoing ambitions to spread knowledge, give back to our community, grow and engage our network, as well as fuel the advancement of important fields that have the opportunity to impact and transform the InsurTech industry.
Thibaut Loilier, Director of Business Development for AXA Next US, kicked off the evening with an overview of the market and global trends — view the presentation here: bit.ly/genomicsoverview
The meetup featured Lisa Alderson (Co-Founder & CEO of Genome Medical), Didier Perez (Board Director of Toolbox Genomics), Kathryn Phillips (Director and Founder, leader in healthcare research from UCSF) and Oliver Keown (senior investor from GE Ventures) for an exciting panel discussion on the current state of genomics and the transformative impact it will have on the future of healthcare. The event brought together a diverse audience from investors and entrepreneurs, to corporate insurtechs, health experts, and students for an evening of dialogue on the power of data driven insights and the potential of genomics to improve patient outcomes and revolutionize healthcare.
Genomics is a vast field of science with a focus on fully understanding how an organism’s DNA works (its structure, function(s) and how they are mapped). A complete set of an organism’s DNA, including all of its genes, is referred to as a genome. Genomics may sometimes be confused with genetics, but they are different — genetics looks at individual genes and how these are passed down through generations, whereas genomics looks at the entire DNA structure and complete set of genes.
Direct-to-consumer genetic testing (which analyzes specific genes) is receiving an increasing amount of attention from investors, as well as the general public. These tests, which provide people insights to their genetic information without necessarily involving a healthcare provider or health insurance company, first came on the market about a decade ago. The demand for genetic testing is global: North America and Asia are two areas where the demand for personalized genetics is the highest, predominantly due to the strong prevalence of chronic and genetic disorders in these geographies.[1] Currently, 26M people have done some form of genetic testing — by 2021, 100M people will have done genetic testing.[2]
Today, genome sequencing is more accessible, cheaper and faster than ever before. In the last 15 years, the cost of reading an individual’s DNA sequence went from hundreds of millions of dollars to around $1,000, and can now take just hours to receive results (versus taking weeks in the past). This is ushering in a new era of precision healthcare in which treatments, prevention strategies and health advice is more accessible and able to reach patients faster. These are contributing factors to why investments in the genomics market have increased so significantly over recent years. Last year, $3B (20% of total investments in digital health globally) were invested in genomic startups: 65% of these investments came from United States, 10% from China, and 8% from the United Kingdom. By 2024, this $10B market is forecasted to increase to $19B.[1]
In response to the steady growth of this market, new healthcare jobs are emerging:
● Genetics counseling: This is a growing area and establishing itself as a key component in the diagnosis and treatment of certain diseases and disorders. According to the Bureau of Labor Statistics, this field is one of the fastest growing career paths in healthcare support, forecasted to see a whopping 29% increase annually, until 2026
● Epigenetics coaching: Epigenetics is an emerging field of science that studies heritable changes caused by the activation and deactivation of genes without any change in the underlying DNA sequence of the organism. A new generation of coaches are now specializing in genetic interpretation and exploring how to design optimal health and wellness strategies, as well as help control outside factors (potential to either turn on or turn off specific genes)
● Gene-editing specialists: Capability to delete, replace, or modify a DNA sequence, typically with the aim of correcting a genetic disorder. The global genome editing market is expected to reach $10B by 2026 (vs. $3B in 2017)
The Case For Personalized Medicine
The genomics field has several characteristics that make it attractive for a large number of investors: it deals with many consumer-facing applications (e.g. DNA testing kits, blood tests, etc.), software, as well as enterprise. “The field of genomics is evolving very quickly and is present everywhere from med-tech and healthcare IT/services, to diagnostics, and consumer products” observed Oliver Keown (GE Ventures). Over the last decade, genomic sequencing was restricted to the research environment. Now, it is increasingly used in clinical practice, and is expected to be generated within healthcare over the coming years.[1]
“Within the population at large, about one out of fifteen individuals has a high penetrant variant that will impact their clinical care. One out of every six has a moderate risk variant that could change clinical care in the future” — Lisa Alderson (Genome Medical) on the importance of customizing healthcare treatment to better meet the needs of each individual. Personalized medicine has the potential to tailor therapy with the best response and highest safety margin to ensure better patient care. By enabling each patient to receive earlier diagnoses, risk assessments, and optimal treatments, precision medicine holds promise for improving healthcare, while also lowering costs. This could also have a positive impact in the overall US healthcare spending: in a recent study published in PLOS One, researchers surveyed physicians across the United States about their perspectives on unnecessary medical care — these physicians reported that more than 20% of overall medical care was not needed.
Lisa continued with an overview of three ways genomics are being used today:
- Understanding predisposition to disease: before you become symptomatic, identify if you are at an elevated risk relative to the population at large — that becomes important because that information can be actionable. For example, with high risk for cancer, you may now be eligible through insurance to get more active surveillance, which means that its detected early when it is most treatable, meaning that it’s better for longevity and quality of life.
- Getting to a more accurate diagnosis of disease: historically, we diagnose disease largely by observing symptoms — we can now use genomes to understand and get to a more accurate diagnosis.
- Understanding how we treat disease: if we can start to look at biomarkers that will show higher efficacy for one therapy over another, we can get that individual on the right drug, faster. That has lots of implications — it reduces adverse drug response and also elevates efficacy of drugs so we save significant costs in getting people the right drugs faster — it’s very pervasive because it touches all areas of medicine and has a huge impact over the course of life.
Didier Perez (Toolbox Genomics) noted the importance of providing consumers with insight into what they’re predisposed for and “helping them understand that even if you’re predisposed for an ailment, it doesn’t mean the gene will ever impact you. With healthcare, good food, good nutrition, and good exercise, the course of predisposed ailments can actually be changed.” Didier shared his positivity for what’s to come, expressing “Today is fabulous — costs are down, people understand the application, and it can only get better, so I’m very excited to continue on in this field.” Kathryn Phillips (UCSF), who works on translating this data into clinical care and health policy, noted that “precision medicine is here to stay, so it’s going to be a very important area for people to understand.”
Empowering Consumers While Balancing Risk
“We don’t know the effects genomics could have on insurance premiums (long term care, life insurance, disability, health coverage). I can see carriers using that against us — for example, if you show a disposition to certain diseases,” noted an audience member. Didier cited that consumers have certain protections, one of which is the GINA Act[1], which protects consumers against discrimination in health insurance based on genetic information. Didier stressed the importance of consumers researching companies they begin working with and becoming aware of their privacy policies. Kathryn pointed out consumers should also be aware of the fact that while the GINA Act protects against discrimination in health insurance, there is no protection against this in life insurance or long term care. Ultimately, predisposition testing is a personal decision and it is important for consumers to educate themselves on the benefits, as well as potential risks.
Prevention and the Opportunity for Genomic Prediction in a Value-based World
In the context of fee-for-value, the healthcare landscape is evolving rapidly. Didier has observed that consumers are increasingly willing to make an investment in something (genomic applications/analysis) if it benefits their health or leads to prevention of disease, noting “People are willing to pay cash to get healthier if there’s something they can do on their own, without taking drugs.” Kathryn expressed that she had to interject here — “The most unhealthy populations are low-income populations (they cannot even afford an extra $100 out of pocket), so while the healthy (who can afford it) get healthier, the people that really need it, can’t get it.” Didier responded with, “This is a governmental issue and all we (Toolbox Genomics) can do is help the ones who would put money into a vacation, put it towards their health instead.”
There are still gaps and opportunity for improvement, particularly with the underprivileged population. For example, there are still many underserved states that have not been able to resource important genomic analyses such as BRCA testing, which identifies harmful mutations in genes. With early detection, it could save lives and the healthcare system a tremendous amount. Although there are still gaps in the healthcare delivery system, there are strides being made in preventative developments that are working towards taking costs out of the system, rather than adding to it. Lisa shared her view on the opportunity to work towards a future where there is more focus on predictive genetic markers and prevention — one of the biggest areas of cost savings she sees for the future is around understanding our gene to drug interaction, an area where the science is still progressing — “Today, over 80% of drugs under development have a biomarker that would show higher efficacy at a given cohort if a person has that biomarker (it is estimated that 40% of the drugs patients are on have no efficacy).” Each year, ~1M individuals are seen in hospital emergency departments for adverse drug events in the United States.[1] Lisa believes that in the future, the vast majority of drugs will not be prescribed until the drug to gene potential interaction is looked at, which can lead to immense savings and improved health outcomes.
Kathryn shared a different perspective, adding that despite popular belief, “Prevention does not usually save money — we think it does, we hope it does, but it doesn’t — the only prevention that typically saves money is vaccines.” She believes that although prevention can definitely provide better health, “It is a misnomer to say there will be cost savings from it” — providing better health is the goal, but it does come at a higher cost” (Lisa called this the “payor’s perspective”).
The conversation closed with a final piece of advice from each panelist as we embark on the future of healthcare:
“Genomics is coming and it’s going to change clinical care”
- Lisa Alderson’s advice for providers
“Be reasonable about what you expect out of genetics”
- Didier Perez’ advice for patients
“Pay attention to the evidence”
- Kathryn Phillips’ advice for regulators and payors
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[1] Mordorintelligence.com. (2019). Genetic Testing Market | Growth, Trends, and Forecast (2019–2024). [online] Available at: https://www.mordorintelligence.com/industry-reports/global-genetic-testing-market-industry [Accessed 1 May 2019].
[2] Regalado, A. (2019). More than 26 million people have taken an at-home ancestry test. [online] MIT Technology Review. Available at: https://www.technologyreview.com/s/612880/more-than-26-million-people-have-taken-an-at-home-ancestry-test/ [Accessed 29 Apr. 2019].
[3] Energias Market Research. (2019). Global Genetic Testing Market Report, Market Analysis, Share, Growth. [online] Available at: https://www.energiasmarketresearch.com/global-genetic-testing-market-report/#1490956978512-aa4994a2-860cfa3f-f4e9 [Accessed 29 Apr. 2019].
[4] Stark, Z., Dolman, L., Manolio, T., Ozenberger, B., Hill, S., Caulfied, M., Levy, Y., Glazer, D., Wilson, J., Lawler, M., Boughtwood, T., Braithwaite, J., Goodhand, P., Birney, E. and North, K. (2019). Integrating Genomics into Healthcare: A Global Responsibility.
[5] Genome.gov. (2019). Genetic Discrimination | NHGRI. [online] Available at: https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination [Accessed 2 May 2019].
[6] Cdc.gov. (2019). Program Focus | Medication Safety Program | CDC. [online] Available at: https://www.cdc.gov/medicationsafety/program_focus_activities.html [Accessed 2 May 2019].
