Managed Care - November 2008 - (Page 26)

about across the specialties these days. The markers have been used increasingly by clinicians to assess individual patients’ risk for diseases. What isn’t yet clear is whether — perhaps by helping to stratify risk and target subgroups for special interventions — they will soon become a practical tool in the hands of health plans. Biomarkers vary by individuals Scientists say biomarkers are personal: Each person’s body functions in a unique way, and biomarkers reflect this uniqueness. For some people, certain biomarker levels naturally run high. For others, they run low. For some, biomarker levels Obesity, diabetes and heart disease fluctuate widely, while for others they are fairly “Before I was tested I thought there was only consistent. “When we look at a patient’s ‘personal one reason to lose weight — to look better,” a Bioreference range’ — his or her past recorded physical client once told Rodgers. “Now biomarker levels — we’re no longer just comyou’ve given me 10 reasons!” Between 1976 paring results to the population, but also and 2004, the prevalence of obesity among looking at what’s normal for that person,” adults ages 20–74 increased from 15 percent says Rodgers. “That can be powerful personal to 32.9 percent, and there were similar hikes health information. By knowing what’s comin diabetes and the pre-diabetes condition ing, patients and their doctors can make speknown as metabolic syndrome, which are cific treatment and lifestyle decisions aimed harbingers of heart disease. Of course, the at slowing or preventing the onset of disease.” Steven R. Peskin, most effective treatment starts early in the The response from the managed care comdisease process, before complications have MD, MBA munity? Yes, this knowledge is potentially set in. Last year, according to a new American powerful, but its practical application on a popuDiabetes Association study, diabetes-related medlation level has yet to be demonstrated. “I guess ical and economic costs in the United States hit the first question would be, ‘How would this in$174 billion. That’s a 32-percent increase from five formation be used in practice, and is there eviyears earlier. There’s a lot of money at stake, as well dence that its use is tied to better outcomes?’” says as many lives. But not all obese patients develop diEric B. Larson, MD, MPH, director of the Center for abetes, so, without symptoms, how does a physician Health Studies at the Group Health Cooperative in determine whom to treat? The answer, says Seattle. “Most markers,” he notes, “have not yet Rodgers, is biomarkers. been shown to be of value in the management of “Biomarkers can tell who has metabolic synpatients.” For example, says Larson, the biomarker drome and who is on the way to diabetes,” he says. APO E4 appears to be found more often in people Metabolic syndrome is diagnosed when a person with Alzheimer’s disease, but no one argues that it has at least three of five factors: high blood pressure, can provide a definitive diagnosis or make a difhigh fasting glucose, high fasting triglyceride, low ference in decisions about treatment or family HDL cholesterol, or large abdominal girth. As a counseling. person’s body mass index increases, so does the Of course, some biomarkers could potentially risk for metabolic syndrome. stir patients to new vigilance in lifestyle choices, Reviewing the results of more than 400 clients, screenings, perhaps even prophylactic surgery. And Biophysical has noted that as BMI goes up, so does Larson is interested enough in a kindred concept to the percentage of people with risk factors for the be a co-investigator in the Multiplex Initiative, a metabolic syndrome. But the correlation isn’t comstudy at the Henry Ford Hospital in Detroit that is plete — one reason that doctors today run blood exploring how more than 2,000 people who are oftests instead of simply using a tape measure on the fered genetic testing make use of the option, and its waist. Some 58 percent of obese people don’t have results. But the jury is out. Writing this year in the journal Nature, Larson and his co-authors note “the mixed success of current risk communications based on elevated cholesterol, blood pressure and other biomarkers in motivating behavior change” and worry that a headlong, market-driven rush to genetic testing might engender mistaken priorities and false hopes. Still, says Larson, “there’s a lot of interest in moving the findings of genomics [genetic mapping] into what’s useful and what’s not, and that’s a role HMOs can play.” 26 MANAGED CARE / NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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