Healthcare…

Healthcare…Sick Care
Key Clinical and Market Trends
Evolving Care Delivery
Willis Healthcare Practice 12th Annual Forum
July 15th, 2008
Presented by Dr. Brian Silverstein
Senior Vice President
The Camden Group
30 South Wacker Drive, Suite 3900
Chicago, Illinois 60606
(312) 775-1700
Agenda
Healthcare….Sick Care
Market Changes
Clinical Changes
Smart Plays
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Copyright © 2008 by The Camden Group. All rights reserved.
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Diseases Follow Predictable Cycles
Copyright © 2008 by The Camden Group. All rights reserved.
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6000+ Diseases To Go…And We Are Adding New
Ones Every Day
Abdominal aortic aneurysm Abdominal Hernia Abruptio Placentae Abscess Acanthamoeba Acanthosis nigricans Accidental death Accidental Eye Injury Accidental injury Achalasia Achondroplasia Acidosis Acne Acoustic Neurinoma Acquired Cystic Kidney Disease Acromegaly Actinic keratosis Actinymycosis Acute Appendicitis Acute bacterial prostatitis Acute Bronchitis Acute Disseminated Encephalomyelitis Acute infections Acute kidney failure Acute lower respiratory conditions
Acute lymphocytic leukemia Acute myeloid leukemia Acute Nonulcer dyspepsia Acute Pancreatitis Acute rheumatic fever Acute stress disorder Acute urinary conditions Acute urinary retention Addiction Addison's Disease Addisonian crisis Adenitis Adenoid disorders Adenoiditis Adenoma Adenomyosis Adenoviruses Adhesions Adjustment Disorder Adolescent conditions Adrenal Cancer Adrenal disorders Adrenal insufficiency Adrenoleukodystrophy Adult respiratory distress
syndrome Adult SMA Adult T-cell leukemia/lymphoma Adult-onset ALD Adverse reaction African Sleeping sickness Age-related macular degeneration Agenesis of the corpus callosum Aging Agnosia Agoraphobia Agranulocytosis Aicardi syndrome Akathisia Albinism Alcohol abuse Alcohol Withdrawal Alcoholic liver disease Alcoholism Alexander Syndrome Alkalosis All Disease Categories Allergic bronchopulmonary aspergillosis Allergic Disorders Allergic rhinitis Allergies Alopecia
Alopecia Areata Alpers Syndrome Alternating Hemiplegia Alveolar Hydatid Disease Alzheimer's Disease Amebiasis Amebic dysentery Amenorrhea Amnesia Amnesic shellfish poisoning Amnestic disorder Amphetamines Amputated arm Amputated finger Amputated thumb Amputated toe Amputation Amyloidosis Amyotrophic lateral sclerosis Anal Cancer Anal conditions Anal fissure Anal itching Anaphylaxis Androgen Insensitivity Syndrome Anemia Anencephaly Anesthesia
Complications Aneurysm Angelman syndrome Angina Angioedema Angioma Animal allergies Animal bite Anisometropia Ankle conditions Ankle fracture Ankle injuries Ankle sprain Ankylosing Spondylitis Ankylosis Anorectal disorders Anorexia Anorexia Nervosa Anovulation Anoxia Anthrax Anti-Social Personality Disorder Antiphospholipid syndrome Anuria Anxiety Anxiety attack Anxiety Disorders Aorta conditions Aortic aneurysm Aortic coarctation Aortic valve disease Aphasia
Aplastic anemia Appendix disorders Apraxia Arachnoid Cysts Arachnoiditis Arbovirus Arenaviruses Arm conditions Arm fracture Arm injury Arrhythmias Arsenic poisoning Arteriovenous Malformation Arteritis Artery conditions Arthritis Arthrogryposis Asbestos conditions Asbestos poisoning Asbestosis Ascariasis Ascites Asperger syndrome Aspergillosis Asphyxia Asthma Astigmatism Astrovirus Asymptomatic inflammatory prostatitis Ataxia Ataxia Telangiectasia Atheroma
Atherosclerosis Athlete's foot Atrial Fibrillation Atrial flutter Atrophic rhinitis Atrophic vaginitis Atrophy Attention Deficit Hyperactivity Disorder Auditory Processing Disorder Autism Autoimmune Atherosclerosis Autoimmune Diabetes Insipidus Autoimmune diseases Autoimmune Endometriosis Autoimmune eye diseases Autoimmune Hemolytic Anemia Autoimmune Hemophilia Autoimmune Hepatitis Autoimmune Interstitial Cystitis Autoimmune Lymphoproliferative Syndrome
Autoimmune Myelopathy Autoimmune Myocarditis Autoimmune neuropathies Autoimmune oophoritis Autoimmune orchitis Autoimmune Thrombocytopenia Autoimmune thyroid diseases Autoimmune Urticaria Autoimmune uveitis Autoimmune Vasculitis Automobile accidents injury Autonomic nerve disorders Autonomic neuropathy Autosomal chromosome conditions Autosomal Dominant Genetic Diseases Autosomal dominant polycystic kidney disease Autosomal Genetic
Diseases Autosomal Recessive Genetic Diseases Autosomal Recessive Polycystic Kidney Disease Avascular necrosis Avoidant Personality Disorder Azoospermia B
Babesiosis Baby blues Back conditions Back Impairment Back pain Bacteremia Bacterial digestive infections Bacterial diseases Bacterial meningitis Bacterial vaginosis Balance disorders Balanitis Barber's rash Barbiturate abuse Barmah Forest virus Barotitis Media Barrett's esophagus Bartholin's abscess Bartholin's cyst Basilar artery migraine Batten Disease Baylisascaris Becker Muscular Dystrophy Bedsores Bedwetting Behavioral disorders Behcet's Disease Bell's Palsy
Benign essential blepharospasm Benign Paroxysmal Positional Vertigo Benign Prostate Hyperplasia Benign Tumors Benzodiazepine abuse Beriberi Bile Duct Cancer Bile Duct Conditions Biliary disorder Binge eating disorder Binswanger's Disease Bioterrorism Biotin deficiency Bipolar disorder Birth Injury Birthmark Bizarre medical conditions Black eye Bladder Cancer Bladder conditions Bladder Incontinence (Pregnancy) Bladder papilloma Blastocystis hominis Blastomycosis
Bleeding disorders Blepharitis Blindness Blood conditions Blood vessel conditions Blue baby Blue veins Body Dysmorphic Disorder Boil Bone cancer Bone conditions Bone Marrow Conditions Borderline Personality Disorder Bornholm disease Botulism food poisoning Bovine spongiform encephalopathy Bowel conditions Bowel Obstruction Brachial Plexus Injury Bradycardia Brain abscess Brain cancer Brain compression Brain conditions Brain damage Brain infection Brainerd
diarrhea Breast abscess Breast Cancer Breast conditions Breast Feeding Breast lump Breech pregnancy Brief Psychotic Disorder Broken Collarbone Broken elbow Broken finger Broken foot Broken hand Broken jaw Broken leg Broken neck Broken nose Broken shoulder blade Broken toe Bronchiectasis Bronchiolitis Bronchitis Bronchopulmonary dysplasia Brown-Sequard Syndrome Brucellosis Bubonic plague Buerger's disease Bulimia nervosa Bullous Pemphigoid Bunions
Bunyavirus Burns Bursitis C
Caesarian Section Calcification Calcinosis Calcium deficiency Callus Campylobacter food poisoning Canavan disease Cancer Cancer of Unknown Primary Site Candidiasis Canker sores Cannabis dependence Carbon monoxide poisoning Carbuncle Carcinoid Carcinoid of Gastrointestinal Tract Carcinoid syndrome Cardiac arrest Cardiomyopathy Cardiovascular diseases Carotenemia Carpal Tunnel Syndrome Carrier conditions Cartilage disorders Cat bite Cat scratch disease
Catalepsy Cataplexy Cataracts Catarrh Catatonia Catheter infection Cauliflower ear Celiac Disease Cellulitis Central line infection Central Pain Syndrome Cephalic disorders Cephalic tetanus Cercarial dermatitis Cerebral Aneurysm Cerebral Arteriosclerosis Cerebral Atrophy Cerebral hemorrhage Cerebral Palsy Cerebrovascular Conditions Cervical Cancer Cervical polyps Cervicitis Cervix conditions Chagas disease Chalazion Chancroid Charcot-Marie-Tooth Disorder ChediakHigashi Syndrome Cheilitis Chemical addiction Chemical pneumonia Chest conditions Chest pain Chiari Malformation Chickenpox Chilblain Childbirth Childhood conditions Childhood disintegrative disorder Childhood nephrotic syndrome Chlamydia Chlamydia pneumoniae Chloasma Cholangitis Cholecystitis Cholera Cholesteatoma Chondromalacia Chondrosarcoma Chorea Choriocarcinoma Choroiditis Chromomycosis Chromosome conditions Chromosome deletion syndromes
Chronic appendicitis Chronic bacterial prostatitis Chronic Bronchitis Chronic digestive diseases Chronic Fatigue Syndrome Chronic Granulomatous Disease Chronic headache Chronic Hepatitis B Chronic Hepatitis C Chronic Illness Chronic infections Chronic Inflammatory Demyelinating Polyneuropathy Chronic kidney failure Chronic liver disease Chronic lower respiratory diseases Chronic lymphocytic leukemia Chronic myeloid leukemia Chronic nonbacterial prostatitis Chronic
Nonulcer dyspepsia Chronic Obstructive Pulmonary Disease Chronic pain Chronic Pancreatitis Chronic Sinusitis Chronic tonsilitis Chronic wasting disease (CWD) of mule deer and elk Ciguatera poisoning Circulatory disorder Cirrhosis of the liver Classic childhood ALD Classic Distal Renal Tubular Acidosis Classic galactosemia Classic migraine Claustrophobia Cleft palate Closed-angle glaucoma Clostridium perfringens food poisoning Clotting disorders Clubfoot Cluster headache
Cocaine Coccidioidomycosis Coccyx injury Coffin-Lowry syndrome Cold sores Colic Colitis Collapsed lung Colon conditions Colonic volvulus Color blindness Colorectal cancer Colorectal Polyps Coma Common cold Common Conditions Common Headache Common migraine Common Variable Immunodeficiency Communication disorders Concussion Conduct Disorder Congenital adrenal hyperplasia Congenital conditions Congenital heart defects Congenital hip dislocation
Congenital hypothyroidism Congenital malformations Congenital SMA with arthrogryposis Congenital syphilis Congenital Toxoplasmosis Congestive Heart Failure Conjunctival disorders Conjunctivitis Connective tissue disorders Constipation Contact dermatitis Contagious Diseases Conversion Disorder Convulsions Cor pulmonale Cornea disorders Corneal abrasion Corneal Dystrophies Corneal flash burns Corneal ulcer Corns Coronary heart disease Corticobasal Degeneration
Cough Cradle Cap Cramp Cranial neuralgia Craniosynostosis CREST syndrome Creutzfeldt-Jakob Disease Cri-du-chat syndrome Criminal injury Crohn's disease Croup Crush injury Cryptococcal Meningitis Cryptococcosis Cryptorchidism Cryptosporiosis Cushing's syndrome Cutaneous Anthrax Cutaneous diphtheria Cutaneous mastocytosis Cyclic vomiting syndrome Cyclosporiasis Cyclothymic disorder Cyst Cystic Fibrosis Cysticercosis Cystitis Cystocele Cytomegalic Inclusion
Body Disease Cytomegalovirus D
Dacryocystitis Dandruff Dandy-Walker Syndrome Deafness Death Decompression sickness Deep vein thrombosis Defibrination syndrome Dehydration Delayed Viral Syndromes Delirium Delirium tremens Delusional disorder Dementia Dementia With Lewy Bodies Demyelinating disorder Dengue fever Dengue hemorrhagic fever Dental abscess Dental caries Dental conditions Dentatorubral Pallidoluysian Atrophy Dependent Personality Disorder Depersonalization disorder
Depression Depressive disorders Depressive episode Dermatitis Dermatitis herpetiformis Dermatomyositis Dermoid cyst Deuteranopia Deviated Septum Diabetes Diabetes Insipidus Diabetic Diarrhea Diabetic Eye Disease Diabetic Gastroparesis Diabetic hypoglycemia Diabetic Ketoacidosis Diabetic Lens Osmosis Diabetic Nephropathy Diabetic neuropathy Diabetic Peripheral Neuropathy Diabetic Retinopathy Dialysis-related amyloidosis Diaper rash Diarrhea Diarrheagenic
Escherichia coli Dichromasy Dientamoeba fragilis Diethylstilbestrol Difficult to diagnose conditions DiGeorge's syndrome Digestive Diseases Digestive system cancer Dilated cardiomyopathy Diphtheria Diphyllobothriasis Diplopia Dipylidium Disability Disc Disorders Discoid lupus erythematosus Diseases contagious contagious mother-to-fetus Diseases contagious during childbirth Diseases contagious from anal sex Diseases contagious from animals Diseases contagious from
bedding Diseases contagious from birds Diseases contagious from blood Diseases contagious from blood transfusion Diseases contagious from breast milk Diseases contagious from cats Diseases contagious from clothing Diseases contagious from contaminated water Diseases contagious from dogs Diseases contagious from droplets Diseases contagious from food Diseases contagious from intravenous needles Diseases contagious from kissing Diseases contagious from oral
sex Diseases contagious from pigs Diseases contagious from rodents Diseases contagious from safe sex Diseases contagious from saliva Diseases contagious from sex Diseases contagious from surfaces Diseases contagious from towels Diseases contagious from vaginal sex Dislocated elbow Dislocated jaw Dislocation Disordered Eating Dissociative Amnesia Dissociative Disorders Dissociative Identity Disorder Diverticular Disease Dog bite Dominant Genetic Diseases Double
Dominant Genetic Diseases Down Syndrome Dracunculiasis Drowning Drug abuse Drug Allergies Drug-resistant infectious agents Drug-resistant Streptococcus Pneumoniae Disease Dry Eye Dry skin Dry socket Duchenne Muscular Dystrophy Duodenal conditions Duodenal ulcer Duodenitis Dupuytren's contracture Dust mite allergies Dwarfism Dysautonomia Dysentery Dysfunctional Uterine Bleeding Dysgraphia Dyslexia Dysmenorrhea Dyspareunia Dysthymia Dystonias E
E-coli food poisoning Ear conditions Ear foreign body Ear infection (infant) Ear Infections Ear wax Earache Earlobe conditions East African Trypanosomiasis Eastern equine encephalitis Eating Disorder not Otherwise Specified (ENDOS) Eating disorders Ebola Eclampsia Ecstasy Ectopic pregnancy Ectropion Eczema Edema Edentulism Edwards Syndrome Ehlers-Danlos syndrome Ehrlichiosis Elbow conditions Elbow injury Elderly conditions Electrical burns Elephantiasis
Embolism Emotional disorders Emphysema Empty Sella Syndrome Encephalitis Encephalitis, California serogroup viral Encephaloceles Encopresis End-stage renal disease Endocarditis Endocrine disorders Endocrine pancreatic cancer Endocrine system cancer Endometrial Cancer Endometrial conditions Endometrial hyperplasia Endometriosis Endometritis Enlarged prostate Entamoeba histolytica Enteritis Enterocolitis Enterohemorrhagic Escherichia Coli Infection
Enterotoxigenic Escherichia coli Enteroviruses Entropion Eosinophilic fasciitis Epicondylitis Epidermolysis bullosa Epididymitis Epiglotitis Epiglottis diseases Epilepsy Epispadias Epstein-Barr virus Erb's Palsy Erysipelas Erysipeloid Erythema Erythema multiforme Erythema nodosum Erythrasma Erythroderma Erythromelalgia Escherichia coli O157:H7 Esophageal atresia Esophageal diverticulum Esophageal stricture Esophageal varices Esophagitis Esophagus Cancer Esophagus
diseases Eustachian tube disorders Ewing's sarcoma Exercise Exertional headaches Exfoliative dermatitis Exophthalmos Extra Nipples Extradural hematoma Eye cancer Eye conditions Eye foreign body Eye neuropathy Eyebrow conditions Eyelid disorders F
Fabry's Disease Face fracture Facial fracture Factitious syndromes Fahr's Syndrome Failure To Thrive Fallopian tube conditions Falls False labor Familial emphysema Familial polyposis Fanconi's syndrome Fasciculations Fascioliasis Fatal familial insomnia Favism Febrile Seizures Fecal impaction Fecal incontinence Feline spongiform encephalopathy Female carrier ALD Female conditions Female genital disorders Female infertility Female sexual conditions Female-only
conditions Feminisation Fetal alcohol syndrome Fetishism Fever Fibroadenoma Fibrocystic breasts Fibroma Fibromyalgia Fibrosarcoma Fibrosis Filovirus Finger clubbing Finger conditions Fire Firearm Injury Fissures Fistula Flat feet Flatulence Flavivirus Flea-borne diseases Flu Fluke infections Fluorosis Folate deficiency Folliculitis Food allergies Food intolerances Food poisoning Foot conditions Foot fracture Foot injury Foot ulcer Forearm injury Foreskin conditions Fractured
femur Fractured Lower Leg Fractures Fragile-X Syndrome Friedreich's ataxia Frigidity Frostbite Frozen Shoulder Fructosuria Fuchs' Dystrophy Fungal infections Fungal meningitis Fungal nail infections G
Galactorrhea Galactosemia Gall Bladder Cancer Gall bladder conditions Gallstones Gambling addiction Ganglion cyst Gangrene Gas Gastric erosion Gastrinoma Gastritis Gastroenteritis Gastroesophageal Reflux Disease Gastrointestinal Anthrax Gastrointestinal Basidiobolomycosis Gastrointestinal bleeding Gastroparesis Gaucher Disease Gender Identity Disorder Generalized anxiety disorder Genetic Disease Genital herpes Genital system cancer Genital warts Germinal
mosaicism Gerstmann's Syndrome Gestational diabetes Gestational hypertension Giardia Gigantism Gingivitis Gingivostomatitis Glanders Glaucoma Glomerular Disease Glomerulonephritis Glossitis Glucagonoma Glucose-6-phosphate deficiency Glue ear Goiter Golfer's elbow Gonorrhea Goodpasture syndrome Gout Graft-versus-host disease Grand mal seizures Granuloma Granuloma annulare Granuloma inguinale Granulomatous amebic encephalitis Graves Disease Grief or
loss Group A Streptococcal Infections Group B Streptococcal Infections Growth plate injuries GSS (Gerstmann Sträussler Syndrome) Guillain-Barre Syndrome Gulf War syndrome Gum cancer Gum disease Gum disorders Gynaecological conditions Gynecomastia H
Hair conditions Halitosis Hallervorden-Spatz disease Hallucination Hammer toe Hand conditions Hand fracture Hand injury Hand neuropathy Hand, Foot, & Mouth Disease Hangover Hantavirus Hashimoto's Thyroiditis Hay fever Head Cancer Head Conditions Head injury Head lice Headache Headache-free migraine Hearing Impairment Heart attack Heart block Heart cancer Heart conditions Heart disease Heart failure Heart injury Heart Murmur Heart valve diseases Heartburn
Heat cramps Heat exhaustion Heat rash Heatstroke Heavy metal poisoning Heel spur Helicobacter pylori bacteria Helminth infections Hemangioblastoma Hematuria Hemianopia Hemifacial Spasm Hemochromatosis Hemolytic disease of the newborn Hemolytic uremic syndrome Hemophilia Hemophilus influenzae B Hemorrhage Hemorrhoids Hemothorax Hendra Virus Hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Hepatitis X Hepatoma Hereditary Spastic
Paraplegia Heritable Disorders of Connective Tissue Hernia Herniated disc Heroin dependence Herpes Herpes gestationis Herpes stomatitis Herpes zoster oticus Herpesvirus Hiatal hernia Hiccups High altitude cerebral edema High altitude pulmonary edema High Cholesterol Hip conditions Hip fracture Hip injury Hip Replacement Hirschsprung's disease Hirsutism Histoplasmosis Histrionic Personality Disorder HIV/AIDS Hives Hoarseness Hodgkin's Disease Holoprosencephaly
Homicide Hookworm Horner's syndrome Hot flashes HTLV HTLV-1 Human adjuvant disease Human bite Human Papillomavirus Huntington's Disease Hydatidiform mole Hydranencephaly Hydrocele Hydrocephalus Hydronephrosis Hyper-IgE Syndrome Hyper-IgM Syndrome Hypercalcemia Hyperemesis Gravidarum Hyperglycemia Hyperglycemic Hyperosmolar Nonketotic Syndrome Hyperinsulinemia Hyperkalemia Hyperkalemic periodic paralysis Hyperkalemic Renal Tubular
Acidosis Hyperopia Hyperparathyroidism Hyperpituitarism Hyperplasia Hyperprolactinemia Hypersomnia Hypertension Hypertensive heart disease Hyperthyroidism Hypertrichosis Hypertrophic cardiomyopathy Hyperventilation Hyphema Hypocalcemia Hypochondriasis Hypoglycemia Hypoglycemic attack Hypogonadism Hypokalemia Hypokalemic periodic paralysis Hypoparathyroidism Hypopituitarism Hypospadias Hypotension Hypothermia Hypothyroidism Hysterectomy Hysteria I
Iatrogenic conditions Iatrogenic pneumothorax Ichthyosis Idiopathic Pulmonary Fibrosis IgA nephropathy Ileitis Iliotibial Band Syndrome Immune deficiency conditions Immune disorders Immune Thrombocytopenic Purpura Immunoproliferative diseases Impacted tooth Impaired glucose tolerance Imperforate hymen Impetigo Impingement syndrome Impotence Imprinted chromosome conditions Impulse Control Disorders Inclusion Body Myositis Incontinence Incontinentia Pigmenti
Indigestion Infant botulism food poisoning Infant conditions Infant Cytomegalic virus Infant Death Infantile colic Infantile Refsum Disease Infantile Spasms Infectious arthritis Infectious Diarrhea Infertility Inflammatory bowel disease Ingrown nails Inguinal hernia Injury Insect parasite conditions Insect sting allergies Insect-borne diseases Insomnia Insulin Resistance Insulinoma Intellectual handicap Intercostal neuralgia Intermittent Claudication Intermittent Explosive Disorder
Intersex conditions Interstitial cystitis Interstitial lung disease Intertrigo Intestinal Conditions Intestinal obstruction Intestinal pseudo-obstruction Intrauterine Growth Retardation Intussusception Invasive candidiasis Invasive group A Streptococcal disease Iodine deficiency Iridocorneal Endothelial Syndrome Iron deficiency Iron deficiency anemia Iron poisoning Irritable bowel syndrome Ischemic heart disease IV infection J
Jacobs syndrome Japanese encephalitis Jaundice Jaw conditions Jet lag Joubert Syndrome Juvenile Rheumatoid Arthritis K
Kaposi's Sarcoma Kawasaki disease Kearns-Sayre Syndrome Keratitis Keratoconus Keratosis Kidney Cancer Kidney conditions Kidney Dialysis Kidney disease Kidney failure Kidney stones Kidney transplant Kleptomania Klinefelter syndrome Klippel Feil Syndrome Knee conditions Knee injury Knee sprain Knee tendinitis Knock knees Korsakoff's psychosis Krabbé Disease Kuru Kwashiorkor Kyphosis L
Labrynthitis Lactic Acidosis Lactose Intolerance Landau-Kleffner Syndrome Laryngitis Larynx Cancer Larynx conditions Lassa fever Latent infections Latent tuberculosis Latex allergies Lattice dystrophy Lead poisoning Learning disabilities Leber's hereditary optic atrophy Left heart failure Leg conditions Leg injury Legg-Calve-Perthes disease Legionnaires' disease Leishmaniasis Lens disorders Leprosy Leptospirosis Lesch-Nyhan syndrome Leukemia Leukocyte Adhesion Defect
Leukodystrophy Lice Lichen planus Lichen sclerosis Lip cancer Lipoma Listeriosis Liver abscess Liver cancer Liver conditions Liver failure Lordosis Louse-borne diseases Lumbago Lung abscess Lung cancer Lung conditions Lupus Lupus nephritis Lyme disease Lymphadenitis Lymphangioleiomyomatosis Lymphangiomas Lymphatic Filariasis Lymphedema Lymphocytic Choriomeningitis Lymphogranuloma venereum Lymphoma Lyssavirus M
Machado-Joseph Disease Machinery accidents Macular hole Magnesium deficiency Major depressive episode Malabsorption Malaria Male conditions Male genital conditions Male infertility Male sexual conditions Male-only conditions Malingering Mallory-Weiss syndrome Malnutrition-related diabetes mellitus Malpresentation Mania Map-dot-fingerprint dystrophy. Marasmus Marburg virus Marfan syndrome Marijuana Marine toxins Masculinisation Mastalgia Mastitis Mastocytosis
Mastoiditis Masturbation Maternal death McCune-Albright Syndrome Measles Medical misadventure Medication errors Megacolon Megalencephaly Melanoma MELAS Melioidosis Melkersson-Rosenthal Syndrome Menarche Meninges cancer Meningioma Meningitis Meningococcal disease Meniscus injury Menkes Disease Menopause Menorrhagia Menstrual conditions Menstruation Mental illness Mental Retardation Meralgia parenthetica Meralgia paresthetica Mercury poisoning
Mesenteric Adenitis Mesothelioma Metabolic disorders Metabolic Syndrome Metachromatic Leukodystrophy Metastatic cancer Methaemoglobinaemia Methahemoglobinemia Microbes Microcephaly Middle ear infection Migraine Miller Fisher Syndrome Mineral deficiency Miscarriage Mite conditions Mitochondrial diseases Mitral regurgitation Mitral stenosis Mitral valve disease Mitral-valve prolapse Mittelschmerz Mixed connective tissue disease Mobius syndrome MODY diabetes
Mold allergies Moles Molluscum contagiosum Monomelic Amyotrophy Mononucleosis Monosodium glutamate (MSG) adverse reaction Mood disorders Morning sickness Mosquito bite Mosquito-borne diseases Motion sickness Motor neuron diseases Mountain sickness Mouth cancer Mouth conditions Mouth ulcers Moyamoya Disease Mucopolysaccharidoses Mucopolysaccharidosis I Mucopolysaccharidosis II Mucopolysaccharidosis III Mucopolysaccharidosis IV
Mucopolysaccharidosis VI Mucopolysaccharidosis VII Multi-Infarct Dementia Multifocal motor neuropathy Multiple endocrine neoplasia Multiple endocrine neoplasia type 1 Multiple endocrine neoplasia type 2 Multiple endocrine neoplasia type 3 Multiple Myeloma Multiple Sclerosis Mumps Murray Valley encephalitis Muscle conditions Muscle contraction headache Muscle pain Muscular Dystrophy Myasthenia Gravis Mycetoma Mycobacterial infections Mycobacterium avium
Complex Mycoplasma pneumoniae Mycosis fungoides Myelitis Myelodysplastic syndromes Myeloma Myiasis Myocarditis Myoclonus Myoclonus epilepsy Myofascial pain syndromes Myopathy Myopia Myotonic Dystrophy Myxedema Ménière's disease Ménétrier's disease N
Naegleria Nail avulsion Nail conditions Narcissistic Personality Disorder Narcolepsy Nasal polyp Natural accidents Neck Cancer Neck conditions Neck injury Necrotizing fasciitis Neonatal ALD Neonatal Jaundice Neonatal lupus Neonatal myasthenia Neonatal ophthalmitis Neonatal Respiratory Distress Syndrome Neonatal tetanus Nephritis Nephrocalcinosis Nephropathy Nephrotic syndrome Nerve cancer Nerve conditions Nervous breakdown Nervous system disorders Neural tube
defect Neuralgia Neuritis Neuroblastoma Neurocysticercosis Neurodermatitis Neurofibromatosis Neurofibromatosis-1 Neurofibromatosis-2 Neurogenic bladder Neuroleptic Malignant Syndrome Neuroma Neuronal Migration Disorders Neuropathic pain Neuropathy Neurosis Neurotoxic shellfish poisoning Neutropenia Nevus Niacin overdose Nicotine addiction Niemann-Pick disease Night blindness Nightmares Nipple conditions Nocardiosis Nocturia Noise-Induced Hearing Loss NonContagious Diseases Non-genetic diseases Non-Hodgkin's Lymphoma Non-Specific Urethritis Nonaffective Psychosis Nonulcer dyspepsia Normal Baby Behavior Normal Baby Development Norwalk-like viruses Nose conditions Nose foreign body Nosebleeds Nosocomial infections Nutritional deficiency Nystagmus O
Obesity Obsessive-compulsive disorder Obsessive-compulsive personality disorder Obstetrical conditions Obstipation Obstructive sleep apnea Occipital Neuralgia Occupational Injuries Ocular Herpes Ocular histoplasmosis syndrome Ohtahara Syndrome Oligodendroglioma Oligohydramnios Oligospermia Olivopontocerebellar Atrophy Onychogryphosis Oophoritis Open Wound Open-angle glaucoma Ophthalmitis Opportunistic infections Oppositional Defiant Disorder Opsoclonus
Myoclonus Opththalmoplegia Optic neuritis Oral cancer Oral thrush Orchitis Orf Orthopedic disorders Orthostatic hypotension Osgood-Schlatter Disease Osler's disease Osteoarthritis Osteochondritis Dissecans Osteochondroma Osteochondroses Osteogenesis imperfecta Osteoid Osteoma Osteoma Osteomalacia Osteomyelitis Osteoporosis Osteosarcoma Otitis Otitis externa Otosclerosis Ovarian Cancer Ovarian cysts Ovary conditions Over-diagnosed conditions Overweight P
Paediatric conditions Paget's Disease Paget's disease of bone Pain Pain Disorder Palate cancer Palpitations Pancreas conditions Pancreatic cancer Pancreatic Islet Cell Cancer Pancreatitis Panic attack Panic disorder Papilloedema Papilloma Parainfluenza Paralysis Paralytic ileus Paralytic shellfish poisoning Paraneoplastic Autoimmune Syndromes Paranoid Personality Disorder Paraphilias Paraphimosis Paraplegia Parasitic Conditions Parathyroid Cancer Paresthesia
Parkinson's Disease Paronychia Parotid gland cancer Parotitis Parry Romberg Syndrome Patau syndrome Peanut allergies Pediculosis Pelizaeus-Merzbacher Disease Pellagra Pelvic fracture Pelvic Inflammatory Disease Pelvis conditions Pemphigus Pemphigus Foliaceus Pemphigus Vulgaris Penicillin allergy Penile candidiasis Penis Cancer Penis conditions Peptic Ulcer Perforated eardrum Pericarditis Perilymph fistula Perimenopause Perinatal conditions Periodic limb
movements in sleep Periodic Paralyses Periodontitis Peripheral neuropathy Peripheral vascular disease Peritoneum cancer Peritoneum disorders Peritonitis Pernicious anemia Persistent Vegetative State Personality disorders Pervasive developmental disorders Petit mal seizures Peyronie's disease Phaeohyphomycosis Pharyngitis Pharynx cancer Phenylketonuria Pheochromocytoma Phimosis Phobias Photosensitivity Physical conditions Physical inactivity Pick's Disease
Pinched Nerve Pinta Pinworm Pituitary Cancer Pituitary conditions Pityriasis Rosea Pityriasis Versicolor Placenta conditions Placenta previa Plague Pleural cancer Pleural effusion Pleurisy Plica Syndrome Pneumococcal meningitis Pneumococcal pneumonia Pneumococcus Pneumoconiosis Pneumocystis carinii pneumonia Pneumocytosis Pneumonia Pneumonic plague Pneumonitis Pneumothorax POEMS Poisoning Polio Pollen allergy Polyarteritis nodosa Polychondritis
Polycystic kidney disease Polycystic ovary syndrome Polycythemia Polydactyly Polyendocrine deficiency syndrome Polyendocrine deficiency syndrome type 1 Polyendocrine deficiency syndrome type 2 Polygenic diseases Polymyalgia rheumatica Polyneuritis Polyp Pontiac fever Porencephaly Porphyria Portal hypertension Possibly Autoimmune Diseases Post streptococcal glomerulonephritis Post-polio syndrome Post-traumatic stress disorder Posterior vitreous detachment
Postnasal drip Postoperative Abdominal Wound Dehiscence Postoperative Hemorrhage Postoperative hip fracture Postoperative pulmonary embolism Postoperative respiratory failure Postoperative septicemia Postpartum depression Postpartum hemorrhage Postpartum psychosis Prader-Willi syndrome Preeclampsia Pregnancy Pregnancy-associated osteoporosis Pregnancy-related conditions Premature Birth Premature ejaculation Premenstrual syndrome Presbycusis
Presbyopia Priapism Primary amenorrhea Primary amyloidosis Primary biliary cirrhosis Primary Glomerulonephritis Primary Hyperaldosteronism Primary Immune Deficiency Primary insomnia Primary Lateral Sclerosis Primary pulmonary hypertension Primary sclerosing cholangitis Prion diseases Problem Sleepiness Proctalgia Proctitis Progeria Progressive external ophthalmoplegia Progressive Multifocal Leukoencephalopathy Progressive Spinobulbar muscular atrophy
Progressive Supranuclear Palsy Prolactinoma Prolapse Prostate Cancer Prostate conditions Prostatitis Protanopia Proteinuria Protozoan Conditions Proximal Renal Tubular Acidosis Pseudotumor Cerebri Psittacosis Psoriasis Psoriatic Arthritis Psychiatric disorders Psychological disorders Psychosis Psychosomatic illness Psychotic disorders Pterygium Ptomaine food poisoning Ptosis Puberty Pubic lice Puerperal disorders Puerperal fever Pulmonary Anthrax Pulmonary edema
Pulmonary embolism Pulmonary fibrosis Pulmonary heart disease Pulmonary hypertension Pulmonary incompetence Pulmonary valve disease Pulmonary valve stenosis PUPPPS Purpura Purpura simplex Pyelonephritis Pyloric stenosis Pyridoxine deficiency Pyromania Q
Q fever Queensland tick typhus Quinsy R
Rabies Radiation sickness Radon poisoning Ramsay Hunt syndrome Ramsay Hunt Syndrome Type 2 Rapid gastric emptying Rare diseases Rasmussen's Encephalitis Raynaud's phenomenon Reactive arthritis Recessive Genetic Diseases Rectal abscess Rectal cancer Rectal conditions Rectal prolapse Rectocele Red-green color blindness Reflex sympathetic dystrophy syndrome Reflux Refractive Eye Disorders Refsum Disease Reiter’s syndrome Relapsing fever Relapsing
Polychondritis Renal carbuncle Renal colic Renal osteodystrophy Renal tuberculosis Renal Tubular Acidosis Repetitive Motion Disorders Repetitive Strain Injury Respiratory conditions Respiratory diphtheria Respiratory failure Respiratory infections Respiratory syncytial virus Respiratory system cancer Restless Legs Syndrome Restrictive cardiomyopathy Retina Conditions Retinal detachment Retinitis Pigmentosa Retinoblastoma Retinopathy Retinopathy of prematurity
Retroverted uterus Rett's syndrome Reye's Syndrome Rhesus isoimmunisation Rheumatic conditions Rheumatic fever Rheumatic heart disease Rheumatoid arthritis Rhinitis Rhinophyma Rib fracture Riboflavin deficiency Rickets Rickettsia Rift Valley Fever Right heart failure Rocky Mountain spotted fever Rodent ulcer Rodent-borne disease Rosacea Roseola infantum Ross River virus Rotavirus Roundworm Rubella Rubella congenital syndrome Ruptured achilles tendon S
Salivary gland cancer Salmonella enteritidis Salmonella food poisoning Salpingitis Sandfly fever Sandhoff Disease Sarcoidosis Sarcoma SARS Scabies Scarlet fever Scheuermann's disease Schilder's Disease Schistosomiasis Schizencephaly Schizoaffective disorder Schizoid Personality Disorder Schizophrenia Schizotypal Personality Disorder Sciatica SCID Scleritis Sclerodactyly Scleroderma Sclerosis Scoliosis Scombrotoxic fish poisoning Scrub typhus Scurvy Seasonal
Affective Disorder Sebaceous cyst Seborrheic keratosis Secondary Dysmenorrhea Sedative dependence Selective IgA Deficiency Self Harm Senile purpura Senior conditions Separated Rectus Abdominal Muscles Separation anxiety disorder Sepsis Septicemia Septo-Optic Dysplasia Seronegative spondyloarthropathy Serum sickness Sex chromosome conditions Sexual aversion disorder Sexual Conditions Sexual dysfunction Sexual headache Sexual neuropathy Sexually
Transmitted Diseases Shaken Baby Syndrome Shigellosis Shin splints Shingles Shock Short Bowel Syndrome Shoulder arthritis Shoulder bursitis Shoulder conditions Shoulder dislocation Shoulder Fracture Shoulder injury Shoulder separation Shoulder tendinitis Shy-Drager Syndrome Sick sinus syndrome Sickle Cell Anemia Silent conditions Silicosis Simple kidney cysts Sinus cancer Sinus node disease Sinusitis Sjogren's Syndrome Skin allergies Skin Cancer Skin conditions
Skin rash Skull fracture Slap-cheek syndrome Sleep apnea Sleep deprivation Sleep disorders Sleepwalking Slipped epiphysis Small Intestine Cancer Smallpox Smoking Snake bite Snoring Social phobia Soft Tissue Disorders Soft Tissue Sarcoma Somatization Disorder Somatoform Disorders Somatostatinoma Soto's Syndrome Sparganosis Spastic disorders Spasticity Specific phobias Speech impairment Spina bifida Spinal conditions Spinal Cord Disorders Spinal cord injury
Spinal Cord Tumor Spinal curvature Spinal fracture Spinal Muscular Atrophy Spinal Muscular Atrophy type I Spinal Muscular Atrophy type II Spinal Muscular Atrophy type III Spinal stenosis Spinocerebellar Ataxia Spleen conditions Spondylitis Spondylosis Sporadic Genetic Diseases Sporotrichosis Sports Injuries Spotted fevers Sprain Sprue Squint St. Louis encephalitis Staphylococcal infection Staphylococcus aureus food poisoning STARI Steatorrhea Stenosis Stevens-Johnson
Syndrome Sticky eye Stiff-Person Syndrome Stitch Stokes Adams syndrome Stomach cancer Stomach Conditions Stomatitis Stones Strain Strangulation Strep throat Streptococcal Infections Streptococcal Toxic Shock Syndrome Stress Stretch marks Stridor Stroke Strongyloidiasis Sturge-Weber Syndrome Stuttering Stye Subacute combined degeneration of the spinal cord Subacute Sclerosing Panencephalitis Subarachnoid hemorrhage Subconjunctival hemorrhage Subdural
hematoma Subfertility Sudden death Sudden Digestive Conditions Sudden Infant Death Syndrome Suffocation Suicide Sun spots Sunburn Superficial thrombophlebitis Surgical errors/complications Surgical foreign body Sydenham chorea Sympathetic ophthalmitis Syncope Syphilis Syringomyelia Systemic disorders Systemic Juvenile Rheumatoid Arthritis T
Tachycardia Tachypnea Taeniasis Tapeworms Tardive Dyskinesia Tay Sachs Teeth grinding Teething Telangiectasia Teleangiectasia Temporal arteritis Tendinitis Tennis elbow Tenosynovitis Tension headache Teratoma Testicle disorders Testicular Cancer Testicular torsion Tetanus Tetany Tethered Spinal Cord Syndrome Thalassemia Thallium poisoning Thiamine deficiency Thigh conditions Thigh injury Thoracic outlet syndrome Throat cancer Thrombocytopenia
Thromboembolism Thrombosis Thumb sucking Thymus Cancer Thymus disorders Thyroid cancer Thyroid disorders Thyroiditis Tick bite Tick paralysis Tick-borne diseases Tics Tinea Tinnitus TMJ Syndrome Todd's Paralysis Tongue Cancer Tongue Conditions Tonsil cancer Tonsil disorders Tonsilitis Tooth abscess Torn Rotator Cuff Torticollis Tourette Syndrome Toxemia Toxic Shock Syndrome Toxocariasis Toxoplasmosis Tracheitis Trachoma Transfusion Reaction Transient
Ischemic Attack Translocation Chromosome Disorders Transmissible mink encephalopathy (TME) Transplants Transsexualism Transverse myelitis Traumatic Brain Injury Traveler's diarrhea Tremor Trichinosis Trichomoniasis Trichotillomania Tricuspid valve diseases Trigeminal neuralgia Triple-X syndrome Triplet Repeat Genetic Disorders Trisomy 22 Trisomy conditions Trophoblastic Cancer Tropical diseases Tropical Spastic Paraparesis Tuberculosis Tuberous sclerosis Tumor
Turner Syndrome Type 1 diabetes Type 2 diabetes Typhoid fever Typhus U
Ulcer Ulcerative colitis Ulnar nerve injury Umbilical cord infection Under-diagnosed conditions Underweight Undescended Testicle Undifferentiated Somatoform disorder Unexplained Illness Upper Respiratory Infection Uremia Ureter cancer Urethral stricture Urethral syndrome Urethritis Urinary disorders Urinary Incontinence Urinary incontinence in children Urinary stones Urinary system cancer Urinary tract infections Urinary tract infections (child) Urine retention Urticaria Usher
Syndrome Uterine Cancer Uterine fibroids Uterine prolapse Uterus conditions Uveitis V
Vaccine-preventable diseases Vagina cancer Vagina conditions Vaginal candidiasis Vaginal Dryness Vaginal fistula Vaginismus Vaginitis Variant CJD Varicocele Varicose veins Vascular neuropathy Vasculitis Vasomotor rhinitis Vasovagal attack Vein disorders Velocardiofacial syndrome Ventricular fibrillation Vertebral fracture Vertigo Vesicoureteral reflux Vestibular neuronitis Vibrio Vibrio parahaemolyticus Vibrio vulnificus Vincent's disease Viral digestive infections Viral diseases
Viral dysentery Viral gastroenteritis Viral Hemorrhagic Fevers Viral Hepatitis Viral meningitis Vision Impairment Vitamin A deficiency Vitamin A overdose Vitamin B deficiency Vitamin B12 Deficiency Vitamin C deficiency Vitamin D deficiency Vitamin D overdose Vitamin deficiency Vitamin E deficiency Vitamin E overdose Vitamin K deficiency Vitiligo Vitreous detachment Volume depletion Von Hippel-Lindau Disease Von Willebrand disease Vulva cancer Vulvitis W
Wallenberg's Syndrome Warts Waterborne Diseases Wegener's granulomatosis Weight cycling Weil's syndrome Wernicke's encephalopathy Wernicke-Korsakoff syndrome West African Trypanosomiasis West Nile fever Western equine encephalitis Wheezing Whiplash Whipple's Disease Whipworm Whitlow Whooping Cough Williams Syndrome Wilms' tumor Wilson's Disease Wiskott-Aldrich Syndrome Wolf-Parkinson-White syndrome Wolfram's disease Worm conditions Wrist
conditions Wrist fracture Wrist injury X
X Chromosome Disorders X-Linked Agammaglobulinemia X-linked Dominant Genetic Diseases X-linked Genetic Diseases X-linked Recessive Genetic Diseases Xanthoma Y
Y Chromosome Disorders Y-linked Genetic Diseases Yaws Yellow fever Yersiniosis Youth risk behavior Z
Zellweger Syndrome Zinc deficiency Zollinger-Ellison syndrome Zoonotic Diseases Zygomycosis
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 4
Healthcare Today Focuses on Symptomatic
Problems and Management
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 5
Why Don’t We Focus on Prevention?
http://www.aei.org/
http://www.amjmed.com/article/PIIS0002934306011879/abstract
ftp://ftp.hrsa.gov/mchb/genetics/screeningdraftsummary.pdf
Copyright © 2008 by The Camden Group. All rights reserved.
6
5/07/2008 ι 6
What Happens If We Get Good At
Prophylaxis…Perhaps Too Good?
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 7
Agenda
Healthcare….Sick Care
Market Changes
Clinical Changes
Smart Plays
05/07/2008 ι 8
Consumers Take Charge
http://www.healthanddna.com/
http://www.ftc.gov/bcp/edu/pubs/consumer/health/hea02.shtm
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 9
Consumers Need Information
http://ratemds.com/social/
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 10
What Is A Rational Consumer?
http://www.stopbuyingcrap.com/pics/sbc/ionicbreeze.jpg
http://www.quackwatch.org/14Legal/ionicbreeze.html
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 11
Price Is Not The Only Factor
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 12
Segments Exist In Healthcare
Types of Segmentation
The PATH Institute
Clinic
Cynic
Unassigned
Avoider
Naturalist
Generic
Independently
Healthy
Traditionalist
Ready Users
Family
Centered
Loyalist
http://www.pathinstitute.com/
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 13
The Workforce is Changing
Copyright © 2008 by The Camden Group. All rights reserved.
Source: ACPE 12/2006
5/07/2008 ι 14
Physician Strategy Options for Hospitals Fall Along a
Continuum of Integration
Least Integrated
•Physician
Liaison
•Physician
Advisory
Councils
•Medical
Directorships
•Call Coverage
Agreement
•Recruitment
•Joint
Marketing
Copyright © 2008 by The Camden Group. All rights reserved.
Most Integrated
•Non‐compete •Provider
Agreement
Sponsored
Clinics
•Gainsharing
Agreement
•Real Estate/
MOB
•MSO Services
•Timeshare/
•PHO
Equipment
Leases
•IT Integration
•Clinical
Services
Management
Agreements
•“Under
Arrangement”
•Select
Employment
•Equity Joint
Ventures
•Full
Employment
Integration
•Hospital
Syndication
•Faculty
Practice Plan
5/07/2008 ι 15
Care Delivery Shifted from the Hospital to the
Outpatient Environment
Inpatient and Outpatient Utilization
Per Thousand Persons, 1981-2004
Inpatient
Outpatient
2500
Outpatient Visits
Per 1000
Inpatient Admissions
Per 1000
180
0
0
1981
% of Hospital
Revenue From
Outpatient Care
Year
13%
2004
36%
Source: American Hospital Association Annual Survey data, 1981-2004, for community hospitals
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 16
Care Is Distributed Everywhere
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 17
Health Care is Big Business
Where Is The Money From?
Copyright © 2008 by The Camden Group. All rights reserved.
Where Does The Money Go
To?
5/07/2008 ι 18
We Spend More on Healthcare as a Percent of GDP
and In Absolute Dollars
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5/07/2008 ι 19
More Expensive Does Not Mean Better
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5/07/2008 ι 20
Why Does It Cost More?
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5/07/2008 ι 21
Technology Is Expensive
Sources of Growth in Projected Federal Spending on Medicare and Medicaid
 22 
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 22
Variation Exists - Understand Your Local Market
Source: Jack Wenberg Dartmouth Atlas
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 23
Payment Is Changing
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 24
Agenda
Health Care….Sick Care
Market Changes
Clinical Changes
Smart Plays
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 25
A Example of Diagnostics in the Future
26
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 26
Google Works Pretty Well, But…
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 27
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 28
Molecular Information Facilitates Personalized
Medicine
4 P’s (from NIH)
Predictive
Personalized
Preemptive
Participatory
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 29
Genetics Plays a More Important Role In Most
Diseases
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 30
Genetic Tests Moving From Rare to Common
Diseases
„ MRSA
„ BRCA 1/2
„
„
„
„
„
„
` Geneotyping
Mammoprint
` 70 gene microarray
Oncotype Dx
` 21 gene analysis
TPMT for Leukemia
` Pharmacogenetics
UGT1A1
` Drug toxicity
www.cepheid.com
CYP450 for multiple diseases
` Gene chip
Companion diagnostics test and treatment
` Her2/neu
` EGFR (Iressa)
Copyright © 2008 by The Camden Group. All rights reserved.
CYP Test to
determine drug
metabolism
Rise of Dx/Rx Bundles
“Theranostics”
5/07/2008 ι 31
Drug Efficacy Improved Through Segmentation
„ Tamoxifen
` Metabolized to active metabolite, endoxifen, by CYP2D6
` CYP2D6 PM have poorer clinical outcomes vs. EM
„ Codeine
` Metabolized to active moiety, morphine, by CYP2D6
` CYP2D6 PM experience ineffective analgesia from
codeine
„ Warfarin
` Dose requirements for efficacy differ based on CYP2C9
genotype and VKORC1* polymorphism
*VKORC1: vitamin K
epoxide reductase
complex 1
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 32
Promises from Industry
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 33
Genetic Testing Is Far From Perfect
„ The disease-causing mutation must be known before relatives at-risk can be
tested
` Most genes have 100s of disease-causing mutations
` Genes have benign variants (polymorphisms) which have no effect on
health
` Sometimes it is unclear whether a mutation is disease-causing or benign
„ Drug response is multi-factorial
` Genetic, environmental, behavioral factors
„ Common alleles known to affect enzyme activity and drug response are tested
` Negative/Normal results ONLY mean alleles for which patient was tested
were not found
` Rare clinically relevant mutations could exist
„ Single vs. multiple polymorphism(s)
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 34
Personalized Medicine is More Than Genetic Tests
 35 
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 35
Cancer Care Becomes Personalized Chronic
Management
Disease In Phase III Cancer Vaccine Trials
• Cervical cancer
• Follicular B-cell Non-Hodgkin's Lymphoma
• Kidney Cancer
• Cutaneous Melanoma
• Prostate Cancer
• Multiple Myeloma
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 36
Cardiac Continues to Migrate From Procedures to
Prevention
http://www.cmediscovery.com/IAVP/images/figure3.jpg
Copyright © 2008 by The Camden Group. All rights reserved.
http://www.fda.gov/Cber/genetherapy/celltherapyheart.htm
5/07/2008 ι 37
Sports Medicine Moves to Prevention and
Replacement
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 38
Agenda
Health Care….Sick Care
Market Changes
Clinical Innovation
Smart Plays
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 39
The Arms Race In Medicine Is Real
Health Affairs, 25, no. 5 (2006): w337-w343
doi: 10.1377/hlthaff.25.w337
© 2006 by Project HOPE
Health Affairs, 26, no. 1 (2007): w31-w43
doi: 10.1377/hlthaff.26.1.w31
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 40
This Technology Era Is Almost Over
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 41
Innovate From Problem Oriented Sick Care to
Healthcare
„ Disease and illness change over time
„ Incremental market forces are brining about large changes to our
system
„ We are part of a dynamic environment where our developments
result in the future landscape
„ Diagnostics are going to be critical for the near and long term
"The significant problems we face
cannot be solved by the same level
of thinking that created them."
- Albert Einstein
G:\Chicago Office\Willis\Camden Willis Trends Personalized Medicine 07-15-08
Copyright © 2008 by The Camden Group. All rights reserved.
5/07/2008 ι 42