Abby Burns (00:02):
From Advisory Board, we're bringing you a Radio Advisory. Your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. Advisory Board has been tracking and analyzing innovations in healthcare for decades. Amid all the activity of the last few years, our experts realized that something deeper is actually going on right now. So much so, they actually coined a new term. We are entering the age of bespoke care. To explain what that means, what it looks like, and why it matters, I'm turning to my colleague, Solomon Banjo and Nick Hula. Solomon, Nick, welcome to Radio Advisory.

Solomon Banjo (00:39):
Hi Abby.

Nick Hula (00:40):
Hi there, Abby.

Abby Burns (00:42):
Guys, we are introducing a new term to the market. And I know you feel passionately, this is not something we're doing as an academic exercise, this is not something we're doing for the sake of adding more jargon into healthcare. We're doing it because we believe that's what this evolution that you all have been tracking actually merits. But I don't know that our audience is going to be bought in right off the bat. So our goal for the next 25 minutes or so, is to first unpack what bespoke care actually means.

(01:11):
And second is to convince listeners that bespoke care is something none of them are exempt from and that they need to start adapting to now because this is actually not something that's coming down the pike. This is something that's already happening. Let's back up and maybe bring me back to the moment in your research when you started to realize that something out of the ordinary was happening. When did you notice the landscape of innovation shifting to the point that you needed to take a step back with your team and figure out what was going on?

Nick Hula (01:50):
Good question. And the thing is, in some ways it's hard, right? Innovation is all that the sectors we focus on do. So we're focused on pharma, we're focused on med tech, we're focused on digital health. So innovation is the air they're breathing. And I think that's actually what helped us realize there was connective tissue there. Because we may be talking about digital therapeutics, we may be talking about how to have outcomes-based contracts for cell and gene therapies. And we start to get a sense that, "Wait, a lot of this is starting to rhyme."

(02:20):
Whether we're talking about robots to help with your IBS or talking about those really expensive therapies. And as a group, we sort of agreed, "Okay, let's see if there's something here." And most importantly, if it's something big enough that we need to be telling the industry that it's going to require something different from them.

Abby Burns (02:39):
So you started to kind of see these patterns and you wanted to see, "Okay, is this an ongoing change? Is this a moment of time change?" What are we really dealing with?

Nick Hula (02:49):
Exactly.

Abby Burns (02:51):
What kind of innovations are we talking about? Because my mind automatically jumps to when I look at what's happening in the industry and the sectors that you just mentioned, high-cost drugs, generative AI. Is that kind of the right vein to be thinking in? Does it go beyond that?

Nick Hula (03:05):
I think it includes high-cost drugs, it includes generative AI, but it also includes a lot of other types of innovations as well. Think things like precision diagnostics, think things like very specialized devices, think things like personalized data capabilities, remote patient monitoring. I think all of these things together as a whole are enabling the kind of individualized care that we're starting to see. We're starting to see all these innovations really work in unison together to create this future.

Solomon Banjo (03:37):
And one thing we did was map those innovations to the patient journey, right? To say, "Okay, what's going on when we're diagnosing patients, when we're treating them, when we're managing them?" And what are some of the underlying data capabilities even that is unlocking this as a fundamental shift in our opinion from the model of almost off the rack, treating to that median patient.

(04:01):
And saying that no, at every stage of the patient journey I just mentioned, to Nick's point, we're able to tailor care in a really meaningful way. And so collectively, you have a new care model developing that is honestly something we've been calling for as an industry for over 20 years, and now it's real.

Abby Burns (04:22):
So I have to ask, because Nick, you used the word personalized. Solomon, you used the word individualized. And so where my mind is going, Solomon's laughing, you know exactly where my mind is going, and I'm sure other people are as well. Isn't that personalized medicine? Isn't that precision medicine?

Solomon Banjo (04:39):
How much time do you have on this podcast, Abby? That'd be my first question, but joking aside, I think, I mean Nick can share this as well. We have gone through three different rounds where our goal was to actually not pick a new term if we didn't need one. But I think a long-standing mission value for Advisory Board has been that language matters, words matter, and they come with meaning. So when I say things like precision medicine, you, the listeners are probably thinking of certain kinds of products and probably thinking cancer care.

Abby Burns (05:15):
Yep, I was.

Solomon Banjo (05:16):
And then we also didn't want to say just patient-centered care, because that in many ways can include everything from motivational interviewing, shared decision-making. We don't want to pretend that that has not been going on for decades either. And more importantly, we wanted a term that not only was accurate, but in and of itself describes the future and present challenges related to the thing we were studying.

Nick Hula (05:41):
Right, exactly. And we sat down with groups of researchers here at Advisory Board with thesauruses and dictionaries. We use AI to try to help us out here to try and find that term that already existed. And I understand if people might be skeptical of this idea of bespoke care, and we were too. That's why we went through that exercise of trying to find a term that fit within what we already have today.

(06:08):
But the more and more we kept thinking about it and kept thinking about the elements of bespoke care and what this can enable, the more we came to that realization of maybe this term bespoke that we're all skeptical of is just the right term we have to describe the future state of care delivery.

Abby Burns (06:25):
Nick, be honest, did ChatGPT come up with the phrase bespoke care?

Nick Hula (06:29):
It did not.

Solomon Banjo (06:31):
I can take credit for that.

Nick Hula (06:33):
That's human ingenuity.

Solomon Banjo (06:35):
But when we gave it the elements of what we were seeing, it was like, "Oh, bespoke care." So we invite the audience at the end of this, put in the prompt and see if it doesn't give you the same response. So that's a dangerous [inaudible 00:06:49], I suppose.

Abby Burns (06:50):
I do want to come back to how you actually came up with the term, because it's very specific language. So I want to learn more about that. But first, I think it would be helpful if we can be really specific for listeners as to exactly what we mean when we say bespoke care. How would you define it?

Nick Hula (07:12):
So there are a couple of different elements or characteristics that make up bespoke care. We already talked about personalization. So this is the idea that care is tailored to an individual's unique characteristics. Think determining what drug will work best for an individual patient based on their unique genetics. But it also goes beyond that. It also thinks about how patients are defining value, not just what's right for them in terms of what's going to enable the best outcomes, but what are their preferences?

(07:45):
How are they defining value of care, not just some clinical association. Maybe that means for them not receiving a surgery that's considered the best way to treat a patient, but maybe that would impact the patient's ability to live the way they want to live. So it's definitely personalization, that patient defined value, but it's also expensive. This type of care might be really expensive in the short term with the promise of avoided care in the long term. Good example of that is a $2 million drug today that reduces the cost of care by much more than that over a lifetime.

(08:21):
And finally it's going to be complex. Bespoke care is difficult to deliver. It's going to require clinicians who are highly skilled in a clinical sense, but also in a personal sense, really knowing what's right for their patients and being able to adjust treatment decisions based off of all the factors that we just listed. So bespoke care is personalized. The patient is paying a more active role in decision making. It's probably more expensive in the short term, and it's super complex to deliver.

Abby Burns (08:55):
When you list out those four elements, Nick, I'm starting to understand why you landed on bespoke. But when I hear the word, my mind automatically goes to clothing, as I'm sure most people do. And I know Solomon in particular, you're quite dapper dresser, and it sounds like you had a hand in choosing this, but tell us more. How did you actually come up with the term bespoke care?

Solomon Banjo (09:20):
Yes, it has that connotation, and I think that again, for those who are aware of it, which is not everyone is actually really helpful when you think about what this means for clinicians, patients and the challenges it brings. So a bespoke suit at the end of the day, that means it's made to fit one person, which also means that it's not going to work as well for someone else, which gets to sort of that tailoring, that personalization piece if you will.

(09:46):
Also, in order to do this effectively, both the tailor and the person who's having the suit has to have a conversation and ultimately settle on a suit and fabric that's going to work for that person. That's the clinical decision making or the shared decision making. You also have the element of bespoke suits tend to be more expensive if we're using that example, but they're going to last. There's going to be a level of durability where that upfront cost is worth it.

(10:13):
And yes, that applies to high cost drugs, but it also applies to tools for surgery that actually help preoperative during the surgery and afterwards optimize that patient outcome. So you're not likely to have as many complications potentially. You're going to provide the right level of education so the patient can sustain the gains from the surgery. And so that is where you start to see why we settled on that term beyond sort of its just generic definition of bespoke equals for an individual.

Abby Burns (10:46):
And Solomon, you just talked a little bit about the expense piece of it, the personalization piece of it, and patient defined value. What about the complexity piece?

Solomon Banjo (10:57):
Yes, and I think that's a huge element as well. This is not easy, and even to make it more real, making a bespoke suit takes a lot longer than to make an off the rack blazer in the same way that the kinds of conversations, education that we need to be having with patients is going to be different than the 15-minute visit you or I are typically used to having with the clinician. And so in the same way that that is a feature, as with all of the four of them, we've got to think about what gets in our way of doing this at scale.

(11:30):
Because I don't want people to think that, "Oh, they're talking about individualized care in a way that's going to be boutique or artisanal." We did not use those words. I do think you can standardize and scale bespoke care. It just requires us investing in the infrastructure to deliver it in the same way we've invested in the infrastructure to deliver that off the rack median care that we all are used to receiving.

Abby Burns (11:55):
Yes. And you're going exactly where I wanted to go next, which is the concept of bespoke care feels like a pretty easy sell. I want that. I want that for my family, for my loved ones. But we've all worked in this industry long enough to know that this type of change does not happen easily, especially at scale. So if we decide, for example, that every person in the US should have a bespoke suit, to stick with your analogies, Solomon. Not everybody can afford that. We don't have enough boutique tailors to make all of those bespoke suits.

(12:30):
330 million bespoke suits is a lot. We might not even have the fabric. Not everyone needs one. So I can imagine that there are similar challenges in healthcare where we've spent the past several decades focused on, again to use your language, sort of treating the median patient. My question is the industry prepared for this kind of change? Nick is shaking his head.

Solomon Banjo (12:55):
Is the industry prepared? In niches. But yes, no, not cohesively. And here's what I'd also say. You mentioned the 330 million suits. I think it's actually... Let's stick with the suit analogy, because when we first had off the rack suits, a lot of the criticisms you were giving now of not everyone needs a suit. How are we going to have enough fabric? All of that was the same thing that when literally we're making off the rack suits that came up, but we developed the infrastructure to scale that.

(13:27):
And so I think the point here is we're not prepared now, but we can absolutely develop the infrastructure in clinical education, health literacy, all across from payment to clinical decision-making to make this a reality. And that's why you'll notice we started talking about innovations and now we're talking about care models. Because at the end of the day, this will change how we interact with patients in a way that pretty soon, we'll probably not be using the word bespoke care because it'll just be how care is done. At least that's my hope.

Abby Burns (14:00):
Trying to obsolete your own term.

Solomon Banjo (14:02):
Yes. That's the goal.

Abby Burns (14:05):
Solomon, I love that you brought that up because one of the things that you all were telling me is, "Abby, this is not something that's coming down the pike or that's going to happen in five years from now. This is actually already happening." And that's the reason it's so important to be having this conversation because no one is exempt from the idea of bespoke care.

Nick Hula (14:24):
Exactly. No part of the industry, no player, no organization is going to be exempt from something like this because, like Solomon said, eventually this is just going to become standard care. And we wouldn't think today of anyone being exempt from patient care and it'll impact their patients and their businesses in some way. Just like in the future, no one is going to be exempt from this concept or this new model of care we're envisioning that is more of bespoke.

Solomon Banjo (14:53):
And that's a great point, Nick, because back to why we did this research and why we continued with this research is we think it will require us to act differently. Which means that if you're just operating business as usual, wherever you sit in healthcare and not thinking about what this means for you in terms of even facility planners and beyond the healthcare delivery. You're going to be impacted by that.

Nick Hula (15:17):
And the way you're impacted might look a little bit different depending on where you sit in the industry, but it's going to require everyone to make some change. It's going to require an industry-wide effort to actually break down a lot of the barriers that stand in our way of enabling this idea of bespoke care on a large scale.

Abby Burns (15:37):
So let's get into that a little bit. What would it look like for the industry to start evolving? Or what is it looking like for the industry to be actively evolving to bespoke care?

Solomon Banjo (15:48):
I think in terms of things that we are seeing in the industry is recognizing that there are really a few key areas that we haven't addressed for many years, and that was fine for us to ignore that as we move to this new kind of care paradigm, it's going to be more important. So let's take, for example, payment. Oftentimes the critical thing preventing payment is reimbursement. It normally takes 18 to 24 months for us to get a new CPT code assigned to enable reimbursement. During that time, using current estimates, 3000 new genetic tests will be in the market.

(16:30):
So there's an element to this. That's the velocity of change. And so we've got to be thinking about how do we ingest clinical evidence quicker to drive our care models? How do we think about appropriate use differently so that we are telling patients, "Yes, this thing exists, but actually based on this data, we don't think it is the right fit for you. Let's have a conversation for what matches your goals. And it's not going to lead to more harms relative to the benefits."

Abby Burns (16:59):
Which in that, Solomon, I hear the personalization element. I hear the patient involvement in defining success, and I hear the complexity.

Solomon Banjo (17:07):
Yes, yes. And underpinning all of this is just we're going to need a lot of data to do this well. Data that we currently have in healthcare and data we don't have. I think it's also going to challenge us to think about how we get patients to see the value and trust us with that information to deliver the best care for them.

Nick Hula (17:30):
I think a lot of these issues... Solomon is mentioning patient data. Solomon is mentioning all these payment issues. None of these are new. The industry struggled with these for a long time. These are all long-standing issues that we know exist. We've acknowledged that these elephants are in the room for a very long time.

(17:54):
As innovation is enabling this idea of bespoke care, it's forcing us to have to address the elephants in the room, to overcome the elephants in the room, as opposed to just saying, "Yes, these exist, these are barriers. Now we actually need to start taking action to overcome them."

Solomon Banjo (18:13):
And to your question, we are seeing examples of this. So when it comes to costs, we're seeing manufacturers plan and occasionally providers actually saying, "Okay, let's do the hard work of finding a metric that we feel reflects the impact that should have on patients. And we're going to put some financial risk in the game. If it works as we anticipate it's going to work, then great, you get paid for it. But if the suit doesn't fit, if you allow that analogy, then I'm not going to pay for that."

Abby Burns (18:45):
What does it look like to try and overcome some of these challenges?

Solomon Banjo (18:50):
It looks like a lot of hard work. I mean, you think about these categories of challenges. How do we pay for things that have multi-year value, appropriate use? They've existed for a long time. And the reason we haven't solved them is because it's hard. And so it's going to require us to experiment. It's going to require us to perhaps take on new responsibilities, new roles, to work with each other across the various sectors in new ways to ultimately identify the worthwhile infrastructure, the new muscles we have to develop to, again, bring this to scale.

(19:28):
And so on the one hand, I don't want us to lose sight of the hard work that will be required and also not lose sight of what this means for patients. We are talking about truly transformative care potentially, and I don't use that word lightly.

Abby Burns (20:46):
We're talking about what this change would look like, what it would require to get there? And I actually want to add one question to the mix, which is this a good change that we're seeing?

Solomon Banjo (20:58):
I think unequivocally, from a patient perspective, it's a good thing. We're talking about new technologies to better identify what's going to give you benefit versus harm. We're talking about treatments that can potentially cure things for which patients had no other alternatives. You may remember an article a few years ago from the New York Times about a cancer trial where every single patient went into remission for multiple years because they realized, "Oh, these patients who don't typically respond to this kind of treatment, here's another drug that targets this biomarker.

(21:38):
What would happen if we reused it in this way?" No remission. It was colorectal cancer, I believe, so no surgery. So that means no side effects like incontinence. So again, not only durable, we hope but again, life-changing impacts.

Abby Burns (21:56):
That's a pretty compelling picture that you paint for what this would look like for patients. But if we take it to a more global scale, what is the end stage we're working toward here?

Solomon Banjo (22:08):
It's a great question, and let me counter with hopefully another good question. Abby, what kind of car do you drive?

Abby Burns (22:15):
What kind of car do I drive?

Solomon Banjo (22:16):
Yes.

Abby Burns (22:17):
I drive a Toyota Corolla.

Solomon Banjo (22:20):
Nice. Why didn't you tell me you drive an internal combustion engine vehicle?

Abby Burns (22:26):
On wheels. I guess I assumed that you assumed.

Solomon Banjo (22:30):
Exactly. That's my point in general, in terms of back to the point about this will become ubiquitous. Because if you drove a Tesla, if you drove a Polestar, because we don't have the infrastructure, because people are not fully familiar with it, you might have used that to describe the vehicle. That is what I think the end stage is, a world in which this is just how we define care. And in the same way that many would argue there's a benefit to that transition. I would say unequivocally, there's a benefit to us treating patients as the rich, complex individuals they are.

Abby Burns (23:08):
If that's the end stage, who gets us there?

Nick Hula (23:12):
I mean, it's going to require an industry-wide effort, of course. So it's going to take providers, be that physicians themselves to adopt this new model of care, but also the health systems to enable them to invest in the technologies, to invest in the infrastructure to deliver that care. It's going to require payers. It's going to require them working with providers, working with the life sciences companies in order to develop the payment models that Solomon was mentioning earlier, that are going to pay for this type of care.

(23:46):
It's going to require life sciences. It's going to require them to be developing the technologies to make this care possible. It's also going to require them to generate evidence that is valuable in this new type of care delivery. So it's going to require a broad industry-wide effort to make this possible.

Solomon Banjo (24:02):
And let me pick up on something Nick said there too, that what's valuable to the industry, because that's my question for your listeners. Since this will impact all sorts of care, what can you do to make it easier for the other stakeholders to deliver this tailored, at this point, Abby, personalized, precision, I don't care what we call it. So long as we collectively wrap hands around the fact that this is better for patients and it's worth the hard work we were talking about earlier.

Abby Burns (24:34):
Well, Solomon, Nick, thank you for coming on Radio Advisory.

Solomon Banjo (24:39):
Thanks for having us, Abby.

Nick Hula (24:41):
Thanks for having us, Abby.

Abby Burns (24:45):
I hope over the course of this episode, we successfully unpacked what bespoke care actually means and convinced you that this isn't just about language, it's about how the conventional wisdom of care delivery is changing. And that it's changing now. Solomon and Nick said it. We all have to adopt an innovator's mindset so that we can design, deploy, and finance these solutions in an equitable way and get bespoke care into the hands of patients that need it. And remember, as always, we're here to help.

(25:27):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your network, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by me, Abby Burns, as well as Rae Woods, Kristin Myers and Atticus Raasch.

(25:45):
The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. We'll see you next week.