Building an innovative model for personalized healthcare.

S1 P ersonalized healthcare is the tailoring of medical management and patient care to the individual characteristics of each patient. This is achieved by incorporating the genetic and genomic makeup of an individual and his or her family medical history, environment, health-related behaviors, culture, and values into a complete health picture that can be used to customize care. Another level of personalization, often called personalized medicine, involves the selection of drug therapy through the use of tests to determine the genes and gene interactions that can reliably predict an indi-vidual's response to a given therapy. This white paper focuses largely on the use of personalized healthcare as a risk prediction tool.   CURRENT STATUS OF PERSONALIZED HEALTHCARE Practitioners and consumers in today's healthcare setting do not yet fully recognize the potential benefi ts of personalized healthcare (Table 1 1). Further, proposals for reform tend to be reactive rather than proactive. Family history is well validated as a tool to predict risk for disease, but, in some instances, genomic information may enhance risk prediction provided by family history. The trial-and-error approach now used to treat disease is costly, but genomic testing has the potential to save money through more effective use of diagnostic tests, counseling about medical management based on gene test results, and prescribing of medications. The case for personalized healthcare: Seeking value To fully appreciate the need to advance the adoption of personalized healthcare into the delivery of medicine , one must consider the operation of our current healthcare system and its ineffi ciencies in terms of delivery and cost, its imprecision in the selection of therapies, and its inability to optimize outcomes. The framework of the US healthcare system as it is now constructed is expensive, disease-directed (instead of health-and wellness-directed), fragmented, and complex. While gross domestic product (GDP) in the United States has increased by approximately 3% per year, 2 the compounded growth rate of health-care expenditures is 6.1% per year. Healthcare in the aggregate now represents 17.6% of GDP and 27% of spending by the federal government and consumes 28% of the average household's discretionary spending , surpassed only by housing. 3 Personalized healthcare can potentially address the need for value consistent with the healthcare system's prominent share of the US economy. The growth in healthcare spending is certain to be a target of the newly created Joint Select Committee on Defi cit Reduction (created …