Welcome to the Blog of the Duke Center for Research on Prospective Health Care

The mission of the Duke Center for Research on Prospective Health Care is to support the development and implementation of prospective health care, a personalized, predictive, preventive and participatory approach to care that is based on the integration of three key elements: (1) personalized health planning, (2) coordination of care, and (3) rational reimbursement. On this blog we discuss current issues in prospective health care and personalized medicine, including ongoing research and outreach in the Center, the work of other leaders in the field, and innovations in science and technology that can promote this model of care. We invite you to this important conversation and look forward to your thoughtful comments and ideas.

The views, opinions and positions expressed by the authors and those providing comments on these blogs are theirs alone, and do not necessarily reflect the views, opinions or positions of Duke's Center for Research on Personalized Health Care.

Friday, October 26, 2012

Dr. Ralph Snyderman Wins AAMC David E. Rogers Award

Dr. Ralph Snyderman will be awarded the AAMC’s David E. Rogers Award on Saturday evening, November 3, 2012, in San Francisco.   The winners of this year’s awards were announced by the AAMC yesterday.

The Roger’s Award is based on a collaboration between AAMC and the Robert Wood Johnson Foundation and is given annually to recognize major contributions to improving the health and health care of the American people. 

Nine individuals, one medical school to receive recognition at association’s annual meeting

Washington, D.C., October 25, 2012—The AAMC (Association of American Medical Colleges) will award national recognition to nine individuals and one medical school for their outstanding contributions to academic medicine. The awards will be presented on Saturday, Nov. 3, during the association’s annual meeting in San Francisco. Information: https://www.aamc.org/initiatives/awards/2012awardsrecipients/

2012 David E. Rogers Award


Ralph Snyderman, M.D., Duke University School of Medicine

Recognized as the father of personalized medicine, Ralph Snyderman, M.D., has played a pivotal role in improving the nation’s health over the past 40 years. Chancellor emeritus at Duke University and James B. Duke Professor of Medicine at Duke University School of Medicine, Dr. Snyderman also serves as director of the Duke Center for Research on Prospective Health Care. Through the center, Dr. Snyderman leads the development and implementation of what he terms personalized health care—a rational way to engage patients in their own personalized, predictive, and preventive care. He seeks to transform care from the disease-oriented approach to one that personalizes health. In 2002, the U.S. Centers for Medicare and Medicaid Services partnered with Duke to develop a personalized care model that tracked the health of patients. In 2003, Duke expanded the model and began offering prospective health care to its employees. 
During his 15-year tenure as chancellor for health affairs and dean of the school of medicine, Dr. Snyderman led the development of the Duke University Health System (DUHS) and served as its founding president and CEO. He established an overarching mission for DUHS to design innovative models of health care delivery. “Societal impact was a fundamental goal at Duke, and a commitment was made to become a new kind of academic institution,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland, John Z. and Akiko K. Bowers Distinguished Professor, and dean of the school of medicine. With Dr. Snyderman at the helm, DUHS “emerged as a leading national and international force in creating initiatives that are transforming how health care is delivered,” Dr. Reece adds. 
Dr. Snyderman also led the creation of the Duke Clinical Research Institute (DCRI), the largest academic clinical research institute in the world. “One of Dr. Snyderman’s major accomplishments was the conceptualization and development of the infrastructure to support clinical and translational research,” says Dr. Reece. “The DCRI is capable of conducting any clinical research project, from the smallest pilot to truly global trials.” 
Always committed to research ethics, Dr. Snyderman chaired the AAMC Task Force on Clinical Research from 1998 to 2000, and his 2000 Science article, co-written with Dr. Ed Holmes, advocated establishing guidelines for the protection of human subjects in clinical research. “This document formed a strong foundation for the actual rules implemented by the U.S. Department of Health and Human Services Office for Human Research Protection,” Dr. Reece says. 
The programs Dr. Snyderman initiated to bring personalized health care to Durham, N.C., regardless of the ability to pay, include Promising Practices, Just for Us, and Latino Access to Coordinated Health Care. “These initiatives focus on cardiovascular disease, obesity, and asthma, and are led by members of the Duke and Durham community to substantially reduce the burden of disease in economically deprived areas,” Dr. Reece says. 
Dr. Snyderman was a member of the AAMC Executive Council from 1997 to 2004, serving as chair from 2001 to 2002. He is a former chair and administrative board member of the AAMC Council of Deans.   
Dr. Snyderman earned a B.S. degree from Washington College and an M.D. degree from Downstate Medical Center of the State University of New York.

Thursday, June 28, 2012


The factious debate regarding the constitutionality of the Accountable Care Act (ACA) is over.  The Supreme Court has ruled that the law is constitutional, including the health insurance mandate which was judged to be a tax.
Health care reform will now be elevated to a major political referendum in the upcoming national election.  Virtually all agree that we need a health care system that is accessible, affordable, and effective in providing quality health care.  Whether the best route forward is through the ACA or other legislative-directed approaches is far less certain than the need to change our underlying approach to health care delivery.
We must move from our current reactive, sporadic approach, using expensive technologies to treat late-stage preventable disease-events to a coordinated preventive, personalized model of care.   Personalized health care addresses the specific health needs of individuals at any time in their life and utilizes predictive technologies to evaluate health risks and employs planning to provide the care most likely to be effective.  This approach to care is personalized, predictive, and preventive and involves an engaged and enlightened patient.  A great barrier to innovation in health care has been a reimbursement system that handsomely rewards high cost intervention for late-stage disease and punishes prevention and coordinated care.  Reimbursement models that reward successful outcomes will help unlock innovation.  As a consequence, personalized health care will be embraced by more and more enlightened providers, employers, and insurers.  So, while the heated debate will focus on legislation, the real work of resolving the problem will occur through fixing health care reimbursement and developing and adopting health care approaches that work.  There is a great degree of creativity being deployed to create the most effective models for care.  New technologies are enabling increasing personalization and are putting capabilities in the hands of consumers and lower cost providers.
With a more rational approach to health care, access and affordability will be attainable.  Absent changes in how care is delivered, health care legislation will do little more than drive up costs and add to the burden of an already struggling economy. The solution to affordable quality care is attainable but the solutions will need to occur outside the partisan health arena.

Monday, June 11, 2012


The recent report from the Department of Labor showing that the United States economy added just 69,000 jobs in May was met with surprise and disappointment and has had an immediate effect on the presidential campaign as well as the stock market.

What was lost in this news, however, is that almost half of the job growth came in the health care sector. Thus, health care provides a large underpinning for our economic growth, but is this a good thing? Currently, health care expenditures are quickly increasing beyond what individuals, employers, or the government can afford. Ironically, what is gained by these increases in employment may be offset by the burden of rising health care costs on the overall economy. This raises an important question. Is the expansion within the health care industry a good thing for our economy and nation or is it an emerging bubble that will inevitably burst?

Over the past decade, national health care costs grew from an already large $1.6 trillion per year and 14% of the GDP in 2002 to $2.6 trillion per year and 18% of the GDP currently. This growth has been fueled by increased costs of treating chronic diseases with expensive specialty and hospital care. Such expenses are driven in part by investments in technologies and new facilities which often rival the opulence of five star hotels. According to the Health Care Cost Institute, price increases and costs of hospital admissions grew nearly three times faster than inflation. Despite the drag on the economy from the rising cost of health care, preventable chronic diseases have continued to grow. Consequently, the increased expenditures have not led to an improvement in the health of the nation.

What is frightening is the parallel between the growth in the health care industry and the recent experience in the real estate market. In real estate, the American dream to own a home was seen as laudable. Unfortunately, the financial market could not sustain the growth of the housing market and it ultimately collapsed. In health care, access for all Americans is at least as important a goal and should be achieved, but it must be done in a way that is effective and affordable. The current approach, in my view, is neither effective nor sustainable. Fortunately, there is a solution to this dilemma. Health care expenditures must be focused toward health promotion, prevention, patient engagement, and coordinated care rather than the current emphasis on high cost, sporadic treatment of disease events which are largely preventable. We know how to make the approach to care far more effective and less costly.

Personalized, predictive, and preventive approaches, with intense patient engagement, are already proving to be far more effective than the current reactive treatment of disease events. At the center of effective care should be the individual (who at times is the patient) who is engaged, informed, and involved in their own health. Coupling the engaged individual with a health care system designed to meet personalized medical needs overtime is the model that we should move toward. Health care sector growth within a system that actually improves health and minimizes preventable diseases will be cost effective, sustainable, and a true boost to our economy. Absent this, growth in the health care industry is a mixed blessing.