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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Center for Personalized Medicine Organization Overview • NorthShore University HealthSystem is a comprehensive, fully integrated healthcare delivery system with approximately 2,100 affiliated physicians serving the Chicagoland area • NorthShore is dedicated to preserving and improving human life through superior clinical care, academic excellence and innovative research Background Personalized medicine aims to customize a patient’s prevention and treatment plans based on their unique genetic characteristics, family history, and personal health record. In recent years, tremendous advancements have been made in diagnostics and genomics, allowing organizations to create links between outcomes and the genes associated with those outcomes, using leading-edge sequencing. These advancements have transformed personalized medicine from a clinical research aspiration into a tangible care delivery method. As a result, NorthShore developed the Center for Personalized Medicine to advance the science of precision medicine and offer its patients this individualized and holistic approach to care. The Center and its associated pharmacogenomics clinic, one of only a few in the country, positions NorthShore as a leader in personalized medicine. Program Details The Center for Personalized Medicine supports North- Shore’s mission by conducting innovative research and applying personalized medicine to deliver superior clinical care to patients. Clinical offerings include: • Analyzing patients’ family genetic histories to initiate prevention for chronic diseases • Identifying patient gene mutations that predispose patients to certain cancers, such as breast and colon cancer, through genomic sequencing • Employing pharmacogenomics testing to develop stroke or blood-thinning medication regimens for patients, based on their genetic makeup To support the Center’s clinical efforts, the Center has an expert coordinated care team that includes medical geneticists, genetic counselors, pharmacogenomics specialists, and disease-specific genomic specialists. Research efforts include: • Clinical trials across a wide spectrum of therapy areas, such as: –– Oncology –– Neurological care –– Cardiovascular conditions –– Endocrinology An Initiative of the 85 | Center for Personalized Medicine

NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation • Research collaborations, such as the Genomic Health Initiative and The DoDoNA Project –– Patients learn about how they can participate in the Genomic Health Initiative through the NorthShoreConnect online portal or mobile app Value Delivered • The Center for Personalized Medicine enables NorthShore to: –– Proactively determine patients’ risk levels for various diseases and conditions –– Customize prevention and treatment based on this information • NorthShore is uniquely positioned to apply personalized medicine findings to care delivery –– Unlike larger academic provider systems, North- Shore treats the majority of its patients across the care continuum –– Having data from all patient encounters enables NorthShore to create actionable care plans based on personalized medicine findings • Personalized medicine is likely to impact care for the majority of patients –– Of patients receiving pharmacogenomics testing at NorthShore, 97% of patients had at least one genetic variation that could lead to a possible change in physician prescribing behavior Path Forward Today, genomics is primarily used to determine if a patient has a certain disease or condition. As scientists’ understanding of genomics expands, physicians are increasingly utilizing genomics to tell patients about risks for developing diseases, as well as risks associated with the use of specific drugs. However, the impact of this type of care coordination has not yet been studied in depth, as insurers are not The Value of Personalized Medicine A 13-year-old patient with depression and anxiety had been unsuccessfully treated with 5 medications in an 18 month period, including several selective serotonin reuptake inhibitors (SSRIs). It was clear that the medications were not only ineffective, but also worsening her symptoms. NorthShore employed pharmacogenomics (PGX) testing in order to identify genes that may have negatively impacted the patient’s ability to metabolize drugs. The testing determined that SSRIs, Abilify, and Effexor are likely to cause side effects without benefitting the patient. Instead, serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta should be prescribed. As a result, the patient has now been stable on Cymbalta and Latuda for over 12 months. The results demonstrate that PGX testing can dramatically improve patient quality of life and enable cost-effective care planning. covering all tests for genetic risk factors. While some tests are well-covered, particularly inherited cancer risk panels, other more novel areas such as pharmacogenetics tests are not. To address this issue, NorthShore promotes changes to healthcare payment models that incentivize insurers to assess the long-term value of services. In the coming months, NorthShore aims to implement personalized medicine strategies broadly across the entire health system, fulfilling a vision to provide personalized medicine at the front lines of care—rapidly and systematically. This includes sending patients a genetic screening guide prior to care appointments, and directing patients with family histories of certain diseases to conduct genetic testing prior to their appointments. NorthShore believes that this proactive and personalized approach to medicine has the potential to greatly increase the value of healthcare delivery by improving patient outcomes and reducing overall costs. Center for Personalized Medicine | 86

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