Intermountain Healthcare: Pursuing Precision Medicine

Headquartered in Salt Lake City, Intermountain Healthcare operates 23 hospitals and hundreds of clinics in Utah and Idaho and provides insurance to approximately 850,000 patients through its insurance arm, SelectHealth. In 2013, Intermountain, known for its commitment to improving health care outcomes and lowering costs by reducing treatment variation, made the surprising decision to invest significant resources in an innovative precision medicine unit, which would provide life-extending, genetically targeted therapies to late-stage cancer patients. Precision medicine was associated with treatment variation and high costs, the latter being of particular concern given that Intermountain often served as both payer and provider for its patients. But Intermountain’s management was convinced by Lincoln Nadauld, MD, PhD, who joined Intermountain’s oncology team in 2013 and spearheaded the creation of Intermountain Precision Genomics (IPG). By 2016, IPG had a cutting-edge genomic sequencing laboratory that provided sequencing services to Intermountain and non-Intermountain physicians, and IPG’s team had conducted research indicating that targeted therapies administered through IPG extended patient lifespans but increased overall costs. Now, in mid-2017, IPG is undergoing a major transition as it prepares to outsource the bulk of its genomic testing volume to Navican Genomics, a for-profit, Intermountain-owned spinoff. As Nadauld contemplates the future of IPG, he must evaluate two exciting opportunities, and students are asked to consider where Nadauld should focus IPG’s resources: should IPG partner with Intermountain’s behavioral health team to conduct joint research on the relationship between genetic markers and antidepressant effectiveness, or should IPG push for the testing of a large biorepository, which will cost $12 million but could lead to the identification of new precision medicine applications? More broadly, students will also need to consider the ways in which IPG complements or conflicts with Intermountain’s mission and culture.