On the challenges of changing physician behavior:

Changing physician behavior might be the hardest thing in all of medicine. The way we changed it was by institutionalizing it. We added a question into the care pathways that physicians fill out when they see new patients: “Did you order next-gen sequencing on this patient, yes or no?” That transformed the amount of testing that happened. We did a second thing: we implemented a molecular tumor board review of all those next-gen sequencing tests so the physician got some support on, what does this test really mean for me and the patient I’m about to see? And the result is that it really began to change lives. 

Lincoln Nadauld, President and CEO, Culmination Bio, Inc.

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On the importance of facilitating the deployment of new tests:

Some newer diagnostics take as long as 15 years to ramp up to reasonable usage in the clinic.  If you think about the career of a clinician, that might be half of someone's career…. So how you deploy and facilitate the deployment of new diagnostics [is critical]. 

Joakim Weidemanis, Executive Vice President, Danaher Corporation

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On cost versus outcomes in defining successful diagnostics:

At CMS [Centers for Medicare & Medicaid Services], we asked: How do you define a success in a model? We rarely – almost never – define it by outcomes. It’s always defined by a reduction in cost, because we don’t have enough data or the ability to track the outcome as accurately as people would expect... [T]here’s a change in focus. We’re moving from diagnostic errors towards diagnostic excellence, – but we have no way of actually defining “diagnostic excellence” from a quality measure. 

Lee Fleisher, Former Chief Medical Officer, Centers for Medicare and Medicaid Services

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On the need to generate rigorous evidence of value:

My team did some analysis to try to understand the biggest barriers to more widespread adoption of precision medicine. Why hasn’t more happened since the completion of the Human Genome Project 20 years ago?

It comes down to evidence. In the absence of consistent regulatory oversight, we’ve got to self-regulate and be really disciplined and committed to generating the proper evidence - not skipping steps - so we can get to the place where we can tell the value story. 

Jill Hagenkord, Chief Medical Officer, Optum Genomics

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On the role of reimbursement and regulation in driving change:

There’s this meme that medicine and healthcare will be “disrupted...” I’m skeptical.

If you look the history of medicine, its had many technology breakthroughs: sterile surgery, anesthesia, antibiotics, organ transplantation, cath labs, statins, chemotherapies, targeted chemotherapies. None of these breakthroughs disrupted the power structures of the day.

The things that have destabilized the power structures of the day are changes in reimbursement and regulation.  

Anthony Philippakis, Institute Scientist at Broad Institute of MIT and Harvard, General Partner at Google Ventures

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These quotes were edited for length and clarity.