[co-author: Vicki Albrecht, Ph.D.]
GUEST POST BY Vicki Albrecht, Ph.D., Senior Vice President and General Manager of ION Solutions
Fueled by technological advances, scientific breakthroughs and significant financial investments, precision medicine (PM) has emerged as a promising approach to disease prevention and treatment. A multi-faceted solution to patient care, PM can improve patient outcomes and increase the effectiveness of the nation’s healthcare system by targeting therapy, predicting disease course and reducing the waste of resources – delivering the right treatment to the right person at the right time. However, the continued growth and success of PM across the healthcare landscape relies, at least in part, on whether physicians are able to integrate the approach into their clinical practices.
The Precision Medicine Initiative, a $215 million national research effort launched in January 2015, aims to eliminate some of the existing barriers to PM and generate sufficient scientific evidence needed to move the concept into clinical practices. Clinicians face challenges in adopting PM, such as reimbursement issues and payment hurdles, but can access tools and resources that enable them to navigate such barriers and successfully implement PM.
Challenges of adoption
The use of next-generation sequencing holds allure for patients and providers. The new tests can produce tremendous amounts of genetic data and, ultimately, enable clinicians to advise patients on their risk of disease, potential response to specific treatments and current state of health. When combined with clinical data, the information can help healthcare providers design a treatment plan that’s tailored to the specific patient.
While extremely valuable, the new wave of tests can be expensive. The steep cost is punctuated by the fact that most insurance companies will cover a portion of the test but not the full price, meaning patients pay higher out-of-pocket costs. In these instances, physicians are presented with a dilemma: Ordering the test may lead to a more precise diagnosis and better course of treatment, but that isn’t guaranteed and the decision creates an additional expense for the patient. That’s compounded by the fact that some test results call for the use of specific medications, which – if they aren’t covered – can add to a patient’s financial stress or, in some cases, preclude access to specific treatments altogether. Even further, some of the mutations identified through these tests do not have approved therapies, though clinicians can help connect patients to appropriate clinical trials.
As new targeted therapies come to the market, oncologists and other specialists are energized by the clinical benefit. Many of the same providers, in both institutional and community settings, are conducting trials on the next generation of targeted therapies.
Oncologists, spurred by the potential to treat a patient’s cancer based on specific genetic abnormalities of the tumor, have been quick to adopt the new therapies where appropriate. Based on their experience, it’s important to leverage oncologists’ insights in order to foresee challenges associated with implementing PM and identify best practices to navigate the evolving landscape and capitalize on the potential of PM.
In our work with oncologists, we found that reimbursement hurdles and logistical challenges serve as main barriers to adopting PM. In the current reimbursement model, physicians are not compensated for the time and resources needed to order, coordinate and analyze the results of the next-generation sequencing test. For example, an oncologist must coordinate with a surgeon to get a biopsy, and then with a pathologist to prepare it to be shipped for examination. Lingering questions and confusion about the reimbursement model serves as a deterrent to adopting PM. In order to mitigate inefficiencies, physicians must integrate the processes required to use PM – from processing and tracking test results to submitting claims and working with payers – into their workflow so it becomes routine rather than a one-off. Furthermore, the turnaround time for these tests needs to improve so providers and patients are not waiting for weeks to make treatment decisions.
The rise of PM reflects the significant advances in science, medicine and technology over the last decade. As the science continues to evolve, it will fuel a pipeline of products that hold promise for patients suffering from chronic diseases. However, the use of PM also means managing and comprehending a complex process. As a result, physicians and payers must gain a comprehensive understanding of the clinical and health economic benefits of diagnostics and pharmaceutical treatments and constantly monitor for any advances. Physicians must be able to interpret genetic tests, including the connection between the genetic mutations, treatment options, and health outcomes, and accurately and empathetically communicate the results and related treatment options to their patients. Their education is essential to the effectiveness of PM.
Solutions to navigate existing barriers
While advances in technology and medicine continue to push PM forward, the industry – from physicians to payers – needs to align on a standardized system of approving and covering diagnostic tests in order to facilitate the widespread adoption of PM. In the meantime, services such as educational initiatives and reimbursement support programs exist to help healthcare providers and patients navigate hurdles and capitalize on the promise of PM.
Companies such as Foundation Medicine offer programs that inform physicians how to leverage test results to help guide treatment decisions. The company offers financial support to improve patient access and launched a program meant to facilitate data exchange and make it easier for oncologists to integrate molecular information with patient outcomes. The programs address the financial barriers of PM and related treatment, creating a more manageable path for both healthcare providers and patients.
AmerisourceBergen leverages its expertise and resources to offer services that help drive improved patient care and increased operational efficiency. AmerisourceBergen offers business consulting services, which help practices identify ways to reduce costs and improve financial performance. Ultimately, the services provide clinicians with the tools and knowledge needed to obtain or increase reimbursement, eliminate payment policies designed to delay or reduce payment, increase patient referrals and reduce administrative burden. Solutions, such as business coaches, can help clinicians reallocate time and resources to managing and overcoming the challenges associated with implementing PM. Meanwhile, IntrinsiQ, a part of AmerisourceBergen, leverages its analytic capabilities to translate complex and disparate healthcare data into actionable business intelligence. By collaborating with diagnostic companies, and aligning longitudinal clinical data with genomic data, IntrinsiQ is able to help providers drive healthcare decisions and improve patient care.
In some cases, when the mutations discovered through these tests do not have approved therapies, companies connect patients to clinical trials. Providers in institutional and community settings are conducting trials on the next generation of targeted therapies. IntrinsiQ and ION Solutions, both a part of AmerisourceBergen, partner with manufacturers to increase access to the clinical trials in order to ensure patients receive the right treatment at the right time. By doing so, the companies improve the patient’s prognosis and accelerate the development pathway.
As the use of PM evolves, clinicians will continue to face barriers when adopting it into their practices. However, the commitment to physician education, coupled with the implementation of a fair compensation model and infusion of programs that improve patient access and affordability, will accelerate the widespread adoption of PM.
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