Wednesday, April 19, 2017

Brief Blog: Gene Test Management for Payers and Others: ECRI-GENE

I recently gave a talk in Berlin and talked about US payer reactions over the last four years to what they perceived, fairly or not, as a "Versicherungsblitzkrieg" (Insurance Blitzkrieg) coming from rapidly growing pharmacogenetic and cardiac testing labs.   (Several such labs fell equally rapidly into bankruptcy amidst commerical payer, DOJ, or CMS actions).

Companies developing to help payers manage genomic test policies include BeaconLBS (covered frequently by Dark Report); the former NextGxDx, now Concert Genetics; and eviCore, which developed for other types of benefit management, like imaging.  To my knowledge, BCBS Evidence Street is another major HTA, but focuses on providing the evidence assessments* rather than outsourceable payer claims handling functions.

Add a specialized service at nonprofit HTA firm, ECRI, called ECRIgene.  Website here.  It's not brand new; see a July 2016 press release, here.

Their homepage states:
Think of ECRIgene as your genetic test control center with experts constantly monitoring activities in this rapidly evolving universe. Our  analysts, nurses, clinicians, and medical librarians research, analyze, and synthesize the key features and evidence on each relevant test using the GRADE-based evidence-rating system. These experts are dedicated to researching your custom requests and answering your specific questions. 
We can imagine sales reps from large and small labs lined up to talk to a clinician; and sales reps from Beacon, Concert, eviCore, and ECRIGene lined up to talk to the patient's health plan. (For a few years, I've used a slide that refers to the growing HTA medical-industrial complex.)

It's been reported that at some point in 2017, BCBS Evidence Street and MolDX will use a common portal, here.