We hear a lot about the multi-lateral precision medicine community, especially in oncology. Here's an important new 2025 paper on the topic:
Find it here:
https://ascopubs.org/doi/abs/10.1200/PO-24-00822
Here's the abstract:
Purpose
Genomic testing is crucial in cancer risk identification, diagnosis, and treatment. However, health care implementation is challenging, even for tests covered by insurance. US payers are important health care participants and may contribute to addressing implementation challenges. We explored whether and how payers consider their role in genomic test implementation, and the perspectives of nonpayer stakeholders on payers' participation.
Methods
We conducted a group interview with private payers (N = 12) to elucidate views on their role in genomic test implementation, implementation challenges, and potential solutions. Subsequently, we conducted individual interviews (N = 10) with nonpayer stakeholders—five cancer advocacy groups and five medical societies working in cancer, examining their reactions to payer input and capturing additional ideas. Qualitative research methods were used to frame the study and analyze results.
Results
Payers considered cancer genomics implementation important and expressed willingness and ability to be involved. They articulated specific challenges relevant to them, including underutilization of covered tests in clinical practice, inequitable test use, and inconsistencies across guidelines, and suggested specific solutions to collaborate on with other stakeholders. Stakeholders viewed payers' participation in implementation as appropriate and feasible, expressed willingness to work with payers where relevant, and concurred with the key challenges noted by payers. Stakeholders' agreement with payers' solutions varied, but they offered additional ideas for addressing challenges.
Conclusion
Both payers and other stakeholders considered payers' role in addressing genomics implementation challenges appropriate and feasible, and offered specific avenues for payer participation. Our findings inform efforts by payers and other stakeholders to address broad health care implementation. They may also help precision oncology professionals, cancer centers, and health systems to frame their own implementation efforts and influence a broader policy and implementation agenda.
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AI Corner
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In Trosman et al., authors believe their findings will "inform efforts by payers" and help "precision oncology professionals." In brief, summarize four ways the findings will inform efforts by payers, and four ways the findings may also assist other stakeholders (other than payers).
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Chat GPT 4o:
How Trosman et al. Inform Payer and Stakeholder Efforts in Cancer Genomics
Informing Efforts by Payers
- Addressing Underutilization – Payers recognize that covered genomic tests are often underused in clinical practice. The study suggests optimizing prior authorization and exploring value-based models to remove barriers.
- Promoting Equity in Test Access – By modeling the impact of policies on disadvantaged populations, payers can refine policies to reduce disparities and improve genomic testing rates among underrepresented groups.
- Improving Alignment with Clinical Guidelines – Payers acknowledge inconsistencies across medical guidelines. Engaging in dialogues with medical societies could improve consistency and streamline coverage decisions.
- Updating Coverage More Efficiently – As genomic testing evolves, payers can accelerate evidence reviews and collaborate with stakeholders to incorporate new data more frequently, ensuring policies remain up to date.
Assisting Other Stakeholders
- Enhancing Physician and Patient Education – Advocacy groups and medical societies can collaborate with payers to develop clinician education programs and patient awareness campaigns about covered genomic tests.
- Strengthening Advocacy for Medicaid and Public Programs – Stakeholders can use payer data to advocate for improved Medicaid coverage and simplify access to germline testing and genetic counseling.
- Facilitating Multistakeholder Engagement – Medical societies can work with payers to clarify clinical guidelines, reducing confusion about test recommendations and ensuring broader adoption.
- Encouraging Institutional-Level Improvements – Hospitals and cancer centers can use payer-provided institutional audit reports on test utilization to refine their own implementation strategies and ensure equitable access.
These insights provide a roadmap for payers, medical societies, cancer centers, and advocacy groups to collaborate and overcome barriers to widespread adoption of cancer genomics.
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Sidebars - Also of Interest
