Understanding Disparities in Access to Genomic Medicine Proceedings of a Workshop (2018) / Chapter Skim
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4 How Can Providers and Payers Make Genomic Medicine More Accessible?
4 How Can Providers and Payers Make Genomic Medicine More Accessible?
Pages 35-46
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From page 35... ...
• Pharmacogenomics has the power to improve health outcomes for individuals with mental health conditions. However, this patient population may face additional barriers to accessing precision medicine (e.g., cognitive decline, provider bias, dis proportionate insurance coverage)
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From page 36... ...
FINDING WAYS FOR GENOMIC MEDICINE TO REDUCE EXISTING HEALTH CARE DISPARITIES From the perspective of a policy maker and a payer, Tunis said, affordability is a key issue, and he noted that spending on publicly funded health care programs rose in the 2000s, while spending on all other categories of social services fell over the same period. In Massachusetts, for example, public expenditures on health care rose by $5 billion between 2001 and 2011, while social services spending fell by $4 billion.
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From page 37... ...
He added that, in his opinion, population health is where the most emphasis should be placed in terms of engaging payers, health systems, and providers in reducing disparities in access to genomics. The Agency for Healthcare Research and Quality routinely publishes reports on health care quality and disparities related to the major causes of morbidity and mortality in the United States, Tunis noted.
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From page 38... ...
Mental health conditions, which have their own early genetic markers for increased risk, are important not only because of how common they are, but also because they happen to co-occur with virtually every other medical condition. In addition, Ahmedani said, the average time between when someone experiences symptoms of a mental disorder and when that person first gets care is 5 to 8 years, in large part because the very nature of a mental health condition can prevent a person from accessing care.
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From page 39... ...
"If some payers cover precision medicine while others do not," he said, "it will be extra work for providers to determine which patients are eligible, which can lead to no one or very few having access" to the care they need. The stigma surrounding mental health conditions can also contribute to health care disparities between those with the mental health conditions and everyone else, Ahmedani said.
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From page 40... ...
Equity is a quality metric, and the focus of health care systems should be on improving quality by educating providers and patients about the value and utility of genomic medicine, on creating decision support tools for providers, on developing m easurement and feedback processes, and on initiating targeted process improvement projects, she said. MGH has a Disparities Solution Center that leads efforts in this field, and the hospital holds Armstrong, as chief 2 The Health Resources and Services Administration (HRSA)
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From page 41... ...
Securing reimbursement for genomic tests can be extremely challenging, Armstrong said, citing a recent study that demonstrated the complex and rapidly changing landscape of payer rules for selected molecular genetic tests (Lennerz et al., 2016)
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From page 42... ...
. After dividing the workers into five wage groups, with the lowest earning less than $24,000 per year and the highest earning more than $70,000 per year, the researchers found that low-wage workers used about half the amount of preventive care and had twice the hospital admission rate, four times the rate of avoidable admissions, and three times the rate of emergency department visits as the top wage earners.
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From page 43... ...
If providing equity in genomic medicine is the goal, then employers and members of their medical benefits advisory committees should be key partners in the discussion, Malani said. DISCUSSION Implementing Equity Programs at Community Health Centers Fullerton asked Armstrong if, in her opinion, a community health care system such as Denver Health could establish an approach that offers genomic tests routinely and equitably in the same way that MGH has done.
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NOTE: IVF = in vitro fertilization; UM = University of Michigan. SOURCES: Preeti Malani, National Academies of Sciences, Engineering, and M edicine workshop presentation, June 27, 2018.
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From page 45... ...
Alternate Payment Models: Coverage with Evidence Development One approach to paying for new precision medicine technologies involves coverage with evidence development (CED) -- a system where insurers pay for certain technologies and services for which the evidence is not considered adequate, but pay for them in the context of carrying out additional research.
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