Integrating Precision Medicine Into Alternative Payment Models

According to a panel at the 2018 AMA Annual Meeting, the AMA is committed to working toward integrating precision medicine into alternative payment models (APMs). This is part of the AMA’s effort to move to a health care system that is rooted in value-based care. 

A report from the AMA Council of Medical Service recently touted precision medicine, which is a tailored approach to health care that accounts for individual variability in the genes, environment, and lifestyle of each person. According to the report, there was the “potential to revolutionize diagnosis and treatment of disease and, in doing so, improve health outcomes downstream.” However, according to the AMA, implementation of an individualized approach to APMs, which emphasizes cost efficiency, may be hindered by front-end price tags of certain precision medicine techniques. 

In an effort to address cost challenges that may develop during integration, the AMA House of Delegates announced they have adopted a new policy. The new policy identifies multiple features that are needed to address the cost challenges.

The new policy will affirm clinical pathways are developed by clinical experts and are leveraged by or integrated into electronic health records for decision support and automation of communication with payers for authorization. The new policy will also encourage alternative payment models to incorporate evidence-based clinical pathways recommended by national medical specialty societies. Further, the policy will support transparent and accessible rapid-learning systems with the ability to extract clinically meaningful information and use it to modify clinical practice guidelines, as well as support assessments within new payment and delivery models of the value of evidence-based precision medicine tests and therapeutics to patients, families, and the health care system.

Finally, the new policy will encourage APMs to integrate precision medicine approaches where they are appropriate in order to improve the diagnostic process and personalize patient care. By encouraging APMs to measure patient outcomes and quality improvements, the use of precision medicine tests and therapeutics that have clinical value will increase over time.—Julie Gould