Patient-Centric Care in Precision Medicine: Overcoming Barriers, Embracing Innovation

The use of comprehensive biomarker testing has been a hot topic for many years, with clinicians welcoming technological advancements such as the ability to identify when targeted therapies will be of clinical benefit. Ultimately, comprehensive biomarker testing will make better-tolerated therapies more accessible to patients and prolong survival. Unfor­tunately, payers have been slow to adopt this technology, citing a variety of reasons. At one time, cost was a major concern, but the cost of comprehensive testing has decreased signifi­cantly with time. Today, the concern seems to lie in the utilization rate, where there is a per­ception that these tests are overutilized and may lead to unapproved, off-label use. Concerns of overutilization have led payers to implement prior authorization requirements, represent­ing an administrative hurdle. Lastly, a social barrier to the use of such testing is present in the high out-of-pocket cost for patients, associated with high deductibles and coinsurances.

Our first featured article looks at the importance of tissue stewardship and best practices to maneuver through a successful comprehensive genomic testing program. The authors point out that widespread adoption of less invasive sampling techniques leaves less diag­nostic tissue for additional or future testing as smaller biopsies are acquired. Their goal is to educate how to overcome challenges with comprehensive genomic testing by providing an overview of current genomic testing methodologies, recommending guidelines on best practices for tissue stewardship, and outlining preanalytic practices for successful testing and efficient turnaround times.

Our second feature addresses the topic of patient-reported outcome measures (PROMs). There have been many discussions on the benefits of using PROM data to improve the quality of care and patient outcomes. But again, payers have been slow to adopt PROM inclusion for several reasons, including the lack of a standardized tool to collect PROM information and the inability to consistently incorporate the data into a patient care setting. An interdisciplinary team at Dartmouth set out to measure the health-related quality of life in hematopoietic stem cell transplant (HSCT) recipients at baseline and through 12 months posttransplant period. They show that PROMs can reliably monitor areas that impact qual­ity of life in HSCT recipients over time, resulting in tailoring interventions to improve symptom management in these patients.

In the first of our recurring columns, Lee Blansett, MBA, presents the second part of HMP Market Access Insights’ study on the impact of pathway programs on treatment selec­tion. Key findings include that pathway programs implemented by providers are not more impactful than payer programs, and that there is little difference in treatment decisions be­tween provider-developed programs and internally developed programs.

Lastly, in our column looking at employer trends and perspectives, F. Randy Vogenberg, PhD, explores the purpose behind managing risk and determining how conflict around care cost management can occur, including through the use of pathways. He points out that the intersection of economic and clinical purposes is likely to clash due to different perspectives, but staying aware of changes in the marketplace that can impact the economic aspects inter­secting with the use of various care pathways will increase in importance for all concerned.

The Journal of Clinical Pathways is always open to receiving your submissions highlighting your work and research in the space throughout the year. Manuscripts can be submitted at editorialmanager.com/jclinpath.