The Payor's Dilemma: Navigating Personalized Medicine's Evolutions w/ Suzanne Belinson

The Promise of Personalized Medicine

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for 2 år siden 23:17

MP3•Episoder hjem

While the healthcare industry innovates at an often unprecedented rate, payors grapple with the complexities of implementation and sustainability. From the payors vantage point, there is both excitement and trepidation surrounding personalized medicine’s rapid evolution.

Today’s guest, Suzanne Belinson emphasizes the critical role of diagnostics companies in helping healthcare systems manage this transformation effectively. Suzanne is the Vice President of Commercial Markets at Tempus, Inc. Tempus is a technology company focused on bringing the power of data and artificial intelligence to healthcare. Her role focuses on commercial growth for Tempus through the development and execution of partnerships with managed care organizations.

The conversation also dives into:

Demonstrating the value of diagnostic testing
How innovation can impact member retention
The urgency to create sustainable platforms & payment models

—----

Stay connected with our host, Perry Dimas, here on LinkedIn!

27 episoder

#Fitness #Medicine #Perry Dimas

The Payor's Dilemma: Navigating Personalized Medicine's Evolutions w/ Suzanne Belinson

The Promise of Personalized Medicine

published for 2 år siden

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MP3•Episoder hjem

The conversation also dives into:

Demonstrating the value of diagnostic testing
How innovation can impact member retention
The urgency to create sustainable platforms & payment models

—----

Stay connected with our host, Perry Dimas, here on LinkedIn!

27 episoder

#Fitness #Medicine #Perry Dimas

Alle episoder

The Promise of Personalized Medicine

1
The Road to Adoption: Bringing Cutting-Edge Diagnostics to Market 34:28

for 13 dager siden34:28

34:28

In this episode of The Promise of Personalized Medicine , Perry sits down with Jonathan Romanowksy, Co-Founder and Chief Business Officer at Inflammatix, Inc. With years of experience in the field, Jonathan shares insights into how personalized medicine is expanding beyond oncology and transplantation into new areas such as infectious diseases, neurology, and immunology. They dive into the challenges and opportunities of bringing innovative diagnostic tools to market, ensuring clinical adoption, and overcoming payer skepticism. The conversation also touches on the critical role of integrated health delivery systems, group purchasing organizations, and the payer community in facilitating the adoption of novel medical technologies. Jonathan provides thought-provoking insights on the need for a more proactive approach from payers, including the implementation of coverage-with-evidence development programs to evaluate and support new innovations. Key Topics Discussed: Sepsis and Acute Infection Management – The critical need for better diagnostic tools and how TriVerity is making an impact Clinical Study Rigor – Why broad, well-designed studies are essential for test adoption and payer reimbursement Payer Considerations in Precision Medicine – Balancing innovation with cost-effectiveness and scalability Early Adoption of Diagnostic Testing – Challenges and strategies for integrating a newly FDA-cleared test into healthcare systems. Impact on Patient Care – How the test can help hospitals decide whether to transfer patients, reducing unnecessary transfers and improving outcomes. Value-Based Care and Pricing Models – The potential for pricing medical products based on the value they bring rather than traditional reimbursement structures. Future of Healthcare Innovation – The need for better collaboration between payers, providers, and innovators to improve patient care and system efficiency. Tune in as they discuss the challenges of reimbursement models, the potential for value-based pricing, and how the healthcare system can work towards a future where the right patient receives the right care at the right time. —------- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Tailored Treatments: How Genetic Profiling is Transforming Healthcare w/Sarah Clancey Overton 32:37

for 27 dager siden32:37

32:37

In this episode of The Promise of Personalized Medicine , Perry sits down with Sarah Clancey Overton, Director of Revenue Cycle Management at Velsera. They discuss how genetic profiling is transforming healthcare—enabling targeted treatments, improving prognostic tools, and even opening doors for disease prevention. The conversation highlights the critical role of diagnostic testing in precision medicine, the increasing collaboration between pharmaceutical companies and labs, and the challenges in payer coverage that impact patient access. It examines why not all doctors are ordering comprehensive genetic profiling, how diagnostics and therapies can be better aligned, and what changes are needed to ensure patients receive the right treatment at the right time. Tune in as they discuss the future of medicine—where data-driven insights and tailored treatments have the power to redefine patient care. —------- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
2024 Year in Review: Highlights, Innovations, and What’s Next for Personalized Medicine 22:07

for 15 weeks siden22:07

22:07

In this year-end wrap-up episode of The Promise of Personalized Medicine , host, Perry is the guest this week and he’s joined by his producer, Angela! They reflect on the significant shifts and trends that defined 2024 in the healthcare and diagnostics industries. Join as they explore FDA regulatory developments, state-level biomarker laws, and innovations shaping personalized medicine. The fantastic lineup of guests from the past year are celebrated—Beth Davis, Wren Gregory, Dr. Sandra Milligan, Debs Pipphard, Rennie Quarles, Tom Cronin, Mark Hiatt, Tyler O'Malley, and Dr. Sherie Smalley—whose insights enriched the conversation around precision medicine. In a fun segment, "How Well Do You Know Your Guests?", Perry tests his memory with standout quotes from our guests, sparking discussions about AI advancements, clinical significance, and the evolution of personalized care. Looking ahead to 2025, the discussion goes towards the industry's trajectory, breakthrough innovations, and the potential impact of policy disruptions on healthcare delivery. Tune in for an engaging and insightful recap of the year that was and a glimpse into what lies ahead. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Aligning Incentives: The Key to Better Healthcare Outcomes 28:31

for 15 weeks siden28:31

28:31

In this episode of The Promise of Personalized Medicine , Perry sits down with Dr. Sherie Smalley to explore the nuanced challenges and opportunities in today’s healthcare landscape. Dr. Smalley shares her unique perspective as a physician and medical director, shedding light on the complexities of aligning patient care, financial responsibility, and clinical decision-making. The conversation dives into the misalignment of incentives within the healthcare system, the critical need for cost transparency, and the importance of equipping both providers and patients with the tools and knowledge to make informed decisions. The conversation also dives into: why value-based arrangements could be a game changer, fostering collaboration, data sharing, and trust among stakeholders while improving patient outcomes. the evolving role of laboratory medicine in supporting clinical decisions the potential of genetic testing to revolutionize care the systemic fragmentation that often hinders progress. This episode is a thought-provoking look at how healthcare professionals, payers, and patients can work together to address systemic challenges and pave the way for better care. —--------- Dr. Sherie Smalley is a healthcare consultant and principal at New Dawn Health LLC. Her background experience as a physician executive with 30 years of healthcare experience includes serving as Chief Medical Officer and Senior Medical Director for Medical Policy for health plans providing government and commercial coverage. Her passion is improving health outcomes by promoting patient-centered, high-quality, personalized healthcare. Dr. Smalley also held a volunteer faculty appointment at the University of Hawaii School of Medicine where she taught problem-based learning. Prior to her health plan experience, Dr. Smalley held a role in the California Department of Public Health and practiced anatomic and clinical pathology in Northern California. Dr. Smalley holds a bachelor’s degree in psychology with a double minor in biology and chemistry from Sonoma State University. She received her medical degree from the University of California, Davis, and completed her residency at Kaiser Permanente’s San Francisco Medical Center. Dr. Smalley is board certified in anatomic and clinical pathology. Sherie has three children and four grandchildren. She is an avid gardener and enjoys growing orchids. She has been a member of the Susquehanna Orchid Society and the Honolulu Orchid Society, and currently has almost 100 orchids under her care. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Building a Better Future for Autoimmune Patients with Precision Medicine 32:34

for 22 weeks siden32:34

32:34

Today we sit with Tyler O’Malley, an expert in the evolving fields of personalized and precision medicine, to explore how advancements in diagnostics are transforming patient care. Tyler shares his vision for healthcare that shifts away from broad-based disease management toward more individualized treatment, especially in challenging fields like autoimmune diseases. He discusses the role of artificial intelligence in leveraging vast data for actionable insights, which enable doctors to take a proactive approach rather than a reactionary one. We dive into the current limitations in autoimmune disease management, using lupus as a case study, where outdated diagnostic tools still dominate. Tyler explains the need for more precise diagnostic testing and the challenges of working within a constrained healthcare system with limited specialist availability. We also tackle the complexities of navigating payer dynamics, where reimbursement policies often lag behind clinical innovations. Finally, Tyler discusses essential strategies for diagnostics companies, emphasizing the importance of early integration of reimbursement planning, setting realistic investor expectations, and fostering strong relationships with payers and physicians alike. If you’re interested in how the healthcare industry is working to deliver better outcomes through innovation, this episode is for you! —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Are We Really More Personalized? Precision Medicine vs. Traditional Healthcare 27:18

for 24 weeks siden27:18

27:18

Imagine going to the doctor and knowing your treatment is designed just for you —tailored to your unique biology, lifestyle, and even your genetic code. That’s the promise of personalized medicine. But with all the advancements in precision healthcare, are we truly getting more personalized care, or are we just layering new technologies onto old practices? Today, we're diving deep into this tension between cutting-edge innovation and traditional healthcare, exploring what it really means to treat the individual patient in this modern medical world. Today’s guest is Dr. Mark Hiatt, a seasoned radiologist. Rooted in the timeless principles of the Hippocratic Oath, Dr. Mark shares his insights on delivering individualized patient care amidst the advancements in genomic medicine and precision diagnostics. He discusses historical influences like the Flexner Report, and examines how modern healthcare can move beyond reactive, highly specialized care to embrace a more preventive and personalized approach. Other topics discussed: the challenges posed by health plans, including the frustrations of prior authorizations and the tension between cost management and patient-centered outcomes innovative solutions such as shifting to an educational approach in prior authorizations and aligning incentives through value-based care models broader issues like the role of employers in health insurance, the financial burdens of medical costs on individuals, and the urgent need for a healthcare system that empowers patients to take control of their own health journeys —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
From Appeals to Adoption: Accelerating Change in Personalized Medicine Reimbursement 35:34

for 26 weeks siden35:34

35:34

The fight for reimbursement often feels like navigating a maze. From lengthy appeals to prior authorizations, labs and healthcare providers must balance innovation with complex payer policies. But what if this process could be less adversarial, more collaborative, and streamlined with the help of cutting-edge technology? Our guest today is Tom Cronin, Senior Vice President, Revenue Cycle Strategy & Analytics at Quadax. Quadax is the leading and trusted healthcare partner delivering revenue cycle optimization solutions driven by the needs of our clients, powered by business analytics, and supported by superior service to improve reimbursement of care. Tom acknowledges that while appeals can be a necessary tactic to challenge denied coverage, they are costly and time-consuming. He contrasts older adversarial approaches with today’s more collaborative methods, where payers increasingly appreciate the economic value of tests in the long-term healthcare of patients. He explains how medical policies and prior authorizations play a critical role in determining coverage, while also discussing the evolving trend of health plans requesting medical records electronically to streamline the process. The conversation also covers technological advancements that could alleviate administrative burdens, such as AI and natural language processing to assist in reviewing medical records. While these technologies are promising, both share that health plans and labs still need human oversight in making final coverage decisions. —---- For more information about Quadax, please visit https://www.quadax.com/ Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
From Biomarkers to Breakthroughs: The Evolution of Precision Medicine 27:32

for 30 weeks siden27:32

27:32

In personalized medicine, where data, technology, and patient care converge, success depends on embracing change and collaboration. As our guest puts it, 'At the end of the day, it's all about patient care. So if we have to make some changes in order to make a positive change for them, let's do that.' Today’s guest is Rennie Quarles, Sr. Director Biopharma Commercialization. She shares insights on the balance between maintaining exclusivity and fostering open access to new treatments, emphasizing the importance of broadening availability for maximum patient benefit as therapies transition to the commercial space. We discuss the evolution in business philosophy around these collaborations, highlighting the multifaceted relationships that companies build with pharmaceutical clients. Other topics: exciting future developments in personalized medicine, such as leveraging data, AI, and machine learning to improve clinical trials and patient care the growing approval of biomarkers, not just in oncology but across other fields like neurology, reflecting the industry's potential to impact multiple disease states the role of patient advocacy groups and the ongoing, incremental advances that drive the field forward. Join us as we explore the challenges, opportunities, and future directions of personalized medicine, always with a focus on what matters most: improving patient outcomes. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Advances in Personalized Medicine: From Paradigm Shifts to AI Integration 33:37

for 33 weeks siden33:37

33:37

Picture this: You walk into a doctor's office, and instead of a one-size-fits-all prescription, you're handed a treatment plan designed specifically for your genetic makeup. This isn't science fiction; it's the groundbreaking promise of personalized medicine, where cutting-edge technology meets the intricacies of human biology to provide precise and effective healthcare solutions. Today’s guest is Deb Phippard, Chief Scientific Officer at Precision for Medicine. They delve into the fundamental concept of personalized medicine, emphasizing the importance of delivering the right drug to the right patient at the right time. Deb shares her perspective on the advancements in the field, particularly highlighting the significant impact of checkpoint inhibitors like Keytruda on cancer treatment. The conversation explores the challenges of the traditional trial-and-error approach in medicine, the crucial role of companion diagnostics, and the transformative potential of AI in integrating complex data for personalized treatment plans. Deb and Perry also discuss the regulatory landscape, comparing the hurdles faced in the U.S. and Europe, and the implications for clinical trials and patient care. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
The Impact of Precision Medicine on Modern Healthcare: A Discussion with Dr. Sandy Milligan 35:17

for 40 weeks siden35:17

35:17

Personalized medicine still has so much potential. With the need for greater adoption and further advancement becoming more apparent, this conversation is necessary. Today's guest is Dr. Sandy Milligan, the President of Research & Development, Laboratory Operations, IT and HR at Aspira Women’s Health. Dr. Milligan explains the nuances of personalized medicine, defining it as an individualized approach to healthcare that leverages precise diagnostics based on omics data analytics. We explore the challenges and opportunities in adopting personalized medicine, particularly in the United States, and discuss the financial, regulatory, and clinical hurdles that need to be overcome. Dr. Milligan shares insightful examples from the fields of hypertension and oncology, highlighting how personalized medicine can revolutionize treatment plans and improve patient outcomes. We also delve into the critical role of biomarkers in developing innovative therapies and diagnostics, especially for complex diseases like endometriosis and various cancers. Tune in to learn about the current state and future potential of personalized medicine from one of the leading experts in the field! —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
The Role of Communication in Precision Medicine: Insights from Dr. Wren Gregory 32:08

for 42 weeks siden32:08

32:08

Clinical research plays a critical role in advancing medical treatments. Today's guest is Dr. Wren Gregory, the Director of Laboratory Operations and Clinical Research at Precision Genetics. Join us as Dr. Wren describes her responsibilities in overseeing lab documentation, compliance, and team mentorship, ensuring smooth operations at Precision Genetics’ facilities in Greenville and Charleston. She also discusses the critical role of clinical champions in advancing precision medicine, particularly in pharmacogenomics, and the challenges of translating robust evidence into actionable clinical utility. We dive into the complexities of personalized medicine and the importance of user interface in clinical tools, emphasizing the need for real-world input from clinicians to create effective, user-friendly diagnostic tools. Dr. Wren provides insights into the intricacies of working with payers, the importance of economic data in demonstrating value, and the necessity of building relationships with reimbursement champions to navigate the administrative hurdles in healthcare. Tune in to learn about the art of managing change in healthcare, the significance of clinical and reimbursement champions, and how Precision Genetics is contributing to the evolution of precision medicine. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
A Decade of Strides in Personalized Medicine and Digital Health 28:03

for 1 year siden28:03

28:03

Progress and transformation–are two words we definitely want to be associated with our US Healthcare. Today’s guest, Beth Davis, addresses the significant strides made in digital healthcare and smart technologies, ranging from wearable devices to implantable devices that monitor vital signs and manage chronic conditions like diabetes. She emphasizes the positive impact on test turnaround time, treatment plans, and patient care management facilitated by advancements in biomarkers, diagnostic platforms, and gene sequencing. The conversation also explores challenges that persist, particularly in the regulatory pathway and the complexities of securing funding for emerging technologies. The lengthy and uncertain timeline for test coverage and reimbursement is a factor, shedding light on the financial burden faced by companies bringing new technologies to market. Other topics discussed include: Common mistakes made by companies when launching novel diagnostic tests in the U.S. & the importance of a well-thought-out reimbursement and market access strategy from the concept phase The evolving relationship between the healthcare industry and health plans, and the collaborative efforts and direct dialogue between manufacturers and payers that are needed Join us for this eye-opening discussion, and if you’re a laboratory professional helping bring forward diagnostic tests, AND have interest in being a guest on this show, please DM Perry on Linkedin. —---- Stay connected with our host, Perry Dimas, here on LinkedIn !…

The Promise of Personalized Medicine

1
Season’s Tidings: Promise of Personalized Medicine 2023 Wrap Up 24:27

for 1 year siden24:27

24:27

The tables are turned on our regular host, Perry Dimas, and this week–he becomes the guest! Our Producer, Angela, takes the hosting seat and asks Perry all those questions you’ve been wanting to know. Questions like: What are YOUR thoughts on Personalized Medicine? What has made Season 2 special, so far? What is the newest piece of information that you believe would help laboratories as they’re developing their tests in 2024? There’s also an insightful game entitled: “How Well Do You Know Your Guests?” Some thoughts about the future round out this 2023 Wrap Up episode. Enjoy! —---- Stay connected with our host, Perry Dimas, here on LinkedIn ! If you’re a laboratory innovator who is interested in guest speaking on the podcast, please DM Perry on LinkedIn!…

The Promise of Personalized Medicine

1
Unraveling the Human Genome: From DNA to Personalized Health 21:22

for 1 year siden21:22

21:22

Our DNA holds the keys to understanding our health and well-being. Our guest today is Jill Davies, CEO at Genome Medical. She emphasizes the crucial role of genetic counselors in deciphering complex genetic information for individuals, offering tailored guidance on healthcare decisions. Jill introduces the concept of genetic counseling assistants, streamlining the process and allowing genetic counselors to focus on the most critical aspects of patient care. The conversation also dives into: Sources of patient referrals Barriers to personalized medicine, including limited access to genetic counselors and concerns about payor coverage Advancements in testing methodologies Jill Davies is a leader in the field of genomic healthcare. With over 20 years of experience in the genomics field, Jill has broad expertise across clinical services, telehealth, strategic planning, business development and leadership. She has a special interest in the role of genomics in primary care and preventive medicine as well as the use of technology to enable access to genomic information and services. —---- Stay connected with our host, Perry Dimas, here on LinkedIn ! If you’re a Medical Director looking to advise laboratory innovators, please DM Perry on LinkedIn!…

The Promise of Personalized Medicine

1
Deciphering the Code: Navigating the Complex World of Genetic Test Coding 29:37

for 1 year siden29:37

29:37

Coding in the world of medical tests and personalized medicine may not be the most scintillating topic, but it's a critical puzzle piece that can make or break the seamless delivery of healthcare services. Our guest today is Dr. James Almas, the National Medical Director for Clinical Effectiveness at Labcorp, who provides an in-depth exploration of the complexities of medical coding in the context of personalized medicine. He shares deep insights into the intricacies of medical coding, especially in the context of genetic testing. The discussion highlights a need for a unified and effective solution in an ever-evolving landscape of genetic testing. The conversation also dives into: How coding impacts reimbursement and clinical utility The background of how coding systems for genetic tests have evolved The introduction of Z codes by Moldex & Dex as alternatives to traditional coding systems and the challenges they present in terms of HIPAA compliance. Dr. Almas is the National Medical Director for Clinical Effectiveness at Labcorp. Prior to that he served as the Medical Director at MolDX (Palmetto) and has served as a medical officer at CMS (Coverage Group). He is a board certified pathologist with years of service as a pathologist. He served as the CAP’s advisor to the AMA’s CPT Editorial Panel. —---- Stay connected with our host, Perry Dimas, here on LinkedIn ! If you’re a Medical Director looking to advise laboratory innovators, please DM Perry on LinkedIn!…

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The Payor's Dilemma: Navigating Personalized Medicine's Evolutions w/ Suzanne Belinson