The Promise of Personalized Medicine

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 c...

The goal of personalized medicine is to pinpoint the most effective treatments and reduce the morbidity and toxicity associated with unnecessary therapies. One of the major challenges in the field is securing reimbursement for personalized medicine services. While Medicare often leads the way in adopting new approaches, other payers vary in their criteria, making it a complex landscape to navigate...

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...

Using genomics or other biomarkers to improve health care is the essence of Personalized Medicine according to today’s guest, Dr. Bruce Quinn. Moving forward with novel diagnostic testing could prove challenging for a variety of reasons, one of them being a disruption to the overall healthcare industry. If one test could replace multiple, costly tests, then the ROI for certain payors goes down.  J...

Having a baseline understanding of each of our individual health needs should be a no-brainer. Yet, America is still mainly practicing a responsive-based medical model vs. a proactive approach.   Today’s guest, Donna Edmonds, says: “We should learn how to manage health, and focus on wellness and prevention.” She is the CEO of BRAINBox Solutions Inc. and is passionate about working with the leaders...

Why aren't Americans benefiting from customized treatment plans utilizing their specific genome types and targeting the unique needs of the problem? Advanced tests are out there but not enough patients are even getting tested, let alone, having the option of the correct tests! Matt Brane helps break down some of the main reasons preventing these kinds of tests from reaching the average Americ...

Who owns the fiduciary responsibility between insurance and physicians? Could the answer include both? This episode includes a fantastic conversation about the perspective of larger economics within these roles.  Today’s guest is Dr. Kenneth Schaecher, the Interim Chief Medical Officer at the University of Utah Health Plan. Not only does he break down current ideas of improvement, but also the his...

There are guidelines that will naturally protect with the patient, employer and payor. It is also beneficial as an employer to establish a helpful relationship with their payor in order to meet the specific needs of their employees.  Dr. Phillip Smith, Regional Medical Director at Oscar Health, takes a deep dive into the benefits of this type of care.  Join us as we discuss:  Clinical Utility and...

What will it take for there to be price transparency for preventative medicine? The No Surprise Bill is a start! There is also the need for consumers to understand their options and for physicians to stay current on the latest technology.  This is easier said than done.  Today's guest is Dr. Linda Britton, Senior Medical Director, Southeast Region at United Healthcare.  Join us as we discuss:...

Ultimately, we want the world to be a better place. Precision Medicine can help with this long-term goal and the labs that are looking to study, test, and prove this kind of work could have incredible opportunities to show up prepared.  Continuing our interview with Dr. Carmen Alfonso, who is the Senior Medical Director of Blue Cross Blue Shield Advantage of Arizona, we dive deeper into how these...

Clearly defining the cost structures so that Doctors, Insurance Companies, and patients feel empowered to use personalized medicine to their advantage is what today’s guest believes is one of the best next steps we can take in healthcare.  In this Part 1 of 2 interviews, we are joined by Dr. Carmen Alfonso, who is the Senior Medical Director of Blue Cross Blue Shield Advantage of Arizona and has i...

With the explosion of popularity with personalized medicine in the last decade, the need for clearly defined clinical utility is ever growing. It’s not enough to have the proof that a test works–but what treatment can Doctors and patients then take with those results?  This question is explored with today's guest, Dr. Charles Stemple, former Humana Medical Director. His insights on clinical u...

Within novel diagnostics tests, needing clinical utility evidence cannot be understated. And the more evidence accumulated over years, the better.  But why? Today’s guest is Dr. Virginia Calega, the President of VCC Healthcare Solutions, and she makes a highly compelling argument that, if payors are going to accept a new novel diagnostic test, and disrupt what they already have, it has to be backe...