Reimbursement for genetic variant reinterpretation: five questions payers should ask.

David L Veenstra, John W Rowe, Jos�� A Pag��n, H Shelton Brown, John E Schneider, Avni Gupta, Sara M Berger, Wendy K Chung, Paul S Appelbaum
Author Information
  1. David L Veenstra: Comparative Health Outcomes, Policy & Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Box 357630, H375 Health Science Bldg, Seattle, WA 98195-7630. Email: veenstra@uw.edu.

Abstract

Reaching the goals set by the Health Care Payment and Learning Action Network requires an unyielding and unrelenting focus on encouraging providers to adopt advanced alternative payment models (APMs). Many of these models will continue to be voluntary because they either are in early stages or have not yet proven their effectiveness. The models that have proven their effectiveness should become permanent, comprising the new way that providers are paid in the Medicare program. Either way, getting today's high performers into those programs and keeping them engaged to continue to innovate and set new benchmarks is as important as attracting and improving the performance of poorer performers. That will require a shift in Medicare's policy on pricing and evaluating APMs.

References

  1. BMC Med Genomics. 2019 Nov 29;12(1):170 [PMID: 31779608]
  2. Genet Med. 2019 Feb;21(2):426-430 [PMID: 29875428]
  3. JAMA. 2018 Sep 25;320(12):1266-1274 [PMID: 30264118]
  4. Nature. 2020 Sep;585(7824):184-186 [PMID: 32901124]
  5. Genome Med. 2019 Nov 21;11(1):72 [PMID: 31752965]
  6. J Genet Couns. 2019 Apr;28(2):313-325 [PMID: 30636062]
  7. J Manag Care Spec Pharm. 2016 May;22(5):448 [PMID: 27123908]
  8. Sci Rep. 2020 Jan 15;10(1):331 [PMID: 31942019]
  9. JAMA. 2017 May 9;317(18):1831-1832 [PMID: 28346599]
  10. Genet Med. 2019 Jun;21(6):1267-1270 [PMID: 31015575]
  11. Genet Med. 2016 May;18(5):467-75 [PMID: 26270767]
  12. Genet Med. 2018 Mar;20(3):346-350 [PMID: 29215655]
  13. Health Aff (Millwood). 2016 Aug 1;35(8):1367-73 [PMID: 27503959]
  14. J Clin Oncol. 2017 Jul 10;35(20):2232-2239 [PMID: 28402748]
  15. N Engl J Med. 2021 Mar 25;384(12):1163-1167 [PMID: 33567186]
  16. Genet Med. 2013 Jan;15(1):14-24 [PMID: 22955111]

Grants

  1. P50 HG007257/NHGRI NIH HHS
  2. U01 HG008680/NHGRI NIH HHS
  3. RM1 HG007257/NHGRI NIH HHS
  4. R01 HG009694/NHGRI NIH HHS
  5. R01 HG010365/NHGRI NIH HHS

MeSH Term

Aged
Humans
Medicare
Reimbursement Mechanisms
United States

Word Cloud

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