Welcome to Season 3!
Dr. Gabriel Bien-Willner Part 2: Helping Payers Adapt to the Paradigm Shift of Precision Medicine
This is the second of two podcasts featuring Dr. Gabriel A. Bien-Willner, Medical Director of the MolDX program at Palmetto GBA.
In Part 1, Dr. Bien-Willner speaks about Reshaping Reimbursement Policies for Genetic and Genomic Testing.
Here in Part 2, we dive into the core challenges that payers face in navigating the explosion of precision medicine tests and treatments, and specifically how the prior authorization process can be streamlined by keeping payers updated on changes in coverage policy for new genes or CDx.
Dr. Bien-Willner launches into the topic by giving us an overview of payer challenges as they relate to the growth of precision medicine. He says one key challenge is that payers don’t have full transparency into coding practices, so they may be confused by codes that, for example, are used for multiple disease states or that are bundled together. Not understanding what they are paying for, payers may simply deny the claim.
Another critical challenge, Dr. Bien-Willner highlights is the current talent gap in the field of molecular genetic pathology. He says, “Why would people go into molecular genetic pathology when there are no molecular pathology jobs to be had at the end of the rainbow? So now, that these tests are becoming more accepted and they're being performed and when they start to get reimbursed, that will open up more positions for hiring molecular genetic pathologists. And that, in turn, will push people to get some specialization in molecular genetic pathology. And so I think it's all of these things that work together. There is no one magic bullet. It's a lot of little things."
Dr. Bien-Willner discusses how he is actively working to tackle these challenges as Director of The Molecular Diagnostic Services (MolDX) Program, which was developed to identify and establish coverage and reimbursement for molecular diagnostic tests.
In summary, precision medicine is here, and in order for more patients to benefit more stakeholders need to be involved and invested with solutions that embrace this paradigm shift in medicine.
Listen to the full conversation above and be sure to tune in to Part 1.
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About Our Guest
Gabriel A. Bien-Willner MD, PhD, FCAP
Medical Director, MolDX and Chief Medical Officer, Palmetto GBA
Dr. Bien-Willner is the Medical Director of the MolDX program at Palmetto GBA, a Medicare Administrative Contractor (MAC). MolDX seeks to understand the molecular testing landscape to implement payer controls, coverage, and to set policy for affiliated MACs, which currently cover 28 states. He is a leader in the Precision Medicine space and practices as a Board-certified Anatomic Pathologist and Molecular Genetic Pathologist.
Throughout his career, Dr. Bien-Willner has been active in research, development, and advancement of molecular diagnostic services, specifically next-generation sequencing. He has worked closely with clinicians to develop clear clinical diagnostic and treatment pathways for directing Precision Medicine programs at community cancer centers. Dr. Bien-Willner received his M.D. and Ph.D. degrees from Baylor College of Medicine with a Ph.D. in Human Molecular Genetics. He completed his residency and fellowship at Washington University in St. Louis before attaining a faculty appointment there. He held several leadership roles in laboratory and biotech companies before joining Palmetto GBA.