Welcome to Season 2!

Part 1 Dr. Gabriel Bien-Willner: Reshaping Reimbursement Policies for Genetic and Genomic Testing

10/29/20

In the first of a two-part podcast, we are joined by Gabriel A. Bien-Willner MD, PhD, FCAP, Medical Director at MolDX, and Chief Medical Officer at Palmetto GBA where he has helped implement payer controls and coverage and set policies for affiliated Medicare Administrative Contractors in 28 states. 

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During his residency, fellowship, and teaching career at WashU in St. Louis, Missouri, Dr. Willner began working with next-generation sequencing technology. He quickly realized that the technology and its applications for cancer were going to change the way medicine is practiced, but he had a lot of questions about why payers were resistant to the possibilities. In particular, he wanted to understand why payers wouldn’t pay for genetic and genomic testing.


His answers came when he was asked to interview to be the director of the MolDX program, which was looking for a genetics/genomics expert. During that interview, he realized that the answers to his many questions about payer behavior stemmed from a lack of knowledgeable talent in the space. Dr. Bien-Willner decided that, rather than being frustrated by what seemed like controversial decisions about reimbursement, he could use his expertise to help payers better understand genetic and genomic testing and make policies that would help all of the Medicare beneficiaries in that system.

 

Dr. Bien-Willner notes that, in the past, payers have had to navigate the growing field of precision medicine without the benefit of expertise, so their only guidance came from the NCCN or consultations with other experts in the field. Today, under his direction, Palmetto GBA is able to base its policies on evidentiary reviews, and he believes this form of evidence-based decision-making should be an industrywide standard.

 

Listen to the full episode above and stay tuned for Part 2 of our interview with Dr. Bien-Willner where he speaks in detail about the challenges that payers face and how they are making changes to keep up with the ever-evolving field of precision medicine.

Download the full transcript of the episode here (pdf).

 

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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.

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