Health Insurance Managed Care My Papers Precision Medicine

Precision Benefit Design

A recent viewpoint from Fendrick and Shope (2018) argues for the need for Precision Benefit Design.

Successful implementation of precision medicine will need to address several system-wide challenges, including administrative complexities, the creation of new financing models, and aligning provider- and patient-focused initiatives. The enormous clinical potential of precision medicine sheds light on the critical importance of using clinical benefit—not acquisition price—to guide and improve how we spend health care dollars. The model that we currently use to pay for medical services is clearly not suited for groundbreaking, one-time treatments, particularly those with clinical benefits that are incurred in the near and distant future.

While I largely agree with the the authors, in my Counterpoint published in the Journal of Clinical Pathways, I argue that any form of precision benefit design faces a number of challenges, including insuring that implementation reflects not only individual patient clinical characteristics but also their preferences as well.  The abstract from my counterpoint is below.

Precision benefit design is an extension of the concept of value-based insurance design (VBID), which aims to link patient benefit design and coinsurance to the likely benefit of a treatment net of its cost. Whereas VBID measures the value of a treatment for the average patient, the advent of precision medicine raises the possibility of implementing a VBID-style approach but measuring a treatment’s value—and concordant benefit design—based on the specific patient genotype information. While precision benefit design is conceptually appealing, to implement this approach in practice would require overcoming at least 3 key challenges.

Do read the full Viewpoint and Counterpoints HERE.

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