Why Preventative Care is Not Being Reimbursed

Genetic biomarker testing has huge potential to improve patient outcomes and significantly reduce costs. Yet it is almost impossible to find an insurer to cover this medical service. Doctors such as Richard L. Schilsky, MD, chief medical officer of ASCO confirm that these tests are becoming critical to selecting the right therapy for individual cancer patients, yet insurers are still not getting on board.

 

The technological advances made in genetic biomarker testing is growing exponentially especially in profiling genes at their most intricate level. Individualized disease management through genetic biomarkers is a real solution to screen, monitor, diagnose, and optimize treatment for patients today. It seems illogical for insurers to not stand behind a service that would heavily reduce their costs and help improve cancer treatment. The cost reduction stems from more accurate diagnoses and optimal treatment plans that avoid adverse or ineffective treatments.

 

The unfortunate reality is that reimbursements of genetic biomarker testing has greatly decreased in the last 2 years. When it is difficult to obtain coverage, doctors are forced to use less effective means of treating cancer patients. The apparent reason for denying coverage may be that it is difficult to see how this predictive tool can save money in the future. It is not as tangible as say paying for chemotherapy, but here arises another flaw in the healthcare system. Every player only considers the present solutions and not how a solution will lead to long-term improvements. Investing in preventative care and in long-term solutions are key to a better healthcare system.

 

Written by Alison Killian

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Alison Killian is a recent graduate of Grove City College who majored in Business Management and minored in Biology Studies. She is a contributor to Medical Groups and passionate about all facets of healthcare. She plans on continuing work in the healthcare field especially in management. She is very interested in healthcare innovation and finding ways to improve the current system. She hopes to go back to school in a few years to earn a degree in medicine.