Unscripted - Bridging Gaps in Precision Medicine: Connecting Stakeholders for Better Patient Outcomes

00:00:00:00 - 00:00:36:00
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Hello and welcome to this episode of unscripted. Bridging Gaps in Precision Medicine at the AMCP Partnership Forum. I'm Mitzi Wasik, senior vice president of practice, strategy and innovation at AMCP. And joining me today is my colleague Cate Lockhart, chief science officer at AMCP.

00:00:36:02 - 00:01:09:16
Great to have you here, CAMate. Thanks, Mitzi. I'm excited to dig into this important conversation. So, Cate, when we think about precision medicine, just to kind of level set, the audience here, what, in your words, what is precision medicine mean to you? Precision medicine is an approach to health care that aims to provide treatments that are specific to a patient's unique characteristics, often by analyzing genetic information or molecular information like biomarkers, to select the best available treatment for your patient outcomes.

00:01:09:18 - 00:01:37:05
You know, I have to admit, as a pharmacist, when I first started digging into precision medicine, I question where does the pharmacist fit in? This is in our traditional model. And as you know, I quickly realize the gaps between the testing side and the treatment side. And if you think about AMC's mission statement, part of it is championing policies that enhance medication access and patient outcomes while controlling health care spending.

00:01:37:06 - 00:02:07:19
This definitely fell right into that bucket. Let's start with the big picture. Cate, can you explain what the AMCP Precision Medicine Partnership Forum was all about? The Partnership Forum was a multi session event held in Alexandria, Virginia over the course of two days, bringing together a wide range of stakeholders patients, payers, providers, pathologists, laboratory benefit managers, leaders from advocacy and professional organizations.

00:02:07:21 - 00:02:32:13
And the goal was to explore how we as a group can improve access, consistency and quality in precision oncology. And I was there. I was lucky enough to be part of that conversation. And I can tell you it wasn't just talk. It was really about aligning clinical guidelines, diagnostics. And then to add on to that the managed care processes to ensure that innovation leads to equitable outcomes.

00:02:32:14 - 00:02:56:21
So, Cate, can you share a bit about your role and what drew you to this topic? Absolutely. As Chief Science officer, I focus on generating evidence that informs policy and practice. And precision medicine is where science meets strategy. And I'm ecology is a space where we can make a real impact, and I mean a real impact in improving patient care and outcomes.

00:02:56:23 - 00:03:19:01
There's research in the literature that shows there's inconsistency in things like biomarker testing to guide optimal optimal care. And we have some really meaningful opportunities here. Yeah. And as I said, you know, I was part of the partnership forum discussions and, you know, just the different stakeholders that we had at the table, it felt different than our normal conversations.

00:03:19:01 - 00:03:46:02
And so, you know, I had many moments throughout those few days that we were in Alexandria. But. Well, from your perspective, what was the most striking takeaway from the forum? One really major theme is the fragmentation in oncology care. There is a really complex ecosystem surrounding precision oncology, and we need to figure out how to better align all the players, but it's a big challenge.

00:03:46:04 - 00:04:11:08
We had a lot of those players in the room, and I think that's a really meaningful step in the right direction. We were using non-small cell lung cancer as an example, and we saw how misalignment across all of these systems leads to delays and missed opportunities for targeted therapies. Yeah, exactly. This isn't your typical situation where we need one player in the field to make changes.

00:04:11:08 - 00:04:45:12
This is really a system level change that will reduce time to treatment and really ensure care is guided by evidence. So how do you see precision medicine transforming oncology care. Well, it's it's shifting us from generalized treatments to targeted therapies based upon the patient's unique biology situation environment. And that's really a game changer. It it can help focus the right therapies for the right patient and ultimately improve outcomes.

00:04:45:14 - 00:05:07:18
But only if we can ensure access and uptake and that people are following the recommended pathway for precision medicine. Yeah. And I think this one is a new one where, you know, it kind of takes us out of your typical payor coverage, where, you know, a lot of times we think about medical versus the pharmacy side of the treatment and who is responsible for what.

00:05:07:20 - 00:05:30:00
And when we came out of that forum. You know, one of the biggest barriers is really that payer alignment. And, you know, precision medicine challenges those traditional coverage models that I mentioned. So we need to build trust among the different stakeholders and demonstrate clinical utility to move forward. So let's talk about some of the themes from the forum.

00:05:30:02 - 00:05:54:17
Let's talk about guideline concordance. That was a fun one. When we jumped into that, from your perspective, what did those discussions really reveal during those few days? Well, I think one thing that it's much more complex than we all really imagine in terms of what is clinical guideline concordance, how do you measure it? What clinical guidelines do you use?

00:05:54:19 - 00:06:28:00
And there's really a disconnect between the clinical guidelines and payer policies in particular. And I think this is an area that we at AMCP have a very clear opportunity to help realign clinical guidelines and payer policies, particularly in precision medicine. We had colleagues from Nccn in the room as well, and there were some examples that helped frame this about how variability in recommendations can complicate coverage decisions.

00:06:28:01 - 00:06:54:19
So there's a lot of issues to unpack with this whole concept of guideline concordance. Yeah, I couldn't agree more. A few surprising friction points that I noticed during the discussions was really around how the evidence is interpreted. You know, some payers want the typical randomized controlled trials while the clinicians that are out there practicing or within the payer world, they rely on real world data.

00:06:54:19 - 00:07:19:05
And as we know from our experience, those two are not aligned right now. So that tension between those discussions was definitely palpable. So shifting to the provider side, from your perspective, what challenges came up during those discussions? Well, we were lucky enough to have a practicing pathologist in the room to give us this firsthand account of of what his experience is.

00:07:19:06 - 00:07:50:23
And one of the pain points was a lack of standardized workflows for reflex testing that the pathologists can automatically follow. And many providers don't have protocols in place which delays biomarker testing and then subsequent treatment initiation. Yeah. If you remember, we did some polling during the exercise and it was pretty clear and the polling revealed that most organizations aren't doing reflex testing consistently.

00:07:51:01 - 00:08:13:01
So I think that just in general is a huge opportunity for improvement. The next real hot topic, and I think was probably one of my favorite discussions, was clinical utility. And really how do we define it? I think that question is still out there. So, and your words are kind of your interpretation of the discussions that were had.

00:08:13:03 - 00:08:45:00
How did the participants define it? Well, fundamentally, I think it's defined as the ability of a test to improve patient outcomes. But there was really no consensus in the room. It was a surprisingly, active discussion. There were many perspectives on this. Some people were focused on cost effectiveness and others were on clinical relevance. And so we never really quite landed on a singular definition of clinical utility.

00:08:45:02 - 00:09:07:01
So I think there still is a lot of work and a lot more discussion to be had around that particular topic. What about you? Any other memorable insights that you can think of? Well, there is definitely a lot, a lot of eye opening, revelations that we talked about with the different gaps that one panelist made, a statement that really stuck with me.

00:09:07:03 - 00:09:33:01
And they said, if it doesn't change what we do, it's not useful. So it's really about what are we doing that is actionable and has impact? Absolutely. So let's shift to action. Mitzi, what steps is AMCP taking to move this work forward? You know, I mentioned in the beginning that, you know, as I started kind of digging into precision medicine, it was really a question of, well, I'm a pharmacist.

00:09:33:02 - 00:10:04:19
Is this really applied to me? And, you know, just during those two days, I think we came up with a massive list of things that we can do from pharmacy and align. So within AMCP, we're really integrating precision medicine across our platforms. When it comes to research, advocacy, education and one of our best superpowers of convening. So our national events that we have in the fall and in the spring will definitely have precision medicine at the table.

00:10:04:19 - 00:10:31:13
And another deliverable that we are working on to kind of help payers align is the Coverage Principles document. So tell me a little bit more about that. Yeah. Let's see I think this is a really important piece that is coming out or that will come out of the the partnership forum and the activities surrounding it. And it's a it's a document that's designed to guide stakeholders on evidence standards.

00:10:31:15 - 00:11:02:12
It's a set of best practices, if you will. Timing of testing alignment with clinical guidelines. And it's reviewing it as a foundational tool for change, particularly for the managed care pharmacists. And let's see what else can listeners expect on this topic. Well, if you would have asked me, you know, a year or even two years ago, what organizations AMCP might be partnering with to push some of the thought leadership activities forward that we're doing?

00:11:02:14 - 00:11:27:21
The collaborations that I'm about to mention never would have been on my radar, but I think it's exciting. I think it's showing how you know, healthcare is fragmented and we're really aligning with the, the top down. And we can't just focus on medical versus pharmacy anymore. So we have collaborations, coming that with Nccn, a triple C amp and ACP.

00:11:27:23 - 00:11:49:01
Plus we're looking at virtual training opportunities to really keep that momentum going and ensure stakeholders are equipped to drive change. So Cate, thank you so much for sharing your insights. Like I said, the forum, it was probably one of my favorites that I've ever attended. And, you know, the diverse stakeholders that were in the room was just, eye opening to me.

00:11:49:04 - 00:12:16:01
And I think it was a really a powerful step toward bridging gaps in precision medicine. I could not agree more. Thanks, Mitzi, also to you for sharing your insights. And it's it's clear you said our superpower, one of our superpowers at AMCP, is the ability to convene the multiple stakeholders, multiple disciplines in the room. And it's clear that when we bring the right voices together, we can build a more connected, equitable system of health care.

00:12:16:04 - 00:12:42:11
All right. Well, as we wrap up, I want to thank our sponsors and our partners for supporting this vital work. And thank you to our listeners. Definitely stay tuned for more conversations. There will be lots of them to come as we move the needle in patient care. This conversation is really just the tip of the iceberg. So thank you for joining.