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Published in Health Care
Dr. Scott Betzelos Dr. Scott Betzelos Courtesy photo.

Blue Care Network launches precision medicine pilot to improve patient outcomes

BY Sunday, April 24, 2022 06:45pm

A Q&A with Dr. Scott Betzelos, chief medical officer and vice president of HMO strategy and affordability at Blue Care Network

Apilot program at Blue Care Network brings the era of precision or genetic medicine deeper in the mainstream of modern health care. Under the pilot launched in early March with about 500 Medicare patients, Blue Care Network proactively reaches out to physicians to have a genetic test done for patients diagnosed with an illness or disease to identify the medication that works best for them. Blue Care Network intends to fully roll out the program in January 2023 at no cost to members and may extend it to PPO members in 2024. MiBiz discussed the pilot that uses pharmacogenomics, or PGx, with Dr. Scott Betzelos, chief medical officer at Blue Care Network, the 670,000-member HMO subsidiary of Blue Cross Blue Shield of Michigan.

What does this pilot really represent for Blue Care Network?

The pilot represents BCN’s ability to bring a novel, innovative program to the marketplace for its members and for its providers. It’s not that PGx is new. PGx, which stands for pharmacogenomics, has been around for 10 years or so, but the adoption of it is still not where it needs to be, or the awareness for providers using PGx and which drugs would be responsive to a gene drug interaction. The increase in knowledge around precision medicine or personalized medicine, a lot of it is around tailored treatment for oncology patients to look at the genomics of the cancer and biomarkers. This is the genomics and DNA of the individual and their ability to metabolize or not metabolize a drug. So, it’s an opportunity to bring not only pharmacogenomics to the forefront, but a wrap-around service for our members.

How does the pilot differ from how Blue Care Network handles requests for genetic testing now?

A physician may order a PGx test and they think about doing it because a member is not responding to a behavioral health medicine, for example. They get the PGx test then. What we’re doing is proactively identifying and predicting members that have a potential gene drug interaction through our vendor, and then we send letters to the provider and the member and a home test gets done, and then we have a pharmacist that will support the provider when the result comes back, especially for more complex patients. It’s about predicting whether or not a drug is going to work when you get placed on it when someone has a diagnosis.

What’s your goal?

What we want to do is get people on the right drug, at the right time, as soon as possible in the process, and this program affords us that opportunity. The potential is in the value that’s provided to the membership in terms of reduced complications, reduced drug interactions, reduced emergency department visits, reduced inpatient admissions, reduced trial and error associated with multiple medications and the multiple costs associated with that. The value is significant for our membership, and there’s also value for the provider and our pharmacist making recommendations.

What do you hope to learn through the pilot?

We want to test our approach to how we’re doing this. We want to see if the providers are feeling supported. We want to know if members are feeling supported. We want to also test the membership trust in the program. Blue Cross Blue Shield does not receive any of the genetic data. We have a robust firewall built so that we don’t. And we also want to learn a little bit about those that have been tested and compare their medication adherence.

So often a patient starts taking a medication and they go off and on, off and on. Some of the literature supports the fact that if you have a PGx test you’re more likely to stay on a medication that you’re on. 

Bottom line: It’s better medicine?

It is better medicine, absolutely. And I believe it’s rapidly going to become the standard of care over the next few years.

This is a real opportunity to address health care on a person-by-person basis that is tailored to each member’s individual needs. Working closely with our members and their physicians, we are now able to cut out the guesswork and make informed decisions that lead to sustainable treatment options and better patient outcomes.

Why do this at this point in time?

Medicine continues to evolve, and when PGx first came out in the late 2000s … it was really only around one or two drugs and then it started to expand. Then it continued to evolve to where the FDA began to recognize these gene drug interactions and it’s rapidly becoming commonplace that we do this type of testing. So, we thought at Blue Cross, let’s develop this novel, innovative program, bring precision medicine to the front door of our physicians and our members, specifically around pharmacogenomics. It’s evolved to the point where there’s multiple labs that do this type of testing and they’re certified.

This is not voodoo medicine. This is real. There is literature that supports it, and we looked at that literature and examined it and wanted to move forward with a program that would provide value to the membership. 

 

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