Dr Bruce Quinn on Cutting-Edge Medicine and Employers' Role in Health Management

Reimbursement is not an issue for basic cancer tests, but questions surround the payment and guidelines for more cutting-edge medical innovations, said Bruce Quinn, MD, PhD, a consultant at Foley Hoag. He added that the role of employers in health management is not changing as quickly as we may think.

Transcript (slightly modified)

Personalized medicine is still in its infancy: what are some of the challenges so far with reimbursement?

Well, as far as challenges to reimbursement, I think that sometimes they get exaggerated. I think that cancer patients for example that have breast cancer, lung cancer, colon cancer, they get the basic tests that they need. Melanoma, you get a BRAF test; colon cancer, you get the right test; and so on. So the question isn’t whether you’re getting the basic tests, the question is what’s the cutting edge and how will that be reimbursed.

And the cutting edge for innovative medical technologies has always been sort of a war zone for decades, or longer. There’ll always be a time when something’s available but it’s not widely covered yet, or it’s not fully caught up in guidelines. That’s really where the cutting edge is.

How does the implementation of the public insurance exchanges and the increasing use of private exchanges change the employer’s role in managing health?

I think that the increasing use of public exchanges and private exchanges is actually not changing the employer’s role that fast.

The things that employers look for, it’s efficiency of the health plan. You may see things like a $200 rebate when you have a gym membership, or you get some incentives to be in a quit smoking or a lose weight program, but those are really on the fringe of healthcare. I mean, they’re important, but you don’t need a 10,000-person health plan in order to have a rebate on your gym memberships. So I think in a lot of ways, the quality coming from the health plan is not moving that fast.