Evidence and Reimbursement For Personalized Medicine Program

A major focus of our work is healthcare coverage, reimbursement, and policy decisions by payers. Since 2007, TRANSPERS has convened an Evidence and Reimbursement Policy Advisory Council comprised of private payers and thought leaders. This unique advisory group includes senior executives from the eight largest commercial US health plans and leading regional plans as well as thought leaders from research, policy and government.

Our work addresses two critical gaps in the translation of personalized medicine into healthcare practice and policy:

  • The need for an evidence base on personalized medicine to enable policy decisions.
  • The need for a forum that brings together the necessary stakeholders to formulate, recommend, and implement relevant policies and approaches.

An evidence-based approach

Through our collaborative efforts, we address a range of important challenges using evidence-based approaches. These include:

  • Identify gaps in the personalized medicine evidence base and how to address them
  • Analyze how payers make policy decisions and the implications for patients, providers health systems and researchers
  • Examine how personalized medicine is affected by the Affordable Health Care Act and how it is integrated into new healthcare models
  • Develop approaches to work with payers that seek to harness data on the use of personalized medicine
  • Create and test, together with payers, a framework for evaluating healthcare system factors for policy decisions
  • Assess the development and timing of payer policies on key examples of personalized medicine, including genomic sequencing
  • Generate a predictive model of the factors that lead to the successful adoption of new technologies in healthcare

TRANSPERS Program on Evidence and Reimbursement of Personalized Medicine

Conceptual framework – Stakeholders, Topics, Capabilities

Payer Approach Diagram

The Council is funded primarily by the National Institutes of Health, with additional funding from foundations.

Payer Board Council Photo

Participating health plans include Aetna, Anthem, Cambia Health Solutions / Regence, CIGNA, Health Care Service Corporation, Health Net, Highmark, Humana, Kaiser Permanente, Premera Blue Cross, and UnitedHealth Group.