Summary of the Ann Arbor Forum

Dow Auditorium - UMHS

11:30 am – 1:00 pm, April 1, 2014

Overview:

The Ann Arbor forum had 18 pre-registrations and an attendance of 16, including 1 from BCBSM and 3 from the Coordinating Center. Four of these attendees did not pre-register. The attendees, excluding BCBSM and the CC) were from Providence St. John Hospital (1), St. Joseph Mercy Hospital (2), ArborMetrix (1), JVHL (1) and the University of Michigan (7). While the number of participants was small, there was a nice mix of clinicians, pharmacists, geneticists, genetic counselors, nurses, pathologists, research scientists and administrators present. This lent itself to a well-rounded discussion, which is summarized below.

Discussion Summary

  1. How do you envision an advisory board working?
  2. The advisory board will need to have clear objectives so that the work they will do can be fully understood and the roles of the advisory board vis-à-vis BCBSM are delineated.
  3. It was suggested that the GTRQC may wish to partner with cancer genetics clinics statewide in this effort to ensure adequate support for this type of an initiative.
  4. Since BCBSM will be looking at more than just cancer genetics testing for assistance, the advisory board will need to have representation from other specialties as well.
  5. The State of Michigan already has a Cancer Genetics Registry with the Michigan Department of Community Health that sees approximately 1500 cases per year registered. How will the GTRQC be different or will this be a duplication of effort?
  6. We hope to work cooperatively with this registry. However we will be looking at using what we learn from the data to provide accessible guidelines and education to the providers and patients. Then we will be measuring the impact of this effort to see if we can improve the outcomes for patients. Rather than being strictly a research enterprise, we are a quality improvement initiative. We want to be sure the right patients get the right tests at the right time and that inappropriate use of the tests are decreased or eliminated.
  7. How will pharmacogenomics be included in the GTRQC?
  8. This role will be defined by the experts in this field. They know better than we do what they can bring to the table. We do want them involved as there are many tests that are run to determine which therapeutic intervention is best for a particular patient. The input of pharmacogenetic specialists will be important to the success of our CQI.
  9. Will primary care providers be involved in the GTRQC?
  10. Yes! We want a significant representation from the primary care provider community as they are the front line for ensuring appropriate use of genetic and molecular diagnostic testing. To participate in the GTRQC, all providers will need to be members of PGIP and an Integrated Health System so we can more easily pull the data needed for our analyses.
  11. Will the GTRQC be looking only at germline mutations or also somatic mutations?
  12. The specific mutations we will analyze will be determined by the Consortium members. This could be germline, somatic, tumor biomarkers or neonatal testing. The members of the Consortium will determine which tests should be reviewed based on impact on patient outcomes and other factors determined by the Consortium members.
  13. What are your greatest needs that the GTRQC may be able to help with?
  14. Insurance authorization for testing.
  15. The GTRQC can drive the process, possibly using a formulary committee approach.
  16. Based on the data that is generated by the GTRQC, we can advise payers on which tests are appropriate for reimbursement and under which conditions.
  17. How to interpret the test results
  18. The attendees suggested that the GTRQC should provide training and educational materials to aid in result interpretation.
  19. The GTRQC’s role will have a major emphasis on education of providers and patients to help them understand these test results.
  20. We anticipate that the guidelines we will review and recommend will include utilizing genetic counselors at various points along the patient’s care continuum to ensure the patient fully understands the test results and their options.
  21. Guidance on who should be ordering the tests.
  22. We anticipate that this type of information will be included in the guidelines and recommendations made by the Consortium.
  23. We strongly support the use of medical geneticists and genetic counselors as part of the process.
  24. How will the GTRQC handle the inevitable economic conflict that will arise as a result of our work?
  25. We acknowledge that some of the recommendations will have economic impacts on both for profit and not-for-profit labs and providers. We realize that, especially in the tumor biomarker area, molecular diagnostics is somewhat of a “wild west” environment. We anticipate addressing this concern by:
  26. Being data driven – evidence based recommendations looking at quality, cost, reliability and other factors.
  27. Making our recommendations clear and concise to aid physician decision making when trying to determine how to proceed with testing.

Interest Surveys

Interest surveys were turned in from the University of Michigan College of Pharmacy and the School of Medicine – Molecular and Translational Pathology.

Phone: 734-763-2616 ● ● ● Fax: 734-936-2629