Interview with Gabriel Bien-Willner of Palmetto GBA

Dr. Bien-Willner is the Medical Director of the MolDX program at Palmetto GBA, a Medicare Administrative Contractor (MAC). MolDX seeks to understand the molecular testing landscape to implement payer controls, coverage, and to set policy for affiliated MACs, which currently cover 28 states. He is a leader in the Precision Medicine space and practices as a Board-certified Anatomic Pathologist and Molecular Genetic Pathologist. Throughout his career, he has been active in research, development, and advancement of molecular diagnostic services, specifically next generation sequencing. Read his full bio.

Interview with Gabriel Bien-Willner, Medical Director, Palmetto GBA

Q: What does your role entail as the director of the MolDX program at Palmetto GBA?

A: The job directing MolDX is multifaceted; first and foremost the MolDX program is responsible for assessing molecular diagnostic tests on the market and makes coverage and pricing determinations for such tests and technology. This is usually done through local coverage determination policies or technical assessments. This involves direct interactions with the providers performing these services and subject matter experts (SMEs) who help provide feedback and insight to utility of these tests. Secondly, we must communicate these findings with the provider community to make sure they understand the policies and how to comply with them to reduce provider burden and lower improper payments from CMS. I am also used as a SME by different branches of the government regarding molecular diagnostics.

Q: What challenges oncologists face in the genomic era and how molecular pathologists could help?

A: As cancer care adopts precision medicine and clinicians employ more and more sophisticated genomic tests, they will become more and more dependent on SMEs to explain the results within a clinical context. Molecular Pathologists can help by becoming more conversant on the clinical use and utility of these tests, the associated pharmacology, and of course the underlying genetic principles and how they can be used to guide the oncologists’ hands.

Q: What advice can you give hospitals and health networks that are planning to implement precision medicine programs that will successfully use genetic testing and gene sequencing in support of clinical care?

A: Having run precision medicine programs outside my role at Palmetto GBA I may be able to provide some helpful suggestions. First, ensure there is administrative support for such a project and that funds are available to enact it. Implementing such a program is not as simple as sending tests out; it requires significant education and expertise to ensure staff adapt to changing processes, technology, and science. Secondly, there have to be leadership in the staff that support the initiative and recruit or have access to molecular pathologists who have expertise in molecular genomics and their clinical applications. These individuals must be able to educate staff about molecular pathways and genetic principles in Molecular Tumor Boards and other educational sessions; they should feel comfortable being part of the treatment decision process. Third, IT infrastructure may become a significant hurdle and it is important to have IT support for this process as data do not often travel freely from clinician workflows to vendor laboratories.