Subject to change.
Subject to change.
Dr. Fickie is a senior medical director at Highmark. In this role, he oversees the medical policy department, the New Technology Assessment Committee and its pilot program, Coverage with Evidence Development. Dr. Fickie trained at the University of Missouri in internal medicine/pediatrics then Harvard Medical School in clinical genetics. After almost 10 years of clinical practice, he joined Highmark. Highmark is the 4th largest Blue Cross Blue Shield member with nearly 7 million members.
Learning Objectives
While digital pathology adoption is increasing and AI image analysis continues to show impressive potential to impact the practice of pathology, the overall return on investment (ROI) for digital pathology implementation remains a significant challenge. With an increasing number of DP solutions being cleared by the FDA for IVD applications, the lack of reimbursement is quickly becoming the most significant barrier to DP adoption.
Category III codes introduced in 2023 for tracking of whole slide imaging have been difficult to implement and may not be generating the evidence required to move forward quickly with significant change. Furthermore, to date, these codes are focused solely on digitization in the lab and do not provide for tracking or reimbursement for emerging AI image analysis solutions developed for digital pathology.
The DPA Reimbursement Task Force has a mission to "Define and shape the pathway to reimbursement for digital pathology solutions enabling broad market access and delivery of value to patients and stakeholders." To this end, we have identified key strategic initiatives to enable the DPA to play a leading role in advocacy for a pathway to reimbursement for AI solutions. In addition, the task force is working through blog posts and webinars to educate the DPA members on the current state of reimbursement for DP and the opportunities ahead.
This session will provide an update on the key work of the task force and provide a detailed look into the framework for DP AI reimbursement that the task force is pursuing.