Published in Health Care
Gov. Gretchen Whitmer speaks as part of the formal launch of BAMF Health Inc.’s flagship cancer treatment facility in Grand Rapids.  Gov. Gretchen Whitmer speaks as part of the formal launch of BAMF Health Inc.’s flagship cancer treatment facility in Grand Rapids. COURTESY PHOTO: BAMF HEALTH INC.

PASSING MUSTER: Insurers control destiny of medical innovators like BAMF Health

BY Sunday, October 23, 2022 06:00pm

GRAND RAPIDS — The advanced medical technology behind BAMF Health Inc.’s new Grand Rapids clinic offers great promise in diagnosing and treating cancer.

Yet before BAMF Health could deploy the medical technology that was previously unavailable in the U.S. and begin seeing patients, the company had to prove to health insurers that it worked and deserved coverage. 

The process serves as a further indicator of the weight that insurers carry in the health care market: Failing to make the case and secure reimbursement from insurers can stall or stop the development or deployment of medical innovations.

To insurers like Priority Health, the decision over whether to cover a new diagnostic test, medical device, procedure or therapy comes down to the scientific evidence that proves its effectiveness and safety, said Dr. Jim Forshee, senior vice president and chief medical officer at the Grand Rapids-based health plan.

The process illustrates the balance insurers must strike between cost, which ultimately affects insurance premiums, and supporting a new technology that can improve quality and generate better medical outcomes in today’s era of precision, molecular-based medicine. A new medical technology does not necessarily “have to be less expensive” for Priority Health to grant coverage if it produces better medical outcomes for patients, Forshee said.

“We constantly look at: Is it evidence-based? Is it the right care, at the right place, at the right time, and are we getting to the right cost?” Forshee told MiBiz in an interview where he explained the extensive review process that care providers and innovators like BAMF Health must go through to secure coverage. 

The review process at Priority Health, the second-largest health plan in Michigan with 1.2 million members statewide, involves committees of health care experts who review information and recommend whether to cover a new diagnostic test, device, procedure or therapy. The ultimate decision rests with the board of directors, Forshee said.

‘Great potential’

For BAMF Health, Priority Health’s review led to a decision to cover the diagnostic scans and treatment the company now offers in Grand Rapids, Forshee said. The technology BAMF Health uses has been deployed successfully in Europe.

The high-speed PET/CT and PET/MRI medical scanners that BAMF Health installed at the Grand Rapids clinic are “unbelievably faster” than what’s been used in the U.S. and are “major improvements in a known technology” to diagnose patients, Forshee said. The process BAMF Health takes to make isotopes for radiation treatment also represents a significant improvement over existing methods, he said.

“We didn’t have a hard time saying, ‘That’s going to be OK,’ and that these very significant improvements in the technology were legitimate,” Forshee said. “It just has great potential.”

BAMF Health uses advanced high-speed scanners, a cyclotron-equipped radiopharmacy and molecular imaging to diagnose several forms of cancer. The company presently treats prostate and neuroendocrine cancer at the theranostics clinic at the Doug Meijer Medical Innovation Building on Michigan State University’s Grand Rapids Innovation Park research campus.

The clinic uses radiopharmaceuticals for molecular imaging combined with artificial intelligence to precisely target radiation therapy on tumors, allowing BAMF Health to customize treatment to the patient. The radiation therapy attacks just the cancer cells without damaging tissue surrounding the tumor and has far less side effects for the patient than traditional chemotherapy or radiation treatments.

In preparing to launch, BAMF Health secured reimbursement agreements with Priority Health, Blue Cross Blue Shield of Michigan and other health carriers, executives said. Approvals with Medicare and Medicaid are pending.

“By Jan. 1 of next year, we will without a doubt be covered by every major insurer and we’ve seen no resistance there,” BAMF Health COO Chad Bassett said. “The data is on our side, and is on the side of theranostics as well.”

More growth ahead

The Grand Rapids facility is the first clinic of its kind in the U.S. to offer the advanced cancer diagnosis and treatment that founder and CEO Dr. Anthony Chang saw doctors successfully deploy in Germany for patients with prostate and metastatic neuroendocrine cancers.

BAMF Health started scanning patients in late July. The company has been steadily ramping up operations toward full capacity by early 2023.

Over time, Chang wants to extend the medical technology to treat other forms of cancer — breast, brain, colon and lung among them — as well as expand to treat neurological diseases such as Parkinson’s and Alzheimer’s.

In addition to providing clinical care, BAMF Health also intends to continue researching new treatments.

“The goal over here is actually trying to push the envelope, push the limit to bring the best technology to the patients,” Chang said. “We’re going to offer the large-scale routine care, but we’re also going to bring in a lot of clinical trials to make sure new technology, new drugs for different kinds of cancer, different kinds of diseases, can actually move forward getting closer to the patients.”

The first trial will target prostate cancer in its earlier stages, Chang said. Other trials will examine pediatric patients and cancers that “currently have no solutions,” including pancreatic cancer, he said.

The Grand Rapids clinic has already seen “incredible demand” to host clinical trials and research in partnership with pharmaceutical companies and researchers, Bassett said.

“We will carefully balance the patient need, the patient demand, with working with other drug companies and with researchers around the country to also advance the medicine for new drugs, new procedures, new treatments,” Bassett told MiBiz. “That’s what the facility was really designed for: to be able to provide both cutting-edge care, but also the research and clinical trials to simultaneously advance care into the future as well.”

BAMF Health already plans to expand outward from Grand Rapids. The company has begun evaluating locations and talking with potential partners in the Detroit area for a second clinic.

Chang envisions developing a series of clinics across the U.S. in the years ahead. He has plans for a smaller clinic at Loma Linda University in California. Other potential locations are in Texas, Florida, Tennessee, Pennsylvania, and Arizona, Bassett said.

“We are working with several significant partners in the field and trying to expand this kind of technology and the platform to major metropolitan areas around the United States,” Chang said. “The demand is so strong and the need is very clear, and we have a lot of patients we need to serve for prostate cancer alone.”

Read 2732 times Last modified on Monday, 24 October 2022 08:42