Why Your Insurance Won't Pay for Prevention (Yet)

In this episode, host Perry Dimas sits down with Dr. Michelle Malcolmson — a physician trained at the intersection of biology, nutrition, and genetics — to unpack what personalized medicine really means and why the healthcare system still struggles to deliver it.

Dr. Malcolmson defines precision medicine as treating the individual rather than the "population average," and explains how falling costs of genetic testing now make it possible to understand a patient's pharmacogenomics (how they metabolize drugs), polygenic risk, and disease susceptibility years before symptoms appear. 

She and Perry dig into why insurance coverage for these tests lags so far behind the science — tracing the problem back to a payment system where private insurers cover people's "healthy years" while Medicare absorbs the cost of their "sick years," leaving little financial incentive for prevention.

The conversation ranges across:

• Why it took over a decade for prediabetes guidelines to catch up to the evidence
• The disconnect between short-term insurance enrollment (patients often switch plans every few years) and the long-term payoff of preventive care
• How oncology has led the way in genetic-guided treatment, and what other specialties can learn from it
• Strategic advice for diagnostic and biotech companies: focus on Medicare reimbursement pathways rather than chasing employer groups first
• The added complexity Medicare Advantage plans bring to prior authorizations and access
• Why patients may need to become the "CEO of their own health" — tracking labs, genetics, body composition, and grip strength — while the system slowly realigns its incentives

The episode closes with a shared vision: shrinking the gap between lifespan and healthspan, and empowering individuals to advocate for their own preventive care even before the payer system catches up.

—-------

Stay connected with our host, Perry Dimas, here on LinkedIn!
📧 Interested in joining our medical director advisory group? Email us at info@accessdx.com
🔗 Connect on LinkedIn: linkedin.com/company/accessdx