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Navigating Risk, Treatment, and Reimbursement in Precision Oncology: Sadie Dobrozsi, MD
Sadie Dobrozsi, MD, of Evolent, discusses how predictive genomics is pushing cancer care into a new era of personalization
Precision medicine has long shaped cancer care by tailoring treatment to the molecular profile of a patient’s tumor. But Sadie Dobrozsi, MD, medical director for genetic testing and oncology imaging at Evolent, says predictive genomics goes deeper, integrating a patient’s genetic makeup, family history, environment, and overall health to guide both risk reduction and treatment decisions.
Dobrozsi explains how predictive genomics identifies individuals with inherited mutations, such as BRCA1/2, that increase cancer risk. This enables personalized risk-reduction strategies, ranging from enhanced screening, like breast MRI, to preventive surgery. While payer coverage for germline testing and screening has improved, coverage for more invasive interventions still varies.
Predictive genomics also shapes treatment planning, not only identifying which therapies may work but also who might avoid unnecessary toxicity. Genomic signatures in tumors can determine the need for chemotherapy in early-stage breast cancer or guide the use of targeted agents like PARP inhibitors in BRCA-mutated tumors.
An emerging area, pharmacogenomics, may further refine treatment by revealing how individuals metabolize drugs, helping avoid ineffective dosing or severe adverse effects. However, Dobrozsi explains the field faces barriers, including data overload, ancestry bias in genetic databases, and inconsistent insurance reimbursement, especially for newer tools like circulating tumor DNA tests.
Evolent plays a key role by aligning clinical evidence with payer policy. Dobrozsi says her team evaluates test quality and relevance, helping health plans streamline access to the most clinically meaningful diagnostics.
As predictive genomics evolves, the goal is clear: “right-sizing” cancer therapy for each individual, using evidence to improve outcomes while minimizing harm.
Listen above or on one of these podcast services:
Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
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Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements
December 1st 2025Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.
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Mental Health Care Use After Leaving Medicare Advantage for Traditional Medicare
December 1st 2025Medicare Advantage beneficiaries with mental health diagnoses see more nurse practitioners and fewer internal medicine and emergency medicine specialists after switching to traditional Medicare.
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