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Olivier Elemento: AI in Hematology – The Path to Coverage

Olivier Elemento/LinkedIn

Jun 29, 2025, 13:26

Olivier Elemento: AI in Hematology – The Path to Coverage

Olivier Elemento, Director of Englander Institute for Precision Medicine, shared a post on LinkedIn:

“AI in Hematology: The Path to Coverage

In my role as a member of the American Society of Hematology Subcommittee on Artificial Intelligence, I had the opportunity to speak at yesterday’s American Society of Hematology (ASH) Carrier Advisory Committee (CAC) meeting.

This meeting provides a vital forum where hematologists and the Medicare Administrative Contractors (MACs) who write local coverage policy can strengthen relationships, discuss policy issues, and find solutions to real-world reimbursement challenges.

My talk briefly covered where the hematology field is at regarding diagnosis and treatment selection, and the work needed to bring AI tools from the lab to the clinic. AI increasingly enables analysis of complex data—from pathology slides to lab tests—to predict a tumor’s genetics or a patient’s response to CAR-T therapy. The core challenge remains the critical “evidence gap”: a lack of prospective, randomized clinical trials needed to prove these tools definitively improve patient outcomes.

There were several important discussions with the MACs at the meeting. A key focus was demystifying the process for creating Local Coverage Determinations (LCDs) and defining the high level of clinical utility evidence required for reimbursement.

While hematology AI carves out its path, we can learn from other specialties. I think it’s important to see that reimbursement for new technology is already happening. AI tools that analyze coronary plaque, for instance, are now covered by several MACs under specific LCDs.

This example highlights that the pathway to coverage is often local, which is why the dialogue between clinicians, innovators, and the MACs at the ASH CAC meeting is so vital for building the bridge from a promising algorithm to a proven, reimbursed clinical tool.”