Highmark’s collaboration with Cognoa on the Canvas Dx autism diagnostic tool signifies a breakthrough in redefining autism care standards. This partnership, marking the first commercial payer support for the innovative AI-driven tool, aims to eliminate barriers to early diagnosis. Canvas Dx not only streamlines the diagnostic process but also generates personalized reports, easing the burden on healthcare providers. The comprehensive coverage provided by Highmark sets a precedent for future payer agreements. Cognoa envisions a future where Canvas Dx becomes the standard of care, reducing wait times and lowering the average age of diagnosis. This collaboration holds promise for transforming autism diagnosis accessibility on a broader scale.
Cognoa’s FDA-approved autism diagnostic tool, Canvas Dx, has achieved a groundbreaking milestone by partnering with Highmark, the first commercial payer to embrace this innovation. This collaboration aims to redefine the standard of care, providing equitable and early access to autism diagnosis for children and families. The Canvas Dx tool, powered by AI, not only facilitates swift and unbiased diagnosis but also generates personalized reports, alleviating clinician burdens. Highmark’s commitment to cover the entire cost sets a precedent for comprehensive digital health coverage. This transformative partnership could pave the way for similar agreements, addressing the pressing challenges of undiagnosed autism.
The tool, Canvas Dx, will now be reimbursed for commercial Highmark members. It aims to enable earlier and more equitable access to diagnosis for children and families without specialists. The tool leverages AI to empower doctors to quickly and accurately diagnose developmental risk without bias, the company claims.
The contract should be seen as “model medical policy,” Dennis Wall, Ph.D., autism researcher and founder of Cognoa, told Fierce Healthcare. Wall hopes the coverage will be replicated across other payers. Highmark will cover the full price, including the total cost of Canvas Dx and the time it takes for a provider to administer it.
Pittsburgh-based Highmark is an innovative, influential payer Cognoa is excited to partner with, Wall said. In 2022, the plan announced its intention to expand coverage for some prescription digital therapeutics cleared by the FDA, reportedly becoming the first large commercial insurer to signal so. The company has 6 million members in Pennsylvania, Delaware, West Virginia and New York. Last year, Highmark claimed to be the region’s first plan to establish a value-based arrangement for behavioral health care.
Under the Highmark contract, Canvas Dx can be prescribed by any clinician or advanced practitioner. It does not require prior authorization, and, if a parent or physician identifies risk, a doctor can prescribe it at will.
This is the first time that any digital solution gets on a medical policy with a price and a code, as far as the company knows, Wall said. “We’re grateful to Highmark for listening to us and for doing the homework to come to the same conclusions we’ve drawn,” he added. Highmark did its own claims analysis to confirm that the costs associated with undiagnosed autism are unsustainable, per Wall.
“On average, the median number of visits that a patient would have after having identified risk and prior to a diagnosis is about 15, and the cost of that exceeds a median of $5,000,” Wall said. That cost doesn’t include the expense of the diagnostic itself. And wait times to see a specialist for a diagnosis can range from months to years.
In autism care, a primary care physician or pediatrician typically refers a patient to a specialist to get a diagnosis, per Wall, who also runs a lab in pediatric innovation at Stanford University. “That’s because they’re not equipped either with the time or skills or training or the tools … to definitively act at the moment the child presents with a risk,” Wall said.
Apart from its AI-driven ability to aid in diagnosis, Canvas Dx also features an automatically generated personalized report with a child’s strengths and challenges based on standard criteria known as DSM-5. This helps eliminate the clinician burden of generating a report, per Wall. The report also includes common treatment options and what is typically covered by a given plan.
Part of the goal with this milestone for Cognoa is to establish Canvas Dx as the standard of care in the autism space in the coming year, Wall said. Within two years, Cognoa hopes to eliminate provider wait lists and ultimately cut the current average age of diagnosis of 4.5 years by two years, he said.
In Wyoming, Arizona and California, Cognoa is participating in an early start program, according to Wall, allowing Canvas Dx to be prescribed and reimbursed under each state’s Medicaid plan. In return, providers offer feedback on adopting the product.
Cognoa’s collaboration with Highmark heralds a new era in autism diagnosis accessibility, with Canvas Dx at the forefront of innovation. The comprehensive coverage provided by Highmark not only addresses financial barriers but positions Canvas Dx as a potential standard of care. By eliminating provider waitlists and targeting a reduction in the average age of diagnosis, this partnership underscores a commitment to timely and effective autism care. As Canvas Dx becomes more widely adopted, it holds the promise of reshaping diagnostic practices and improving outcomes for children and families. This collaboration stands as a testament to the transformative impact that pioneering technology and forward-thinking payer partnerships can have on healthcare.