NEW YORK (GenomeWeb) – AIM Specialty Health has partnered with InformedDNA to help health plans manage appropriate genetic testing use and increase patients and physicians' access to genetics professionals.
AIM is a benefits management company and an affiliate of national insurer Anthem. The company provides specialty benefits management services to a variety of payors in radiology, cardiology, oncology, sleep management, and specialty drugs. InformedDNA, an independent network of genetics specialists, is collaborating with AIM so it can draw on InformedDNA's expertise to guide appropriate use of genetic testing in line with medical guidelines and payer policies.
"[Genetic testing] is becoming an integral part of medicine," Amber Trivedi, senior VP of provider and client services for InformedDNA, told GenomeWeb. "InformedDNA and AIM are collaborating on a joint product that supports all types of genetic testing and is not limited to any specific areas."
Trivedi further explained that the partnership between the two firms focuses on genetic testing utilization management. Over the past year-and-a-half Trivedi has noted growing interest among health plan providers for genetic testing benefits management services. There has been an "explosion of new genetic tests" being put on the market, she said.
According to healthcare technology firm NextGxDx, there are around 60,000 commercially available genetic testing products in the US market, and on average labs are launching 10 new tests daily. In this environment, it requires genetics expertise to know when a test is necessary and when it isn't, and what types of tests to order.
InformedDNA is experienced in this regard. For example, a few years ago the company began providing genetic counseling services to Cigna members considering testing for breast cancer risk, colorectal cancer syndromes, and Long QT syndrome.
A critical part of the services InformedDNA provides for insurers involves reviewing claims for genetic testing. At insurance companies, those reviewing genetic testing claims may not understand why a test might be medically relevant. As a result, patients "are just denied coverage for testing," Trivedi said. "We want to modify policies so they are practical, covering tests that should be covered. Historically, genetic testing policies haven't adequately addressed ordering providers' needs since policy-writers didn't have practical knowledge of genetics in medicine."
Several years ago, Aetna started tracking testing patterns in the community healthcare setting following accounts from payors that doctors were inappropriately ordering BRCA testing to assess women at higher hereditary risk for breast and ovarian cancer. Last year, researchers from Aetna and elsewhere published results from a survey of more than 3,600 women who had BRCA testing, and showed that around 37 percent received counseling from a genetics clinician before getting tested and 16 percent didn't meet testing criteria.
Now, a number of insurers dictate that patients undergo genetic counseling to ensure that the testing is medically necessary. For example, starting Jan 1, UnitedHealthcare began requiring genetic counseling for coverage of BRCA testing. These policies coincide with increasing availability and demand for next-generation sequencing-based panels that can assess multiple genes at once.
The American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists, together known as ACOG, issued a statement last year expressing concerns that insurers' prior authorization requirements will make it harder for women to get the care they need.
However, Trivedi noted that payors that have implemented requirements for genetic counseling have done so in ways that mitigate barriers to patient access. "In addition to traditional face-to-face appointments with genetics providers, payors have made genetic counseling accessible via telephone with evening and weekend appointments and expedited scheduling to accommodate patients with immediate treatment decisions," she said.
She added that payors have also worked with ordering physicians and testing labs to educate them on how to make the genetics referral process as streamlined as possible. "Genetic counseling is the standard of care for these tests, and there is ample literature revealing suboptimal patient outcomes when genetic counseling is not provided," Trivedi said. "Patients report great satisfaction from the genetic counseling requirement, with several testimonials of patients truly appreciating counseling even when they were initially reluctant to go through the process."
Ultimately, increasing patients and physicians' access to genetics experts through health plans will ensure appropriate use of genetic testing and reduce wasteful spending, Trivedi believes. She added that "increasing access to experts will also significantly improve patient care and help non-genetics providers stay abreast of best practices."