When Nicole Lambert started working as a genetic counselor 25 years ago, patients had to meet a long list of criteria to access testing. They had to have four relatives with breast cancer or ovarian cancer to get genetic testing.
Since then, “everything has changed,” said Lambert, who is now the president of Myriad Genetic Laboratories. Any woman with a history of breast cancer is eligible for genetic testing, regardless of their family history.
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She and other panelists reflected on how much access to genetic testing has increased at MedCity’s INVEST Precision Medicine conference. At the same time, a proliferation of available tests poses new challenges for healthcare providers and insurers.
“To capture the benefits of genomics, we have to improve access,” said Dr. Peter Hulick, medical director of NorthShore University Health System. “We have a large division relative to our health system, (but) we can’t see every patient that possibly would benefit from genetic testing.”
The health system has been working over the past five years to integrate genetic tests into patients’ primary care through best practice alerts. So far, 1,000 patients in this effort have received results that they’ve acted on medically.
Part of the challenge is that too much care can be just as harmful as under-care, Hulick said. Not only do physicians have to be willing to order a test, but insurance also has to be willing to cover it.
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Payers have to not only consider whether ordering a test would be cost effective, but what patients will do when they get their result.
“The fear of the payer is this is going to all sorts of downstream interventions that may or may not be medically necessary and will be costly to the system,” Lambert said.
Scott Snyder, the co-founder and CEO of a startup called Geneticure, said his company had taken the approach of focusing more narrowly on genes that are most likely to affect a patient’s response to blood pressure medication.
“The panel has to make sense from a health economic standpoint to payers,” he said. “Whole genome sequencing is plummeting in cost, but until a panel like ours is so cheap that you could practically put it in everyone’s chart, payers aren’t going to cover it.”
Companies must constantly prove the cost-effectiveness and value of their tests, especially in an environment where there are so many options.
“Payers are in a difficult spot. With the explosion of technology, they’re being asked to evaluate new technologies and new genetic tests hundreds by the day,” Lambert said. “It’s very difficult for them to sort out what’s going to provide true value to them and what’s not.”
Featured Photo credit: iLexx, Getty Images
