Last month, leading health plan executives joined us for an in-depth discussion on managing the cost, quality and value of genetic testing. The exchange offered an inside look at their efforts to manage genetic testing and included practical advice for health plan leaders seeking to better manage this space.

Highlights from the discussion include:

Costs are rising fast.
“Our spend in this category has hit triple-digit increases in a couple of years. The area is exploding.” (6:35)

Knowledge gaps exist.
“We also had an internal knowledge gap…a lot of our staff weren’t well equipped to understand these tests.” (8:50)

Health plans need to understand what tests they’re paying for now.
“Job #1 was trying to understand what our spend was for. For that, we went outside and into a relationship with NextGxDx (*now Concert Genetics) to take a look at our claims data.” (10:19)

Quality data can be scarce.
“Of the many thousands that are out there, maybe 400-500 have any level of evidence or evidence-based guidelines or clinical utility. It’s a small fraction.” (23:00)

Cost-effectiveness is the goal.
“One of our challenges is…not only what is the right test but, once we have that category finished, to say what’s the most cost-effective or economical test in that area that still delivers good quality.” (35:00)

The panelists also discussed:

  • Establishing laboratory partnerships and narrow networks

  • The value of genetic counselors

  • Working with the limitations of billing codes

  • Advice for health plan leaders just getting started

We hope you find the insights from this session valuable, and we look forward to more events like it in the coming year.

*NextGxDx became Concert Genetics in March 2017. 


Thu. January 5, 2017
Back to Blog