As we enter into 2022, health organizations should expect three industry-wide issues that have simmered on the back burner to begin rising to the forefront:
- Equitable access to care;
- Stronger embrace of telehealth technologies;
- Advances in personalized medicine and how to know when they’re ready (or not) for prime time standard of care.
Below is a look at how each may impact health plans’ genomics strategies in the coming year.
Trend 1: Equitable access to genomic testing
The increased pressure we’ve recently seen from legislators, lobbyists, and others to improve members’ access to genomics-based diagnostic tests and treatments promises to create space for health plans to innovate their current approach to genomic testing access.
Although that may seem counterintuitive at first, consider the fact that prior authorization processes too often are blamed for limiting access to genomic testing. The question is this: Will eroding prior authorization processes really increase access to those who can benefit from genomic testing?
The key to success is to enable equitable access. What good does it do to open access to tests with limited clinical utility that neither improve health outcomes nor increase healthcare affordability for members?
For that reason, we predict that removing prior authorization will not be the sought-after “silver bullet” solution to equitable access that some stakeholders believe it to be. Instead, we will need to see more education about the impacts of genomic testing, in tandem with new approaches to health plans’ coverage decision frameworks.
As some health plans have begun to realize, the old evidence framework doesn’t work for genomics—as large panel tests have shown. We have seen cases where labs, providers, and societies try to benefit from new technologies by pushing forward coverage and recommendations for large panel tests. The problem is that evidence review processes haven’t caught up with the pace of test development. As a result, there’s no consistency yet in how plans are proceeding to employ a new model to address the level of complexity involved.
Health plans must begin establishing new coverage frameworks to prevent member and provider abrasion, take into account best clinical practices and society recommendations, and decrease potential risks. Indeed, now is an excellent opportunity to become more active in the dialog by adopting a clear and systematic coverage framework. The health plan, with the right genetics expert support, can help ensure accessibility to the tests that meet members’ needs and providers’ demands while limiting the use of tests without solid evidence of clinical utility.
Members’ access to care will only improve when clinically applicable guidelines and policies for genetic testing are aligned with and help identify opportunities for engagement and value-driven interventions. Such coverage frameworks will allow health plans to give broader member populations access to necessary genomic testing, even as they reduce the potential harm from inappropriate testing and treatment.
Trend 2: Stronger embrace of telehealth technologies
Digital health technologies have been around for years, but it’s no secret that the pandemic fast-tracked people’s reliance on them. Although members largely preferred in-person healthcare visits over video appointments in the past, COVID-19 quickly increased their comfort level with virtual encounters.
Moreover, the market’s prominent focus on the benefits of virtual care since the emergence of COVID-19 has increased market readiness for telehealth solutions. Now that many virtual solutions have been adopted for COVID-19 use-cases, health plans can begin seizing opportunities to apply them to other areas as well, including genetics.
As an industry, we’re finally at a point where there is enough telehealth adoption that it can be leveraged to engage members—individually and at a population level—like never before. By combining more member education about the impacts of genomics screening with more equitable access through telehealth technologies, health plans can start to better manage both clinical and financial risks at the population health level.
Trend 3: Advances in personalized medicine
The enhanced and hopefully expanding awareness throughout society of the impacts of diversity, equity, and inclusion (DEI) is sure to spur even further advances in genomic testing and treatments, as genomic medicine continues to take its place as a significant element of value-based care and personalized medicine.
At the heart of equitable healthcare is identifying how the needs of different subpopulations may differ—and then determining how to address those needs for each individual efficiently and effectively. Genomic testing and counseling can aid both endeavors. They not only help health plans, providers, and members ascertain their immediate needs, but they then point the way toward more personalized proactive interventions and effective treatments.
The tie between genomics and personalized medicine has not gone unnoticed by the market, either, as evidenced by alliances such as the recent acquisition of telemedicine company Lemonaid Health by consumer genetics company 23andMe. In all likelihood, we will continue to see more mergers and acquisitions between genomics and primary care organizations seeking to leverage the personalization benefits that genomics can offer. Health plans will need to partner with organizations that have a deep bench of genomics expertise to ensure the most effective position in personalized genomic medicine.
Prepare for the genomics revolution
Genomic medicine is complex. A solid foundation is required for health plans to implement its benefits for members in ways that minimize risk and maximize clinical and financial outcomes. That’s why we believe 2022 will be a year for health plans and others to advance the strategic groundwork necessary for the effective application of genomics. But then—with the proper groundwork, education, and planning in place—we will begin to realize all the benefits of a full-fledged genomics revolution in healthcare.
If you’d like to learn more about InformedDNA and the expert genetics services we offer for health plans, healthcare providers, or pharmaceutical companies, please get in touch – just fill out the short form below, or give us a call: 844-846-3763.