Executive Summary, by InformedDNA
Precision medicine that harnesses advances in genomics holds enormous promise for impacting every aspect of a health plan’s business. When properly integrated, genomics enables more tailored care with the potential for tremendously improved outcomes–especially in specialties such as oncology and reproductive health. Genomics is a technically complex discipline with a growing number of expensive tests and treatments. However, rapid advances in genomics currently far outpace the resources that most health plans are able to allocate to keep up with the developments. Although genomics now informs diagnoses and treatments that cross multiple medical specialties, plans are challenged to translate the molecular advances to the precise circumstances under which they will deliver clinical benefit.
Unfortunately, in this evolving space, traditional benefits management paradigms fail to produce optimal outcomes. Health plans need solutions that go beyond the typical single-discipline evidence review to stay abreast of the scientific advances and understand when and how they can be applied to improve member care while ensuring responsible cost management. However, few health plans currently experience the benefit of a fully optimized genomic benefits management (GBM) strategy.
A GBM strategy should ameliorate the complexity through a comprehensive methodology that brings clarity, not questions, to decision-makers. Effective GBM requires a holistic approach to applied genomics that optimizes genomics-related decision-making.
Moreover, it should further the tenets of value-based care and the Quadruple Aim of improving member/patient care experiences (including quality and satisfaction); improving population health; reducing per capita healthcare cost; and, improving providers’ work life. A holistic GBM strategy involves the following three key components:
- Clinical Guidance. Leverages clinical genomics, bioethics, and public health experts to curate the latest evidence-based knowledge and proactively defines the ideal framework for member care. This framework informs the development of clinically applicable guidelines and policies that reduce provider abrasion, increase adoption, and deliver clinical value.
Cost Management. Institutes advanced cost control approaches with smart algorithms, expert-powered logic, and analytics to manage genomic test and treatment payment. It removes clinically unnecessary or inappropriate costs without compromising patient outcomes. It provides industry insights for health plans to contract with laboratories for only evidence-based testing with the most appropriate codes and rates.
Patient Navigation. Removes friction caused by insufficient knowledge for both providers and patients. It proactively enables health plans to: identify opportunities for value-driven interventions; empower informed decision-making; counsel and guide members; and, support providers with education and decision support.
Comprehensive GBM goes beyond utilization management; it creates value for the provider, patient, and across the health plan. Applying deep clinical and scientific genomics expertise and experience is the foundation of GBM. An applied genomics solution partner like InformedDNA can help you execute all of the fundamental components for a highly effective GBM strategy, and help you stay ahead of the genomics revolution.
Learn more about genomics benefits management, download our complimentary eBook today.
We are the nation’s largest and most experienced organization of full-time, lab-independent genomics specialists, letting you stay ahead of the curve by applying expert genomics insights. As the leading innovator of genomic benefits management (GBM) solutions, InformedDNA has a long history of collaborating with national and regional health plans to create and scale successful solutions. By augmenting health plans’ in-house teams, we empower them to promote precision medicine, optimize spending, and enhance experiences for sponsors, providers, and members.