Genomics-informed precision health holds enormous promise for patients – and can impact every aspect of a health plan’s business. When properly integrated, precision health may enable tailored care and potentially improve outcomes. However, rapid advances – including a growing number of expensive genomic tests and treatments – far outpace the resources that most health plans can allocate to keep up with these developments.

Unfortunately, traditional benefits management paradigms are not well-suited to this evolving space. A genomic benefits management (GBM) strategy can help health plans translate precision health breakthroughs into the precise circumstances in which they can deliver clinical benefit

A GBM strategy should guide decision-makers using a comprehensive methodology that brings clarity, not questions. Effective GBM requires a holistic approach that optimizes genomics-related decision-making. By going beyond the typical single-discipline evidence review, a GBM strategy can help plans understand when and how scientific advances can improve member care while ensuring responsible cost management. GBM should also further the tenets of value-based care and enhance member care experiences, advance population health, reduce per capita healthcare cost, and improve providers’ work life.

At InformedDNA, our holistic GBM strategy is built on three key components:

• Clinical guidance. We leverage clinical genomics, bioethics, and public health experts to curate the latest evidence-based knowledge and proactively define the ideal framework for member care. This informs the development of clinically applicable guidelines and policies that reduce provider abrasion, increase adoption, and deliver clinical value.
• Cost management. We help institute advanced cost-control approaches with smart algorithms, expert-powered logic, and analytics to manage genomic test and treatment payment. This removes clinically unnecessary or inappropriate costs without compromising patient outcomes. It also provides industry insights for health plans to contract with laboratories for evidence-based testing with the most appropriate codes and rates.

Patient navigation. We remove friction caused by insufficient knowledge for both providers and patients. If a more appropriate genetic test is available, providers can receive decision support from genetic specialists in real-time. In addition, our team of genetic counselors can empower members to make informed decisions around