Guidelines and Policies
The InformedDNA genomic benefits management (GBM) solution utilizes the latest in evidence, bioethics, and public health expertise to help health plans offer provider-friendly genomic coverage policies and guidelines. Our condition-specific approach to genomic coverage policy reduces complexities and provider abrasion, all while decreasing inappropriate genetic testing and its related spend.
Our clinical guidance solutions centralize and evaluate all of the most current research and evidence in the context of additional relevant factors, bridging the gap between the evidence that health plans require and the evidence available in the unique field of genomics.
Reduce Complexity and Costs
Our clinical guidelines for appropriate use of genomic testing improves patient care while decreasing inappropriate costs.
Decrease Provider Abrasion
Our guidelines, written by genomics expert, for clinicians, enable plans to consolidate policies and incorporate real-world clinical care practices, leading to decreased provider abrasion and increased adoption.
Optimize Appropriate Use
Expert curation and quarterly review of clinical guidelines and changing genetic testing markets ensures coverage of currently available tests to stay ahead of new, yet medically unnecessary testing.
Let’s talk about your needs!
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Applied Genomics Resources and Expertise
InformedDNA provides the broad and deep genetic counseling expertise that we need, while making the process easy and convenient so their services are well received by our providers and patients. Because of our partnership, we’re able to offer timely access to genetics experts, who provide the level of care, recommendation and follow up that is truly desired by our constituents.
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Reduce Prior Authorization Complexities
Avoid unnecessary denials by guiding providers to alternative test options and labs when appropriate. Our holistic genomic benefits management (GBM) approach enables us to provide:
- Guidelines developed through our rigorous process that integrates evidence-based review with clinical expertise
- A fully automated genetic testing prior authorization solution with our channel partner, with ability to get point of care approvals
- Expert opinion reviews, as needed, by genetic analysts who based on their experiences as clinicians can synthesize case-specific data and evidence-based criteria into determination recommendations
Reduce Genetic Test Complexity and Spend
Balancing national guidelines with condition-specific criteria leads to improved payer policies and better health outcomes for patients. InformedDNA supports your guideline development with:
- The largest full-time staff of lab-independent genetic specialists in the nation
- Proprietary up to date library of evidence reviews encompassing thousands of detailed summaries of available tests and potential genetic diagnoses for policy and review support
- Clinical experience and deep subject-matter expertise
- A clear understanding of the challenges associated with using genetics in healthcare—and the most appropriate, safe, effective solutions
Rigorous, provider-friendly guidelines reduce abrasion and drive adoption
New genetic tests enter the market every day, making it difficult to keep pace with change and determine which should be covered in your plan’s policies.
The guidelines must address many factors in the face of rapidly changing genomic science and a rapidly changing test landscape. This is further complicated by the cross-specialty relevance of genetic tests. Adopting a clinical specialty-based — rather than a gene- or test-based — approach to policy development represents a paradigm shift for most health plans. Traditional clinical utility frameworks are difficult to apply to genomics because they focus only on the amount and strength of research-based evidence — which is often limited in genomics.
To address the scarcity of outcomes evidence and clinical specialty-centric view needed, our clinical guidance evaluates the most current evidence in the context of clinically important factors. These include professional guidelines and expert opinion, clinical availability of comparable alternatives, personal utility, downstream costs, risk of overutilization, and risk of harm, all of which impact coverage assessment.
Once condition-specific guidelines are written, they are deployed in a systematic approach that ensures the policies evolve based on changing science and with real-world applications in mind.
Learn about InformedGENOMICS™, our evidence-based genomics guidance subscription service for health plans.
Your Trusted Partner in Applying Genomic Science
InformedDNA is the nation’s first telehealth genomics services company. Our real-world clinical guidance, cost management and patient navigation solutions are built upon the most current genomics insights and are designed to optimize clinical decisions across the care delivery spectrum.
We have helped manage the health benefits of more than 100 million covered lives and have navigated hundreds of thousands of people to the right treatments or clinical trials.