Promote consistent, evidence-based testing for your members while improving your bottom line.
Genetic testing spend continues to grow at about 15% annually. However, that doesn’t mean your plan has to accept high growth trends. The health plans we work with see a return of 5 times their investment or more by reducing or eliminating genetic and lab cost trends.
Co-Founder and Chief Medical Officer Rebecca Sutphen discusses health plan challenges with precision medicine.
In this three-minute video interview, Dr. Sutphen discusses the role of genetic testing in the growing area of precision medicine. She describes how InformedDNA works with our health plan clients to help ensure the most appropriate use of genetic testing, as part of bringing the promise of precision medicine to health plan members and providers.
Cigna’s genetic testing cost trend has remained relatively flat, compared to competitors with a cost trend up to 40%.
Since program inception, Cigna has experienced approximately 50% fewer Non-Specific Genetic Testing Code approvals, leveraging InformedDNA’s clinical expertise to help drive better medical necessity decisions.
When Cigna and InformedDNA collaborate with the ordering provider, about 50% of the time there is consensus that a more clinically appropriate test than the one initially ordered is available.
With valuable input and assistance from InformedDNA, Cigna consolidated coverage policies for genetic testing and reduced the number of policies from more than 30 to 8, which made the policies more clinically appropriate and easier to administer.
1 out of 5 individuals who received genetic counseling with proper informed consent decided not to pursue genetic testing.
Achieved 97% member satisfaction with genetic counseling services.
Help ensure the most appropriate testing - based on current medical evidence.InformedDNA provides clinical decision support on the appropriate use of genetic tests to three of the top five US health plans. Our program addresses every element of genetic testing management, from policy development through prior authorization, counseling, lab network optimization and expert consulting.
Cover evidence-based, medically appropriate testing.Our genetics specialists work with health plan medical management staff to develop evidence-based medical policy and coverage determinations for new tests and labs, based on a thorough and constantly up-to-date review of medical evidence. We also can incorporate your plan’s accepted medical policy with ours.
Stay current as the field of precision medicine expands.There are over 70,000 genetic tests, with 10 or more tests added every day. Our unique condition-oriented approach to guideline development, along with our substantial genetics expert staff, enable us to maintain out-of-the-box guidelines addressing all genetic tests. Thus you can manage high-volume and high-impact tests and the broad spectrum of available tests.
Jeffrey Hankoff, M.D., Medical Officer, Cigna
Bend the test trend curve.
In conjunction with our partner, AIM Specialty Health®, we provide a fully automated genetic test prior authorization service, including a provider portal that enables instant approvals for 80-90% of approvable requests. When manual review is necessary, our genetic analysts consider case-specific information and evidence-based criteria in recommending an outcome. We also guide providers to alternative tests and labs when indicated by medical evidence - automatically.
Empower members to make informed medical decisions.
We employ a full-time staff of 60+ genetic counselors nationwide, to provide guidance directly to your members and providers, as warranted by your medical policy.
Get the most value out of your lab network.Our experience with millions of genetic test claims enables us to determine which labs offer the best value and reasonable billing practices. Our deep genetic test expertise enables us to understand which labs are most clinically appropriate to perform certain tests. We guide you on which labs are best to perform which tests for your members.
Drive additional savings and the most appropriate care.Our genetic specialists can provide ad hoc or ongoing consulting support to assist with coverage policy, payment policy and lab network development. We also provide detailed analyses of genetic test utilization patterns and savings opportunities.
Eliminate genetic test claim overpayments.About half of all unnecessary genetic test spend is from claims overbilling and overpayment. This is exacerbated by insufficient codes for test identification and the rise of gene panel billing. We provide claims edit algorithms that identify the specific tests performed, then apply evidence-based rules to block approval and payment of unnecessary claim line items or units.