InformedDNA will be exhibiting and presenting at Mayo Clinic’s Individualizing Medicine Conference, September 12-13, in Rochester, MN.
About the conference: Attendees will discover practical applications of genomic medicine, integrating precision medicine therapies into patient care. Designed with the professional in mind, concurrent sessions offer will offer practical genomic medicine applications in practice to in-depth discussions about the microbiome, epigenomics, pharmacogenomics, and more. Expert speakers from Mayo Clinic and around the world will inspire attendees through plenary presentations, focused breakout sessions and a poster session.
InformedDNA’s poster sessions will include the following:
1. Why genetic test utilization management strategies are a partnership between payers, physicians and genetics experts
Presented by Kelly Athman, MS, CGC, Director, Utilization Management Review
With the rapid rate at which genetic tests are being introduced to the market – 10 per day according to Phillips et al (2018) – it is nearly impossible for physicians to keep up with the science that informs whether genetic testing is necessary. Physicians self-report, not knowing what type of test to order or how to interpret results, which leads to unnecessary and wasteful testing. Therefore, payers are increasingly relying upon genetics specialists and genetic testing utilization management (GTUM) to help ensure that patients receive the most appropriate genetic tests backed by evidence of clinical utility.
Contrary to what some believe, GTUM is not just about saving payers money by managing genetic tests. This presentation highlights the partnership between physicians, payers and genetics experts to enhance the patient experience in pursuing personalized genetic testing.
Payers must consider multiple aspects of genetic testing strategy from a member population perspective, including:
- Focus on providing equitable and cost-effective care across an entire population
- Appropriateness of testing in each clinical scenario
- How the test results lead to a change in management and improved outcomes
Physicians and payers share a similar goal: to provide excellent healthcare services that will result in improved patient outcomes. This poster session explores ways in which clinical genetics specialists are fostering effective Genetic Benefits Management to ensure this goal can be met; and, educates clinicians on how to implement these principles in their own practice to ensure effective use of genetic testing.
2. How Inaccurate Coding of Genetic Tests Impacts Access and Cost
Presented by Julie Kaylor, MS, CGC, Client Liaison
Today, there are more than 70,000 genetic tests and testing products on the market, with about 10 new genetic tests released each day. The growing number of tests put enormous pressure on coders to keep up with codes for analyte-specific procedures.
However, new research shows codes for genetic tests often do not accurately reflect the service being rendered: A study by InformedDNA of 3,139 prior authorization requests for genetic testing showed 30 percent were submitted with inaccurate coding.
Many multi-gene panel tests on the market are still coded with multiple Tier 1 and Tier 2 codes stacked together to represent a single test as a vestige of previous methodology-based molecular coding. Even the establishment of genetic sequencing codes in 2015 to accommodate panel testing was not enough to keep pace with the enormous volume of new multi-gene tests.
Our study, completed in late 2017, analyzed prior authorization requests for both a national payer and a regional payer. The authorization requests spanned many genetic testing categories. Thirty percent of genetic testing requests were coded inaccurately, with 12.4 percent undercoded, 9.7 percent with incorrect codes, and 7.6 percent had a more specific code that was available, but wasn’t used.
Inaccurate coding of genetic tests not only affects accuracy, transparency and costs, but also inhibits patient access: Genetic coding discrepancies can limit coverage for patients regardless of medical necessity. Meanwhile, inaccurate coding means payers and providers may have little insight into the types of services being requested or performed.
If you’d like to schedule a time to meet while at the conference, please fill out the form below and we’ll be in touch shortly.