After receiving daily advertisements to attend the AHIP conference in Las Vegas in June (here; Jeb Bush is keynote speaker), I clicked through and browsed around, coming across a May 16 webinar on controlling genetic test utilization sponsored by AHIP and a startup management company called NextGxDx:
More after the break.
The webinar description includes,
"Today, the nearly 14,000 types of genetic tests clinicians can order for their patients are represented by fewer than 200 procedural billing codes. As a result, health plans have limited visibility into genetic testing claims, including what tests they are reimbursing and the market prices for those tests....these issues are unlikely to resolve themselves. Health plan leaders must take proactive steps to address these challenges....Attendees will learn existing best practices as well as emerging solutions for managing the mounting challenges associated with genetic testing reimbursement and utilization management."
The webinar advertised through AHIP by NextGxDx foots well to a flurry of media in just the past few weeks. Payer efforts to control genomic test utilization are getting increased visibility, as with these four current articles:
- April 2016 coverage in Managed Care magazine, under the headline, "Health Insurers Struggle to Manage Number, Cost, of Genetic Tests" (here).
- Also in April 2016, Fast Company ran an article on how many patients are hit with genetic test bills after tests are ordered, by payers deny coverage (here).
- In May 2016, the pathology trade journal Dark Report (subscription only) ran an article on Kailos Genetics, which offers genetic tests to patients only on a cash basis (no insurance) for the past year.
- Similarly, Color Genomics focuses on the circa $200 genetic testing space (April 2016 in Forbes, here).
- In May 2016, Genomeweb ran an article on how InformedDNA and AIM Specialty Health "partner to provide genetic test guidance to payers" (subscription; here). AIM is part of Anthem, rather like Optum under UnitedHealthcare.
The company's home page is here. NextGxDx is a venture-funded startup which has raised $6M so far (for more press read here, here; Reuters here).
NextGxDx Introduces GenePayer
In April 2016, it announced a new offering to help payers manage genetic test costs, full press release here. The payer advisory offering, GenePayer, has its home page here. "Gene testing is one of the fastest growing areas of healthcare - Is your spend optimized?"
GenePayer is trademarked (August, 2015) to provide:
Business information analytics and management consulting services in the field of genetic testing; business services, namely, providing an online computer database in the field of information about business cost and payment management of genetic testing; business data analytical services, namely, collecting and analyzing genetic testing cost data for insurance providers
Business services, namely, providing an online computer database for financial transaction and payment processing services in the field of cost and payment management of genetic testing
Providing a website that allows users in the field of genetic testing to analyze market and pricing statistics, to verify genetic testing categorization and coding, and to categorize areas of molecular pathology for the purpose of identifying areas for economic growth and policy development; software as a service (SaaS) services featuring software that allows users in the field of genetic testing to analyze market and pricing statistics, to verify genetic testing categorization and coding, and to categorize areas of molecular pathology for the purpose of forecasting areas of economic growth and policy developmentClinical Groups and Access
Some clinical groups have complained about overly onerous payer requirements for access to genetic testing, including ACOG (trade journal here; position paper here) and ACMG here.