InformedDNA®, the nation’s leading applied genomics solutions company, today announced it will launch a new evidence-based genomics guidance solution. The new service, InformedGENOMICS™, will equip medical directors and clinical reviewers at health plans with ready-to-use criteria and clinical utility reviews to ensure members have access to the highest quality genomics care.
“We hear repeatedly from medical directors that the sheer number of emerging genomic technologies and therapeutics is overwhelming. With an increasing number of non-genetics providers ordering these tests, health plans need the ability to efficiently and confidently access the most current genomic information to make the right decisions for members,” said Megan Czarniecki, MS, MA, CGC, senior vice president of payer solutions at InformedDNA.
InformedGENOMICS, which leverages InformedDNA’s 15 years of genomics expertise, is the next step in InformedDNA’s journey delivering holistic genomic benefits management solutions for national and regional health plans. The service was developed to support medical directors and clinical reviewers’ most acute challenges, including complex clinical reviews, peer-to-peer discussions, and appeals evaluations. InformedGENOMICS is designed to provide health plans the ability to offer consistent guidance and make confident decisions with step-by-step support in genetic test evaluation through access to:
- Best-in-class medical/coverage policies;
- Molecular test technical assessments and coding guidance; and
- On-demand access to evidence reviews for hundreds of genetic conditions and thousands of genomic tests.
“Genomics is the ‘Wild West’ for health plans, especially with the explosion of available and in-development genomics-based therapeutics,” said Czarniecki. “We know that many health plans and health care providers are feeling the pressure to keep up with the latest advances in genomic medicine, which has become increasingly difficult in a continually growing market that has more than 150,000 genetic tests. InformedGENOMICS puts genomics decision support services directly in the hands of health plans so they can provide the latest in evidence-based coverage of genomic testing for their members.”
InformedGENOMICS complements and augments existing utilization management (UM) programs within health plans. The clinical policy that drives prior authorization and other UM approaches needs to be viewed through a genomics-specific lens to meet the pace of development and complex demands of the genetic testing landscape. The traditional approaches to policy development are difficult to apply to genomic testing because of the rapid introduction of novel technologies, paucity of published evidence, and heavy market pressures.
Guiding InformedDNA’s approach is a recent market survey that identified the three biggest health plan needs related to genetic testing:
- Clinical support for genomic policy development;
- Clinical expertise to aid in policy application; and
- Appeal support.
As part of the InformedGENOMICS service, health plans will be able to license use of InformedDNA’s up-to-date genomic coverage policy criteria, library of comprehensive literature reviews and references on hundreds of genetic conditions, coverage decision workflows for clinical reviewers, and detailed molecular coding and test insights. Additional services, such as consulting on government policy application and appeal navigation will further assist health plans in augmenting their in-house expertise.
Czarniecki added, “As the largest applied genomic solutions company, we have the tools to provide health plans with this deep level of support today. Together, we can help health plans ensure that each of their members has access to the genetic testing necessary to improve their health and health outcomes, while avoiding waste.”
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