Key opinion leaders addressed cost, accessibility, and other barriers limiting use of comprehensive genomic profiling (CGP), and how employers can help drive preventive care and precision medicine through CGP.
Closing the care gap in what is possible through genomic testing and current medical treatment warrants a collaborative approach beginning at the physician level and expanding to payers, delivery systems, and employers.
Randy Scott, PhD, executive co-chairman, Genomic Life, noted during the panel discussion, “Let’s Get Personal: The Power of Genomics,” that despite the rapid pace in which DNA sequencing technology has evolved in recent years, the use of genomic information remains underutilized to prevent, diagnose, or treat disease.
Issues such as a lack of physician training and cost/access barriers have been cited to impede use of genomic profiling in the past. Scott mentioned that at Genomic Life, they aim to work directly with employers to monitor all the available technologies on the market and pair the right test with employees.
“We can actually screen people for cardiovascular risk, cancer risk, which are the 2 leading causes of death," he said. "And we now know that roughly 6% of the population, that's 20 million people in the United States, have an inherited risk for cancer and cardiovascular disease that's clinically actionable."
From the point of care, genomic testing has the potential to minimize emergency room visits, hospitalizations, and even death—all major cost-related events for employers. Optimizing the health- and cost-related significance of this data is no simple feat, in which one of the major challenges to leveraging genomic testing is understanding the subsequent results.
But by taking the steps necessary to ensure adequate interpretation of these data is provided, its ability to predict risk of developing diseases and response to certain therapies can have notable implications for employers who can form respective health plans that are preventive in design and lead to reduced health care spend. Cancer treatment costs currently account for 12% of employer health care spend, and are expected to reach $240 billion overall by 2023.
“The technology of sequencing, the technology of variant interpretation is propelling itself so quickly, and so usefully, it's actually hard for doctors to keep up,” said Robert Green, MD, MPH, medical and clinical advisor, Genomic Life. "And that's why it's really important to have specialized resources, specialized expertise to bring this solution to people, both through their health care systems, through their employers, through their own personal doctors.
“The important thing here is we're not taking it out of the hands of your doctor, we're creating a resource that should make your doctor happy, because it's going to supplement what they know, and frankly, what they don't know.”
Describing genomics as the tip of the spear for precision medicine and risk stratification, Green highlighted that the capabilities of pharmacogenomics have widespread implications for employers who manage the care of large diverse populations.
“If someone could come in and say: Hey, you've got a tendency towards this, and you will do better on this drug than that drug—it wouldn't be perfect, it's a statistical thing—but it would have guided your clinicians on starting you on smarter drugs that were better for you faster…when you apply this across many, many people, you get statistically significant results, you get improvements, and you eventually will get cost savings.”
Speaking on next steps to better leverage genomic testing, Scott addressed the negative feedback loop present between physicians and health insurance: physicians typically do not order tests that are not covered by health plans, and health plans do not cover services that doctors are not routinely using.
Working directly with employers to provide coverage for genomic testing was recommended to buck this trend. Ultimately, employers are at the forefront of cost burden risk when losing employees to disability or early death.
Referencing the BRCA mutations, which commonly presents in patients with breast and ovarian cancer, Scott said that 80% of people with the mutation have never had a genetic test or screening.
The health and cost benefits of doing so are substantial, mentioned Scott, who noted the availability of targeted drugs and different types of chemotherapy that can lead to better outcomes for these patient populations.
“We can dramatically save lives and save money….If you're at 10,000 employees, you have half of a percent each year of developing cancer. So, having this cancer population, have they ever been tested? Are they getting the right drugs? The impact is dramatic,” he said.
“I think that's what's going to drive health equity. For poor communities that don't have access, they can't afford to drive 3 hours to me, they can't probably afford the cost of parking most medical centers. Now with telemedicine and telegenetics, we could really wrap a package together that says we can bring this to everybody, and I think that's a huge difference maker.”