The genetic testing landscape has many testing options available. Intricacies in CPT coding, complex methodologies, and rapid market growth contribute to making this area of medicine difficult to navigate. With all the complexities of ordering genetic testing, it is often challenging for providers without specialized genetics training to monitor the available options and evaluate the usefulness of these tests in various clinical scenarios. One study found that 54% of 1,404 academic family physicians surveyed did not feel knowledgeable about genetic testing options that were available1. Another study found that approximately 74% of 220 internists surveyed rated their understanding of genetics as “poor.” Despite reporting a low understanding of genetic testing and their guidelines, 44% of these internists reported that they still ordered genetic testing2. At InformedDNA, we receive many genetic testing requests that are ordered by non-genetics providers.
Pre-test genetic counseling is best practice and the ideal way to ensure genetic testing is performed safely and efficiently. However, this counseling is not always pursued by a patient or provider. Utilization management allows for expert opinion review of genetic testing requests prior to the test being performed. This provides an opportunity to identify test requests that are not clinically appropriate and allows for intervention to avoid testing that may lead to unnecessary care. It also provides an opportunity to offer alternative testing options that may better fit the goals of genetic testing for the patient and provider.
At InformedDNA, I work with a team of board-certified genetic counselors with specialized training in evidence review, policy, and case review. We review medical histories, prior test results, and best practice evidence-based criteria to improve access to cost-effective and high-quality genetic testing. We facilitate decision support for providers in ordering tests and our process allows an opportunity to connect them with genetics professionals who can assist with test interpretation and ordering. Healthcare providers that we work with have reported being appreciative of having these conversations with someone who is specialized in genetics and understands the complexities. This work helps to prevent psychological, medical, and financial harm to patients from the inappropriate utilization of genetic testing. Our team of genetic counselors also works with payer clients to align policies and procedures with best practice, evidence-based standards in genetic services.
As genetic counselors, we have the right skill set and knowledge to perform all aspects of genetic testing utilization management review. Our skills perfectly position us to speak with providers about best practice guidelines, determine and discuss appropriate genetic testing options that fit their patients’ needs, and influence policy writing for payer clients. All of my past clinical experience and training has led to expertise in critical thinking, communication, and providing education to healthcare providers. Additionally, this role has allowed me to increase my own breadth of knowledge across all specialties of genetic health that I may not have encountered in clinical work.
In my current position, I work with ongoing automation improvement of our utilization management process at InformedDNA. I use my clinical and genetics expertise to create algorithms based on best practice guidelines and policy criteria to automate determinations on 80-90% of genetic testing requests that we receive. This process allows for complex cases to be reviewed in greater detail by a genetic counselor working at the top of their scope and to scale our services to more patients. My role allows me to feel a larger public health impact while also knowing that I can have a great impact on providing appropriate genetic care to individual patients.
Utilization management roles are often found outside of the private sector, such as in hospital laboratories, or as part of a larger organization that may be less familiar with genetic counselors. In these areas, it is important to advocate for yourself and your skill set to work at the top of your scope. For any utilization management role, it is helpful to develop and highlight your skills in effective concise verbal and written communication, attention to detail, and critical thinking. It is also beneficial to be a lifelong learner as the genetic testing landscape is constantly changing and you may be reviewing genetic testing requests in areas you are less familiar with. For myself, I have learned much more about tumor testing and pharmacogenetics than what I would have been exposed to in a clinical role. I am happy to speak with anyone considering a role in utilization management or answer any questions. I can be reached by email at ajennings@informeddna.com.
1: Mainous AG 3rd, Johnson SP, Chirina S, Baker R. Academic family physicians' perception of genetic testing and integration into practice: a CERA study. Fam Med. 2013 Apr;45(4):257-62. PMID: 23553089.
2: Klitzman R, Chung W, Marder K, Shanmugham A, Chin LJ, Stark M, Leu CS, Appelbaum PS. Attitudes and practices among internists concerning genetic testing. J Genet Couns. 2013 Feb;22(1):90-100. doi: 10.1007/s10897-012-9504-z. Epub 2012 May 15. PMID: 22585186; PMCID: PMC3433636.
