Catalyst for Payment Reform

How-to Guide: Unraveling Genetic Testing Benefits

How-to Guide: Unraveling Genetic Testing Benefits

Answering critical questions about the value of genetic testing

New genetic tests enter the market each day, putting us on pace to see over 80,000 tests in the market by 2020. Employers and other health care purchasers already pay for many tests available today. But does genetic testing benefit employees?

In November 2017, CPR kicked off Collaborative 4 with leading purchasers and subject matter expert Dr. Jeffrey M. Davis, MD, MPH, Senior Health Management Consultant at Willis Towers Watson. The work group educated purchasers on the risks and opportunities in this field.

How to use the toolkit

CPR developed a comprehensive How-to-Guide to help purchasers assess value in genetic testing benefits. This tool provides background and education on the genetic testing landscape and the implications for their health care purchasing strategies and tools to evaluate their health plan and third-party genetics vendors.

Included in the toolkit

This How-T0-Guide includes:
  • Background and Education on Genetic Testing Landscape. Learn key terminology, the scope, challenges, and benefits of current genetic testing benefits, and key trends for purchasers to be aware of.
  • Health Plan Questionnaire. A robust set of over 40 questions that purchasers can use to evaluate how effectively their health plan or administrator is monitoring this space across four categories including medical policy/claims processing, benefit design, network design, and available resources.
  • Health Plan Data Request Template.  The data request asks for cost and utilization data and automatically calculates trend.  In addition, purchasers can use this template to obtain summary and detailed data (by genetic testing category) for the current and baseline year (by test).
  • Framework to Evaluate Specialty Vendors. The framework includes recommended areas to consider as purchasers evaluate potential partners. The framework applies to vendors that offer or conduct genetic testing; however, purchasers can modify the criteria to apply to other vendors in this space.


Other CPR resources on this topic:  In August 2018, CPR hosted a Genetic Testing Educational Series for purchasers featuring health plans and specialty vendors including Aetna, UnitedHealthcare, Quest Diagnostics, InformedDNA, and Counsyl. We encourage purchasers to check out this resource as well.

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Type: How to Guide



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