Anthem Blue Cross introduces new solution to help doctors and members leverage genetic testing to improve outcomes, decrease costs and increase health care efficiencies
New automated system can turn around approval times in minutes
Jul 28, 2017
THOUSAND OAKS, Calif. – July 28, 2017 – As the rapidly growing field of genetic testing is creating complex challenges for health plans, providers and members, Anthem Blue Cross has launched a Genetic Testing Solution aimed at driving appropriate, safe, and affordable testing and counseling for patients. The program is designed and administered by national specialty benefits management leader, AIM Specialty Health® (AIM).
“While the use of genetic testing has become more common, its complexity has often left both consumers and physicians without the expert guidance they need to decide which tests are most appropriate, what their test results mean—or whether they should have genetic testing at all,”
With more than 70,000 genetic testing products currently on the market and an average of 10 new products introduced every day1, stakeholders across the health care system are increasingly challenged to manage the pace of change. This, along with a global market forecast projecting a $10.3 billion market by 20242, has thrust the health insurance industry into an ongoing debate about how to handle the increasing array of complicated and costly tests.
“Staying current with all the advances in genetic testing is really confounding for physicians,” said Dr. Razia Hashmi, Anthem medical director for commercial business. “With the health care community focused on disease prediction, detection and prevention, it’s more important than ever to empower providers with the best information possible about genetic testing so they can help their patients make informed decisions about their health care.”
The Genetic Testing Solution promotes appropriate use and provides education that addresses the clinical and financial complexities of genetic testing. Through a combination of clinical review of testing requests and coordination with genetic testing laboratories, providers and members have new resources to support clinical decision making. The program has been implemented as of July 1 among fully-insured and self-insured members, and national account members will be added in 2018.
The implementation of the Genetic Testing Solution will improve the efficiency of the health care system for laboratories, doctors’ offices and insurers by moving from a manual, labor-intensive and post-service process to a real-time automated system that can deliver prior authorizations to doctors as they are sitting with their patients. It can also reduce the likelihood of errors in filling out paperwork, which adds to labor and time. For many tests, using the solution can cut down the average time for submitting and processing an insurance claim from days to minutes because the prior authorization review provides specific CPT code information to the insurer to facilitate the claim processing.
“While the use of genetic testing has become more common, its complexity has often left both consumers and physicians without the expert guidance they need to decide which tests are most appropriate, what their test results mean—or whether they should have genetic testing at all,” said Brandon Cady, president and CEO of AIM. “Through our newest solution for genetic testing management, we are offering the market a unique approach and highly automated system that incorporates a requirement for genetic counseling into the clinical review process supported by the largest independent network of qualified genetic counselors in the U.S.”
The AIM Genetic Testing Solution expands on the company’s proven approach to ensuring appropriate and evidence-based care, along with increasing affordability and reducing costs for more than 50 million members. AIM administers programs on behalf of health plans for radiology, cardiology, oncology, specialty drugs, sleep medicine, musculoskeletal and genetic testing. The Genetic Testing Solution was developed in partnership with InformedDNA, the premier genetic testing clinical decision support and genetic counseling services company.
“Genetic testing is transforming genomic medicine and having a dramatic impact on health care today,” said Dr. Rebecca Sutphen, clinical and molecular geneticist and chief medical officer at InformedDNA. “When physicians and patients are informed by insights from appropriate genetic tests, we see better outcomes and management of potential downstream care.”
AIM Specialty Health
Lori McLaughlin: 317.407.7403
# # #
About Anthem Blue Cross:
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association®. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. Also follow us on Twitter at www.twitter.com/AskAnthem or www.twitter.com/AnthemPR_CA, on Facebook at www.facebook.com/AskAnthem.
AIM Specialty Health® provides clinical solutions that drive appropriate, safe and affordable care. Serving more than 50 million members across 50 states, D.C. and US territories, AIM promotes quality care through use of evidence-based medicine guidelines, provides consumer value and delivers significant cost of care savings in radiology, cardiology, oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, and genetic testing. As a national leader in specialty benefits management, AIM positions health plans, providers and employers to deliver on the promise of quality improvement in health care through an integrated suite of solutions combining clinical excellence, technology and superior customer service. AIM is a wholly owned subsidiary of Anthem, Inc. (ANTM). For more information, visit www.aimspecialtyhealth.com.
1. The Current Landscape of Genetic Testing, Concert Genetics
2. Genetic Testing: A Global Strategic Business Report, Global Industry Analysts Inc.