Innovations in Service Delivery in the Age of Genomics Workshop Summary (2009) / Chapter Skim
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3 New Models for Service Delivery
3 New Models for Service Delivery
Pages 21-32
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From page 21... ...
. The report goes on to offer the telephone genetic counseling service model of Informed Medical Decisions (INFORMED)
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From page 22... ...
Acting on lessons learned, INFORMED developed a telephone and Internet protocol for cancer genetic counseling service delivery that focuses on access to high-quality unbiased genetic counseling services that are in accordance with national guidelines. Counseling is required before testing can be considered, and the primary care physician is engaged throughout the process.
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From page 23... ...
In late 2007, after an initial pilot program, Aetna decided to cover INFORMED's telephone genetic counseling services for all 16 million Aetna members nationwide. In addition to this direct partnership, INFORMED collaborates in other ways with payers and physicians, such as helping payers assess which genetic tests have proven clinical utility, creating reimbursement or coverage criteria for those tests, and providing individual case consultation as needed, for example, when a patient appeals a denial for genetic testing.
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From page 24... ...
. Models of service range from direct access testing that has no physician ordering, no context given for results, and no professional support, to a "virtual" clinic, which includes physician involvement, genetic counseling, and ongoing support and education.
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DNA Direct has condition-specific protocols -- for example, BRCA testing requires in-depth, pretest genetic counseling services. Once a patient chooses to pursue a genetic test and the results are available, a web-based customized report is provided that includes family and medical history information, a lab report, and letters to the physician and the family.
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From page 26... ...
As new research emerges, Navigenics evaluates evidence about the clinical validity and utility of genetic tests and updates member reports with the new information. To be included in the Navigenics Health Compass risk estimates, each SNP–disease association must meet a series of scientific and clinical criteria: • The association must be replicated and published in top-tier jour nals.
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From page 27... ...
Genomic discoveries can help define molecular and cellular mechanisms of disease, can be the basis for new therapies, can identify predispositions to childhood disorders, and can identify susceptibility to unintended responses to available therapies. At Cincinnati Children's Hospital Medical Center, researchers and clinicians are collaborating on two projects aimed at bringing genetics
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From page 28... ...
One of the key features of the system is that providers order pharmacogenetic tests by drug, rather than by gene, so there is no need for providers to memorize or keep up-to-date on gene–drug associations. The developers of the program strove to make the ordering system intuitive, efficient, and simple.
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From page 29... ...
He expressed concern that in this confusing, rapidly moving environment, new ways of implementing service delivery may be risky. Shappell responded, stating that INFORMED does not sell genetic testing; it provides access to genetic counseling.
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From page 30... ...
If a test that is clinically useful according to national guidelines is warranted and the insurer has not yet created a testing coverage policy, INFORMED works with the health insurer to assist in developing an appropriate policy for coverage. Prows concurred with the questioner that there are no large, randomized controlled trials that prove the clinical utility of pharmacogenetic testing for psychiatry.
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From page 31... ...
As such, clinicians did not consistently document in the charts how pharmacogenetic testing affected their clinical decision making, hindering attempts to assess the impact of the tests by implementing a retrospective research study. Additionally, clinical services do not systematically collect outcome data.
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