Precision Medicine Challenges Persist, Aetna Leads Response

Precision medicine has the potential to significantly improve health outcomes and save members and their payers, so Aetna is overcoming the major challenges associated with implementing the personalized medicine approach and bolstering its precision medicine efforts.

Aetna is leading the precision medicine charge by establishing a breast and ovarian cancer testing program using the BRCA gene test, implementing a genetic information privacy policy, and becoming the first health plan to require quality credentialing of genetic testing labs, the payer recently announced on its website.

“As our understanding of genomics continues to grow, we are seeing the development of a new generation of genetic testing and targeted treatments,” said Joanne Armstrong, MD, MPH, senior medical director at Aetna, in the announcement. “Although we have a long way to go to replace the current ‘one size fits all’ medical model with individualized genetics diagnostics and hyper-specific treatments, the evolution of this field is exciting.”

Precision medicine not only improves members’ health outcomes but also decreases costs for members and their payers. A study of 13,000 behavioral health patients found that genetic testing resulted in fewer drug prescriptions, savings of on average $1,036 in prescription costs, and 17 percent higher adherence.

PwC’s Health Research Institute (HRI) also recently named precision medicine as a tool to combat the impending six percent increase in the 2020 medical cost trend.

But implementing precision medicine has been a challenge for payers. Genetic data security, research and information sharing, and payment mechanisms are the top precision medicine challenges identified by industry experts at HIMSS18.

The panelists noted interoperability and members’ ability to access information as chief barriers to progress.

“While providers have growing access to more and more data, this data is typically only beneficial to the provider, not the patient. Too often patients are unable to access pertinent health information, preventing them from being able to make informed, actionable decisions when it comes to their health,” an Aetna press release on the conference stated.

Movement toward a value-based system that endorses precision medicine would also require a value-based payment system, the panel recommended.

Lastly, precision medicine is best achieved in a long-term payer-member relationship. Approximately 20 percent of patients switch healthcare insurance each year. This diminishes the ability for a payer to continue following up and tracking the member’s progress.

Aetna is overcoming these challenges through its recent precision medicine efforts. The payer follows a precision medicine strategy that includes clinical policy research and development, utilization management, quality lab contracts, genetic counseling support, care considerations, notification of research opportunities, and data analytics.

Notably, the payer developed one of the first comprehensive program for breast and ovarian cancer testing using the BRCA gene test.

Genetic factors contribute to 30 percent of premature deaths due to diseases such as cancers and diabetes. BRCA1 and BRCA2 genes have been linked to both ovarian and breast cancers. Among ovarian cancer patients, 15 percent, or one in five hundred women, can attribute it to hereditary causes, five to ten percent for breast cancer patients.

By developing over 50,000 genetic tests, experts are working to decrease these percentages. They have identified 10,000 genetics-related medical conditions which can be predicted, identified, and prevented through precision medicine.

In response to increased genetic testing, Aetna introduced an online interactive genetic testing guide in 2002, which was awarded the 2003 World Wide Web Health Award from the Health Information Resource Center.

In 2007, the company applied telehealth to genetic testing by initiating a genetics-related counseling phone line. Through a partnership with Informed DNA, Aetna allows members to call an expert to confidentially discuss their genetic risk for cancer and other associated medical conditions.

Since then, the company has funded cancer-centric molecular genetic testing through the Aetna Foundation.

As the company’s investment in precision medicine grows, Aetna has also touched on the major precision medicine challenges.

Aetna addressed security concerns related to genetic-testing with two new policies. The company compiled the industry’s first genetic information privacy policy. Not long afterwards in 2006, it implemented a genetic nondiscrimination policy, which was also the first of its kind in healthcare.

Aetna sought to facilitate greater information sharing, making its labs’ research available to the public through ClinVar, the National Center for Biotechnology Information’s public database on genetic testing.

Aetna also implemented value-based payment to bolster precision medicine implementation. In 2018, 53 percent of Aetna’s medical expenditures were with value-based providers and the company aims to increase that number to 75 percent by 2020.

Although the steps forward are significant, precision medicine continues to face significant challenges broadscale, including interoperability and educational and practical barriers for physicians who may need to become more aware of molecular genetics and biochemistry.

But Aetna plans to leverage its “history of leadership in the field to help ensure that members receive the right treatments in the right place at the right time.”