Managed Care - February 2009 - (Page 21) Health Plans Join Up For the Genomics Revolution Some of the biggest insurers in the country scramble to make sense of a field that will change treatment techniques forever Aetna members and physicians. “They feel they’re destined to get it, and as a result get mammograms every six months, sometimes four times a year when they’re in their twenties. We have a very logs a certified genetic counselor, Heather ical conversation with them: A grandmother’s Shappell learned early on how to calcubreast cancer slightly increases risk, but it’s not inlate an individual’s hereditary risk of evitable.” cancer and how to adjust that person’s Faced with a surge of new genetic research studmedical care to account for it. ies as well as a growing roster of genetic tests that If someone comes to her with a family history of can be used to guide treatment protocols or to redcolon cancer involving two “second-degree relaflag a health risk, Aetna, Humana, Cigna, and other tives” — an uncle and a grandparent on the same insurers have been scrambling to side of the family, for example — that make sense of a field that is reshaping person stands a 12-percent to 18-perthe way people are treated. They are cent risk of contracting the disease, hammering out new policies regusignificantly higher than the 6-perlarly in an attempt to ensure that cent lifetime risk run by an average physicians can understand the person but still a far cry from a death genomics revolution — hoping to imsentence. prove care without incurring unnecFollowing established medical essary costs. guidelines, Shappell would recomCounseling services like Shappell’s mend that the patient get a are being offered so that doctors and colonoscopy every five years, starting patients can learn how to separate fact 10 years before the first family diagfrom fancy as more genetic services nosis of cancer — say at age 35 if the are marketed directly to them. uncle was diagnosed at 45 — rather “It’s the right thing to do,” says than the custom of every 10 years Most physicians lack basic understanding of the role of Shappell, “but there’s also a financial starting at age 50. incentive to do it.” Shappell possesses a rare skill. Only genetic counseling, says Joanne Armstrong, MD, an Aetna medical It’s also still very much a work in about 2,000 certified genetic coun- director. Nor do they score high on progress. selors are at work in the United States. proper use of genetic tests. Their advice often comes as a big surprise to patients and other practitioners. The doctor dilemma “In the vast majority of cases, we are telling peo“The overarching theme is that to extract the ple things that they haven’t heard,” says Shappell. In real value, the economic value that these tests and case after case, she’s trying to put risk into pertherapies offer, we need systems to be prepared for spective for people who believe they’ve been living the good, evidence-based use of it,” says Joanne on borrowed time. Armstrong, MD, a senior medical director at Aetna “A lot of people overestimate their risk of cancer,” who developed the genetic counseling service for its says Shappell, who leveraged her experience in gehealth plans that cover genetic testing. netic counseling to start a new company — InSome specialists, particularly in oncology, earn formed Medical Decisions — that is now on call for kudos from insurers for their knowledge of the field. By John Carroll Contributing Editor A FEBRUARY 2009 / MANAGED CARE 21
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