CEO SUMMARY: This summer, both Geisinger Health and Sanford Health will introduce genetic tests designed specifically for use by primary care physicians in their daily practice. This is a significant milestone on the road to wider deployment of precision medicine services. In the case of Sanford Health, it plans to offer patients a $49 genetic test that looks at susceptibility for 60 diseases and 30 drug-gene interactions. The test won’t be billed to insurers, but will be paid for by the patient.
IN RECENT MONTHS, several innovative health networks announced plans to provide genetic tests to patients being seen in primary care clinics. This is a development that has important implications for clinical laboratory administrators and pathologists across the United States.
Until now, genetic tests have primarily been used for specialized care, such as in oncology and for hereditary diseases. One reason for this has been the expense of gene sequencing and analysis of that data.
However, improvements in gene sequencing technologies mean that exomes and whole human genomes can be sequenced faster and more accurately—and at less cost—than ever before. In turn, that changes the cost-clinical benefit analysis in ways that support expanded use of gene sequencing in many other areas of clinical care.
These are all factors in the decision of Geisinger Health, of Danville, Pa., to begin offering DNA sequencing to patients as part of routine preventive care. In May, Geisinger officials announced that this service would launch in the next six months.
Similarly, Sanford Health of Sioux Falls, S.D., is ready to offer a $49 genetic test panel in its primary care clinics. It plans to initiate the service by mid-year.
Both health networks have been at the forefront of collecting genetic information from patients and using that data in various research programs and clinical studies. Their respective plans to offer genetic tests in primary care settings are a logical next step for them.
Geisinger is preparing to provide gene sequencing to its patients as a regular part of routine preventive care. The program will start this summer and the clinical pilot will involve 1,000 patients in several Geisinger clinics.
Exomes for $300 to $500
Exomes will be sequenced at a cost expected to be between $300 and $500 per patient. Patients will not be charged. Geisinger estimates that the program will cost $5 million and the money will come from donors and from the Geisinger health plan.
“We’re going to start doing it the same way we would talk to patients about getting a cholesterol check,” stated Dave T. Feinberg, MD, on a conference call with reporters in May. He is confident that this genetic testing service will demonstrate its value in patient care. “We think by scaling it we’ll hopefully more quickly show the cost-effectiveness of it, and it will become pretty obvious that everybody should be getting this,” noted Feinberg.
At Stanford Health, there are high expectations that offering genetic tests will be welcomed by patients. “Nobody else in the world is doing this,” declared Nate White, Executive Vice President of Sanford Health Fargo. “What we’re after is the primary care setting.”
Markers for Diseases, Drugs
Sanford officials said that its genetic test includes markers for such conditions as aortic aneurysms, thyroid cancer; Lynch syndrome (a hereditary form of colorectal cancer); hereditary breast and ovarian cancer; retinoblastoma (a form of eye cancer usually developed by children); Wilms’ tumor (a type of cancer that starts in the kidneys); and Wilson disease (which causes copper to accumulate in the liver, brain and eyes).
The choice of genetic markers for the 60 diseases and 30 prescription drugs included in Sanford Health’s genetic test panel is based on the fact that each marker is clinically-actionable. The result should be measurable improvement for patients.
Sanford Health’s confidence in moving ahead with genetic testing in primary care settings is a result of the research it has conducted since it received a $125 million donation in 2014 from benefactor Denny Sanford, for whom Sanford Health is named.
Geisinger Health and Sanford Health may be first-movers in offering genetic testing to primary care patients. But a growing number of health networks are developing similar plans for deployment of genetic tests within their health system.
Geisinger Wants to Push Gene Tests into Daily Care
AS IT PREPARES TO OFFER genetic testing in primary care settings, Geisinger Health is building on several years of research it has conducted that includes the gene sequences of Geisinger patients.
That is the MyCode research program. According to Geisinger CEO David T. Feinberg, MD, the research study is testing 59 different genes for 27 conditions. The final mix of conditions that will be included in the primary care clinical pilot has yet to be determined, but could include BRCA mutations, Lynch syndrome (which indicates a higher risk for colon cancer) and familial hypercholesterolemia.
Feinberg gave a specific example of how such gene sequencing can benefit a patient. He noted that familial hypercholesterolemia is a genetic condition that causes high cholesterol and an increased risk for cardiovascular disease, heart attack, and stroke. Its incidence in the population is one in 250 people. Clinical guidelines call for this condition to be treated, starting at the age of eight. But, as Feinberg pointed out, such treatment seldom happens because “nobody knows who has it because nobody is testing broadly besides us.”