The growth of direct-to-consumer (DTC) genetic testing presents several medical and financial implications for the healthcare industry to consider. In this article, Milliman consultant Barbara Culley examines the demand for DTC genetic testing and industry concerns. The excerpt below highlights a few of them.
Providers and regulators have expressed concerns about the DTC process, including the absence of healthcare providers from it, concerns for unnecessary testing, patient anxiety, erroneous test results, and misinterpretation of test results by untrained consumers. Insurers have concerns about the possibility of adverse selection. If a person knows they have a positive indicator for a disease, will those people seek insurance in greater numbers than those without any genetic concerns?
One key factor driving concerns is that not all persons with a positive genetic test will develop the indicated disease. Many variables, including environment, personal lifestyle choices, and other genetic factors, have a significant impact on health. Concern exists that genetic test results may lead to unnecessary treatment. In the case of false positive and false negative outcomes, the added concern is that treatment choices may be made in error. In a 2012 study13 of 179 people from four countries, the average person was found to have about 400 defects in their genes, some associated with disease. However, these people were well. Even if results cause people to seek insurance or care, they may never develop the disease indicated by genetic testing.
Concerns have been raised about the potential for DTC testing to create added costs and consume resources in the healthcare system with little value. For example, positive DTC genetic testing results may lead consumers to follow up with their physicians for treatment based on a test result that may not indicate a genuine health issue.
Barbara also provides some actionable measures that health plans can take to respond effectively to the evolving DTC genetic testing market. The following excerpt summarizes her considerations.
Continued growth in the marketplace is probable with the recent FTC approvals for DTC genetic testing and health risk reporting for diseases. Growing consumer use and subsequent follow-up with healthcare providers and insurers can be anticipated.
Data trends indicate consumers are likely to seek information perceived as helpful in self-management of health. Health plans may wish to consider how to best respond to the evolving impact of DTC genetic testing and subsequent member expectations with education, tools, and medical policy that optimize the use of these tests and support member engagement in their health.