Concert Genetics Bringing Leaders Together to Maximize Potential
The field of precision medicine is growing at an astronomical pace, with nearly a dozen new tests hitting the market daily. Tracking what's out there ... and how effective it is ... is a big task, and it's one being tackled by Nashville-based Concert Genetics.
In June, the precision medicine specialists released a white paper called "Connecting the Genetic Health Information Network: Critical Steps to Realizing the Potential of Precision Medicine." Their goal, said company founder Mark Harris, PhD, is to start a conversation among stakeholders in the personalized medicine marketplace.
"We are in a unique position in the personalized medicine space, since our clients are labs, hospitals and health plans," Harris said. Concert Genetics clients include seven of the nation's top 10 children's hospitals, while the company also provides analytics management and consultative services to health plans, helping them understand what they're paying for.
"As we dug into the problems facing these stakeholders and thought about our own position in the market, we quickly realized there wasn't one simple solution," Harris said. "We see things being brought to the market that will benefit one stakeholder or another, but no one is talking about systematic problems facing the industry."
Harris, who earned his doctorate in Cancer Biology from Vanderbilt University, said the absence of a systematic approach to industry challenges is likely to hinder big picture progress within the precision medicine space. "We felt compelled to tell the story from multiple stakeholder angles, bring to light some of the problems and try to find solutions with stakeholders engaged, as well," said Harris.
Problems in Precision Medicine
So, what exactly are the problems hindering precision medicine? For starters, a tremendous lack of standardization and nomenclatures in coding.
"Today's IT systems weren't built with genetics in mind and aren't nearly as granular as they need to be," Harris said. In an industry with more than 70,000 genetic tests on the market, only 200 genetic CPT codes exist with a mere four to five added quarterly. "There's no good translation tool between claims and tests being ordered," said Harris, noting that data regularly gets lost in the information transfer between lab orders and reported outcomes.
More times than not, genetic tests fall into the "miscellaneous" category, resulting in a general loss of efficiency across the board. "There's frustration from the lab's perspective because they want to get paid appropriately, and the health plan side is seeing a bunch of different codes for the same test and are wondering if they're paying a fair price or if the lab's making a mistake," said Harris. "Both sides are worried about the other's intention because there's a lack of transparency."
The ongoing coding war between providers and health plans is an ugly industry struggle, with both groups trying to figure out how to maximize reimbursement. Harris believes consistent coding could help resolve conflict from both sides.
Another industry roadblock is the lack of clinical utility data and patient outcomes available on many of these tests. "The data is held in silos, meaning some is in the providers' hands, while other pieces are with labs and health plans," he said. "Nobody is combining the data so that we, as an industry, can see which tests are working."
How was the patient before the test occurred, and what happened to the patient afterward are two important questions each industry player needs answered. "We need to know if they had surgery or a medication change following the test, and we need access to claims data and lab results, as well as EHR data," Harris said.
"We envision a stage where there's a consortium of providers and labs willing to submit a subset of data into a common repository leveraged by researchers," he continued.
More Dialogue Needed
Discussions between Concert Genetics and their clients have led to positive conversations and a mutual desire to sit down with other industry leaders to brainstorm possible solutions for some very big problems.
"Each stakeholder is very familiar with his own set of problems but generally isn't as familiar with problems from the other perspective," Harris said. "When you lay it out for them they say 'this makes sense,' and by working together, we've identified a few core issues causing problems across the board."
In September, Concert Genetics will host an invitation-only industry summit for the 100 top genetics leaders with the simple goal of starting that conversation on a larger scale. The meeting could be the first steps in changing the trajectory of personalized medicine. "
We're seeing a lot of interest from all parties to come together and solve this," Harris said. "It will take time to put these pieces together, but we're excited about the positive feedback so far."