Introducing Concert for Health Plans: The Next Step Towards Achieving Transparency and Efficiency in Genetic Testing

Since the launch of Concert Genetics (formerly NextGxDx) in 2010, we have been dedicated to enhancing the transparency of genetic testing data and streamlining the complex processes related to the selection, ordering, and management of genetic tests. As the marketplace has grown to include more than 60,000 unique genetic testing products, we’ve seen how technology and organized data can help clinicians, laboratories and hospitals across the country manage this rapid change.

Now we are taking the next step in that journey by launching Concert for Health Plans, a new suite of solutions to support health insurance plans in the rapidly growing genetic testing field.

Built on our core database (the same one that powers our Genetic Test Search and GeneConnect), the new suite of solutions will give health plans greater insight into their genetic testing claims, and help them better manage the growing market. For example, we’ll be helping them recognize the testing products within their claims so they can better understand variation in payments, inaccurate claims and gaps in medical policies. In doing so, we will support data-driven policy development, informed payments and a streamlined reimbursement workflow.

This new offering grew in part out of hundreds of conversations we’ve had with our lab and healthcare provider partners as we developed and introduced our products. We heard loud and clear how the pace of change is pushing the limits of coding, billing and payment systems. With fewer than 200 procedural billing codes available for describing the nearly 14,000 types of genetic tests, there’s confusion about how to code, how to bill and how to approach preauthorization to ensure proper and timely payment.

Health plans receiving claims for genetic tests face a similar challenge: they have limited visibility into what tests they are reimbursing and the market prices for those tests. With Concert for Health Plans, we believe health plans will get the information they need to develop informed payment policies and streamline reimbursement related to genetic testing – which benefits all parties involved. As this effort progresses, we envision that labs and healthcare providers will experience greater predictability and certainty around their reimbursements for these tests, making it easier for them to plan their own operations and growth.

Of course, this won’t happen all at once – the market is complicated and growing fast – but we know we can work together to make it more transparent and efficient for everyone involved. And, if we do that, we believe we can help stakeholders across the healthcare system deliver the great promise of personalized medicine to the patients who count on us to give them our best.

So, as you can tell, we’re excited about this new suite of solutions. Our goal is to make the genetic testing market more efficient by bringing value to every player – clinicians, laboratories, hospitals and payers – and improving the connections between them. This is the next step in fulfilling that mission.