Geisinger CEO: Routine DNA sequencing will save money

Geisinger patients won't have to foot any upfront costs as the health system rolls out DNA sequencing as part of routine care, and the program will ultimately reap cost savings by catching diseases earlier, the system's CEO said Monday.

Donors and Geisinger's insurance company will take on the financial burden, and the health system will spend "under $5 million" to sequence a "huge number" of patients' DNA in a new program, Geisinger President and CEO Dr. David Feinberg said. That money will go to the cost of the actual tests, which he estimates will range from $300 to $500 per patient.

Under the new program, all Geisinger patients will have the chance to have their DNA sequenced.

Feinberg intends DNA sequencing to eventually be as routine as checking for high cholesterol. But for now, the health system is starting with a pilot program to sequence 1,000 patients' DNA.

To outside experts, it's a sign of things to come.

"We are reaching the point where genomic sequencing is cost-effective and inevitably going mainstream," said Nilesh Chandra, a healthcare consultant with PA Consulting Group. "We expect more systems to adopt similar strategies in the future."

Geisinger will cover the cost of every patient's sequencing, no matter the patient's insurer, and the health system is prepared for a long-term investment.

"It's probably going to take decades to really prove that this really works," Feinberg said. "Our gut feeling is that we will be able to show that it's sustainable and actually a decrease in cost overall."

That will lead to greater commercial payer coverage of genetic testing, Feinberg predicted. As commercial insurers see the money Geisinger saves on the patients covered by its own plan, they will follow suit.

Though Geisinger will cover the cost of the test itself, patients will still be responsible—whether through copays or otherwise—for the costs associated with follow-up care, such as genetic counseling.

That follow-up is important, according to Morris Panner, CEO of Ambra Health, a medical imaging software company. But it's still unclear what providers actually do with patients' genetic information.

Geisinger providers will use the testing data to improve the quality of care for patients, and Geisinger researchers will use the de-identified information, Geisinger Chief Scientific Officer David Ledbetter said.

Geisinger researchers already study the DNA of patients enrolled in the health system's MyCode precision medicine program, which was established in 2014 in partnership with the Regeneron Genetics Center.

Geisinger is not alone in pursuing precision medicine. Most recently, the National Institutes of Health launched its All of Us initiative, a program to collect the health records and DNA of 1 million people to advance precision medicine. The NIH will make those data freely available to researchers starting in 2019.

Meanwhile, the consumer genetic testing market is bursting at the seams. As of Aug. 1, 2017, there were about 75,000 genetic tests available, according to a new study published in Health Affairs. But coverage for these tests is inconsistent, they wrote. "There are concerns that patients may face high out-of-pocket spending for many genetic tests," they wrote.

The clinical usefulness of these tests remains somewhat unknown, according to the study.

"The good thing about Geisinger is that within their system, they should be able to access the data and see what kind of impact it's having," said Patricia Deverka, one of the authors and a researcher at the American Institutes for Research.