Genetic Testing Management for Health Plans: Cost, Quality and Value

  • December 15, 2016
  • 1:00 PM – 2:00 PM ET

Advances in science and technology and the rise of personalized medicine are driving rapid growth in genetic testing. Spend for many health plans is rising more than 25 percent per year.

Managing this space, which spans across oncology, pharmacology, rare disease, women’s health, and many other clinical areas, is uniquely challenging. There are more than 65,000 genetic testing products on the market, and 8-10 new products enter each day. Yet, fewer than 200 codes exist to bill these tests, and clinical utility data is often sparse and inconclusive. As a result, health plans face the overlapping challenges of establishing medical policies, contracting with laboratories, paying claims correctly, and ultimately, serving their members, all in the presence of limited data and continual change.

In this webinar, executives from UnitedHealthcare and Blue Shield of California will discuss their perspectives on the present and future of genetic testing, and how their organizations are managing it.

This webinar is presented by NextGxDx.

Attendees will learn:

  • Key reasons genetic testing is an area of focus for leading health plans;
  • Perspectives on assessing clinical utility, establishing medical policy – and ultimately, measuring value – when data is scarce;
  • Practical lessons from experience implementing utilization management programs; and
  • Advice specifically for leaders who are just beginning to address genetic testing management for their health plan.

Who should attend this webinar:  

  • Medical directors and other clinicians at health plans charged with assessing clinical utility and establishing medical payment policies;
  • Health plan contracting professionals faced with the challenge of contracting with genetic testing laboratories;
  • Claims operations, cost management and payment integrity professionals seeking to ensure genetic testing claims are paid fairly and accurately; and
  • Health care providers and laboratories seeking insight into health insurers’ perspectives on genetic testing.


Lee N. Newcomer, MD, MHA
Senior Vice President, Oncology and Genetics
Dr. Newcomer’s career with UnitedHealth Group started in 1991 as the Chief Medical Officer with responsibilities for clinical services, Medicare and Medicaid. He focused his later work on the development of performance measures and incentives for the improvement of clinical care until 2001. He returned in 2006 to lead a pilot initiative combining clinical, financial and program management experts to improve the quality and affordability of cancer care. This team was the first to complete an episode payment program for cancer treatment and it has built the only commercial database combining clinical and claims information for cancer patients.

Prior to his work at UnitedHealth Group Dr. Newcomer practiced medical oncology for nine years in Minneapolis and Tulsa, Oklahoma. He served as the Medical Director for Cigna Healthcare, in Kansas City and he was a founding executive of Vivius, a consumer directed venture that allowed consumers to create their own personalized health plans.  He is a former Chairman of Park Nicollet Health Services (HealthPartners), an integrated system of physicians and hospitals based in Minnesota with national recognition for its leadership in quality, safety and cost effectiveness.

Dr. Newcomer holds a BA degree from Nebraska Wesleyan University, a MD degree from the University Of Nebraska College Of Medicine and a Masters of Health Administration from the University of Wisconsin at Madison. His clinical training included an internal medicine residency at the University of Nebraska Medical Center and a medical oncology fellowship at the Yale University School of Medicine.


Henry Garlich
Director of Enhanced Clinical Programs
Blue Shield of California
Henry Garlich is Director of Enhanced Clinical Programs, a newly developed department he created within Blue Shield of California’s Health Care Quality and Affordability division chartered with identifying, evaluating and developing utilization and disease management programs that improve quality and value-based care pathways. His extensive experience working in the medical device and pharmaceutical industry with emphasis in clinical research, healthcare economics and policy development has led to significant payer focused utilization management innovations in the areas of cardiology, orthopedics, oncology and genetics.

His recent development of a molecular diagnostics and molecular oncology program designed with a multi-faceted strategy to address medical policy, claims editing, access to care, genetic counseling, education and strategic laboratory partnerships as well as improving cost containment and decision support appropriately aligned with the current medical evidence and guidelines, has led to significant improvements in the utilization management of genomic and molecular diagnostic testing. Henry is chairman of the BSC genetic testing task force and a holds a BS degree in molecular, cellular and developmental biology and a masters of science in biochemistry.


Clifford Goodman, PhD (moderator)
Senior Vice President and Director, Center for Comparative Effectiveness Research, The Lewin Group

Cliff has 30 years of experience in the public and private sectors in such areas as health technology assessment, comparative effectiveness research, health economics, and studies pertaining to health care innovation, regulation, and payment for pharmaceuticals, biologics, medical devices, and other interventions.

He served as Chair of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) for the Centers for Medicare & Medicaid Services (2009-12). Dr. Goodman served as President of the professional society, Health Technology Assessment International (HTAi, 2011-13), and is a Fellow of the American Institute for Medical and Biological Engineering. A compelling public speaker on these topics, Cliff is also a nationally recognized health policy issues moderator and expert panel facilitator. He received a Doctor of Philosophy from The Wharton School, University of Pennsylvania, a Master of Science from The Georgia Institute of Technology, and a Bachelor of Arts from Cornell University.