Genetic Testing Utilization Management: Achieving Transparency, Efficiency and Value

  • May 16, 2016
  • 1:00 PM – 2:00 PM ET
  • Online

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Genetic testing is among the fastest growing areas of health care, and it shows no signs of slowing. There are more than 60,000 unique genetic testing products on the market – representing nearly 14,000 distinct, clinically relevant categories of tests – and an average of 10 new products enter the market every day.

Though this rapid growth is advancing medical diagnostic and treatment options for patients, it also pushes the limits of coding, billing and payment systems. Today, the nearly 14,000 types of genetic tests clinicians can order for their patients are represented by fewer than 200 procedural billing codes. As a result, health plans have limited visibility into genetic testing claims, including what tests they are reimbursing and the market prices for those tests.

Given the rate of change in the market, these issues are unlikely to resolve themselves. Health plan leaders must take proactive steps to address these challenges.

Drawing on an industry-leading database of more than 60,000 genetic testing products, as well as active relationships with top healthcare providers and genetics laboratories, the presenters will share a data-rich overview of the genetic testing market. Attendees will learn existing best practices as well as emerging solutions for managing the mounting challenges associated with genetic testing reimbursement and utilization management.

Webinar participants will learn:

  • The state of the 2016 market in genetic testing
  • The underlying tensions and drivers of change in the market
  • Insights on how health plans are responding to mounting challenges
  • Practical solutions for achieving transparency, cost savings and greater value, while maintaining strong relationships with providers and laboratories

Who should attend: Health plan medical directors, especially those responsible for personalized medicine and/or genetic testing, along with network, contracting and payment integrity professionals interested in genetic testing, laboratory testing and personalized medicine.


Harris_MarkMark Harris, PhD, MBA, CEO, NextGxDx
Drawing on a background in molecular biology and technology commercialization, Mark founded NextGxDx to bring efficiency and transparency to the growing field of genetic testing. He leads a dynamic team of software engineers, data scientists and clinicians who are dedicated to overcoming the practical and systemic challenges associated with the effective use of genetic testing.

Before founding NextGxDx, Mark planned a Next Generation Sequencing platform for Athena Diagnostics. He earned his PhD (Cancer Biology) and an MBA from Vanderbilt University.

Hooker_Gillian Gillian Hooker, PhD, CGC, VP Clinical Development, NextGxDx
Applying her background in molecular and clinical genetics, genetic counseling and behavioral science, Gillian is committed to overcoming the barriers to effective translation of genome science at the patient, provider, payer and overall health system levels. As a researcher in academic and government settings including the National Institutes of Health, Gillian has worked with numerous transdisciplinary teams on the front lines of genomics, developing and evaluating methods for delivering genomic information to patients and their providers.

Gillian completed her doctoral degree in Molecular, Cellular and Developmental Biology at Yale University and her masters degree in Genetic Counseling at the Johns Hopkins School of Public Health / National Human Genome Research Institute Genetic Counseling Training Program. She has been actively involved in the National Society of Genetic Counselors.

Participants Will Learn:


On how health plans are responding to mounting challenges


Tensions and drivers of change in the market


Solutions for achieving transparency, cost savings and greater value, while maintaining strong relationships with providers and laboratories