NASHVILLE (June 10, 2020) – Concert Genetics, a company that seeks to standardize and digitize disparate data on genetic testing, has teamed with Blue Health Intelligence® (BHI®) to use BHI’s extensive U.S. commercial claims repository to refine tools that will fuel the growth of the genetic testing and precision medicine markets.
Until recently, the ordering, collecting, storing, and billing of genetic tests were hampered by a lack of uniform standards and antiquated processes for sharing testing data among payers, providers, labs, and manufacturers. Additionally, a lack of payment standards was producing wildly different rates for genetic testing.
To address these pain points, Concert Genetics built a database of 150,000 genetic tests, including every test used in the United States. To assure the market utilized and valued this test information, Concert Genetics leveraged BHI’s repository of more than 20 billion secure medical and pharmacy claims from all 50 states to create credible and trustworthy genetic testing benchmarks.
By mining BHI’s data, Concert Genetics found 2.2 million unique genetic test claims from 2016 to 2018. In this sample, multi-code claims were prevalent, and genetic testing reimbursement was hugely variable – between $90 and $2,000 per test. From the findings, Concert Genetics created quartiles of code combinations and allowed reimbursement amounts to transparently provide health plans, labs, and consumers with standardized information on specific genetic tests.
“BHI offered a strong, robust set of claims data that we used to operate at a granular level,” said Rob Metcalf, Concert Genetics’ CEO. “BHI has core data elements that are important to us: a reliable, substantial set of claims data, uniquely tied to provider IDs.”
Today, health insurers use the information to ease administrative burdens associated with managing testing benefits. Labs use the information to know what code combinations are acceptable to bill for the genetic tests, and consumers are leveraging the benchmarks to make more informed testing decisions.
“The importance of this research cannot be overstated,” said Swati Abbott, BHI’s CEO. “Genetic testing is the key to individualized, precision medicine and is seen by most clinicians as a powerful tool for treating and curing a wide range of diseases. We are thrilled that our database helped standardize coding, billing, and payment for testing, further improving the credibility and value of this new diagnostic tool.”
About Concert Genetics
Concert Genetics is a software and managed services company that advances precision medicine by providing the digital infrastructure for reliable and efficient management of genetic testing. Concert’s market-leading genetic test order management platform leverages a proprietary database of the U.S. clinical genetic testing market (today more than 140,000 testing products) and integrates with leading electronic health record and laboratory information management systems. Concert also provides genetic testing management solutions to leading health plans across the U.S. Learn more at www.concertgenetics.com.
About Blue Health Intelligence®
Leveraging the power of medical and pharmacy claims data from more than 200 million Americans, Blue Health Intelligence (BHI) delivers insights that empower healthcare organizations to improve care, reduce costs, and optimize performance. With the largest, most up-to-date, and uniform data set in healthcare, BHI provides an accurate representation of the health profile of commercially insured Americans. Our team of data analysts, clinicians, IT experts, and epidemiologists provide analytics, software-as-a-service, and in-depth consulting to payers, providers, employers, medical device companies, and other healthcare stakeholders. BHI is an independent licensee of the Blue Cross Blue Shield Association and carries the trade name of Health Intelligence Company, LLC. For more information, visit bluehealthintelligence.com.
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