Now, the insurance provider Blue Cross Blue Shield of Michigan and the University Health System have established a collaborative to improve and create more guidelines for genetic testing, which can screen patients for genes linked to an array of illnesses and conditions.
The Genetic Testing Resource and Quality Consortium aims to investigate and improve current genetic testing practices.
David Share, senior vice president of Value Partnerships at Blue Cross Blue Shield of Michigan, said he believes genetic testing will positively impact patient care in Michigan.
“Such testing has the potential to add great value to the care of people with conditions, or at risk for conditions, with a genetic component, which can affect their future health and also future treatment,” Share wrote in an e-mail interview.
Co-clinical directors David Keren, professor of pathology and director of the Division of Clinical Pathology, and Scott Owens, associate professor of pathology and medical director of professional practice evaluation, worked with Blue Cross Blue Shield for approximately 18 months to develop the program.
“We want to see how genetic tests are currently being conducted by physicians around the state of Michigan, how they compare with national guidelines around the state and working with hospitals around the state,” Keren said.
The collaborative is one of 21 Collaborative Quality Initiatives at the University that help teach hospitals and clinics how to prevent complications and improve patient outcomes.
Blue Cross Blue Shield develops the CQIs to help hospitals save money and improve their surgical and testing procedures. Keren said he believes the purpose of the CQIs is to respond to problems physicians might face around the state.
“The idea isn’t to tell the people of Michigan what to do but listen to what’s going on,” Keren said. “It is to sit together and listen to people across the state and create guidelines. Then we look at outcomes to see if adherence to those guidelines actually makes a difference.”
Blue Cross Blue Shield contacted the University Department of Pathology and collaborated to create the consortium. Owens said he believes the collaboration lays the foundation for how people will continue to do genetic testing in Michigan.
“Ideally, it’ll benefit patients and make sure that the right tests are being done for the right patient at the right time,” Owens said. “Then once they get the test done, they can get the right follow-up help for both themselves and their families.”
Keren and Owens traveled around Michigan to collect information on how clinicians perform genetic testing. They inquired how often the physicians conducted testing and how they would use the results. While their research found large discrepancies from clinic to clinic, Keren said he hopes this initiative will help testing become more uniform throughout the state.
“The goal is to make it rational so that everyone is following the same guidelines that have been established,” Keren said. “Hopefully it’ll rein in the costs of testing, and give opportunity to people to see what is the best way to help people clinically.”
The collaborative will start with the breast cancer associated BRCA gene testing, which detects mutations in breast cancer susceptibility genes. Owens said since the test is well-known and performed often, it will be a clear test of where discrepancies lie in the system.
“We’ll use BRCA to set up our process of gathering this information,” he said. “The physician organizations and laboratories and so on that join the collaborative will be the ones that together have meetings and decide how to move forward from there.”
Owens said the results will be used to improve the initiative for future gene testing.
“We’ll be looking at evidence with an eye to figure out if it tests exactly what we think its going to test, and then we’ll look at the clinical validity,” he said.
Physicians will then use this information to critically look at and develop new guidelines for genetic testing.
“We’re going to start with this test and ask: what is the current practice across the state?” Keren said. “We will work together with national organizations to create educational material to see if we can improve the practice across the state.”
After experimenting with the BRCA test, the collaborative will focus on other types of genetic testing.
“We’re going to be doing this with many different tests over the years,” Keren said. “What these hospitals are going to be doing that are working with us is sitting on our committees and deciding which tests we should be looking at. They help us decide how to create educational materials that would be appropriate for physicians in hospitals or practices.”