The case for providing rapid access to genetic counseling

The number of conditions for which genetic testing is available has increased by nearly 500% in the past 15 years¹. As genetic testing has become mainstream for guiding clinical decisions across virtually all medical specialties, health care organizations of all types are looking to increase their genomic services to serve their patients. Many are considering or have adopted genetic counseling as critical to accompany the testing, but may have difficulty scaling to adequately serve their patients with timely access. What are the considerations for a cost-effective solution that provides optimal patient care? 

Need for specialized expertise of a genetic counselor

A genetic counselor has specialized training in medical genetics and counseling. Incorporating genetic counselors into a multidisciplinary team can avoid problems such as inappropriate or incomplete test ordering, misinterpretation of test results by both patients and clinicians, inappropriate screening and prevention recommendations, and psychosocial issues². In addition, payors, as well as accrediting organizations, such as the Commission on Cancer, have now recognized this expertise, requiring genetic counseling to be provided. 

Importance of providing genetic counseling to meet patient demand 

The rapidly expanding need for genetic counselors³ has quickly placed a higher burden on clinicians straining to serve the growing number of patients. The result is often long wait times for appointments, which can reduce the likelihood that patients will follow through with genetic counseling. This, in turn, may reduce uptake of recommended genetic testing and continuation of care within the health system. 

One such study estimates that no-show percentages increased with longer wait times–as high as 21.6% ⁴. Genetic counseling helps identify high-risk patients who require continuation of care for surveillance, prophylactic surgeries and potential treatments, which can generate downstream revenue. Providing prompt access to genetic counseling serves both the patient and the organization. 

 

Methods to scale genetic counseling, including telehealth 

In scaling genetic counseling services, options include hiring internally, outsourcing to a telehealth service or a combined approach. In a recent review of the job board at the National Society of Genetic Counselors, 95 organizations were hiring for more than 850 open positions⁵. Given this tight job market and the growth trajectory, it is a reasonable approach for organizations to seek additional service delivery models such as telehealth, to meet their needs. 

In the 10th Annual Hospital Study, conducted in 2019 by L.E.K. Consulting, ~50% of hospital executives indicated that telehealth is a high priority, and the vast majority of respondents expected meaningful increases in telehealth over the next three years⁶. Telehealth for genetic counseling, specifically, has also grown. In the 2018 Cancer Care Survey, genetic counseling was the most popular service to be provided via telehealth–at 35% of respondents, with an additional 29% planning to provide in the next two years⁷. Importantly for patient care, numerous studies have confirmed that genetic counseling delivered via telehealth is equivalent to in-person⁸.

 

How to effectively incorporate telehealth genetic counseling–what to consider

A telehealth genetic counseling service can be an efficient method to enable an organization to scale to meet a high and variable volume of patients. A telehealth service and technology platform should fit seamlessly to follow the same workflow as that used by the internal team. Or, if there isn’t an existing team, to develop a custom workflow that aligns with the organization’s needs. 

Questions to ask of a telehealth genetic counseling service may include these four key areas: 

Expertise Cost-effectiveness 

• What is your genetic counseling expertise? 
• Do you have coverage in all states, including those with licensure requirements? 
• How do you measure and provide patient satisfaction and quality metrics? 
• How do you charge for your services? 
• Is there a cost for use of your platform? 
• Do you require minimums or upfront payment? 
• How will you help us lower costs? 
  

Service delivery Technology integration 

• What is your average appointment wait time? 
• Can your workflow fit our current process? 
• How will you work with internal genetic counselors? 
• How can you help us scale to meet our large precision medicine efforts? 
• Is your platform one-size-fits-all or customizable? 
• Can your platform integrate with our systems (API)? 
• Are patients required to use your platform? 
• How quickly can we get up and running? 
  

 

Conclusion

Genetic counseling is critical and the need can be met.

Telehealth for genetic counseling can be an efficient and cost-effective way to reach a large, diverse and growing population of patients. Organizations can be selective to find a service that is designed for their needs and to serve their patients in a timely manner.

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References:

1 Diamonstein, C. et al. , (2018), Physicians’ Awareness and Utilization of Genetic Services in Texas. J Genet Counsel, 27: 968-977. 2 Pal, T et al. Genetic Risk Assessments in individuals at high risk for inherited breast cancer in the breast oncology care setting. Cancer Control. Oct 2010. 3 U.S. Bureau of Labor Statistics projects a growth rate of 29% for genetic counselors https://www.bls.gov/ooh/healthcare/genetic-counselors.htm. 4 Shaw, T., et al.. (2018), Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service. J Genet Counsel, 27: 1473-1481. 5 https://jobconnection.nsgc.org/jobseekers/ Accessed 10/17/2019. 6 10th Annual Hospital Study: A Retrospective and a Glimpse into the Future. Volume XXI, Issue 59. 2019. https://www.lek.com/insights/ei/10th-annual-hospital-study 7 Highlights from the 2018 Trending Now in Cancer Care Survey by the Association of Community Cancer Centers and the Oncology Roundtable. Accessed October 2019. 8 Athen, A et al. A systematic review of randomized controlled trials to assess outcomes of genetic counseling. J Genet Counselor 26: 902-933, 2017.,  Visit: Gene-Matters.com GeneMatters Copyright ©2019