Webinars for Health Insurers and Payers: Understanding Genetic Testing

To address the growing need for medical staff in the insurance industry to understand genetic testing, the National Human Genome Research Institute (NHGRI) has collaborated with the Blue Cross Blue Shield Association to produce this educational webinar series. The goal is to prepare insurers to understand genetic testing strategies, interpretations, outcomes and patient care, and use that understanding in making sound decisions regarding the healthcare activities of their insured.



Type Website
CME Available No
Topic
Cost Free
Note



Genomic Competencies

Experts from the disciplines listed below have tagged this resource as fulfulling genomic competencies.

Pharmacist

  • Basic Genetic Concepts
    • B1:   To demonstrate an understanding of the basic genetic/genomic concepts and nomenclature
    • B2:   To recognize and appreciate the role of behavioral, social, and environmental factors (lifestyle, socioeconomic factors, pollutants, etc.) to modify or influence genetics in the manifestation of disease
    • B3:   To identify drug and disease associated genetic variations that facilitate development of prevention, diagnostic and treatment strategies and appreciate there are differences in testing methodologies and are aware of the need to explore these differences these differences in drug literature evaluation
    • B4:   To use family history (minimum of three generations) in assessing predisposition to disease and selection of drug treatment
  • Ethical, Legal and Social Implications (ELSI)
    • E1:   To understand the potential physical and/or psychosocial benefits, limitations and risk of genomic/pharmacogenomic information for individuals, family members and communities, especially with genomic/pharmacogenomic tests that may relate to predisposition to disease
    • E2:   To understand the increased liability that accompanies access to detailed genomic patient information and maintain confidentiality and security
    • E3:   To adopt a culturally sensitive and ethical approach to patient counseling regarding genomic/pharmacogenomic test results
  • Genetics and Disease
    • G1:   To understand the role of genetic factors in maintaining health and preventing disease

Physician Assistant

  • Patient Care
    • 3:   Distinguish between genetic screening and genetic testing
    • 4:   Incorporate genetic tests into patient management

Nurse

  • Professional Responsibilities
    • PR-2:   Advocate for clients' access
      • PR2-K1:   Resources for healthcare professionals and lay public
        • PR2-1:   Demonstrate appropriate care and concern for all clients throughout their referral, provision of direct care and follow-up to genetic services.
        • PR2-2:   Demonstrate knowledge about accessing local/regional genetic and/or genomic resources.
        • PR2-3:   Include genetic health care professionals in team building and collaborative strategies to optimize client outcomes.
        • PR2-4:   Help client negotiate system barriers that limit access to genetic/genomic services.
        • PR2-5:   Identify strategies that could be used to facilitate reimbursement for access to genetic/genomic services and/or tests.
      • PR2-K2:   Resources for genetic and/or genomic referrals within one's community
        • PR2-1:   Demonstrate appropriate care and concern for all clients throughout their referral, provision of direct care and follow-up to genetic services.
        • PR2-2:   Demonstrate knowledge about accessing local/regional genetic and/or genomic resources.
        • PR2-3:   Include genetic health care professionals in team building and collaborative strategies to optimize client outcomes.
        • PR2-4:   Help client negotiate system barriers that limit access to genetic/genomic services.
        • PR2-5:   Identify strategies that could be used to facilitate reimbursement for access to genetic/genomic services and/or tests.
    • PR-6:   Advocate for the rights of all clients
      • PR6-K1:   Potential benefits, risks and limitations
        • PR6-1:   Ensure privacy when discussing genetic and genomic information.
        • PR6-2:   Maintain confidentiality when recording genetic and genomic information.
        • PR6-3:   Demonstrate awareness of the potential impact of genetic/genomic information on the individual and other family members.
        • PR6-4:   Respond appropriately to inquiries about genetic and genomic health care concerns.
      • PR6-K2:   Ethical, legal and social issues
        • PR6-1:   Ensure privacy when discussing genetic and genomic information.
        • PR6-2:   Maintain confidentiality when recording genetic and genomic information.
        • PR6-3:   Demonstrate awareness of the potential impact of genetic/genomic information on the individual and other family members.
        • PR6-4:   Respond appropriately to inquiries about genetic and genomic health care concerns.
      • PR6-K3:   Impact of genetic and genomic information
        • PR6-1:   Ensure privacy when discussing genetic and genomic information.
        • PR6-2:   Maintain confidentiality when recording genetic and genomic information.
        • PR6-3:   Demonstrate awareness of the potential impact of genetic/genomic information on the individual and other family members.
        • PR6-4:   Respond appropriately to inquiries about genetic and genomic health care concerns.
      • PR6-K4:   Components of informed decision-making
        • PR6-1:   Ensure privacy when discussing genetic and genomic information.
        • PR6-2:   Maintain confidentiality when recording genetic and genomic information.
        • PR6-3:   Demonstrate awareness of the potential impact of genetic/genomic information on the individual and other family members.
        • PR6-4:   Respond appropriately to inquiries about genetic and genomic health care concerns.
  • Identification
    • ID-1:   Identify clients who may benefit from genetic and genomic information and services
      • ID1-K1:   Components of family history needed to identify disease susceptibility or genetic/genomic condition
        • ID1-1:   Identify factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or genetic/genomic condition.
        • ID1-2:   Identify clients who may benefit from further evaluation of the identified disease susceptibility or genetic/genomic condition.
        • ID1-3:   Demonstrate assessment of client concerns or understanding about information received from specialty genetic services (i.e., on-line genetic testing results).
        • ID1-4:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • ID1-5:   Incorporate into the interprofessional plan of care the need for further genetic/genomic evaluation or other risk management interventions in collaboration with the client.
      • ID1-K2:   Inheritance patterns
        • ID1-1:   Identify factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or genetic/genomic condition.
        • ID1-2:   Identify clients who may benefit from further evaluation of the identified disease susceptibility or genetic/genomic condition.
        • ID1-3:   Demonstrate assessment of client concerns or understanding about information received from specialty genetic services (i.e., on-line genetic testing results).
        • ID1-4:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • ID1-5:   Incorporate into the interprofessional plan of care the need for further genetic/genomic evaluation or other risk management interventions in collaboration with the client.
      • ID1-K3:   Indicators of disease susceptibility or a genetic condition
        • ID1-1:   Identify factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or genetic/genomic condition.
        • ID1-2:   Identify clients who may benefit from further evaluation of the identified disease susceptibility or genetic/genomic condition.
        • ID1-3:   Demonstrate assessment of client concerns or understanding about information received from specialty genetic services (i.e., on-line genetic testing results).
        • ID1-4:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • ID1-5:   Incorporate into the interprofessional plan of care the need for further genetic/genomic evaluation or other risk management interventions in collaboration with the client.
      • ID1-K4:   Common health conditions with a genetic/genomic component
        • ID1-1:   Identify factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or genetic/genomic condition.
        • ID1-2:   Identify clients who may benefit from further evaluation of the identified disease susceptibility or genetic/genomic condition.
        • ID1-3:   Demonstrate assessment of client concerns or understanding about information received from specialty genetic services (i.e., on-line genetic testing results).
        • ID1-4:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • ID1-5:   Incorporate into the interprofessional plan of care the need for further genetic/genomic evaluation or other risk management interventions in collaboration with the client.
      • ID1-K5:   Indicators of need for targeted treatment selection
        • ID1-1:   Identify factors in a family and health history that contribute to: disease susceptibility; disease characteristics, treatment, prognosis; or genetic/genomic condition.
        • ID1-2:   Identify clients who may benefit from further evaluation of the identified disease susceptibility or genetic/genomic condition.
        • ID1-4:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • ID1-5:   Incorporate into the interprofessional plan of care the need for further genetic/genomic evaluation or other risk management interventions in collaboration with the client.
  • Referral activities
    • RA-1:   Facilitate referrals for specialized genetic and genomic services
      • RA1-K1:   Professional roles of providers delivering genetic and genomic services
        • RA1-1:   Develop an interprofessional plan of care in collaboration with the client that incorporates genetics and genomics.
        • RA1-2:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • RA1-3:   Develop a plan for follow-up of a client post genetics/genomic referral.
      • RA1-K2:   Resources for health care professionals and lay public
        • RA1-1:   Develop an interprofessional plan of care in collaboration with the client that incorporates genetics and genomics.
        • RA1-2:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • RA1-3:   Develop a plan for follow-up of a client post genetics/genomic referral.
      • RA1-K3:   Resources for genetic and genomic referrals within the community
        • RA1-1:   Develop an interprofessional plan of care in collaboration with the client that incorporates genetics and genomics.
        • RA1-2:   Uses genetic and genomic indicators as rationale for clients who may benefit from further evaluation or other risk management interventions.
        • RA1-3:   Develop a plan for follow-up of a client post genetics/genomic referral.
  • Provision of education, care and support
    • PECS-6:   Collaborate with insurance providers/payers to facilitate reimbursement for genetic and genomic health care
      • PECS6-K1:   Determinants of clinical utility of genetic/genomic tests
        • PECS6-1:   Identify strategies to facilitate reimbursement for genetic/genomic services and/or tests.
        • PECS6-2:   Describe other methods of payment for genetic/genomic health care services (i.e., laboratory indigent assistance programs).
      • PECS6-K2:   Economic impact of new genetic / genomic based therapies
        • PECS6-1:   Identify strategies to facilitate reimbursement for genetic/genomic services and/or tests.
        • PECS6-2:   Describe other methods of payment for genetic/genomic health care services (i.e., laboratory indigent assistance programs).
      • PECS6-K3:   Influence of predisposition gene variants, genetic disease/disorder on access to health
        • PECS6-1:   Identify strategies to facilitate reimbursement for genetic/genomic services and/or tests.
        • PECS6-2:   Describe other methods of payment for genetic/genomic health care services (i.e., laboratory indigent assistance programs).

Physician

  • Family History
    • P-FH1A:   Patient Care
      • 1A1:   Conduct patient interview to assemble family history
      • 1A2:   Use standard pedigree symbols in assembling family history
      • 1A3:   Recognize patterns of Mendelian inheritance and calculate simple Mendelian risks; provide this information to patients and family members as appropriate
      • 1A4:   Use empirical risk figures to provide appropriate information for complex (multifactorial) medical conditions.
      • 1A5:   Recognize that traits may cluster in families due to multifactorial rather than Mendelian patterns of inheritance
      • 1A6:   Formulate an action plan to address relevant family history information
    • P-FH1B:   Knowledge for Practice
      • 1B1:   Describe the basic patterns of Mendelian inheritance
      • 1B2:   Explain the difference between Mendelian and multifactorial inheritance
  • Genomic Testing
    • P-GT2A:   Patient Care
      • 2A1:   Discuss the indications for genomic testing - specifically the benefits, risks, and alternatives
      • 2A2:   Explain the implications of placing genomic test results in the patient’s medical record
      • 2A3:   Discuss the possibility of incidental findings and how they will be handled
      • 2A4:   Discuss risks of having genomic testing done: e.g., psychological implications for the individual as well as the family; the potential for discrimination; and the potential effect on insurance coverage.
      • 2A5:   Explain to the patient issues of costs and financial coverage of genomic testing
      • 2A6:   Order, interpret, and communicate the results of appropriate genomic tests, within the physician’s scope of practice
      • 2A7:   Provide referral to an appropriate specialist for genomic testing of a condition outside the physician’s scope of practice
      • 2A8:   Respond to the results of an abnormal genetic screening test, such as newborn screening, including immediate management and appropriate referral
    • P-GT2B:   Knowledge for Practice
      • 2B1:   Describe the major forms of genomic variability
      • 2B2:   Explain how different genomic changes may result in different phenotypes
      • 2B3:   Recognize that genomic tests require interpretation with respect to the patient’s clinical status (e.g., pathogenic, likely pathogenic, benign)
      • 2B4:   Explain the concepts of analytic validity, clinical validity, clinical utility as they relate to genomic testing
      • 2B5:   Recognize that medically ’non-actionable’ genomic results can be useful to the patient and family (i.e., personal utility)
    • P-GT2D:   Interpersonal and Communication Skills
      • 2D1:   Ensure that undergoing genomic testing is a joint decision of the patient and the physician
      • 2D2:   Explain and document findings from genomic testing to patient, including implications for other family members
      • 2D3:   Facilitate access to resources to enhance patient learning about the results of genomic testing
      • 2D4:   Address the needs of the patient as an individual as well as the needs of family members
    • P-GT2E:   Professionalism
      • 2E1:   Be aware of and comply with local and federal laws and regulations regarding use of genomic tests
      • 2E2:   Be aware of and responsive to patients’ concerns about genetic discrimination
      • 2E3:   Respect patient’s privacy and need to maintain confidentiality of genomic information
  • Patient Treatment Based on Genomic Results
    • P-PM3A:   Patient Care
      • 3A1:   Identify medical conditions and drug responses that have a strong genetic component
      • 3A2:   Recognize that variants affecting drug responses found in a patient may also have implications for other family members
      • 3A3:   Discern the potential clinical impact of genetic variation on risk stratification and individualized treatment
    • P-PM3B:   Knowledge for Practice
      • 3B1:   Appreciate the importance of genetic diversity of humans and the abundance of genetic variants in each individual genome
      • 3B2:   Identify single-gene disorders that may be amenable to targeted pharmacological therapy
      • 3B3:   Recognize that genomic test results may guide choice of therapy for multifactorial disorders
      • 3B4:   Recognize that there is variability in the phenotypic expression of genetic variants and in response to therapy
      • 3B5:   Recognize that the effects of some medications are strongly influenced by inherited or somatically acquired genetic variation
    • P-PM3D:   Interpersonal and Communication Skills
      • 3D1:   Discuss benefits, risks, and alternatives of various preventive and therapeutic approaches driven by genomic findings
      • 3D2:   Communicate clearly with other medical professionals involved in the care of the patient about the therapeutic implications of the genetic information garnered about the patient 3D3. Discuss pharmacogenomics implications for future health
      • 3D3:   Discuss pharmacogenomics implications for future health
    • P-PM3E:   Professionalism
      • 3E1:   Respect and guard privacy of the patient and the family members

Genetic Counselor

  • Genetics Expertise and Analysis
    • 4:   Identify, assess, facilitate, and integrate genetic testing options in genetic counseling practice.
      • 4a:   Investigate the availability, analytic validity, clinical validity, and clinical utility of screening, diagnostic and predictive genetic/genomic tests.
      • 4b:   Evaluate and assess laboratories and select the most appropriate laboratory and test based on the clinical situation.
      • 4c:   Identify and discuss the potential benefits, risks, limitations and costs of genetic testing.
      • 4d:   Coordinate and facilitate the ordering of appropriate genetic testing for the client.
      • 4e:   Interpret the clinical implications of genetic test reports.
      • 4f:   Recognize and differentiate specific considerations relevant to genetic versus genomic and clinical versus research testing in terms of the informed consent process, results disclosure, institutional review board (IRB) guidelines, and clinical decision-making.