One of the most important objectives for physicians is ensuring that their prescribed treatments are the best and most effective for treating patients. Insurance companies, which cover most of the costs of care, share that objective. In this context, ConsultativeGenomix– a physician practice group with operations in Alpharetta and Augusta– specializes in molecular genetic pathology and has developed a unique construct to address these issues with game-changing results.
Human bodies, like human personalities, are all very different. A treatment that is right for one person may not work for another. Trial and error – trying various treatments until they find one that works – is time-consuming, expensive, self-serving for pharmaceutical companies, and consumes precious time as doctors search for the best approach to treat their patients.
Dr. Hani El Shawa, COO & Laboratory Director of ConsultativeGenomix in Alpharetta
That’s why using genetics to identify the best treatment – through molecular genomic pathology – is now being utilized by doctors.
“Historically, physicians have reached out to large labs or specialized independent genetic labs to run these tests. Most labs have done a good job running lab orders and sending test results back to the ordering physician, explains ConsultativeGenomix COO and Lab Director Dr. Hani El Shawa. “Everything sounds great, right? Well, perhaps not so much.” ConsultativeGenomix VP of Sales Dino Dakuras explains:
“The reality is ordering physicians need help knowing the proper genetic tests to order, when to order them and finally how to interpret and act on the test results to provide the best care for their patients. Our molecular pathology physician groups has genetic pathology MDs and genetic counselors that specialize in this field which is critically important to help ordering physicians in these areas and represents a breath of fresh air for insurance companies.”
Unfortunately insurance companies including Medicare and Medicaid have been unfairly tasked with determining what to cover and, El Shawa says, condemned to become the enemy of both patient and physician.
“I’ve watched from the early stages as genetics-based precision medicine has unfolded. It is very refreshing and exciting to see companies like ConsultativeGenomix come to market with very responsible solutions that take the burden of medical necessity and negative patient response out of the insurance company domain. That’s so the rest of the industry can focus time on ensuring that people get these important tests, when appropriate to create the game-changing value they are destined to provide,” explains Jeff Fusile, a former president of Georgia Blue Cross Blue Shield.
To add more icing to the cake, or perhaps vinegar, bad actors in this important health care arena have seized on the opportunity to profit from these aforementioned inefficiencies by taking advantage of ordering physicians, patients and payers resulting in considerable fraud, waste and abuse.
“There have been laboratories that take advantage of the way the system is built. They are in for one year and then out. Some have started as toxicology labs and evolved into genetics or allergy laboratories. It is very sad to see a critical component of health care be attacked by bad actors; it casts a dark shadow on all the good that has been done and progress made.” says Dr. Ellen Shaver, Chief Medical Director of ConsultativeGenomix
So, what is being done to elevate this important genetic-based personalized care to even greater potential?
In researching ConsultativeGenomix, it is an example of a company that has shifted away burdens that patients, physicians and payers face when ordering genetic testing to mitigate fraud waste and abuse. Doctors can now zero in on the best treatment based on a patients’ genes. Insurance companies and their customers benefit as well, since time and covered services are not wasted on approaches that don’t work.
“Ordering physicians should be made aware of companies that have the ability to assist them as well as insurance companies with lab orders, interpretation and medical necessity as it makes us all better stewards of health care dollars,” emphasizes Dr. Peter Greenwood, Senior Medical Director for ConsultativeGenomix.
“There have been bad players in the industry, but what we’re doing provides checks and balances to maintain compliance and to ensure physicians are referring to a group like us.” explains Lab Director El Shawa. “We established ConsultativeGenomix in 2017 and our focus has always been molecular pathology. We’ve prided ourselves on being an expert in the industry and with manufacturers, and we believe our reputation is strong. We have a positive relationship with the academic side, including hospitals and medical groups across the country.”
“Genetic testing is a once-in-a-lifetime test that provides information that can be utilized for the rest of your life,” El Shawa adds. “The information it provides is important for patients and their physicians, who utilize the information we provide to treat their patients with what they need.”
Chief Medical Director of ConsultativeGenomix Dr. Joseph Shaver sums it up:
“Through established detailed concise methods and utilizing ever changing technology, ConsultativeGenomix will always strive to be at the forefront of ensuring the appropriateness of medical necessity as it applies to each and every patient and for all types of molecular and genetic testing. Our goal is to allow genetic testing to always be a great advantage for patients and their physicians, and to the best of our ability never allow it to be taken advantage of.”
Tal Wright is a staff writer for InsiderAdvantage and James magazine.
