Genome Medical Bridges Genomic Testing, Medical Practice

Lisa Alderson, co-founder and CEO, Genome Medical

Many well-known barriers are slowing the integration of genomic testing into routine clinical practice, including workforce shortages and a lack of knowledge about genomic testing among many community-practicing primary care physicians. Genome Medical thinks it can fill in these current gaps.

Genome Medical is a newly launched medical genomics practice serving both patients and physicians through an online and telemedicine-type model. Founded by some big names in the molecular testing industry, including medical geneticist Robert Green, M.D., director of the Genome2People research program at Brigham and Women's Hospital, Broad Institute, and Harvard Medical School, and Randy Scott, Ph.D., chairman of genetic testing firm Invitae, Genome Medical has ambitious plans for growth this year.

DTET recently spoke to Lisa Alderson, Genome Medical's co-founder and CEO, to learn about the company's business model and its role in driving awareness of genomic testing.

What was the motivation for starting Genome Medical?
I envision a world where genomic information is fully accessible, easily understandable, and integrated into everyday health care. We think there is a critical opportunity to help patients and health care providers use genomic information and genetic services to ultimately improve health, decrease the cost of care, and potentially prevent disease.

The field of genomics is exploding. There are now great tools and technology more abundantly available and yet most clinicians are not knowledgeable about how to use this information for the benefit of patient care. This trend is creating the need for Genome Medical. There is an increasing gap between the technological advancements and medical care. We want to bridge that gap by making genetic experts more accessible and by focusing on actionable genetic insights to improve patient care.

How does the Genome Medical model mitigate workforce shortages?
There are roughly 2,500 geneticists and 4,000 genetic counselors in the entire United States. They are not all clinicians seeing patients, so the number of genetic experts available to patients is even smaller. If you think of this in relation to a population of 330 million and the accelerating pace of genetic testing, it is very clear there is a shortage in the workforce. Genome Medical is really rethinking the service delivery model and trying to increase efficiency through the use of tools and technology. This will enable us to provide high-quality, medically appropriate service, but in a scalable manner. It is about evolving the present care model to enable clinicians to increase high-value patient interactions and remove a lot of the mundane processes by having care coordinators and technological solutions to support clinicians.

In some regions of the country, there are reported wait times of three months or longer to see a geneticist. Additionally, most geneticists are located at leading academic centers in major metropolitan areas. Whether for a patient in a rural area or a patient seeking shorter wait times or convenience, we think the online, telehealth service delivery model can increase availability and efficiency of genetic clinical care, complementing what is already available today.

Community-practicing physicians often report a lack of knowledge about genomics. How does Genome Medical's model help providers?
Our mission is to serve patients directly and to help health care professionals. On the professional side, we want to be a resource to help physicians bring genetics and genomics into their practice setting. We can do that in two ways. First, we are set up as a medical practice and can accept patient referrals. So for physicians who recognize the opportunity genomics provides and want to offer their patients genetic services, they can simply refer patients to us. We would see them, just as any specialist would, and would provide information back to the referring physician related to recommended clinical action for ongoing patient care.

The second pathway is to provide education, training, and support to physicians in order to enable them to become more familiar with genomics. This could be broad support or very limited in cases of high complexity or high acuity. We cue off the interests and needs of the physician. Part of our vision is that if we are working with a physician on a particular patient case, they are increasing their knowledge and as they do that across more and more cases, they eventually feel more comfortable integrating genetics into their practice. We see this as a path to accelerate adoption and appropriate use of genetic services and genetic testing over time.

Patients can also access Genome Medical directly, right?
Yes. For the direct patient approach, we are a navigator for the patient. As an expert navigator, we can help guide patients to determine whether testing is right for them. The answer may not always be to pursue testing. It is really about understanding the patient's likelihood of having a hereditary condition, risks and benefits of testing, and potential actionability of results. Then, if testing is indicated, we guide to the right test for that patient. Currently, we offer patient pay approaches so that patients can have easy access for questions regarding increased risk due to health history, family history, or ethnicity. In the future, we will accept insurance.

With growth of sequencing, there has been some discussion about the appropriateness of re-analysis as genomic knowledge increases. Does Genome Medical have a role to play in recontacting patients?
As a navigator for patients, we want to ask the right questions at the right time and reveal the right information. It is about putting genomic information into the appropriate clinical context. For someone who has been sequenced, the interpretation of variants of unknown significance may change over time. Tracking, monitoring, and notifying patients about any change in the interpretation is an important part of making information clinically actionable. Part of our role as navigator is to help determine when science has advanced enough for it to make sense to re-examine the results or re-sequence the individual. There won't be a universal approach, but our support can help map a patient's journey.

How do regulatory issues impact your ability to expand?
We are currently in an early access program with services in select states due to regulatory requirements. Regulatory and compliance vary state by state for the corporate practice of medicine. As a physician practice, we are set up, including licensure and ownership by physicians, in the relevant states in which we practice. We are focused on a telehealth approach immediately. Our hope is to aggressively grow to full 50-state coverage.

We have two areas of service. The first is for genetic counseling, where we are further along. We can offer genetic counseling services in more than 40 states today. For physician services, we are in a very limited access program in a handful of states. We expect 50-state coverage by the end of 2017 in both lines of service.

What is your relationship with the laboratories you refer to?
Our responsibility and obligation is to the patient. We try to determine the best path—whether testing is appropriate, and if so, the best test for that patient. We are constantly evaluating the available testing options across multiple labs so that we can select those labs with the highest quality and great service for our patients. As a medical practice, we can order from any lab. We are truly independent, meaning that we are laboratory, technology, and platform agnostic.

Patients are finding laboratories and services online and essentially show up virtually to pursue testing. The lab can only say, 'Talk to your doctor.' But, if patients go to the average primary care physician and say they would like to pursue testing, it puts the physician in an uncomfortable position. They are being asked to act as a specialist in a field where they are not. We see this as an area of acute need. Through Genome Medical, patients can talk to a genetic counselor and can be guided to appropriate testing. This provides patients with easy access and a more rapid response. Particularly in cases with anxiety or concern triggered by an individual's or a family member's recent diagnosis, expert care delivered with speed, efficiency, and convenience are all critical.