Genetic testing continues to increase in popularity, with more people than ever purchasing direct-to-consumer genetic tests to learn about their ancestry or susceptibility to certain diseases. Tests are also being ordered more frequently in health care as an important part of precision medicine, alongside environmental and lifestyle risk factors. As we speed toward an era of precision medicine, we can expect insurance wellness programs that are truly designed to improve the health and well-being of policyholders to also accelerate in popularity.
From late 2020 into earlier this year, RGA conducted a global survey asking insurers around the world if/how they planned to incorporate genetics into their business models. Only 13 percent of respondents said they had a focus on genetics or a genetics-related initiative underway. Despite the surprisingly low percentage, RGA and RGAX are actively exploring opportunities in the field of wellness-based insurance products. At the same time, we’re seeing an increase in interest from health-tech startups and healthcare-related organizations we work with.
Following our genetic survey results, I sat down with the team of experts behind the development of the survey. We invite you to listen to our conversation in this two-part podcast and then continue reading about the real-time impact of precision medicine on our industry.
Let’s take a look at how precision medicine is set to play a vital role in the future of wellness and how insurers can remain relevant parties to the conversation.
What is Precision Medicine?
Precision medicine tailors healthcare services to the patient, often using genetic information, to optimize the prevention of a disorder or enhance the efficacy and therapeutic benefits of a treatment or wellness regime. In essence, precision medicine is about delivering the right therapies, to the right patient, at the right time.
Genetics Opens Up a New World of Wellness
Scientists have known for decades that certain diseases, such as cystic fibrosis and Huntington’s disease, can be inherited. As we learn more about the human genome, genetic markers for other diseases are becoming ubiquitous. Our understanding of how the interplay of environmental factors and genetic make-up may contribute to disease is also increasing.
In addition to predictive diagnostics, healthcare providers will soon be able to utilize an individual’s genetic make-up to develop and deliver a wide variety of tailored services to better serve their patients and customers. Here are just a few examples.
Nutrigenomics looks at the interaction of nutrition and genes, particularly with regard to the prevention or treatment of disease. Nutrigenomics is about more than using genetic testing to get patients to follow the same dietary advice they have been given for years.
As a simple example, nutritionists have debated for decades whether some individuals might live healthier on certain types of diets, e.g., animal-protein based, even if those diets don’t fit the currently accepted ideal. Nutrigenomics may provide supportive evidence for the tailoring of individual diets.
Pharmacogenetics examines how one specific gene influences an individual’s response to a particular drug. This will allow physicians to tailor their prescriptions for more effective treatment and help avoid adverse drug reactions (ADRs). Pharmacogenetics has obvious benefits for the patient in terms of more effective therapies with fewer side effects. However, this aspect of precision medicine has special relevance for insurers. Ineffective treatments lead to additional claims, and ADRs cost the industry billions of dollars every year. Some pharmacogenetic tests are now recommended as part of the standard treatment process, such as the case with determining the need for adjuvant therapy for breast cancers of low recurrence risk. Also, along with the advent of gene therapies, pre-treatment genetic confirmatory tests may become increasingly common as well.
Liquid Biopsies have already proven useful in the management of certain types of cancers for which a physical sample of the tissue is unobtainable or inadvisable. In a liquid biopsy, healthcare practitioners look for cancer cells or genetic material from a tumor in a sample of blood. If an individual has a predisposition to a certain type of cancer, a liquid biopsy can help detect cancer before the cells reach a stage where a biopsy is even possible. They can also be a less intrusive way to diagnose or monitor the progress of a disease, such as many types of organ cancers. Liquid biopsies are very much still in the early stages and while the data is promising, we still have a lot of ground to cover during this discovery period.
Gene therapy features the genetic modification of cells to produce a therapeutic effect. The costs of this type of approach are expected to be very high, and more advances will need to be made to ensure cost effectiveness. As an example, the most expensive drug in the world is currently a gene therapy aimed to treat spinal muscular atrophy, which until recent years has no known curative treatment. In view of the notable interests in the area, it is expected that gene therapy may continue to develop rapidly and radically alter the field of medicine as we know it today.
Precision Medicine Changes the Calculus for Insurers
Every year, insurers invest millions in wellness programs and other therapies designed to keep their customers healthy or help them return to health as quickly as possible. Sometimes the benefits of these programs are obvious, but at other times, insurers may struggle to justify the costs. If the program is popular among customers, the insurer may continue to offer the services simply to differentiate themselves in the marketplace.
Precision medicine promises to allow insurers to focus their investments on more quantifiable returns. Here are a few ways insurers might think about incorporating genetics into their programs and service offerings:
- Covering genetic testing for those who wish to participate in a more uniquely tailored program
- Under this model, the insurer would remain blinded to the policyholder’s results but encourage or even incent consultation from a qualified professional
- Covering preventative treatments/tests that mitigate genetic predisposition to certain diseases
- E.g., more frequent cancer screenings for patients with key genetic markers. As above, liquid biopsies may have a significant role to play in the early diagnosis of disease in the future.
- Encouraging participating physicians to use pharmacogenetics wherever appropriate to increase treatment efficacy and avoid ADRs
- Setting up tailored wellness programs and services designed for individuals with certain genetic markers
- It can be challenging to get wellness programs to “stick,” but when customers have evidence they’re predisposed to certain diseases, they may be more motivated to use these programs.
Not only will being an early provider of genetics-based wellness programs and supporting genetics-based therapies allow insurers to focus their efforts, but these initiatives will also set the insurer apart from its competitors. As evidenced by the increase in sales of health-tech, such as apps and wearables, people are more eager than ever to take responsibility for their own health and well-being. Given the concurrent rise in at-home genetics testing, precision medicine, and highly individualized wellness programs seems to be a natural next step.
Listen to Episode 1 of 2: Global Genetics Survey Podcast
Listen to Episode 2 of 2: Global Genetics Survey Podcast
Join the Conversation
RGA and RGAX are working closely with carriers to craft market-ready strategies that leverage the latest advancements in genetic testing and precision medicine. If you’d like to explore the exciting new opportunities in this emerging field, here are a few additional resources:
We'd love to hear from you and are always open to a conversation to share more about what we've heard from insurers on this topic. Feel free to reach out: RGA Genetics Strategy Group.