BLOOMFIELD, Conn., June 05, 2014 - Last September, Cigna (NYSE: CI) implemented a national program to require counseling from an independent board-certified genetics specialist for individuals who are seeking coverage for genetic testing and are at heightened risk for certain hereditary conditions, such as breast cancer, colorectal cancer or Long QT syndrome. Cigna was the first national health service company to require independent board-certified genetic counseling before approving coverage for testing.
Since then, Cigna's program has helped the right people get the right genetic testing at the right time, and has helped customers seeking genetic testing make informed decisions about potentially life-altering medical decisions.
"There's a lot of misunderstanding and misinformation about genetic testing, particularly regarding who should be tested and what the test results mean," said David Finley, M.D., Cigna's national medical officer for enterprise affordability and policy. "We have an obligation to our clients to ensure their health care dollars are spent wisely. We also have an obligation to the individuals we serve to help them receive the best information so they can make informed decisions about their health care."
Dr. Finley noted that since implementing the program, the number of Cigna customers who have received counseling from a board-certified genetics specialist has increased 4 ½ times. "That means more Cigna customers have gained access to information and are armed with the knowledge they need to make a choice that's right for them."
"We're also getting better, more robust information about the individual from the genetic counselor, which enables us to better determine if the individual meets national criteria for testing," Dr. Finley said. "That means people who truly are good candidates for the testing and could benefit from it receive coverage for it, while those who aren't good candidates, based on their medical and family history and other criteria, avoid an unnecessary test."
Dr. Finley also said that with counseling, a higher percentage of people choose not to take a test, for a number of reasons. "They may realize that someone else in their family is a better candidate, or they may come to realize that they won't take any action based on the test results and decide not to have it. Whatever the reason, by going through counseling, that individual is able to make a better, fully-informed decision."
A Cigna customer from New Jersey wrote to the company: "I would like you to know how happy I am that Cigna required that I have genetic counseling before proceeding with the BRCA gene test. At first I was annoyed because I knew I was negative for the gene, but my counselor Rhonda went over everything with me, what the test would represent if it was positive and why they do genetic counseling. I got a call from Rhonda to go over my results, and to my surprise I was positive for the BRCA1 gene mutation. I was totally shocked to say the least, but with a very well informed conversation with Rhonda about what this all meant, I hung up thinking that this test changed my life, but I was so educated on everything that I was ok and knew this would all work out for the better. I do feel that Cigna should require everyone to be genetically counseled as it was an eye opener for me and has truly helped me get through this."
Ellen T. Matloff, MS, CGC, director of the cancer genetic counseling program at the Yale School of Medicine/Yale Cancer Center, isn't surprised by this customer's experience. "Cigna plays an important role by connecting its customers to independent board-certified genetics specialists who have deep knowledge of genetics and are able to spend the appropriate time to take a complete, three-generation family history, help people understand if a test is right for them, and then help them understand their options if they do proceed with testing," Matloff said.
Matloff noted several misconceptions about genetic counseling; for example, that qualified genetic counselors are in short supply.
"The reality is that there are thousands of clinical genetic counselors and medical geneticists in the U.S. Many have outreach clinics covering large geographic areas, and they are also available by telephone."
Cigna's Dr. Finley said that the company took this into consideration when it developed the program, which also provides for telephonic counseling in collaboration with InformedDNA.
"Through our program, a qualified genetic counselor is just a phone call away for people living in remote areas or areas that don't have a sufficient number of qualified counselors," Dr. Finley said.
Another misconception is related to the ability of an individual's own doctor to determine if genetic testing is appropriate.
"Genetic counseling is ever-evolving, especially as the number and type of genetic tests continues to grow exponentially," Matloff said. "Most doctors don't have the education, training or certification that's needed to keep up with these changes. We continue to see evidence that physicians order too much testing or incorrect testing, and sometimes this has led to serious, life-threatening errors in treatment."
A third misconception is that requiring counseling will slow down treatment and put the individual's health at risk.
"There's no evidence to support that position," Matloff said. "It's routine for genetic counseling centers to see patients right away if they have an urgent need; and genetic counselors are available by phone."
Another misconception is that the evaluation of the medical need for genetic testing should be made only between the patient and his or her doctor. However, it's of great benefit to involve a trained expert, such as a genetic counselor or medical geneticist, who has the time and expertise to help the patient receive appropriate education and testing.
According to Matloff, "Patients don't expect their doctor to be expert at everything. Patients understand the concept of specialization and expect that their doctor will refer them to the right specialist. Anyone who has had a medical appointment lately knows that most doctors are short on time; the average office visit lasts about 20 minutes. Taking a proper history, making an assessment of medical necessity and counseling the patient before and after a test can take hours. Cigna's genetic counseling program supports doctors; it's a resource that frees them to concentrate on providing medical care to their patients."
Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products including group life, accident and disability insurance. Cigna maintains sales capability in 30 countries and jurisdictions, and has approximately 80 million customer relationships throughout the world. To learn more about Cigna®, including links to follow us on Facebook or Twitter, visit www.cigna.com.