Northeast Business Group on Health Releases Employer Guide to Genomic Medicine

NEW YORK, November 20, 2018 – Northeast Business Group on Health (NEBGH) today released “Genomic Medicine and Employers:  Separating the Hope from Hype,” the industry’s first employer guide to help HR and benefits leaders better understand and make coverage decisions about genomic medicine and genetic testing.

According to the National Human Genome Resource Institute, genomic medicine is an emerging medical discipline that uses genomic information about an individual for diagnostic or therapeutic decision-making. Genomic medicine is most commonly applied in oncology, pharmacology, cardiology, rare and undiagnosed diseases, infectious disease, maternal health and mental health. While many treatments based on genomic research are still years away, when it comes to screening and diagnostic testing, marketplace progress in genomics is happening quickly.

Earlier this year, NEBGH convened a roundtable on genomic medicine consisting of more than three dozen stakeholders — employers, clinical experts, benefits consultants and genomic vendors. Its aim was to explore basic concepts including the relevance of genomic medicine for employers, how it is being used for diagnostics and treatment, and the medical conditions for which it is most useful. The group was also interested in knowing whether genomic medicine can improve health outcomes and lower costs, and in this fast-changing field, what employers can expect from genomic medicine in the future.

“Employers are beginning to take a heightened interest in genomic medicine,” said Candice Sherman, CEO of NEBGH. “They clearly want to better understand genomic medicine and know what guidelines they should follow in making relevant benefit decisions. We developed this guide to provide a solid orientation on genomic medicine and give employers and HR a good place to start.” 

The Genomic Medicine and Employers:  Separating the Hope from Hype guide provides employers with definitions of an assortment of terminology associated with both genomics and genetics including genes, genetic testing and genetic disorders. The 24-page report includes a discussion of common forms of genetic testing for inherited traits. Some employers have added benefit coverage for more genetic tests in addition to traditional prenatal and maternity screenings. While employers usually provide benefits coverage for standard forms of genetic testing — screening for Down syndrome in high-risk mothers, for example — some industry stakeholders don’t recommend coverage of consumer genetic tests.

The Guide also highlights questions and challenges genomic medicine poses for employers noting that when it comes to genetics and genomics, questions exist about the trade-offs between cost and potential benefit.

The Guide includes a discussion on the future of genomic medicine, benefits coverage, and questions employers should ask their health plans and themselves when considering a strategy for genomic medicine. These questions include, but are not limited to:

  • Is the company a trendsetter when it comes to benefits or does it tend to follow standards in its industry and among its peers?
  • To what extent does the company want to reward specific behaviors that could lower costs such as genetic screenings for cholesterol?
  • Is the company likely to opt for a generous coverage policy for prenatal testing to avoid complaints among prospective parents?
  • When it comes to cancer, for example, how big a factor is cost in deciding what to cover?
  • If the employer’s health plan does not cover a specific test ordered by an employee’s doctor, how does it want to handle that physician’s request?

“Genomic medicine is an exciting area and many promising discoveries await us. However, employers should not be expected to have the clinical expertise needed to make coverage decisions about genomic medicine. For now, it may make sense for employers to turn a skeptical eye on the hype that surrounds this area and rely on their benefits consultants and health plans for guidance when making benefits decisions,” said Mark Cunningham-Hill, medical director at NEBGH.

The guide is available free of charge to all employers and the public at large. It can be accessed HERE.

About Northeast Business Group on Health
NEBGH is an employer-led coalition of healthcare leaders and other stakeholders with the mission of empowering members to drive excellence in health and achieve the highest value in healthcare delivery and the consumer experience. 


 Media Contact:
Mark Cunningham-Hill
212.252.7440 ext. 221