In February, telegenomics clinical care provider Genome Medical announced it was significantly bolstering its genomic medicine program with the addition of Huntington Willard, Ph.D., as chief scientific officer and vice president of medical affairs. Also joining Willard are Erica Ramos, MS, LCGC, as vice president of population genomics, and Beth Denne, MS, CGC, who directs education and engagement. All three were formerly key leaders of the Geisinger National Precision Health Initiative, which sought to broaden the use of Geisinger’s care model, largely leveraging its MyCode population genomics offering.
Since its creation in 2016, Genome Medical has been a provider of genetics testing and counseling, largely through a teleconferencing approach. Now, with the additional expertise of the former Geisinger trio, the company plans on scaling its services to include health systems, larger provider practices, and insurers, along with its current capabilities for smaller practices and single providers.
“We chose to partner with Genome Medical because they are clearly a healthcare company determined to bring the services necessary for genomic medicine to what they call ‘everyday care’,” said Willard. “That resonated with us. It was similar to what we were trying to do at Geisinger in a much more limited scope.”
Willard, Ramos, and Denne developed the Geisinger National Initiative in 2017 as an outgrowth of its parent, Geisinger Health, the Pennsylvania-based health system. From the start, the plan was for the Initiative to move beyond the Geisinger Health system within a few years.
History of cooperation
Prior to joining Genome Medical, Ramos had an established relationship with the company. “I’ve been fortunate to work with Genome Medical in various different ways over the past several years,” she said. While in market development at Illumina, Ramos was the clinical lead for a partnership with Genome Medical producing a series of educational and engagement programs called Understanding Your Genome (UYG). She worked closely with Robert Green, M.D., MPH, of Brigham & Women’s Hospital, and one of Genome Medical’s co-founders.
“During that process, Robert and others realized there was a big need for more distributed genetic services,” said Ramos. Very quickly, Illumina and Genome Medical began an association to offer the UYG program educating clients about how to seek and receive good genetic counseling, good genetic expertise input, and the experience of having genetic testing. Ramos again bumped into Genome Medical when Illumina offered an employee program to receive genetic testing and the company was selected as the provider for genetic counseling services.
“When it came to wrapping up our work within Geisinger and considering next steps in terms of expanding the opportunities for precision health and population genomics, Genome Medical rose to the top as a great fit because they already had some technology solutions, genetic counselors, and some of the service solutions,” said Ramos. “It was a great fit for expanding how we do genomics in a health care setting.”
Ramos has spent nearly 20 years providing genetic counseling services. “New technologies are accelerating access to genetics for patients and I have always been interested in how we can use technology to reach more people,” Ramos said. “And I realize the central key to effective counseling is really around prevention. How do we help patients diagnosed with risk of a genetic disease before they get that disease?”
Initially, Ramos’s focus is working with health systems and other large sequencing initiatives and genomics initiatives to offer genomics services and optimize them across the institution. “My role is around implementation,” she said, “learning what health systems need to identify more patients, offer more patients genetic testing and counseling, and to manage and take care of these patients over time.”
Experience with growing pains
The team’s ultimate goal is to provide genetics services to health systems and organizations across the country. When the Geisinger National Health Initiative closed at the end of 2019, the team had worked out many of the logistics.
“While at Geisinger we learned how to implement this strategy,” noted Willard. “We have seen the stress points, figured the work-arounds and how to avoid them, and see them when they are approaching. Because we have been through it, we know it can work at scale all the while keeping the patient first.”
Based on that experience, the current vision for the Genome Medical team is to bring it beyond Geisinger to a broader set of health care systems, patients, providers, and payors around the country. But Willard wants the experience to be seamless. “There will be a lot of diversity how you get to us, but if you need and want support for genetic medicine to impact your care—in terms of diagnosis and/or going forward with treatment and management of your care—we can do that.”
Scaling for growth
Genome Medical currently provides services nationwide with its own team of 50 genetic counselors. Results, information, and guidance are provided via phone chat or a teleconference call within 24 hours of request.
With its expanded leadership team, Genome Medical’s immediate focus is to add more bandwidth to the company’s existing book of business. As more stakeholders integrate genomics services, several have formed collaborations with the company including Cigna, Kaiser Permanente Northwest, Renown Health, and Shriners Hospital.
“Now we scale it,” said Willard, referring to the first stress point for the genetics services field currently. How do you scale? “The answer has to be technology and education.”
Denne’s 20 years of genetic counseling experience and her role as education specialist are essential components of the new Genome Medical vision. The plan is not to hire large numbers of geneticists or genetic counselors. Instead, the company principally uses technology to educate providers and avoid the need for one-on-one interactions, a model unfriendly to scaling.
Genome Care Delivery
In October 2019, just before the Geisinger trio joined the company, Genome Medical debuted its Genome Care Delivery cloud-based service platform. Its four-point strategy includes:
educating patients and physicians with information about genetic conditions, genetic testing and the potential impact on patient care
providing assessment tools and virtual care consults with genetic specialists to determine which patients are at an increased risk for a genetic condition
guiding patients toward clinically relevant specialty care pathways and personalized recommendations regarding appropriate genetic testing
creating a personalized plan based on genetic test results and medical management guidelines, as well as personal and family health history
The company’s network of geneticists and counselors rely on the Genome Care Delivery platform as a means of educating their clients, arranging for appropriate genetic testing, delivering results, and providing ongoing support.
Funneling more patients into testing
Ramos explained that only 10% to 15% of patients at high-risk for hereditary cancer are referred for genetic services. Of these, she believes that current testing guidelines omit between 25% to 50% of at-risk individuals. “So there is still a long way to go to get everybody who should be getting genetic services into that funnel and down that path so that they have the opportunity to consider what they want to pursue in the genetic space,” she said.
Capturing those 25% to 50% of people in the early-risk funnel is an early goal for Ramos. “Genome Medical now has the opportunity to bring it all together: the technology they developed, counseling services, and the expertise around how we implement all of this into health systems so that more patients access the funnel and get diagnosed.”
Willard views Genome Medical as a healthcare partner. “Both in the short- and longer-term—these are journeys of a lifetime,” he said. He envisions a system that not only adjusts with increasing numbers of patients, but also scales temporally from diagnosis to long-term management of genetic disease and risk.
“The more we learn about genomic information over time, we want to be sure we can provide access to the new information and provide the guidance that comes with that new information,” Willard explained. “A defining feature of our services will be to take the results of that analysis on an ongoing basis and then in a very efficient way, reintroduce that back into the health care services you are providing over the next year, five years, decade, or a lifetime.”
One could work either directly with a patient or with his or her provider to provide information about genetic associations, risks, treatments, and clinical trials, and keep them fully engaged and supported through their lifetime.
“You want to avoid patients getting an email or letter in the mail with genetic testing information,” added Ramos. Genome Medical plans on bridging those gaps and all of the disconnected components of providing genetic testing. “We aim to provide a clean, clear, efficient, trustworthy path for all parties in the process so that patients receive medically useful information.”