Wamberg is an advisory firm that provides genetic products and services as part of employer benefit packages. Bellanca discusses how the burgeoning field of genomic testing has the potential to improve employee health and reduce employer medical spend.
How did the organization get its start?
WGA was founded about a year and a half ago with a team made up of individuals with a background in life insurance, employee benefits, and the clinical and genetic side of things.
There was a lot of interest in this field, but no one had done a good job of bringing the two sides together—genetics and employee benefits. The mission is to make genomic programs affordable and accessible to the masses because we believe genetic testing can improve the overall health and well-being of an individual.
Cancer Guardian is your flagship product. Why is cancer a good space for genomics?
Cancer is a genetic disease and is the most common genetic disease in the country. Anywhere from 10% to 15% of all cancers are hereditary. We test for genetic markers relating to breast, ovarian, uterine, colorectal, melanoma, pancreatic, stomach and prostate cancer.
The first aspect included in the Guardian product was advanced DNA testing of the cancer itself. The value of that is you are looking at a very comprehensive test of the cancer. This can help ensure accurate diagnosis and identify genetically matched treatment.
The normal standard of care doesn’t include this type of testing, and insurance often doesn’t cover it either. If someone wants this type of testing, they have to pay out of pocket, and often the cost can range from $5,800 to $10,000 depending on the specific type of test. We offer it in a more affordable way by having employers pay for the Cancer Guardian on a per-member, per-month basis. They roll it out, and if—God forbid—anyone is diagnosed, they will have access to this when they need it most.
What opportunities are there in genetic testing to improve cancer care?
[Cancer Guardian] is designed as a comprehensive cancer support program. When someone is diagnosed with cancer, we have a team of nurses trained in oncology who guide the person through their journey and give personalized information based on their diagnosis.
It begins with an orientation assessment with one of our support specialists. They find out where the patient is in their journey, and a nurse navigator reaches out to their physician directly to let them know the employee is enrolled in the program and they have access to DNA testing at no additional cost. If they choose to take part, we do the testing and offer a second opinion pathology review through Duke Medicine. We also cover the cost of an on-site nurse who can go with the individual to doctors’ appointments to ensure they are getting all of the information they need. When testing is completed, we can educate their oncologist on their options and let them choose how to move forward. It may show that chemotherapy or radiation is best, but it also may show that immunotherapy is a better option.
We also recently embedded hereditary screening into the program. So an employee will have access to this test through Color Genomics Inc., our screening partner. This product is offered before any kind of cancer diagnosis. An individual provides a saliva sample and gets a report offering information including their hereditary risk for cancer. (We also give information on their risk for heart disease and what their response might be for behavioral health medications.)
Color offers access to licensed genetic counselors to help individuals understand their results. It may show someone has an elevated risk of a certain type of cancer, and that can be scary news. But now that they are aware of it, they can potentially do things to help prevent or delay them from getting it.
How are these programs different from what someone would get by being tested with a commercial product like 23andMe?
Direct-to-consumer tests are very limited by the U.S. Food and Drug Administration because, once the information they provide passes a specific threshold that is clinically actionable (like Cancer Guardian), it requires a physician to sign off on the results. These tests are really more recreational, and about 24 million people bought them in 2018.
There has been such an increase in the number of consumers who have taken genetic tests in recent years. It really goes back to the first whole genome sequencing. Since then, the cost has dropped like a rock and bottomed out (a recent MIT technology review showed sequencing a human genome has dropped from $95 million in 2001 to about $1,100 today). Down the road, the cost of interpreting and understanding how to apply the results will be more expensive than the testing itself.
What kind of companies will these products work for? How are they doled out on a national level?
Our plans range from an eight-life law firm to 10,000-life tree-trimming company. So it works with a wide range of employers.
We are not a lab. We don’t do any of the testing itself. Instead, we have a chief science officer who vets the lab partners we work with for advanced cancer testing. Employees can pick up the phone to talk nurses on the support line and ask any cancer-related questions they have. We also partner with a national network of nurses who take part in the on-site visits with patients and physicians.
How is the benefit paid for?
We learned that, to make the programs accessible and look like other benefits, we had to price them on a per-employee, per-month basis instead of charging one fee. It has to look and feel like every other benefit and be offered seamlessly. It is a voluntary benefit that the employer pays for.
This is somewhat early-stage work. Is there much outcome data in this space?
There are some studies that back up the importance of genetic testing, especially in relationship to cancer. Like with breast cancer, if someone knows they are at higher risk, they might be able to catch cancer earlier, which improves outcomes. If you catch it at Stage 1 as opposed to Stage 4, 98% of people are alive five years later, and 25% have the chance of being alive beyond that.
Another study showed that there’s a 31-month median survival length for Stage 4 lung cancer patients who had DNA testing and then received a targeted therapy. Those without the testing had a median survival rate of just more than a year.
Why should employers consider these programs?
One in every two individuals born today will be diagnosed with cancer at some point. It not only decreases productivity but is a big driver of healthcare spend. It makes sense that they would look for solutions here.
Taking part in genetic testing also increases the opportunity for employees to participate in clinical trials, which can be beneficial to patients and also to employers. If they can have a patient qualify for a clinical trial, the drug sponsor often covers the cost of the drug used for the treatment. And the average cost of cancer treatment is around $10,000 per month.
We heard from Bayer at one point that one of the biggest challenges they face is finding participants in clinical trials for new drugs. A big reason is they often have to find people with a specific genetic biomarker to qualify for treatment. In many cases, if individuals don’t undergo this type of testing, there is no way to know if they can take part. There are some estimates that people have more than double the chance of qualifying for clinical trials if they have genetic testing than those just going through the traditional standard of care.
What’s the ROI?
According to research we found, the annual cost savings for avoiding one cancer misdiagnosis by getting a second opinion is $21,500 a year. This would be per 1,000 employees, assuming there were seven to eight diagnoses in a year. We also estimate that having a support specialist reduces the annual cost per cancer diagnosis by just more than $13,000.
A study presented at the 2018 ASCO [American Society of Clinical Oncology] annual meeting by researchers from the Cleveland Clinic looked at metastatic non-small-cell lung cancer and genomic testing. The researchers analyzed data from more than 2,000 patients and estimated from their records that, on an annual basis, more than $250,000 can be saved for commercial insurance plans if cancers are tested to see if they are amenable to being treated with immunotherapy. Savings could be found in reduced testing costs and earlier implementation of appropriate therapies.
Anything else people should know about how genomics is changing cancer care?
These tests are a lot more comprehensive than ones most insurance pays for. We include upfront and backend comprehensive DNA testing to look at 300 to 500 genes of the individual’s cancer itself. For certain types of cancer, it’s important that this is done. Under the standard of care today, most insurance tests are single-gene and hot-spot tests and are much more limited in nature. These have a high miss rate for identifying genetic drivers of cancer.
Our entire focus is to provide clinically actionable insights that are predictive so people can be proactive and preventive. If someone has the cancer genes, they have a much higher risk of getting cancer than if they don’t. The risk for breast, ovarian and colorectal cancers goes from less than 20% to between 50% and 75%. When cancer is caught early, it increases the survival rate dramatically and reduces treatment costs 50% to 90%.
But people should know that your genes are not your fate. Just because an individual has a higher risk, it doesn’t mean they will be diagnosed. But they do know they are at risk, so now can take steps to reduce that risk.