What to consider before adding a genetic testing benefit
As employer clients look for new voluntary benefits to help attract and retain employees, a growing number are turning to direct-to-consumer genetic testing for all employees to their benefits plans. According to the latest statistics from the Society for Human Resource Management, 18% of employers provide a health-related genetic testing benefit, an increase of 6% over the previous year.
For the most part, it can be a smart move: Not only can the benefit differentiate one employer from others vying to hire from the same employee pool, genetic testing providers market the benefit as a way to potentially lower healthcare costs and increase employee wellness.
This type of testing can be valuable for employees at an increased risk for certain types of cancer, such as breast and ovarian cancer related to mutations of the BRCA1 and BRCA2 genes, those considering having a child who have risk factors for genetic conditions such as cystic fibrosis and Tay Sachs disease, those who have a family history of conditions like high cholesterol, and those who take medications such as blood thinners and anti-depressants. There also are tests that look for genes associated with conditions such as Parkinson’s disease, Alzheimer’s disease and celiac disease.
But employers also have to realize that genetic testing for all employees, regardless of family history and risk factors, comes with potential downsides. In fact, some physicians believe that widespread genetic testing of this type may even present a risk of harm. There’s also the issue of regulation and oversight of direct-to-consumer genetic testing. The industry is not currently regulated, which, some researchers have found, can lead to inaccurate or varying results. One study found that when the same genetic variant was provided to nine different labs for analysis, the answers provided were different 22% of the time, highlighting the risk of false positive and false negative results.
So for employers who offer — or are considering adding — a genetic benefit, make sure to think about the potential outcomes that can occur by doing so.
The potential for lower costs as well unnecessary healthcare spending
If an employee’s genetic test is positive for a mutation that’s associated with cancer or another disease, he or she may be more proactive about screening for the disease and may make lifestyle changes that may lower the risk of developing the disease. There are potential healthcare cost savings to early detection of some conditions. For example, by some estimates, the cost for treating early stage breast cancer is more than 50% less than the cost to treat the same cancer at an advanced stage.
For employees who undergo testing related to how effective a blood thinner or antidepressant will be, there can be better health outcomes as well as cost savings. One study found that when physicians prescribed the blood thinner Warfarin based on pharmacogenomic testing, adverse events decreased by 27%. Avoiding adverse events and making sure employees are taking the medications that can most effectively treat their conditions can help keep them healthy, out of the hospital and productively on the job, all of which has a positive financial impact.
But when you’re screening people who don’t have risk factors or a family history of these conditions, a positive test result can lead to unnecessary testing and medical procedures, potential complications from those procedures and the costs associated with that testing and care.
Before and after testing, education
Employers who offer genetic testing without a physician referral need to take steps to ensure that employees understand the risks and benefits of these tests upfront and that they know what a genetic test can and cannot tell them about their health now and in the future. The first step is for any employer offering genetic testing to provide education for employees.
Many employees don’t realize that having a gene mutation that’s associated with a disease does not mean that he or she will ever develop that disease. The risk associated with most genetic variations is, in fact, relatively small. Because of that misunderstanding, employees may experience needless worry or, if the test is negative for mutations related to a disease, may forgo screenings like mammograms, colonoscopies and cholesterol tests that can help detect health problems earlier when they are often more treatable. In the case of genetic testing for mutations associated with cancer, employees may not be aware that most cancers are not caused by a mutation in the single gene that the test screens for.
For some of the conditions that genetic tests screen for, like Alzheimer’s disease, there are currently no treatments. This can again cause anxiety for employees and their families. Genetic tests also have implications that reach beyond the specific employee who is tested. A positive test can affect siblings and children as well, opening the question of whether the employee wants or feels compelled to share the results with other family members who may also be at risk.
Employers who offer employees genetic testing should ensure that all employees who choose to undergo testing are guided by experienced genetic counselors who can help them interpret and understand the results of their test and can connect them with other healthcare providers for additional testing or treatment as needed.