Lyric and Concert Genetics: The Power of Strategic Partnerships and Innovation in Genetic Testing Claims
The field of genetic testing is rapidly evolving––presenting both challenges and opportunities in healthcare management. Genetic testing has exploded over the past decade, rocketing from 10,000 available tests in 2012 to over 175,000 today –– a 1650% increase, and it's estimated that another ten new tests are introduced daily. This diagnostics revolution brings boundless potential to transform personalized medicine through early risk detection and tailored treatment plans.
However, with breakthrough innovation comes complexity that strains healthcare payment systems, along with the potential for abuse. While genetic tests make up about 1% of all healthcare claims, they account for 15-20% of all medical services reviewed by health plans, such as prior authorizations and claim reviews.
The rapid growth in the number of tests, their expanding clinical applications, and the evolving body of supporting evidence for appropriateness pose challenges for both healthcare providers and insurers. Consequently, payers, providers, and patients frequently encounter a disjointed and exasperating experience. As health plans struggle to keep pace, while inaccuracy and inefficiency swell, there is a demand for innovative solutions.
That’s why Lyric has forged an exciting strategic partnership with Concert Genetics, a leader in end-to-end genetic testing management, to enable automation and clarity across genetic testing claims management. Together, we will equip health plans to reap genomic testing’s benefits while safeguarding payment integrity as adoption accelerates.
By incorporating genetic testing content, Lyric aims to streamline the process, improve consistency in payment decisions, and ultimately enhance the overall experience for all stakeholders involved.
Concert Genetics: Clinical Expertise Where It’s Needed Most
Concert Genetics stands out with its deep specialization and network in genetic testing, offering solutions that are critical for navigating the complexities health plans face today. Their approach begins with patient registries, crafting policies around genetic testing administration, which are then translated into actionable edits for health plans.
The company brings deep expertise in emerging specialty areas like genomic testing where constant change overwhelms health plans. Concert’s Chief Scientific Officer, Gillian Hooker, PhD, ScM, CGC, is the past President of the National Society of Genetic Counselors, with a background in molecular and clinical genetics, genetic counseling, and behavioral science. She has worked with numerous transdisciplinary teams on the front lines of genomics, developing and evaluating methods for delivering genomic information to patients and their providers.
Lyric recognized the synergies between Concert Genetics’ pioneering navigation of clinical complexities and our own vision to simplify payers’ administrative complexities through integrated payment accuracy solutions. The Lyric solution, leveraging Concert’s genetic test edits through the Lyric Genetic Testing Module, is a quantum leap forward in eliminating complexity in the ever-changing genetic testing space.
Strategic Vision Meets Complementary Capabilities
While Lyric has a 30-year history as a market leader in claims editing, with over 80 health plans and 7 of the top 8 payers as longstanding clients, we view partnerships as instrumental to fulfilling our mission of payment integrity across the entire healthcare spectrum. Concert Genetics not only addresses current gaps in genetic testing intelligence, but also continues building tomorrow’s payment safeguards across further clinical frontiers.
Concert’s genetic testing management capabilities leverage the only proprietary database of the U.S. clinical genetic testing market - encompassing over 175,000 different testing products - that supports genetic test ordering, resulting, coding, coverage, and payment integrity. This shared commitment to tackling the very crest of innovation with sophisticated analytics and automation makes our collaboration exemplary.
United by a Common Goal
Lyric’s Genetic Testing Model effectively establishes a bulwark against runaway costs from next-generation diagnostics while capturing their abundant potential value. The modular solution helps plans improve payment integrity workflows to increase savings, reduce administrative waste, and identify fraud relating to genetic testing claims. Meanwhile, Concert Genetics concentrates intricate clinical details to proactively identify risks, nonsense trends and opportunities hidden within multidimensional data. It takes diverse talent to decode healthcare’s polymorphous challenges - exactly what this partnership embodies.
The result? Health plans can rapidly tap clinically validated edits and policies for genetic tests, sidestepping costly delays from internal development attempts unlikely to match specialty partner effectiveness. Immediate savings and frictionless workflows manifest when clinical sophistication synchronizes with administrative streamlining.
However, this collaboration is not just about managing costs but also about increasing transparency and reducing provider abrasion through clear communication and education on genetic test claim edits. Today, one third of genetic tests are ordered in error, increasing administrative burden for payers and providers, impacting both treatments and outcomes. We’re helping our health plan customers stay ahead of the curve so that they are approving the right claims and then flagging those where additional education is needed.
Clarity and Care for All Stakeholders
Of course, payment integrity solutions demand responsible design fostering collaborative, not combative, ecosystems. Concert Genetics' independent review rigor applied to our shared edits minimizes turbulence for providers struggling to keep pace with protean guidelines. Equally important, coupling deep clinical insights with explainable AI promises clarity for practitioners through plain language recommendations, precisely answering why changes occur and suggesting alternatives aligned with current standards. Getting on the same page accelerates value realization for all.
The Future Is Now
Lyric’s seamless integration capability will allow Concert Genetics to penetrate more health plans than possible alone, bringing expert navigation across genetic testing’s intricate landscape - already benefitting early customers since launching late last year. With infectious disease edits now onboarding to the joint solution, the partnership has proven volume, velocity, and value - a springboard for continued leaps forward in clinical payment accuracy.
In the end, any single player holds one fragment of healthcare’s genetic puzzle. But collaboration like that between Lyric and Concert Genetics assembles the complete picture to overcome challenges while unleashing health data’s immense latent power. Together, we are pioneering the future of payment integrity.
About Lyric
Lyric, formerly ClaimsXten, is a leading AI healthcare technology company, committed to simplifying the business of care. Over 30 years of experience, dedicated, expert teams, and top technologies help deliver up to $14 billion of annual savings to our many loyal and valued customers—including 9 of the top 10 payers across the country. Lyric’s solutions leverage the power of machine learning, AI, and predictive analytics to empower health plan payers with pathways to increased accuracy and efficiency, while maximizing value and savings. Lyric is investing in AI driven technology to ease implementation and speed to value for customer savings, while offering enhanced and newly available solutions through internal product development and strategic partnerships, including recently announced partnerships with Concert Genetics, Autonomize AI, and now, Codoxo. Discover more at Lyric.ai.
