The Washington Post's June 9th article: "Doctors couldn’t help. They turned to a shadow system of DIY medical tests" was their #1 "most read." It's a medium-long read, but it crosses so many aspects of healthcare and employee benefits, that I'd say it's a must read.

WAPO notes that DIY medical testing has burgeoned onto the scene, buoyed by a regulatory vacuum and mistrust in traditional medical systems. They put Silicon Valley at the epicenter of the shift, with a number of companies having developed a wide array of home tests that, whether intentionally or not, are bypassing the doctor’s office entirely.

This "shadow system" of self-testing is both a response to and a product of a healthcare ecosystem that many patients feel has failed them. But what does this mean for employer-sponsored health plans?

Consider the case of Angelika Sharma. Desperate for answers about her daughter’s severe food allergies, she turned to Tiny Health, a start-up that offered a gut microbiome test. The results led to dietary adjustments that transformed her daughter's health. This success story highlights the potential of DIY tests to provide relief where traditional medicine has not, but it also raises important (troubling?) questions about the long-term implications for health plans and the broader medical industry.

Growth factors
The rise of home testing is being driven by several factors:

• a growing distrust of Big Medicine,

• the convenience of home diagnostics,

• confidence in self-testing that surged during the Covid-19 pandemic.

Companies like Everlywell, Cleancard, and Tiny Health have expanded rapidly, and the home diagnostics market is expected to nearly double to $10 billion annually by 2032. But growth like this tends to bring with it a good deal of controversy, including ardent fans who sometimes try to shout down the doubters. Critics argue that bypassing professional medical oversight can lead to misdiagnosis, questionable remedies, and delayed care.

Will health plans end up paying for reparative treatments?
For employers, this evolving landscape poses significant challenges. One pressing question is whether health plans will end up paying for reparative treatments when DIY tests go wrong. As Dr. Karen Tang, a gynecologist, pointed out, many home tests fall into a regulatory gray zone, leading to a "Wild West" of medical information. When patients take these tests without proper medical guidance, they may face inaccurate results and inappropriate treatments, potentially resulting in higher healthcare costs down the line.

On the other hand, should health plans begin covering a broader range of DIY tests? After all, there is certainly a convenience factor, along with a possible boost to an employee / patient's sense of self-empowerment. But Dr. Disha Narang, an endocrinologist, expresses skepticism about the reliability of self-administered tests, a sentiment echoed by many in the medical community. Covering these tests might encourage their use, but it could also lead to increased spending on unverified diagnostics.

Per test, per dose, per treatment, by subscription - or what?
As Direct Primary Care (DPC) models began to show up in the benefits world some years back, patient-pay, based on Fee-For-Service models, began to shift to subscription models and memberships. In a way, they "flipped" the capitation models from the providers to the members. Now, companies like Function Health offer a suite of lab-drawn tests for a flat annual fee, positioning themselves as integral parts of proactive health management.

Not to get too far ahead, but will these models get packaged as the latest evolution of voluntary benefits? How will employers balance the desire for effective health solutions that don't run directly through the health plan with fiduciary obligations to operate health plans solely for the interests of the members? Or will new-fangled VB product providers include risk mitigation elements via professional oversight, while still empowering patients?

The implications of this trend are thorny, and multifaceted. Employers should be aware, though, that this dynamic is growing - and begin contemplating its impacts. Will the integration of self-testing into health plans improve overall health outcomes, or will it lead to a surge in unnecessary and potentially harmful tests? Should companies negotiate partnerships with reputable DIY test providers to ensure accuracy and oversight?

Healthcare's emergent scarcity factor
Just last week, Forbes explored the ongoing debate about expanding the scope of practice for nurse practitioners (NPs) amid a shortage of physicians in the U.S. in "The Doctor or NP will see you - does it matter?" While nursing groups and some state legislatures advocate for greater autonomy for NPs, doctors argue that this could compromise patient safety due to NPs' less rigorous training.

The type of care setting and case complexity often determine whether a patient should be seen by an NP or a medical doctor. As the number of NP graduates surpasses that of physicians, healthcare systems increasingly employ NPs and physician assistants (PAs) to cut costs. Despite this trend, the article highlights the indispensable role of physicians in managing complex medical cases, emphasizing that NPs are well-suited for primary care and following established protocols for known diagnoses.

Meanwhile, another WAPO article notes that "Pharmacists cite the highest number of drug shortages since 2001."

The last word
Who knows where all of this will go? But employers, consultants, and vendors will surely have to up their game to stay abreast of change that's no longer incremental. While it may not yet be happening at exponential rates, it's the nature of compounding that, sooner than many think, the curve turns vertical.

~ Mark Head
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