Ralph Moher who is the VP of Marketing for General Data and who recently launched a blog emails me with the following question regarding the Early Health Model and its emphasis on the diagnosis of pre-symptomatic disease:
What is the possibility that insurance companies in the future will require the use of biomarker panels to identify pre-symptomatic disease to determine eligibility and coverage?
In a diagram contained in a previous note (see: Wellness, Preventive Medicine, and the Classic Disease Model), I placed the Early Health Model, the detection of pre-clinical, pre-symptomatic disease, within what I referred to as the Wellness Domain. Also included in this space was Genomic Medicine and the predisposition to disease. This set of patients was compared to patients with acute and chronic diseases, whom I placed in the Overt Disease Domain.
I was thus commenting on the fact that genomic medicine is identifying people with a predisposition to disease and the Early Health Model is identifying people with early forms of disease as manifested by biomarker abnormalities. For the present, such "healthcare consumers" (not patients) are best categorized as being "well" because we are uncertain how many of them will go on to develop overt symptomatic disease. Also implicit in this statement is that we also don't know which of these patients with early forms of disease and a predisposition to disease to treat.
Historically, some consumers have been reluctant to undergo genomic testing for fear that, if the results were positive (i.e., show a genetic abnormality), they would be ineligible for health insurance coverage. One way to avoid this stigma, but also to be informed about the results of the test, would be to undergo testing in a clinical lab with a guarantee that the results would not be accessible by anyone other than the individual being tested. The same course of action, of course, would be available to anyone seeking biomarker test panels designed to detect early disease.
Ralph, however, is asking a different question: Do I foresee a time when insurance companies would require biomarker panels in order to cull out those people with early forms of disease ("identify pre-symptomatic disease to determine eligibility and coverage")? He is asking what I would call a socio-economic question rather than a medical one. We know, of course, that health insurance companies can and will refuse insurance to applicants with pre-existing medical conditions. I am opposed to the idea of health insurance companies cherry-picking their customers by denying coverage to applicants with a genetic pre-disposition to a disease or a pre-disease identified by biomarker abnormalities. This does not mean that they won't attempt to pursue such a strategy.