David Nixon: “Why we need to shift from a ‘healthcare’ system to a ‘wellcare’ system”

Christina D. Warner
Oct 6, 2019 · 12 min read
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Shift from a “healthcare” system to a “wellcare” system. By focusing on rewarding those who contribute to preventive care, we can be proactive in improving outcomes. For example, we now have the power to understand certain health risks through genetics, and applying available genetics expertise, we are able to promote preventive and risk-reducing approaches.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview David Nixon. David brings more than 25 years of healthcare experience and a record of entrepreneurial leadership to his role as CEO of InformedDNA. Since joining InformedDNA in 2007, David has led the company’s transformation from the premier national genetic counseling provider network to becoming the first mover in the rapidly growing field of genetic testing utilization management. InformedDNA is now the leading Genetic Benefits Management™ organization, working with national and regional health plans as well as hospitals and health systems throughout the U.S. to ensure that patients have convenient access to genetics services and providers have access to genetic testing decision support.

A lot of my learning was outside of a traditional classroom environment. After working on my high school newspaper, I moved to the newsroom at my university and eventually began running the business side of things. In fact, our paper received a national award for business operations. After that, I never looked back. I set my sights on becoming an entrepreneur and that’s where I focused on developing my leadership talents.

In my early 20s, I started my first company, The Nixon Group, which I led for more than a decade as CEO. The Nixon Group was a consumer and healthcare communication firm that allowed me to pursue a path of patient advocacy. I’ve always been passionate about arming people with accurate information, and truth and fairness are core to who I am as a person and leader. Working with The Nixon Group, I was able to develop programs like the iconic “Truth” campaign that informed consumers of the hazards of smoking and persuaded them to reject tobacco.

When the partners who started InformedDNA approached me in 2007, it seemed the ideal opportunity to put my leadership skills and entrepreneurial spirit to work for an organization that upholds my core ideals. InformedDNA is the nation’s largest provider of expert genetics services, including genetic counseling. We are a partner to health plans and pharmaceutical companies, an advisor to health systems and providers, and an advocate for patients by working on the leading edge of genetic counseling and policy. It was a perfect fit, as InformedDNA’s mission is to provide fair access to genetic insights and expertise, and to empower people with knowledge in an area that is quickly growing and highly complex, one that can be confusing for even the most experienced healthcare professionals.

It involves an anecdote wrapped inside an insight. Like many of us, as a consumer and an employer, I had the perception that health plans were the “bad guys,” primarily focused on trying to avoid spending dollars. When I started working with health plan executives and chief medical officers, however, it really struck me how committed they are for doing what’s right for the patient and putting the patient first. This was a revelation to me because of my existing bias. It truly is a misunderstood industry. It’s become clear to me that health plan leaders are striving to ensure everyone in their networks are delivering evidence-based medicine, which is what the system is designed to pay for. We put health plans in a quasi-regulatory role because they have to assure appropriate use of healthcare dollars, leading to common negative perceptions like the one I’d previously held.

The health plan commitment to evidence-based medicine became vivid when we started talking to them about developing medical policy for genetic testing and having us manage their prior authorization and provider decision-support programs. InformedDNA has become their objective voice and platform for delivery of genetics expertise at the point of care.

Under the category of, “It wasn’t funny at the time…”: The company was founded when we secured a contract with Aetna for telehealth genetic counseling services as a covered benefit for all commercial members. At the time, Aetna had about 16 million members, so we thought our success had been secured. The hard lesson learned is that being an in-network provider is just permission for folks to refer to us. As a start-up, we didn’t have the resources to do any direct-to-consumer (or direct-to-provider) marketing. Predictably, we had very little uptake for at least a couple years.

That gap was a gift, though. We kept collecting data, which revealed that about a third of the time the patients referred to us for genetic testing (typically hereditary cancers) were not good candidates for undergoing the testing. This enabled us to prevent wasting dollars — and from giving patients inaccurate information. Ultimately, we helped many health plans adopt medical policies requiring genetic counseling as a means of establishing medical necessity for hereditary cancer testing. Health plans can now administer the policy in the most thoughtful, evidence-based, patient-centric way. This type of transparency builds trust and helped build our business.

As a business, what makes us stand out is that we were the first — and remain the leading — genetic services company in the U.S. No other organization supports more health plans, more health systems, more providers, and more patients than InformedDNA. As the genomics revolution continues to mature, being on the front lines of that revolution helps ensure that people who might not otherwise have access to genetics expertise always will.

We’re all about informing people — whether it’s talking with patients about their testing and diagnosis, doctors about clinical decision-making in genetics, or payers about how to best approach new genetic tests and treatments. I’ve always felt personally responsible for informing the public about social or health matters, and my colleagues share the same drive to do right by our clients and provide the most empathetic, impactful services we possibly can.

There’s a true spirit of transparency and knowledge-seeking throughout InformedDNA that infuses this philosophy into the cellular level of the company. I’ve always worked to create an environment of fairness and empowerment, and I believe that is evident in the way InformedDNA operates. Our genetic counselors and other staff are continuously taking on their own research, or working with new partners and clients to explore areas they’re passionate about that can help our world through the advancement of genetic information. This curiosity helps generate more knowledge that can arm everyone we work with to make better decisions and create a better genetic and healthcare ecosystem.

I find it essential to have clearly defined values, then to ensure that people and processes are accountable to make sure we’re living up to those values every minute of every day. These aren’t just words on paper. At InformedDNA, our trusted and dynamic team of genetic specialists and support staff have a commitment to one another and to those we serve. We will stay true to our values above all else. These values include:

  • Respect everyone
  • Be accountable
  • Exceed expectations
  • Use your wicked smarts
  • Get it done through teamwork
  • Live life in balance
  • Know your true north
  • Give back

I’d like to turn the question around to show what we are doing to contribute to improving the U.S. ranking. The U.S. healthcare system is fraught with fraud, waste and abuse. InformedDNA is on the right side of the equation.

Let’s consider fraud. With our deep expertise in analysis of health plan genetic testing claims, we are able to transform what is largely indecipherable to the health plan because of coding issues into a transparent view — we can identify wasteful spending in genetic testing and help plans reduce this. We also help avoid provider errors by bringing our deep subject matter expertise to the patient and provider at the time of decision-making so they’re empowered to make well-informed decisions.

With preventable conditions, we identify those at risk and provide accurate information about their specific risks and options, turning this critical knowledge into a personalized screening plan that can often take a patient with elevated risk down to a number lower than the general population risk.

By providing access to experts through telehealth, we remove barriers to care and advice. Online provider decision-support tools and access to genetics experts leads to medically necessary, evidence-based care in accordance with clinical guidelines. Our whole business model is built on addressing persistent problems in the healthcare system and being part of the solution.

by expanding access to genetics expertise. By doing so, individuals are empowered to own, understand and control their own genetic information and make more informed decisions about their health.

By focusing on rewarding those who contribute to preventive care, we can be proactive in improving outcomes. For example, we now have the power to understand certain health risks through genetics, and applying available genetics expertise, we are able to promote preventive and risk-reducing approaches.

. In addition to growing preventable care initiatives, designing communities that encourage activity enables potential patients to perform their own preventive care by engaging in a healthier lifestyle.

Enable providers to prescribe reimbursable healthy interventions. For instance, if a provider discovers that his/her patient is pre-diabetic, instead of starting off by discussing diabetes treatments with the patient, the provider should first prescribe — versus just recommend — changes related to diet and exercise. And, costs of programs to support that prescription should be reimbursable.

. Patients trying to participate in decision-making about their own healthcare often face challenges understanding options/benefits and costs. Confusing explanation of benefits (EOBs) and billing surprises are common. In genetic testing decision-making, ensuring patients and providers have access to genetics specialists by telephone and/or video means transparency for everyone and help with getting the right tests, understanding their meaning for the individual and their family, and options available to ensure their best health — eliminating these roadblocks and ensuring patients know about costs of care among available providers and are given choices in their care options.

I’m as progressive as they come, but this is going to sound fairly conservative: People need to embrace ownership for their health and care. To the best of their ability, patients should try to understand the health risks resulting from their behaviors and to understand options for care. Smoking, eating poorly and avoiding exercise eventually become a greater problem. We all have a duty to ourselves and to society to be our best selves.

Designing a benefits package that encourages employee wellness and healthfulness comes to mind as a great way for corporations to encourage individuals’ wellness. This means not only offering relevant genetic testing, but ensuring employees have convenient access to the best expertise and guidance to fully understand their options.

As a whole, communities should encourage activity through safe parks, walking paths, biking trails, farmers’ markets, etc. to proactively create and promote options for a healthier lifestyle for residents.

For all of this to come together, leaders must learn to focus on the greater good, not what’s self-serving. By shifting the mentality, we can come together to support an overall better healthcare environment focused on outcomes and arm patients with the knowledge to make the best choices for themselves.

It’s well known that integrating behavioral health and general medicine services improves patient outcomes, saves money, and reduces mental health stigma. The Mental Health Parity and Addiction Act has been the law for over a decade, yet making it a reality has been elusive. The Collaborative Care Model places primary care providers at the center of patient care, with a support team of behavioral healthcare managers, psychiatrists and other mental health professionals. We don’t need to reinvent what’s already working, but promote and spread it.

This is not unlike the InformedDNA belief that, ultimately, care decisions need to be placed in the hands of patients and their trusted healthcare providers with the appropriate genetics experts at their side. The genetic space can hold not only medical impact, but also some significant emotional ramifications if not supported with the proper expertise. Just like genetics is relevant to all of us, most of us will face a mental health challenge at some time in our lives. It’s called being human. We need to demystify it and get people to the reimbursed care they need as quickly as possible.

That’s an easy one: An excellent healthcare provider always puts the patient first, relying on and delivering evidence-based care.

Ghandi said very simply, “my life is my message.” I subscribe to this as a truth. I would like to be sure that when I’m gone, people will say that I adhered to the values that I championed.

We recently launched a new service line to help identify patients for clinical trials. If you’re in drug discovery, especially for rare diseases, one of the biggest challenges is finding eligible patients. And if you’re a patient and you’re not among the 20 percent or so getting care in an academic center, you might not know about clinical trials. As a national provider with thousands of patients coming through our door every month for clinical genetic counseling and genetic testing decision support, we’re in a unique position to help patients throughout the U.S. find clinical trials.

Our telehealth model removes barriers and most new therapies in various stages of clinical trials have a genomic component. Frontline physicians, especially in community-based settings often don’t have the resources to identify patients who might be eligible for clinical trial or become so through genetic testing. With our ability to do that nationwide on a virtual basis, patients who would not otherwise have access to life-improving or lifesaving clinical trials have new hope.

I’m an insatiable consumer of politics and business, particularly entrepreneurial endeavors. I rely primarily on trusted, objective resources like Bloomberg (markets, politics, healthcare), CNBC, Washington Post, and New York Times. In industry news, I keep up with Laboratory Economics, Managed Care Magazine, and McKinsey reports, among others. Some interesting podcasts for healthcare management professionals are Code Red, the Healthcare Policy Podcast, and TedTalks Health Podcast.

Be kind to one another. It’s sad that we need to be reminded of that, but, right now, there’s so much animosity in the world. I would love for us to be kinder to each other.

I ask those who are interested in my work to visit the InformedDNA website, which includes blog posts, ebooks, and other breaking news and information, and to our social media channels.

Authority Magazine

Leadership Lessons from Authorities in Business, Film…

Christina D. Warner

Written by

Author of The Art of Healthcare Innovation. Order it at amzn.to/31TBrZM or christinadwarner.com

Authority Magazine

Leadership Lessons from Authorities in Business, Film, Sports and Tech. Authority Mag is devoted primarily to sharing interesting feature interviews of people who are authorities in their industry. We use interviews to draw out stories that are both empowering and actionable.

Christina D. Warner

Written by

Author of The Art of Healthcare Innovation. Order it at amzn.to/31TBrZM or christinadwarner.com

Authority Magazine

Leadership Lessons from Authorities in Business, Film, Sports and Tech. Authority Mag is devoted primarily to sharing interesting feature interviews of people who are authorities in their industry. We use interviews to draw out stories that are both empowering and actionable.

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