Modernizing Genetic Counseling in Women’s Health Programs: Enhancing Clinical Workflows While Reducing Provider Burden

Kaylee Henson, MS, CGC, Senior Product Manager, Pipeline Products, Myriad Genetics
Susan Manley, MS, CGC, Senior VP Medical Services, Myriad Genetics

A model ripe for innovation

The genetics landscape has changed tremendously as it has emerged from modest beginnings over the past 30 years. For example, genetic counselors (GCs) have taken their rightful place as an invaluable part of educating patients and matching them with the right services.

Yet, as demand for GCs has risen sharply due to greater testing capabilities and an increased awareness of how much genetics contributes to many aspects of our health and wellbeing, the current capacity of the GC workforce and the model in which GCs work are becoming strained in their ability to meet demand.

In many situations, when a physician thinks a patient should have a genetic test, that patient must schedule a separate consultation with a GC. After the appointment, the GC may refer them back to the healthcare provider to get the test. The GC or someone else on the care team interprets the results, and next steps are defined.

But many GCs work in small groups in large metropolitan areas and are a relatively rare resource, with wait times of weeks or even months. Even when these GC consults happen, they sometimes occur within traditional in-clinic models where a patient sits down with a GC, has a highly detailed conversation about their medical and family history, then receives recommendations about tests, next steps, or information they need to find.

Sometimes this extra step is one that patients don’t want to take. They may not have time to see another healthcare provider. Not to mention that genetic counseling is not always a covered benefit, and they don’t always want to pay for it.

For many health systems and clinics outside of large urban areas, genetic counseling is something you outsource. A GC is an expert who is not in your practice, or even your health system. As a result, information that comes from GCs is likely variable and often doesn’t fit into workflows or processes providers have built for their practices.

As valuable as it is, the GC experience can be lengthy and frustrating with a lot of opportunities for the patient to become non-compliant. By definition, this is not a programmatic approach.

Patient-first, clinician-aligned testing

We’d like to suggest a more programmatic way to approach the GC experience in Women’s Health practices.

Consider that when a patient enters a provider’s office, they begin a journey with many different steps as they move through the practice. Patient registration manages insurance information, a medical assistant collects vital signs and passes them to the provider, and ideally the provider has everything in front of them to be able to address the patient’s needs during the visit.

In a more modern approach to genetic counseling, the same workflow principles apply. For example, patients could receive personalized education from a board-certified GC. Pre-test education would prepare patients for testing while post-test sessions would be available to discuss results and answer questions. The program would be designed to be an extension of the patient’s healthcare team, working collaboratively to enhance the patient experience. The program would aim to empower patients with knowledge about genetic testing and its implications for their health. In the process, healthcare providers could expand their reach to more patients and effectively manage their workloads.

A streamlined, programmatic approach to genetic testing can benefit all stakeholders, especially patients and providers.

Using a programmatic approach like the one described above, all these steps can be incorporated without the need for extra space in the healthcare practice while optimizing patient time that might otherwise be spent waiting. Now the provider receives a succinct summary from the patient that tells them exactly what needs to happen. The patient can be tested during a regular visit, and the patient can get all questions answered by a GC once results are available.

Of course, a robust workflow is never one size fits all. A modern GC model should be flexible enough to support a variety of approaches. In some cases, healthcare providers can talk to a patient about genetic testing, order the test, and interpret the results themselves.

In others, when they encounter a patient with an unusual family history, the practitioner might feel that this case would benefit from a GC who sees it more frequently than they do. As in every other specialty, there will be cases that make them feel that they should refer that patient to a specialist, like a GC.

The power of alternative service delivery models

It’s important to note that this alternative service delivery model for GC services offered by the test lab provider should not feel competitive with any local GC resources, or as if a responsibility is being passed off.

At Myriad Genetics, we now have more than 50 genetic counselors who answer calls during business hours from patients about genetic testing. These patients wait an average of less than three minutes and have conversations that average less than 12 minutes.¹ We talk about any red flags in their personal or family history. We gauge their interest in the test. If the patient agrees, then their healthcare provider can submit a sample, and a test can be ordered that day. Paperwork can be delivered to providers immediately after the conversation.

Meanwhile, the primary healthcare provider can perform other tasks in their practice while this patient is getting education from the testing lab provider’s GC. The clinician and testing lab provider work together to meet the patient’s needs. The clinician still guides the conversation and can provide evidence-based recommendations to the patient. It can be individualized, but it’s also meeting patients where they are in a standardized way.

As for in-house GCs, the burden on their schedules is reduced, so instead of seeing every patient they are able to focus more on the ones that have a complicated family history or unusual circumstances. This allows the GC to practice at the top of their scope and to free up more visits for people who need their expertise. Patients, meanwhile, report a great experience, which reflects well on the health system. Myriad Genetics currently has a GC satisfaction score of 9.85 out of 10.²

In all these ways, a modern genetic counseling model works as a form of value-based care.

Reaping the benefits of modernized genetic counseling

Based on direct evidence working with thousands of patients as well as GCs, APPs, and MDs in healthcare practices, we’ve seen a host of value-based benefits to this programmatic approach:

In-house GCs have been able to double their outreach in their health system, leveraging our GC services to see patients up front and allowing them to follow up with patients post-testing. This might include referring a patient to a high-risk breast clinic, coordinating family testing, or coordinating follow-up referrals.³

GCs can better demonstrate their value to the health system – which can be an uphill battle given low reimbursement rates – but also to the local community in the catchment area since family members may be included in follow-up testing. Working with the testing lab provider’s GCs, they can better inform, educate, and guide patients about genetic screening and testing.

Providers feel less burdened with their own workflows. With face-to-face time during primary care appointments averaging 18 minutes,⁴ clinicians appreciate a standardized, efficient process for genetic education and testing that fits into their existing workflows. Point-of-care education, testing, and risk reduction can be achieved with the patient without additional burden.

The benefits rebound to the health system. Good healthcare is good business, so being able to identify more patients who are appropriate for interventions, like a breast MRI, and using those interventions to manage that patient’s early detection and ongoing care management can improve utilization within the health system.

Finally, there is the patient benefit. Every day patients say to our team, “I had no idea that I was eligible for this. I had no idea that this was something that I could benefit from. Why hasn’t anybody ever mentioned this to me before?” We’re often reaching patients who have fallen through the cracks for years.

Does your testing lab provider reduce your care burden?

Identifying efficiencies can have a positive ripple effect within your health system. One way to do this is engaging a genetic testing lab provider that helps provide information to more patients, offers standardized services (for the sake of both efficiency and patient equity), and furnishes ongoing support in the way of training and assistance from workflow experts that can help institute scalable solutions within large healthcare systems.

By closely collaborating with health systems, testing lab providers can help to deliver on the values or mission statements that health systems live by. These typically include accessibility, more engaged patients, improved outcomes, and the ability to deliver healthcare in an effective and scalable way.

The patient experience is enhanced when women realize that adding five or ten minutes to a regular appointment will enable them to become more educated about their risk of hereditary cancer without having to set up a separate visit.

And engaged, satisfied patients tend to stay in your health system longer, which is an ideal outcome for any women’s health program.

References

Myriad internal data, 2025
Myriad internal data, 2025
Myriad internal data from a 20-month period, 2022-2023
Neprash H, Mulcahy J, Cross D, et al. Association of Primary Care Visit Length with Potentially Inappropriate Prescribing. JAMA Health Forum. 2023;4;(3):e230052. doi:10.1001/jamahealthforum.2023.0052.