Genomics as a consumer proposition
Genomics arrives in a hospital group as a capability before it arrives as a business. A lab partnership is signed, or a sequencer is bought, a clinical champion is found, a panel menu is drawn up, and the executive committee is told that precision medicine is the future. Then someone turns to growth and asks for the demand plan. And the honest answer, the first time I was asked, was that there was no demand. Nobody was searching for the thing we had built.
Every other service line I had run captured demand that already existed. People know they need a cardiologist. Nobody wakes up wanting a hereditary cancer panel. Genomics is a demand-creation problem dressed as a lab line, and the moment you treat it as capture — a landing page, a campaign, a price — the volumes disappoint, the sequencer sits idle, and the line becomes an argument at the next budget review about why the capital was approved.
This is what it took to turn a test nobody asked for into something people bought, and what I would do differently. It is a story about packaging, channels, a counselling step that is secretly a sales step, and data questions that are harder than anywhere else in the hospital.
Demand creation is a different job from demand capture
The search data tells the story. Volume exists for questions — is cancer hereditary, should my daughter be tested, what does a positive result mean for my sister — and for a small number of well-known test names. Volume does not exist for panel names, for sequencing methods, or for the categories a lab menu is organised around. The person searching has a fear or a family history, not a product in mind.
Demand creation means meeting that fear with an explanation before mentioning a test. Content about what a family history actually implies. Content about what a result does and does not change. Tools that let someone answer six questions about their family and be told, honestly, whether a test would be informative for them — and often that it would not. The instinct to convert on the first page is wrong here. The first page is where trust is built, and the test is bought three interactions later, usually after a conversation with a human.
The commercial implication is that the acquisition timeline is longer and the content investment is front-loaded, which the CFO will want to see modelled before the capital case rather than after. I would rather present genomics as a two-year demand-building programme with a lab attached than as a lab with a marketing budget. The first framing survives the first disappointing quarter. The second does not.
The doctor-as-channel problem
The obvious channel is the doctor. The oncologist orders the tumour profile, the obstetrician orders the carrier screen, the cardiologist orders the cardiomyopathy panel, the paediatrician orders the exome. In theory the group’s own clinicians are a captive channel for the group’s own lab.
In practice three things get in the way. Most clinicians are not confident interpreting genomic reports, and a doctor who cannot explain a result will not order the test that produces it. The turnaround is long — weeks — which does not fit the rhythm of a consultation. And the referral pattern is already established: the doctor sends samples to the external lab whose representative visits, whose report format they know, and whose turnaround they trust. Switching costs are real even when the group owns both ends.
The channel work, then, is not a sales pitch to doctors. It is a product for doctors: a report format designed with the group’s clinicians so it answers their questions on the first page, a stated turnaround that is kept, a genetic counsellor available to the clinician as well as to the patient, and an ordering flow inside the tools the doctor already uses rather than a separate form. Track ordering by clinician, discuss it at the specialty review alongside the medical director, and expect adoption to be led by a handful of early clinicians whose reports become the internal proof. It is slower than a campaign and it is the only thing that works.
Packaging and pricing
A lab menu is not a product. A list of forty panels with technical names and a price against each is a catalogue for a referring pathologist. The consumer needs three or four propositions, named for the question they answer, priced as a whole with counselling included, and explained in a paragraph.
The packaging decisions I have had to make: how many propositions, which family histories each addresses, whether pre-test and post-test counselling are bundled or separate, whether the sample collection is at home, and how the proposition relates to the group’s existing health-check products. That last one is the most tempting and the most dangerous. Adding a genetic panel as an upgrade to an executive health check drives volume fast and also positions genomics as a premium add-on for the worried well, which is not the clinical case for it and not a brand the group wants.
Pricing is a signal here more than anywhere else. Discounting a genomic test tells the market that it is optional. Pricing it well above the external labs without a visible difference in counselling and interpretation tells the market that the hospital is taking a margin. The price has to be explained by what is included — the counselling, the interpretation, the family follow-up — and those things have to be real. I have seen a group price the test to compete with the external lab and then find that the counselling it was funding could not be delivered at that price. The proposition failed for reasons that looked commercial and were actually structural.
Payer coverage is limited and mostly absent for predictive testing, so the proposition is largely self-pay. That narrows the market and sharpens the language, and it means the health-check base — already self-pay, already trusting, already in the CRM — is the natural first audience, approached with information rather than an offer.
The counselling step is the conversion step
Genetic counsellors are scarce in India. Every group underestimates how many it needs, and every group discovers that the counsellor is the bottleneck on volume and the single biggest driver of it.
The pre-test conversation is where the person decides. Not on the page, not on the price, but in the fifteen minutes when someone explains what the test can tell them, what it cannot, what a result would mean for their siblings and children, and whether, in their case, it is worth doing. That conversation converts when it is honest, including when it advises against testing, because the person who is told “not for you” tells their family, and the family member for whom it is relevant comes back. It fails when it is a script with a close.
The product decision is how to scale it. Video counselling makes a small team reach every unit in the group and every Tier 2 city, and it is the only way the economics work. The intake before the counselling session — family history, existing reports, the question the person is actually asking — has to be structured so the counsellor’s time is spent counselling, not collecting. And the counsellor must never carry a sales target. The moment that happens the conversation changes, the clinicians notice, and the channel described above closes. Measure conversion after counselling as a health metric of the proposition, not as a performance metric of the counsellor.
Data and consent under DPDP
Genomic data is the most sensitive information a hospital holds, and it is sensitive in a way the rest of the record is not: it is also information about people who never consented to anything. A result on one person is a probability on their siblings, their parents and their children. The data-protection framework asks for specific, informed consent for a stated purpose, and the purpose here has to be written with unusual care.
The questions I have had to answer, with legal and the clinical lead in the room: what the sample is used for beyond the ordered test; whether it is stored, for how long, and whether the person can ask for it to be destroyed; whether de-identified data is used for research, and whether that needs a separate consent; whether results are shared with the ordering clinician, the group’s own record, or a family member; what happens to incidental findings the person did not ask about; and who inside the group can see the data at all. Marketing cannot. The CRM should hold that a test was done and that the counselling follow-up is due. It should not hold the result, and it should not be able to.
The consent form is a product artefact. It is read on a phone, in a regional language, by someone who is anxious, and it decides both whether the group is compliant and whether the person proceeds. Written by legal alone it is unreadable. Written by marketing alone it is unenforceable. It has to be built by both, tested with real people, and versioned. I would put more design time into the consent flow than into the landing page.
What genomics does to the brand
The stated reason for a group to enter genomics is clinical: better decisions in oncology, obstetrics, cardiology and paediatrics. The unstated reason is positioning: the group wants to be seen as the place where medicine is precise and modern. Both are legitimate. The risk is that the consumer proposition undermines the second by being seen as a premium test sold to people who did not need it.
The brand test is simple. If the counselling step routinely advises against testing and the group publishes that fact, the proposition is trusted. If every enquiry becomes a test, it is not. The demand data will show which one you have built within two quarters — by the ratio of counselling sessions to tests, by whether clinicians order, and by whether the referrals into the line come from families who were tested or from the health-check upsell.
The commercial case as it should be presented
Genomics rarely justifies itself as a lab line in the first two years. The volumes needed to make owned sequencing pay are large, and the buy-versus-build decision — a partner lab with the group’s own counselling and interpretation on top, or the full stack — should be made on realistic volumes rather than the capital case’s hopeful ones. I have generally argued for partnering on the sequencing and owning the counselling, the report and the patient relationship, because that is where the group’s advantage and the margin actually sit.
The case to the executive committee should be presented as three lines: the direct test revenue, which is modest; the downstream clinical work the tests inform, which is where the value sits and which needs cohort tracking to be visible; and the brand and referral effect, which is real and should be stated qualitatively rather than invented numerically. A CFO can accept the first as small if the second is tracked honestly and the third is not oversold.
If you’re starting this next quarter
- Pull search and enquiry data for the fear questions, not the test names. Build content and a self-assessment tool for those questions before building a product page.
- Reduce the menu to three or four named propositions with counselling included, priced on what is included, and kept away from the health-check upsell.
- Recruit or contract genetic counsellors for video delivery across units. Build the structured intake so their time is spent counselling.
- Design the report format with the group’s own clinicians. Put ordering inside their existing tools. Track ordering by clinician and review it with the medical director.
- Write the consent flow with legal and product together, in regional languages, tested on phones. Decide storage, research use, incidental findings and access before the first sample.
- Lock the CRM out of results. It records that a test happened and that a follow-up is due, nothing more.
- Present the case as demand-building with a lab attached, on partner sequencing, with downstream clinical revenue tracked by cohort.
You are not selling a test. You are selling the conversation that decides whether anyone should take one.
Questions people ask
Because nobody wakes up wanting a hereditary cancer panel. Search volume exists for questions — is cancer hereditary, should my daughter be tested, what does a positive result mean for my sister — and for a handful of well-known test names. It does not exist for panel names, sequencing methods or the categories a lab menu is organised around. The person searching has a fear or a family history, not a product in mind. Every other service line captures demand; genomics has to create it.
Capture is what most service lines do: people know they need a cardiologist, so you make sure they find yours. Creation means meeting a fear with an explanation before mentioning a test — content on what a family history implies, tools that let someone answer six questions and be told honestly whether a test would be informative, often that it would not. The test is bought three interactions later, usually after a human conversation. The acquisition timeline is longer and the content investment is front-loaded.
Not as a lab menu. Forty panels with technical names and a price against each is a catalogue for a referring pathologist. The consumer needs three or four propositions, named for the question they answer, priced as a whole with pre-test and post-test counselling included, and explained in a paragraph. The packaging decisions are which family histories each addresses, whether sample collection is at home, and how the proposition sits relative to the group’s existing health-check products.
It is the most tempting move and the most dangerous. Adding a genetic panel as an upgrade drives volume fast and positions genomics as a premium add-on for the worried well, which is neither the clinical case for it nor a brand the group wants. The health-check base is the natural first audience — already self-pay, already trusting, already in the CRM — but it should be approached with information rather than an offer, and kept away from the upsell.
Pricing is a signal here more than anywhere else. Discounting tells the market the test is optional. Pricing well above external labs without a visible difference in counselling and interpretation tells the market the hospital is taking a margin. The price has to be explained by what is included — counselling, interpretation, family follow-up — and those things have to be real. I have seen a group price to match the external lab and then find it could not fund the counselling at that price.
Three reasons. Most clinicians are not confident interpreting genomic reports, and a doctor who cannot explain a result will not order the test that produces it. Turnaround is weeks, which does not fit the rhythm of a consultation. And the referral pattern is established: the external lab whose representative visits, whose report format they know and whose turnaround they trust. Switching costs are real even when the group owns both ends. The fix is a product for doctors, not a sales pitch.
Build the report format with the group’s clinicians so it answers their questions on the first page. State a turnaround and keep it. Make a genetic counsellor available to the clinician as well as the patient. Put ordering inside the tools the doctor already uses rather than a separate form. Track ordering by clinician and review it at the specialty meeting with the medical director. Expect adoption to be led by a handful of early clinicians whose reports become the internal proof.
Because the person decides in the fifteen-minute pre-test conversation, not on the page or the price. Someone explains what the test can tell them, what it cannot, what a result means for siblings and children, and whether it is worth doing in their case. It converts when it is honest — including when it advises against testing, because that person tells their family and the relevant relative comes back. Counsellors are scarce in India and every group underestimates how many it needs.
Never. The moment they do, the conversation changes, the clinicians notice, and the doctor channel closes. Measure conversion after counselling as a health metric of the proposition, not as a performance metric of the counsellor. The product decision is how to scale the counsellor’s time: video delivery so a small team reaches every unit and Tier 2 city, and a structured intake — family history, existing reports, the actual question — so the session is spent counselling rather than collecting.
With more care than anywhere else in the record, because a result on one person is a probability on siblings, parents and children who never consented to anything. Decide before the first sample: what the sample is used for beyond the ordered test, whether it is stored and for how long, whether de-identified research use needs a separate consent, who receives results, what happens to incidental findings, and who inside the group can see the data. Legal and the clinical lead must be in that room.
No, and it should not be able to. The CRM records that a test was done and that a counselling follow-up is due. It does not hold the result. Marketing cannot see genomic data at all. The consent form itself is a product artefact — read on a phone, in a regional language, by someone anxious. Written by legal alone it is unreadable; by marketing alone it is unenforceable. I would put more design time into the consent flow than the landing page.
Partner on the sequencing and own the counselling, the report and the patient relationship — that is where the group’s advantage and the margin actually sit. The volumes needed to make owned sequencing pay are large, and the buy-versus-build decision should be made on realistic volumes rather than the capital case’s hopeful ones. Genomics rarely justifies itself as a lab line in the first two years, and a sequencer sitting idle becomes an argument at every budget review.
As a two-year demand-building programme with a lab attached, not a lab with a marketing budget. Three lines: direct test revenue, which is modest; downstream clinical work the tests inform, which is where the value sits and which needs cohort tracking to be visible; and the brand and referral effect, stated qualitatively rather than invented numerically. A CFO can accept the first as small if the second is tracked honestly and the third is not oversold. The first framing survives a disappointing quarter.
The demand data shows it within two quarters. The ratio of counselling sessions to tests — if the counselling routinely advises against testing and the group is comfortable saying so, the proposition is trusted; if every enquiry becomes a test, it is not. Whether the group’s own clinicians are ordering, tracked by name. And whether referrals into the line come from families who were tested rather than from the health-check upsell. Those three tell you which brand you have built.
