In Minnesota, home testing expands beyond COVID-19

Medica is seizing on people's comfort with at-home COVID-19 testing with a new option to identify risks for chronic kidney disease.

The Minnesota health insurer announced Thursday that it is sending urine tests to nearly 50,000 members in Minnesota, Wisconsin and the Dakotas who have diabetes or hypertension. Plans for at-home diagnosis of all kinds of conditions have emerged since the latest pandemic wave, when people emptied pharmacy shelves of rapid COVID-19 tests.

Annual tests are recommended for people at heightened risk for kidney disease, but many don't even see doctors, said Dr. David Webster, Medica's chief clinical officer. "We know that so many people don't get the screening that they need, so let's make it easier for them."

Early identification can prompt people to make changes before kidney damage requires costly and invasive treatments such as dialysis, or leads to heart problems. The Healthy.io test remains experimental in the United States, and is being sent to Medica members as part of a study to gauge public interest while the Food and Drug Administration reviews it.

The test works by having mobile phone apps scan urine samples for discoloration that suggests abnormal protein levels. Results are provided instantly. Medica is hoping for more than 30% participation.

Home diagnostic testing was nudging along before the pandemic, beyond its long-standing use for pregnancy and blood sugar. Mayo Clinic researchers created Cologuard, a test in lieu of a colonoscopy where people obtain stool samples and mail them in to assess colon cancer risks. In recent weeks, multiple companies have announced plans to create home tests or expand access to existing tests for everything from fertility to iron levels to cancer.

Quest Diagnostics expects revenue from its consumer-testing service to almost quadruple from 2021 to 2025. Labcorp last month launched an OnDemand platform where people can buy tests online or schedule them in affiliated labs, pharmacies and clinics.

Home testing "is going to be dramatically accelerated in the wake of the pandemic," said Dr. Bill Morice, president of Mayo Clinic Labs and chair of Mayo's pathology department. Home testing was the top topic last week when he attended the annual meeting of the American Clinical Laboratory Association.

At-home COVID-19 tests grew popular because people could gain quick and confidential results if they had symptoms or upcoming travel plans or in-person events. But the trend presented tradeoffs.

Minnesota has used 8.6 million test results since July 1 to track the spread of the delta and omicron coronavirus variants. Testing identified 470 more infections that were reported by the Minnesota Department of Health on Thursday along with 10 more COVID-19 deaths.

The state also has increased monitoring of viral samples in wastewater to anticipate changes in COVID-19, but it still has a blind spot because at-home test results aren't reported publicly. By some estimates, home tests were double or triple those performed in clinics and centers during the latest waves.

Testing for chronic diseases doesn't present that same dilemma, and offers advantages for insurers such as Medica that want to reduce complications and resulting costs. People 66 and older with chronic kidney disease made up 13% of Medicare fee-for-service enrollees in 2019 but about 25% of the program's spending.

Many home tests offer pictures and instructions without words, but Morice said accurate collection remains a concern.

Mayo was studying whether Rochester residents could collect nasal samples for determining if they had influenza or other infections when the pandemic emerged. Mayo repurposed swabs from the study for COVID-19 testing at a time when there was a global shortage of swabs.

Mayo now is working with Cue Health— the company that produced home COVID-19 tests promoted by Minnesota Timberwolves star Karl-Anthony Towns — on development of mobile apps to help people conduct tests accurately.

Some tests provide instant results while others require samples to be mailed for analysis. Regardless, advice on how to interpret the results will be important, especially as more tests are being provided by labs and insurers and not doctors, Morice said.

People on their own might not understand the nuances, like how a positive result might mean a heightened but still low risk, he said. "If you get a test back in the mail saying your blood cancer screen is positive for cancer, most people ... are going to stop reading everything else."

Medica officials said calls and education up front in this study should help people understand their results. Copies will automatically be forwarded to primary care doctors that Medica has on record.

"The test result would just say that it may show early kidney damage ... and that we recommend that they follow up with their physician," said Nancy Williams, Medica's director of value and enablement.

Testing is only one part of the consumer home-health wave. People purchased oxygen-saturation monitors to assess the severity of their COVID-19, but before that, they were using smart watches to track their pulse, breathing and sleep.

While people as a result are more interested in off-the-shelf tests, they might end up buying the wrong ones, said Dr. David Boulware, an infectious disease expert at the University of Minnesota. A negative COVID-19 result might bring so much relief that people then overlook the need for strep tests.

"If the only question is do I have COVID or not? Or am I pregnant or not? That's simple," he said. "If the question is, what is the cause of XYZ illness? Then that's more complex. One could use a lot of inappropriate tests that lead people the wrong direction."