The promise of precision genomics — care personalized to a patient’s genetic profile — is becoming a reality. According to an HHS analysis, Medicare Part B paid for 18 million genetic tests in 2024, a 160% increase from 2018, and genetic tests now account for 43% of Medicare’s clinical laboratory spending.
Still, precision genomics has not yet reached its full potential even though the evidence continues to prove its utility. Gaps include limited awareness and infrastructure, silos, fragmented workflows, lack of integration into the electronic health record (EHR), and inconsistent care pathways. The key for health systems is building an enterprise capability to implement precision genomics at scale across multiple service lines.
Genomics as a strategy
For health systems, precision genomics is becoming a strategic priority. Wells Messersmith, MD, chief medical officer of oncology services at Aurora, Colo.-based UCHealth, noted, “You cannot care for a cancer patient in 2026 without precision medicine.” He added that precision genomics supports UCHealth’s mission of improving lives. “If someone has cancer, we’re trying to prolong their life and improve their quality of life,” he said. “We can’t do that without precision medicine.”
At Scottsdale, Ariz.-based HonorHealth, “The five-year strategic plan prioritizes building on success in precision oncology by extending precision genomics into other disease categories, like cardiovascular and neurocognitive care — at scale,” said Laura Goetz, MD, who was director of precision medicine at HonorHealth Research Institute when interviewed.
Genomic testing today
Today, genomic testing is reshaping how cancer is diagnosed, treated, and monitored across the care continuum. Precision medicine programs are growing rapidly, incorporating key genomic and pharmacogenomic diagnostic tests to drive more personalized treatment across the cancer journey. While screening for inherited risk using hereditary cancer testing and incorporating comprehensive genomic profiling for therapy eligibility are now seen as standard of care in many settings, molecular residual disease (MRD) testing continues to show promise as a critical component in a precision medicine plan.
MRD testing uses blood-based analysis to detect tiny fragments of tumor DNA in the bloodstream, offering a window into cancer recurrence at the molecular level, often before it’s evident on a scan. The clinical evidence is compelling. The CIRCULATE-Japan GALAXY study, published in Nature Medicine, showed that Natera’s Signatera™ test for MRD detected recurrence a median of nearly six months before imaging in a 2,240-patient analysis.
“Precision medicine — specifically cell-free DNA and MRD — has revolutionized women’s cancer and gynecologic cancer,” Saketh Guntupalli, MD, chair of obstetrics and gynecology at the University of Colorado School of Medicine and gynecologic oncologist at UCHealth, told Becker’s.
Beyond relapse, MRD testing can help clinicians evaluate response to certain treatments — including immunotherapies — before radiographic imaging. A study by Bratman et al. found that Signatera could identify exceptional responders and was strongly prognostic for recurrence risk after just two cycles.
Leveraging precision medicine effectively across the cancer care continuum requires a multimodal approach. Intentional investment in standardized protocols for serial testing, EHR-integrated results, and automated follow-up is vital to delivering consistent, personalized care.
“Across many areas, precision medicine is critical,” Dr. Messersmith said. “If you’re treating patients without knowledge of inherited mutations, mutations in their tumor, and how they will metabolize specific drugs, it’s difficult to provide care that’s consistent with national guidelines.”
Challenges and opportunities
Experts see significant opportunities to further elevate and scale the use of precision genomics, which require overcoming operational and scientific challenges.
Dr. Messersmith described the primary opportunity as scaling infrastructure to carry a program from hundreds of patients to tens of thousands. “You have to decide how you’re going to move from 10 to 100 to 1,000 to 100,000 patients. That’s where the electronic health record and industry partnerships really come into play,” he said.
Dr. Guntupalli described what that infrastructure could yield within five years: A patient is diagnosed and automatically triaged to tissue and blood testing, and the tumor’s genetic profile is uploaded to the shared record. By the time the treating oncologist opens the chart, the panel of the most important mutations for that cancer is already there to guide therapy. “I think that’s where we will be in five years, and we’re probably there to some extent now, but that’ll be so standard as part of what we do,” he said. “If you’re not doing that, you’re going to be behind the times.”
For James Stover, PhD, senior vice president and general manager of health systems at Natera — which processed more than 3.5 million tests in 2025 — one of the greatest opportunities lies in the systems built around precision medicine testing. While some health systems view implementing precision genomics at scale as primarily a testing decision, Stover sees it differently.
“The science is there. What unlocks the greatest impact are operational and workflow improvements,” he said.
Opportunities remain to simplify how genomic tests are ordered, make results easier to access, and build the clinical decision support that helps both clinicians and patients determine the most appropriate next steps.
Dr. Messersmith described the ideal fix: “You have an integrated system where all the information is ingested into the EHR and delivered to the physician and patient. You also need to close the loop to ensure the clinician and patient see the results.”
Operational complexity and variability are exacerbated when different teams within health systems use different tests from different vendors. “In my experience, health systems probably have too many genomics testing partners,” Dr. Stover said, noting that vendor selection is often ad hoc and some systems integrate with 10 partners.
Another challenge — and opportunity — is extending precision genomics beyond oncology to other diseases. “While oncology has nailed it in a lot of ways, other disease disciplines have confusion about what precision medicine is and how to apply it,” Dr. Goetz said. Natera is helping close that gap with tests in women’s health (Panorama®, Horizon®) and in organ health (Prospera®, Renasight®), bringing its genomic expertise to new clinical areas.
Genomics infrastructure of the future
Health systems can unlock the full value of precision genomics by elevating genomic testing from a department-level tool to an enterprisewide strategy integrated across service lines and embedded in the EHR.
This starts with standardizing genomic tests across the enterprise and creating a data foundation that integrates information across the health system. It includes making it easy for clinicians to order genomic tests through Epic-native ordering across service lines, along with genomics-focused decision support at the point of care and closed-loop processes where reporting of test results is embedded into the EHR workflow.
Dr. Messersmith sees tremendous value in a modern genomics infrastructure that functions as a “continuously learning system.” UCHealth is working with Natera to build this infrastructure, aggregating de-identified genomic and clinical data from across UCHealth — and potentially other health systems — to continually derive new insights.
“The hope is with AI-enabled systems and in partnership with Natera, we can pull our data together and researchers can find signals we might not have found,” he said. “We can update treatments in real time based on what we learn, rather than waiting for years.”
Scaling requires strategic partners
Experts draw a distinction between a vendor and a strategic partner. A vendor sells a test; a partner works collaboratively across service lines to integrate with the EHR, embed genomic testing into workflows, simplify operations, and improve outcomes.
Dr. Messersmith observed that because precision genomics is so complex and evolving so rapidly, health systems must partner to integrate and operationalize precision genomics across the enterprise and to keep up with constant innovations.
“We’ve increasingly turned to partners like Natera versus homegrown labs,” he said. “Homegrown labs still play a role, but it takes collaboration with industry leaders to keep up with the new tests and treatment options.”
Vision of the future
Precision genomics is primed to deliver breakthroughs across medicine — building on the rapid advances already seen in oncology and expanding into new disease areas.
For example, postoperative chemotherapy is commonly provided to many cancer patients who don’t need it or won’t benefit from it. But clinicians don’t know which patients will benefit, so they prescribe it broadly.
“If we could focus our therapy on just those who are definitely going to benefit, that would be incredibly powerful,” Dr. Messersmith said.
He sees great potential in cell-free DNA tests that detect MRD — such as Natera’s Signatera test — continuing to lead the way to allow clinicians to “see the smoke, even when we can’t find the fire.” He believes these tests and other tests that detect cancer earlier will lead to therapies that increase the cure rate by identifying at-risk patients when they have far fewer cancer cells, and enabling targeted therapies that cure these cancers. Realizing this potential requires that health systems move from evaluating the science of genomic testing to operationalizing the infrastructure, building the enterprise capabilities, and integrating these capabilities into EHRs and daily workflows to bring precision genomics to scale, so more patients can benefit.
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. We aim to make personalized genetic testing and diagnostics part of the standard of care to protect health and inform earlier, more targeted interventions that help lead to longer, healthier lives. Natera provides each patient an individualized and clinically validated cfDNA test or diagnostic test to understand their unique molecular biology and support more informed health care decisions in critical health moments.
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