Table 1 Laboratory business model characteristics.

Emergent topics and subtopics	For-profit and not-for-profit full-service laboratories (FSL)	For-profit germline laboratories (PGL)	Not-for-profit germline laboratories (NGL)
Billing
Third-party billing^a	√	√	√
Client billing^b			√
Direct patient billing		√
Contracting
Payers^c	√	√
Health-care organizations/hospitals	√	√	√
Value-based reimbursement^d		√
Research^e			√
Business arrangements
Acquisitions/mergers	√	√
Investors		√
Partnerships
Industry^f		√
Academia^g	√	√	√
Pricing
Diagnostic service	√	√	√
Commodity-based^h		√
Consumer-facing serviceⁱ
Available		√
Not available	√		√

^aThe payer, an insurance company or health agency uninvolved in the direct care of the patient that pays for the care or services rendered to the patient (i.e., the first party).
^bDescribed as “account” or “passthrough” billing, where medical providers compensate a laboratory for testing services and submit claims to payers for those services.
^cPayers, as described by key informants: health insurance companies, employer groups.
^dReimbursed based on cost-effective, improved quality of care rather than volume.
^eContracts to perform germline testing, most often exome or genome sequencing, to support research performed by other organizations (e.g., biotechnology companies, pharmaceutical companies, or academic institutions).
^fPartnerships with pharmaceutical and biotechnology companies for companion diagnostics and gene discovery.
^gFSLs tend to gain technological expertise (test development, results interpretation) through academic partnerships, whereas PGLs and NGLs typically have research partnerships with academia.
^hDiscounted pricing with the expectation of future payoffs.
ⁱConsumers request genetic testing using a laboratory-contracted physician or medical corporation.

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