How to Bring Cancer Testing In-House: Advice from An Integrated Healthcare System

Precision oncology is experiencing immense movement, with a significant increase in the types of available molecular tests, increased reimbursement and coverage for tissue and liquid biopsy, and an increase in approved targeted therapies. More cancer patients are able to access targeted therapy today than ever before, but questions remain about how public and private payers will respond. This can make it difficult for healthcare systems to standardize care and control total cost of care, while working with patient populations to improve outcomes. 

During the annual Association for Molecular Pathology conference, Canexia Health’s Brady Davis spoke about this evolving frontier with Dr. Greg Tranah, Executive Director of Precision Medicine Research at Sutter Health.  

Dr. Tranah shared challenges, benefits, and insights and his work with Canexia Health on several clinical and economic validation studies to build the business case for bringing cancer testing in-house.

Sutter Health, in Northern California, is the fourth largest non-profit integrated delivery network in the US, serving more than 3 million patients per year, with diverse demographics, through its network of 5,000 physicians, 26 hospitals, and 28 ambulatory surgery centers. 

Here are key takeaways from the workshop, which you can watch in full here. 

 

1. The complexity of large healthcare systems poses multiple challenges to bringing cancer testing in-house.

According to Dr. Tranah, “Sutter  has physicians in private practice and physicians working directly within our system. There’s no top-down management, so that means we have a send-out model for testing and each physician or practice decides who to work with. Since testing goes out to many different places, we don’t have the ability to learn from the testing that comes back to our doctors and back to the patients to develop a system-wide strategy that helps everybody moving forward.” 

“For example, one practice prefers one testing company, another practice prefers another company. Testing happens in isolation. There’s no way to learn from results. Patient care isn’t impacted, but we’re not leveraging information in a way in aid of becoming a learning healthcare system.”  

To execute testing in-house, he says, “We also need to bring along multiple stakeholders. We need to understand how physicians are going to adopt this technology, how our labs will adopt it for a very large system, how IS and IT will integrate it into existing systems, which is no simple feat given security and privacy. And, finally, leadership has to be open to adoption,” which requires a strong business case. “We’re not an academic center, we’re a large healthcare system. We need to bring all of these stakeholders along with us when we’re going to adopt new technology.” 

“Only after we’ve done all of these things can we then move on to the business case. What do these tests cost, what can we be reimbursed for, and in case of total cost of care, how does this improve outcomes and help us do a better job of spending and investing?” 

“Before we can adopt any new tech, we have a lot of work to do. Everyone is very excited about ctDNA testing, but to move a very large organization in a new direction, you have to prove value. That’s why we have a partnership with Canexia.”

 

2. In-house testing can enable healthcare systems to meet the demands of total cost of care environments, while realizing their vision to be learning systems.

“Once we’ve proven the case, then we can scale,” says Dr. Tanah. “This is when it becomes exciting, when we integrate testing into a system-wide service line strategy — meaning it doesn’t matter where you live, if you are in our system you have access to that test and expertise.” 

“It’s expensive to send out testing. It’s going to be necessary to standardize our approach in a triage-type model and control processes that enable us to control costs and get better access to data. This is important not just for us, but for all healthcare systems.”

“Ultimately we want to have a systemwide process for ctDNA testing that allows us to care for patients in our system no matter where they live, while every physician benefits from that information and learns in a scaled, comprehensive way. This will be especially important in total cost of care environments. We’re responsible for patient care from end to end, not just one step along the way. That’s why we’re looking to bring ctDNA testing in-house.” 

“All of this supports our vision to become a learning healthcare system. The only way we can do this is when we can deploy at scale. Right now we’re going through the first steps in proving this out.”

 

3. Organizations can’t tackle everything alone. Partnerships are key.

To that end, Dr. Tranah and team are working with Canexia Health on multiple clinical and economic validation studies.

According to Davis, “Innovation isn’t easy so working with partners is critical. It’s important to pick the right partners to help make this type of expertise and testing available to all, across an entire system. 

“Canexia is focused on making cancer testing equitable and accessible around the world with highly sensitive tests and rapid turnaround. Adding to benefits we’ve already discussed, COVID-19 has caused dramatic drops in testing. Bringing ctDNA testing in-house, during this time and beyond, de-risks for patients, makes testing accessible closer to home, and ensures treatment selection isn’t delayed.”

“All of that said, complex testing requires deep and diverse expertise, especially in a clinical setting. The right partner really makes a difference. How? In a nutshell, we help healthcare organizations like Sutter Health implement quality-assured, next-generation sequencing based tests with a model that can be standardized and is reflexible to bigger panels. We develop assays that fit existing reimbursement models and continue to advance the technology for our partner labs.”

Davis continues, “Our solutions support treatment selection, as well as cancer recurrence monitoring. Our AI/ML team continues to build on sensitivity and our overall solution, which can also be used to identify valuable data for biopharma to help recruit for clinical trials. We provide support throughout the entire tech transfer process.”

“Finally, Canexia has a strong triage and reflex model that can offer health systems significant cost savings, helping to reduce total cost of care. By using our Follow It test for triage, total cost of care is reduced as fewer patients require a comprehensive test.” 

Dr. Tranah adds, “One important benefit of working with Canexia that I want to make sure to note is we’re joining a community of likeminded health systems and academic centers learning from each other and taking the learning healthcare system beyond our walls. We’re actually joining a much larger team – local, national and global.”

“While the environment I work in is highly complex, it also offers up so many opportunities to help patients, improve the way we understand how testing can help patients, and also how testing can improve the bottom line for healthcare systems.” 

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