At the University of Chicago’s 10th Annual International Clinical Cancer Genetics & Genomics Conference last month, CancerIQ’s Chief Product Officer Haibo Lu and Vice President of Sales Matt Valin presented the challenges of high-risk cancer program design.
Building a sustainable high-risk cancer program — one that balances patient flow and capacity — is easier said than done. While some programs are underutilized, others are overwhelmed with patients and barely treading water. More still may be questionably effective, offering patients screening and testing but little by the way of long-term care management.
“To be sustainable, you want to have an appropriate [program] design,” Lu said. “It has to be appropriate for your setting, and it has to be appropriately resourced. If you do it well, you can generate incredible outcomes.”
The fundamental pieces of a high-risk cancer program are (1) screening to identify potential high-risk patients; (2) evaluation, including genetic testing and counseling; and (3) care management and follow-up. But there’s a lot more that goes into building a successful high-risk program. So how do health systems build effective, sustainable high-risk programs that drive positive clinical and financial outcomes? It all comes down to program design.
3 Models for High-Risk Cancer Programs
Based on learnings from hundreds of high-risk program implementations in diverse settings around the country, Lu outlined three common program models:
Example 1: The Genetics Island Model
In this model, genetics services exist on an “island” within the health system, taking in patient referrals from a variety of places. Once patients are screened, tested, and evaluated, programs with this model send patients back to the referring providers for care management.
While this model can benefit systems with limited genetics experts on staff, common challenges include inconsistency and overwhelm due to lack of control over referral volume, as well as a lack of visibility into outcomes.
Example 2: The Hub and Spoke Model
This popular high-risk model conducts high-risk screening across health system settings, including imaging, primary care, OB/GYN, oncology and more. High-risk patients are funneled into a central program for patient testing, counseling, and management.
Like the genetics island model, the hub and spoke design also faces the risk of overwhelm, especially because it involves managing long-term care plans. Another challenge is maintaining clinical belief at all screening sites, to ensure screening remains consistent and accessible for all patients.
Example 3: The Integrated Subway Model
The last model integrates screening, testing, and managing high-risk patients directly into practice workflow, most commonly oncology and OB/GYN.
Your High-Risk Program
While every model comes with its own challenges, none are insurmountable. Designing the optimal high-risk cancer program is unique to local market conditions, health system structure and target patient populations. When a high-risk program finds the right balance, it can become a fundamental part of the health system, driving improvements in population health and millions of dollars in downstream revenue. Learn how health systems successfully navigated these challenges in our free eBook, The Definitive Guide to High-Risk Breast Programs.
Not sure where to begin? CancerIQ can help. Our team is now offering personalized program consultations to help health systems evaluate program challenges and learn best practices from successful high-risk programs around the country.