The clinical benefits of identifying and treating patients with elevated risk of cancer are clear. High-risk breast programs increase rates of early cancer detection, improving patient outcomes, lowering the cost of care and engaging patients in long-term preventive care.
Sometimes, though, the financial benefits aren’t as clear. Breast centers often face resource limitations that make it difficult to implement and scale cancer risk assessment and genetic testing. After all, conventional thinking suggests that a high-risk program requires significant investment in labor and operations, from IT to clinical equipment to overhead. Increased spending drags down margins, which makes it difficult to scale, which makes it difficult to see more patients.
The good news is it doesn’t necessarily have to be this way. Our experience working with breast centers in diverse markets around the country has shown us it’s possible to optimize cancer risk assessment, genetic testing, and care management processes to deliver a clear ROI through high-risk breast programs. We see health systems generate about $160 in downstream revenue for each patient screened. For a program that screens 10,000 patients annually, that amounts to $1.6 million in annual revenue.
Based on what we’ve learned from the most successful breast centers, here are 10 essential steps to establish a sustainable high-risk program:
- Identify and assemble the right stakeholders. Before drafting a program blueprint, organizations should gather input from a range of clinicians and care providers, including specialists, nurse practitioners, genetic counselors and care navigators. It’s also important to bring leaders from operations, finance, IT and marketing into early planning conversations.
- Look for gaps in the continuum of care. Set the stage to offer end-to-end care by proactively identifying and closing potential gaps, especially related to patient handoffs and long-term medical management.
- Calculate operating expenses. The three main categories will be expenses related to IT, clinical technology and overhead costs for supplies and marketing.
- Calculate labor volume and costs. Labor is the biggest investment when building a high-risk breast program. Programs will need breast imaging navigators and genetic counselors, though these roles can be supplemented with technology.
- Choose an implementation model. Programs should establish care pathways to ensure high-risk patients are navigated to the appropriate follow-up services. Programs often use referral-based models, point-of-care scheduling or point-of-care testing based on the resources available.
- Adapt workflows to manage no-show rates. Reducing wait times between appointments, providing educational material in advance, sending reminders and offering discounted transportation or parking are all measures that can help limit no-shows for new business units.
- Identify direct service revenue. High-risk breast programs can generate revenue first through family history assessments, genetic counseling services and other office events.
- Identify downstream revenue. Programs also generate revenue via preventive services for high-risk patients, including breast MRIs, other imaging procedures, chemoprevention, and prophylactic surgeries.
- Project program ROI. Choose metrics to track program success. Examples include time spent per patient, high-risk patients identified, cancer screening rates, counseling appointments, high-risk patients managed, additional preventive service revenue and long-term cost savings.
- Enable support for virtual and home-based care. Virtual and home-based care options lower barriers to access, increase visit volume and can help programs use staff and resources more efficiently.
Ready to learn more about how to build the business case for a high-risk breast program?
Watch our free webinar, “How to Meet 2024 NAPBC Standards & Deliver Clear ROI with Limited Resources,” to learn how to overcome resource challenges and build a high-risk breast program that can drive ROI for your breast center.
