Removing Barriers to Improve the Use of Diagnostic Tests for Precision Cancer Care

Currently, the number of patients who are actually utilizing precision cancer care treatments is small, but it is growing fast. As that happens, physicians will need to get comfortable with ordering the right tests, explained Clynt Taylor, chief executive officer of Intervention Insights, and Lee Newcomer, MD, formerly of UnitedHealth Group.

There are, according to Newcomer, 3 big barriers to getting access to diagnostic tests and wider adoption of precision medicines. First is the challenge of figuring out what panel the clinician needs to order. Do they need to order a single-gene or a 7-gene or even a 500-gene panel?

“So, that clinical question is pretty tough for physicians to answer right now,” he said. “All of this is new. It’s evolving. They struggle with it.”

A second barrier is choosing the laboratory that offers the best test for what the physician needs. The third barrier is what tests are paid for by the payer. There is a lot of work on the part of the physician to get through all 3 of those barriers, involving multiple phone calls.

Newcomer is now on the board of Intervention Insights, which has a product, Trapelo, that tries to remove some of those barriers. According to Taylor, there is wide variability in oncologist level of comfort with using precision medicines, which is another barrier that Trapelo tries to overcome.

Intervention Insights had started in the area by developing a knowledge base of all evidence related to genes or biomarkers and their diseases. That information was used to provide a summary for reports coming back from the lab to make it easier for physicians to interpret the results, Taylor explained. Trapelo is the next step and moves downstream a little to help physicians start making decisions around which tests to order.

After working with physicians, the company decided that a single platform could help align the interests of oncologists, laboratories, and payers in real time, “so that our colleagues could look to order from a single place that would help that doctor know, for each patient, what to order, from which labs, what genes needed to be tested, [and] what would be paid for them,” Taylor said.

This work takes place in the electronic medical record (EMR), and according to Taylor, the company was very aware that Trapelo needed to work very synergistically with the EMR so as not to add more work to the day for oncologists. The usability of the program was key, Newcomer added.

For a while now, the diagnostics field has been tough to reimburse because of the Current Procedural Terminology codes used, Newcomer said. These codes have been nondescript and confusing, and health plans have been looking for vendors who can make it easier to understand what test is being ordered and how to pay for it.

New payment models, such as the Oncology Care Model (OCM), help to get diagnostic tests used more, because OCM rewards practices that are cost-efficient and get better outcomes.

“So, if you were to know in advance from the gene test, that drug probably isn’t going to work, whereas another one will, that’s very useful information…” Newcomer said.