When it comes to medical breakthroughs, it can be a long journey between discovery and implementation.
Implementing new technologies and therapies for patients is often hindered by slow adoption, inaccurate application, and delays caused by the rapid pace of guideline updates, which providers may struggle to keep up with. These challenges can prevent patients from fully benefiting from medical breakthroughs, leaving their potential only partially realized.
For example, the development of genomic testing and targeted therapies to treat cancer has enormous potential to advance treatment, but it is proving difficult to achieve widespread adoption for various reasons.
Genomic testing and targeted therapies for non-small cell lung cancer (NSCLC) work together to improve diagnosis and patient outcomes. However, gaps in care often prevent patients from fully benefiting from these advancements. Many patients either go untested, miss out on appropriate therapies, or experience unnecessary delays between diagnosis and treatment. These disconnects undermine the integration of testing and therapy, limiting their ability to deliver optimal results.
Undertesting
One problem with implementing targeted therapies is the underuse of genetic testing. An internal analysis of health plan members found that 44 percent of patients with NSCLC had no evidence of biomarker testing in their history. A retrospective study showed that only 18 percent of NSCLC patients received all gene mutation tests recommended by the National Comprehensive Cancer Network (NCCN).
One proposed change to decrease testing underutilization is replacing the standard tissue sample test, which has several disadvantages, with the newer liquid biomarker testing. Here’s why:
- Tissue testing requires medical professionals to extract tissue; noninvasive liquid biomarker testing does not.
- Tissue testing can take two to three weeks longer than liquid biomarker testing.
- Tissue testing requires a sample from each tumor; liquid biomarker testing does not.
- Tissue samples might be insufficient for complete testing and require coordination involving multiple care team members; liquid biomarker testing does not.
- Patient costs and insurance coverage are significant barriers to tissue testing, according to oncologists.
- Testing rates are different across ethnicities and practice types.
The underuse of genetic testing often prevents patients from receiving targeted therapies that could benefit them the most. According to multiple analyses of members with NSCLC:
- Forty-three percent of members with NSCLC are on a biomarker drug with no evidence of them undergoing a genetic test to show that the drug is appropriate for their cancer.
- In a study of over 27,000 members with NSCLC, 29 percent were not on the appropriate targeted treatment based on their lab results.
- In a study of over 9,500 members with NSCLC, 44 percent had a positive biomarker and were not on the NCCN-recommended therapy.
Shortening delays
Another problem is the unnecessarily long delay between diagnosis and the beginning of treatment.
In some cases, starting treatment for NSCLC takes 40 to 60 days from diagnosis. This process involves multiple communications among providers, labs, and the health plan concerning prior authorizations (PA), test orders, results, and, finally, treatment. Six to eight weeks is too long for patients to wait.
It doesn’t have to be that long. The process can be shortened to roughly 15 days and more precisely by eliminating PA bottlenecks and matching cancers to the right therapy. Health plans work with a lab benefits manager (LBM) that contracts with a network of genetic testing labs qualified for automated PAs based on their performance. The LBM also has the necessary clinical databases and expertise to match a tumor’s specific mutation results to the correct member and the most appropriate drug for treatment. These improvements can be achieved through effective lab values management (LVM).
Here’s how it would work:
- Once an NSCLC diagnosis is confirmed, the provider receives an automated PA from the health plan to order a liquid biomarker genomic test.
- A lab performs the test, part of a curated network under contract with an LBM. It identifies the cancer’s genetic makeup.
- The results are sent to the provider and LBM, which matches the tumor mutation to the guideline-indicated drug and sends reports to the provider and plan.
- The provider receives an automated PA from the plan to administer the drug indicated for that patient’s tumor mutation. The patient begins treatment, and a claim is filed with the plan.
A better and faster way
This process has considerable advantages over the current model. It increases the quality of care by applying guideline-concordant treatment, utilizing broad panel genomic testing, and incorporating liquid biomarker testing. Care begins sooner by reducing testing time and eliminating two PA bottlenecks. Additionally, it reduces administrative costs for health plans and providers, improves outcomes, and ultimately reduces the overall cost of care.
While this use of LVM to improve cancer treatment is relatively new, it is already proving its worth and will soon be expanded to treat new clinical conditions.
Michael Dovidio and Matthew Ingram are health care executives.
