Low-Value Care Directly Leads to Development of Cancer Genomic Pathways

Digital cancer pathways are truly the way of the future of cancer care.

Tatjana Kolevska, MD, Medical Director of National Cancer Care, Kaiser Permanente, referred to herself as a “true believer” in digital cancer pathways during her presentation, “Diagnostic and Therapeutic Benefits to Maximize the Benefits and Creating Value with Thoughtful Genomic Testing,” which closed out Session 5 at the 2022 Oncology Clinical Pathways Congress.

The goals in this area are to investigate low-value care and how it contributes to the desire to develop cancer genomics pathways.

Dr Kolevska opened with a statement that speaks to the heart of cancer genomics pathways and the driving force at Kaiser Permanente.

“The core of cancer genomics, and what guides Kaiser Permanente: making the right thing to do, the easiest thing to do,” she said.

A key reason why digital pathways are the way of the future, Dr Kolevska said, is the doubling time of medical knowledge. In the 1950s, it took 50 years to double medical knowledge. In the 1980s, medical knowledge doubled every 7 years. In 2020, that time frame dropped to a stunning 73 days to double our medical knowledge.

“In the 1980s, the medical knowledge doubles in 7 years, and that’s a lot of pressure on us,” Dr Kolevska said. “And that’s a major reason why recertification was introduced. I recertified every 10 years because what we learned in medical schools, in fellowships, residencies, is not good enough for our whole career.

“Now, it’s exploded. Every 3 months—less than 3 months—our medical knowledge doubles.”

Obviously, there are no humans who can track this overwhelming amount of new knowledge, so we have to ask computers to help us, Dr Kolevska said. This is where digital pathways come into play.

In discussing where the money to fund the development of clinical pathways would come from, Dr Kolevska points to a study that shows that the United States wastes more money in low-value medical care than it spends on the military. More than one-quarter of health care money spent on cancer diagnosis is considered low-value.

“That’s a huge amount of money right now that is literally going down the drain,” she said.

Clinical pathways allowed physicians to eliminate low-value care and focus on the patients.

Genomic pathways will play a part in a comprehensive cancer care pathway that will also include personalized screening/self-booking, treatment plans, and survivorship plans.

The goal is not only to make the cancer care pathways feasible to the care team, but also to make it visible to the patients. All 12 million Kaiser Permanente members can readily access their medical records.

The FDA has approved more than 160 genomic tests, with the vast majority coming in lung, breast, and colorectal cancer. In developing the pathways, Kaiser Permanente attempted to eliminate the low-value diagnostic, have care provider guidance, and optimize pricing.

Dr Kolevska then provided an example of how a physician could order a test as recently as 2019, and how much quicker and more efficient it is now. Just 3 years ago, a patient chart was time-consuming and required the physician to type in the full names, and then the lab performing the tests might be unfamiliar with the processes.

Kaiser Permanente’s genomic pathways have been greatly improved, streamlined, and simplified. Now, it takes six clicks, no typing out names, and less than 5 minutes to go from initiating genomic testing to signing a treatment order. And labs that receive the test orders are familiar with the processes and pathways, saving time and money throughout the pathway.

“How much difference did we make here?” Dr Kolevska asked in concluding the presentation. “We analyzed and presented this at ASCO. From all the patients we sequenced, we find actionable mutations in about 45.4%, so it really, really, really matters.

“Genetic pathways are like a time-making device. In the past, on average an oncologist would spend about 20 minutes ordering these genomic tests, and some physicians took much longer. Right now, we spend literally less than 5 seconds. If you calculate for our 320 oncologists across 67 clinics across the country, we save about 3,000 hours per year, and that’s time saved for physicians to spend with patients.”