3 Tips for Building a Breast Health Network

Developing a network of primary care services available at the front end for annual or biannual screening mammograms directly impacts downstream oncologic diagnosis and treatment volumes. Strategically building this initial point of entry is a key to the success of a breast care program.

Adherence to breast screening protocols directly impacts breast cancer survival rates. Breast health is a major population health issue and represents an opportunity for health systems in both fee-for-service and population health models. Breast cancer is the second most common cancer behind prostate and accounts for 14 percent of all cancer cases and 29 percent of all cancers afflicting women. Nationally, one in eight (12 percent) women born in the United States today will have a breast cancer diagnosis during her lifetime.1

Developing a network of primary care services available at the front end for annual or biannual screening mammograms directly impacts downstream oncologic diagnosis and treatment volumes. Strategically building this initial point of entry is a key to the success of a breast care program. Three screening network tips are outlined below.

Tip 1: Understand market demand
Accurately measuring demand for breast health screenings will help planning for the entire continuum of care. The graphic below depicts typical flow for understanding the demand for mammography and the resulting downstream diagnostic and treatment.

The percentages used vary based on the specific market, its medical practice culture and availability of services, but the components that should be measured are consistent across all markets.

Understanding market demand begins with the total population. The majority of individuals utilizing mammography are women over the age of 40 years.^₂ There are a small percentage of people accessing screening mammography outside of these parameters, but, for planning purposes, these younger women and men represent a small fraction of the screenings.

The unique demographic characteristics of the market also have a direct impact on the total demand. Nationally, 51 percent of all women 40 years old and older have a yearly mammogram. However, locally these rates vary significantly depending on many factors such as socioeconomic status, ethnic background, education, access to health insurance, age and geographic location. Screening rates based on many of these factors can be found through the American Cancer Society.

Also important to consider are the environmental changes shifting demand for screenings. One of the main reasons people do not get yearly mammogram screenings is out-of-pocket expense or lack of healthcare coverage.³ For example 55 percent of women 40 years old and older with health insurance report having a mammogram within the last year, whereas the rate drops to only 17 percent for the uninsured.⁴ Healthcare reform increases the number of people with access to health insurance while also requiring insurance coverage for screening mammograms as part of yearly preventative care with no out-of-pocket expense.⁵ This shift could greatly increase demand for mammography screenings and significantly change the percentage of women accessing yearly screenings.

Another environmental shift, potentially offsetting some of the increased demand from healthcare reform, is the recommendation on how frequently women should be screened. A lot of discussion and controversy exist on when women should begin screenings. The United States Preventative Services Task Force now recommends screenings every two years beginning at 50.⁶ According to a survey by Avon Foundation for Women, 24 percent of breast cancer health providers and educators surveyed noted a decrease in women under 50 being screened following the implementation of these guidelines.⁷ Keeping abreast of these changes is important for projecting future screenings expected from a market.

Tip 2: Recognize access and convenience are key factors for screening
Mammography is a service that should be distributed to improve patient access. Depending on the market this will vary but, recent experience at a large hospital system suggests women are willing to drive an average of 8-10 minutes for care in suburban or urban markets and about 30 minutes in unpopulated rural markets. This means screening sites need to be distributed throughout the market to capture volumes.

Additionally, patients will need access to a primary care network to help manage their primary healthcare. Although patients do not need a referral to get a mammogram screening, many women still rely on advice from their primary care physician to get screened. A study in the Journal of Women's Health indicated a positive correlation between access to primary care providers and mammography screening rates.⁸

All access points will need to consider options to make them more convenient. Flexible scheduling options such as online, extended hours and on-demand care should be available. Location should be convenient to traffic pattern with easy parking. Building design should prioritize way finding, privacy and ease of access to entrances. Processes should be designed to eliminate registration and wait times. Any element to increase convenience is critical to the success of capturing and retaining screening volumes.

Tip 3: Create confidence and solutions to capture the downstream volumes
Screening volume is the first step to building a breast health network, but processes and systems must be in place to transition the referrals generated from the screening volume into downstream activity within the system and revenue. For the patient, the referral for more testing is an emotional and stressful time. Guiding the patient through additional testing and potentially to oncologic care requires both a clinical and emotional component.

One way to do this is through quick turnaround times for screening results. Many systems will offer same-day results, and some will even offer same day scheduling or appointments for additional testing. The Henry Ford West Bloomfield Hospital in Detroit is one example of a hospital that recently underwent a project to provide results within 48 hours of a screening or even same day.⁹ They found 54 percent of their surveyed patients wanted results within 48 hours, and 15 percent wanted same day results.¹⁰ Quick turnaround times are a priority for patients and will help increase loyalty.

Also important is to provide elements to better coordinate care. Involving navigators at the point of a positive diagnosis can help transition volume to oncologic care. Helping the patient navigate the next level of testing, what types of tests are likely, and understanding what the testing means in coordination with the patient's primary care provider is an important part of attending to the emotion component of the equation. On the clinical side, ensuring the best high-quality options are available is key to creating patient confidence in the program. This includes multidisciplinary clinics, access to clinical trials and the supporting components such as genetics, nutrition, reconstruction, survivor support groups, etc.

Summary
Building a strong mammography screening network is an important strategy for health systems that want to develop and grow breast oncology programs. Creating this screening network, organizations must understand the market, build convenient options and link the screening network with rigorous post screening testing and treatment options.

Victoria Gerber is a strategic analyst and Luke C. Peterson is a principal at Health System Advisors. They can be contacted at Victoria.Gerber@HealthSystemAvdvisors.com or Luke.Peterson@HealthSystemAdvisors.com. Health System Advisors is a strategy consultancy whose mission is to advise leaders, advance organizations and transform the healthcare industry. For more information contact HSA at 877.776.3639 or www.HealthSystemAdvisors.com.