As healthcare providers hone their strategies for strengthening access to care, improving health outcomes, and satisfying patients, innovative cancer testing and personalized medicine are increasingly at the forefront. Solaris Health, a national healthcare platform, is one such organization that is helping to advance those aims.
Solaris Health is a urological managed services provider whose affiliate practices across the country are recognized as centers of excellence across the continuum of urological care, from testing to diagnosis, specialty consultation and treatment. For certain cancer patients, its affiliates offer personalized medicine based on each individual patient’s genetic fingerprint.
Becker's Hospital Review recently spoke with two clinical leaders at Solaris Health about their decision to bring hereditary cancer testing in-house for its affiliates:
- Deepak Kapoor, MD, Solaris Health chair, chief ecosystem officer and president of Integrated Medical Professionals (IMP), Solaris’ New York Metro Market affiliate; and
- Kathleen Latino, MD, Solaris Health chief medical officer and IMP’s medical director.
Improved access to genetic data optimizes patient care
Solaris Health has a growing network of urology affiliates and specialty services across the U.S. The organization is committed to business best practices enabling its clinical affiliates to deliver state-of-the-art clinical care; this vision has enabled Solaris Health to grow in just three years from two affiliate practices to more than 650 affiliated providers in 13 states.
Currently, when patients are diagnosed with certain types of prostate cancer, urologists rely on hereditary cancer test results generated by independent laboratories for information germane to optimizing treatment options. Access to the data can be limited, as is its usability.
"It was frustrating," Dr. Kapoor said. "Commercial genetic testing providers are able to accumulate data but it comes in as PDF reports which cannot be easily integrated with the electronic health record. An individual's genetic fingerprint is crucial for personalized medicine, but to optimize its clinical utility, it needs to be linked to histology findings, lab results, pharmacy data and of course, treatment outcomes."
IMP, a multispecialty practice with over 50 locations in the New York Metro area, developed a vision to create sophisticated genetic profiles for specific disease states that were actionable and could be integrated into the patient record. The best, but most difficult, way to accomplish that goal was to bring hereditary cancer testing in-house. At the time, no urology practice had taken that approach, and it was a monumental undertaking. It took IMP nearly two years and a team of a dozen highly trained professionals to get it right. The results have been more than gratifying.
"Thanks to in-house hereditary cancer testing, we can offer targeted therapies more efficiently as well as counsel patients regarding both their personal and their family’s risk of hereditary cancers,” Dr. Kapoor said. "It’s been well worth the effort.”
A significant advantage of in-house testing is that results are provided rapidly to the clinicians caring for the patient, including surgical, radiation and medical oncologists. In addition, as new genes are identified with potential health impacts, laboratories at Solaris Health affiliates can re-modulate a patient's test to incorporate those new genes.
IMP shared the results of its efforts with the Solaris Health leadership team, and the organization agreed it would be worthwhile to support efforts to help other affiliates do the same—an important component of this was contracting with Illumina to access its comprehensive sequencing research panels.
"We are using a 113-gene panel," Dr. Kapoor said. "Not all of the genes on the panel are currently linked to diseases that our physicians treat; however, they may be relevant in the future. By conducting the hereditary cancer tests in-house, we can go back later and unmask those additional genes without doing more wet work in the lab."
Dr. Kapoor noted how quickly in-house testing mechanisms have advanced. "When we first started at IMP, we looked at 10 genes," he said. "That grew to 14, and we will likely expand testing to 17 genes related to prostate cancer. It would be impossible to do this if we weren't performing testing in-house."
In the journey to helping its affiliates adopt in-house hereditary cancer testing, Solaris Health has found that physician education is a key success factor.
"Using genetic testing is very different from what most clinicians do every day," Dr. Latino said. "It's not like ordering a lab or an imaging test. It requires a different way of thinking about patient care. That's where education comes in. It helps our doctors think differently and proactively, because hereditary cancer testing affects patient care and patient treatment."
In-house testing as a pathway to improve the patient experience
From a patient perspective, in-house hereditary cancer testing has numerous advantages. Not only is data available more rapidly to support treatment plans, but it can also be used for genetic counseling. If a patient has a tumor with genetic predisposition, for example, the risk of developing other cancers is much greater. In addition, that person's immediate family members may be at higher risk of developing cancer. This is an opportunity to provide cascade testing to the family members for their personalized care paths.
"For example, we treated a man who had prostate cancer and had a BRCA mutation," Dr. Latino said, reflecting on a case handled at IMP. “He discussed it with his family, and his daughter decided to get tested. She also had a BRCA mutation, and it turned out that she had early ovarian cancer, which was treatable. This was so gratifying for all of us. Without the testing, the ovarian cancer probably would not have been found until much later, possibly leading to a tragic outcome."
Since many advanced drugs in the prostate cancer space are related to genetic mutations, in-house hereditary testing expands the therapeutic options that Solaris Health affiliates can offer. This also enables patients to keep their urologist's practice as their medical home during cancer treatment.
"Before we had this testing, we weren’t as able to effectively counsel patients regarding the appropriateness of these treatments," Dr. Latino said. "Now, we are able to take total care of our patients. In-house hereditary cancer testing has really changed how we treat patients."
Dr. Kapoor added how, in many cases, patients have an established urologist before they are diagnosed with prostate cancer — a type of rapport and familiarity that should stay intact, if possible. "When patients are diagnosed with cancer, many want to stay with a provider with whom they are comfortable," he said. "We've found that patients seem to thrive when their medical home is in their urology office. Our affiliates’ offices are in the patient’s communities, which makes a big difference. Patients don't have to travel to a tertiary care center or an academic hospital setting for treatment, where care is more expensive, is likely more inconvenient and may feel more impersonal than when delivered in our community-based offices."
Although Solaris Health believes that its affiliates are the most appropriate home base for a patient with genitourinary cancer, to deliver the best patient outcomes, the focus is on teamwork and collaboration.
"I can't stress enough the importance of the collaborative effort," Dr. Latino said. "At IMP, the radiation oncologist, oncologist, urologist and I as chief medical officer can have a conversation about a patient and decide what treatment to use. It's never competitive; it's totally collaborative."
From an economic standpoint, in-house hereditary cancer testing also improves the patient experience at each Solaris Health affiliate. Patients don’t receive bills from third-party labs that may not be in their network and they aren't financially responsible for multiple co-pays.
For Solaris Health, the ability to provide its affiliates with the intellectual property to develop in-house hereditary cancer testing helps them provide a competitive balance to hospitals and hospital systems. Given reimbursement advantages enjoyed by hospitals, it is crucial for independent practices to differentiate themselves through enhanced access and reduced costs while continuing to provide world-class care. In-house hereditary cancer testing is a crucial tool in allowing independent practices to be the value-based site of care.
Solaris Health has found that in-house hereditary cancer testing at its affiliates has also opened the doors for expanded services.
"Integrating the test data enables practices to stay at the cutting edge of their specialties and makes them relevant to patient care," Dr. Kapoor said. "For a group like ours with affiliates across the nation, that's critically important as we facilitate the development of value-based care models. The business case isn't around the profitability of the test itself; it's around what the test enables our affiliates to do today and more importantly, what it will enable all of us working together to do in the future."
Solaris Health is simultaneously working with affiliate practices in Florida, Detroit and Philadelphia, all of whom will shortly roll out genetic testing capability. Two additional deployments in Chicago and Cincinnati will come online in mid-2024. The results of genetic testing will be de-identified and ultimately be pooled in a data lake with other sources of clinical information.
"Our ability to identify cohorts of patients on a prospective basis to participate in research or to analyze our own data is tremendous," Dr. Kapoor said. "The data has broad geographic, ethnic, gender, racial, socioeconomic and genomic diversity."
For example, the Solaris Health clinical leadership team evaluates specific treatment pathways to determine their effectiveness. For patients, they can analyze important metrics like survival, cost of care and morbidity. These pathways are loaded into a cloud-based application available to affiliate practices as a reference tool for clinicians.
Looking ahead to 2024, the plan is to roll out a complete digital pathology solution with artificial intelligence that can streamline integration of data.
"For a human to physically read a PDF file, look at a slide, and then review the medical record is extremely labor intensive," Dr. Kapoor said. "Using AI technology, we can create cohorts almost instantaneously. This will be critically important for participating in or designing any kind of research trial for patient therapies."
Innovative testing is critical to achieving industry aims
In-house hereditary cancer testing using Illumina solutions has enabled Solaris Health to help its affiliates deliver on the Quadruple Aim in healthcare: better patient outcomes, an improved patient experience, an enhanced clinical experience and lower costs.
"It's been wonderful to bring state-of-the-art research to the community and to make this a reality," Dr. Kapoor said. "It all goes back to making sure the right patient gets the right treatment at the right time."