Indianapolis-based Community Health Network is a nonprofit health system with more than 200 sites of care. Having served patients in central Indiana for more than 60 years, the organization has deep ties to the areas it serves.
Furthering its mission to enhance the health and well-being of those areas, Community became one of the first U.S. health systems to offer the Galleri® test in 2021. Galleri, a multi-cancer early detection (MCED) test, can help physicians screen for many of the deadliest cancers that don’t otherwise have recommended screenings today, including pancreatic, esophageal, ovarian, and liver*. By 2023, Community had thousands of patients who received MCED testing and subsequent care.
Becker’s Hospital Review recently spoke with Patrick McGill, MD, Community’s chief transformation officer, to learn about the health system’s journey as an oncology innovator, the decision to implement the Galleri test and their experience thus far offering MCED testing.
Community’s commitment to innovation and cancer care converge
To strengthen Community’s position as an innovation leader, the health system created an Office of Transformation. Responsible for analytics, clinical decision support, navigation services, emerging technologies, process improvement and patient experience, the Office of Transformation works with physicians to drive innovative change across its entire network.
In addition to bolstering its reputation as an innovator, Community initiated a strategic goal to advance cancer care by expanding its efforts to detect cancer sooner among its patient populations. This effort strengthened the organization’s decadelong commitment, which began when Community’s president and CEO positioned Community as an oncology care leader. This promise led to an affiliation with Houston based MD Anderson Cancer Center, which was elevated to a formal partnership in 2022, and one of only six such partnerships for MD Anderson in the country.
Community also created a Center for Genetic Health, soon to become Community’s Cancer Prevention and Genetics Center, which involved investment in genetic testing and counseling.
“We track our patient satisfaction data closely,” Dr. McGill said. “Patients rate us as the top provider in many areas within our market, and our outcomes data regularly track above benchmarks. Even still, we saw an opportunity to enhance patient perception around our commitment to innovation. Cancer care was one of the areas where we looked for technologies and strategies that would enable us to bring the latest and most practical solutions to our patients.”
Expanding on their cancer care investments, Community also wanted to look for screening options that were evidence based and easy for physicians to implement.
“We had already invested in genetic testing and counseling to round out our prevention, oncology and genetics programs, but we wanted screening options that could help support early detection beyond the typical guideline-driven cancer screenings,” Dr. McGill said. Galleri is one of those technologies we vetted to help us meet these goals.”
Thoroughly vetting the Galleri test — clinically and financially
Upon learning about Galleri, Community looked into evidence from GRAIL’s clinical trials and spoke with GRAIL’s leaders about implementation.
“The clinical trial data was compelling, and the implementation seemed manageable,” Dr. McGill said. “After reviewing the evidence, we decided to bring it to our patients. With Galleri, we started to see where there is synergy between precision medicine and population health.”
Also, implementation of the Galleri test didn’t require any capital — an essential consideration for Community. “We found Galleri to be a relatively low investment for our health system compared to the impact it could have for our patients,” Dr. McGill said.
Keys to implementation: educating providers, building in alerts & centralizing support
As an early adopter of MCED testing, Community has learned valuable lessons. “With any new strategy or innovation, engaging and educating providers is paramount,” Dr. McGill said. In this instance, it was important for Community to educate providers, especially primary care physicians throughout the network, on how the new Galleri test differed from existing, singlecancer screenings and genetic testing.
This support led to the development of alerts to encourage both routine testing and identify patients who may be good candidates for Galleri. Prior to a visit with a patient at an elevated risk for cancer, the provider gets a reminder in the HER to discuss screening options and whether MCED testing may be appropriate. “This type of clinical decision support makes it easier to plan for a patient visit and helps the provider manage their time,”
Dr. McGill said.
Community continues to help providers and patients by offering centralized support when Galleri returns a cancer signal detected. For the 1% of patients that screen positive, in line with the cancer incidence rate**, Galleri will predict the most likely origin of the cancer***. For providers, this means quick access to guidelines and pathways for diagnostic workups.
“One of the biggest values of centralizing results management is relieving primary care physicians’ concern about knowing what to do when they receive a cancer signal detected,” Dr. McGill said. “Centralization creates expertise in triage and familiarity with nuances in positive cancer signals.”
A new care paradigm
Dr. McGill sees Community’s decision to offer the Galleri test as a new evolution in the care delivery paradigm.
“A test like Galleri shifts our thinking from vertical healthcare to horizontal healthcare,” he said. “You are screening an individual for multiple cancers versus screening for one cancer. Part of the conversation with the patient is explaining what to expect and how the results will be handled. That works best when you can assure the patient that you have care pathways in place across your entire healthcare system.”
Dr. McGill explained how a cancer signal detected result also prompts the centralized team to help with peer-to-peer consults as needed. “That peer-to-peer review could bring multiple providers together who otherwise may not have a reason to collaborate,” he said. “The patient benefits from a concerted effort to manage their care, and the providers learn
from each other.”
Continuous learning has emerged as a key theme in Community’s adoption of MCED testing. Dr. McGill emphasized the organization’s excitement in looking at new ways to expand how testing is offered to patients, including virtual ordering models. “We’ve only just begun this journey for Community and our patients,” he said.
Important Safety Information
The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. The Galleri test does not detect all cancers and should be used in addition to routine cancer screening tests recommended by a healthcare provider. Galleri is intended to detect cancer signals and predict where in the body the cancer signal is located. Use of Galleri is not recommended in individuals who are pregnant, 21 years old or younger, or undergoing active cancer treatment.
Results should be interpreted by a healthcare provider in the context of medical history, clinical signs and symptoms. A test result of “No Cancer Signal Detected” does not rule out cancer. A test result of “Cancer Signal Detected” requires confirmatory diagnostic evaluation by medically established procedures (e.g. imaging) to confirm cancer.
If cancer is not confirmed with further testing, it could mean that cancer is not present or testing was insufficient to detect cancer, including due to the cancer being located in a different part of the body. False-positive (a cancer signal detected when cancer is not present) and false-negative (a cancer signal not detected when cancer is present) test results do occur. Rx only.
Laboratory / test information
GRAIL’s clinical laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accredited by the College of American Pathologists (CAP). The Galleri test was developed, and its performance characteristics were determined by GRAIL. The Galleri test has not been cleared or approved by the Food and Drug Administration. GRAIL’s clinical laboratory is regulated under CLIA to perform high complexity testing. The Galleri test is intended for clinical purposes.
References
1. Schrag D, et al. PATHFINDER: A Prospective Study of a Multi-Cancer Early Detection Blood Test. Presentation at European Society of Medical Oncology (ESMO) Congress September 9-13, 2022; Paris, France.
*Sensitivity in study participants with - Pancreas cancer: 83.7% overall (61.9% stage I, 60.0% stage II, 85.7% stage III, 95.9% stage IV). Esophagus cancer 85.0% overall (12.5% stage I, 64.7% stage II, 94.7% stage III, 100% stage IV). Ovary cancer: 83.1% overall (50.0% stage I, 80.0% stage II, 87.1% stage III, 94.7% stage IV). Liver/bile duct cancer: 93.5% overall (100% stage I, 70.0% stage II, 100% stage III, 100% stage IV).
**Galleri does not detect all cancers and not all cancers can be detected in blood. False-positive and false-negative results do occur. Galleri should be used in addition to recommended screening tests. Galleri Negative Predictive Value (NPV) was 98.5% in the
PATHFINDER Study1. This represents study participants with “No Cancer Signal Detected” who did not have cancer diagnosed during 12 month follow-up. The cancer incidence rate for patients 50-79 years old is approximately 1%.
*** If cancer is not confirmed with further testing, it could mean that cancer is not present or testing was insufficient to detect cancer, including due to the cancer being located in a different part of the body.