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Across the U.S. and Globally, Healthcare Systems are Collaborating to Accelerate Precision Cancer Medicine Development

September 23, 2016
by Heather Landi
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Leading healthcare systems are developing innovative collaborations with other health systems as well as with commercial partners to drive forward advancements in precision medicine, with an eye to accelerating personalized cancer treatments.

Earlier this month, Salt Lake City-based Intermountain Healthcare, a 22-hospital health system, announced a partnership between its genomics division, Intermountain Precision Genomics, and Singapore-based Asia Genomics to collaborate on offering genomics testing in four Southeast Asian countries—Singapore, Philippines, Vietnam and Malaysia. The collaboration is the first for Intermountain Precision Genomics outside the U.S.

As part of the agreement, Asia Genomics, a molecular diagnostics company, now contracts with Intermountain Precision Genomics to offer Intermountain’s ICG100 testing in those four countries.

Intermountain Precision Genomics is a service of Intermountain Healthcare, which offers genetic sequencing of solid tumors.

Asia Genomics has been offering various types of genomic tests in the healthcare environment since 2014. The primary focus of the tests Asia Genomics offers center on reproductive health and cancer care. “We are excited to be the first value-adding partner with Intermountain Precision Genomics outside of the U.S. Leveraging Intermountain Precision Genomics’ years of experience in cancer research, diagnosis and treatment, we aim to improve survival and quality of life for cancer patients in Asia,” Wong Mun-Yew, M.D., CEO and founder of Asia Genomics, said in a prepared statement.


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According to Don Tarinelli, Intermountain Healthcare’s business development director, the collaboration will entail Intermountain Precision Genomics serving as the reference laboratory for the ICG100 next-generation sequencing testing. Essentially, Asia Genomics will be a distributor for the ICG100 test in Singapore, Philippines, Vietnam and Malaysia.

“Later this year, Asia Genomics will likely expand the testing into Thailand and Indonesia. In the future, Asia Genomics hopes to do next-generation sequencing in-house, at which point we will act more as a collaborative partner for the interpretation and the bioinformatics portion of the process,” Tarinelli says.

The collaboration comes at a time when the Obama Administration’s Cancer Moonshot initiative aims to accelerate cancer research. As reported by Healthcare Informatics Senior Editor Rajiv Leventhal, earlier this month, a Blue Ribbon Panel released a report describing a set of consequential recommendations for fast-tracking cancer research. The report presents 10 recommendations and one of those recommendations focused on developing new enabling cancer technologies. Specifically, the report calls for support for the development of promising new technologies that will accelerate testing of therapies and characterization of tumors.

Many U.S. healthcare systems are collaborating on genomic and molecular testing in order to share expertise and combine capabilities with the aim of accelerating precision medicine. Earlier this month, Pittsburgh, Pa.-based Allegheny Health Network (AHN) Cancer Institute announced plans to collaborate with Johns Hopkins Kimmel Cancer Center in order to provide molecular testing to AHN patients with certain late-stage cancers to deliver more targeted drug therapies.

“As we move into a new era in the war on cancer, collaboration among institutions is an essential ingredient to success,” David Parda, M.D., Chair, AHN Cancer Institute, said in a statement.

Back in May, Lincoln Nadauld, M.D., Ph.D., executive director of precision medicine and precision genomics at Intermountain Healthcare, spoke to Healthcare Informatics about Intermountain’s just announced clinical genomics partnership with Stanford Genome Technology.

“I think one thing that [Vice President Joe] Biden’s MoonShot for Cancer team really wants to see is inter-institutional collaboration and cooperation. I think our effort with Stanford is an ideal example of what they are helping to promote. …Now we are going to marry those two strong capabilities for the benefit of patients, and I think that’s exactly what Biden and the MoonShot team want to see; that’s what they are trying to promote,” Nadauld says.

In a press release announcing the Intermountain Precision Genomics and Asia Genomics collaboration, Terri Kane, vice president of Intermountain Healthcare’s southwest region, which includes Intermountain Precision Genomics, said targeted therapies are proving to be the most effective treatment for late-stage cancer patients.

Intermountain’s ICG100 test is next-generation sequencing that identifies individual mutations within a person’s cancer cells to identify specific DNA targets for personalized drug treatments. Currently the ICG100 test is approved for late-stage cancer patients who have failed a traditional treatment method.

Intermountain Precision Genomics scientists developed its ICG100 test to detect any irregularities or cancer markets within a patient’s genes and DNA. According to Intermountain, its researchers have identified 96 genes that can play a part in developing cancer, and the ICG100 test looks at each one to determine if any show abnormalities.

Tarinelli says, “From a basic patient-centered level, what we do is that the physician will send us a tumor biopsy, we extract the DNA, the cancer cells, out of that sample, and through this process of next generation sequencing and our bioinformatics, we’re able to determine what genes have mutated in that patient and are causing the cancer to grow. And that’s half the battle,” Tarinelli says.

In order to accommodate the diverse variants generated by its sequencing chemistry, Intermountain Precision Genomics developed a collaborative, interdisciplinary board, a Molecular Tumor Board, consisting of scientists and physicians in genomics from across the western United States. The board meets weekly to discuss individual, effective treatment options based on genomic data and clinical relevance.

“The Molecular Tumor Board reviews the patient samples and the reports and, in addition to just identifying the mutations, we actually make specific recommendations as to what drugs to use to target that specific mutation. And with a lot of patients today we’re able to recommend oral medications that can be taken at home and don’t have all the side effects of traditional therapies,” Tarinelli says.

Intermountain Healthcare leaders report they are seeing promising results from the more personalized treatments for late-stage cancer patients due to the advancements in genomic diagnostic technology.

Earlier this month, researchers with Intermountain Healthcare, along with researchers from University of Utah School of Medicine, Durham, N.C.-based Duke University School of Medicine and Stanford University School of Medicine, published a study in Journal of Oncology Practice based on a retrospective analysis of precision medicine outcomes in patients with advanced cancer. According to the study authors, the study findings indicated improved progression-free survival without increased healthcare costs.

“We’re part of an integrated care delivery system, so we are able to track outcomes from patients that receive targeted therapies and the outcomes have been very good,” Tarinelli says, referencing that particular Journal of Oncology Practice study.

For that study, researchers analyzed the outcomes of patients who received genomic testing and targeted therapy, or precision cancer medicine, compared with control patients who received standard chemotherapy.

The study findings indicated, Tarinelli says, that the average progression-free survival was 23 weeks for patients who received precision cancer medicine compared to similar patients with traditional therapy, in which the average progression-free survival was 12 weeks. “So, effectively, we’ve been able to double the progression-free survival rate for our patients,” he says.

“Another significant benefit to these targeted treatments is there isn’t all the side effects as with traditional chemotherapy. These patients grow their hair back, they get out of the wheelchair and some are going back to work and living their lives, and more importantly, living their lives on their terms and are able to enjoy the additional time that they have spending time with their families, as opposed to being in a hospital bed or in a hospice,” he says.

Moving forward, the collaboration with Asia Genomics enables Intermountain Precision Genomics to increase its volume of testing.

“And, more importantly, we are able to expand our reach for this particular test, which has been able to help a tremendous amount of patients in Utah and across the U.S.,” Tarinelli says. “We’re going to be able to leverage it to help patients across those four countries in Asia. And we’ll be able to work with them from a research perspective, but also really expand our borders from Intermountain.”


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NCQA Moves Into the Population Health Sphere With Two New Programs

December 10, 2018
by Mark Hagland, Editor-in-Chief
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The NCQA announced on Monday that it was expanding its reach to encompass the measurement of population health management programs

The NCQA (National Committee for Quality Assurance), the Washington, D.C.-based not-for-profit organization best known for its managed health plan quality measurement work, announced on Dec. 10 that it was expanding its reach to encompass the population health movement, through two new programs. In a press release released on Monday afternoon, the NCQA announced that, “As part of its mission to improve the quality of health care, the National Committee for Quality Assurance (NCQA) is launching two new programs. Population Health Program Accreditation assesses how an organization applies population health concepts to programs for a defined population. Population Health Management Prevalidation reviews health IT solutions to determine their ability to support population health management functions.”

“The Population Health Management Programs suite moves us into greater alignment with the focus on person-centered population health management,” said Margaret E. O’Kane, NCQA’s president, in a statement in the press release. “Not only does it add value to existing quality improvement efforts, it also demonstrates an organization’s highest level of commitment to improving the quality of care that meets people’s needs.”

As the press release noted, “The Population Health Program Accreditation standards provide a framework for organizations to align with evidence-based care, become more efficient and better at managing complex needs. This helps keep individuals healthier by controlling risks and preventing unnecessary costs. The program evaluates organizations in: data integration; population assessment; population segmentation; targeted interventions; practitioner support; measurement and quality improvement.”

Further, the press release notes that organizations that apply for accreditation can “improve person-centered care… improve operational efficiency… support contracting needs… [and] provide added value.”

Meanwhile, “Population Health Management Prevalidation evaluates health IT systems and identifies functionality that supports or meets NCQA standards for population health management. Prevalidation increases a program’s value to NCQA-Accredited organizations and assures current and potential customers that health IT solutions support their goals. The program evaluates solutions on up to four areas: data integration; population assessment; segmentation; case management systems.”



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In this webinar, we will review how tumor board solutions, precision medicine frameworks, and oncology pathways are being used within clinical quality programs as well as understanding their role in driving operational improvements and increasing patient retention. We will demonstrate the requirements around both interoperability and the clinical depth needed to ensure adoption and effective capture and use of information to accomplish these goals.

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At the D.C. Department of Health Care Finance, Digging into Data Issues to Collaborate Across Healthcare

November 22, 2018
by Mark Hagland, Editor-in-Chief
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The D.C. Department of Health Care of Finance’s Kerda DeHaan shares her perspectives on data management for healthcare collaboration

Collaboration is taking place more and more across different types of healthcare entities these days—not only between hospitals and health insurers, for example, but also very much between local government entities on the one hand, and both providers (hospitals and physicians) and managed Medicaid plans, as well.

Among those government agencies moving forward to engage more fully with providers and provider organizations is the District of Columbia Department of Health Care Finance (DHCF), which is working across numerous lines in order to improve both the care management and cost profiles of care delivery for Medicaid recipients in Washington, D.C.

The work that Kerda DeHaan, a management analyst with the D.C. Department of Health Care, is helping to lead with colleagues in her area is ongoing, and involves multiple elements, including data management, project management, and health information exchange. DeHaan spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding this ongoing work. Below are excerpts from that interview.

You’re involved in a number of data management-related types of work right now, correct?

Yes. Among other things, we’re in the midst of building our Medicaid data warehouse; we’ve been going through the independent validation and verification (IVV) process with CMS [the federal Centers for Medicare and Medicaid Services]. We’ve been working with HealthEC, incorporating all of our Medicaid claims data into their platform. So we are creating endless reports.


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Kerda DeHaan

We track utilization, cost, we track on the managed health plan side the capitation payments we pay them versus MLR [medical loss ratio data]; our fraud and abuse team has been making great use of it. They’ve identified $8 million in costs from beneficiaries no longer in the District of Columbia, but who’ve remained on our rolls. And for the reconciliation of our payments, we can use the data warehouse for our payments. Previously, we’d have to get a report from the MMIS [Medicaid management information system] vendor, in order to [match and verify data]. With HealthEC, we’ve got a 3D analytics platform that we’re using, and we’ve saved money in identifying the beneficiaries who should not be on the rolls, and improved the time it takes for us to process payments, and we can now more closely track MCO [managed care organization] payments—the capitation payments.

That involves a very high volume of healthcare payments, correct?

Yes. For every beneficiary, we pay the managed care organizations a certain amount of money every month to handle the care for that beneficiary. We’ve got 190,000 people covered. And the MCOs report to us what the provider payments were, on a monthly basis. Now we can track better what the MCOs are spending to pay the providers. The dashboard makes it much easier to track those payments. It’s improved our overall functioning.

We have over 250,000 between managed care and FFS. Managed care 190,000, FFS, around 60,000. We also manage the Alliance population—that’s another program that the district has for individuals who are legal non-citizen residents.

What are the underlying functional challenges in this area of data management?

Before we’d implemented the data warehouse, we had to rely on our data analysis and research division to run all the reports for us. We’d have to put in a data request and hope for results within a week. This allows anyone in the agency to run their own reports and get access to data. And they’re really backed up: they do both internal and external data reports. And so you could be waiting for a while, especially during the time of the year when we have budget questions; and anything the director might want would be their top priority.

So now, the concern is, having everyone understand what they’re seeing, and looking at the data in the same way, and standardizing what they’re meaning; before, we couldn’t even get access.

Has budget been an issue?

So far, budget has not been an issue; I know the warehouse cost more than originally anticipated; but we haven’t had any constraints so far.

What are the lessons learned so far in going through a process like this?

One big lesson was that, in the beginning, we didn’t really understand the scope of what really needed to happen. So it was underfunded initially just because there wasn’t a clear understanding of how to accomplish this project. So the first lesson would be, to do more analysis upfront, to really understand the requirements. But in a lot of cases, we feel the pressure to move ahead.

Second, you really need strong project management from the outset. There was a time when we didn’t have the appropriate resources applied to this. And, just as when you’re building a house, one thing needs to happen before another, we were trying to do too many things simultaneously at the time.

Ultimately, where is this going for your organization in the next few years?

What we’re hoping is that this would be incorporated into our health information exchange. We have a separate project for that, utilizing the claims data in our warehouse to share it with providers. We’d like to improve on that, so there’s sharing between what’s in the electronic health record, and claims. So there’s an effort to access the EHR [electronic health record] data, especially from the FQHCs [federally qualified health centers] that we work closely with, and expanding out from there. The data warehouse is quite capable of ingesting that information. Some paperwork has to be worked through, to facilitate that. And then, ultimately, helping providers see their own performance. So as we move towards more value-based arrangements—and we already have P4P with some of the MCOs, FQHCs, and nursing homes—they’ll be able to track their own performance, and see what we’re seeing, all in real time. So that’s the long-term goal.

With regard to pulling EHR information from the FQHCs, have there been some process issues involved?

Yes, absolutely. There have been quite a few process issues in general, and sometimes, it comes down to other organizations requiring us to help them procure whatever systems they might need to connect to us, which we’re not against doing, but those things take time. And then there’s the ownership piece: can we trust the data? But for the most part, especially with the FHQCs and some of our sister agencies, we’re getting to the point where everyone sees it as a win-wing, and there’s enough of a consensus in order to move forward.

What might CIOs and CMIOs think about, around all this, especially around the potential for collaboration with government agencies like yours?

Ideally, we’d like for hospitals to partner with us and our managed care organizations in solving some of these issues in healthcare, including the cost of emergency department care, and so on. That would be the biggest thing. Right now, and this is not a secret, a couple of our hospital systems in the District are hoping to hold out for better contracts with our managed care organizations, and 80 percent of our beneficiaries are served by those MCOs. So we’d like to understand that we’re trying to help folks who need care, and not focus so much on the revenues involved. We’re over 96-percent insured now in the District. So there’s probably enough to go around, so we’d love for them to move forward with us collaboratively. And we have to ponder whether we should encourage the development and participation in ACOs, including among our FQHCs. Things have to be seen as helping our beneficiaries.

What does the future of data management for population health and care management, look like to you, in the next several years?

For us in the District, the future is going to be not only a robust warehouse that includes claims information, vital records information, and EHR data, but also, more connectivity with our community partners, and forming more of a robust referral network, so that if one agency sees someone who has a problem, say, with housing, they can immediately send the referral, seamlessly through the system, to get care. We’re looking at it as very inter-connected. You can develop a pretty good snapshot, based on a variety of sources.

The social determinants of health are clearly a big element in all this; and you’re already focused on those, obviously.

Yes, we are very focused on those; we’re just very limited in terms of our access to that data. We’re working with our human services and public health agencies, to improve access. And I should mention a big initiative within the Department of Health Care Finance: we have two health home programs, one for people with serious mental illness issues, the other with chronic conditions. The Department of Behavioral Health manages the first, and the Department of Health Care Finance, my agency, DC Medicaid, manages the second. You have to have three or more chronic conditions in order to qualify.

We have partnerships with 12 providers, in those, mostly FQHCs, a few community providers, and a couple of hospital systems. We’ve been using another module from HealthEC for those programs. We need to get permission to have external users to come in; but at that point, they’d be able to capture a lot of the social determinants as well. We feel we’re a bit closer to the providers, in that sense, since they work closely with the beneficiaries. And we’ve got a technical assistance grant to help them understand how to incorporate this kind of care management into their practice, to move into a value-based planning mode. That’s a big effort. We’re just now developing our performance measures on that, to see how we’ve been doing. It’s been live for about a year. It’s called MyHealth GPS, Guiding Patients to Services. And we’re using the HealthEC Care Manager Module, which we call the Care Coordination Navigation Program; it’s a case management system. Also, we do plan to expand that to incorporate medication therapy management. We have a pharmacist on board who will be using part of that care management module to manage his side of things.



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