Health system Jefferson Health is deeply committed to doing the right thing for the health of its employees. And the health system knows that precision medicine, based on a personal risk analysis thanks to genomics, can help individuals predict risk, but also can help physicians develop the right care plans.
“We knew we had to offer that to the 32,000 people who work with us,” said Dr. Stephen K. Klasko, CEO of Jefferson Health and president of Thomas Jefferson University.
In addition, the health system hosts an NCI-designated cancer center – the Sidney Kimmel Cancer Center at Jefferson. Sidney Kimmel has been a leader in cancer genomics and in genetic counseling to diagnose and predict outcomes. Most recently, Sidney Kimmel created a genomic screening center for men.
“That counseling is critical: Once the results come in, we had to provide immediate help to employees who would ask, ‘What does this mean?’“ Klasko said.
That is where Color came in. Color is a vendor of genomics, precision medicine and population health technologies.
“Color is able to integrate its own counselors with the genetic counselors we have at our cancer center to ensure when an employee gets a result that shows an increased risk for cancer or heart disease, they have the resources and information to take action with their physician,” Klasko explained. “Color also is able to meet another Jefferson priority: We wanted a system that protected our employees – blinded to us as employers.”
In fact, Jefferson Health elected not to make data from its employees available for clinical research without additional steps to gain consent and privacy. Research was not the first priority. The priority was helping the employees, and Klasko believes that is why the health system has had rapid adoption.
“That’s where the real opportunity is to cut costs in healthcare: Identifying risks and using that information to influence behaviors that lead to better health.”
Dr. Stephen K. Klasko, Jefferson Health and Thomas Jefferson University
“What we were looking for was a solution that offered a fully integrated, convenient and cost-effective approach to helping our employees engage, access and learn about inherited risk for conditions such as cancer and heart disease and how to take action,” he said. “It wasn’t enough to simply offer a genetic test. We needed an end-to-end solution with engagement, ongoing relationships, education materials, digital infrastructure and genetic counseling support.”
For example, Jefferson Health knew employees are walking around with genetic mutations such as BRCA1 that significantly increase their risk for cancer. But they haven’t had the tools available to understand that risk and develop a preventive action plan with their physician.
“That was unacceptable to my team and me, as it should be to any institution responsible for the healthcare of a large population,” Klasko insisted.
Most important, Jefferson Health was not looking for a “vendor,” per se, he added.
“We wanted to be partners in developing precision medicine for our employees,” he explained. “Color was willing to work with Jefferson and our cancer center to develop the offer to our employees, and to follow up. The biggest takeaway for any digital health firm interested in working with an academic medical center is to think about how you can be a partner, not a vendor.”
Jefferson Health and Color started working together in October 2018, when the health system announced it would provide access to Color’s genomics services to all 32,000 employees for free.
“We chose Color because the technology is easy for employees to access, provides useful information to patients and physicians, includes access to board-certified genetic counselors and – most important – links results and counseling to each employee’s healthcare provider, meaning they can take real action,” Klasko said.
Employees responded to the service more than the health system expected. More than 4,000 employees signed up to use the service in the first week alone. Today, more than 10,000 Jefferson Health employees are using Color.
MEETING THE CHALLENGE
For Jefferson Health, the most important part of this precision medicine work is its ability to help employees use their genetic information in ways that meaningfully improve their health – whether or not they test positive for a specific mutation.
“We’re one of the first to approach genomics this way – not as a one-off test, but as a source of valuable information that can influence the course of care, regardless of the results,” Klasko contended. “We believe this approach is crucial to leverage the power of population genomics at scale. We’re in a unique position to pioneer a genomics program. For one, we are one of the largest employers in the Philadelphia area. We also provide care to the majority of these employees.”
This means Jefferson Health can not only use Color to integrate genomics with overall health, but also use it to improve employee engagement, he added. For example, the health system is using the platform to check in with employees after the initial test for follow-up with preventive screenings such as mammograms.
“That’s where the real opportunity is to cut costs in healthcare: Identifying risks and using that information to influence behaviors that lead to better health,” Klasko said.
Jefferson Health believes the employee response to the program indicates a major success.
“We expected 20% of employees to opt in over nine months,” Klasko said. “Instead, we reached more than 30% within the first year. And we’ve seen the highest uptake among families who have tested positive for known genetic markers.”
Employees already are seeing the benefit of participating in Color, he added.
“Multiple people, already, can share how it changed their clinical care and potentially saved their lives,” he contended. “We expect to find more stories down the road. Due to privacy concerns, we can’t share specific numbers, but we’ve identified more employees with hereditary conditions or metabolic abnormalities than expected.”
Further, almost 90% of people who have used the program have completed the full risk assessment, which includes mapping their health history to genomics information, adding rich, actionable data to their medical records, he said.
ADVICE FOR OTHERS
“A genomics program like our partnership with Color offers valuable insight into individual and population health, tools for creative ongoing engagement and the potential for significant cost savings through preventive action,” Klasko said. “But for these programs to work, they must be easy for individuals to understand, frictionless for clinicians to use, and clinically valid.”
Providers must be absolutely confident that the genomics information they receive is high-quality enough to use to make medical decisions, he advised. The technology also must be integrated across the health system, and data and security must be part of the core business, he said.
“Finally, the partner must do more than make a one-off test, or a widget that attaches to the overall system,” he cautioned. “It must be motivated to solve the ‘last mile’ problem in genomics and be driven to connect and integrate genomics information to clinical care and outcomes.”