At the Association of Community Cancer Centers (ACCC) Annual Meeting and Cancer Center Business Summit (March 20-22, 2019; Washington, DC), Journal of Clinical Pathways spoke with Clynt Taylor, CEO, Intervention Insights, about a new platform designed to cater to the needs of providers, molecular labs, and payers in the testing and ordering of appropriate targeted therapies for patients with cancer.
Can you explain some of the unique challenges that the widespread adoption of precision medicine poses?
The challenges come from different perspectives because if you are an oncologist, then you have to grapple with the amount of new information coming out. Imagine you are an oncologist and it has been a while since you were at ASCO, where you walked up and down the aisles of posters with all this new information. Now, you are in your practice seeing patients at 4:15 in the afternoon, it’s the 15th patient you have seen today, and you have to remember the information you saw as well as the myriad of articles you have read since then, and then apply it all and you have just a few minutes with the patient. This is just a glimpse of the magnitude of the challenge that faces oncologists.
On the other hand, payers are grappling with the question of what to pay for. What tests, genetic responses, or therapies should they reimburse for, based on the information that is current, relevant, and approved.
Furthermore, as a lab, you are faced with the pressure of competing with the next lab. How do you win the mind-share of the oncologist who is going to make a decision to order a test today, and make sure that they do not forget you tomorrow or the next day?
Finally, the research or pharma perspective cannot be lost here. Are practices missing opportunities to identify and place patients on appropriate clinical trials?
All of these perspectives combined create a large picture of the complexities in the scalable use of precision medicine. These complexities are what we set out to tackle at Intervention Insights. When I joined the team, we had this knowledge base that had been developed over the past few years of therapies, genes, diseases, and other important aspects of care. We realized a single platform that caters to labs, prior authorization systems, and clinicians alike and is a collection of all the latest available clinical evidence could really benefit the system and cut out some major inefficiencies. We call this platform Trapelo, and it resolves the complexities of precision medicine and aligns the interests of oncologists, labs, and payers at the point of care.
On the surface, Trapelo is a molecular test selection and results-reporting solution that standardizes cancer treatment selection based on the latest clinical evidence and with payer preferences upfront. Trapelo obviates traditional prior authorization and speeds the delivery of the most appropriate cancer care for patients, including the latest clinical trials.
Underneath, Trapelo is a shared knowledge-base that give labs, payers and oncologists unprecedented insights into the business of cancer and optimal patient care. But Trapelo is not just another digital health solution; driving Trapelo’s knowledge-base is a team of PhDs who curate and rank evidence on a daily basis. For oncologists using Trapelo, this means they have real intelligence when they need it – often ahead of slower, standard guideline reporting systems.
Are there varying products within the platform for different types of users?
There is, in that sense that what each stakeholder needs to satisfy for themselves is different. The provider needs to know what to test for, which labs to build or maintain a relationship with, the products that these labs offer that captures and includes what they need to test for, and how to make sure that they obtain the right products for every patient. The payer needs to be ensured that they are only paying for tests that drive results or provide meaningful outcomes. The providers and payers have different needs. Our product is called Trapelo for either stakeholder, but there are different dashboards and functionality for each.
What are some of the distinguishing factors of Trapelo?
What we have managed to do with Trapelo is design a product that providers and labs both want to use. Furthermore, payers preferences are integrated through a fast path and transparent option that eliminates traditional prior authorization. These characteristics set Trapelo apart. Most of our competitors sell to labs, doctors, or payers exclusively.
Additionally, many companies in our space today like to talk about artificial intelligence and machine learning. What oncologists have found is that the technology today is not quite ready and adaptable for 100% artificial intelligence use. We use artificial intelligence to sift through the seemingly limitless amounts of data and published literature, and then the resulting information is curated through our team of scientists. Our scientists say, “Here is what the research article that artificial intelligence flagged is really saying, here are some of the nuances to that, and here is how it should be put into a database or a knowledge base,” which we then curate and maintain.
This shared process of artificial intelligence and man brain-power gives us and our users confidence that not only is the appropriate research being identified, but it is also being double-checked for relevance by informed human beings. There have been instances in our industry today where relying entirely on artificial intelligence has sometimes let doctors down. When this happens, trust in the product is eroded. There is no question that clinicians, labs, and payers that we speak to like the fact that we have experts in the field of each disease who know the science behind the recent research and they review the artificial intelligence selections real time. They like that rich and deliberate oversight.
Can you provide a brief explanation of how Trapelo works?
Based on a few simple questions, Trapelo provides a list of routine, actionable markers that should be tested for that patient and support an evidence-backed treatment option. Trapelo then provides the payer-recommended labs within the patient’s network, the appropriate tests from the selected lab that account for all markers selected, and any recommended additional tests. Trapelo gives doctors the ability to customize orders as well. Finally, after doctor authorization and a final administrative step, Trapelo then processes the order.
Once the lab report comes back, actionable results are presented in a dynamic dashboard environment. The results are normalized from multiple labs and are stratified to provide the number of therapies recommended for the disease (including level of evidence to support use of each therapy and references to support this evidence), available clinical trials, and trials that are within the provider’s network. The original lab report is still available in a downloadable form.
Is the provider-facing platform compatible with electronic medical records (EMRs)?
Trapelo is very complimentary to EMRs, and we have designed a solution to be accessed from inside an EMR. We are currently interfacing with multiple, large EMR companies. We are finding that EMRs already have a lab ordering system, but we come alongside that system and rather than require the information to be entered in accordingly, we basically say, “Go through these steps. We will tell you what to do and then drop it into the EMR at that point.”
Trapelo’s innovation team was charged with creating the simplest, most-intuitive test ordering experience for oncologists. In just five questions, providers know the markers to test. From there, they move right to ordering, where they see the preferred labs and recommended tests as well as other options. Using Trapelo is fast and precise. The EMR integration allows their administrative team to complete and submit the order. This allows oncologists to focus their time on patients.
What has been some of the feedback from the users?
We are still very early in the implementation of Trapelo; however, the responses we have received thus far have been very positive. When we have a payer or a provider who sees what we are doing with Trapelo, we have not had anyone yet who has said, “I do not think there is a need for obviating the need for prior authorization in precision medicine.” One-hundred percent of everybody says, “This needs to happen. This is a problem.” It does not matter whether you talk to the payer or the provider. They recognize that it is not scalable.
In fact, we have a list of business drivers that we often discuss when demonstrating the value of Trapelo to providers. These include problems that oncologists in most practices are facing, such as not knowing what tests to order or which labs to order from. We discuss inconsistencies in use of precision medicine among doctors within a practice. Some doctors order from one lab, some do not order at all, and some order for a lot of their patients. This inconsistency makes it difficult for a practice to establish and maintain practice-wide value-based care and quality standards. We usually get through about the first three or four of these business drivers before the practice says, “We have all these challenges.”
Our approach is very holistic. It takes into account the fact that if we were only trying to advise the doctors on making a better treatment decision while leaving out the payers, then at the end of this process when the doctors are ready to order a treatment, they would have to go through the process again and explain to the payer what tests they ordered, why they ordered it, what the result was, and how they got to that decision.
Are there any other concluding points you wanted to make about Trapelo?
We are very passionate about making it easier for oncologists to know what to test for and which patients to test so that they do not have to wait for a prior authorization. We believe that labs should not have to go through prior authorization barriers. Labs want to partner with us because we provide a service that takes that off their plate.
Payers are interested in our model because not only does Trapelo bring representation of their policies and preferences much earlier in the decision-making process, but we also give them access to data that they never before had. For example, patient outcomes can be optimized and expenses better managed when therapies are selected on the basis of appropriate testing and testing results, both of which are not currently visible to the payer without a platform like Trapelo.
Payers are often limited to information in claims data, which only shows the testing methodology and not the specific markers or results. This makes the subsequent choice of chemotherapy vs targeted therapy vs chemoimmunotherapy impossible to adjudicate without traditional prior authorization – which is still a manual process.
Other important issues with traditional prior authorization for molecular testing are that it disrupts the clinical workflow of a practice and can unnecessarily slow care delivery. The prior authorization process for testing is not always connected to the prior authorization process for treatment (in fact they are often performed by different vendors), which impacts the ability to ensure that the right tests were authorized based on appropriate treatments available. Trapelo offers an entirely new way to manage and streamline prior authorization by providing insights that take payer policy into consideration upfront.
So ultimately, the biggest winner in all of this is the patient. The average time it takes from when a doctor decides to do molecular testing for a patient who has failed first-line therapy to when the doctor is ready to order the appropriate drug can be as much as 4 weeks or longer, including the period in the middle when lab work is being processed. With Trapelo, the administrative time for the whole process decreases to mere minutes.
Everybody in our ecosystem agrees this is what we should be doing in health care. How do we eliminate waste, lost time, and unnecessary delays all while meeting what all of the stakeholders want: accountability, transparency, efficiency, and appropriate use of molecular testing to arrive at appropriate, targeted therapies for patients? Trapelo is the answer.