Pilot plan offers test screenings for cancer
Harvard Pilgrim, Tufts Health parent evaluating benefit
Susan Downard’s father died of lung cancer; one of her grandfathers was also diagnosed with the disease. Then, about 12 years ago, doctors found a node on one of Downard’s lungs. It wasn’t cancerous, but given her family history, she was concerned.
“You have that in your head forever,” she said.
Downard, 53, director of clinical pharmacy at Point32Health, the parent company of Tufts Health Plan and Harvard Pilgrim Health Care, wanted to know more. And, after participating in Point32Health’s pilot program for a DNA test that can detect more than 50 types of cancers, she does.
The results of the blood test she took in March showed no indications of cancer.
After testing about 460 of its own employees this year, Point32Health, based in Canton, is rolling out the second phase of the pilot program to a small group of members in December. If it’s determined to be a success, the insurance provider will evaluate expanding the program further. Point32Health, whose plan covers 2.2 million people, is the first commercial insurance provider to start offering the test, developed by the California cancer-detection company Grail.
The test, called Galleri, examines the DNA in patients’ blood to detect abnormalities that can indicate the presence of cancer before any symptoms develop, said Point32Health chief medical officer Michael Sherman. The cells that shed this DNA have unique sequences, called methylation patterns, that can indicate where in the body they come from, revealing whether the cancer was detected in the pancreas, prostate, liver, or elsewhere. If the test comes back positive, patients can get follow-up tests with their doctors, whether it’s an MRI, CAT scan, or additional blood work, to confirm whether they have cancer.
Sherman, who has a family history of prostate cancer on his father’s side and gastric cancer on his mother’s, recently took the blood test and was relieved it came back negative.
“We think this is a huge opportunity,” he said.
Currently, only five types of cancers
are regularly screened for in the United States: prostate, colon, breast, cervical, and, in highrisk patients, lung. Grail’s blood test, which has been designated as a “breakthrough device” by the Food and Drug Administration, allowing doctors to prescribe it, is still awaiting final FDA approval. The recommended retail price is $949; the cost for Point32Health employers, and their employees, has not been determined.
Earlier this year, Point32Health, which employs 4,300 people, started offering the test free of charge to employees age 40 and over with a family history of cancer.
In a study conducted by Grail in adults over 50, cancer was detected in about 1 percent of those screened, and 71 percent of those with confirmed cancer had one of the 45 types with no routine screening available.
Several other companies are developing cancer-screening DNA tests, said Grail chief medical officer Jeffrey Venstrom, but Grail is the only multi-cancer early detection test on the market. About 52,000 people have been prescribed the test in the United States since it was launched in the spring of 2021.
Point32Health isn’t collecting data from the test results, which are being analyzed by Grail, but is offering pre- and post-test counseling to those who take it. Employees receive their results in the mail within a few weeks and can have them shared directly with their doctor as well.
While the screening doesn’t provide a cancer diagnosis, it provides the opportunity to pursue further testing far earlier than someone otherwise might based on irregularities detected in the bloodstream, noted Peter Church, chief people officer at Point32Health.
“It’s a pretty heavy thing,” he said. “You’re getting a window into things you might not ordinarily see.”
But given the events of the past few years, he said, from the #MeToo movement to the pandemic to the racial reckoning sparked by the murder of George Floyd, employers have a greater responsibility for their workers’ mental health and well-being than ever.
“You need to take care of your people,” he said.
More companies have been providing innovative health benefits in recent years, said Robin Antonellis, executive director of the New England Employee Benefits Council. Cancer care is of particular interest, she said, noting a panel her organization held earlier this year focused on benefits such as nurse navigators to help employees handle a cancer diagnosis, second opinions via telehealth, and free flights for far-flung cancer treatments.
Downard, Point32Health’s clinical pharmacy director, had actually started putting money in her tax-free flexible spending account to purchase the Grail test on her own before her employer announced the pilot program. She admits she had some doubts about what she would do if she got a positive result: “You have to think about, ‘Do I really want to do this?’” But she decided that contributing to “the greater good” outweighed those concerns, especially considering there are so many people who, like her father, wait until they’re sick to seek medical care.
Prior to getting sick, Downard’s father had given blood every eight weeks due to a blood disorder, she said — and he likely would have gotten an early-detection DNA test if it had been available. He lived for 15 years after he was diagnosed, she said, and it was a struggle: He had a lung removed, suffered from chronic pain following chemotherapy, and needed supplemental oxygen.
“After seeing what my dad went through, to know that one day you can just go in and get tested for cancer by having a blood draw, and find out really early that you have something that could be treatable, that’s exciting,” she said.
Christopher DeCaro, senior manager of member service training for Point32Health call centers, also has cancer in his family. His mother had ocular melanoma when he was young, and DeCaro has had basal cell carcinoma.
He decided to take the test and was relieved when his results came back negative.
“I slept a little easier after that,” he said.
“It does give you some peace of mind.”
‘It’s a pretty heavy thing. You’re getting a window into things you might not ordinarily see.’ PETER CHURCH, chief people officer at Point32Health