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Independence helps to get more at-risk members screened for liver cancer

Liver cancer rates are set to rise globally by 55 percent in the next two decades, according to the World Health Organization. While anyone can get liver cancer, it tends to occur more often in people with certain underlying health conditions, such as chronic infection with hepatitis B virus or cirrhosis of the liver. Knowing this, Independence Blue Cross (Independence) worked on a new approach – adapted from work it helped fund at Penn Medicine – to identify individuals who are at a higher risk for liver cancer. The approach is already yielding great results. In just one year, the number of members being screened for liver cancer across Independence’s network has increased by 110%.

Importance of surveillance

Understanding your risk and being monitored regularly is important. Regular screening can help identify new cancers at an earlier and more treatable stage.

“Increasing awareness of screenings that are available for certain diseases and chronic conditions, as well as improving access to care, is a constant priority for our team,” said Dr. Ellen Riccobene, senior medical director at Independence Blue Cross. “Surveillance is especially important for those at risk for liver cancer because there aren’t a lot of signs or symptoms when it’s at an early stage. The American Association for the Study of Liver Disease and the National Comprehensive Cancer Network recommend that certain high-risk individuals get an abdominal ultrasound and alpha fetoprotein (AFP) surveillance every six months.”

Independence developed a Hepatoma Screening Report to help make sure members who are at risk for liver cancer are getting monitored with ultrasound screenings every 6 months, as recommended. The report uses an algorithm that identifies these patients. In 2022, the report was distributed to primary care doctors and gastroenterologists in the Independence network, who are likely to see this type of at-risk patient. Population Health Specialists from Independence are also working with these doctors to make sure they have what they need to reach out to the patients identified and to help get their screenings scheduled.

The Hepatoma Screening Report was adapted from the LiveAware digital platform created at Penn Medicine. The algorithm and platform were designed by Penn researchers to increase imaging-based screening rates, with the pilot use case being patients at risk for hepatocellular carcinoma (the most common type of primary liver cancer). With this work as guidance, Independence was able to configure the system to its beneficiaries.

“One of the main reasons there are low screening rates for liver cancer is that patients at risk for hepatocellular carcinoma are challenging to identify,” said Tessa Cook, MD, PhD, an associate professor of Radiology at Penn Medicine. “Independence’s Clinical Care Innovation Grant in 2021 helped advance our work toward technology that reduces the load on doctors by helping to determine who is eligible for screening, streamline ordering, and support patients in following through on their screenings.”

Positive results

The investment and time Independence and its network of doctors committed to this effort is already paying off after just one year.

In 2022, before the Hepatoma Screening Report was in place, 3,750 Independence members were found to be at risk for liver cancer. Of those members, only 372 (10%) had an ultrasound done within the recommended six months and 3,378 (90%) of members did not. In 2023, after the report was in place, 4,240 members were found to be at risk for liver cancer. Of those members, 904 (21%) had an ultrasound done within the recommended six months and 3,336 (79%) did not. That’s a 110% percent increase in compliance since the program started in 2022.

“We’re extremely proud of the results we’re seeing, which align perfectly with Independence’s overarching mission to enhance the well-being and health of the communities we serve,” said Dr. Riccobene. “We continue to learn more along the way about why certain patients keep up with their surveillance while others do not and what obstacles members who do not receive screening may be experiencing.”

The work doesn’t stop here

“We’re not stopping here,” said Dr. Riccobene. “The Population Health Specialists are dialing up their outreach to build upon the success we’re seeing. Moving forward we’re going to be exploring a two-prong approach that includes reaching out to both doctors and members. We will also be evaluating liver cancer surveillance with a health equity lens.”


Media contact:
Diana Quattrone