Individual, provider, clinic, and societal level barriers have been shown to undermine the potential impact of genetic testing. The current approach in the primary care setting places an exorbitant burden on both providers and patients. Current literature provides insight into how to address barriers across multiple levels (patient, provider, clinic, system) and at multiple stages in the testing process (identification, referral, counseling, and testing) but interventions have had limited success. After outlining the current approach to genetic testing in the primary care setting, including the barriers that prevent genetic testing uptake and the methods proposed to address these issues, we recommend integrating genetic testing into routine medical care through population-based testing. Success in efforts to increase the uptake of genetic testing will not occur without significant changes to the way genetic services are delivered. These changes will not be instantaneous but are critical in moving this field forward to realize the potential for cancer risk genetic assessment to reduce cancer burden.

Cancer is a significant burden, particularly to individuals of low socioeconomic status (SES). Genetic testing can provide information about an individual’s risk of developing cancer and guide future screening and preventative services. However, there are significant financial barriers, particularly for individuals of low SES. This study used the Early Detection of Genetic Risk (EDGE) Study’s patient baseline survey (n = 2329) to evaluate the relationship between socioeconomic status and interest in pursuing hereditary cancer genetic testing. Analysis was completed for two interest outcomes—overall interest in genetic testing and interest in genetic testing if the test were free or low cost. Many demographic and SES variables were predictors for interest in genetic testing, including education, income, and MacArthur Subjective Social Scale (SSS). After controlling for the healthcare system, age, and gender, having a higher education level and a higher household income were associated with greater general interest. Lower SSS was associated with greater interest in genetic testing if the test was free or low cost. If genetic testing is the future of preventative medicine, more work needs to be performed to make this option accessible to low-SES groups and to ensure that those services are used by the most underserved populations.

Cascade genetic testing, a highly effective method of identifying high penetrance cancer risk mutations in the family, is a promising method of prevention. Cascade testing is defined as directed genetic testing of at-risk relatives of individuals known to have actionable mutations However, it is tremendously underutilized in clinical practice, and the reasons are complex and diverse. We discuss these reasons and consider areas of research for key findings, strengths and weaknesses. We offer testable solutions for increasing interest and use of cascade testing opportunities in families and in clinical practice using colorectal cancer as an example. This area of clinical research has great potential to save lives by improving cancer prevention and early detection in families at high genetic risk, and should be actively pursued with resources and ideas.

Introduction: The Collaborative Care Model (CoCM) has a robust evidence base and is widely accepted as an effective strategy to treat common mental health disorders in primary care. With the growing adoption of the newer CoCM billing codes in healthcare systems, there has yet to be an in-depth analysis of the impact of the implementation of these codes. Aim: To examine the feasibility of implementing Collaborative Care billing codes and the impact on clinical and process-of-care outcomes as well as revenue. Setting: This study was done in a large, urban academic health system, in primary care clinics with established Collaborative Care programs. Comparisons were made between clinics that billed psychotherapy codes (N=4) and clinics that billed CoCM billing codes (N=4). Program Description: This quality improvement study was designed to evaluate the implementation of the new CoCM billing codes by comparing clinics using different billing strategies. Program Evaluation: We employed a retrospective observational study design, examining data before and after the CoCM billing implementation. Primary outcomes for this study were the amount of services delivered and the estimated revenue generated. Additionally, we examined the amount and type of activities billed under CoCM. Qualitative data was obtained through clinician interviews to understand their perspective of this type of large-scale billing implementation.Discussion: The results of this study demonstrate that implementation of the CoCM billing codes is operationally feasible, and there was no significant difference in the amount of services or revenue generated. These preliminary findings indicate that adopting new billing codes did not have an adverse impact on the delivery of patient care or revenue, though further evaluations are needed to understand the longer-term impact of CoCM billing on clinic operations and reimbursement.