Exact Sciences is setting its sights on large hospital systems across the country as part of an effort to get more doctors to order Cologuard, Exact’s stool-based DNA test for colorectal cancer screening, for their patients.
Madison, WI-based Exact (NASDAQ: EXAS) launched Cologuard in 2014 and as of last month, nearly 102,000 clinicians in the U.S. had ordered the test at least once. One way Exact plans to increase this figure—and, in turn, the number of patients who get screened for colorectal cancer—is by making it as simple as possible for healthcare providers to order Cologuard using electronic patient records systems. That’s according to analysts at Leerink Research, which recently hosted Exact executives at a conference in New York.
“Electronic ordering is essential for broader market penetration,” Leerink analysts Puneet Souda and Kai Wang said in a research note last week. Still, making more doctors aware of Cologuard will be key to boosting sales of the test, they said, meaning Exact is likely to continue existing sales and marketing initiatives alongside its electronic ordering push.
In the U.S., the majority of primary care physicians—the main group of doctors Exact seeks to educate about Cologuard—are employed by a set of 400 to 500 large hospital systems and medical practices, according to the Leerink note. Exact “is only penetrated in 50 of those currently,” Souda and Wang said.
Moreover, most of these large healthcare providers and practices have electronic health records (EHR) software installed at their hospitals and clinics, the analysts said. That’s important because according to the note, Exact has said that when doctors can order tests electronically—rather than by fax—the reorder rate for Cologuard tends to be about twice as high.
“One of the key headwinds that we have seen is physicians would rather order electronically,” Maneesh Arora, Exact’s chief operating officer, said last year. “It’s one of our key priorities for our organization to get more orders electronically.”
While only 1 percent of U.S. hospitals rely entirely on paper to manage their patients’ records, “the fax machine is still a major part of medical communication” today, according to a recent Vox report. And as CNBC reported earlier this month, some members of the Millennial generation didn’t know what a fax machine was before being required to use one as part of their medical training. Exact’s overtures toward large hospital systems seem to be aimed in part at getting more young, computer-savvy physicians to order Cologuard for patients.
One way Exact plans to get Cologuard on the radar of more clinicians at large hospital systems is by doubling its sales force focused on health systems, to 30 employees, this year, according to a research note by analysts at Robert W. Baird & Co. (That’s part of Exact’s larger goal to add a total of 200 salespeople company-wide in 2018.)
Exact might also be able to get more clinicians to start ordering the test by creating an “order set” that includes Cologuard, Souda and Wang of Leerink said in a previous note, from November. Order sets are groups of orders designed to save healthcare providers time when they’re dealing with common clinical scenarios. For example, an order set for a patient who has been admitted to the hospital with chest pain might include an electrocardiogram, blood panel, and other tests, as well as medications like aspirin.
Order sets can be pre-loaded and managed using EHR systems. The Leerink analysts said they spoke with chief information officers and IT directors at large hospital systems, and concluded that “the process to gain an order set for Cologuard remains fairly standard.” However, Souda and Wang said, the process can take several months, and building an order set around Cologuard doesn’t address a primary challenge facing Exact: increasing physician awareness of the test.
Cologuard has since 2016 been included in a group of quality measures for colorectal cancer screening, known as the Healthcare Effectiveness Data and Information Set. The hospital IT leaders Leerink interviewed saw this as “attractive and likely to help drive incentives and awareness for broader adoption.”