State and Local Public Health Departments Can Play Key Roles in Addressing Tier 1 Genomic Applications

Getting Started

Because of their unique ability to partner, facilitate, and provide leadership across the health sector, public health departments have important roles in implementing Tier 1 genomic applications. Model state genomics programs have identified important first steps for states beginning Tier 1 programs to consider.

Identify existing priorities and activities in your state:

Review your state comprehensive cancer control plan (CCP) and heart disease and stroke plan to identify objectives related to Tier 1 applications.

For example, the Michigan comprehensive cancer control plan (2009-2015) [PDF 1.69 MB] includes an objective to “expand public knowledge about the impact of genetics on cancer risk and management (breast, ovarian, and colorectal cancers)”.
The Idaho heart disease and stroke state plan (2009-2013) [PDF 7.21 MB] includes objectives promoting “evidence-based screening for heart disease and stroke risk factors”, which might serve as a point of entry for discussions around addressing FH.

If your state plans do not have objectives related to Tier 1 applications, consider examples from other states, and network with potential partners to identify the needs in your state.

Review the CDC clickable map of state genomics activities to identify existing Tier 1 activities and resources in your state.

Review the successful examples provided in this toolkit and choose an objective/project that best meets your state’s needs. Building strong relationships with partners with similar goals is one of the most important ingredients for success.

Consider contacting your state or local cancer registry to see if existing data can be used for cancer genomics surveillance and education to promote the Healthy People 2020 cancer genomics objectives. Other states have used this approach to identify thousands of cases of cancer that could benefit from genetic evaluation. For many states starting on Tier 1 and able to focus only on one cancer project, bi-directional reporting is well worth considering.

Consider working with health plans and health care providers in your state to develop evidence-based policies that promote the Healthy People 2020 cancer genomics objectives. For example, Michigan has found that coverage can be extended to millions through partnerships with payers.

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Phase 1

Phase 1 approaches generally address identifying individuals (index cases) who could benefit from Tier 1 genomic applications. With a relatively few resources, state, district and territorial public health departments can take evidence-based actions to begin saving lives now. A few “pioneer” states have already implemented these important steps and others can learn from their work. Phase 1 approaches, include: (1) “bi-directional” cancer registry reporting with partner provider systems for case finding or other purposes; (2) informing policy making, such as evidence-based coverage by payers for services specified by Tier 1 recommendations; (3) developing and tracking surveillance indicators to follow progress in achieving widespread implementation of Tier 1 recommendations and /or the Healthy People 2020 objective (if available); and (4) designing and implementing educational outreach programs targeting the general public and health professionals with interest in Tier 1 applications.

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Phase 2

In Phase 2, states with mechanisms in place to identify index cases, such as those described in Phase 1, develop approaches to identify the at-risk family members of index cases who can benefit from evidence-based preventive strategies through cascade screening. While the challenges and opportunities differ by state, success in any of these efforts requires establishing partnerships among public health, healthcare providers and payers within each state.

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