Sanford Health Optimizes Colorectal Cancer Screening with "Human-in-the-Loop" AI

• Established a system-wide Steering Committee with operational, clinical, and administrative leadership representation

• Initiated an enterprise-wide communication and socialization campaign

• Developed methodology for the AI-powered CRC risk score beyond traditional risk factors

• Continuously refined CRC risk score methodology with feedback from clinical leaders before deployment

• Deployed AI-powered CRC risk score at the enterprise level with ongoing refinement based on PC feedback

• Mailed letters and SBT kits to average-risk patients in batches that were never screened, overdue for screening, and/or on the colonoscopy wait list

• Developed a dashboard tracking key process metrics, e.g., return rates, positivity rates

• Manually tracked key clinical outcome data, e.g., precancerous polyps, number of cancer diagnoses

• Continue mailing campaign in waves on an annual basis, with bulk of outreach from March to June and a campaign in the Fall

• Automate previously resource-intensive, manual functions to facilitate scalability and incorporate expanded patient populations

Key Facilitators of Success:

✔️Data-driven case for change

✔️GI-led PC education

✔️CMO-led socialization and buy-in campaign

✔️External partner support.

Key Facilitators of Success:

✔️Data-driven & transparent PC engagement

✔️Steering Committee representation

✔️Centralized workflows and staffing

✔️Opt-out distribution model

✔️SDOH burden mitigation

Key Facilitators of Success:

✔️Continuous EDA collaboration

✔️Outreach aligned with GI capacity

✔️Payer collaboration

1. Pre-Campaign Launch

To build a strong foundation and garner buy-in from physician leaders prior to launch:

• Data-Driven Case for Change: Anchor the “why” in priorities familiar to key stakeholders, defining how the status quo approach is untenable with closing the gap on enterprise population health goals

• CMO-Led Socialization & Buy-In Campaign: Continuous, direct communication from senior executive to explain the “why” behind novel population health model; project team initiates feedback loop to build confidence in validity of AI-powered CRC risk score, tapping into existing governance bodies (e.g., service line physician councils)

• GI-Led PC Education: Address lack of PC familiarity & comfortability with SBT screening modality through GI-led “Grand Rounds” with PC clinics, building trust and enhancing best practices adherence

• External Partner Support: Consult screening kit partners who have experience with similar deployments to learn from other organizations, access existing resources, and ultimately reduce ramp-up time (e.g., workflows or templates, risk score filters)

2. Initial Launch

To sustain key stakeholders’ trust and strengthen proof-of-concept:

• Steering Committee Representation: Ensure diverse expertise from administrative and physician leaders on the Committee to inform post-launch decision points, especially when new scenarios arise

• Data-Driven & Transparent PC Engagement: Sustain trust using dashboard and clinical outcomes data; vet decision-making around workflow changes in PCPs’ on-the-ground knowledge & patient interactions

• Centralized Workflows & Staffing: Centralized model reduces variation and ensures scalable compliance when compared to a clinic-by-clinic approach; dedicated staff develop program-specific expertise

• Opt-Out Distribution Model: Rather than asking patients to opt in, project team sends communications and kits to eligible patients unless they specifically opt out, increasing return rates.

• SDOH Burden Mitigation: Address transportation or financial barriers by leveraging health system (e.g., referral distance calculator tool schedules colonoscopies based on patient distance and choice) and screening kit partner resources (e.g., Exact Sciences/Abbott partnership with UPS to pick up completed SBT kits).

3. Scaling & Sustainment

To disseminate lessons learned and ensure continuous quality improvement:

• Continuous Sanford EDA Collaboration: Once proof-of-concept is in place, facilitate scaling by automating previously manual or resource-intensive processes (e.g., tracking clinical outcomes) and applying project logic to expanded patient populations.

• Outreach Aligned with GI Capacity: Ongoing partnership with local GI teams to safeguard program sustainability; SBT outreach volumes are determined relative to GI teams’ maximum capacity to conduct follow-up colonoscopies.

• Payer Collaboration: Demonstrate value by applying proof-of-concept to payers’ member rolls, increasing resource efficiency for payers and reducing patient confusion over duplicative outreach for SBT screening.