ACCC launched its Precision Medicine Stewardship Program to highlight institutions that have successfully built the infrastructure, workflows, and leadership models needed to deliver precision medicine at scale. TriHealth Cancer and Blood Institute in Cincinnati, Ohio, offers a compelling example of what it takes to move from aspiration to execution.
Precision medicine—tailoring therapies to an individual’s specific genetic and molecular markers—is no longer an emerging concept in oncology. Yet as precision medicine increasingly becomes a standard of care in oncology, many cancer programs across the United States still struggle to operationalize it consistently and equitably.
Disparities persist for underserved populations, often due to financial, geographic, socioeconomic, and systemic barriers, and the result is a persistent gap between what is clinically possible and what patients actually receive.
To help close this gap, the Association of Cancer Care Centers (ACCC) launched its Precision Medicine Stewardship Program highlighting institutions that have successfully built the infrastructure, workflows, and leadership models needed to deliver precision medicine at scale. TriHealth Cancer and Blood Institute in Cincinnati, Ohio, offers a compelling example of what it takes to move from aspiration to execution.
From Small Workgroup to Systemwide Infrastructure
James F. Maher, MD, PhD, medical oncologist and hematologist at TriHealth, has spent more than a decade building and scaling the organization’s precision medicine capabilities. What began as a small genomic workgroup of three clinicians has evolved into a fully integrated, system-wide precision medicine program spanning oncology, cardiology, neurology, and perinatal care.
“Our Precision Medicine Institute covers every specialty, not just cancer,” Dr. Maher said.
Today, the program includes physicians, genetic counselors, data analysts, laboratory staff, and information system specialists—all working within coordinated workflows that embed genomics directly into care delivery.
This evolution reflects a key insight: these programs are most effective when they function as a system of tightly integrated processes and teams.
At TriHealth, success has depended on building the operational infrastructure needed to deliver genomic insights at the point of care. One of the most critical investments was the integration of genomic data directly into the electronic health record (EHR). Through partnerships with specialty labs—in TriHealth’s first case, Tempus—and a fully integrated Epic workflow, clinicians can access genomic results in real time without relying on static reports or manual workarounds. Additional labs have since been integrated with similar outcomes and benefits.
This level of integration enables faster, more informed treatment decisions and reduces delays that can compromise outcomes. At TriHealth, full biomarker results are usually available within 10 days and germline testing within a week.
As Dr. Maher noted, the reality for clinicians without this infrastructure can be overwhelming. “You want me to see 25 patients every day…and I’m juggling pieces of paper trying to make sure…I need help.”
TriHealth also redesigned key workflows across the care continuum, including:
These changes translated into measurable improvements. The organization reduced failed sample rates from double digits to approximately 5%, while bringing turnaround times for results down to about one to two weeks. Care gaps—such as eligible patients who had not yet received biomarker testing—can now be identified and addressed within weeks.
For Dr. Maher, these metrics are essential. “There’s a two- to four-week window…if you don’t get started on these patients, you’re affecting mortality,” Dr. Maher said. “You have to be able to see it in the data and make changes in real time.”
While many organizations still frame precision medicine as an innovation, Dr. Maher already sees it as an expectation. In diseases such as lung cancer, comprehensive biomarker testing is foundational to treatment selection. Without it, patients may not receive the therapies most likely to benefit them. Dr. Maher regards omitting biomarker testing in lung cancer as a deviation from the standard of care with direct consequences for patient outcomes.
This urgency shapes TriHealth’s approach. Precision medicine is treated not as an optional enhancement, but as core clinical infrastructure with workflows, staffing, and accountability aligned accordingly.
Although Dr. Maher emphasizes clinical necessity, TriHealth has also demonstrated a strong business case. Program analyses revealed that each genetic counselor generates approximately $250,000 to $400,000 annually in downstream revenue through testing, surveillance, and preventative care. This is consistent with published data showing about $457,000/year at one institution.
“You actually save money by having a proper precision medicine program,” Dr. Maher said.
Importantly, Dr. Maher notes that health systems often underestimate this impact by attributing downstream procedures, such as preventative surgeries, to individual departments, rather than recognizing the upstream role of precision medicine in identifying at-risk patients.
Beyond direct revenue, improved workflows reduce inefficiencies, shorten time to treatment, and expand access to targeted therapies.
TriHealth’s experience highlights several essential elements for institutions seeking to build or expand precision medicine programs:
Successful programs require both physician and administrative champions, as well as strong collaboration with information systems leaders.
“You have to have a champion,” Dr. Maher said. “This is typically a physician working alongside an administrative counterpart.” That champion's role, he emphasized, is to bring solutions, not just surface problems. "Most doctors complain about something but don't come up with an answer.”
Embedding genomic data into the EHR is foundational. Without this, clinicians are left navigating fragmented information, increasing the risk of delays and missed opportunities.
Precision medicine depends on coordination across specialties, from pathology and radiology to genetics and oncology. Clearly defined workflows ensure that testing is performed consistently and results are acted upon efficiently.
Turnaround time, sample adequacy, and care gap closure are critical indicators of program effectiveness. Data-driven insights enable continuous improvement.
Even as clinicians recognize the importance of genomics, many need support in applying it effectively.
“Every medical oncologist…said genomics and genetic testing is very important, but only 31% understand what that means and how to use it,” Dr. Maher explained. Ongoing education—and the use of real patient stories—can help build understanding and organizational buy-in.
Dr. Maher and his team are also actively engaged in an ongoing process review that identifies strengths and areas for improvement, reflecting their commitment to continuous quality improvement for program success.
TriHealth’s next phase of growth reflects a broader shift in precision medicine—from treating disease to preventive care.
In May 2025, TriHealth’s Precision Medicine Group partnered with Helix Genomics to launch a population genomics initiative with the goal of enrolling 100,000 patients in Southwest Ohio over the next 5 years and delivering clear Tier 1 recommendations for screening for the reported 11 genes. As part of the study. Participants receive free whole exome sequencing, with results integrated into their medical records for lifelong use.
“All 20,000 genes [from whole exome sequencing] now live within that person's medical record,” Dr. Maher explained. This approach enables identification of genetic risk factors, more precise screening, and may potentially tailor therapies across multiple conditions—not just cancer.
For Dr. Maher, the trajectory is clear: Precision medicine will increasingly underpin all areas of care, with genomics informing decisions long before disease develops.
TriHealth’s experience demonstrates that building a successful precision medicine program requires more than adopting new technologies. It demands sustained investment in infrastructure, workflows, and culture.
To learn more about ACCC's Precision Medicine Stewardship, visit the Precision Medicine Stewardship Program page.
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