RadNet executives will spend the next 18 months learning what does and doesn't work for operating small in-store retail breast cancer screening clinics in three areas of the U.S.
In early December 2023, the first of RadNet's three pilot MammogramNow clinics opened in a Walmart Supercenter in Milford, DE. Two more screening clinics are planned to open in 2024 in Walmart: one in Phoenix, AZ, the other in Hanford, CA, according to the company.
Tim Merchant, national director of screening networks and population health strategy for RadNet, said the Delaware location expands RadNet's statewide breast cancer screening network farther south in Delaware and adds an AI-enabled retail screening-only clinic to the multisite Delaware Imaging Network.
In-store screening clinics
The three Walmart Supercenter-based breast cancer screening pilot programs were planned in three types of markets, Merchant explained. Milford is a small town of about 11,500 people, according to its website. Hanford has a population of about 70,000, Phoenix about 1.65 million.
"In Delaware, we saw the ability to expand with the goal to provide statewide coverage," Merchant told AuntMinnie.com. "We believe the vast majority of patients that come in will have some kind of [insurance] coverage. We're currently working to find ways to support patients that don't have insurance. We want to make sure everyone has the opportunity to get screened."
A look at a high-definition 3D mammography system inside a MammogramNow clinic. The first to open in a Walmart Supercenter is located in Milford, DE. Photo courtesy of RadNet.
Each equipped with one 3D system, RadNet's new retail clinics in Walmart potentially expand the company's Enhanced Breast Cancer Detection (EBCD) mammography offering, an elective program that began incorporating AI in breast cancer detection earlier this year. The EBCD program was launched first in RadNet's New York and Delaware Imaging networks.
AI-enhanced service
Underpinning the EBCD program and the new MammogramNow clinics is Saige-Dx from DeepHealth. RadNet acquired DeepHealth in 2020. Then, in 2022, the U.S. Food and Drug Administration (FDA) granted 510(k) clearance for Saige-Dx which succeeded DeepHealth's earlier Saige-Q worklist triage product.
Saige-Dx optimizes breast cancer screening to help radiologists detect even subtle lesions, according to the company. The system assigns a "suspicion level," indicating the strength of suspicion that cancer may be present, for each detected finding and for the entire case. It assists in a recall or don't recall decision. It also serves as a look-behind for radiologists referred to as a “Safeguard Review.” For women electing to participate in the EBCD program, the cost is $40 out of pocket.
DeepHealth founder Gregory Sorensen, MD, a board-certified neuroradiologist who has worked on the industry side since 2011 and now serves as chief scientific officer for RadNet, leads AI efforts for RadNet and DeepHealth.
"The reason we felt like we could do Walmart now at RadNet is because of artificial intelligence," Sorensen told AuntMinnie.com. "With the quality that we're seeing artificial intelligence allows us to deliver, we felt like it was reasonable to expand into these new areas." Saige-Dx is intended to be used on women 35 years old and older, and it is not intended to replace a physician's own review of a mammogram.
Lower recall rates
"This is a way for a woman to tap into the power of AI in a manner that RadNet has shown, after studying over a million women, has identified cancer with a higher detection rate than without," Sorensen said. "We have presented data that shows we get as much as a 17% increase in the rate at which cancer is detected. We also can lower recall rates with the EBCD program."
RadNet and DeepHealth have been piloting use of Saige-Dx internally. "We saw how powerful it was to have this safeguard review, in which a woman gets an additional AI-driven read where the AI flags that the first doctor may have missed something," Sorensen added.
Tim Merchant (left) of RadNet, and Gregory Sorensen, MD (right), of DeepHealth, help lead RadNet's new Walmart MammogramNow clinic standups.
DeepHealth Inc. was created in 2017 after DeepHealth LLC was founded in 2015, and that’s when the Saige AI technology was first initiated. The FDA clearance process formally started in 2019, Sorensen said.
The outputs of Saige-Dx are intended to be used as a concurrent reading aid for interpreting physicians on screening mammograms with compatible digital breast tomosynthesis hardware.
"The goal is to provide access for cancer screening with the highest level of screening technology through artificial intelligence. We're trying to make a big difference," Merchant said. "By setting this up through our network we've detected well over 400 breast cancers that might otherwise have been missed."
Sorensen said the clinics, which are about 1,000 sq ft each, are located in areas where follow-up diagnostic imaging can take place, when needed, in a nearby RadNet imaging center. Elsewhere, RadNet provides outpatient diagnostic imaging services and has formed joint ventures with health systems, with the most recent expansion announced in November 2023 with nonprofit academic Cedars-Sinai in Southern California called the Los Angeles Imaging Group.
Clinic staffing, operations
In the Walmart pilot, RadNet is testing various hours of operation for MammogramNow clinics. A majority of customers using RadNet's first Walmart screening clinic in Delaware have been walk-ins, but appointment scheduling is also available by phone or web. A key piece of the retail cancer screening clinic operation is DeepHealth's new OS that orchestrates a full operational workflow that includes scheduling and business-side applications such as billing and reimbursement.
"This is a new setting for us," Merchant said, "so we all have a lot to learn about how to set this up successfully and attract enough patients into the locations to make this a scalable population health solution."
He said the sites were chosen because they are underserved communities lacking enough easy access to breast cancer screening.
"We have the opportunity now to look at additional markets," he said.
Walmart targets healthcare
MammogramNow retail clinics coincide with Walmart Health larger initiatives.
In the first half of 2023, Walmart announced it would open 28 Walmart Health centers in 2024. The company intends to surpass 75 community clinics across the U.S. with Walmart Health centers concentrated in its home state of Arkansas, as well as Florida, Georgia, Illinois, Texas, Arizona, and Missouri.
Unlike the smaller MammogramNow in-store setting, Walmart's new health center facilities will be approximately 5,750 sq ft and feature Walmart Health’s full suite of health services, according to the company, including primary care, dental care, behavioral health, labs and x-ray, audiology, and Walmart Health Virtual Care telehealth services.
