This is the final part of the series on the value of laboratory diagnostics in value-based healthcare. Stay tuned to colLABoration for more information, as Orchard Software will be sure to post on additional information as it is released. If this is the first post you’ve come across, please check out Part 1, Part 2, Part 3, and Part 4.

Integration of Point-of-Care (POC) Testing

Healthcare reform is accelerating the shift of providers away from private practices into the protection of large hospitals. Over the last five years, hospital employment of physicians has grown steadily. According to a survey by Accenture, only 36 percent of physicians will own their own practice by the end of 2013, which is a 57 percent decrease from the year 2000.

As healthcare organizations shift in size and ownership, decisions are being made about where laboratories fit to provide the best service. ACOs or Patient-Centered Medical Homes (PCMHs) that include large laboratories may introduce several satellite urgent care testing sites that offer POC lab tests to deliver care to patients at the site of service. This can help reduce the burden on primary care providers and reduce unnecessary hospital admissions. POC testing can provide the information needed to quickly make decisions and stabilize the patient, ultimately avoiding an unnecessary hospital admission or ER visit.

This makes integration of POC testing into the EMR an important area because, as POC testing increases, that data needs to be structured and mineable just as other lab results to enable analytics that include POC test volumes and results.

Call to Laboratory Leaders

In order to successfully achieve value-based healthcare reform, strong leadership is needed—laboratory leaders, administrative leaders, and physician leaders. Laboratorians must align with physicians and organizational leaders to help determine how to best position their laboratory to achieve the desired analytics and outcome measures needed to support the new reimbursement models. The goal is to use information technology to care for populations based on their disease-specific needs in a proactive and patient-interactive manner. Although it is difficult to predict the exact structure the new healthcare system will take, we can expect big changes.

The coordinated care model redefines the role of the clinical lab as even more central to healthcare: the lab becomes the integrator of data and information, as well as the provider of critical insights that can lead to improved patient outcomes and satisfaction. Laboratory leaders need to be thinking of how the lab brings value to a value-based healthcare system and how the lab can best fit the needs of their healthcare organization and the patients it serves.

I am going to be working on a white paper regarding this topic of how the lab brings value to value-based healthcare, and I am eager to hear any of your thoughts on how labs bring value in the new model of healthcare. Respond to this blog, or email me directly at kfutrell@orchardsoft.com.

Kim Futrell, MT (ASCP)
Products Marketing Manager
Orchard Software Corporation

Comments (0) May 16 2013

This is the fourth of a five-part series on the value of laboratory diagnostics in value-based healthcare. Stay tuned to colLABoration for the rest of the five-part series.

Care Management Teams

Another widespread addition to facilities are care management teams—or health coaches—who are leaders in the value-based care arena. Nurse care managers may be made responsible for the management of targeted patients who need chronic disease support. These nurse care managers focus, in part, on the transition from hospital to home—a crucial time when interventions are imperative to avoid unnecessary readmissions.

Part of the attractiveness of having an in-house laboratory is that you can include key laboratorians as members of the care management team. The lab team can be in direct communication with the nurse manager or provider, looking at new evidence or new research and having discussions about how the lab can provide better service or introduce new offerings and technologies.

Eliminate Waste

With the incentive to deliver care efficiently comes the opportunity for quality and cost improvement associated with reducing waste. One way to reduce waste is to get the diagnosis correct as soon as possible. Inaccurate or delayed diagnoses occur all too often with unintended negative consequences, such as driving up healthcare costs and causing more inappropriate testing. In an outcome-based reimbursement system, inaccurate diagnoses that waste time and efforts—that were perhaps overlooked in a fee-for-service scenario—will not support the concept of efficiency needed in the value-based system.

In Don Berwick’s publication “Eliminating Waste in US Healthcare,” he discusses iatrogenic effects—negative outcomes that are unintended, caused by lack of communication, overuse of diagnostic tests, and waste. Becoming more efficient in a value-based healthcare forum is imperative. Laboratorians are in the perfect place to monitor and communicate instances of redundant testing, thus saving healthcare dollars.

Feel free to share your ideas for eliminating redundant or unnecessary testing and the best methods you have established for communicating with providers and nurse care managers.

Kim Futrell, MT (ASCP)
Products Marketing Manager
Orchard Software Corporation

Comments (0) May 09 2013

This is the third of a five-part series on the value of laboratory diagnostics in value-based healthcare. Stay tuned to colLABoration for the rest of the five-part series.

Variation Analysis for Best-Decision Practices

As we continue our discussion of what is working thus far in the transition to value-based healthcare, the development of best-decision practices and standards is definitely at the top of successful implementations for many organizations. The monitoring of laboratory test utilization can be instrumental in identifying test order variation patterns between providers. While we feel that all providers have their patients’ best interests at heart, there can be a surprising amount of variation in their ordering patterns for patients with the same symptoms and diagnosis. National guidelines are updated regularly, making it difficult for every provider to keep abreast, so they may tend to err on the side of caution and deliver more care than is needed.

If test utilization data is amassed and presented to the providers along with collaborative data that indicates that more testing does not equate to better outcomes, it can be made evident that there is a best practice somewhere in the middle that balances at the right amount of testing for the best outcome. Back this up with recommended guidelines published by the national council experts for that specialty or diagnosis (e.g. American Diabetes Association (ADA), American Heart Association (AHA), etc.), and you can establish best-decision practices that lead to significant cost savings. By adopting and circulating organization-wide best-practice standards, more accurate test ordering patterns can achieve greater efficiency of care, leading to better patient experience at the lowest possible costs.

Has your practice implemented best-practice guidelines? Do you feel like laboratorians can provide insight to support best-practice guidelines? Please feel free to share your opinions, concerns, or experiences.

Kim Futrell
Products Marketing Manager
Orchard Software Corporation

Comments (2) May 02 2013