12 <strong>ADVANCE</strong> <strong>for</strong> <strong>Executive</strong> <strong>Insight</strong>
Healthcare is evolving faster now than ever in response to a number of powerful <strong>for</strong>ces. These include HI- TECH, Meaningful Use, big data, decreasing costs and increasing availability of personalized medicine, and EMR adoption. However, most significant is the creation of Accountable Care Organizations (ACO) under the Af<strong>for</strong>dable Care Act, and the significant shift, practically and culturally, from volume to value. If the financial outcome under the fee <strong>for</strong> service model keeps patients in the hospital, then they will be kept out under the ACO model. While ACOs do not remove fees <strong>for</strong> services, they do create savings incentives to motivate volunteer organizations to meet specific quality benchmarks which demonstrate that they have saved healthcare dollars, and ultimately improved patient care. One problem, however, is that while volume is easy to measure (the more you do, the more you get paid), proving value with quality metrics is more difficult. And when trying to predict outcomes (e.g., keeping patients out of the hospital) the difficulty only increases. So how can the clinical laboratory contribute to this new challenging environment? The fact that it is the production engine and custodian of vast amounts of test result data that is relied upon <strong>for</strong> over 70% of diagnoses by some measures, is insufficient. The key to the laboratory fulfilling its potential, and enabling the ACO to fulfill its potential, lies in understanding how to interpret and apply its data in a strategically meaningful way. Three specific areas The laboratory cannot become a data enabler in a meaningful way <strong>for</strong> the ACO unless it becomes a data partner with all of the other relevant and willing moving parts. it can support to achieve this are test ordering guidance, admissions and discharges and pharmacy. Test Ordering Guidance The test ordering process is one initial area upon which the laboratory can have a significant impact. Under the ACO model, we must unite a disparate network of physicians on the one hand, and the need <strong>for</strong> first-time accuracy of testing and rapid turn-around time on the other. With rapidly expanding test menus, particularly in molecular diagnostics, it is unrealistic <strong>for</strong> physicians to know all of the recommended ordering practices. Inevitably, the ordering of old tests when new ones are available, the ordering of new tests to a “‘panel”’ without replacing one in that panel or the ordering of tests useful <strong>for</strong> research but not necessarily in diagnosis, are all risks to ACO success. Just as pharmacists influence physicians’ drug ordering, the lab can make a difference in test ordering to pre-empt such potential issues. One currently uncommon method is to create a lab test <strong>for</strong>mulary. When offered tests are presented to the physician as <strong>for</strong>mulary products, some may require pathology review, some infectious disease review, and even <strong>for</strong> some, chief medical officer review, be<strong>for</strong>e being approved. Such an approach also aligns well with broader industry ef<strong>for</strong>ts such as the American Board of Internal Medicine’s “Choose Wisely” campaign which that focuses on encouraging stakeholders to address tests and procedures that may be unnecessary. 1 Even without required By Jonathon Northover, JD, BVC (ICSL), and James Carson, PhD, MBA, MLS(ASCP) scott frymoyer <strong>ADVANCE</strong> <strong>for</strong> <strong>Executive</strong> <strong>Insight</strong> 13
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