Today, health plans are shifting dollars to more value-based contracts along with investments in population health management. Digitizing lab results across all care settings and unlocking the potential of lab values can help health plans reach the Triple Aim of improving the patient experience, improving the health of populations, and reducing the per-member cost of health care.
Lab testing is where value-based care starts. It is the gateway for appropriate diagnosis and treatment planning, which ultimately impacts cost, quality, and outcomes. From diagnosis to medications, and from hospital admittance to discharge, 70% of patient treatment decisions are guided by lab results.
Today, health plans are shifting dollars to more value-based contracts along with investments in population health management, because better managed patients have a higher quality of life and incur lower overall costs, including reductions in hospital and emergency room admissions.
Since lab testing is quickly growing and evolving, it is essential for health plans to unlock and utilize lab data to its full potential to support the achievement of the Triple Aim.
Lab Testing Growth
The US clinical laboratory test market is expected to grow at a compounded annual growth rate (CAGR) of about 2% through 2026. The increase in lab testing is the result of several factors, such as:
Health plans pay for broad lab testing for their members, but they are just starting to use lab data to its full potential to broadly inform care and improve outcomes.
Digitized Lab Results Accelerate Quality Care
Having a correct and timely diagnosis is the key to the success of value-based care. The most common breakdowns in securing a diagnosis and delivering value-based care are: under-testing; the misinterpretation of data; timing of the test, resulting in lost care/treatment time; and test location, as test result analysis capability varies by lab.
Consider that 90% of people with chronic kidney disease (CKD) are unaware they have it. Today, many patients already have lab results that are consistent with early-stage CKD. Identification and aggressive management of blood pressure, and blood sugar if comorbid with diabetes, has been shown to reduce the progression of advanced kidney disease.
Today, many patients already have lab results indicating that they should be classified as stage 2 to stage 5; however, the International Classification of Diseases, Tenth Revision (ICD-10) that would trigger plan and provider involvement are not coded. Leveraging digitized lab results earlier and using lab values to look across more than one episode of care can improve the early identification of CKD.
Another example of test underutilization (and health care inequity) involves the genetic test to determine whether chemotherapy is necessary for women who underwent a lumpectomy for human epidermal growth factor receptor 2 (HER2)–negative breast cancer. When the results of this genetic test are combined with other meaningful treatment information, the result is lab values that can accelerate care decisions and improve outcomes.
While all plans cover this test, Black women, regardless of their risk level, are less likely than White women to undergo genetic testing for HER2-negative breast cancer with lumpectomy. Unfortunately, Black women have a 42% higher death rate from breast cancer compared with non–Hispanic White women.
Accountable Care Organizations (ACOs), as envisioned by the Affordable Care Act, have the potential to improve access, care quality, and cost for all Americans. Some inventive population health initiatives that grew out of ACOs are for diagnoses such as diabetes and kidney disease. The problem is that these programs are based on ICD-10 codes that assume a correct diagnosis was made—but in making a diagnosis, there may be a data gap from all care settings over time.
So, how do you use data from testing to come to the right diagnosis and improve patient outcomes? It takes a focus on science and data to provide actionable lab-driven insights in real-time at scale.
Instead of implementing process-based measures of quality using administrative claims data, health plans should access lab values to increase the efficacy of these programs by accurately representing patients’ health care trajectories over time. Lab values should be secured from all care setting sources and analyzed at scale in a timely fashion to provide the correct diagnosis.
Lab claims, member and ordering physician information, and digitized lab results from lab partners are used to first confirm the right test is ordered by enforcing evidence-based policies to ensure overutilization (7% to 10% industry average) does not occur. Algorithms are applied to gain meaningful intelligence and deliver actional insights to help inform care. To address underutilization, advanced analytics on individual member profiles helps identify opportunities for appropriate testing.
It's time to start thinking differently about lab testing’s role in advancing value-based care and population health. Digitizing lab results across all care settings and unlocking the potential of lab values is helping health plans reach the Triple Aim of improving the patient experience, improving the health of populations, and reducing the per-member cost of health care. The ability to drive preventive and proactive patient care is moving from promise to practice.
Perioperative Nivolumab Boosts NSCLC Survival: CheckMate 77T Trial
May 16th 2024This interim analysis of the CheckMate 77T trial, outcomes were compared between adult patients receiving neoadjuvant nivolumab plus chemotherapy or neoadjuvant chemotherapy plus placebo for resectable non–small cell lung cancer (NSCLC).
Read More
Decitabine, Venetoclax Combo Boosts Survival in Patients With AML and MDS
May 16th 2024Study findings demonstrate that combining decitabine with venetoclax enhances molecular response rates in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), correlating strongly with improved clinical outcomes and overall survival.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Atypical Marker Expression in T-Cell Acute Lymphoblastic Leukemia/Lymphoma
May 15th 2024Two unique case reports highlight the diagnostic challenges and critical importance of comprehensive immunophenotyping in cases of T-cell acute lymphoblastic leukemia/lymphoma that present without typical immaturity markers but with rare γδ T-cell receptor expression.
Read More
After the ACA Expanded Health Care Access, 2024 Elections May See Voters Demand Affordability
May 15th 2024At the spring conference of the New Jersey Health Care Quality Institute, speakers discussed how health policy, affordability, and transparency may play a role in voters’ decisions.
Read More