Crises or Opportunity or Both? What Happens to the Clinical Lab Industry as:! Healthcare Transforms! Payers Get Tougher! New Diagnostic Technologies Are Used to Improve Patient Care Executive War College 2 May 2017 New Orleans, Louisiana rmichel@darkreport.com ph: 512-264-7103 fax: 512-264-0969
My Goals This Afternoon
Shubham Singhal
Lâle White
Khosrow R. Shotorbani
Myra L. Wilkerson, MD
Big Message: Change is Coming Fast!
Healthcare s Big Transformations
A Word on MACRA Understanding MIPS & APMs
Why Clinical Lab 2.0 Now?
Attributes of Lab 1.0 vs. Lab 2.0 Clinical Lab 1.0: Transactional Sick Care Receive Test Sample Result Test Sample Clinical Lab 2.0: Integrative Health Care Population Health using Lab data Total Cost-of-Care leveraging Lab data Time-to-Diagnosis Optimization of: diagnosis, therapy, monitoring Care Optimization Screening Optimization Risk Management Identification of Risk Real-time tracking of Risk Escalation/De-escalation of Acuity Source: Improving American Healthcare Through Clinical Lab 2.0 : A Project Santa Fe Report, Academic Pathology Volume 4: 1 8
Attributes of Lab 1.0 vs. Lab 2.0 Clinical Lab 1.0: Transactional Wellness Programming Managed by Treating Physician Lab is Derivative Clinical Lab 2.0: Integrative Wellness Programming Gaps-in-Care closed using Lab data Outcomes of program using Lab data Predictive Analytics What will happen? When? Why? Payment Models Lab is a Commodity Value is Cost-per-Test Payment Models Value of Lab for Total Cost-of-Care Source: Improving American Healthcare Through Clinical Lab 2.0 : A Project Santa Fe Report, Academic Pathology Volume 4: 1 8
Laboratory Value Pyramid
Project Santa Fe: What Is It?
Project Santa Fe: What Are Its Goals?
Project Santa Fe: Other Goals?
Project Santa Fe: Why Publish?
Project Santa Fe: Who Are the Members?
Project Santa Fe: Your Lab s Opportunity
Project Santa Fe: March 2017 Second annual meeting At the Banbury Conference Center, Cold Springs Harbor Laboratory, New York
Relating Shubham Singhal s Expectation to Clinical Lab 2.0 Horizon 1: Evolution (0-3 Years) Interconnected, integrated, hospital-centric systems focused on high performance and population health Providers still at the center of vertically and/or virtually integrated health systems Disease-based, clinical orientation of critical health services provided at scale Focus on quality, efficiency, and transparency enabled through digital
Relating Shubham Singhal s Expectation to Clinical Lab 2.0 Horizon 2: Transformation (3-10 Years) Consumer-centric, health ecosystems building on core performance through scale and partnerships across care continuum: Consumers at the hub of broad health eco-systems Health systems provide consumers ability to create personal health networks and assist in coordinating complex webs of care Focus on retention, health service coordination and experience integration
Relating Shubham Singhal s Expectation to Clinical Lab 2.0 Horizon 3: Revolution (10+ Years) Fundamental shift in health system identity towards becoming orchestrators of health, risk, and lifestyle choices for consumers in fundamentally new market spaces: Consumers remain at the core of health ecosystems Health systems become preferred partners for consumers in convening and managing health, wealth and lifestyle holistically vs. orchestrating delivery alone Focus on service architecture and curation and integrated engagement platforms
What Changes for Doctors?
What Changes for Labs?
How Labs Should Prepare?
Sonora Quest Laboratories/Laboratory Sciences of Arizona Executive War College 2016 David Dexter CEO, Sonora Quest Laboratories Using Big Data to Drive Healthcare Decisions 29
Sonora Quest Laboratories/Laboratory Sciences of Arizona Our Analytics Journey Laboratory Testing: Essential for Management of Chronic Disease and Risk Assessments Support Population Health Management and Coordinated Care Merge Behavioral Health and Physical Health Information Exchange Interoperability: Shifting Our Focus to a Diagnostic Information Business Development of Dynamic Data Analytics Platform & Business Intelligence Support the Longitudinal Patient Health Record Discrete Data Delivery to EMRs, HIEs & Repositories Implementation of Patient-Centric Information Technology Platforms and EMPI Data Follows Patients to Point of Care 30
Sonora Quest Laboratories/Laboratory Sciences of Arizona Actionable Insights Management (AIM) Report for Diabetes Management Practice Management and Patient-Centric reporting capabilities Flexibility to capture physician groups, attributed ACO lives, or eligible health plan participants Delivery of reporting in near real-time to prompt timely action and track progress Payer Mix Pa*ent A1c Tes*ng Compliance Historical A1c and LDL Trends Physician Benchmarking and Performance Diabe*c Popula*on by A1c Results 31
Sonora Quest Laboratories/Laboratory Sciences of Arizona Closing Clinical Gaps in Care: A Case Study Healthcare Plan approached SQL to assist them with improving Case Management of Hepatitis C patients SQL developed information exchange protocol to identify affected patients and track progress against testing program using our EMPI Healthcare Plan now able to easily monitor and intervene when needed on patients in testing program Improved patients Sustained Virologic Response (SVR), or CURE, at 12 weeks by 61.5% and at 24 weeks by 26% Economic benefit when compared to end stage HCV, liver cancer, liver failure, and catastrophic measures 32
Big Data Led by the Lab Example of TriCore Reference Laboratory in Albuquerque, New Mexico. Formed in 1998 by University of New Mexico Health Sciences Center and Presbyterian Healthcare Services. Produces 80%+ of patient lab results in New Mexico. Has access to patient clinical data electronic health record (EHR) systems. Presented in 2015 by Khosrow Shotorbani, CEO of Tricore Reference Laboratory.
Targeted Interven*on Modules (TIM) 3 components to a TIM " Surveillance Data Disease/health state specific Summaries/dashboards/heat maps Real Cme " AcConable work lists Detailed lists of acconable informacon by pacent Eliminate care gaps IdenCfy high risk pacents " Alerts ER visits, hospitalizacons, changes in disease/health state tricore.org 34
TIM Diabetes Surveillance Data tricore.org 35
TIM Diabetes AcConable Work Lists tricore.org 36
RSV Influenza A Influenza A H3 RSV: Respiratory syncytial virus
Summary Laboratory innovacon requires: ExiCng the lab to provide a true impact within healthcare; Pharmacy, ICU LOS, NICU days Take data and provide acconable results for clients: Provide interprecve results rather than passive data dumps Remove the ancillary scgma from lab: We have to regain our posicon as Clinical Colleagues, not a commodity market It cannot be taken for granted informacon will innovate medical care, we have to prove it. tricore.org 39
Carpe Diem for Labs