What is anatomic pathology’s (AP) role in value-based healthcare? How can AP groups best position themselves for what’s to come? How can pathologists define and ensure better transparency to add to the value and efficiency that AP services deliver? These are questions being asked by many in the AP field, and the answers are not trivial.
We’re all familiar with the challenges we face in our industry: declining reimbursement, policy changes, consolidation, and staff shortages. Let’s look at some of the measures AP labs are taking to navigate the challenges that are inevitably coming their way, including taking a patient-centric approach to quality, driving efficiency, and highlighting AP value.
- Disease-based testing. Pathologists are at the center of the personalized medicine revolution, and realizing the value of this position requires expanding their role by offering intelligent services and analytics that provide rules-based test protocols for specific diseases and span tissue, molecular, and other tests.
- Patient-centered reporting. Overwhelmed clinicians sometimes struggle with interpreting asynchronous, complex test results when working up patients with a wide variety of tests. Pathologists can use analytics systems to integrate findings and generate patient-specific, summary diagnostic services.
- Minimizing follow-up errors. A frequent cause of diagnostic errors involves failure of clinicians to receive or appropriately act upon AP test results. Pathologists can add value to their services by using analytics systems to identify these potential errors and intervene to mitigate risk.
Laboratories have to be as cost-efficient as possible. However, multiple studies have proven that up to two-thirds of workflow process in AP labs is non value-added. While significant efforts are being made on workflow improvement and cost improvement initiatives, it is critical to create sustainable performance improvements in the lab. Analytics enable AP labs to drive sustainable efficiency in the following areas:
- People. Pathology lab leaders should staff by analyzing historical trends from which they can more accurately predict their needs by day, hour, or month, rather than anecdotally. They also should ensure that team members know how their performance is measured, and that they have real-time insight into their performance metrics and the tools to be able to impact those metrics.
- Process. Using real-time analytics, lab leaders should empower the lab to identify and respond to errors in a timely manner. They should make sure they have detailed turnaround time information, enabling them to identify points in the process where there may be opportunities without having to seek them out. To manage backlogs and reallocate resources appropriately, real-time workload analyses are critical; they enable labs to react in a timely fashion.
- Tools. Investments in laboratory equipment are made to leverage people and process. It’s important to ensure that they optimize staff productivity. Ensuring that the use of those tools is synchronized with AP workflow can have tremendous impact on efficiency.
While AP has already experienced significant declines in reimbursement, the shift to bundled and value-based payments will be an even greater upheaval in the reimbursement model.
Every healthcare service line, including AP, will have to articulate the value and impact of its services across the continuum of care. Here are ways in which AP labs can achieve that:
- Quantifying. Lab leaders should quantify the true cost and downstream impact of AP services both in the lab and across the care continuum. They need to know and be able to demonstrate the cost of a missed or inappropriate diagnosis, e.g., inappropriate work-ups and treatments for an inaccurate cancer diagnosis, and to be able to identify the cost of a delay in diagnosis. (In the case of cancer, this might include poor outcomes or malpractice consequences.) They need to measure and monitor performance on these key measures of value.
- Sharing. AP labs should proactively share information with key constituents: health plans, patients, and providers. Full transparency on service levels which trends are occurring within the patient population, and test utilization recommendations develop “stickiness” and trust among clinicians the lab serves. For example, payers developing oncology management and bundling programs are interested in accessing oncology AP results in a timely manner, enabling decision support interventions. Transparency and proactive, information-based communication are no longer luxuries; they are expectations.
- Engagement. Working collaboratively with other areas of the lab will allow a unified, strategic approach to the health system. Laboratory testing is often misunderstood, and it’s critical that AP lab leaders drive awareness of how the laboratory can impact organization-wide goals. It is a good strategy to engage physician peers in discussions about the value of laboratory testing and share responsibility for system-wide outcomes and performance.
The value of analytics
These initiatives are challenging to the AP lab, and many questions remain unanswered. The information required to support these efforts is sometimes difficult to access, analyze, and share with the tools currently available to labs. However, AP labs are increasingly utilizing analytic solutions as organizations realize the importance of their data assets, including investments in electronic medical records. In fact, reports show that investment in healthcare analytics is growing at a 26 percent plus CAGR (compound annual growth rate) over the next few years, and is expected to reach more than $18 billion in 2020. It’s time for AP laboratories to align with organizational strategies and invest in analytics to drive many of these key initiatives in the lab, as well as its impact outside of their walls.