The Lab as an Early Warning System: How You Can Improve Population Health

Contributing Lab Leaders: Philip Chen, MD, PhD; Judy Springer; Lester Wold; Lale White; and Rob Atlas

CLINICAL

Article highlights:

Give careful consideration to lab biomarkers that may predict risk in specific patient populations
Doing so can help elevate the value of your lab, mitigate risk, and reduce cost
Acting in a consultative role with hospital colleagues is essential for labs to become vital partners in population health

Are you ready to step boldly into the new world of population health? We hope you are. Because as laboratorians, you’re smack-dab in the middle of a golden opportunity to show how critical a role you play in the continuum of patient care.

So move forward with confidence. Put a little swagger in your step. Get in there.

And start looking for trouble.

Find It Before It Finds Them

That’s our LabLeaders’ advice. This means watching out for biomarkers that indicate high risk—and taking action early to mitigate that risk.

This type of proactive approach brings enormous value in terms of population health. Think of predictive biomarkers as pieces of actionable intelligence inside your data. Because you see these first—before anyone else in a patient’s episode of care—and understand them best, you are in a unique position to act decisively.

That’s a tremendous responsibility. It’s also a tremendous opportunity. We encourage you to embrace it. Because doing so can help reduce length of hospital stays and readmission rates—key metrics in measuring population health outcomes.

Let’s look at the two examples.

Case Study #1: Faster Action On Fasting Glucose

Judy Springer, Vice President of Quality/Case Management at North Kansas City Hospital shared a perfect example with us. Her institution has been dealing with cases of patients with diabetes who become hypoglycemic while they are in the hospital. She sees an opportunity for laboratorians to play a vital role in preventing this—and laments that they haven’t done so already.

Consult Consciously

The laboratorians in Ms. Springer’s hospital would do well to begin thinking of themselves as clinical consultants—and act accordingly.

Why not do so yourself? When you see a lab marker that may indicate trouble, pause for a moment. Think: what can I do that I might not routinely do? Who might I share this with? How do I bring it to their attention? How can we work together to make changes based on this knowledge?

Be an Agent of Change

According to our lab leaders, the existing IT infrastructure in Ms. Springer’s hospital could easily be changed to trigger a hypoglycemic alert at the higher FPG of 70. Think of the tremendous value a laboratorian could have demonstrated had he or she brought this issue to light. Positive change could have been effected at an operational level that might have resulted in less time in the hospital for patients, and less overall cost.

It is what we must do.

On Making a Difference with Markers

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Judy Springer

Vice President, Quality/Case Management

North Kansas City Hospital

Case Study #2: Leveraging Lab Data For Accountable Care

Learn how Dr. Philip Chen's team used lab markers to help an ACO anticipate hidden costs.

Dr. Chen and his team analyzed the ACO’s claims data, looking at patients who had been characterized as:

High-spending – expected to spend significant healthcare dollars due to diagnosed conditions
Low-spending – not expected to spend significantly

Identifying hidden dangers

Looking specifically at the low-spending pool, Dr. Chen’s team:

Identified a subset of patients who unexpectedly presented to emergency departments with significant issues such as chest pain
Noted that health spending for these patients was above what the ACO had anticipated, because they had been identified as “low-spending”

For this subset of patients, Dr. Chen’s team went back and analyzed their lab markers from tests conducted a year earlier.

They identified markers that could have predicted the emergency events. They shared these findings with the ACO.

Moving forward

By identifying these markers, Dr. Chen’s lab is now in a position to keep an eye out for them going forward. When they see similar trends, they alert physicians who can intervene appropriately—as well as the ACO, which can budget accordingly.

Exchange Data

Dr. Philip Chen talks about the importance of making sure you have the data you need—and filling the gaps when you don’t.

On Managing Population Data

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Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

You Can't Do Everything

Diabetes and chronic kidney disease are two areas where labs might act as early warning systems by using markers to take preventative action. Other areas include needle biopsies for breast lesions, where looking at the percentages of atypical hyperplasia, intraductal cancer, and basal cancer diagnoses might help evaluate risk and control costs.

But you have to be selective. You can’t do it all. Some diseases like hypertension or hyperlipidemia have no markers you can easily measure. But for those that do, look for ways to share your actionable intelligence, so you can pursue solutions in collaboration with colleagues outside your lab.

You Can't Do It Alone

Demonstrating higher value in this way will help elevate the status of your lab in the world of population health. Begin today. Do what you can. It may be enough to gain the attention of hospital administrators and get them to recognize the lab’s value as a business center. And you’ll need their help in order to make a difference in as many populations as you can reach.