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Case Study: Shaping the Health of Populations with Predictive Biomarkers

Contributing Lab Leader: Philip Chen, MD, PhD

Case Study: Shaping the Health of Populations with Predictive Biomarkers
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Article highlights:

  • There is hidden potential in the predictive biomarkers you see everyday
  • One US lab is using predictive biomarkers to reduce costs and mitigate risk in specific patient populations
  • Focusing on patients lost to follow-up can help your lab become an influencer for the entire health system

In How to Negotiate Contracts: Leveraging Quality to Combat Price, we shared with you how Dr. Philip Chen, Chief Informatics Officer at Sonic Healthcare, maximized his lab’s services to strengthen their contract negotiations. His lab used predictive biomarkers to return to care patients with diabetes and chronic kidney disease (CKD) who had been lost to follow-up.

Now, we’ll take a more in-depth look at Dr. Chen’s initiative and how his lab is using it to influence the entire health system and improve outcomes in high-risk populations.

It’s a model that can help us all shape the very future of population health.

Avoid Costly Care

 

The goal of Dr. Chen’s initiative is to keep high-risk patients out of the hospital. This helps reduce Medicare costs for hospital stays. It can also reduce the human cost that disease-related complications exact on lost-to-care patients—those who eventually end up in hospital emergency departments.

Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

Begin with Biomarkers

 

In Dr. Chen’s lab, efforts to keep patients out of the hospital begin with looking at predictive biomarkers in 2 high-risk populations:

  • A1c in patients with diabetes

  • EGFR (estimated glomerular filtration rates) in patients with CKD

Using ADA (American Diabetes Association) and NKF (National Kidney Foundation) guidelines, Dr. Chen’s team identifies patients at-risk. They then narrow down these data sets to patients who have not seen their physician in a year or more. In other words, those who are “lost to follow-up.”

Go Directly to the Lab

 

If Dr. Chen’s lab is working with an ACO (accountable care organization), they may simply hand these data over in a report to the ACO’s care coordination team, who will take responsibility for finding patients and returning them to care.

But in other instances, Dr. Chen’s lab contacts patients themselves, on behalf of physicians. Such direct interaction allows the lab to schedule patients for necessary lab tests before their return visit to the physician. This reduces costs by consolidating the typical 2 physician visits (1 before the lab tests, 1 after) into a single visit.

Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

The Consolidation Conundrum

 

But there are 2 sides to the visit consolidation coin. This is because we’re straddling the fee-for-service and value-based reimbursement worlds.

On the One Hand...

 

Consolidating a patient's return-to-care to a single visit:

  • Frees up a practice's capacity to see additional patients.
  • Reduces the burden of multiple visits of the patient.

On the Flip Side:

 

Consolidating a patient's return-to-care to a single visit:

  • Reduces practice revenues under fee-for-service agreements.
  • Upsets physicians who need the revenue more than the capacity.

When we see this as laboratorians, it's our duty to actually share this kind of information with the policy makers, the payers, and the healthcare team ... to bring it up, to say: How do we mitigate the issues that still exist in the system? Because no one wants to be seen twice when things can be done in one visit.

Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

Staggering Statistics

 

Sharing informatics on patients lost to follow-up can have a profound effect on ACOs, payers, and physician practices—and on their relationships with labs.

In Dr. Chen’s case, he shared with the CEO of an ACO the percentage of their patients with diabetes who were lost to follow-up. The number was eye opening to the CEO and opened doors of opportunity for Dr. Chen’s lab.

In one ACO,

 

30% of patients with diabetes NEVER SHOWED UP FOR CARE in the past 12 months.

 

When presented to the ACO, these data resulted in 

 

ATTENTION and ACTION

 

  • Demonstrated value above-and-beyond PQRS (Physician Quality Reporting System). PQRS measures only what we're doing for patients who show up.
  • Motivated all parties to do something: How do we get these patients back?
  • Led to more conversations between the ACO and the lab: What other conditions do you have data for?

 

Value beyond reimbursement
even in a fee-for-service world.

Patient Prioritization

 

Sometimes, the informatics Dr. Chen’s lab share can be overwhelming to practices. For example, his lab once issued a 70-page report identifying 1,200 patients with diabetes from a single practice that were lost to follow-up.

The response from the practice was understandable: whom do we bring back in first? Some type of risk stratification is required to create a manageable list of patients with the greatest needs.

But in a case like this, risk stratification may be beyond the purview of what the lab can offer. Fortunately, there are resources out there that can help. Dr. Chen cites the Johns Hopkins Adjusted Clinical Groups® (ACG®) system as 1 example.

He sees an essential role for laboratorians in bringing the issue of risk stratification up and working collaboratively to solve it.

Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

Make Your Mark with Biomarkers

 

Think about the predictive biomarkers you see every day in your lab. Use your data to identify patients lost to follow-up in just one disease state. Provide the informatics to a practice or payer and watch how they respond. As Dr. Chen says, these are the types of initiatives we must promote and proceed with to control costs and ensure better outcomes for patients under population health.

Contributing Lab Leader

Philip Chen, MD, PhD

Chief Strategy Officer

Sonic Healthcare

 

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