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Realizing the True Value of Your Data: How to Increase Revenue without Increasing Test Volume

Contributing Lab Leader: Jason Bhan, MD

Realizing the True Value of Your Data: How to Increase Revenue without Increasing Test Volume
LEADERSHIP

Article highlights:

  • Laboratorians are experts at applying data for a spectrum of clinical purposes                             
  • You may be surprised at the multitude of applications for your data—beyond clinical
  • Hear from data expert Jason Bhan, M.D., on how you can leverage lab data in unexpected ways to advance your business

It’s no secret that your lab data are invaluable to your institution, especially if you’re part of an ACO. You have likely used these data for a host of clinical applications, including identifying high-risk patients, tracking quality of care, targeting data management investments, developing treatment algorithms and advancing proactive care.

But are you aware of the many ways your data can be leveraged beyond clinical applications?

Here’s your essential guide on how you can put your data to work, from our data expert, Jason Bhan, M.D.

Labs are great at performing tests and analytics and understanding what’s in the data. But there’s also significant information in there that you can use to improve your business.

Jason Bhan, MD

Chief Medical Officer

Prognos

Lab data provide unique value vs. other health care data

 

It’s well understood that lab data—derived from 2%-3% of the health care spend—influence 70%-80% of physician decisions. That’s because they provide a distinct level of depth and timeliness1. See for yourself in this comparison:

 

  Lab data Claims data EMR/EHR data
Clinical depth Tests administered with comprehensive clinical results Only tests administered, not clinical detail Clinical data are often incomplete (gaps range from 35%-65%)
Reliability High degree of quality control from source labs Dependent on provider scrutiny; frequent coding errors Dependent on physician effort and connectivity to data
Responsiveness Rapid, near real-time results Weeks to months in lag time, depending on claims processing Rapid, near real-time results

You can do all kinds of mental gymnastics with claims and Rx data to try to figure out which patients are in control or out of control, or at risk or not at risk. Or you can just look at the lab values.

Jason Bhan, MD

Chief Medical Officer

Prognos

Less obvious applications for lab data

 

You don’t need to increase your volume to increase your value—or your revenue. Be inspired by these practical applications and see which ones you can put into practice.

Secondary use cases

  • Identify major health care problems the lab can help solve
  • Determine access to new markets

Access to medical workflow

  • Determine if the lab can play a role as a distribution channel for data-enabled services in the medical workflow

ACO-specific

  • Report quality measures back to government
  • Help resolve risk adjustment (accounting for patient complexities/comorbidities)

Having access to the data in a meaningful, usable format helps dictate which charts you should be pulling for your risk-adjustment scores.

Jason Bhan, MD

Chief Medical Officer

Prognos

Results

  • Identify lab coverage
  • Validate whether lab data are sufficient or need to be integrated

You can apply clinical data alongside socioeconomic data, claims data and other transactional stuff to come up with real models as to how we should be reimbursing for particular patients.

Jason Bhan, MD

Chief Medical Officer

Prognos

Outreach

  • Target patients who could potentially benefit from further care

If you have a patient who’s diabetic and the lab data are showing other comorbidities, that can be an outreach opportunity for you to work with his or her provider.

Jason Bhan, MD

Chief Medical Officer

Prognos

Profitability analysis

  • Resolve average reimbursement rates in a given test category

Economic analysis

  • Demonstrate downstream costs/savings from assay utilization

Market share analysis

  • Determine lab volume vs potential volume for a test category within a geographic area

Market sizing

  • Forecast assay launches

Volume leakage

  • Identify missed opportunities within a health system’s affiliated practices

Pharma-specific

  • Inform profiling, market sizing and field force planning
  • Determine sales force effectiveness and multichannel marketing
  • Shape call planning and messaging

3 essential steps before putting your data to work

 

1. Aggregate your data

 

Required steps

  • Lab connectivity: Accept lab data directly from any laboratory information system (LIS) or in any other delivery format
  • Member match: Identify plan-specific members
  • Data extraction: Perform a daily call to member labs to pick up results that were logged in the preceding 24 hours

If you look across multiple labs, you can build fairly complete pictures of patients, like, which patients need a proactive disease management program. This has tremendous value for population health, reporting or all those other things you’re beholden to from CMS.

Jason Bhan, MD

Chief Medical Officer

Prognos

2. Standardize your data

 

Required steps

  • Refinement: Format data fields appropriately, confirm fields have valid data and redistribute data in single records to individual results
  • Non-numeric terminology alignment: Ensure the same term is used for a particular lab test output across different labs
  • Units of measure conversion: Ensure same units are used for the lab test output across different labs

You need to harmonize your data so you can put it together at a scale that allows you to actually engage and do something with it.

Jason Bhan, MD

Chief Medical Officer

Prognos

3. Enrich your data

 

Required steps: non-clinical

  • Logical Observation Identifiers Names and Codes (LOINC®) mapping: Missing LOINC codes must be populated by unsupervised machine learning models based on laboratory test menus and LOINC organization reference data
  • Practice enrichment: Reference datasets must be used to populate practices missing a name, address or type
  • Provider enrichment: Reference datasets must be used to populate provider information missing a National Provider Identifier (NPI), name or specialty

More data-driven insights. More lab-delivered power.

Clearly, your traditional data create untraditional opportunities to support accountable care. Dr. Bhan concludes, “Getting your lab data to the provider is great, but also getting it to the ACO, the payer and anyone else for business purposes—that’s how the lab can create higher-level value.”

Reference:

  1. Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group: and the US Department of Commerce, Bureau of Economic Analysis and US Bureau of the Census and company estimates. (2013). Retrieved Nov. 16, 2018.

Contributing Lab Leader

Jason Bhan, MD

Chief Medical Officer

Prognos

 

Related resources

  • The Value of Lab Data in the Healthcare Ecosystem
    By Dhiren Bhatia and Tim Kuruvilla
    Continue learning about the untapped potential of clinical labs to drive decisions throughout health care—on the levels of business, strategy and organizational direction.

  • Laboratory Data in ACO Environments
    By Jenny Xu, Ph.D. 
    Learn expert strategies for clinical labs to apply their data and thrive in the new reality of accountable care.

  • ACOs Are Learning to Use Big Data
    By Pamela Scherer McLeod 
    Read this article to understand how Pathologists and clinical laboratory managers are finding opportunities to add value through the use of big data.

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