As the healthcare industry continues its paradigm shift from fee-for-service toward a value-based approach to care, Diagnostic Management Teams find themselves uniquely positioned to make valuable contributions in all facets of healthcare delivery. They offer multidisciplinary input on the diagnosis of challenging cases and aim to reduce the number of medical errors that occur due to lab test over- and under-utilization.
Whereas a fee-for-service model is based on volume, reimbursing healthcare providers for each patient visit and each service rendered regardless of result, a value-based model focuses heavily on patient outcomes and quality based on specific measurables. Ultimately, the goal of value-based care is to standardize healthcare processes through best practices in order to achieve the most desirable outcomes for patients.
“Since value-based care models are driven by data, providers must report metrics and demonstrate improvement,” explains Dr. Bruce Friedman, Emeritus Professor of Pathology, University of Michigan Medical School in Ann Arbor. “I like to say value-based care increases both the efficiency and the effectiveness of care — efficiency is doing things right, and effectiveness is doing the right things.”
Value-based care also emphasizes proactive measures such as early detection, accurate diagnosis, close monitoring and lifestyle incentives to help patients achieve improved outcomes. As organizations continue to integrate and consolidate to reduce healthcare costs, this trend creates a more integrative, collaborative environment in which to coordinate a more seamless delivery of patient care.
Diagnostic Management Teams (DMT) operate by convening multi-disciplinary groups of healthcare professionals on an as-needed basis to evaluate individual patient histories and interpret clinical data. They generate an expert-driven narrative diagnostic report that is then communicated to physicians to guide patient treatment.
“Even though it’s called a Diagnostic Management Team, what we’ve realized over time is that the results we’re able to provide have a major influence and impact on patient outcomes,” says Dr. Michael Laposata, Professor and Chairman of the Department of Pathology at the University of Texas Medical Branch in Galveston. “The fundamental activities of a DMT include recommending the correct tests for quick and definitive diagnoses without ordering unnecessary options; this is a goal that connects nicely into the overall concept of personalized medicine.”
Because it relies on input from a multidisciplinary group of experts, implementation of a Diagnostic Management Team can help direct patient treatment based on a complete informed view of the lab tests ordered and results. This is opposed to depending solely on the interpretation of one provider who may not be well versed in appropriate lab test selections from what is often an overwhelming and confusing menu of choices for complex cases.
“It can be challenging for healthcare providers to understand the clinical significance of laboratory tests relative to the diagnostic testing options available, and the complexity of lab tests continues to increase rapidly,” Dr. Laposata points out. “It’s gotten harder for providers to arrive at correct diagnoses simply because there’s so much more diagnostic information now to digest. The ensuing likelihood of making diagnostic errors has increased dramatically.”
Additionally, DMTs can offer valuable interpretations of genetic information that most providers may not understand, and therefore educate providers as to why certain drugs and products may or may not be effective for a particular patient.
“Mining data and evidence determines which processes work and which don’t,” Dr. Friedman explains. “This forms a foundational pathway that includes bringing the efforts of DMTs into the process to achieve the best outcomes for patients.”
In keeping with the tenets of the value-based care approach, DMTs can help optimize value in measurable ways by directing patients to effective treatment sooner and reducing the likelihood of diagnostic errors.
“There’s an increased emphasis on taking a team approach to coordinate patient care in the most timely and effective manner,” Dr. Friedman adds. “The ideal result is lower readmissions, less frequent hospitalizations and fewer trips to the emergency room.”
While some providers and organizations have been reluctant to embrace the shift to value-based care because of the learning curve its presents, the potential of such a move offers the promise of industry-wide improvements in care delivery and personalized medicine. What this means for DMTs is the need to present a strong case for the value they bring to organizations in terms of cost savings and improved care with fewer medical errors.
Certain hurdles do still exist that must be overcome to generate support for DMT creation on a widespread basis. Payment and reimbursement avenues for DMT services still need fine-tuning, and future leaders must be identified, trained and encouraged as opportunities to form new DMTs emerge.
“DMT interpretation greatly increases the speed and accuracy of diagnoses, but it can be difficult to correlate the improvement to the DMT as the source of information,” Dr. Laposata admits. “We have to make a cultural shift in the field to prioritize this work, but these obstacles are surmountable if we are willing to make the necessary changes.”
In summary, the current healthcare transition from fee-for-service toward personalized medicine and value-based care presents prospects for DMTs to demonstrate their worth through lower incidence of medical errors, better patient care and improved outcomes.
“DMT activities have been shown to reduce the over- and under-utilization of diagnostic tests, the diagnostic errors that stem from misinterpretations of lab test results, and inappropriate or ineffective use of medications and blood products,” Dr. Laposata says. “All of these changes greatly improve clinical outcomes and decrease the cost of healthcare.”
“Value-based care is a long-term goal, a proactive concept that if executed correctly, will conserve resources and produce better healthcare outcomes,” agrees Dr. Friedman.
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