Moving Toward A High-Value Care Strategy Begins in the Lab: 3 Steps to more efficient, effective patient care

The following is a guest article by Diane Janowiak, Senior Director of Client Solutions, hc1.

For healthcare organizations to succeed in an era where they are expected to deliver optimal patient results at the lowest cost, they need to abandon traditional low-value care models, which are characterized by patient care that does not lead to better outcomes. This inefficient practice can be detrimental to patients and costs the healthcare industry more than $340 billion per year.

Understanding how this process occurs — and how to eliminate it — is the first step toward implementing a high-value care strategy that works proactively toward lowering costs and improving results. And the best place to start is the lab, where blood and test utilization are responsible for most of the waste and inefficiencies that reside across the healthcare industry.

With the right infrastructure and processes in place, healthcare organizations can draw on the power of lab data and realize near immediate return. The following three steps provide a foundation for reducing costs, guiding physician behavior, fueling growth, and delivering on the promise of high-value care.

  1. Cut Back on Needless Testing

Diagnostic testing represents the majority of healthcare activity today. However, despite the large amount of diagnostic data available to help study testing patterns and trends, very few healthcare leaders have the capabilities to turn this information into actionable insights. Lab tests take up as much as 5% of a hospital’s budget — yet between 30% and 50% of these tests are unnecessary.

The reality is that physicians base 80% of lab recommendations on traditional practices — many of which lead to inefficiencies or unnecessary testing that does little to improve a patient’s outcome. For example, one study found that healthcare professionals may inappropriately request tests for non-evidence-based medicine because of risk avoidance, lack of experience, uncertainty, lack of awareness of guidelines or the cost of investigations, as a consequence of protocol-based requesting, as a result of patient or peer/supervisor pressure, or a lack of awareness of recommended repeat-testing intervals.

As Medicare claims change the way lab tests are handled, having a clear picture of utilization trends is critical to reducing low-value care activities. Transparent views can help healthcare professionals identify where waste is occurring and opportunities for process improvement by categorizing test orders by physician, specialty, and diagnosis. Ongoing analysis can uncover such information as:

  • physicians ordering the least-common tests for a specific diagnosis
  • why inappropriate test ordering is occurring
  • repetitive or duplicative tests

By implementing a high-value care strategy and a focused monitoring of testing insight, organizations can be proactive when it comes to physician ordering patterns, thereby reducing costs and helping to improve outcomes for patients.

  1. Reduce the Cost of Wasted Blood

Appropriate blood utilization is also a key pillar of a high-value care strategy. Because most physicians and nurses are not formally trained in ordering or administering blood products, inappropriate rates of utilization can run as high as 50%. As a result, the average healthcare organization wastes approximately 10,000 units of blood per year at up to $400 per unit — a heavy cost that can be prevented with the right processes in place.

Healthcare organizations can practice effective blood utilization by monitoring volumes of usage across all departments, facilities, and locations. Executives can then share this data with ordering physicians to make positive changes toward high-value care.

By monitoring crossmatch ratios and transfusions, healthcare leaders can eliminate the manual number crunching and rely instead on automated and continuous monitoring. This will help create alerts whenever benchmarks are violated or unnecessary transfusions are ordered, which could lead to the creation of education-based programs to help eliminate these mistakes.

In addition, real-time monitoring of blood product waste helps healthcare organizations take a proactive approach to spikes in waste, enabling them to resolve potential issues before they become costly. Real-time monitoring also allows medical professionals to get to the root of what caused the increase — internal error, expiration date, etc. — and make the necessary corrections.

  1. Build A Governance Program

Because leadership is crucial when implementing high-value care programs, it is important to form a governance committee led by the organization’s Chief Medical Officer and that includes leading physicians.

The committee should be well-represented with members from the care teams, data/analytics teams and clinical working groups from imaging and labs. In order for the governance program to work properly, it needs to be incorporated into the leadership branch of the entire organization, where it has the authority to make changes and can receive support from the administration, finance, IT and quality control departments.

The overall goal of this program is to prioritize and support high-impact, high-value projects that promote safe, effective, and efficient use of resources, including blood testing.

Reducing Lab Spend

Addressing blood and lab utilization issues in a high-impact, evidence-based way is foundational to any high-value care model.

By reducing unnecessary testing and blood waste, organizations will run more efficiently and lower costs while providing patients with a higher quality of care — the goal of any healthcare organization.

Moving in this direction takes time, planning and the right solution — but if done well, it can save organizations time and money while allowing patients to reap the benefits.

About Diane Janowiak

Diane Janowiak, MT(ASCP), is senior director of client solutions for hc1, which provides critical insight, analytics, and solutions for precision health.

   

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