How Can We Reduce Unnecessary Lab Testing?
Laboratory tests provide doctors with crucial information for diagnosis, monitoring disease progression, evaluating organ function, assessing risk factors for diseases and more. Laboratory testing can be reassuring, however, it is often deemed unnecessary.
In this short episode recorded at HLTH, we’re going to talk about laboratory test optimization. How can it be done without undermining clinical autonomy, what kind of real-time insights can be offered to doctors with tech and more. You will hear from Pam Stahl, President of of Avalon Healthcare Solutions - American Lab Insights Company, that help payers and providers optimize treatments, improve outcomes, and drive down overall cost.
Laboratory tests provide doctors with crucial information that aids in several aspects of patient care. Here's a breakdown of what these tests can reveal:
Diagnosis of Diseases and Conditions: Lab tests can help confirm or rule out the presence of a specific disease or condition. For example, blood tests can diagnose conditions like diabetes, HIV/AIDS, anemia, or thyroid disorders.
Monitoring Disease Progression: Once a diagnosis is made, lab tests are used to monitor the disease's progression. For example, cancer markers are monitored to assess the effectiveness of treatment.
Evaluating Organ Function: Tests like liver function tests and renal panels provide insights into the health and performance of organs such as the liver and kidneys.
Checking for Infection: Cultures, antibody tests, and PCR tests can identify infections caused by bacteria, viruses, fungi, or parasites.
Assessing Risk Factors: Lab tests can identify risk factors for disease. For instance, lipid profiles can determine the risk of cardiovascular diseases.
Monitoring Treatment Efficacy: Doctors use lab tests to see how well a treatment is working. For example, measuring blood sugar levels in diabetic patients helps in adjusting medication or dietary recommendations.
Preventative Screening: Regular tests like cholesterol checks or Pap smears can catch potential health issues early, when they're often easier to treat.
Allergy Testing: Specific tests can identify allergies to foods, environmental factors, or medications.
Blood Clotting Tests: These tests assess how well blood clots, important in conditions like hemophilia or for patients on blood thinners.
Genetic Testing: To identify genetic disorders or predispositions to certain conditions, aiding in personalized medicine.
Here is a summarized version of the interview with Pam Stahl:
Avalon Health Solutions is renowned for turning lab results into actionable, real-time insights. Could you explain what that means and the value it brings to clinicians skilled in interpreting lab results?
Let's look at the broader problem: annually, 14 billion lab tests influence 70 percent of clinical decisions, yet 30 percent are unnecessary. Avalon stands out as the only end-to-end lab benefits management company. We craft clinical policies with top lab experts, which we then use to evaluate claims from health plan clients, ensuring the accuracy and appropriateness of the tests ordered and their subsequent interpretations in line with health plans and patient needs.
When an unnecessary test is ordered, what's the consequence? Is the cost denied?
Avalon doesn't adjudicate claims. We assess them against clinical policies and advise health plans and providers on the scientifically and medically appropriate tests and their interpretations.
How do you bridge the gap between the tests that should be ordered and the doctor's decisions?
Avalon facilitates a learning curve for providers by offering specific data that guides appropriate test ordering. We tackle both overuse and underuse of lab tests. For example, 75 percent of routine or negative tests are often unnecessarily reordered, and 55 percent of the time, there's an underuse where tests that should be ordered are not.
In what areas are lab tests frequently underordered?
Cancer detection is a prime example. Certain tests are crucial for identifying the right targeted therapies, yet the vast array of tests makes it challenging for physicians to stay informed about the most appropriate ones to use.
Besides cancer, where else do you see the potential for optimizing lab result utilization?
We're particularly excited about leveraging lab data for predictive purposes. For instance, we've piloted projects that help identify patients at an early stage who are likely to develop chronic kidney disease, allowing for earlier intervention.
Do you also compile patient profiles based on lab results for better predictions?
Yes, our predictive analytics and data engine enable us to track lab values over time and guide health plans and providers to offer tailored patient care paths, such as for chronic kidney disease.
What strategies are you using to expand your customer base?
Our client base is expanding rapidly, now encompassing over 33 million members through our health plan clients. A significant challenge is scaling our operations to keep pace with this growth.
Tune in to the full episode:
Show notes:
[00:02:04] - Introduction to Avalon Health Solutions and their role in generating actionable insights from lab results.
[00:02:21] - Discussion on the big picture problem in healthcare: the overuse and underuse of lab tests and the drive towards improving clinical decision-making.
[00:03:25] - Clarification on Avalon's approach to managing unnecessary tests and their non-involvement in claims adjudication.
[00:03:49] - Explanation of how Avalon provides guidance on appropriate test ordering and interpretation based on evidence-based medicine.
[00:04:20] - The learning curve for providers in test ordering and the issue of test misuse.
[00:05:16] - Areas where lab tests are often underutilized, particularly in cancer diagnosis.
[00:05:45] - The potential of using lab data predictively, with a focus on chronic kidney disease.
[00:06:20] - How Avalon creates patient profiles and uses predictive analytics to improve healthcare management.
[00:06:53] - Avalon's ongoing development of predictive models and their impact on healthcare.
[00:07:36] - The challenge of changing the status quo in lab test utilization and the cost savings involved.
[00:07:47] - Avalon's growth and the scale of their operations, with a client base of 33 million members.
[00:08:00] - The role of patient engagement and communication strategies in healthcare management.
[00:08:41] - The importance of accurate and clear communication channels with patients to avoid confusion.
[00:09:08] - The rapidly evolving field of genetic testing and Avalon's role in managing the abundance of available tests.
[00:10:07] - Addressing concerns about over-systemizing lab test ordering and the potential for provider friction.
[00:11:13] - Feedback from clinicians and Avalon's clinical advisory board on the impact of their services.
[00:11:55] - The broader implications of cost savings and sustainability in healthcare through better lab test management.
[00:12:11] - In-depth look at predictive analytics and its application in healthcare outcome improvements.
[00:13:18] - Strategies for Avalon's customer expansion and managing growth.