3/18/2016. Laboratory Outreach Challenges, Solutions and Future Survival Strategies. Learning Objectives. Outreach - Defined

Transcription

1 Laboratory Outreach Challenges, Solutions and Future Survival Strategies Jane M. Hermansen MBA, MT(ASCP) Learning Objectives Describe laboratory outreach challenges in today s healthcare environment Identify the transition and evolution of outreach processes caused by the changing roles of healthcare providers and patients Establish a strategy to enhance laboratory value and future diagnostic integration Outreach - Defined Outreach is: Testing that is sent to the laboratory at the discretion of the customer Owned provider (a.k.a. in-reach ) Non-owned provider Facility Patient Payor Other (employer) Outreach is not: Emergency Department Same Day Surgery Observation Room (True) Hospital Outpatients 1

2 OUTREACH CHALLENGES Competition Changing face of laboratory outreach competition: Horizontal competitors are like competitors, providing an equivalent product at a similar price. Substitute competitors are those that provide a similar service, but it is delivered in a different manner, typically at a lower price. Vertical competitors are those that impact the profitability (contribution margin) of the laboratory. Industry consolidation and contraction Health system formation and integration Hospital purchases Culture Adaptation Change Clash Consolidation Kaufman, Hall & Associates, LLC 2

3 Payor Constraints Steerage Ask your doctor to use in-network labs. You ll pay less. Exclusivity Heavy-handed contracting approach (Anthem BCBS/IN) Uniform fee schedule for hospital testing a test that may have cost $400 at an out-of-network laboratory would cost as little as $45 for a patient reducing their out-of pocket costs from as much as $120 to $4.50. Godfather-like offer that they can t refuse. Rate cuts of 50-80% Increasing power via payor consolidation (pending) Aetna/Humana Anthem/Cigna Cost-conscious patients Rising out-of-pocket responsibility Premium Deductible Co-insurance Consumerism Co-pay Hospital-centric laboratory model is viewed as expensive Cost-conscious Consumers >75% of exchange customers list premium and out-ofpocket cost as extremely or very important Range of benefits (61%) Choice of providers (60%) 3

4 Increasing Medical Debt Unexpected medical bill (not covered by insurance) = $1,500 31% pay it off without going into debt 43% would have to go into credit card debt or borrow money to pay it 15% would not be able to pay at all Commoditization of Laboratory Testing Incorrect public perception of Medical/Clinical Laboratory Science Perceived quality or value via standard accreditation organizations Carve-outs Disruptive models Retail Clinics Direct Access Testing Commodities are most susceptible to price-shoppers Inflexible Organizations 4

5 HEALTHCARE EVOLUTION AND THE IMPACT ON OUTREACH PROGRAMS Shifting Provider Relationships Organizational ownership of providers has shifted outreach focus to inreach Expectation that providers will use all ancillary or support services of parent organization Health System Infrastructure Built-in Integrated Delivery Network or Health System capabilities: Information Technology Logistics Multiple patient access locations Provider relationship management Shift in Focus from Sales to Service Not limited to laboratory 5

6 Patient-Focused Communication Don t rely on your brand only 53% are loyal to primary care but would switch if they had a compelling reason* 1. No longer accept insurance 2. Cost >$250/year additional 3. Error/poor experience Address price-sensitivity Combat steerage Support consumerism *The Advisory Board Company Annual Enrollment Cycle of Patient Choice and Points of Contact The Advisory Board Company The Advisory Board Company ENHANCING VALUE AND INTEGRATION VIA HIGH QUALITY DIAGNOSTICS 6

7 What Does the Lab DO, Anyway? American Osteopathic Association Awareness Campaign The lab does not diagnose a person. I DO Lab tests don t care. I DO. Realigning the Purpose of Laboratory Testing The Power of Laboratory Data IF KNOWLEDGE = POWER AND LABORATORY DATA = KNOWLEDGE THEN LABORATORY DATA = POWER 7

8 ABILITY TO IMPACT 3/18/2016 The Laboratory and the Continuum of Care Source: Sg2.com High Value Diagnostics Support population-based initiatives Population Health Management Triple Aim Proactive Population Health Management 80% OF COSTS SITUATIONAL RISK Family Hx Environment EARLY RISK Diet Exercise HIGH RISK Cholesterol BP Blood sugar SYMPTOMATIC ILLNESS Active Dz Diabetes COMPLEX ACTIVE ILLNESS LIFETIME 8

9 The Triple Aim (Institute for Healthcare Improvement) Improving the patient experience of care Improving the health of populations Reducing the per capita cost of health care High Value Diagnostics Support population-based initiatives Population Health Management Triple Aim Advancing technology Personalized medicine -omics Wearables Payment models Shift to prevention Reward wellness Patient Engagement "I deserve more. I want to be healthy. I want to help manage my care and my health. I want to see every piece of data you have. The Patient of the Future, Gienna Shaw, HealthLeaders Media, September 10,

10 Lab s Role in New Payment Models Value-Based Reimbursement Bundled Payments ACOs Total cost of care Contact Information Jane M. Hermansen, MBA, MT(ASCP) Manager, Network and Outreach Development hermansen.jane@mayo.edu herm Mayo Medical Laboratories 3050 Superior Drive NW Rochester, MN Phone: Toll free: Title Text 10