Cultivate stronger population health outcomes with low-cost interventions

As healthcare moves toward value-based care models, effectively leveraging lab data to manage chronic conditions like diabetes, chronic kidney disease (CKD) and heart failure has become crucial for payors and providers. That’s due to the staggering financial implications to the entire healthcare ecosystem.

Chronic conditions and mental health conditions account for 90% of the $4.5 trillion annual U.S. healthcare costs. Diabetes alone, a condition affecting 38 million Americans, costs the U.S. nearly $413 billion yearly. These figures are expected to rise significantly in the coming years.

During a recent “Leveraging lab data to manage chronic disease and optimize risk agreements” webinar, Dr. Mark Reardon, a Value-based Care advisor from ClosedLoop, and Laura Doyle, Senior Director of Physician Health Systems and Value-based Care at Labcorp, discussed how integrating lab data can help organizations with their population health initiatives and support improved care management, coding accuracy and quality metrics.

Industry challenges driving the need for better data

Along with the aforementioned rising tide of chronic disease, other serious challenges continue to impact the healthcare industry today, affecting payors, providers and patients alike:

• Persistent high utilization. Many plans anticipated a spike in utilization as patients returned for deferred care post-pandemic, but the rebound has been steeper and more sustained than expected. Elective procedures and advanced imaging specialty consultations have not only normalized, but in some cases, they have exceeded pre- pandemic baselines. This has increased medical costs and pressured margins for accountable care organizations (ACOs) and risk-bearing provider organizations.
• Policy uncertainty. There is ongoing ambiguity around whether the Centers for Medicare & Medicaid Services (CMS) will double down on value-based care models or adjust payment approaches. This uncertainty makes it especially challenging for payors to form long-term strategies and completely invest in initiatives that hinge on regulatory signals. For example, initiatives like the CMS-HCC V28 risk adjustment model update is set to recalibrate condition hierarchies and coefficients as more stringent quality measure benchmarks require evolving care delivery models. Any future changes to these models will affect not only care strategies, but also how they are implemented and their payment approaches.

These will all impact financial margins, as well as patient treatment plans and costs. The good news? Lab data can help.

The singular power of lab data insights

One of the critical advantages of incorporating lab data is the ability to detect rising risk earlier than claims data alone, even though many have invested in claims-based infrastructures for risk prioritization and predictive analytics. Lab data is a powerful tool that adds actionable insights by broadening the patient profile and adding deeper context to what traditional claims data provides. 

Metrics like glycemic control, renal function panels and lipid profiles allow you to proactively identify members trending toward higher risk before utilization patterns emerge.

National laboratory databases contain billions of standardized data points in real time, enabling more effective and timely monitoring and preventative interventions. National data also allows for out-of-network data integration so you can consolidate patient records across providers into a single standardized database, giving a comprehensive view of each patient's health history.

Practical, scalable applications of lab data

Lab data offers three practical, scalable ways healthcare organizations can leverage lab data to achieve their goals:

1. Risk stratification. By aligning lab results with existing patient coding, organizations can support appropriate risk adjustment and anticipate future care needs. This enables early detection of high-risk patients, more accurate prediction of disease progression and better allocation of care management resources.

2. Care gap closure. Lab data can help you identify patients missing crucial diagnostic screening, offer follow-up test capabilities, and implement targeted interventions. Working with a lab to offer home-based test kits and specimen collection, like dry blood spot A1C tests, can help close gaps in care for patients who face barriers to visiting clinics. Lab data can also help pinpoint gaps in care across regions, states, payor organizations and ACOs. 

3. Coding accuracy. By analyzing lab data alongside coded diagnoses, organizations can identify missed coding opportunities and their associated patient and financial impacts. Matching lab data to ICD10 codes allows for tighter tracking of disease severity and care outcomes over time. It can also improve clinical condition recapture opportunities, risk adjustment accuracy, and offer better alignment with quality measures in value-based care contracts, while reducing miscoding and inappropriate reimbursement.

The path forward for payor and provider organizations

Partnerships with national labs offer a relatively low-cost way to enhance data resources. By tapping into the power of lab data, payors and providers can cost-effectively form strategies to improve population health.

In the shift toward value, integrating this clinical data into existing workflows allows for proactive, personalized and patient-centered care management. Using pre-built analytical tools, you can implement targeted interventions based on data insights and optimize treatment plans.

With lab data, you can proactively build gaps in care strategies throughout the year instead of waiting until year-end, also allowing you to gain more information about your customer base to actively target them in future programs. Practical tools like home testing kits and specimen collection help overcome patient barriers and increase engagement at a relatively low cost, impacting Star and HEDIS ratings. 

Targeted gaps in care programs also allow you to monitor and measure campaign outcomes by tracking quality metrics, assessing financial impact and evaluating patient engagement. This makes it possible to constantly refine and evolve future programs.

The impacts of these programs go beyond cold, hard data—they positively affect patients’ quality of life and finances. 

Case studies show real-life patient and financial successes

Real-life case studies demonstrate the impact of lab data integration.

CHAS Health 

It's important to understand which risk and disease factors impact your local community in near-real time so you can help prevent them from getting worse with targeted intervention. 

CHAS Health, a Federally Qualified Health Center, worked with Labcorp to help implement a tailored home specimen collection program for diabetes patients facing transportation issues and other barriers in Washington state.

By leveraging Labcorp's analytics and home testing capabilities, they were able to pinpoint high- and rising-risk patients overdue for A1C testing and mail them home test collection kits. CHAS Health achieved a 34% kit return rate in the second year of the program, helping drive better diabetes control, improve access to care and better monitor some of their most vulnerable populations. This helped cultivate a healthier, thriving community. 

National provider organization

A provider group used Labcorp's data to reveal 63% of diabetic patients and 72% of CKD patients went uncoded. This represented a significant missed opportunity for both patient care and appropriate reimbursement. 

Addressing this coding gap allowed the organization to substantially improve clinical outcomes and was estimated to yield a $14 million annual revenue improvement.