This is the age of advanced analytics in healthcare: population management, predictive analytics, personalized medicine, and clinical decision support. Laboratory analytics are a dominant — in fact, disruptive — solution well-suited for many health systems.
The massive upheaval in healthcare payment and delivery has accelerated in recent years. In a financial sense, going from fee-for-service to value-based care is an inversion. Fee-for-service is essentially managing to the top line, and it’s been very fragmented. Doctors and providers are paid for everything they do, regardless of quality. In the value-based world, to which things are rapidly moving, you’re paid essentially for your bottom line, and outcomes are critical. Fee-for-service is not gone yet, but in 2015 Medicare stated that by 2018, a large share of reimbursements are going to be tied to value.
The case for a new era in analytical tools
Not only is value-based payment here, but population health management is the new mandate. As David Nash, MD, MBA says, “No outcome, no income,” meaning that there is nothing more important than this move to population health.
“No outcomes, no income.”
To be driven by outcomes has important implications. Certainly this is being felt in the laboratory. Healthcare providers are struggling in terms of what they have to do for care delivery, as well as how they manage their costs. Operational efficiencies have been a big part of managing the lab for a number of years, but things have become more urgent.
Testing utilization management — certainly in molecular — is something payers have been demanding. And, there’s a notion, which extends beyond the laboratory, that if services and specialties can’t demonstrate their value to payers and health organizations they will be fully commoditized, driving reimbursements further down.
Healthcare providers have to improve their outcomes. In order to manage a population, they have to be able to project, and of course manage down, the population’s cost. Then, they have to know what their clinical costs are and focus on avoiding them. All of this makes the case for a new era in analytical tools.
For more of Dr. Herriman’s insights into the new era of analytical tools, download “Advanced Laboratory Analytics — A Disruptive Solution for Health Systems“.