Rahul Singal, MD, joined Avalon Healthcare Solutions as its chief medical officer in 2021. Dr. Singal has more than 20 years of health care experience as a scientist, practicing internist, health plan medical director, and health care information technology entrepreneur.
Rhonda Willingham, RN, BSN, joined Avalon Healthcare Solutions in 2020 and is the executive vice president of sales and marketing. Rhonda has more than 25 years of experience partnering with health plans and provider organizations with a focus on driving clinical, financial, and operational value-driven results for populations.
COVID-19 has changed how we think about and deliver health care. One of those changes is the acceleration of the adoption of value-based care models.
In the new value-not-volume world, the success of value-based health care hinges on having the right data. More than 13 billion clinical tests are performed each year and an estimated 70 percent of clinical decisions are based on lab testing.
However, lab test results are primarily given to the ordering clinician and only occasionally to the patient. They are not captured and digitized at a population level in near real time. Hence, the lab test results are locked and not used to their full potential.
Now, by using lab claims, including CPT codes, member and ordering information, and digitized lab results from outpatient lab partners, we can ensure the right test is ordered, digitize the lab values, apply algorithms to gain meaningful intelligence, and deliver actionable insights to key stakeholders.
Having the right data can make a significant difference toward value-based care, especially where lab values are being used to manage complex conditions, such as chronic kidney disease (CKD), cancer, and diabetes.
Chronic kidney disease
According to the U.S. Centers for Disease Control (CDC), as many as 90 percent of people with CKD are unaware, and when patients are diagnosed, it is usually at stage three or later. Leveraging lab results earlier and using lab values to look across more than one episode of care improves the early identification of the CDC-established health parameters to diagnose patients and effectively slow the progression of CKD.
Consider a 45-year-old female who goes to her doctor where a lump is discovered during a routine breast exam. A biopsy is sent to the hospital pathology lab for analysis of the tissue and reveals stage two breast cancer. In addition, the cancer biopsy tissue is sent to a genetic lab provider for genomic testing.
The provider refers her to genetic counseling. Her genetic test results, combined with other meaningful treatment information, then result in lab insights that can accelerate value-based care with actionable data to help inform the treatment course. Presume the test result is consistent with “chemotherapy does not improve outcomes.” For patients who have this particular result, chemotherapy is not indicated because there is a very low recurrence of metastasis.
When it comes to type 2 diabetes (T2D), there are key process measures that improve outcomes, such as an annual A1c test, annual lipid profile, and biannual checkups. Each process measure serves as a quality-of-care indicator.
Providers ideally perform these activities during patient visits. When looking at visit data, quality-of-care indicators, such as whether providers are performing all three process measures for T2D, can be seen. Drilling down into the digitized lab data allows for the identification of high-quality providers and how they are delivering patient care. The true outcomes of that care can be examined when looking at practice patterns. Whether the provider adjusts treatment decisions based on lab values can be seen by looking at prescription-level data.
Use of lab values will dramatically move the needle on realizing the success of value-based care by connecting traditional processes with improved outcomes.