The devil is in the data: How to eliminate information siloes to boost patient care and elevate the bottom line
As the healthcare industry shifts from a volume to value-based payment model, new economic incentives have evolved to drive a higher level of service among patient, provider and payer relationships.
At the same time, healthcare organizations must look for ways to grow while becoming more efficient and reducing costs.
In other words, healthcare organizations today must begin to act more like businesses by providing the best customer experience possible at a sustainable cost.
This shift requires a new customer-focused mindset that can create challenges for labs, which often lack real-time insight needed to better evaluate staffing levels, understand ordering patterns, maximize reimbursements, and conduct business reviews for clients.
The silver lining is that the typical lab houses an abundance of clinical and business data needed to succeed in today's new healthcare environment. The key is being able to unlock the power of this data.
In general, lab data today is siloed and inaccessible. Much time is spent gathering data, receiving incoming calls, and searching through paper records. While a lab may already employ several systems such as LIS, billing, and case tracking solu-tions, the challenge lies in unifying this data to uncover trends and challenges in real-time.
Innovative labs are taking a page out of the business playbook and implementing lab-specific customer relationship management (CRM) solutions—also called healthcare relationship management (HRM) solutions. These solutions consolidate data silos and bring long-sought visibility into what's going on in the lab.
Here are a few ways labs are benefiting.
Cutting Costs by Understanding Workflows
An HRM can enable lab directors to accurately visualize the busiest times for busi-ness by tracking workload volume and turnaround times by the hour and day of the week. Staffing directors can then use this data to increase staff during peak hours or when turnaround times are lacking. Rearranging staff hours streamlines internal processes and increases efficiency across the entire team.
One large healthcare organization decided to implement an HRM to consolidate critical and urgent test reporting from 10 separate test labs in an effort to stream-line workflow and improve customer service. The HRM gave the organization in-creased transparency, accuracy, and compliance across all locations, and reduced issue resolution time by 60 percent.
Automating Quality & Utilization Management
CLIA-certified labs are subject to ongoing quality inspections required to remain in operation. Because data often is siloed and inaccessible, it's not uncommon for labs to shut down any initiatives outside of its core testing processes in order to gather and report on key performance indicators (KPIs) needed for inspections. These reports often rely on "hindsight" metrics uncovered by a team of analysts.
An HRM platform can eliminate manual work by automatically translating data into insight and make trends available via real-time dashboards. Lab directors can take immediate action based on any findings and track those interactions within the HRM so all stakeholders can see exactly what steps are being taken to tackle any issues.
An HRM platform also facilitates important utilization practices, which boost productivity by measuring over-utilized, under-utilized, antiquated, or unreim-bursed tests, giving lab directors the information needed to guide ordering physi-cians towards more efficient and profitable ordering practices.
For example, Sonora Quest Laboratories (SQL), located in Arizona, found that cli-ents were ordering duplicate tests and standalone assays instead of pre-defined screens. This resulted in high volumes of under-reimbursed tests. After implement-ing an HRM platform, what used to take the lab five hours daily to pull performance reports, now takes just 45 minutes. The lab was able to identify providers with the highest under-reimbursed test volume and work with these accounts individually to educate them on more cost-effective test ordering processes.
Boost Reimbursements with Real-Time Analytics
To counterbalance declining reimbursement rates, labs can use an HRM platform to generate data-backed analytics showing how to maximize reimbursements from ex-isting accounts.
Maximizing reimbursements is possible by understanding metrics—such as physician ordering patterns, reimbursed test volumes, and frequency of unreimbursed tests—then educating providers about which tests to order in place of unreimbursed tests.
Gaining real-time insight into ordering patterns also enables lab directors to flag ordering errors—such as incorrect coding—and assign actionable follow-up before it's too late.
For example, Incyte Diagnostics, a leading clinical pathology laboratory in Spokane, Wash., found that ordering physicians were sending in unnecessary, antiquated tests that were costing both the lab and physicians money. Using actionable reports housed in their HRM platform to identify areas of over-utilization, reps were able to train ordering physicians on new, efficient ordering processes. Armed with data and documentation, the lab is able to deliver up-to-the-moment reports outlining this training and education to their top payers. The lab's insurance providers worked directly with the internal team to retroactively authorize reimbursements and pay-ments, creating a new process for reimbursements across the entire lab.
A promising future relies on holistic in data
The healthcare industry is at a tipping point. With new CMS rules expected to re-duce lab test fees by more than $5 billion over the next 20 years, labs must look for new ways to grow and be profitable.
Cutting costs, automating internal quality processes, and maximizing incoming re-imbursements will be necessary to survive. Implementing an HRM platform will be an important tool to enable lab directors to make faster, better decisions that drive higher quality, superior care, and a more profitable business.
(About the author)
Diane Janowiak, Vice President of Premium Client Solutions at hc1.com the world's leading healthcare relationship management platform.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
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