Perspectives  from  the  System  Level,  Provider  leadership,  Quality  

and  Value  Owners  Ilan  Rubinfeld,  MD,  MBA,  FACS,  FCCP,  FCCM  

Chief  Medical  Officer-­‐  Associate  Henry  Ford  Hospital,  Detroit  

Executive  War  College,    New  Orleans,  2017  

Plan  for  the  Conversation  

!  Overview  from  the  the  perspective  on  laboratory  medicine  from  the  system,  hospital,  quality  and  medical  leadership  

!  Creating  your  LAB  2.0  infrastructure  and  pipeline:  people,  process,  governance,  software,  projects,  project,  project,  data,  data,  data  

!  Tools  in  action:    Projects  from  the  tools  and  learning  perspective  

What  laboratorians  think  of  themselves    

3  

People  are  always  so  angry  when  they  call  

How  do  we  get  past  all  of  the  pushback?  

Why  do  they  keep  doing  all  of  these  useless  

test?  

That  test  became  irrelevant  10  years  

ago…  

Why  don’t  I  get  invited  to  the  decision  table?  

Does  anyone  understand  how  valuable  we  are?  

I  want  to  be  a  profit  center  again  

How  clinicians  (often)  see  laboratorians…  

4  

Difficult  to  contact  the  lab..  

Don’t  understand  technology..  

Difficult  to  collaborate…  

Resistance  to  change  …  

Why  don’t  you  come  to  the  room  and  tell  the  paIent  why  you  aren’t  running  this  lab?  

Did  they  cancel  my  lab  again?  

Insufficient????  I’ll  show  you  insufficient!  

Not  paIent  focused  

How  the  Clinicians  see  themselves…  !  

5  

As  a  doc,  I  face  the  paIent  and  their  families  in  this  

consumer  oriented  nightmare  we  call  modern  healthcare  

Your  liPle  microscope  is  cute,  but  I  operate  with  

a  robot  

I  take  the  Hit  each  and  every  Ime  the  Lab,  Pharmacy,  or  

Radiology  don’t  do  what  I  tell  them…  

You  guys  are  a  liability,  when  we  get  into  bundled  care  I  don’t  even  want  you  in  the  

room  

Each  day  is  like  the  Lord  of  the  Rings,  or  Star  wars…  I  am  on  an  holy  quest  to  save  my  

paIent  

Lab  is  not  going  to  tell  me  how  to  pracIce  

medicine  

Pain:    across  the  system  and  where  lab  rests  in  the  ”pain  milieu”  Value  is  a  nebulous  concept  Unpredictable  competitive  markets  Unstable  assumptions  impede  forecasting  and  planning  

Revenue  ceiling  is  easier  to  find  then  limits  on  expenses  Everyone  wants  to  be  a  loss  leader  We  never  have  enough  data  that  transitions  to  insight  and  knowledge  The  payors,  pharma,  device  industry  all  invests  heavily  in  analytics,  and  we  are  behind  in  this  analytics  arms  race  to  insight  

Lab  is  just  one  of  the  many  expenses  In  a  “lab”  pursuit  of  excellence,  the  clinical  and  operational  needs  may  be  secondary.  No  offense  please,  but  lab  doesn't  exactly  make  for  great  eye  candy  on  a  marketing  or  philanthropy  campaign  

The  great  semantic  game  leading  to    Pain  in  any  Value  Future  

!  In  every  other  industry  and  economic  discussion  Value  is  an  euphemism  for  “cheap”  

!  Only  in  healthcare  is  it  rolled  into  an  expectation  of  increasing  quality.  

!  The  frame  of  reference  has  been  co-­‐opted  by  the  payors  −  Decrease  cost  sound  like  a  universally  good  thing  −  But  we  must  learn  via  Google  translate:    they  mean  our  

Revenue!  

Revenue  

Gain:    What  do  we  hope  lab  and  lab  informatics  can  do  for  us?  !  Keep  the  spend  down,  as  you  always  have  !  Be  lean,  model  lean,  and  teach  everyone  else  how  to  be  lean  !  Partner  with  other  “expenses”  and  clinical  drivers  of  utilization  to  

decrease  utilization  across  the  board  !  Develop  and  drive  a  “value  engine”:    enabled,  empower,  inspired  

by  lab  and  lab  informatics  to  work  these  utilization  projects  across  the  expense  spectrum:    ambulatory  to  inpatient,  population  to  acute  −  Population  is  now  a  nebulous  term:    all  of  primary  care?    Just  members  of  

an  at  risk  contract?    ACO?  HMO?    

SWOT  Analysis:    HFHS  as  a  system  and  Lab/Lab  Informatics  

Strength  

• HFHS  •  Lab/Lab  InformaIcs  

Weakness  

• HFHS  •  Lab/Lab  InformaIcs  

Opportunity  

• HFHS  •  Lab/Lab  InformaIcs  

Threats  

• HFHS  •  Lab/Lab  InformaIcs  

SWOT:    Strength  

Health  System    •  Excellent  Care  and  Outcomes  •  Quality  and  Reliability  Focus  •  Collaborative  Improvement  Culture  •  Strong  Core  Values  •  Mission  Driven  •  Succeeding  with  Growth  Initiatives  •  Improved  Financial  position  

Lab  and  Lab  Informatics  

•  Excellent  quality  •  Excellent  performance  metrics  •  Financial  strength  and  vitality  •  Lean  mastery  •  Growth  via  reference  lab  activities  •  Growth  via  new  projects  (precision  medicine)  

•  Increasing  collaborative  presence  

SWOT:    Weaknesses  Health  System    

•  Uncertainty  and  Unpredictability  •  Single  Payor  dominance  •  Increased  competition  for  less  commercial  patients,  and  the  suburbs  are  really  pretty  

Lab  and  Lab  Informatics  •  Inward  focus  •  Non-­‐prominence  in  governance,  provider  and  operational  leadership  

•  Nerd-­‐geek-­‐in-­‐the-­‐lab  •  Making  successes  within  the  department  clear  successes  across  the  enterprise  

SWOT:    Opportunities  

Health  System    

• Growth  •  Referral  •  M  and  A  

• ACA  isn't  dead  yet  • Continue  to  run  faster  then  the  competition  

• New  Technologies  • Acute  care,  emergent  complex  care  

•  Collaboration:    Pharmacy?    Primary  care  •  New  Testing,  Growth,  Referral  (high  margin  testing?)  

•  DATA!  DATA!  DATA!  •  You  know  certain  things  first  •  Retail  

Lab  and  Lab  Informatics  

SWOT: Threats Health  System    •  Risks  related  to  urban  coverage  in  a  potential  post-­‐ACA  world,  less  covered  lives,  less  things  covered  

•  Single  dominant  payor,  gets/seizes  even  more  market  power  

•  Urban  conditions  make  referral  business  difficult  to  maintain  

•  Expenses  continue  to  rise  despite  aggressive  management  (market  manipulative  scarcity  like  the  pharmaceutical  markets)  

•  Can  Providers  alignment  for  to  thrive  in  times  of  change  (We  know  we  must  be  bigger  then  HFMG  alone)  

Lab  and  Lab  Informatics  •  Can  lab  face  the  market  manipulative  scarcity  like  pharmacy?    How  will  that  distort  everything?    Automation?  Lean?  

•  Clinicians  wont  change  and  will  not  partner  •  Retail:    pharmacy?  

Pay  for  Performance  Programs  at  HFHS  Dollars  at  Risk  >  $50M  

•  CMS  Pay  for  Performance  $13.6M  •  Value  Based  Purchasing  (Core  Measures,  Patient  Satisfaction,  

Outcomes,  Spend  per  beneficiary)  

•  Readmissions  

•  Hospital  Acquired  Conditions  (CLABSI,  CAUTI,  complications)  

•  BCBS  -­‐  Hospital  Bonus  $  12.0M  

•  BCBS  Doctor  Group  Bonus  $4.2M  

•  MiPCT    $4.3M  for  Primary  Care  

•  Health  Information  Technology  2011  to  2013  =  $58M    

•   30  Certification  Programs  (P2P)  and  Select  Networks  

•  Lab  and  Lab  Informatics  involvement:  •  HAI  (CAUTI,  CLABSI,  SSI,  MRSA,  CDIFF)  •  Patient  Safety  Indicators:      

•  PSI  9:    Post  Op  Hemorrhage  •  PSI  10:    Post  Op  Acute  Kidney  Injury  •  PSI  13:    Post  Op  Sepsis  

•   Population  Metrics  related  to  •  HgbA1C,  Glucose  Control,  Cholesterol,  etc.  

Lab  testing  -­‐-­‐>  Hospital  quality  metrics  •  Median  Ime  from  ED  arrival  to  ED  departure  •  Diagnosis  of    

•  Central  line  associate  bloodstream  infecIon  •  Catheter  associated  urinary  tract  infecIon  •  Methicillin  resistant  Staph  aureus  bacteremia  •  Clostridium  difficile  infecIon  

•  Blood  cultures  performed  within  24  hours  prior  to  or  24  hours  a]er  hospital  arrival;  in  ED  prior  to  first  anIbioIc  received  

•  Screening  for    cervical  and  colorectal  cancers  •  Comprehensive  diabetes  mgmt  (HbA1c)  

15  

Help  Us  Build  Value  

!  In  a  parade  of  expenses  be  the  prize  winning  float  !  Cannibalize  yourself:    partner  on  the  “value”  project  !  Leverage  your  Lean  !  Leverage  your  analytics  and  informatics  !  Learn  how  and  then  be  “THE”  partner!,  remember:  Radiology,  

Pharmacy,  Cardiac  Testing  are  all  breathing  down  your  neck  !  Find  ways  to  create  growth,  bring  in  patients  and  business:    new  

medical  records,  high  margin  testing  !  Challenge  the  traditional  ROI  

Lab  2.0  Infrastructure:    People,  Process,  Technology  

FickenscherK,  BakermanM.  Physician  Exec.  2011  Jan-­‐Feb;37(1):73.  Trastek  VF,  et  al.    Mayo  ClinProceed.    2014;89(3):374-­‐381    

People  

Process  Technology  

Change  Management  

Process  Improvement  

Strategic  Planning  

P6:    LUTF:    The  System  Lab  Utilization  Task  Force:  The  activated  clinical  leadership  •  Stage  of  Development:    

Launched,  Here  to  stay,  a  proven  team  that  gets  the  job  done,  a  trusted  and  sought  after  partner,  needs  more  resources  and  clinical  actors  to  mature  further  and  take  on  more  projects  of  bigger  scope  

•  Targeted  Metrics:  •  Projects  completed  •  ROI  in  multiple  formats  •  Publications,  podium  presentations,  system  and  

operational  metrics  

•  Amount  of  Impact:  •  Priceless  

•  Top  Line  Goals  through  2019:      •  Develop  the  pipeline  to  provider  reporting,  

scorecards  and  OPPE  •  Refine  ROI  calculations  based  on  believable  

finance  metrics  •  Focus  on  the  market-­‐basket  improvements  

•  Lets  look  at  tools  in  detail  

• What  are  the  ingredients  in  our  utilization  recipe  for  success?  

•  The  “Perpetual  Stew”  of  LUTF  

Agree  to  a  Collaboration  Framework  

Process  

CommunicaIon  

Roles  and  RelaIonships  

Authority  and  Leadership  

Goals  and  Mission  

Knowledge  $  Relevance  

Identify  the  Common  Goal  

Multidisciplinary  and  collaborative    framework  for  laboratory  testing  

Medically-­‐relevant  

Cost-­‐  effective   Scalable    

and  Integrated  

Evidence-­‐based  

Self-­‐learning  and  Open  

Acquire  Legitimacy:    Stake  your  claim  in  the  governance  model    

PROVIDER  LED-­‐  Focusses  on  exisIng  tesIng  menu  and  find  opportuniIes  to  standardize  and  raIonalize  lab  tesIng  

MulIdisciplinary  

Provider  Council  

Medical  Laboratory  Formulary  CommiPee    

Clinical  EvaluaIon  and  Technical  Assessment  

CommiPee  

Laboratory  UIlizaIon    

Taskforce  

PATHOLOGY  LED-­‐  Focusses  on  send    out  tesIng  and  provision  of  services  within  Pathology  

ExecuIve  leadership    13  members  from  across  hospitals  and  business  units  

Form  a  ‘Steering  Committee’  

• Pathology  CETAC/MLF  

• Project  mgmt.  

• System  Performance  Improvement  

• Project  mgmt.  

• Pathology  &  Lab  Medicine  

• Pathology  Management  

• Providers  • Governance  • AnalyIcs  •  IT/EMR  

Associate  

CMO  Clinical  

Pathologist  

Medical  Technologist  

Project  Manager  

Gather  the  ‘Team’  

Providers  

PaIent  

Laboratory  

Laboratory’s  idea    of  stakeholders  

Medical  Leadership  

EMR  IT  AnalyIcs  Teams  

Finance  Experts  

External  Vendors  

Extended  scope  of  stakeholders  

Define  the  Process  and  Pipeline:    Project  Ideation  and  Intake  

Project  Intake  

Providers:    Residents,  Mid-­‐levels,  Faculty  

Nursing  and  Other  Allied  Care  providers  

Laboratory  

Guidelines,  Evidence  Base,  Choosing  Wisely  

PaIent  and  Employee  Feedback  

Define  the  Process  and  Pipeline:    Project  Review  

Project  

Review  

Finance  

OperaIons  

Evidence  

Pilot  Data  

Usability:    build  implicaIons  

Define  the  Process  and  Pipeline:    Transition  to  pilot  or  fail  fast  

Intake  

Providers  

Laboratory  

Guidelines  

Pilot?  Formal  Project  

Reject/DOA  

ANALYTICS  •  Incidence  •  DistribuIon  •  Affected  party  •  $?  

EMR  •  Reasons?  •  Workaround  ?  •  Timeline?  

Define  the  Process  and  Pipeline:    governance  and  high  level  cover  

Successful  Pilot  

Governance  

DemonstraIon  of  proof-­‐of-­‐concept  and  underlying  

data  

Approval  as  standard  of  pracIce  

Define  the  Process  and  Pipeline:    Spread  and  Hardwire  

Approved  by  Governance  

AdopIon  

ImplementaIon:  EMR  

EducaIon  Roll  out  

Tracking  of  clinical  and  financial  outcomes  

5.  Define  the  Process  

Hardwiring  &  

Conclusion  AdopIon  Governance  Pilot  

Steering  

Group  IdeaIon  

LAB   Providers   EMR   AnalyIc  Finance  

Define  the  Process  and  Pipeline:    Project  Ideation  and  Intake  

P6LUTF.    EMR  Build,  Tricks,  Games,  and  Pitfalls  

Formulary  and  Beyond:  Utilization  options  for  the  EMR  !  If  it  can’t  be  ordered  it  won’t  be  done,  the  formulary  is  very  

powerful  !  Creative  naming  can  help  avoid  inappropriate  ordering  !  Immediate  Alerts  (Best  Practice  Advisory),  Choosing  wisely,  can  

help  cancel  an  order,  or  perhaps  gather  information  on  appropriate  utilization.  

!  Build  type  can  influence  use:    all  blood  products  are  ordered  only  from  an  order  set  to  help  guide  and    

!  Look  for  any  and  all  utilization  opportunities  within  the  EMR  

Pitfalls  and  Watch-­‐outs  

!  Many  ordering  modes  and  methods:  −  Can  modify  a  system  order  and  still  find  it  on  a  preference  list  −  Ordering  from  an  ED  workflow  looks  very  different  from    −  Despite  the  promise  of  order  sets  and  the  control  they  give  over  the  

ordering  process,  utilization  must  be  watched  and  monitored,  the  a-­‐la-­‐carte  order  is  often  quicker  by  providers…    

−  only  force  this  when  you  really  need  to  at  the  system  level.  

!  Flanking  maneuvers  intentional  and  unintentional  −  Upgrades,  refresh  −  Backdoor  orders  

P6LUTF.  Reporting  and  Analytics  

•  Need  many  tools  in  the  tool  chest  •  Different  report  focus  and  perspective  •  Labs,  types,  quantities,  associated  conditions  •  Encounter  and  Episode  reporting  

P6:    Keys  to  success,  maintenance  and  expanding  collaboration  

Labo

ratory   Providers  

CommunicaIon  Pathways  

Aligned  goals  and  understanding  

Data-­‐driven  problem  solving  

Governance  and  process  

Success  in  Collaboration  

•  Face-­‐to-­‐face  interaction  •  Positive  interdependence  •  Individual  accountability  •  Shared  responsibility  and  purpose  •  Norms,  structure,  processes  •  Willingness  to  fail  •  Process  beats  power  

•  Shared  system  Values:      One-­‐Henry    

Watch  out  for  these  or  you  will  hit  a  wall!  •  Not  having  a  clear  authority  and  joint-­‐

ownership  with  Clinical  Leaders  •  Not  triaging  projects  with  actual  data  •  Not  having  a  clear  and  defined  process  

But  the  real  prize  is  the  Project  of  Project:    building  an  enterprise  utilization  infrastructure  for  enduring  value  creation  

For  each  project  we  will  briefly  review  its  main  goal  and  approach,  and  then  discuss  the  tools  for  spread  and  enduring  change  developed  therein.  

P1:    Multiple  Troponin  Syndrome:  Decreasing  the  “third  negative  troponin”  occurrence  

Delays  TAT  in  ER  Labs  and  delays  pa2ent  discharge  

in  the  ED?  

Is  this  appropriate  u2liza2on?  

Increases  troponin  orders  in  the  ER  labs  

Order  of  a  3rd  

troponin  a@er  2  

nega2ves  0  

1000  2000  3000  4000  5000  

HFH   MCT   WBF   WYN  

Third  orders  

Abnormal  

CriIcal  

P1:    Multiple  Troponin  Syndrome:  Decreasing  the  “third  negative  troponin”  occurrence  •  Stage  of  Development:    Launched,  Changes  established,  Handed  off  to  clinical  operational  team  (slight  fumble)  

•  Targeted  Metrics:  •  Business  unit  rate  of  third  negative  troponin  

•  Cost  and  Time  in  Observation  •  Amount  of  Impact:  

•  Working  on  more  robust  ROI  process  •  Total  troponins  down,  but  have  not  captured  LOS  in  recovery.  

•  Top  Line  Goals  through  2019:      •  Get  the  measure  to  stick  on  the  ED  system  council  dashboard  

•  Tools  and  Methods  Acquired:  •  Multi-­‐business  unit  support  •  EMR  build  and  System  Analytics  methods  •  SME  process  for  targeted  projects  •  Handoff  to  clinical  operational  ownership  

P2:    Eliminating  ‘Daily’  Labs:

P2:    Eliminating  ‘Daily’  Labs:  •  Stage  of  Development:    Launched,  Changes  established,  maturing  metrics  for  next  round  Daily  Lab  2.0  

•  Targeted  Metrics:  •  Technical  fix:    no  use  of  “daily”  frequency  in  

order  entry  in  EMR  •  Labs  per  discharge,  labs  per  D/C  after  24  hrs.  

•  Amount  of  Impact:  •  Depending  on  BU  5-­‐10%  reduction  of  total  labs  

per  D/C  

•  Top  Line  Goals  through  2019:      •  Formalize  the  utilization  metric  and  put  in  

clinical  dashboards  •  Develop  more  robust  view  of  encounter  and  

episode  lab  utilization  for  provider  dashboards  with  some  adjustment  

•  Working  on  repeated  labs  like:    CBC  q6  in  GI  bleeds  

•  Tools  and  Methods  Acquired:  •  Multi-­‐business  unit  support  •  Accessed  all  levels  of  governance  across  the  

organization  •  EMR  build  and  System  Analytics  methods  •  SME  process  for  targeted  projects  •  Increasing  sophistication  of  lab  utilization  

metrics  in  collaboration  with  System  Analytics  •  Evolution:  

•  Labs  per  discharge  •  Labs  per  hospital  day  (adjust  for  LOS)  •  Labs  after  24  hours  (adjust  for  maintenance  

which  is  actual  target)  •  Developing  provider  dashboards  with  severity  

adjustment  to  look  at  the  “lab  bucket”  •  Labs  per  anemia  burden?  

P3:    Blood  Utilization:  “7  is  the  new  10”,  and  “waste  not,  want  not”  

P3:    Blood  Utilization:“7  is  the  new  10”,  and  “waste  not,  want  not”  •  Stage  of  Development:    Launched,  and  operaIonal,  improvements  on  blood  wastage  and  transfusion  avoidance  is  immense.    Developing  second  round  of  improvements  while  conInuing  to  improve  from  the  mulI  pronged  first  round.  

•  Targeted  Metrics:  •  Total  transfusion  •  Transfusion  with  no  prior  documented  Hgb  <  7  •  Transfusion  adjusted  by  anemia  burden  

•  Amount  of  Impact:  •  On  track  for  100s  of  units  of  PRBCs  a  year.  

•  Top  Line  Goals  through  2019:      •  Targeted  intervenIons  with  willing  partners:    CT  Surgery,  

Orthopedics,  Anesthesia  •  Targeted  admission  types  like  GI  bleed  and  L  and  D  •  Develop  an  anemia  burden  for  adjustment  •  Develop  the  growth  story:    we  have  increased  transfers  

from  the  Jehovah's  Witness  community  •  Mobilize  uIlizaIon  metrics  especially  Hgb  7  metrics  to  

dashboards  for  teams  and  individual  providers  •  Look  at  overall  expenses  in  the  transfused  populaIon.  

•  Tools  and  Methods  Acquired:  •  MulI-­‐business  unit  support  •  Partnered  with  exisIng  uIlizaIon  efforts  •  Partnered  with  choosing  wisely  campaign  and  choosing  wisely  alerts  from  Stanson  

•  Accessed  all  levels  of  governance  across  the  organizaIon  

•  EMR  build  and  System  AnalyIcs  methods  •  SME  process  for  targeted  projects  •  Increasing  sophisIcaIon  of  lab  uIlizaIon  metrics  in  collaboraIon  with  System  AnalyIcs  

•  Daily  Harm  reports:    who  got  blood  yesterday!  •  EvoluIon:  

•  Blood  as  a  whole  •  Blood  with  no  HGB  <  7  •  Team  and  Disease  focused  intervenIons  •  Dashboards  and  adjusted  data  •  Anemia  burden  

P4:    Vitamin  D  Labs  •  Stage  of  Development:    Launched  organically,  strong  year  1  performance,  maturing  the  metrics,  based  on  mature  metrics  will  refine  intervention  

•  Targeted  Metrics:  •  Began  with  order  less  (labs  total)  •  Developing  benchmarked  versions  

•  Amount  of  Impact:  •  Decrease  total  order  type  •  Decrease  expensive  order  type  (less  1,25  OH)  

•  Top  Line  Goals  through  2019:      •  Formalize  the  utilization  metric  and  put  in  

population  health  clinical  dashboards  •  Develop  more  robust  view  of  encounter  and  

episode  lab  utilization  for  provider  dashboards  with  some  adjustment  

•  Working  on  repeated  labs  like:    CBC  q6  in  GI  bleeds  

•  Tools  and  Methods  Acquired:  •  Multi-­‐business  unit  support,  increased  awareness  and  

interaction  with  primary  care  and  population  health  •  EMR  build  and  System  Analytics  methods  

•  Ordering  and  Lab  improvement  •  Formulary  •  Naming  •  Alerts  and  advisories  

•  SME  process  for  targeted  projects:    population  health  •  Increasing  sophistication  of  lab  utilization  metrics  in  

collaboration  with  Population  and  System  Analytics  •  Evolution:  

•  Total  labs  based  on  MEDC  project  •  National  benchmarks:    per  visit,  1  vs  1,25  OH,  and  

benchmarking  by  CBC  or  Metabolic  profile  

P4:    Vitamin  D  Labs  Vitamin  D  -­‐>  Vitamin  D  (screening  to  be  used  only  in  symptomatic  patients,  no  longer  broadly  indicated)  

Vitamin  D  1,25  DiHydroxy    -­‐>  Vitamin  D  1,25  DiHydroxy  (Rarely  indicated,  Limited  use,  endocrinology  and  sarcoid  use  only)  

Synchronize  with  other  groups!  (HFMG  Ambulatory  2016  initiative)    

685   683  

805  

582  617  

585  

463  491  

402  

322  

192  150  

P5:    Choosing  Wisely:  Care  and  feeding  of  the  BPAs  in  Epic  (alerts,  popups  and  other  workflow  annoyances)  

•  Stage  of  Development:    Implemented  and  in  place,  pipeline  developed  for  ongoing  launch  of  next  alerts.    Continuing  to  develop  monitoring  and  interventions  for  alerts.    Continuing  to  monitor  alert  and  develop  analytic  approach.    Our  committee  owns  all  lab  related  alerts  for  the  system  (no  other  group  has  stepped  forward  for  a  slice)  

•  Targeted  Metrics:  •  Began  with  order  less  (labs  total)  •  Developing  benchmarked  versions  

•  Amount  of  Impact:  •  Decrease  total  order  type  •  Decrease  expensive  order  type  (less  1,25  OH)  

•  Top  Line  Goals  through  2019:      •  Formalize  the  utilization  metric  and  put  in  population  health  

clinical  dashboards  •  Develop  more  robust  view  of  encounter  and  episode  lab  

utilization  for  provider  dashboards  with  some  adjustment  •  Working  on  repeated  labs  like:    CBC  q6  in  GI  bleeds  

•  Tools  and  Methods  Acquired:  •  Multi-­‐business  unit  support,  increased  awareness  and  

interaction  with  primary  care  and  population  health  •  EMR  build  and  System  Analytics  methods  

•  Ordering  and  Lab  improvement  •  Formulary  •  Naming  •  Alerts  and  advisories  

•  SME  process  for  targeted  projects:    population  health  •  Increasing  sophistication  of  lab  utilization  metrics  in  

collaboration  with  Population  and  System  Analytics  •  Evolution:  

•  Total  labs  based  on  MEDC  project  •  National  benchmarks:    per  visit,  1  vs  1,25  OH,  and  

benchmarking  by  CBC  or  Metabolic  profile  

Conclusions  

•  'Value'  and  'Value  based'  reimbursement  models  will  influence  the  design  and  delivery  of  healthcare  

•  Any  lab  (or  non-­‐lab)  service  that  improves  quality  and  reduces  costs  is  valuable  

•  Laboratories  are  strategically  situated  in  value  delivery.  •  Centrality  in  the  care  episode  •  Connection  to  all  specialties  •  Data  handling  capabilities  

Conclusions  •  The  challenges  that  the  laboratories  face  are:  

•  Self  imposed  isolation  and  sole  focus  on  the  analytic  step  •  Limited  understanding  of  how  our  customers  utilize  our  services  

•  These  challenges  can  be  overcome  by:  •  Collaborating  with  providers  through  a  structured  process  and  framework  

•  Making  the  clinical  care  processes  more  efficient  by  provision  of  correct  and  timely  laboratory  services,  and  measuring  its  financial  and  quality  impact