Sono

ra Q

uest

Lab

orat

orie

s

David N. Moore, CIOSonora Quest Laboratories

November 6, 2014

How Becoming Patient Centric Aids in the Volume to Value Transformation

California Clinical Laboratory Association

Sono

ra Q

uest

Lab

orat

orie

s

Learning Objectives• We will cover three main topics:

– How is the Outreach/Independent Laboratory’s definition of Patient Centric different from a Health System’s definition?

– How does being Patient Centric enable the Outreach/Independent Laboratory to effectively support ACOs and Patient Centered Medical Homes?

– How can the Outreach/Independent Laboratory use Patient Centric data to interact with the patient?

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition• How is the Outreach/Independent

Laboratory’s definition of Patient Centric different from a Health System’s definition?– Health Systems can enforce more strict data

gathering efforts.• Most importantly, the patient is there. • There is time to research the HIMs data to affirm the

patient’s identity.• Insurance verification can be done during the

patient’s stay and corrections made prior to discharge.

• The Health System physically “tags” the patient for verification during their stay.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition– Labs can enforce more strict data gathering

efforts. But there are some challenges:• We only see the patient around half the time.

– At Sonora Quest Labs (SQL), we process over 23,000 orders every week day.

– But we only “see” 55% of the patients in our service centers or by our In Office Phlebotomist (IOP).

• Our time with the patient is limited. We try to serve the patient in 30 minutes or less with a limited staff.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition• For the patients we don’t “see”, we have to rely

on the information submitted by the physician.– A substantial portion (65%) of our orders

come to us electronically– We still get a significant number of orders that

must be keyed into our LIS– Incorrect data is submitted that the lab knows

is wrong » A male with a Pap test ordered or» Tubes with John D. XXX as the name and David XXX

as the name on the order.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition

• Our CFO’s pet peeve – the insurance data submitted has been wrong for years in the EMR and continues to flow in electronically. If there is no eligibility for this insurer, a denial will follow and the research effort resumes. Efforts to get the EMR updated are in vain.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition• But even Health Systems have these

issues as they affiliate with physician practices.– Banner uses NextGen for its owned practices

and exports its system MPI ID to them, but consider• One affiliated specialty practice uses Allscripts• Another affiliated specialty uses Greenway, etc.

– We get orders from all of them. No big deal, right?• When the same patient is referred from BHS to the

others, we now have three MPIs for him/her.• Even better, what if the patient is named John D.

XXX at one and David XXX at the other.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition

• Here is the rub– Banner expects their results back with their

NextGen MPI.• The first specialty expects their results back with

their Allscripts patient ID and the name John D. XXX.

• The second specialty expects their results back with Greenway patient ID and the name David XXX.

– But these orders and results all refer to the same patient.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition– Well, just use the patient’s SSN.

• Based on 15M orders over the last 28 months,• We only get a value in the SSN field 33% of the

time.– Of the 5M SSNs received, almost 70% were

bogus.• Like 123-45-6789 • or all the same digit• or “None”• or used repeatedly (bought from an identity thief)

– So for us, an SSN has no weight as a component in establishing a patient ID.

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition• Labs need to be able to track

patients across ordering entities while– Maintaining the uniqueness of the patient

information for return the results to the client’s EMR,

– Retaining insurance information on a date of service basis (for rebilling), and

– Combining results and billing information for HEDIS reporting requirements

Sono

ra Q

uest

Lab

orat

orie

s

Different Definition• Solution lies in setting up your own

Patient ID– We partnered with Atlas Medical to build our

Enterprise Master Patient Index (EMPI)– Spent 3 months in design of algorithms

• Holistic approach to data analysis allows– Probabilistic rankings for first name/nicknames

matched with last names– Comparing incoming data from ordering client

EMRs for changes using chart ids as a key• Processed 12.5M accessions (24 months of

volume)• Identified 3.6M unique patients

Sono

ra Q

uest

Lab

orat

orie

sSupporting ACOs and

PCMHs• As these entities accept patient populations, they will go after the low hanging fruit– Banner and Aetna announced (Oct 14th issue

of Healthcare IT News) that they had reduced average medical costs by 5%,

– Reduced their readmission rates by 9% and– Similarly reduced their utilization of expensive

radiology services.– But they are still working on tracking diabetes

patients.

Sono

ra Q

uest

Lab

orat

orie

sSupporting ACOs and

PCMHs• But these gains are based on retrospective data– How can we help them be proactive?

• One idea is to receive their discharge summaries and set up a watch list based on our EMPI for the patient.

– When an order is entered for that EMPI, we can send a secure message to the care team alerting them to the encounter.

– The team can then follow up with the patient to understand the reason for the test and intervene if needed.

– Some compliance issues need to be addressed still.

Sono

ra Q

uest

Lab

orat

orie

s

Supporting ACOs and PCMHs• But these gains are based on

retrospective data– How can we help them be proactive?

• We have been asked to help an AHCCCS (Arizona’s Medicaid program) insurer track subscribers that have had lap band surgery to help control their diabetes.

– Very small number of patients out of 225K subscribers.

– But the insurer needs proactive actionable information regarding the patients’ blood sugar and A1c results upon release and not at the end of the month.

Sono

ra Q

uest

Lab

orat

orie

s

Supporting ACOs and PCMHs• But these gains are based on

retrospective data– By watching for orders and looking for

specific tests for these subscribers• We can send a message to the insurer that there is

an order pending• And send a message when the results are released

so that the insurer can access and monitor the results.

– By applying this logic to other cases for other insurers/ACOs/PCMHs, we can help in following the patient’s compliance with orders as well.

Sono

ra Q

uest

Lab

orat

orie

s

Supporting ACOs and PCMHs• Supporting HIEs

– Each HIE has their own patient ID (PID)• By linking the HIE PID to our EMPI we

– Include our EMPI as a key in the results data– Provide historical base of results

• HIE provides patient opt in/out facility• HIE provides continuum of care view of patient

activity– Supporting Multiple HIEs

• Patient crosses into different service areas– EMPI allows cross connection between HIEs– Data shared only if agreed to by HIEs

• We encourage Health Systems to join instead of form

Sono

ra Q

uest

Lab

orat

orie

s

Interacting with Patients• Meeting Expectations

– Voice of the Customer - Patients• Improvements wanted in

– Managing Appointments– Appointment Reminders– Getting Results

• New items– Managing insurance information– Family registration– Medical Information

Sono

ra Q

uest

Lab

orat

orie

sInteracting with Patients

• Managing Appointments– Updated Appointment System

• Improved process to make/update appointments– Includes maps and locators based on zip code– Simplified appointment locator – E-mail notifications

• Linked to company website– One stop shopping– Consistent branding

Sono

ra Q

uest

Lab

orat

orie

s

Interacting with Patients

• New Items– Providing Insurance Information

• Website provides place– Enter or update patient demographic

information– Enter or update insurance information– Family information

» Associate themselves with a dependent» Allows multigenerational support

• Pay outstanding invoices

Sono

ra Q

uest

Lab

orat

orie

s

Interacting with Patients• Delivering Patient Results

– Recent Federal law changes allow labs to deliver results to patients on request• Patient submits request by phone, fax or website• Health Identity Management (HIM) team (3 FTEs)

– Determines that the requestor is in fact the patient

– Uses the EMPI inquiry function to find all accessions related to the requested date of service

– Requests reprint for delivery to patient• Since Arizona law changed prior to the Federal

law, SQL has been handling a weekly volume which has grown to >1,200 requests.

Sono

ra Q

uest

Lab

orat

orie

s

Interacting with Patients

• Discovery Efforts– Every lab has to, at one time or another,

produce all the results for a patient to support• Legal action• Follow up studies• Internal audits

– Using the EMPI inquiry function, the search time has been reduced from weeks to minutes

Sono

ra Q

uest

Lab

orat

orie

s

Interacting with Patients• Additional Benefits

– Cash collections at encounter• We have 75+ Patient Service Centers (PSC)

– Of the daily PSC encounters, 350 patients (3%) owe us, on average, $40, or $14K/day

– Or $3,000,000 per year!!• How we are impacting our bad debt

– Use the EMPI to retrieve accession balances post insurance adjudication

– Check for past due amounts at check in

Sono

ra Q

uest

Lab

orat

orie

sInteracting with Patients

Sono

ra Q

uest

Lab

orat

orie

sInteracting with Patients

Sono

ra Q

uest

Lab

orat

orie

s

How IT Can Add Value

Questions?