The Lab as an Early Warning System: How You Can Improve Population Health
Are you ready to step boldly into the new world of population health? We hope you are. Because as laboratorians, you’re smack-dab in the middle of a golden opportunity to show how critical a role you play in the continuum of patient care.
So move forward with confidence. Put a little swagger in your step. Get in there.
And start looking for trouble.
Contributing Lab Leaders
- Give careful consideration to lab biomarkers that may predict risk in specific patient populations
- Doing so can help elevate the value of your lab, mitigate risk, and reduce cost
- Acting in a consultative role with hospital colleagues is essential for labs to become vital partners in population health
Philip Chen, MD, PhD
Chief Healthcare Informatics Officer
Vice President of Quality/Case Management
North Kansas City Hospital
Lester Wold, MD
President and CEO
Find it before it finds them
That’s our LabLeaders’ advice. This means watching out for biomarkers that indicate high risk—and taking action early to mitigate that risk.
This type of proactive approach brings enormous value in terms of population health. Think of predictive biomarkers as pieces of actionable intelligence inside your data. Because you see these first—before anyone else in a patient’s episode of care—and understand them best, you are in a unique position to act decisively.
That’s a tremendous responsibility. It’s also a tremendous opportunity. We encourage you to embrace it. Because doing so can help reduce length of hospital stays and readmission rates—key metrics in measuring population health outcomes.
Let’s look at the two examples.
Case study #1:
faster action on fasting glucose
Judy Springer, Vice President of Quality/Case Management at North Kansas City Hospital shared a perfect example with us. Her institution has been dealing with cases of patients with diabetes who become hypoglycemic while they are in the hospital. She sees an opportunity for laboratorians to play a vital role in preventing this—and laments that they haven’t done so already.
On making a difference with markers
The laboratorians in Ms. Springer’s hospital would do well to begin thinking of themselves as clinical consultants—and act accordingly.
Why not do so yourself? When you see a lab marker that may indicate trouble, pause for a moment. Think: what can I do that I might not routinely do? Who might I share this with? How do I bring it to their attention? How can we work together to make changes based on this knowledge?
BE AN AGENT OF CHANGE
According to our lab leaders, the existing IT infrastructure in Ms. Springer’s hospital could easily be changed to trigger a hypoglycemic alert at the higher FPG of 70. Think of the tremendous value a laboratorian could have demonstrated had he or she brought this issue to light. Positive change could have been effected at an operational level that might have resulted in less time in the hospital for patients, and less overall cost.
It is what we must do.
Case study #2: leveraging lab data for accountable care
Learn how Dr. Philip Chen's team used lab markers to help an ACO anticipate hidden costs.
Dr. Chen and his team analyzed the ACO’s claims data, looking at patients who had been characterized as:
High-spending – expected to spend significant healthcare dollars due to diagnosed conditions
Low-spending – not expected to spend significantly
Identifying hidden dangers
Looking specifically at the low-spending pool, Dr. Chen’s team:
Identified a subset of patients who unexpectedly presented to emergency departments with significant issues such as chest pain
Noted that health spending for these patients was above what the ACO had anticipated, because they had been identified as “low-spending”
For this subset of patients, Dr. Chen’s team went back and analyzed their lab markers from tests conducted a year earlier.
They identified markers that could have predicted the emergency events. They shared these findings with the ACO.
By identifying these markers, Dr. Chen’s lab is now in a position to keep an eye out for them going forward. When they see similar trends, they alert physicians who can intervene appropriately—as well as the ACO, which can budget accordingly.
Dr. Philip Chen talks about the importance of making sure you have the data you need—and filling the gaps when you don’t.
On managing population data
This guide from the Centers for Medicare and Medicaid Services includes details on nationally recognized ACO quality measures in at-risk patient populations.
This article details the contribution of multiple healthcare disciplines to prevention and population health, with an eye toward future opportunities.
This article presents results from a clinical study that identified biomarkers with novel associations to chronic kidney disease progression and describes the predictive utility of those biomarkers.