Utilization Management

Inside the Diagnostics Industry: Quest-hc 1 System Leverages Lab Data to Help Providers Monitor Test Utilization

Getting Medicare and private insurers to pay for lab tests is as challenging as it’s ever been. It’s not just about reimbursement. Payors have become fanatically dedicated to weeding out lab testing overutilization. While this puts the squeeze on labs, it also creates opportunity to the extent that the source of the most direct and useful data for identifying and preventing lab test overutilization and underutilization are the labs and ordering providers themselves.

The Quest Lab Stewardship Service

The opportunity for labs to leverage their own test data for utilization monitoring has not been lost on Quest Diagnostics, which recently announced that it was partnering with healthcare data analysis firm to offer an innovative new service to help health systems control and track test ordering. Quest Lab Stewardship is designed to integrate with the electronic medical record to guide doctors through the test ordering process so they can be sure they’re ordering the right tests and in the right amounts to ensure proper treatment and reimbursement. The system also has the capabilities to create a systemwide set of tests and utilize testing trends across the entire organization.

That’s a big deal because health systems typically do a poor job of how much their lab testing varies across the network, explains hc1 CEO Brad Bostic. “They usually have a multitude of test compendia in various hospitals that have been acquired and consolidated—getting a standard one is almost impossible.” This variation in testing patterns can lead to higher costs and poorer outcomes.

How It Works

On the front end, the Quest Lab Stewardship system displays the tests that a patient most likely needs based on customized parameters which also make lower-value or less-proven tests harder to order. It alerts physicians if tests are ordered twice and directs them to testing results. The system can also be used to monitor ordering patterns, both organizationally and by individual doctors.

In addition to selling the new service, Quest offers a streamlined version of the new service at no additional charge to its reference lab customers. “There are opportunities to drive out overutilization and underutilization, but it’s really about driving clinical value,” explains David Freeman, general manager of information ventures at Quest. “It is about giving clinical lab directors the tools they need to help them figure out where the problems are” and how they can be solved.





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