Each year, health systems perform nearly 6 billion lab tests in the United States at an annual cost of almost $70 billion; approximately 30-50% of these tests are not medically necessary, according to the International Journal of Clinical Chemistry.
Likewise, nearly 21 million blood products are transfused annually at a cost of almost $5 billion, and an estimated 30-60% of these transfusions are not necessary, according to Transfusion Medicine Review.
After successfully implementing a comprehensive blood management program that reduced system-wide blood utilization by more than 30%, McLaren Health Care, the largest health system in Michigan, decided to introduce the same infrastructure and tactics to expand a range of clinical projects through the creation of a high-value care program. This HVC was an initiative designed to provide the best possible patient care while reducing unnecessary costs to the health system.
In order to do so successfully, McLaren partnered with Healthcare Forward, a physician-led company that partners with healthcare organizations to develop and deploy a scalable High-Value Care infrastructure, and hc1, a vendor that focuses on IT and services that ensure the right patient gets the right test and the right prescription.
The three organizations worked to develop test and blood utilization programs across the health system’s hospitals. Healthcare Forward was selected to develop the strategy and execution for the HVC program, while hc1 Test Utilization was chosen as the technology offering based off its lab analytics capabilities.
“Lab directors and pathologists need to realize that lab utilization is not a lab issue – it is a clinical issue.”
Dr. Tim Hannon, Healthcare Forward
“One of the significant challenges faced for implementing the HVC program was accessing data across a large health system with several different EHR and lab information systems,” said Dr. Dennis Spender, chief medical officer at McLaren Health Care. “Combined with a very large lab formulary and lack of standard nomenclature of lab test naming, prior to using hc1 Test Utilization, there was no real ability to analyze, improve or control lab utilization across the system.”
MEETING THE CHALLENGE
McLaren Health Care is an integrated health network consisting of 14 hospitals, ambulatory surgery centers and imaging centers. Using hc1 Test Utilization, all of these systems were connected to bring full visibility to the entire organization in one dashboard.
“HVC committees were formed at each hospital location and the lab directors were able to pull reports specific for their hospital, as well as at the system level,” Spender explained. “Strategic goals were set at each location, and the hc1 dashboard provided the ability to monitor change and track progress over time.”
The first clinical practice change for the HVC program focused on reducing unnecessary and repetitive inpatient lab testing. Substantial reductions in the utilization rates of individual analytes at the hospital level were achieved within 15 months, including:
- 63% reduction in unnecessary potassium tests.
- 44% reduction in unnecessary TSH tests.
- 40% reduction in unnecessary magnesium tests.
- 40% reduction in unnecessary lipid panels.
- 39% reduction in unnecessary phosphorus tests.
- 29% reduction in unnecessary CBC w/ diff tests.
“The system-wide impact of these efforts has been a 5.6% reduction in lab tests per patient per day, which amounts to 147,000 fewer unnecessary tests per year and a conservative cost savings of $383,000, based upon a variable cost of $2.60/ test,” reported Dr. Tim Hannon, CEO of Healthcare Forward.
ADVICE FOR OTHERS
“Lab directors and pathologists need to realize that lab utilization is not a lab issue – it is a clinical issue,” Hannon advised. “As such, changing deeply embedded lab utilization practices requires a large group of stakeholders, including laboratorians, nurses and administrators, and must be led by physicians who are actively involved in managing patients.
“The governance infrastructure to accomplish appropriate lab utilization can be accomplished through a multidisciplinary lab stewardship committee,” he concluded, “or in the case of McLaren Health Care, through a system-wide HVC program.”
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
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