Oct 05, 2017 | Renee Caruthers
NEW YORK (360Dx)– As accountable care organizations continue to grow in number, BioReference Laboratories is aiming to leverage its lab data to better support value-based payment models. Through an alliance announced last month, the company and ACO technology platform provider The Garage plan to jointly develop deep analytics designed to drive down healthcare costs while improving patient care.
"The plane has shifted from a volume-based business and revenue model to one in which value, in the form of outcomes of patients, is becoming the norm," said Gregory Henderson, president of BioReference Laboratories.
The alliance will add BioReference diagnostic data to Bridge, The Garage's analytics platform that ties together information from sources such as electronic medical records, claims files, third-party registries and other medical information sources to give physicians a unified view of patient information.
"The laboratory generates 70 percent of all medical information, but that information is probably used only minimally in terms of what value could be unlocked," Henderson said. "The challenge is how do you connect that laboratory information with patients directly, and with patient records, and demographics and treatment plans."
The Bridge platform collects healthcare data from a variety of sources and converts it into compatible formats to make it actionable for physicians, according to Pranam Ben, CEO of The Garage. The two companies plan to use BioReference Laboratories' genetic data to develop analytics to help identify at-risk populations, as well as the lab company's historical data to identify broad healthcare trends.
"If I can use patient metadata to understand what data results look like for similar patients over the last 10 years in this zip code, for this gender, in this age group, that kind of deep breakdown-analytics is very difficult to find in the industry," Ben said. "It can give you very interesting insights that can help predict outcomes for any given population."
While the two companies will develop analytic models, physician groups who use them will be able to tailor the analytics to their patient populations, according to Ben.
"The way you implement a population health management system, you are going to see certain nuances that are tied to the different organizations and the communities they serve," he said.
Growing value-based models
At the end of the first quarter of 2017, the US had 923 active public and private ACOs, or healthcare provider organizations for whom quality metrics impact the payment they receive, according to figures tracked by Leavitt Partners in partnership with the Accountable Care Learning Collaborative. Those ACOs cover more than 32 million patients, representing an increase of 2.2 million patients in the past year, according to the organizations.
Jane Pine Wood, chief legal officer for BioReference Laboratories, who represented labs for law firm McDonald Hopkins before joining BioReference a year ago, said that there has been growing interest in as well as growing implementation of value-based payment models.
The most common value-based payment model is the Medicare shared savings model, used in Medicare ACOs, Wood said. In that model, patients who receive a plurality of their primary care services from a certain doctor, are assigned to that doctor's ACO for accounting purposes. The patient can still receive medical care elsewhere, but Medicare tracks the total cost of care for patients assigned to an ACO, and if the aggregate cost of care of the group of patients declines, Medicare will split the savings with the ACO.
What percentage of healthcare saving is shared with an ACO depends on which risk model the ACO is using. Higher risk models enable ACOs to collect a larger percentage of the savings, but also require them to share the additional costs if the patient group's aggregate healthcare costs rise, Wood explained
Another value-based care model that is seeing a resurgence among private payors, is the capitation model, whereby a primary care provider will get a set monthly fee for taking care of patients, whether the patient visits the doctor or not, Wood said. All the patient's expenses, including lab costs and ancillary services must be paid from the monthly fee, she explained.
Yet other organizations are using a hybrid value-based payment model known as a withhold, said Wood. Through this model, doctors and all other parties receive payment for their services, but a certain percentage of that payment is withheld. If at the end of the year, patient costs remain below a certain agreed-upon threshold, physicians can collect their withhold. Lab data, combined with analytics can help physicians spot conditions where preventative steps can potentially reduce future costs and help ACOs capture incentives, she said.
"We are positioning ourselves to really be valuable in terms of helping clinicians utilize our laboratory data to more efficiently manage patients," Wood said.
In addition, in the capitation model of value-based payment, physician groups may get a larger capitation payment for patients with costly conditions, such as diabetes, than for patients without health issues, Henderson noted.
"A lot of the initial effort is in the ability to extract physician data at the time of enrollment to make sure we know exactly how sick the patient is so that the amount of money coming in is accurate," Henderson said.
An electronic data infrastructure
Henderson says the BioReference partnership with The Garage specifically targets physician groups using value-based payment models, as hospital-based ACO groups often already have existing information infrastructures.
"There are a whole lot of value-based groups that are not in a hospital-centric model but are a network of primary care or specialty care physicians, and this empowers them to be managed in an even better way," he said.
For physician group ACOs, an electronic platform, such as The Garage's Bridge, can be a critical link tying the group together, Henderson said.
"Many times physician groups will come together to form an ACO, and even though the individual physician groups might have an electronic medical record, or EMR, the four or five or six physician groups that come together may have four or five or six different EMRs. Their ability to extract data from the various EMRS, and then add to that our lab data piping through, becomes and extraordinarily powerful tool," he said.
While most of the analytics on the Bridge platform are focused toward patient care management, the platform also provides analytics on other value-based payment issues, such as risk and revenue optimization and patient engagement, The Garage's Ben said.
The Bridge platform is also designed to help physician groups comply with reporting protocols used in value-based payment models, Ben said. The system collects data for protocols such as the Healthcare Effectiveness Data and Information Set, known as HEDIS, used by US health plans to measure performance, and the Physician Quality Reporting System, called PQRS, which supports the Centers for Medicare & Medicaid Services' quality improvement incentive program.
"The data we receive from the pipeline at BioReference is going to help them be compliant with those reporting requirements. Instead of a last minute hustle to meet those requirements, you are basically compliant all year long and you can look at real-time insight into your quality performance," Ben said.
As the Bridge platform is cloud-based, it does not require a specific technology infrastructure in order to be deployed by physician groups, Ben said. The platform can be accessed from anywhere by any internet-connected device through a secure web URL. To comply with HIPAA patient privacy requirements, local software cannot be added to the platform, and all users have secure credentials with different privilege levels depending on the information each user is allowed to access.
The system also includes a teleconferencing feature, which Henderson describes as essentially Skype for doctors, that allows doctors to have live consultations with patients through the Bridge platform.
While The Garage collects lab data for individual ACOs as needed on a case-by-case basis, the partnership with BioReference data is unique in the tight integration of the company's lab data into the platform, and the specialized analytics the companies aim to develop using that data. In addition, Ben said, the tight integration will allow users to directly order a lab test from BioReference data through the system when patient data indicates testing is needed.
"A case in point – while you are looking at the longitudinal view of the patient, you realize, or it is recommended, that the patient needs a particular lab test to be done. By clicking an easy button you can place the order into BioReference," Ben said. "You will see an intelligent lab order experience where the system will make it very easy to order the lab, get the result, and make sense of the result for the patient."
Ben said he hopes the partnership with BioReference serves as the starting point for a larger ecosystem of shared data among different types of medical service providers. He envisions lab data being used alongside data from imaging centers, home healthcare providers and other medical stakeholders.
"Garage and BioReference Laboratories are coming together to get that ecosystem started," he said.
Meanwhile, BioReference Laboratories is looking forward to seeing what insight can be derived from the years of diagnostic data that it has accumulated.
"We absolutely know that the greatest untapped force for healing and medical management lives within the lab testing data, and it has just not been tapped effectively," Henderson said.