CEO SUMMARY: Two trends are driving a movement to standardize laboratory operations across large regions: the integration of clinical care and the need for hospitals and health networks to continuously improve patient outcomes. THE DARK REPORT outlines an ambitious program in Michigan, where Ascension Health is working to align itself with an integrated health system by standardizing lab testing activities among seven organizations, 14 hospitals, and 18 laboratories.
ONE BY ONE, MAJOR HEALTH SYSTEMS in the United States are recognizing the need to evolve into fully-integrated care delivery networks. Integrated health systems make it possible to eliminate gaps in care, maintain a complete health record of all patients, and improve patient outcomes while reducing healthcare costs.
An essential step in these integration efforts is to standardize and consolidate clinical laboratory services throughout the health system. Pathologists and lab administrators know that a complete record of a patient’s lab test data allows physicians to identify gaps in care and to be more effective in how they diagnose, treat, and monitor patients.
In response to the trends of integrated care and fully-integrated health systems, the laboratory team at Ascension Health in Michigan has embarked on a program to fully regionalize, standardize, and consolidate laboratory services. What makes this a particularly ambitious project is that there are seven system organizations involved, not to mention 14 hospitals and 18 laboratories.
Nationally, Ascension Health is the largest Catholic integrated health system and is one of the largest non-profit health networks. It will take several years to achieve full regionalization of lab testing services throughout Ascension’s facilities in Michigan.
During a presentation at THE DARK REPORT’S Executive War College in May 2018, Carlton Burgess, MSM, Vice President of Laboratory Services at Ascension Health’s St. John Providence Clinical Pathology Laboratory in Grosse Pointe Woods, Mich., outlined six primary goals for this ambitious lab program. The program’s goals are:
- Faster workflow and shorter cycle times;
- Improved identification and elimination of non-value-added processes;
- Increased adoption and use of continuous improvement, Lean concepts, and similar methods;
- Better use of sophisticated informatics and real-time analytics;
- Collaboration with other providers to deliver more value from lab test results; and,
- Measurable improvements in patient outcomes and lower costs of care.
“Essentially, all the Ascension labs in Michigan are working to align their mission and values with those of the parent organization by improving the quality of care and cutting needless spending,” stated Burgess. “In addition, our labs are working to implement the Ascension quadruple aim at about the same time that the health system itself is doing so.
“Ascension Michigan’s quadruple aim involves: 1) delivering the highest quality care; 2) improving the patients’ experience; 3) improving the providers’ experience; and 4) delivering care at the lowest possible cost,” said Burgess.
From Cost Centers to Revenue Generators
Another goal in this statewide reorganization and standardization of these laboratories involves generating revenue. “When fully implemented, this project will transform clinical laboratory operations from a financial cost into a revenue generator,” he added. “Our first target is to deliver $5.3 million in additional net revenue annually.
“These four goals are a challenge for a system as large as Ascension in Michigan,” noted Burgess. “In just our one state, we have seven member organizations, 14 hospitals, and 18 laboratories. In addition, we have six different Laboratory Information Systems, myriad different registration and electronic medical record systems, and an enterprise master patient index.
“Our pursuit of Ascension’s quadruple aim puts our labs at a crossroads between quality and finance,” Burgess commented. “Does that mean finance or quality will drive these initiatives?
Low Costs or High Quality?
“The commitment to the quadruple aim forced us within the organization to look at the financial opportunity versus the effect on quality,” Burgess noted. “When we did, we found there was much support from senior leadership to lean toward quality. This means our lab initiative is never to affect the patients’ or the providers’ experience negatively just for the sake of getting down to the absolute lowest cost.
“Once we knew that, it became much easier to get buy-in from senior leadership for our proposed lab standardization project,” he added. Plus, he explained later, the accounting department showed that the project would help increase revenue.
In support of the quadruple aim, the path to regionalizing and standardizing Ascension’s 18 Michigan labs required all labs to work together. “To achieve this, the labs will be linked in four regions, a process we describe as regional integration,” he said.
“Each region has a core lab and rapid response labs and each region will be responsible for building lab volume through increased outreach laboratory services,” he added. “In addition to changing how labs serve each region, our statewide standardization project has three objectives:
- “Repatriate existing send-out lab testing back into Michigan;
- “Establish standard test menus for each facility; and,
- “Renew each lab’s focus on growing lab outreach business.
“To accomplish these goals, Ascension Health in Michigan has eight labs operating as rapid response labs (RRLs) and this number will rise to 12 RRLs,” Burgess said. “The lab at the Saint John Hospital and Medical Center (SJHMC) in Detroit will be expanded into that region’s core lab.
“In addition, we are already nearly standardized on Roche automation equipment,” Burgess explained. “This will help us standardize test methodologies and reference ranges across all laboratories. This automation also will handle the increased volume that will come from repatriating tests that are currently sent outside of Michigan, as well as handling the increased volume from growth and consolidation.
“Currently, Ascension Health labs sends more than 25,000 tests annually outside of Michigan,” he stated. “By bringing those tests back into our labs, we can save those costs.
“At the start of this project, lab leadership had a high-level perspective of what it wanted to accomplish,” he said. “That included fully-integrated health systems within the four regions and the 18 laboratories, supported by a modern core laboratory in every region.
Right Test at the Right Time
“We are like many other health systems in that way because we want to do the right test at the right time in the right location,” Burgess added. “Our goal is to keep our lab testing in our system.
“Another goal is ensure that each facility has rapid response capabilities commensurate with the medical services that facility offers,” Burgess said. “Doing so will help us expand lab outreach programs in each region and regionalization will improve outreach program efficiency at each site.
After discussing the basic strategies for lab regionalization, Burgess discussed how information technology would support standardization.
Have you worked on standardizing lab testing in an integrated health system? Please share your experiences with us in the comments below.