HEALTHCARE’S ONGOING TRANSFORMATION AND THE EMPHASIS ON VALUE-BASED REIMBURSEMENT are creating a new opportunity for savvy clinical laboratory executives and pathologists. This opportunity is centered around the need of self-insured employers to address the problem of employee presenteeism.
“Helping employers with presenteeism can create a value stream for clinical laboratories,” says Kristine Bordenave, MD, FACP, a consultant in precision medicine with KKBordenave Consulting Group in Chicago. “I see an opening for laboratories and laboratory benefit managers to work directly with employers, as the pharmacy benefit managers have done for the last 20 to 30 years.”
Not Productive on the Job
Specifically, clinical labs can help solve a major problem for companies: “presenteeism,” a term used to describe those times when employees are on the job but not working their best due to a chronic condition, acute illness, or an injury. According to Bordenave, presenteeism is four to five times more costly for employers than acute injuries, resulting in loss of over $150 billion per year in productivity. That amount is more than losses from absenteeism.
Bordenave spoke on the topic during a general session at the Executive War College in November 2021 and later provided further details to The Dark Report.
The phenomenon of presenteeism isn’t new, as Harvard Business Review wrote back in 2004. According to that article, many of the health problems that result in presenteeism are common, such as seasonal allergies, asthma, headaches, depression, back pain, arthritis, and gastrointestinal disorders. People who don’t feel good simply don’t perform at their best, noted the article.
For example, people with uncontrolled diabetes generally are less productive than those whose diabetes is controlled. As a result, “It is important to provide early intervention and continuous support as a preventive measure against not only diabetes and diabetes-related complications but also presenteeism,” according to research published in the journal BMC Public Health in October 2021.
Presenteeism-related declines in productivity sometimes can be offset by relatively small investments in screening, treatment, and education. This is where clinical laboratories can step in.
Bordenave suggested that lab directors approach health benefits administrators at self-insured companies and demonstrate how a well-designed program utilizing clinical data could help reduce the costs associated with presenteeism. Using the lab’s test results in proprietary algorithms as actionable indicators of employee health, the data can be the basis for community-based wellness initiatives focused on early detection, early intervention, and better disease management.
This type of program is best suited for self-insured employers because those businesses can set their own requirements for testing coverage, Bordenave said. Most self-insured plans work with outside contractors in addition to managed care providers who administer the plan. Health plan administrators typically have a medical director with a background in population health who determines the best approach to improve the overall health of workers and reduce presenteeism.
Efforts to ward off COVID-19 offer a good example of how repeated lab testing may benefit the employer, she noted.
“Many employers want to make sure their workers are negative and require more frequent testing than would be covered under their health plan,” she said. “Clinical laboratories are already playing a role in keeping workplaces safe and employees healthy.”
Take a Hint from Lab 2.0
Clinical laboratories that are not already involved in community health or population health initiatives can learn a thing or two from labs such as TriCore Reference Laboratories in Albuquerque, N.M., Bordenave suggested.
TriCore is a leader in Clinical Lab 2.0, an initiative established to help develop the evidence base for the valuation of laboratory services in the upcoming era of global healthcare. Those involved in Clinical Lab 2.0 focus on using data and insights generated by labs to support the evolving needs of health systems, hospitals, physicians, and health insurers. Under this model, clinical labs play a key role in personalized medicine and are reimbursed not just for the testing they perform, but also for the value they provide.
TriCore is believed to be one of the earliest clinical labs to collaborate with health insurers in ways that meet the Clinical Lab 2.0 business model, making its experience useful to other labs seeking to develop new sources of revenue while pursuing value-based care. TriCore has arrangements with some payers under which the lab receives compensation on a per-member per-month (PMPM) fee in exchange for providing data and insights that can improve health outcomes of the members.
Bordenave said that clinical labs that are interested in developing their own programs to assist employers might start by joining a local business group on health and engaging with participants about what their needs are. A program can then be developed to help meet those needs.
“It goes way beyond just performing tests,” Bordenave said. “Some labs are even offering blood pressure measurements. Labs can fill the gaps in services because they touch people so frequently.”
Many employers need help to properly manager their workers’ health conditions, and if clinical laboratories don’t step up to meet this need, someone else will, Bordenave cautioned.
Contact Kristine Bordenave at 312-520- 6657 or firstname.lastname@example.org.
Health Company Meets Community Need
CORIELL LIFE SCIENCES (CLS), A PRECISION-BASED MEDICINE COMPANY based in Philadelphia, is one example of an organization that saw an unmet need in the community and developed a program to address it.
In 2018, CLS initiated a personalized medicine pilot program in conjunction with the Teachers’ Retirement System of Kentucky, which is self-insured.
CLS used pharmacogenomic testing to determine members’ response to medications based on how their genes metabolized drugs. One key aim of the pilot was to advance patients’ health and to reduce costs using pharmacogenomics and expert pharmacy review.
During the initial phase of the pilot, more than 4,000 retirees enrolled and 2,800 submitted DNA samples, according to CLS. About 83% of retirees received recommendations for an alternative medication or dosage adjustment based on the results of their DNA tests. In addition, 94% of these suggestions were approved by prescribers. The project pilot received a national award for healthcare innovation from the State and Local Governments Benefits Association.