A little more than 20 years ago, care delivery in California started to change. Large-scale independent physician associations (IPAs)—such as the subject of this case study—began taking on full-risk commercial contracts. These contracts, similar to more recent Medicare and ACO programs, were meant to improve patient care and reduce overall costs in a densely populated state. Since 2005, one large, California-based IPA has partnered with Labcorp to conduct yearly fecal occult blood test (FOBT) gap closure programs with a proven return track record of 30-40%.
The success of this program is a result of the IPA care coordination team leveraging Labcorp’s data to identify patients with screening gaps and coordinate distribution of FIT testing home kits for patient collection. This made it easier for patients to fulfill screening, particularly in underserved populations.
Cost management is a critical challenge for IPAs, especially in the case of capitated models with a per member per month (PMPM) cost structure. In a densely populated region, there is an increased risk of patients and communities being underserved due to affordability and other social determinants of health. So, when an IPA takes on PMPM costs in a state like California, this poses a significant financial liability.
This large, California-based IPA was concerned many of their patients were not meeting annual care guidelines. These gaps in care could have a profound impact on patients’ health, as well as impact the organization’s contractual quality performance. The organization worked with Labcorp to identify two volatile and growing gaps in the healthcare of the general population:
The organization had a mountain of data to analyze and needed a diagnostics partner to inform next steps to ensure proper testing and management of care.
Prior to 2005, the IPA ran some diagnostics in-house and supplemented their efforts through a partnership with a smaller laboratory. However, they determined that fully integrated lab data was necessary to deliver consistent, quality care across their large member base. Changes in reimbursement additionally impacted profitability and efficiency of running their own lab.
Closing care gaps can improve patient outcomes and is often tied to bonus payments that are critical to the long-term success of the IPA. Locating the right patients to close gaps in care is difficult in the best of situations, but the large member base of this IPA increased the degree of difficulty significantly. Initially, the IPA attempted to reach patients by proactively sending test kits directly to patients’ homes. This wide-net approach incurred exorbitant costs and eventually led the IPA team to explore a more targeted approach.
Leveraging the IPA’s patient data, combined with insights from Labcorp’s proprietary Insight Analytics reports, the IPA was able to generate a new targeted list. Working collaboratively, Labcorp and the IPA sent out targeted emails and called individual patients. Patients received a prerecorded message from their physician, urging them to get the recommended test—in this case colorectal cancer screening and hemoglobin A1c.
Furthermore, the IPA and Labcorp created a solution for fecal occult blood test kits (FOBTs) that accomplished goals with a more efficient cost structure.
Labcorp created this customized solution to meet the specific needs of this organization. As those needs evolve, Labcorp continues to optimize the program. Labcorp and the IPA continue to find new ways to maximize the partnership, such as working to implement bulk order processes to help provide more efficient test ordering and reduce the need for full-time employees to manually enter orders.
To start a discussion about how Labcorp might assist you with your health system’s unique challenges, contact us at https://labcorp.com/hospitals-contact.
