Jane Hermansen, Outreach and Network Manager at Mayo Medical Laboratories in Rochester, Minnesota, recently authored an article featured in MedicalLab Management on integrating laboratory outreach across the health system. Vertical integration of laboratory services is critical to support the delivery of care in each area of patient access across the continuum. However, due to the essential nature of laboratory testing for immediate patient care, integrating laboratory services across the system raises additional complexities.
For example, laboratory outreach may be identified in different ways. According to Hermansen, "Some may include outpatients from employed providers, while others may consider testing from only non-affiliated sources. Regardless of the criteria used to define outreach testing, a systematic approach is required to maximize the impact of an integrated system laboratory outreach program. It is incumbent upon laboratory leadership to optimize both the horizontal and vertical integration of laboratory services within the organization."
Hermansen says it's important to start with a vision. There are opportunities to realize operational efficiencies across multiple laboratories in terms of standardizing equipment, procedures, systems, etc., consolidating purchasing contracts, reorganizing management structure and staff, and creating centers of excellence.
It is also critical to identify an executive sponsor. According to Hermansen, "An administrative champion can provide support, make key decisions, spearhead change, and communicate laboratory needs to executive leadership."
When optimizing outreach activity system-wide, it is essential to establish a baseline inventory of each laboratory’s outreach program capabilities. These include:
- Current Outreach Business Status: First, identify the customers and locations. Then, quantify the associated volumes and revenues.
- Current Outreach Performance: Each market has unique dynamics and challenges related to the strength of its competitors and individual patient or provider preferences. It is important to understand how local outreach programs have developed and how they leverage competitive advantages to survive in their specific markets.
- Competitive Analysis: It is essential to understand the program’s competitors and their market-share trajectories.
- Current Outreach and Health System Infrastructure: Vertical integration requires the health system to create a supportive infrastructure for providers and non-hospital-based patient-care locations.
After determining a baseline inventory, it is important to evaluate data and outreach structure options. While there are many outreach program models, no one model can be singled out as the best solution. Models include:
- Individual Outreach Program: Each hospital laboratory maintains its own outreach program, with a separate infrastructure and unique processes.
- Hub Outreach Program: Regionally located (usually larger) hospital laboratories within the system are outreach hubs. Specimens collected in a defined region are transported to a regional hospital for testing. A local hospital may perform stat testing if required. Infrastructure may be managed regionally or at the corporate level.
- Shared Service/Turnkey Infrastructure: The outreach infrastructure is managed entirely at a corporate level with testing performed in local hospitals. The local hospital pays for the use of the health system resource.
- Core Outreach Laboratory: Market size and geography notwithstanding, all outreach activities, including infrastructure and testing, are performed at a single location. Regardless of the source of the specimen, it is tested in a centralized location, and all patient interactions and customer relationships are managed by core program staff. There may be exceptions to the testing location for stat testing, but localized outreach testing is minimal.
According to Hermansen, "As health system consolidation continues, laboratory outreach must be leveraged to retain laboratory testing within our health systems and aid in the local provision of integrated patient care. When integrating a laboratory outreach program across a health system, make small changes, perform pilot activities, pause, re-evaluate, and then continue to move forward. The key to enduring success is to ensure alignment with system objectives while leveraging location-specific best practices, recognizing local and competitive dynamics, and using data to drive decisions and track progress."