How diagnostics fuel quality improvement, efficiency and access to health and well-being across populations for value-based care

The healthcare landscape is shifting toward value-based care, where providers are incentivized to improve outcomes, reduce costs and close equity gaps. Despite the proliferation of clinical and claims data, many organizations face challenges with:

• Gaining visibility into rising-risk members
• Using clinical data for real-time risk stratification
• Coordinating gaps in care between providers and labs
• Persistent health equity gaps in providing preventive care

These challenges hinder the ability to identify at-risk patients early, intervene effectively and meet quality performance goals, resulting in missed opportunities for early intervention, unmanaged chronic conditions and widening disparities in care.

Diagnostic data is the missing link that turns insight into action, driving measurable improvement in overall outcomes and costs across populations. With lab data on over half the U.S. population, Labcorp helps providers and payers turn these over 45 billion tests results into diagnostic insights for measurable improvement.

The value-based care challenge: Data without direction

Diagnostics—sometimes viewed as a transactional lab service—can be a powerful upstream driver of value-based care success with the right strategic partner. One reason provider organizations and health plans struggle to turn clinical data into strategic action to improve outcomes and equity is the limited coordination, fragmented systems and/or separate data workflows between providers and labs, resulting in impeding effective use of diagnostic data. 

When integrated into care management workflows, diagnostic data can help improve  coding accuracy, real-time risk stratification and targeted interventions to ensure the right care at the right time and close gaps in care, while also expanding access and advancing health equity.

Three ways to use diagnostics as a strategic asset

Diagnostic data has a strategic value that goes far beyond test results. In addition to its ROI and effect on CMS Stars and HEDIS reporting, it can provide visibility into longitudinal patient data such as lab results ordered by providers outside of the network, helping target care gaps associated with payer quality incentives. When integrated into workflows, lab data becomes a catalyst for:

1. Earlier detection, improved risk identification, stratification and coding accuracy

Using comprehensive laboratory data from diverse sources, organizations can create a more complete patient risk profile, and gain early, valuable insights into patient health status, risk factors and potential disease progression. This information assists providers in proactively implementing prioritized and tailored interventions for patients who need it the most, ultimately improving outcomes and reducing healthcare costs. 

Lab data can also help organizations identify uncoded or misdiagnosed chronic conditions—especially in new patient panels. For example:

• 20%-30% of diabetic patients go uncoded
• 70% of chronic kidney disease (CKD) patients are either uncoded and/or aren’t accurately coded for the appropriate stage

Organizations that align lab results with existing patient coding can support appropriate risk adjustment and anticipate future care needs. This enables early detection of high-risk patients, more accurate prediction of disease progression, accurate payment based on the risk of the population and better allocation of care management resources.

Labcorp’s national lab data and Insight Analytics® platform help providers reconcile coding discrepancies, align documentation with actual patient health status and prepare for the transition to the V28 HCC coding model. In fact, we helped one large provider network uncover a potential $14 million annual impact by correcting coding for diabetes and CKD. 

2. Solving for silos and fragmented systems with seamless integration into care management workflows 

Effective integration of diagnostic data into care management workflows is at the heart of successful value-based care initiatives and crucial for improving patient outcomes. However, siloed data and fragmented workflows can hinder care coordination and impede progress. 

Organizations that seamlessly integrate diagnostic data into care management workflows can streamline processes, enhance communication and make sure critical information is readily available to all stakeholders. It helps providers make informed decisions, facilitate timely interventions and foster collaboration among care teams, ultimately leading to improved patient experiences and better health outcomes.

Integrating solutions that feed data analytics platforms into provider workflows also provides comprehensive lab utilization, results values and related patient data that reduces patient and provider friction and improves efficiency. 

Seamlessly integrating data into care management workflows helps:

• Assess disease prevalence
• Support planning for access and well-being across populations
• Optimize provider test ordering and utilization
• Support clinical decision-making at the point of care
• Streamline result delivery and eliminate manual data entry
• Gain real-time access to lab histories, regardless of ordering provider
• More effectively close gaps in care 

Labcorp’s tools, including Diagnostic Assistant®, break down lab data siloes and embed them into the care continuum—supporting timely interventions, accurate documentation and coordinated care. The Insight Analytics dashboards also offer predefined population health analysis, allowing administrators to quickly identify patients with multiple overdue tests. Shared access to lab results, outcomes and cost data align providers, payers and care teams around a single source of truth, improving clinical decision-making. 

3. Advancing health outcomes across populations through access and outreach

Ensuring access and well-being across populations is a fundamental pillar of value-based care and diagnostic services play a pivotal role in addressing disparities in access to preventive care. Health equity gaps lead to missed opportunities for early intervention, preventing disease progression and providing more cost-effective care.

Health equity isn’t just about ensuring access and well-being for all—it also can be a key performance driver. Yet:

• Over 100 million Americans face barriers to primary care
• One in three Americans experiences at least one care gap
• 50% of adults skip routine screenings, and along with chronic diseases and mental health conditions, drive $4.1 trillion in annual healthcare costs 

Lab diagnostics can play a significant role in promoting access and well-being across populations by identifying and addressing disparities in healthcare outcomes. Integrated, innovative solutions can help organizations understand health trends in specific geographies and socially vulnerable patient populations.

Providers can use these insights to make data-driven decisions for targeted, personalized interventions to more effectively address gaps in care. Labcorp has lab data on over 50% of the U.S. population, helping you identify and address care gaps with patient-centric solutions, including:

• Access to over 2,200 patient service centers and their partnerships with Walgreens that expand local access
• Multilingual outreach and culturally tailored engagement to improve compliance among diverse populations
• Access to community-based lab data for disease trending, benchmarking and identifying underserved populations
• Health equity dashboards that combine geo-coded disease prevalence with area deprivation indices to help target interventions
• At-home testing kits to expand access and reach patients where they’are, reducing geographic and logistical barriers, especially for underserved populations
• An Open Orders program that sends personalized email reminders to patients, resulting in improved patient compliance and supporting quality measure performance
• The ability to generate actionable lists for care coordination teams to engage patients and address health concerns and target patients with overdue testing

By pairing member education that highlights the importance of routine medical care with convenient and accessible diagnostic services, healthcare organizations can improve coordination across the care continuum and provide actionable information to connect members with the next steps in their healthcare journey. 

Case studies demonstrating success

Several case studies demonstrate the effectiveness of diagnostics in value-based care:

• One large independent physician associations (IPA) partnered with Labcorp to manage CKD. Labcorp's data reports helped identify uncoded CKD patients and a lack of referrals to nephrologists, resulting in the IPA receiving more upfront financial support to provide appropriate care management.
• A large FQHC network collaborated with Labcorp to optimize testing efficiency and improve patient care. Using Insight Analytics, the network viewed utilization reports for tests of interest based on national guidelines and best practices, allowing the network to eliminate $84,000 in unnecessary testing expenses in the first year.
• A large IPA partnered with Labcorp to conduct yearly fecal occult blood test gap closure programs, achieving a 30%-40% return rate in closing screening gaps. By leveraging Labcorp's data to identify patients with screening gaps and coordinate distribution of fecal immunochemical test (FIT) home collection kits, the IPA received over $1 million in incentive payments.
• A large, national health plan with over two million lives was looking to increase colon cancer screening rates, especially with their members in hard-to-reach geographical regions. Working with Labcorp, they found a flexible and cost-effective specimen collection kit process that produced a 2.6x higher return rate.

These case studies demonstrate improved compliance, reduced downstream costs and supported quality measure performance across diverse populations. 

Benefits for providers, health plans and ACOs

The integration of diagnostic data with local or at-home testing into value-based care initiatives offers numerous benefits for providers, health plans and accountable care organizations (ACOs).

For providers, the integration of diagnostic data:

• Deepens the patient-provider relationship
• Advances quality performance and value-based care strategies
• Reduces the burden on primary care providers by reaching patients where theyare and ensuring primary care has access to the results
• Provides actionable data and creates opportunities for meaningful, relevant patient outreach and intervention
• Offers a unified view of the patient, helping improve quality performance and reduce duplicative testing 

For health plans and ACOs, integrating diagnostic data:

• Improves the member experience
• Enhances payer-provider relationships
• Advances quality performance and value-based care strategies
• Identifies conditions that disproportionately drive healthcare costs
• Streamlines data aggregation to improve quality performance and reduce total cost of care
• Provides a cost-effective way to enhance quality performance measures and earn higher shared savings bonuses

By linking lab results to outcomes and cost data, organizations can measure performance, close care gaps and drive accountability across networks.