A challenge of meeting minimums
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:
- Colorectal cancer screenings (CRCs) were occurring for less than 20% of the recommended population
- A large portion of the diabetic population was not scheduling timely checkups or hemoglobin A1c (HbA1c) screenings
By closing these care gaps, the IPA could recognize incentive payments of more than $1 million.
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.
Finding a partner with insight
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.
The IPA partnered with Labcorp to create a solution that would decrease costs and boost program participation.
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.
Labcorp’s Gaps-in-Care program included:
- Identification of a targeted list of patients most in need of testing
- Delivery of home collection kits with step-by-step collection instructions
- Labcorp Patient Portal access for patients to view results
- Result delivery to IPA providers through existing data feeds and result routes
- Creation of patient letters with client branding and population-specific language
- Dedicated customer service (9 a.m. – 9 p.m. EST)
Furthermore, the IPA and Labcorp created a solution for fecal occult blood test kits (FOBTs) that accomplished goals with a more efficient cost structure.
A partnership that endures
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.