Tout ATLAS Benefits to Payers

Penetrating managed care networks is not easy for laboratories to do.

In fact, Clinical Laboratory News reports labs need to go “above and beyond” to get their services in-network with managed care providers, which seek value, data and access to new markets.

“We are looking for value-added services,” Richard Gentleman, Aetna’s senior director of national ancillary contracting, said in a recent Clinical Laboratory News article. “Do they (labs) offer outreach services to improve convenience for patients?”

“We’re interested in the quality of the test and how it affects outcomes. . . We’re looking for labs that provide physician support on the front-end and on the back-end,” added Bryan Loy, MD, Humana’s vice president of oncology, laboratory and personalized medicine, in the Clinical Laboratory News story.

Meanwhile, accountable care organizations (ACOs) seek cost containment and reward value and good outcomes. ACOs, launched with the Affordable Care Act, are collections of hospitals, primary care doctors and specialists. ACO members accept responsibility for quality and cost of patient care and obtain financial rewards as targets are met.

Fortunately, contract access is possible even for local and independent labs. That’s one of the observations made by Chi Solutions, Inc. in its recently released study, “Strategic Implications of Chi Laboratory Outreach Survey Findings.”

Adjunct Lab Technology is Right for Labs and Payers

Lab leaders are balancing traditional fee-for-service reimbursement with up-and-coming value-based payment and emergence of ACOs. To help address payers’ demands, labs need adjunct technology to the laboratory information system (LIS).

Specialized technology offers labs value-based solutions, while enabling the electronic health record (EHR) and LIS to augment each other and electronic medical record (EMR) functionality.

ATLAS solutions including Physician Portal, PSC Portal, Advanced EMR Connectivity, and Multi-Lab Networking, all built upon the ATLAS Coordinated Diagnostics Platform, make these benefits possible for labs and insurers:

  • Advanced connectivity with EMRs, LISs, other labs
  • Outreach diagnostic services (as well as inpatient, outpatient and inreach)
  • Efficient lab workflow, insurance-directed lab send-outs, reduced costs
  • Clean and complete test orders with extensive validation including medical necessity
  • Physician support in appropriate test utilization and, on the back-end, with results reports
  • Patient satisfaction with in-network testing

Winning Over Payers with an Efficient Workflow That Builds on Their Rules

Physicians and patients may have favorite labs. But payers increasingly drive decisions about where tests need to go. So, laboratory technology needs to alert labs to possibly send-out tests to a lab, based on criteria such as the patient’s insurance plan.

That was the case at Maury Regional Medical Center, which performs about two million tests each year. The lab was experiencing challenges in getting orders to labs in patients’ insurance networks. An ATLAS team (using the company’s Multi-Lab Networking solution) loaded a joint test catalog—a critical first step toward an efficient lab workflow. Through one ATLAS interface, multiple test compendiums are electronically available to doctors, keeping workflow simple for busy physician practices.

Adding Value to the Test Ordering Process – Provide a More Personal Service

When doctors electronically place outreach orders with Maury through their EMR or the ATLAS Physician Portal solution, the ATLAS rules-based technology, along with lab-configured rules, directs the test orders to the correct performing lab (Maury, LabCorp or other affiliated Maury labs). With test routing based on payer rules or patient status, the process is seamless for the physicians during the order process, and ultimately elevates patient satisfaction as well.

“What we wanted to do is help the physician with that workflow. Doctors want to place an order in their EMR, have it flow to Maury, and for us to do the work (getting the order to the in-network lab),” explained Robin Thomas, Maury’s laboratory information systems manager, in an ATLAS webinar,Don’t Lose Orders to Other Labs—Maximize the Order Flow to Your Lab.”

“We have also decreased patient complaints, ‘You didn’t send my lab work to the right place,’” added Robin, who pointed out during the webinar that the Maury lab has decreased denials by insurers and manual processes in the lab while increasing revenue and physician satisfaction.

In addition to insurance information, the ATLAS Platform validates orders and aims for a clean orders strategy through use of appropriate test codes, complete answers to order-entry questions and medical necessity checking. Printing of advanced beneficiary notices (ABNs) and private payer waivers further enhance medical necessity functionality.

Helping Doctors on the Back-End with Results, Leveraging Lab Data

Research suggests payers also want labs to support doctors on the back-end. The ATLAS Platform enables electronic results reporting and replaces manual processes, which often impede lab workflow. Test results, part of one order, are combined by ATLAS in one report, which saves doctors from having to look for several loads of information in an e-mail box. Results are shared with doctors in the ATLAS Physician Portal or sent electronically using Health Level 7 (HL7) format standards to the physician’s EMR. With the embedded rules engine, physicians can see results when and how they want them, based on physician specific preferences maintained by the lab. So, for example, physicians who prefer to see partial results can still do so, or can wait until the report is final. Further, if the physician wants to see only final reports, but would like the report when the only remaining test is a micro test, the report can be issued with all complete results and the preliminary micro, so as to not hold up the report distribution for what could be an extended amount of time

At Huntsville Hospital Health System Laboratory (HHL), the lab team, using ATLAS solutions Physician Portal, PSC Portal and Advanced EMR Connectivity, chose to file all test results for inpatients and outpatients into the ATLAS Platform which then pushes the data to the results portal. So, doctors can see results in an easy-to-read format, which helps to speed diagnosis.

When a provider logs in, they have an opportunity to view results for tests ordered as well as other test results such as those ordered by a specialist who saw the patient. Labs can use ATLAS-provided tools to define rules that enable HIPAA compliance.

“Using that power, we made the decision to allow physicians opportunity to view results ordered by other physicians. It may be a result that was ordered by the patient’s cardiologist or oncologist. Or perhaps the patient was in the ER the night prior, and the primary care provider needs to follow-up,” said Vicky McClain, administrative director, laboratory services, Huntsville Hospital.

“With ATLAS, they can get the data they need when they need it,” she added. (Learn more by requesting the Atlas Medical Success Story Huntsville Hospital Laboratory Achieves Dramatic Improvement in Services at PSCs, Clean and Accessible Test Orders and More After Turning to Atlas Medical).

Don’t Be Shy; Tell Payers What the Lab Value Can Do

In the end, labs and payers want the same things: serving physicians and patients with cost effective and medically appropriate tests that lead to better health outcomes.

To make this possible, lab leaders need to engage specialized technology – such as ATLAS solutions Physician Portal, PSC Portal, Advanced EMR Connectivity and Multi-Lab Networking – which interfaces with the LIS and other systems and delivers value-based care solutions labs and payers seek. Then, lab leaders can be prepared to answer a question such as the one Michael Snyder, Avalon Healthcare’s senior vice president of provider management, put to Clinical Laboratory News: “Do you (the lab) represent a proprietary and clinically useful technology I can’t get through the big labs?”

Lab leaders should not be reticent about their labs’ technology capabilities. After all, insurers are publishing their expectations. This is not the time for properly equipped labs to be shy.

Questions for Discussion: What do insurers expect from your lab? What challenges does the lab have in penetrating managed care networks?