Unlocking Value in Diagnostics: Leveraging the Evidence

By Ross Coapstick, Executive Director of Population Health, AdventHealth

Healthcare is evolving rapidly, and value-based contracts create the economic alignment to drive optimized outcomes at a viable cost. Diagnostic exam choices have a tremendous impact on outcomes and cost. With the proper understanding of value and evidence-based standards, providers are driving toward this change, continuing to improve patients’ health. However, the cost of care is difficult to wrangle. Creating standards that care teams and systems adhere to ensures that diagnostic choices represent clinically appropriate and cost-effective care. Health systems, provider networks, and medical groups each play a role in leading this change, and they must work together. The way out of the labyrinth of cost is an unwavering and shared commitment to leverage the evidence.

Aligning Payment Models to Best Practice

“Value-based care” is defined in several different ways; it is an approach to care delivery that prioritizes and rewards quality of care, efficiency of service delivery, and patient satisfaction with the care received. The caregivers must also be engaged and satisfied with the model for it to be viable and sustainable. The idea of care centered around the patient and provider requires all members and processes of health care delivery to work in concert with each other to achieve high-quality, evidence-based, and accessible care. In value-based models, payment economics may even penalize the participants financially when goals are left unmet. The alignment of performance and payment is the most important difference from a traditional fee-for-service payment model. Yet, it is fair to assess that not all value models recognize the evidence completely. Productive critique is needed and drives the evolution of payment.

The way out of the labyrinth of cost is an unwavering and shared commitment to leverage the evidence.

The Importance of Evidence-Based Diagnostic Choices

Diagnostics testing is an essential step in the clinical care process. The utilization of diagnostics is wildly different from one model of care or provider to the next. Inconsistencies create variability in cost, and ultimately outcomes suffer. The question is, “Why does variability exist?” A degree of variability is always expected in medicine, but as clinical care and medical training has evolved, inconsistencies are exacerbated while providers chase the latest guidelines and evidence.

Additionally, patients often demand testing from providers who recognize the most efficient best practice may not alleviate the fear that a test might. Many disciplines of providers, clinical staff, finance leaders, analysts, and care teams are nobly charging headlong to solve the value equation within their silos. Research yields multidisciplinary, evidence-based protocols that should supersede individual experiences.

Collaboration to Create Clinical Standards

Health systems, networks, and provider groups must work together to develop and implement these diagnostic standards within clinical protocols. Just as critical as the clinician is the expertise of the diagnostics teams. Intentional effort should be made to engage leadership from the clinical laboratory, imaging, cardiology, neurology, pathology, genetics, endoscopy, electrophysiology, etc. This collaborative effort extends into the multidisciplinary teams of clinicians, analysts, researchers, and experts in value-based care who can review the existing evidence and collectively establish best practices. Regular updates and reviews of standards ensure they remain current with the latest medical advancements and research findings. Many top academic and care delivery institutions have taken this step forward, engaging systematically across disciplines. They are unlocking value, publishing additional evidence, and as they do, the improvement cycle continues.

Measure, Measure, Measure

Once clinical standards are agreed on, monitoring adherence and outcomes helps sustain momentum. “Cost to deliver care” and “cost charged to deliver the care” are two separate crucial indicators that frequently get confused—the time burden and cost of each care staff member and how that value gets maximized. There are various approaches to analyzing these costs; all of them are tedious, but they are still equally worthy. Until the cost of each moment of care, each turn of the cog, and each unit of resource is identified, the true cost opportunity is unknown. Understanding the “cost to deliver care” creates transparency and repeatable value, reducing waste in the system from overutilization, errors, and inefficient processes.

Summarizing Success: Evidence-based Diagnostic Cost Containment

1. Engage Multidisciplinary Teams: Involve diverse groups of experts, including diagnostic experts. Their combined expertise ensures the protocols are comprehensive.
2. Leverage the Evidence: Allow the evidence to drive the decision-making, avoiding the variability and cost associated with preferences and habits.
3. Education and Training: Provide ongoing education and training for healthcare providers to ensure they are familiar with and adhere to the standardized diagnostic pathways.
4. Find the “Cost to deliver care”: Implement costing analysis as a standard. Start small, gain competency, then scale. Differentiate “cost to deliver” versus “price charged.”
5. Data and Analytics: Leverage clinical data to analyze the effectiveness and costs of different diagnostic tests, refining clinical pathways.
6. Monitoring and Feedback: Ensure mechanisms for surveillance of implementing diagnostic standards and adherence. Create a path for users of the protocol to give feedback.
7. Improvement Cycle: Engage multidisciplinary teams to consistently review and update diagnostic standards to reflect the latest evidence.

Improving value and achieving diagnostic cost containment requires engagement from your stakeholders – be sure to invite your diagnostic leaders to the table. Health systems leaders, provider networks, and medical groups are uniquely positioned to leverage their operational sophistication and influence to drive change. A consistent feed of new evidence into the improvement cycle unlocks the value of diagnostic choices, elevating effective and efficient care. A shared commitment to the evidence must prevail.