Sonora Quest Laboratories
How Becoming Patient Centric
Aids in the Volume to Value
Transformation
California Clinical Laboratory Association
David N. Moore, CIO
Sonora Quest Laboratories
November 6, 2014
Learning Objectives
Sonora Quest Laboratories
• We will cover three main topics:
– How is the Outreach/Independent Laboratory’s
definition of Patient Centric different from a Health
System’s definition?
– How does being Patient Centric enable the
Outreach/Independent Laboratory to effectively
support ACOs and Patient Centered Medical
Homes?
– How can the Outreach/Independent Laboratory
use Patient Centric data to interact with the
patient?
Different Definition
• How is the Outreach/Independent
Laboratory’s definition of Patient Centric
different from a Health System’s definition?
Sonora Quest Laboratories
– Health Systems can enforce more strict data
gathering efforts.
• Most importantly, the patient is there.
• There is time to research the HIMs data to affirm the
patient’s identity.
• Insurance verification can be done during the patient’s stay
and corrections made prior to discharge.
• The Health System physically “tags” the patient for
verification during their stay.
Different Definition
Sonora Quest Laboratories
– Labs can enforce more strict data gathering efforts.
But there are some challenges:
• We only see the patient around half the time.
– At Sonora Quest Labs (SQL), we process over 23,000
orders every week day.
– But we only “see” 55% of the patients in our service
centers or by our In Office Phlebotomist (IOP).
• Our time with the patient is limited. We try to serve the
patient in 30 minutes or less with a limited staff.
Sonora Quest Laboratories
Different Definition
• For the patients we don’t “see”, we have to rely on the
information submitted by the physician.
– A substantial portion (65%) of our orders come to us
electronically
– We still get a significant number of orders that must
be keyed into our LIS
– Incorrect data is submitted that the lab knows is
wrong
» A male with a Pap test ordered or
» Tubes with John D. XXX as the name and David XXX as the
name on the order.
Different Definition
Sonora Quest Laboratories
• Our CFO’s pet peeve – the insurance data submitted has
been wrong for years in the EMR and continues to flow in
electronically. If there is no eligibility for this insurer, a
denial will follow and the research effort resumes. Efforts
to get the EMR updated are in vain.
Different Definition
• But even Health Systems have these issues as
they affiliate with physician practices.
Sonora Quest Laboratories
– Banner uses NextGen for its owned practices and
exports its system MPI ID to them, but consider
• One affiliated specialty practice uses Allscripts
• Another affiliated specialty uses Greenway, etc.
– We get orders from all of them. No big deal, right?
• When the same patient is referred from BHS to the others,
we now have three MPIs for him/her.
• Even better, what if the patient is named John D. XXX at
one and David XXX at the other.
Different Definition
• Here is the rub
Sonora Quest Laboratories
– Banner expects their results back with their
NextGen MPI.
• The first specialty expects their results back with their
Allscripts patient ID and the name John D. XXX.
• The second specialty expects their results back with
Greenway patient ID and the name David XXX.
– But these orders and results all refer to the same
patient.
Different Definition
– Well, just use the patient’s SSN.
• Based on 15M orders over the last 28 months,
• We only get a value in the SSN field 33% of the time.
Sonora Quest Laboratories
– Of the 5M SSNs received, almost 70% were
bogus.
•
•
•
•
Like 123-45-6789
or all the same digit
or “None”
or used repeatedly (bought from an identity thief)
– So for us, an SSN has no weight as a component
in establishing a patient ID.
Different Definition
Sonora Quest Laboratories
• Labs need to be able to track patients
across ordering entities while
– Maintaining the uniqueness of the patient
information for return the results to the client’s
EMR,
– Retaining insurance information on a date of
service basis (for rebilling), and
– Combining results and billing information for
HEDIS reporting requirements
Different Definition
Sonora Quest Laboratories
• Solution lies in setting up your own Patient
ID
– We partnered with Atlas Medical to build our
Enterprise Master Patient Index (EMPI)
– Spent 3 months in design of algorithms
• Holistic approach to data analysis allows
– Probabilistic rankings for first name/nicknames
matched with last names
– Comparing incoming data from ordering client EMRs
for changes using chart ids as a key
• Processed 12.5M accessions (24 months of volume)
• Identified 3.6M unique patients
Supporting ACOs and PCMHs
Sonora Quest Laboratories
• As these entities accept patient populations,
they will go after the low hanging fruit
– Banner and Aetna announced (Oct 14th issue of
Healthcare IT News) that they had reduced average
medical costs by 5%,
– Reduced their readmission rates by 9% and
– Similarly reduced their utilization of expensive
radiology services.
– But they are still working on tracking diabetes
patients.
Supporting ACOs and PCMHs
• But these gains are based on retrospective
data
Sonora Quest Laboratories
– How can we help them be proactive?
• One idea is to receive their discharge summaries and set
up a watch list based on our EMPI for the patient.
– When an order is entered for that EMPI, we can send a
secure message to the care team alerting them to the
encounter.
– The team can then follow up with the patient to
understand the reason for the test and intervene if
needed.
– Some compliance issues need to be addressed still.
Supporting ACOs and PCMHs
• But these gains are based on retrospective
data
Sonora Quest Laboratories
– How can we help them be proactive?
• We have been asked to help an AHCCCS (Arizona’s
Medicaid program) insurer track subscribers that have had
lap band surgery to help control their diabetes.
– Very small number of patients out of 225K
subscribers.
– But the insurer needs proactive actionable information
regarding the patients’ blood sugar and A1c results
upon release and not at the end of the month.
Supporting ACOs and PCMHs
• But these gains are based on retrospective
data
Sonora Quest Laboratories
– By watching for orders and looking for specific tests
for these subscribers
• We can send a message to the insurer that there is an
order pending
• And send a message when the results are released so that
the insurer can access and monitor the results.
– By applying this logic to other cases for other
insurers/ACOs/PCMHs, we can help in following the
patient’s compliance with orders as well.
Supporting ACOs and PCMHs
• Supporting HIEs
Sonora Quest Laboratories
– Each HIE has their own patient ID (PID)
• By linking the HIE PID to our EMPI we
– Include our EMPI as a key in the results data
– Provide historical base of results
• HIE provides patient opt in/out facility
• HIE provides continuum of care view of patient activity
– Supporting Multiple HIEs
• Patient crosses into different service areas
– EMPI allows cross connection between HIEs
– Data shared only if agreed to by HIEs
• We encourage Health Systems to join instead of form
Interacting with Patients
• Meeting Expectations
Sonora Quest Laboratories
– Voice of the Customer - Patients
• Improvements wanted in
– Managing Appointments
– Appointment Reminders
– Getting Results
• New items
– Managing insurance information
– Family registration
– Medical Information
Interacting with Patients
• Managing Appointments
Sonora Quest Laboratories
– Updated Appointment System
• Improved process to make/update appointments
– Includes maps and locators based on zip code
– Simplified appointment locator
– E-mail notifications
• Linked to company website
– One stop shopping
– Consistent branding
Interacting with Patients
• New Items
Sonora Quest Laboratories
– Providing Insurance Information
• Website provides place
– Enter or update patient demographic information
– Enter or update insurance information
– Family information
» Associate themselves with a dependent
» Allows multigenerational support
• Pay outstanding invoices
Interacting with Patients
• Delivering Patient Results
Sonora Quest Laboratories
– Recent Federal law changes allow labs to deliver
results to patients on request
• Patient submits request by phone, fax or website
• Health Identity Management (HIM) team (3 FTEs)
– Determines that the requestor is in fact the patient
– Uses the EMPI inquiry function to find all accessions
related to the requested date of service
– Requests reprint for delivery to patient
• Since Arizona law changed prior to the Federal law, SQL
has been handling a weekly volume which has grown to
>1,200 requests.
Interacting with Patients
• Discovery Efforts
Sonora Quest Laboratories
– Every lab has to, at one time or another, produce
all the results for a patient to support
• Legal action
• Follow up studies
• Internal audits
– Using the EMPI inquiry function, the search time
has been reduced from weeks to minutes
Interacting with Patients
• Additional Benefits
Sonora Quest Laboratories
– Cash collections at encounter
• We have 75+ Patient Service Centers (PSC)
– Of the daily PSC encounters, 350 patients (3%) owe
us, on average, $40, or $14K/day
– Or $3,000,000 per year!!
• How we are impacting our bad debt
– Use the EMPI to retrieve accession balances post
insurance adjudication
– Check for past due amounts at check in
Sonora Quest Laboratories
Interacting with Patients
Sonora Quest Laboratories
Interacting with Patients
Sonora Quest Laboratories
How IT Can Add Value