NEW YORK – BioReference Laboratories has seen demand for its services as a well-known PCR test provider in the US climb significantly over the course of the COVID-19 pandemic.
But even before the pandemic, Opko Health subsidiary BioReference was planning to broaden its footprint and make moves into digital healthcare and remote patient offerings with the development and launch of its Scarlet Health program.
The program, which brings laboratory specialists directly to a patient's door for sample collection and launched in January, was in a pilot stage for more than a year and in development before that.
The "full digital patient experience," as Jon Cohen, BioReference's executive chairman, refers to it, has multiple potential use cases, although currently BRL is only using it in one specific way, to schedule at-home sample collection.
To use Scarlet, a doctor puts a laboratory order into the workflow, which is integrated with a doctor or health system's electronic medical record. The patient then receives a text or email asking if they would like to have a professional come to their home or office to collect the specimen. If so, it offers two choices of a date and time for the patient to pick, sometimes within a day if the patient so chooses, and provides information on how to prepare for the appointment.
On the day of the appointment, the patient will receive some information about the person coming to take their sample and can "track the person like you track Uber" until the tech arrives, Cohen said. The patient can decide where the sample will be taken, i.e., in the garage or outside, and once the sample is taken, it's transported to the BioReference laboratory for testing. The patient and provider will receive a notification when the test results are available.
Scarlet's specimen collection is performed entirely by BRL employees who have received special training on how to go to patients' homes and offices and collect samples, including guidance on making patients comfortable and how to deal with pets in a home. "We believe strongly that it's a much better patient experience if the employee works for us," Cohen said.
The actual test turnaround time isn't impacted or changed based on how the sample is collected, Cohen said. Results are usually available within 48 hours regardless of whether a patient has their sample collected at home or at a patient service center. Patients also don't have to pay an additional out-of-pocket cost when using Scarlet.
Currently, the service is targeted for specific providers and medical groups based on who already had a relationship with BRL and who was interested, Cohen said, although he said other entities were interested in the service, such as payors and telehealth companies. Patients whose doctors aren't in the program can't request at-home sample collection, although he added that eventually, doctors won't have to be in the Scarlet Health program for patients to get their samples collected via the service.
In most places where Scarlet is currently available, BRL is already integrated into the provider's electronic medical record, and setting up the program only involves adding the code for the ordering service to the EMR, Cohen said.
While there is "no question" the COVID-19 pandemic accelerated the demand toward home healthcare, Cohen said, the development of Scarlet was driven by a belief in the movement toward home delivery of health services, as well as demand for convenience and the growing impact of telemedicine, he added. A lot of people who had never considered this kind of home delivery were now interested after the pandemic, he said.
One of the challenges during the pilot was making sure physicians understood the change in workflow and how to use the program with the EMR, Cohen said. The pilot, which was limited to two medical groups and one payor, also helped BRL figure out changes in software and how different aspects of the interface were presented, he added.
Scarlet's other future uses could include help with telehealth visits on both the front and back ends and specialty solutions in oncology and women's health. For patients with telehealth visits, providers will be able to order labs before the visit, so the information is available during the visit and patients don't have to go out of their way to get samples collected.
In addition, Cohen noted that with telehealth visits, "getting access to labs is not that easy." In a report on top health industry issues, PwC's Health Research Institute found that 40 percent of health services providers said retaining patients for ancillary services, such as laboratory services, was a significant challenge for growing their telehealth programs. Providing a way for patients to get those services without leaving their homes could help address that challenge.
The specialty solutions for oncology and women's health will allow for regular sample collection, since many oncology patients and pregnant women have labs drawn every month or trimester for monitoring. Scarlet would allow them to get those labs done without having to see their doctor simply for monitoring purposes, Cohen said.
The main problem Scarlet is addressing, Cohen said, is gaps in care and making sure patients complete the testing they need. Providers often struggle with patients completing their lab orders, with roughly 30 percent of lab orders never getting filled, he said. Scarlet currently has a 90 percent completion rate of orders, with only 10 percent going unfilled, Cohen added. BRL has also surveyed users of the program, with 92 percent highly recommending it, he said.
It can also be difficult for providers to reach patients, especially in rural areas, even if they know they need testing. For providers serving communities with high rates of diabetes or other chronic conditions, or patients in communities that may need lead testing, getting a patient to come in and receive that testing can be difficult, Cohen said. By going to the patient's home or office to collect the sample, those people can be reached more easily.
Although he declined to speak specifically about Scarlet Health, David Grenache, president of the American Association of Clinical Chemistry, said via email that "at-home sampling could be particularly beneficial for patients who can't easily go to a healthcare setting to provide a sample, whether it's because they live in a remote area or because they don't have access to transportation."
He noted that there could be concerns about the stability of a sample "as it is subjected to different environmental conditions during the time it is in transit to the lab" in at-home collection.
Scarlet is currently available in 11 markets around the US including Arizona, California, Colorado, Florida, Kansas, Illinois, New York, New Jersey, Virginia, Texas, and Washington, and BRL is trying to "cover 80 percent plus of the US population within the next six months," Cohen said.
BioReference isn't the only laboratory with options for professionals to collect samples at home, however. TeloPoint, a New York-based company, offers a service in which phlebotomists come to a patient's home for a scheduled blood draw, although it is only for patients in Manhattan. Sonora Quest Laboratories also offers a mobile phlebotomy service for sample collection in a patient's home for most routine labs, including lipid panels and complete blood counts. Other mobile phlebotomy and sample collection services include Phleetbo, TopLab, and Med2U Laboratory Services.