NEW YORK (360Dx) – TriCore Reference Laboratories has begun offering targeted lab analytics as a standalone service to insurers, with one insurer already signed on as a paid subscriber.
The service includes targeted intervention modules, or TIMs, that focus on providing guideline-based analytics for specific medical conditions, according to David Grenache, TriCore's chief scientific officer. The lab provider currently offers TIMs in the areas of prenatal care, hepatitis C, diabetes, and chronic kidney disease.
For insurers, the service is currently aimed at helping insurers meet quality control guidelines that can affect their reimbursements, according to Rick Van Ness, TriCore's director of diagnostic optimization product development. The analytics can help insurers meet measurement standards such as Healthcare Effectiveness Data and Information Set (HEDIS) performance measures maintained by the National Committee on Quality Assurance that are widely used in the managed care industry, or the star rating system used by Medicare to measure how well Medicare Advantage, or Part D, plans perform.
Insurers' Medicare star ratings may be tied to how well they have met a performance measure in a particular area, such as what percentage of their diabetic patients have hemoglobin A1C measures that are considered under control. As a lab company, TriCore is able to use its data and analytics to give insurers a timely picture of where they stand in relation to these measures, Van Ness said.
"The reality is, [insurers] are so focused on these stars and these HEDIS measures, that we have been able to attach a value to it, and to seeing that data in real time," Van Ness said.
The data is information that insurers already have, Grenache and Van Ness said, but they are typically not reviewing it in relation to the quality metrics they are measured against. As a result, TriCore sees the service as selling data insight.
"The insurers already have this information. We are not sharing any patient-specific information that they don't already have," said Grenache. "They aren't looking at it this way. They don't have the domain knowledge to do what we are doing." he said.
To launch the service, TriCore began with a seven month pilot program with a single insurer. That insurer, whom TriCore is not disclosing, subscribed to the service following the completion of the pilot and has been a subscriber for approximately six months, Grenache and Van Ness said.
Insurers can access data from the TIMs service either by logging into a portal that collects data and flags patients who need attention. For insurers who are less comfortable accessing the portal directly, TriCore can send reports, according to Van Ness.
The service was developed in house by TriCore. Lab personnel supplied the domain expertise and determined which medical conditions should be the first areas of focus. Rhodes Group, the clinical information technology company that is a wholly owned subsidiary of TriCore, built the portal platform.
For TriCore, the service signals a shift in the role of labs in medicine.
"What people traditionally think of when they think of a clinical lab is capacity. The way labs have operated for decades has been, I order the test, you do the test, you sent me the results and we're done," Grenache said. "This is really an evolution of how laboratories should be perceived and are beginning to be perceived at this point."
The four modules of TIMs that were selected to launch the program were chosen because there were patient care guidelines that could be clearly tied to performance measures, according to Grenache.
"With the prenatal TIM, if you look at national guidelines from say the American College of Obstetricians and Gynecologists, certain tests should be done at certain gestational ages," Grenache said, noting that the timing of testing in pregnancy underscores the importance of having a real-time picture how patients are being treated.
"Because we do the laboratory tests, we can identify which tests are being performed, and which tests are not being performed, so we can get a very nuanced picture for that individual patient."
The insurance company's care coordination team then reaches out to the patients, who have been flagged by TriCore, to encourage them to schedule an appointment for the testing or additional medical care, he said.
In addition to flagging patients who are not receiving the proper care, the service can flag potential risks, said Van Ness.
"We have a history of patients coming into the lab, so we can see that a year ago this patient tested positive for diabetes and today she is pregnant. According to ACOG that is a higher risk for preterm delivery so you might want to increase your care coordination for this person," Van Ness said.
With its current client, TriCore had promised to meet certain improvements in quality measures as a term of its contract, and since using the data the insurer has exceeded all promised improvements, according to Grenache and Van Ness. The goal, they said, is that eventually insurers will look beyond quality measures and use the data to assess improved outcomes, as well.
"Insurers have gotten so incentivized and focused on just quality measures, but timeliness of prenatal care is highly correlated to better outcomes," Van Ness said. "I think as we get them to better quality measures, it's going to eventually get them to think about the outcomes, and that will move toward more of a value-based care arrangement."
The service is offered as a separate standalone service to insurers with a subscription cost tied to the number of patients served. It was important to offer the service as an entirely separate service from laboratory contracts for regulatory purposes to ensure that regulators would not view it as an inducement for signing a lab contract, Van Ness said.
TriCore has met with providers as well as insurers about the service but has so far targeted insurers as clients because they are more incentivized to adopt it, Grenache said.
Looking ahead, TriCore also hopes to expand the service to more medical conditions. Other medical conditions that TriCore is current evaluating or planning for development include opioid abuse, liver fibrosis, sepsis, antibiotic stewardship, multiple drug resistant organisms, and rheumatoid arthritis, Grenache said.