NEW YORK (360Dx) – As patients increasingly move toward a hands-on approach to their healthcare — a trend that is part of a larger evolution in how consumers are paying for their healthcare — Quest Diagnostics is taking notice.
Recently, in response to such market changes, the company launched a service that enables patients to obtain diagnostic tests without a physician's order, breaking from the traditional "gatekeeper" model.
According to Cathy Doherty, senior vice president of clinical franchise solutions at Quest, the desire among at least some patients for such patient-initiated testing may be linked to an uptick in the number of patients signing up for high-deductible health insurance plans, in which patients pay more out-of-pocket for their healthcare before their insurance kicks in.
Some patients who may need testing on a regular basis, like those suited for patient-initiated testing, may choose to avoid the cost of going through a physician to have them ordered, Doherty said, and added that in these cases, patients may decide to use flexible spending accounts to cover the costs of their tests, which would allow them to pay with untaxed dollars.
"We think that this is becoming the norm and it will continue to influence an increasing proportion of lab spend," Doherty said.
According to Quest's website, prices for its tests range from $25 for individual tests to $181 for a men's health profile that includes a complete blood count, comprehensive metabolic panel, lipid panel, a test for prostate specific antigen, and a urinalysis.
Savings to consumers using Quest's patient-initiative service will vary depending on many factors including the type of insurance coverage, the reason for visiting a doctor, and the type of testing, Quest said.
It also said that while patient-initiated testing could provide cost savings for some patients, the primary driver for launching QuestDirect was to give patients the power to manage their own health and wellness through laboratory testing.
According to Doherty, consumers are looking for more convenience and access, and Quest believes that the patient-initiated test offering caters to those needs.
The service is a pilot project for now, and Quest is making it available without physician referrals only in Colorado and Missouri. The company will evaluate progress around the middle of this year and decide on the next step, and possibly expansion to other states.
Quest's patient-initiated test service is part of a strategy that's centered on being a diagnostic information service provider of choice, and it's one among a few diagnostic-test initiatives that the firm has introduced directly targeting consumers. Other direct-to-consumer Quest initiatives include wellness centers that provide diagnostic testing within retail stores; ancestry genetic tests that can be ordered online; and tests for athletes and other sports enthusiasts that enable performance improvements.
Several companies are surfacing that offer direct-to-consumer test services, but many of them provide a technology front and outsource their testing services to reference laboratories, Doherty said, adding that DTC testing is "a very fragmented business."
It's also one that regulators have an eye on. One firm that sought a DTC strategy, Theranos, has run into a heap of trouble during the past year and has had to dramatically scale back its ambitions. Both the US Food and Drug Administration and the Centers for Medicare and Medicaid Services have come down hard on the Palo Alto, California-based company, and during the summer CMS banned Theranos Founder and CEO Elizabeth Holmes from owning or operating a clinical lab for two years.
Walgreens also abruptly ended a partnership it had with Theranos in June after it came to light that Theranos had to void two-years worth of testing results and send thousands of corrected reports to doctors and patients.
Most recently, Theranos shut down its clinical labs and wellness centers and laid off several hundred employees. Meanwhile, the Arizona attorney general's office plans to sue the firm, alleging a "long-running scheme of deceptive acts and misrepresentations."
Those developments have not deterred Quest from pressing ahead with its initiatives, however.
In June 2016, Quest and Safeway said that they would team up to offer testing in patient service centers at 12 of the food and drug retailer's locations. They had already been offering testing in two locations, in Arizona through Quest's Sonora Quest Laboratories joint venture with Banner Health, and in Oklahoma through Diagnostic Laboratory of Oklahoma. The service centers provide a standard battery of tests available in Quest service locations.
Quest CEO Steve Rusckowski noted in a statement that the centers would make it easier for people to "get the quality diagnostic insights they need in convenient locations."
Doherty said that Quest had more than 50 patient service centers in operation by the end of 2016, and would have an additional 200 in place by the end of this year.
In another step into the DTC testing space, soon after the Safeway announcement, Quest inked an agreement with AncestryDNA with the objective of addressing consumer demand for genetic tests that provide insights into genetic ethnicity, origins, and other factors.
Quest said that the collaboration would enable Ancestry.com, the provider of the AncestryDNA service, to scale up its services. As part of a multiyear global collaboration, Quest began providing genotyping test services on behalf of Ancestry.com, which is among the largest consumer genomics providers with more than 2 million consumer DNA samples in its database.
Other Quest consumer offerings include Blueprint for Wellness, a growing wellness business, and Blueprint for Athletes, a DTC biomarker monitoring service for amateur and professional athletes.
Patient Test Options
The new Quest-Safeway patient service centers tie in with Quest's patient-initiated test service, Doherty said. People signing up for tests online could get testing done at one of these new centers. Alternatively, consumers have thousands of dedicated Quest test centers from which they can select a location.
Residents of Colorado and Missouri interested in Quest patient-initiated testing can order tests online at Quest Diagnostics' website, QuestDiagnostics.com/QuestDirect.
The patients identify the tests they need and then attend one of the Quest patient test centers. Consumers select from a range of tests that appear to carry relatively low risk, and do not include, for example, higher risk molecular tests for cancer diagnostics. Health profiles are available such as those completed during routine doctor visits, which include lipid tests indicative of heart health. Doherty noted that the test service may be particularly suitable for consumers interested in testing the body's response to specific health activities, such as the effect of a change in exercise and diet on cholesterol, for example.
Quest also offers patient-initiated testing for hepatitis C, which can be fatal and is underdiagnosed and undertreated, Doherty said. Sexually transmitted infection screening for herpes, gonorrhea, chlamydia, and syphilis is also available, as is diabetes testing.
After identifying tests on Quest's website, patients then make an appointment online and attend one of the firm's patient service centers.
The firm has a network of physicians that connect with people, when they notice that their test results are outside the normal reference range, to discuss the results and encourage them to visit a physician.
Patient test results are provided through the company's MyQuest by Care360 patient portal and mobile app.
In December, Quest announced that an unauthorized third party accessed the MyQuest by Care360 internet application and obtained protected health information of around 34,000 individuals. However, Doherty said that the data breach did not include Social Security numbers, credit card information, insurance, or financial information, and was unlikely to impact the growth of its patient-initiated testing or other new services.
The MyQuest patient portal and mobile app had around 3.3 million registered users in December 2016, and it was growing at a rate of around 100,000 users per month, proof that consumers want convenient access to their lab results, Doherty said.
As Quest thinks about consumer desire for convenience, "we're also trying to understand that whole consumer buying journey," Doherty added.