Live Blog: Utilization Management and Leveraging the Laboratory
The leading voices in the fields of value-based health care, utilization management, and laboratory outreach will be in Rochester this week. Follow this blog to read presentation highlights and see photos from throughout the week:
Ending Leveraging with a Bang
The final half of this year’s conference had a session for all interests and areas of focus. Subjects ranged from the law to quality to social media.
Mayo Medical Laboratories Legal Counsel Sharon Zehe delivered a state-of-the-law update for clinical laboratories. Consisting of a lot of acronyms, her update detailed FDA’s intentions with LDTs, profiled PAMA, and introduced MACRA. (Decoder key: Food and Drug Administration, laboratory developed tests, Protecting Access to Medicare Act of 2014, and Medicare Access & CHIP Reauthorization Act of 2015).
Speaking of making things less complicated, Mayo Clinic Systems Engineer Heidi Miksanek took attendees on a Lean/Quick Win Waste Walk. Her presentation outlined key concepts necessary to effectively apply continuous process improvement to the laboratory.
As the first two subjects highlighted clearly, change is a constant in health care and the laboratory. To bring some order and strategy to the storm of change, quality expert Jason Majorowicz described the latest approaches to change management. His very lively session described the difference between adaptive and technical challenges, summarized the core elements of leading successful adaptive change initiatives, and identified the hazards of leading adaptive change efforts.
The last presentation was EPIC. The super-awesome session was about social media and how laboratories can utilize various platforms to reach several target audiences, including patients and other health care professionals. The world-class presenters (the incomparable Kelley Schreiber and Andy Tofilon) helped the attendees document their own social media content plan. Wow. =)
Thursday, 11:31 p.m.
The Business of Outreach
Day two of Leveraging the Laboratory featured breakout sessions to guide laboratory leaders through the business of outreach success. All great outreach programs have an institutionally supported business plan. One of the first sessions was delivered by Mayo Medical Laboratories’ James Colbenso. His hands-on session guided attendees through how to assemble the building blocks of a well-constructed plan.
One of the most important aspects of the laboratory business is getting tests in the door. To ensure attendee laboratories are serving as much of the community needs as possible, Dustin Bilton and Marsha Dobric, Mayo Medical Laboratories, added some color to the conference with their presentation, “The Art (& Science) of Sales.” Their interactive session sketched out the science of how people make decisions, filled in the lines by helping paint the lab’s story, and helped attendees create their own sales masterpieces.
With sale successes come customers. Mike Hiltunen, GreatLakes Laboratory Network, provided our attendees a primer in “Selecting a Customer Relationship Management (CRM) System.” Hiltunen’s presentation charted the evolution of CRM, available systems, critical functionality, and the process by which to select a new CRM partner.
The next step is getting the sample. Beth Schroeder, Rochester Regional Health, gave this year’s attendees a 101 course in opening a new patient service center. Her 55-minute presentation outlined the foundational steps of patient service center operations, including appreciating the right reasons to open a center, understanding the customers you will be serving, key logistical considerations, developing a business plan, and effectively marketing and branding the center.
Wednesday, 4:22 p.m.
Know Your Role and Collaborate
Everyone in the laboratory knows the important role he or she plays within an institution. Steve Sorensen, Holland Hospital, described the laboratories’ key contributions to a hospital facility and how to promote the impact of the laboratory to the organization.
“The lab is like the center,” said Sorensen. “It’s important to have an aligned purpose with your organization to leverage the laboratory.” He outlined "strategic essentials" to leverage the laboratory. The essentials included financial strength, growth, quality, superior service, and a superior workforce.
The last presenter of the day was Pam Carter, Marshfield Clinic, who emphasized the Power of Collaboration. Key tenants of her talk were how to:
- Improve lab operations and service delivery in a rapidly changing environment.
- Understand how external partnerships can benefit a lab’s performance and impact the cost of care.
- Gain insight about positive outcomes that can be leveraged through collaboration and commitment.
Ms. Carter finished with the empowering thought, "Be curious. Be innovative. Be willing to try and fail, and be committed. Take others with you."
Wednesday, 2:30 p.m.
Community Engagement: Stepping outside of the Laboratory Walls
After lunch, presentations continued, and discussions turned to the topic of community engagement.
Danielle (Danni) Franzen from Great Plains Health provided positive outcomes from her facility’s cardiac screening program. Hospital recognition and perception were noted as minor impacts from the program—saving lives and improved customer satisfaction were the outcomes that her facility is most proud of.
To follow in the community-engagement conversation, Lori Baumbach from Mayo Clinic came on stage and talked about community collaborations. She got the audience on their feet with a fun “energy burst” exercise.
There are far too many community engagements to note in this post, but we will stress Ms. Baumbach’s recommendation—“strive for collaborations that promote health and wellness for the entire community.”
Wednesday, 12:03 p.m.
Morning Wrap Up: Applying Business Discipline, Aligning Organization Structure, and Demonstrating Leadership
The first morning of Leveraging the Laboratory was dedicated to the impact that Outreach makes on the laboratory.
First to the stage was Charles V. Wilson from Robert Wood Johnson University Hospital. Mr. Wilson discussed that one strategy for effectively growing a laboratory's margins in the face of declining reimbursements is to focus on leadership.
“Getting people to do what needs to be done because they want to do it,” was how Mr. Wilson described what leadership should be.
Next up was Dennis Sumwalt from Sanford Health Integrated Laboratory Services. Mr. Sumwalt helped the room visualize what an organizational structure of an outreach program could look like.
If you take one thing away from the morning presentations, ask yourself this, “How can your organization structure support (or limit) your business plan, and then, what do you need to be successful?”
The final speaker of the morning was Mark Hyde, Mayo Clinic, who detailed the key aspects of good leaders in health care. His presentation included a wide range of dynamics in the workplace, employee development, and how to get the best out of each employee.
Wednesday, 10:10 a.m.
Laboratory Outreach Takes the Stage
As day two begins of our fall education conferences, Leveraging the Laboratory is in full swing. In addition to opening remarks from our course directors, two amazing health care leaders delivered powerful presentations to set the stage for the two-day conference. First up was Charles Wilson from Robert Wood Johnson University Hospital. Next was Dennis Sumwalt of Sanford Health Integrated Laboratory Services. Rounding out the morning will be Mark Hyde of Mayo Clinic, who will emphasize leadership strategies for health care leaders. A full summary of the first morning of Leveraging will be posted during the lunch break.
Tuesday, 5:17 p.m.
Ending the Day on a High Note
The last two presenters of this year's conference were two influential Mayo Clinic laboratory directors. Drs. Bobbi Pritt and Joaquin Garcia discussed how their clinical laboratory divisions assess, plan, implement, and evaluate utilization management initiatives. Dr. Pritt discussed several microbiology initiatives and interventions that have been successfully implemented in partnership with various Mayo Clinic clinical departments. Dr. Garcia capped off the day with a series of anatomic pathology-specific examples of how pathology practices can effectively manage the demands of a daily practice through best practices.
Tuesday, 3 p.m.
William Mundell, M.D., Associate Chair for Inpatient Practice at Mayo Clinic, Asked Attendees, “How Do We Assess Value?”
The presentation, which stressed the importance of the clinician’s role in laboratory medicine, explained:
- The differences between doctors and systems.
- How to grade physician value and maximize that value for patients.
- Future approach suggestions for clinicians and LabPath administration.
It was fun to hear the inspirational quotes from Mayo Clinic founders throughout the presentation.
This quote seemed to sum up the importance of the clinician in the laboratory: “Sometimes, I wonder whether today we take sufficient care to make a thorough physical examination before our patient starts off on the round of the laboratories, which have become so necessary that oftentimes, we do not fully appreciate the value of our five senses in estimating the condition of the patient.”- Dr. Will Mayo
Tuesday, 2 p.m.
Value-Based Utilization Management and the Role of Analytics
The afternoon started with Eleanor Herriman, M.D., Chief Medical Informatics Officer at Viewics. Dr. Herriman outlined how medical facilities can use analytics for developing a UM program.
The presentation summarized:
- How to use multi-variable and integrated data sources.
- Ways to create UM interventions by using clinical peer reports.
- The use of analytics for monitoring UM progress.
"Big data" seems to be a trend at today's conference. Thanks to Dr. Herriman for providing specific examples of using data analytics to measure UM institutional value.
Why Should Hospitals Worry about Inpatient Test Utilization?
Co-Director of the Mayo Clinic Cardiovascular and Hospital Clinical Laboratories Leslie Donato, Ph.D., answered that question for the group during this lunch-time presentation.
Dr. Donato highlighted:
- The positive outcomes when reviewing order sets.
- The importance of providing education regarding unnecessary ordering.
- The sizable impact that the cost of blood tests have on health care expenditures.
- How to create a UM strategy around standing orders; routine inpatient lab testing adds up.
Tuesday, 11:30 a.m.
Blood Management Now and the Future
The conference switched gears and turned the focus to blood management. James Stubbs, M.D., Chair of the Division of Transfusion Medicine at Mayo Clinic, stepped up to the mic and shared strategies to efficiently manage blood resources, optimize hemostasis, and improve patient outcomes.
Dr. Stubbs provided a history of how blood management was “born” at Mayo Clinic. He shared the successes of implementing laboratory-guided algorithms and the importance of educating and empowering laboratory staff members.
"Develop tools to make it easy to do the right thing," Dr. Stubbs stated when explaining the effectiveness of the Transfusion Dashboard being used at Mayo Clinic.
So what does the future look like?
Two words—“big data.”
Tuesday, 11 a.m.
Connecting Test Utilization Initiatives to Quality Health Care Delivery
Gary Procop, M.D., Medical Director of Enterprise Test Utilization at Cleveland Clinic, discussed ways to improve test utilization through clinical decision support, personal intervention, and teamwork.
Patient safety was of focus during Dr. Procop’s presentation. A few key points included:
- Over- and underutilization produces waste. Each year, more than 100,000 Americans receive the wrong care.
- Implement “soft” and “hard” stops to reduce unnecessary testing.
- In 2015, soft stops averted 5,100 unnecessary tests in his facility.
Tuesday, 9:45 a.m.
Linking to Value-Based Health Care: A Pathologist’s Perspective
We heard the payer perspective from Dr. Sandy and the hospital perspective from Dr. Nesse. Mayo Medical Laboratories Chief Medical Officer Curtis Hanson, M.D., took the stage and gave the laboratory perspective on UM. He highlighted the major disruptors in the health care industry and challenged us to be “smarter” and to be engaged in value-based strategies to reduce waste in our institutions.
“Laboratory UM, if done in isolation, merely becomes a local cost-containment effort,” Dr. Hanson said. “Laboratories have to be able to show how they can contribute to the overall value-based payment efforts.”
Drs. Hanson, Nesse, and Sandy then took the stage for a panel discussion and addressed many questions from audience members. Thanks for the insightful discussion, Gentlemen.
Tuesday, 9 a.m.
Responding to Payment Reform
Robert Nesse, M.D., Senior Medical Advisor for Payment Reform at Mayo Clinic, presented, “Responding to Payment Reform.” Dr. Nesse stressed the importance of understanding the inconvenient truth of our current payment situation and encouraged us all to adapt and move forward while honoring our missions and values.
A few key facts from his presentation include:
- Middle-class families’ spending on health care has increased 25% since 2007.
- The majority of volume by 2022 will be Medicare.
- Bundled payment models are becoming increasingly sophisticated in their design.
- Mayo Clinic and selected external partners are working with CMS to inform new risk modifiers and support value-based payment models.
Tuesday, 8:45 a.m.
Clinical Laboratory Services in a Transforming Health Care System
Attendees were anxiously awaiting Executive Vice President for UnitedHealth Group Lewis Sandy, M.D, to take the stage and kick off day two of the Utilization Management Conference.
Dr. Sandy shared the astonishing number $765 billion. That’s the amount of money wasted in health care costs each year. So, when thinking of all this waste and the health care environment changing, where does a hospital want to be and NOT want to be?
|Hospitals DON'T Want to Be:||Hospitals WANT to Be:|
|A commodity supplier||Efficient, effective, connected|
|Solely a cost center||Provide value in operations and analytics|
|An inefficient operation||Advancing the state of the art in diagnostic errors, health equity, and consumer engagement|
|Data rich, information poor|
Tuesday, 7:15 a.m.
The State of the Union for Clinical Labs
We were honored to kick off this year's conference with one of the most important voices and leaders in our industry. Julie Khani, Executive Vice President at the American Clinical Laboratory Association (ACLA), started off this year’s Utilization Management conference with a "State of the Union for Clinical Labs" presentation.
Ms. Khani’s insightful presentation shared the federal outlook for 2016 and beyond, as well as key federal legislative and regulatory issues that impact the laboratories.
It wouldn’t be a state of the union talk without bringing up the controversial topic of lab-developed tests (LDTs). Ms. Khani shared ACLA’s position on the 2014 FDA draft guidance and mirrored what we’ve been hearing in the laboratory world—FDA has stated its intent to finalize the LDT guidance this year. We think the health care industry hopes that timeline is true, and we're anxious to see what the final guidance looks like.
Monday, 9:17 p.m.
Here we go!
The week we have all been waiting for is finally here. We had an amazing kick-off presentation tonight, and this year's attendees and speakers were able to connect at an opening night reception.