Recapturing their market through precision coordination

Case Study

Prevented from providing testing services to its community members due to a non-compete agreement with a national laboratory, Kootenai Health laboratory leaders deepened their relationship with Mayo Clinic Laboratories, receiving tactical support and guidance to launch an in-house reference lab just days after the non-compete agreement expired.

Their challenge

Throughout its 70-year history, Kootenai Health has provided comprehensive medical care to residents of northern Idaho. Laboratory testing is an important component of Kootenai’s services and in 2017 the medical center entered into a reference laboratory agreement with Mayo Clinic Laboratories. The agreement kept routine testing for hospital inpatients local and enabled esoteric tests to be performed at Mayo Clinic Laboratories. At about that same time, a large, national laboratory purchased several laboratories in the nearby community and took over testing for outpatients and other residents.

“During this time, we were seeing that partnering for lab services with an external commercial laboratory presented some challenge with physicians on our end not feeling like they had the level of control or the ability to follow up on issues,” says Angela Vetch, director of laboratory services.

By the numbers


lab volumes are 7.8% over plan YTD in 2023


million in-house tests performed in 2023


patient service center visits in 2023

Their solution

Kootenai Health officials quickly recognized how the inability to perform testing for outpatients and community members affected the ability of providers to consistently deliver high-quality care. Almost immediately, they began planning to change the testing paradigm when the contract expired. 

“There was a lot of work done to assess what it would look like if we brought these lab services in-house and doing some business planning around that,” Vetch says. “Since we were already partnering with (Mayo) on the inpatient reference lab side, it was really a seamless conversation to go to them and say, ‘We have these plans to expand our business, how can you guys help?’”

Mayo Clinic Laboratories outreach specialists demonstrated to Kootenai’s leadership that expanding Kootenai’s laboratory services would positively impact patients, providers, and hospital operations as a whole. With those insights and ongoing support from Mayo strategists, Kootenai laid the groundwork to insource outpatient clinic testing and created a streamlined pipeline for outpatient reference lab work to be sent to Mayo Clinic.

“It was very easy for the Mayo team to explain that as we grow and are sending less to (Mayo), that enables Mayo to focus on the more esoteric tests,” Vetch says. “But also, as we grow our business, we still have an increased need for (esoteric) reference lab tests. So ultimately, we do still grow (Mayo) business as well as we grow. It's a really nice synergy to see that and to explain to our executive team and to people we're working with in the community what the benefits are to everyone involved.”

In March of 2022, when the non-compete expired, Kootenai hit the ground running. In one very busy weekend, a new electronic medical record (EMR) went live across the hospital and laboratory system, more than 700 tests directly interfaced to Mayo Clinic Laboratories through the EMR launched, and three patient service centers opened to the public.

“They shut down on Friday,” Vetch explains. “We went live with our EMR on Saturday, and we were open on Monday for patients, which I wouldn't necessarily recommend if you want to keep your hair, but I think it was a really big effort on our team's part to just get the equipment in there, get all of the workflows established beforehand, do as much pre-work as we could.”

Since bringing testing back in-house, the growth experienced by Kootenai Health’s laboratory has exceeded initial projections, Vetch says.

“We’ve basically recaptured all of that business and then grown beyond what we were previously doing on behalf of that (commercial) reference lab,” Vetch says. “At our busiest site, I think we projected to see 100 patients a day, and we routinely see 180 patients a day. We are a year and a half in, and we are looking at what is the next location we need to open because we are kind of bursting at the seams. We’ve had a lot more sent to Mayo than even we were anticipating, so it’s been a fairly fun ride.”

Their results


Built more than 700 tests interfaced to Mayo Clinic through an EMR.


Opened three patient service centers.


Daily patient volumes exceeded by 50–100%.

What’s next?

In 2023, just one year after launching outpatient testing, Kootenai engaged Mayo Clinic for a more comprehensive, insights assessment to better understand how to further extend their reach to providers and clinics not already served.

"We have a lot of interest from the community with independent practices that want to send to us instead of a commercial lab where their specimens are transported hundreds of miles away to be run,” Vetch says. “We can provide better turnaround time and have results in the patient's chart when they come to us, as the local hospital.”

As Kootenai Health’s laboratory services continue to evolve, laboratory leaders will maintain a close relationship with Mayo Clinic Laboratories’ outreach partnership for ongoing support and guidance.

To help manage the increase in testing volumes, a dedicated Mayo Clinic specimen processor now handles all Kootenai samples. “Having that reliability of someone that’s really up to date on all the changes has been really instrumental,” Vetch says.

In early 2024, the Mayo Clinic outreach team will return to Kootenai for a second round of assessment to review the progress made and next steps, which include bringing on additional testing and using marketing to promote their business.

“It's really exciting to see that from the stage of being an idea or the next thing we need to do, to something that we're actively doing and maybe have even done in the last year, and then that enables us to serve more patients and keep that care closer to home for them,” Vetch says.

“Mayo is always really supportive of their clients bringing more testing in-house … because that benefits our patient populations directly. Mayo shares our value of doing what's best for the patient and decisions being guided that way.” Angela Vetch, director of laboratory services, Kootenai Health

More information

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Robin Huiras-Carlson

Robin Huiras-Carlson is a senior marketing specialist at Mayo Clinic Laboratories and a Mayo Clinic employee since 2015. Her writing focuses on specialty testing, innovation, and patient-focused initiatives.