COVER STORY

Two plus two really does equal four

Why working together is a win/win for the healthcare industry.

By Tonya Mallory, President & CEO, Co-founder, Health Diagnostic Laboratory, Inc.

Healthcare spending in the U.S. continues to rise at an unsustainable pace, projected to reach $4 trillion, or 20% of the gross domestic product, by 2015.¹ One response to this alarming trend in recent years has been renewed attention to coordination of medical care services across the continuum of care, particularly in the area of prevention, monitoring, diagnostics, treatment optimization, personalized medicine, and disease management. Continuity of care has long been a core goal of family medicine and is a defining component of many current healthcare reform initiatives such as the Patient Centered Medical Home. Disease prevention and management programs attempt to combine enhanced screening, monitoring, increased coordination of care, and use of best medical practices to improve health outcomes, patient satisfaction and quality of life, and to reduce healthcare costs. These programs usually involve collaborative relationships between a team of providers and the patient, emphasizing patient education and empowerment. The economic case for disease prevention and management programs is that decreased use of acute care services should offset the initially higher cost of increased screening, monitoring, and educational services.

However, utilizing these concepts in a way that demonstrably improves patient outcomes and reduces overall healthcare expenditures must overcome three major limitations of our current healthcare system. First, health care in the U.S. is too often fragmented, poorly coordinated, discontinuous, and duplicative, characterized by many payers and providers with no common information platform between them. Second, disease management programs and the payers and providers who encourage their use, have historically been oriented disproportionately toward treatment rather than prevention. The third limitation—an undervaluing of personalized medicine—limits the impact and cost effectiveness of prevention, management, and treatment by failing to recognize that important differences among patients can have large impacts on each of these factors.

Tightly coupling advanced laboratory services, such as those of HDL, Inc., with prevention and disease management programs clearly has the potential to address some of these limitations, as laboratories are able to offer an increasingly impressive array of tools to enhance the effectiveness of these programs. For example, improved risk stratification with the next generation of biomarkers allows prevention efforts to be appropriately focused most aggressively on those patients most likely to benefit. The ability to more accurately predict responses to particular drug treatments via pharmacogenomics promises to enhance the effectiveness of medical management while reducing adverse events and consequent costs. Non-genetic approaches to personalized medicine are also being implemented, e.g., sterol testing can easily distinguish cholesterol “hyper-synthesizers” from “hyper-absorbers” and take much of the guesswork out of determining appropriate lipid-lowering medication. Thus, a relatively simple blood test cannot only help to more rapidly attain therapeutic goals, reducing the likelihood of inappropriate treatments leading to avoidable adverse events, but also lower the cost to the heavily burdened healthcare budget. Tools to instantly access and share historical trends in laboratory markers support and enhance informational continuity and coordination of care. When combined with data generated from other assessment tools, such as clinical evaluation and medical imaging, advanced clinical laboratory data offers a rich and complementary source of information. With appropriate clinical education in test utility and result interpretation for physicians, the ability to provide optimal and personalized prevention and treatment regimens will be greatly enhanced. Perhaps most importantly, involving the patient in this process in a way that educates and empowers has great potential to improve patient compliance — the key to any prevention or disease management program. The ability to see relatively rapid improvements in biomarkers resulting from actions taken is often a more salient reinforcer than the promise of avoiding adverse events at some unknown time in the future.

There is now substantial evidence supporting the economic benefits of incorporating the advanced clinical laboratory services model of aggressive risk factor management with disease prevention and management functions, and anecdotal evidence of dramatic improvements in patient outcomes at advanced testing practices is mounting.² The enormous potential for improving outcomes while simultaneously reducing costs over the medium to long term, in the face of the alarming healthcare spending projections for the coming decades, should justify the resources necessary for the large-scale clinical trials required to truly demonstrate the value of this approach. Meanwhile, cross-sectional and cohort studies assessing the effects on patient outcomes and return on investment of risk factor management with advanced testing are ongoing. The HDL, Inc. focus on complete coordination of medical services across the continuum of care really does make logical sense, i.e., “two plus two really does equal four.” Healthcare providers must find ways to work with payers to allow this model to continue to develop, for everyone’s sake.