Beyond the Result: Podcast Episodes 3 & 4 Focus on Value-based Care and Targeted Testing
By Stephanie Ibbotson and Molly Frazier
Experts from Washington University in St. Louis and Cedars-Sinai in Los Angeles share their perspectives on trends and priorities in laboratory medicine
Diasorin’s Beyond the Result podcast has been a hit with the clinical laboratory community, and we’re grateful to everyone who has taken the time to watch or listen. These podcast discussions, featuring our own Angelo Rago speaking with a guest expert on topics ranging from diagnostic stewardship to clinical decision support, are an important resource for a community that’s already stretched thin and continually being asked to do more with less.
That’s why we’re excited to share the release of two new podcast episodes: one with Mark Zaydman, MD, PhD, from Washington University in St. Louis, and the other with Margie Morgan, PhD, from Cedars-Sinai in Los Angeles.
Value-based care depends on defining and measuring value
Dr. Zaydman serves as an assistant professor of pathology and immunology in the Division of Laboratory and Genomic Medicine. In the podcast episode, “Value Matters: Measuring What Counts in Lab Medicine,” he and Angelo discuss the transition to value-based care, keeping the focus on the patient, and promoting diagnostic stewardship.
Dr. Zaydman notes that achieving a healthcare system based on value would not be feasible without the ability to define and measure that value. “We know we need to move away from fee-for-service and focus on value, but we don’t have a consensus about how to define value, who the value is for, and how we measure it,” he says. “That’s kind of a precarious position.” Without those clear definitions, Dr. Zaydman adds, the focus on value is often misinterpreted as cost-cutting without a clear patient benefit.
In laboratory medicine, establishing value requires understanding how a clinician will use any test result, and whether those results will lead to real changes in patient care. Unfortunately, it isn’t easy to ascertain those details across every clinician and every type of test. Dr. Zaydman recounts conversations with clinicians about what they’d do with a positive result, and how that would differ from what they’d do with a negative result. “These conversations are really informative about how lab medicine matters, but one-on-one calls like this are very expensive,” he says. It’s almost impossible to scale from those conversations to something equally substantial about all test algorithms. “This is all-hands-on-deck time,” he adds.
Another challenge Dr. Zaydman identifies is getting alignment across numerous stakeholders in the healthcare system, many of whom are accountable for widely varied goals. “Putting the patient at the center, and their best outcomes as the goal, is the only way we can align,” he says.
Hear this and more from Dr. Zaydman on Beyond the Result Episode 3 or wherever you find your podcasts.
Targeted, flexible testing is more appropriate and cost-effective than syndromic panels for most patients
In the podcast episode “Speed Meets Strategy: Rapid Results, Smarter Decisions,” Angelo speaks with Dr. Morgan, director of clinical microbiology at Cedars-Sinai. Their discussion covers the challenges of delivering top-notch care to a large patient population with diverse needs, finding ways to guide physicians to use the most appropriate and cost-effective test without relying solely on syndromic panels, and teaming up with clinical counterparts to achieve more.
At Cedars-Sinai, the laboratory team is responsible for developing and delivering the right test for a wide variety of care scenarios. “That makes for an interesting but difficult landscape to develop the right test,” Dr. Morgan says. “No one size fits all. Sometimes you want to use a large multiplex panel, and other times that’s the last thing you would use. We have to look at all these situations and try to develop the right thing to do for each patient.”
Dr. Morgan also has to push back against clinicians’ ingrained instincts to order syndromic testing for all patients. “There was a time when we thought more is better,” she says. “That’s not the right way to go about things these days. That’s why stewardship is so important.”
By collaborating with infectious disease experts and the infection control team, she and her lab established “soft stops and hard stops” in the test ordering system to help guide users to the most appropriate test for each situation. For example, a large multiplex respiratory panel can only be ordered for ICU patients — not for outpatients or non-ICU inpatients. Another clever technique that has been very effective: Dr. Morgan rearranged the placement of tests on the ordering screen, putting the more targeted tests at the top and the syndromic panels toward the bottom. “That has eliminated some of our issues,” she states, noting that it helps to avoid high-priced syndromic panels that are unnecessary for the situation and might be financially burdensome for patients. Her team has implemented Flex™ Testing to enable the development of custom panels, including targeted mini panels, to provide as much flexibility as possible for cost-effective testing options.
Hear this and more from Dr. Morgan on Beyond the Result Episode 4 or wherever you find your podcasts.
Stay tuned!
Beyond the Result Podcast >
Discussions on the Beyond the Result are happening monthly, with future guests including:
- Kyle Rodino, PhD, D(ABMM) Assistant Professor of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania
- Gabriel Bien-Willner, MD, PhD, Medical Director, MolDX; Chief Medical Officer at Palmetto GBA
Whether you’re a healthcare executive, decision-maker, or laboratorian, “Beyond the Result” is your front-row seat to the future of diagnostics—because better diagnostics means better care.
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