December 2024—Some health systems have sold their clinical laboratory outreach business; others seek to grow theirs. CAP TODAY publisher Bob McGonnagle asked Compass Group members for a quick look at their outreach programs when they met online on Nov. 5.
The Compass Group is an organization of not-for-profit IDN system laboratory leaders who collaborate to identify and share best practices and strategies.
The outreach laboratory business is competitive and some large integrated delivery networks have been worried about their programs. I’d like to get a sampling of the thinking of Compass Group members about their own programs. Rochelle Odenbrett, tell us what you’re doing at Sanford Health in terms of outreach.
Rochelle Odenbrett, MT(ASCP), MBA, vice president, Sanford Health, Sioux Falls, SD: We have a robust outreach business. We service about 1,300 clients in the upper Midwest. We have a full client support team that does 24/7 phone coverage and focuses on client interfaces and client billing. It helps us financially fill in some capacity because in rural health care it’s hard to fill capacity at times. Picking up outreach business helps us fill the excess capacity on our equipment and in our locations and reduce our cost.
I’m sure it also helps justify some of the technology you’d like to have in your system, correct?
Rochelle Odenbrett (Sanford Health): Yes, having that volume helps to justify some of the automation.
Sterling Bennett, can you comment on outreach at Intermountain Healthcare?
Sterling Bennett, MD, MS, senior medical director, pathology and laboratory medicine, Intermountain Healthcare, Salt Lake City: Intermountain’s outreach is similar to what Rochelle described, but one of the benefits not often talked about but clearly seen is that as we grow our volumes of outreach, we can insource more of our tests, and there’s a financial benefit to that. The really impactful benefit is that we have to import additional expertise. The people who are tied to these increased volumes then can participate with our clinical teams and clinical programs, and they integrate laboratory services in a stronger way with our clinical colleagues. We increase our own staff and expertise, and those people then work with our clinical colleagues to elevate the level of care in other disciplines.
Would you imagine that this level of outreach is going to hold steady, increase, or decrease over about the next five years?
Dr. Bennett (Intermountain): We hope it increases. That’s our plan, and that’s what we’re working toward. Some factors could come into play that could send it the other direction; we’re trying to avoid those.
Greg Sossaman, tell us about your outreach within Ochsner.
Gregory Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: We have a large employee group, so a big focus of ours is to ensure there’s not as much leakage from that group. We focus on what I’ll call in-reach instead of outreach and ensuring that most of the work of the Ochsner providers stays in the system. That’s the majority of the volume. We have very little leakage outside the system, and many others probably focus on that also. When you’re able to keep 95 percent of that volume within the system, it helps tremendously and prepares us better for outreach. We defray the cost of the outreach market here by the high volume we run through the core laboratory—the basic economics that everyone looks at.
We think there’s more opportunity here than we currently take advantage of. Where you’re able to put venipuncture stations and go in and compete, we usually do pretty well because of our cost structure. So we intend to grow our outreach volume in the next few years. As we continue to see organic volumes grow year over year, we think we’re well positioned to take advantage of more outreach in selected markets.
Dhobie Wong, tell us about Sutter Health.
Dhobie Wong, MBA, MLS(ASCP), CLS, VP of laboratory services, Sutter Health, Sacramento, Calif.: At Sutter Health we’re fortunate that we have strong linkages with our IPAs and a strong in-reach program. We do have a bit of lab leakage. That’s one of our initiatives this year. We just created a dashboard to do a deep dive into what the opportunities are there. We are seeing ambulatory growth and have a five-year strategic plan to increase it. In addition to the typical three percent growth we would see, our ambulatory growth is pushing our volumes—about 10 percent. That’s a significant amount of growth we’re going to need to contend with.
So we are looking at ways to expand our capacity. We have one system reference lab and don’t have any more space, which we’ve conveyed to our leadership team. We’re fortunate in that there will be some investments. We’re terming it a super lab. So we are continuing to grow our in-reach but are also looking at outreach. It is an opportunity we haven’t really tapped into, but we would be remiss if we didn’t look at that as part of our growth strategy.
Where does some of that new demand come from? Is it from closures of clinics or doctors’ offices or smaller hospitals?
Dhobie Wong (Sutter): Yes, and we have an aggressive strategy for increasing our ambulatory access for new patients.
Richard Vander Heide, what are you experiencing and doing at Marshfield Clinic?
Richard Vander Heide, MD, PhD, MBA, medical director of pathology and laboratory medicine service line, Marshfield Clinic Health System, Marshfield, Wis.: We have a small but steady business of outreach. Our most recent growth came from another system closing in the Fox Valley. We’re trying to grow that business and are looking for other new outreach clients.
We have our own courier system, of course, for our in-reach activities and for servicing our hospitals and clinics. It makes sense for us to make sure that a new outreach client is on one of our courier routes or at least close enough that we don’t have to develop a significantly new delivery and recovery system. We try to look at clients that fit in best with what we have, which is a fairly extensive route service.
There’s always a threat that a client thinks they can save a few bucks elsewhere, but they don’t realize we’re providing medical directorship and other support.
There is business to be found if you go about analyzing your maps in the right way. Who knew you’d have to be a cartographer to be a great laboratorian? Chris Scanlan, what are you seeing at BayCare?
Christopher Scanlan, director of laboratory services, BayCare Health System, Clearwater, Fla.: The Tampa Bay metro area population has grown since the pandemic, and that has fueled our growth. We’ve seen 10 percent growth annually in patient encounters for our outreach program. That growth is informing our investments in additional capacity that we are planning for now.
Similar to what Dr. Sossaman said about focusing on in-reach and working with your health system partners, we’ve been able to coordinate the driving of more colorectal screening with our partners, bringing in new testing to support their screening programs. The growth has been great for us. It has also become clear that patient experience matters; service experience matters to people in the market. We see evidence of this throughout our patient reviews. Our customers aren’t shy when it comes to telling us about the poor experiences they’ve had at the national labs and why it’s beneficial for them to come to BayCare for lab work.
We’re selectively working with the skilled nursing facilities that are preferred partners with the organization to accept our discharges. Many of those entities may have had contracts with the two larger labs and they are simply in need of a higher level of service. So they’re coming back to the health system for laboratory services. We have to be careful in how we manage that—split billing, Medicare Part A, outpatient lab work, that can be a challenge. We’re also trying to figure out ways to support them with phlebotomy because it’s a cost you have to consider when taking on new clients. We’re very strategic about our growth.
How do you improve the patient experience?
Chris Scanlan (BayCare): The two private large labs have kiosks: You enter the lab, you put in your insurance card. It’s an informal process of arriving and checking in at the laboratory. We’re a little old-fashioned. We still have face-to-face registration, but there’s a sense of communication and direct patient contact, which play a big role in the patient experience. And we’re fast and efficient in getting patients in and out. From the time they check in until they leave, it’s about 11 to 14 minutes. They love that. Every year we go through customer service training to reiterate the importance of owning the moment. On Fridays we share our five-star reviews with everyone in the laboratory division. These reviews are posted on all the various social media sources—Google, Facebook, you name it. That really creates not only an enormous sense of pride, but also an internal, friendly competition to get more five-star reviews than the other patient service centers.