Full presentation by Dr. Philip Chen delivered to healthcare and laboratory medicine leaders at the Roche Efficiency Days (RED) 2018: REDefining perspectives in Guangzhou, China.

The US Healthcare delivery system is rapidly shifting from volume-based fee-for-service arrangement to one that focuses on value and patient outcome. The goals are to improve patient care and reduce healthcare expenditure on the population basis. Patient outcome is measured by specific Clinical Quality Measures (CQM’s). In the value-based environment financial incentives are provided for better patient outcome while fee schedule reductions are deployed to remove incentives for inappropriate and unnecessary use of healthcare resources. Clinical laboratory data can provide valuable actionable information.

However, in order to receive value-based incentives, laboratories must be able to demonstrate direct impact on improved clinical and financial outcome in care delivery. At this session, how to perform integrated clinical and health insurance claims analysis to identify high value intervention strategies will be reviewed. Experiences in establishing novel informatics services by clinical laboratories to provide direct population health management in a community setting will be shared. Establishing financial values for these unconventional laboratory services and how to use them to negotiate for value- and outcome-based reimbursement will be discussed.