“Future Role of the Clinical Lab in Population Health” from Population Health Magazine
Future Role of the Clinical Lab in Population Health
Population Health Management
Authors: Khosrow R. Shotorbani, Kathleen M. Swanson, and Beth Bailey
The COVID-19 pandemic has illustrated how today’s health care environment and current delivery models are ill-equipped to address community health and public safety. Through the process of “test, trace, treat,” the pandemic has moved public health and clinical diagnostics to the forefront. This collaboration during the pandemic has collectively informed health care policy, care delivery, and community actions, but a multitude of future opportunities still exist. Clinical laboratories can share the same objectives of population health by serving both individuals and populations1 through the 4 interacting concepts or pillars of chronic care management, quality and safety, public health, and health policy.2 This Point of View proposes an advanced role for clinical laboratories as a key partner in population health management by fostering partnerships with a broader group of stakeholders3 and supporting the Quadruple Aim.4
Clinical laboratories can serve as the conduit for delivery on the principles of this collaborative model using the Clinical Lab 2.0 model. This model was first published in 2017 in Academic Pathology with an article entitled “Improving American Healthcare Through “Clinical Lab 2.0”: A Project Santa Fe Report.”5 The Project Santa Fe Foundation (PSFF) provided thought leadership and assisted in the development of the evidence base for the Clinical Lab 2.0 movement. The movement defines the future valuation of clinical laboratory services and evolution of the clinical laboratory business model. Using this new paradigm, laboratories can move from a transactional commodity delivering test results for sick care, defined as Clinical Lab 1.0, to an integrative component of value-based care providing clinical insights, defined as Clinical Lab 2.0.5 PSFF today actively supports organizations globally to demonstrate these principles. Publications describing Clinical Lab 2.0 concepts have highlighted the laboratory’s role in population health and chronic disease management in support of value-based health care. Authors have demonstrated how laboratory data can contribute to clinical decision support, and actionable patient data,6,7 provide value for health plans monitoring chronic conditions such as diabetes,8 and apply laboratory analytics to support disease surveillance.9 These examples describe how the laboratory can collaborate to create clinical strategies for early disease identification, monitor chronic conditions, and support new disease management methods with clinical interventions to mitigate clinical and financial risk.
Clinical Lab 2.0 can augment the reactionary “test, trace, treat” process through longitudinal clinical insights and analytics to promote early risk identification in chronic diseases and identify opportunities for intervention prior to hospitalization. Advantages would include downstream cost avoidance for many chronic and costly conditions. This hidden but measurable value from proactive laboratory insights allows for the recognition of illness before it has advanced and the monitoring of diseases at earlier stages of progression. Examples of this include chronic kidney disease and diabetes.
The application of Clinical Lab 2.0 concepts described for chronic diseases also can be adapted for high-prevalence infectious diseases, including COVID-19. Application of the Clinical Lab 2.0 concepts to support the COVID-19 pandemic has the potential to extend collaboration with public health outside traditional infectious disease case count reporting. In this new, advanced role, the laboratory can serve as an essential resource for population health and public safety. Laboratories are first to know and can be the first to respond. Laboratories can provide predictive data analytics and facilitate clinical services to limit the spread of COVID-19, reengage those needing health care after the pandemic, and avoid unnecessary expenses to the health care system both now and after the pandemic.