FREQUENTLY

ASKED QUESTIONS

1. What are Data Diagnostics®?

Data Diagnostics® is a suite of hundreds of patient-specific data analyses that can be ordered individually on demand by clinicians at the point of care within their existing workflow. The solution helps clinicians identify and address gaps in quality, risk, utilization and medical history insights, supporting improvement in clinical and quality outcomes and financial performance across the healthcare community in real time.

Data Diagnostics® will be at the center of patient care by giving medical personnel valuable insight into patients, which was previously unavailable. The instant access to historical patient information and the capability to allow clinicians to order advanced analytics for their patients on demand will allow medical staff and responders to make comprehensive decisions on patient care, empower medical personnel to more quickly assess the patient, and will enable more efficient and successful care.

The solution draws on two of the world's largest datasets of clinical, claims, quality and laboratory data, including Quest's 20 billion clinical laboratory test results and Inovalon's clinical datasets on more than 231 million patients.

Data Diagnostics® are also unique for providing seamless integration within Quest's more than 200,000 installations of Care360® and lab ordering and connectivity platforms serving approximately half of the physicians and hospitals in the United States. This integration means physicians can readily order and access Data Diagnostics® reports within their existing clinical workflow, a functionality that is key to bringing the power of big data to the point of care in real time.

The launch includes several categories of analyses designed to assist health plans, accountable care organizations (ACOs), hospitals, integrated healthcare delivery systems, provider organizations, and individual physicians to achieve superior patient care, strong clinical and quality outcomes, utilization efficiency, and overall financial performance. Available through more than 200,000 Quest Care360® installations and more than 400 electronic health record (EHR) platforms that are interconnected with the Quest information platform, the national roll-out of Data Diagnostics® will bring real-time insights and analytics to the point of care inside of the existing clinical workflow at approximately 50% of all U.S. physician offices and 50% of all U.S. hospitals.

2. What are real-word examples of issues that are addressed by ordering Data Diagnostics®?

A physician's patient can't recall what medications have been prescribed for them, or is worried that there may be some confusion around different physicians ordering a potentially conflicting or dangerous combination of medications.

  • Order: "Current Medication History Panel x1 Year" Data Diagnostic
  • Receive within seconds a report outlining all medications, a physician has prescribed and whether the prescriptions had been filled by the patient.

A physician wants to achieve high quality scores for their patients and they are part of an organization that is incentivized to achieve high quality scores. The problem is that the physician doesn't know specifically what the quality measures are to achieve a high score and what the patient has already achieved vs. still has outstanding to achieve a strong score.

  • Order: "Current Quality Status Panel" Data Diagnostic
  • Receive a report outlining which quality measures are relevant to the patient, which measures are already compliant, which measures are non-applicable, and which are applicable but still not compliant (with instructions on how to achieve compliance and by when it is needed).

A physician works in an ER and a patient comes in, who has been in a car accident, and is badly injured. They have never been to the hospital before.

  • Order: "Comprehensive Medical History Panel xAll Years" Data Diagnostic
  • Receive a report outlining all known diagnosis, medications, imaging study orders, laboratory results, procedures, surgeries, vaccinations, and other pertinent information, which could help save the patient's life and avoid unnecessary guesswork or testing.

A physician is trying to make sure that they are comprehensively paying attention to all of a patient's needs and thoroughly documenting all active conditions. They are part of a healthcare organization whose payments are adjusted for patient disease severity (known as risk-adjusted payments).

  • Order: "Comprehensive Risk-Related Diagnosis Panel" Data Diagnostic
  • Receive a report outlining all known historical risk score-related diagnosis and ones which are suspected as still being active, but not yet appearing within the current calendar year. This can serve as a reminder to the physician to evaluate these diagnoses and determine whether they are still enquiring attention and, if so, make sure they are properly documented so the patient's medical history data is complete and accurate as well as the associated payment models.

3. Who benefits from Data Diagnostics®?

Data Diagnostics® benefit all stakeholders across the health system. Specifics:

  • Clinicians: Clinicians have dual challenges: 1) to deliver high-quality care in an increasingly complex healthcare environment, and 2) to increasingly be mindful of factors impacting performance goals, such as utilization efficiency, objective metrics, and healthcare economics. Data Diagnostics® enable clinicians to more readily gain insight into their patients in ways that empower them to save time, improve care, and achieve critical metrics that impact their financial performance.
  • Patients: Data Diagnostics® support the goal of patients to receive superior, quality care, decreased costs through minimizing duplicated or unnecessary medical services, and the confidence that their clinician's decision making is based on a personalized, holistic understanding of the patient's medical history and current health status.
  • Healthcare Organizations: Data Diagnostics® support health plans, accountable care organizations (ACOs), hospitals, integrated care delivery systems, and physician organizations who are engaged in capitated, shared-risk, and other value-based arrangements to achieve and benefit from superior quality scores, comprehensive and accurate risk score data, improved utilization efficiency and greater coordination of care.
  • Researchers: Using Data Diagnostics®, researchers and pharmaceutical companies can specify the eligibility criteria for specific clinical trials or studies. The Data Diagnostics® platform would return in real-time the indicators of eligibility, such as patient history, age, laboratory profile and medication, along with other pertinent information, such as contact information.

4. Why is this transformative for healthcare?

As the U.S. healthcare system transitions from consumption- and volume-based paradigms to quality- and value-based care models, each segment of the healthcare system is under pressure to deliver better care and financial performance.

  • Health care spending in the United States has been growing at an unsustainable rate, now reaching $3.8 Trillion a year.[1] Yet this growth arguably has not corresponded with improvements in quality and outcomes. A landmark report by the Institutes of Medicine in 2012 estimated that about 30 percent of health spending in 2009 -- roughly $750 billion -- was wasted on unnecessary services, excessive administrative costs, fraud, and other problem, and 75,000 deaths could have been prevented had every state performed at the highest level of quality of the top state. The report also noted that the solution will involve "embracing new technologies to collect and tap clinical data at the point of care" and designing "incentives and payment systems (to) emphasize the value and outcomes of care."[2]
  • Specific providers range from: health plans, hospitals, government programs, shared-risk organizations, ACOs, integrated care delivery systems, physicians, pharmaceutical and life sciences companies, who are now under pressure to deliver high quality care, while being vigilant of financial performance, and of course their patients. Delivering on these goals requires the right information at the right time within the clinician workflow. Data Diagnostics® empower not only the clinician in their pursuit of success in this new market environment, but also support the broader healthcare system in its achievement of quality and financial goals.

Specifics:

  • The U.S. Department of Health & Human Services (HHS) has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50% of payments to these models by the end of 2018. HHS also set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs, such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reduction Programs.[3]
  • Disease severity-based reimbursement models (known as risk adjustment of premiums) now dictate more than 50% of Medicare Advantage, managed Medicaid, commercial ACA, and ACO reimbursements.[4]
  • The cost inefficiency caused by overtreatment (often caused by the absence of insight into a patient's previously received care or related healthcare information) has been estimated to be between $158 and $226 billion.[5]
  • Each year there are approximately 550 million primary care provider office visits, 450 million specialty provider visits, and 136 million emergency room visits within the U.S., each of which has the opportunity to benefit from Data Diagnostics®.[6]

[1] forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/
[2] IOM report press release, 2012 - www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=13444
[3] Source: Cited from HHS.gov January 26, 2015
[4] Source: cms.gov 2015 Medicare Advantage rate book and prescription drug information, HHS Final HHS Notice of Benefits and Payment Parameters for 2016, and various SDOH regulations
[5] Donald M. Berwick and Andrew D. Hackbarth, "Eliminating Waste in U.S Healthcare," JAMA 307, no. 14 (April 11, 2012): 1513-6.
[6] cdc.gov/nchs/fastats/physician-visits.htm

5. What are the Data Diagnostics® Categories?

Data Diagnostics® allow clinicians to request analysis on specific patients on demand, and receive the answer back within seconds. Hundreds of Data Diagnostics® are organized into categories with examples below:

  • Quality-Related: Quality-Related Data Diagnostics® allow clinicians to gain on-demand insight into patient's historical, current, or predicted clinical and quality status under models such as NCQA HEDIS®, Medicare Advantage 5-Star Quality bonus programs, managed Medicaid quality incentive programs such as New York's QARR program, the Affordable Care Act's commercial Quality Reporting System (QRS), and Accountable Care Organization (ACO) quality performance hurdles for shared savings, and a multitude of other quality performance programs that now are used to measure quality and dictate billions of dollars of annual incentive bonuses. The results of quality-related Data Diagnostics® inform clinicians on precise quality measure status and provide insight to facilitate improvements to quality measurements for the patient.
  • Historical Data-Related: Historical Data-Related Data Diagnostics® allow clinicians to gain on-demand insight into historical disease progression, laboratory results, medication adherence, cardiac tests, vaccination histories, surgical procedures, and other factors, which can materially aid in the clinician's evaluation of the acutely ill and previously unknown patient, new patient intakes, specialty consultations, and other valuable patient assessments. The results of Historical Data-Related Data Diagnostics® can save significant amounts of encounter time, improve the targeted nature of exams, save lives when patients are unable to provide data accurately or are previously unknown to a physician or emergency department, and save costs by avoiding unnecessary duplicative evaluations or tests.
  • Risk Score-Related: Risk Score-Related Data Diagnostics® allow clinicians to gain on-demand insight into historical risk score status, progression, diagnosis contributors and predicted future progression across all major risk score models, including Medicare Advantage, state-specific managed Medicaid, commercial Affordable Care Act, and Accountable Care Organization (ACO) models. The results of Risk Score-Related Data Diagnostics® provide insight to support the achievement of patient risk score accuracy, supporting accurate disease burden documentation of unaddressed or worsening conditions, and appropriate reimbursement accuracy.
  • Waste Avoidance-Related: Waste Avoidance-Related Data Diagnostics® allow clinicians to gain on-demand insight into factors impacting care costs, such as medication prescription formulary alternatives, back imaging, head imaging, and acute care utilization. The results of Waste Avoidance-Related Data Diagnostics® provide insight into the how unnecessary duplication of tests can be avoided, less expensive formulary alternatives can be identified, and high-cost patient behaviors can be addressed.
  • Eligibility-Related: Eligibility-Related Data Diagnostics® allow clinicians to gain on-demand insight into patient eligibility for payment and/or support programs related to care, support, rehabilitation and more. The results of Eligibility-Related Data Diagnostics® provide insight for clinicians, administrators and patients to determine payer eligibility (e.g. Medicaid eligibility status), state-specific program eligibility (e.g. NY DSRIP), and patient-specific support eligibility (e.g. a local Diabetes Support Program or Cystic Fibrosis Home Care Nurse Support Program).

In addition, organizations participating with the Data Diagnostics® platform can request custom analytics to be developed for clinicians to order on demand; receiving responses back in real-time directly within their existing clinical workflow. Examples would include custom formulary optimization analysis, custom quality and care measures, and many other examples.

6. Do physicians and clinicians need to use a separate platform to access Data Diagnostics®?

No. Physicians can order and receive Data Diagnostics® reports within their current workflow using the same Care360® platform and/or EHR that they use today to order a laboratory test. There is no different process change need.

7. How does an organization take advantage of Data Diagnostics®?

Any healthcare organization (health plan, accountable care organization (ACO), integrated care delivery system, hospital, physician organization, or government program) can become a "Participating Organization", so that the clinicians associated with their organizations can order Data Diagnostics® for the patients associated with their organization.

An organization wanting to become a Participating Organization simply contacts Quest Diagnostics or Inovalon. After completing necessary paperwork, data connectivity is setup and certain datasets pertaining to the organization are integrated with the Data Diagnostics® platform. Quest will provide user education and support so that the physicians associated with the organization will know how to order Data Diagnostics® within Care360® or an EHR platform that is connected to the Quest platform.

Once a Participating Organization is connected and paperwork is completed, physicians can then order Data Diagnostics® for any patient associated with the Participating Organization.

8. Does a physician need to sign up for Data Diagnostics®?

No. The ability to order Data Diagnostics® will automatically appear within a physicians' Care360 platform or interconnected EHR platform. As soon as an organization associated with a patient (e.g. a health plan, ACO, hospital system, etc.) becomes a Participating Organization, Data Diagnostics® can be ordered and paid for by the Participating Organization.

9. How does a clinician order a Data Diagnostics®?

Data Diagnostics® are ordered just like a Quest Diagnostics lab test would be ordered through Quest's connectivity platform - the difference is that a Data Diagnostic is analyzing data and returns an answer within seconds. The results also seamlessly appear within the Quest connectivity platform (i.e, Care360® or the associated EHR).

10. What are the costs associated with Data Diagnostics®?

Participating Organizations pay a small fee monthly to have their data connected to the Data Diagnostics® platform.

Each time a Data Diagnostic is ordered and a report is provided, a fee for the Data Diagnostic is charged to the relevant Participating Organization.

Pricing for a Data Diagnostic ranges depending on the analysis ordered. There are hundreds of different Data Diagnostics; however, the majority of their pricing falls between $15 and $50, depending upon the type of Data Diagnostic ordered.

The Participating Organization is motivated to pay the fee because of the expected savings as a result of more efficient care and improved outcomes and because of the associated financial incentives for meeting federal/state quality, risk and other metrics.

11. How does the privacy protection work? What kind of verification does the system require to assure that the patient consented to this information being shared, and to verify the requester is indeed a physician and treating this particular patient?

Quest Diagnostics and Inovalon take data security very seriously, and have robust processes in place to protect private health information at all stages of the process.

Data Diagnostics® can only be ordered by clinicians registered within Quest's Care360® or EHR connectivity platform. A physician would order an analysis much the same way they would order a lab test from Quest. In order for a Data Diagnostic to be provided, the Quest system or EHR system facilitates an eligibility check of the patient, in which the system validates the proper insurance information and that a payer has authorized the provision of the Data Diagnostic report. Only when this specific healthcare eligibility information is verified will a result be provided, and only to the clinician that ordered the Data Diagnostic. As with any other area of treatment, the physician validates the patient consent for such treatment at the time of service.

12. Do physicians pay per report or do they have to subscribe to this service?

Data Diagnostics® are ordered just like a specimen-based lab would be (the difference is that a Data Diagnostic is analyzing data and returns an answer within seconds). As such, physicians don't need to sign up for the service, as it will appear automatically in the lab compendium as it is rolled out across the nation. Most Data Diagnostics® are paid for by the health plan, ACO, provider organizations, or hospital within a shared-risk arrangement that covers a patient for whom a Data Diagnostic is ordered.

Data Diagnostics® are charged on a per order basis, much like a specimen-based lab, and will drive tremendous value for the health plans, ACOs, provider organizations, and hospital systems (and for physicians who share risk with them) in achieving successful outcomes in clinical and quality outcomes, and financial performance. Pricing for a Data Diagnostics® ranges depending on the analysis ordered.

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