Enticing Promises

As a reminder, Theranos proposed several attractive features:1

• Innovative technology
• Micro-specimen volume
• “Finger stick for all” testing
• Patient-generated test orders (ie, Direct Access Testing)
• Unlimited test menu
• Self-scheduling
• Access to draw locations in neighborhood pharmacy stores
• Patient experience as a “guest”
• Affordability (posted prices at 50% of CMS Clinical Laboratory Fee Schedule [CLFS])
• Electronic access to test results

Today’s patients are savvy health care consumers and are increasingly involved in their own care decisions. As the health care industry becomes more commoditized, patients will seek differentiated services. Accordingly, laboratory leaders must ask themselves, what are we doing to differentiate or elevate our laboratory services to meet and ideally, exceed the expectations of today’s health care consumers? To do so, we can begin by looking at how patients view health care, what they value, and what they do not.

Patient as Consumer

In 2014 the Advisory Board published the results from their Primary Care Consumer Choice Survey,2 with many aspects parallel to imaging and laboratory services. Primary care providers (ie, family medicine, general internal medicine) order laboratory testing on over a third of their outpatients, with laboratory testing comprising 85% of diagnostic procedures ordered.3

For a hospital, health system, or integrated delivery network, integration of primary care is critically important because, “where a consumer receives care for her sore throat will likely influence where she receives her mammogram and knee arthroscopy.”2 In the Advisory Board study, over 4000 health care consumers shared their preferences across five categories and 56 clinic attributes for on-demand care related to flu symptoms. The 5 categories are:

1. Access and convenience
2. Cost
3. Quality
4. Service
5. Reputation

Overwhelmingly, consumers valued access and convenience, with six of the top ten most important attributes falling in this category. When considering the patient/laboratory interaction, access and convenience may entail the following:

• Laboratory conveniently located in or near provider office: 77% of consumers prefer having laboratory (phlebotomy), imaging, and pharmacy services in the same location as their provider and will drive up to 20 minutes farther in order to gain this level of convenience.
• Minimal wait time: Consumers expect to wait less than 30 minutes to see a health care provider and expect phlebotomy wait times to be less than 20 minutes.
• Same day appointment: Consumers would rather make a same-day appointment than wait for an hour or more.
• Evening or weekend hours of service: Preference here varies by age, with younger (<50) patients slightly preferring evening access (51-54%), and older (>50) patients preferring weekend access (57-61%).

The Consumer and Cost

Health care is coming under increased criticism due to the fact that patients (ie, the consumer) rarely know the exact price of clinical care until they receive a bill. In the Advisory Board study, consumers indicated that they would be willing to trade access for price transparency; 92% would rather go to another location for laboratory testing, 76% would drive an additional 20 minutes, and 74% would pay $50 out of pocket in order to avoid a surprise bill.2 With an increase in high-deductible health plans (HDHP), consumers are increasingly price conscious, with out-of-pocket cost sometimes driving the choice of a commoditized service. In two studies,4,5 over 10% of patients “price-shopped” for laboratory and imaging testing online prior to selecting a service provider. The average cost savings for laboratory testing ranged from $1.13 to $3.45 per visit.5 With such a slight savings, one can conclude that it is more important for patients to know what they are going to pay for a service than to pay less for that service.

The Consumer in Charge

An increasing number of patients are managing their own care and monitoring their laboratory values, a process enabled by testing that can be performed by the patient in their own home. However, as many tests are not available in the home, patients do still prefer the idea of autonomy over ordering their own tests and monitoring their own results without requiring a physician visit. In states where it is allowed, patients may prefer the convenience and affordability of Direct Access Testing to provider-ordered testing.

The Consumer and Quality

In the clinical laboratory, quality is one of our core premises. However, when consumers are selecting lab services, quality is a dubious consideration. Only 22% of consumers indicated that more expensive providers (and testing) was indicative of higher quality.4

The Consumer and Brand Reputation

In the Advisory Board survey, consumers did not cite reputation or brand in their top criteria for selecting a commoditized service. Affiliation with a “Best Hospital” or “University Hospital” ranked 19th and 36th, respectively.2

The Consumer Demographic

It is tempting to generalize consumer preferences, but it is important to recognize key differences. Younger cohorts (ages 18-49) tend to prefer affordability, 50-64-year-olds prefer accessibility and convenience, and the over 65 cohort value reputation and brand more than younger groups.2

The Consumer, Summarized

What we have learned about the health care consumer is that they require convenient access and want to know how much they will pay for services. Brand and reputation play a small role when selecting a provider and higher cost does not equate to a perception of higher quality. Looking at TABLE 1, how do health care consumer preferences compare to the laboratory offerings of Theranos?

 

A Call to Action

If this experience was a wake-up call for how our industry manages health care consumers, then the response from laboratory should be to take the wants, needs, and concerns of our patients seriously. How do today’s clinical laboratories compare in the areas so important to consumers? Today’s health care consumers are engaged, discerning, and demanding, and in order to meet these demands, we must prepare our laboratory services to be consumer-focused and patient-centric. The following five areas should therefore be thoughtfully considered:

1. Access/Convenience

• Provide lab (phlebotomy) services in or near physician offices
• Provide clear signage and directions so patients can locate the laboratory
• Reduce patient wait times
• Expand hours (evenings/weekends) to meet patient needs
• Provide online scheduling and same-day appointments

2. Cost

• Offer flexible fee schedules (vs. single hospital charge master)
• Post prices for testing (price transparency)
• Provide access to price estimation tools to determine patient out-of-pocket responsibility

3. Quality

• Focus on service quality and post metrics of performance
• Monitor online patient reviews, strive for excellence

4. Service

• Create consistent service standards
• Ensure patient wait time for phlebotomy is less than 30 minutes
• Ensure patients’ physical comfort
• Provide an excellent patient phlebotomy experience
• Provide patient-directed testing (as appropriate)
• Provide patient access to laboratory test results (as appropriate)

5. Reputation

• Leverage your organization’s brand
• Represent your organization professionally and deliver the mission daily
• Strive for patient loyalty
• Create a personalized, patient-centric experience
• Tailor your messaging and approach to meet the specific needs of different demographics
• Develop a reputation for providing high quality patient experience, which will drive repeat patients and attract new patients
• Innovate and leverage technology in order to improve your patient-centered activities

Conclusion

Change is constant in the clinical laboratory industry, and the needs of our patients also are changing. The health care consumers’ willingness to embrace an idea like Theranos was proof that our industry had not evolved to meet their needs. Today’s health care consumer will judge a laboratory’s service based upon their own criteria of convenience, access, cost, quality, service, and reputation. Therefore, it is up to us to create a consumer-centered experience and maintain a service reputation that will set the laboratory apart.

References

1. Carreyrou J. Bad Blood: Secrets and Lies in a Silicon Valley Startup. New York: Alfred A. Knopf; 2018.
2. Daughterty A. What Do Consumers Want from Primary Care? The Advisory Board. June 25, 2014.
3. Ngo A, Gandhi P, Miller, WG. Frequency that Laboratory Tests Influence Medical Decisions. J App Lab Med. 2017;1(4):410-414.
4. Mehrotra A, Dean KM, Sinaiko AD, Sood N. Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information. Health Affairs. 2017;36(8):1392-1400.
5. Whaley C, Schneider Chafen J, Pinkard S, et al. Association Between Availability of Health Service Prices and Payments for These Services. JAMA. 2014:312(16), 1670–1676.

Jane M. Hermansen, MBA, MT(ASCP), is outreach and network manager at Mayo Medical Laboratories in Rochester, Minnesota. She received a BA in medical technology from Concordia College in Moorhead, Minnesota, and an MBA from the New York Institute of Technology. Jane’s 25+ years of clinical laboratory experience spans clinical research; process engineering; project management; and laboratory outreach consulting, training, and facilitation.