Get the image: how full -based laboratory data helps payers to fill the gaps and optimize care

The gaps in care is among the most intimidating challenges faced by American health care. According to a study, Less than 10% of people aged 35 and over receive all preventive care services They need – and almost 5% receive none.

When patients do not receive preventive services and screening, they can be diagnosed later, incur higher costs and cope with less good results. At the same time, health plans can deal with higher costs, lower quality scores and an increase in the unsubscribe of the limbs.

But other gaps do not get as much attention. Call them in the data. When health plans do not have a complete vision of the history of screening for their members, they cannot risk appropriately to adjust their members, fill the gaps in care and identify risky members who could benefit from care coordination strategies and interventions.

“Most health plans only have access to complaint -based laboratory data, so that they can only have partial opinion on the health of members,” explains Kirk Loveless, HExecutive director of the ELTH Plan of Health Analysis and Solutions at Quest Diagnostics. “It’s like trying to solve A puzzle that has missing key parts; Our goal is to provide these missing parts. »»

Quest offers health plans access to complete data -based laboratory data, a quest for service is only positioned to provide. As the world’s leading supplier of diagnostic, information and services tests, Quest generates 4 billion laboratory results each year and has more than 90% of us insured.

With the full offer of members based on members, the plans can access

• Complaints subject to the plan by quest
• Complaints subject to other payers by quest
• Complaints subject to plan by an IPA
• Complaints subject to plan by a supplier
• Complaints subject to plan by a hospital

The full supply of data -based data can provide 18% to 25% additional laboratory test results compared to complaint -based data.

What is the difference? Access to members -based data can allow payers

• Fill the gaps in members’ data, which could potentially improve quality performance measures linked to the laboratory, such as HEDIS®.
• Identify populations at high risk and intervene earlier, reduce membership costs and improve the results for the health of members over time.
• Identify unregistered health problems and clarify the coding of the diagnosis of the disease, which could lead to more precise and higher reimbursements.
• Determine an optimal care plan to provide better health and better members’ experience.

The advantages of complete laboratory data based on members appear clearly with diabetes, a condition that affects Almost 12% of the American population. Recently, Quest Diagnostics analyzed the data difference in a payer receiving test results only through complaint data. It was discovered that the payer had access to only 63% of the members who had an HBA1C laboratory test result. They could only see:

• 61% of their members who have undergone an HBA1C test led to the prediabétes range
• 66% of their members who suffered an HBA1C test led to the diabetes range

“This prediabetes issue is particularly worrying,” says Loveless. “We know that people who join a structured prevention program can Reduce their diabetes risk by 58% – 71% if they are over 60 years old. »»

Of course, payers also benefit from it when members obtain the services they need, potentially benefiting from lower costs and higher hedis scores and medical insurance notes. (For 2026, the hedis scores represent 25% of the star note of an advantage medication plan.) Laboratory data based on members can help fill the test deviations linked to nine quality measures and three medicare stars measurements.

Quality measurements

1. Evaluation of glycemic status for patients with diabetes (GSD)
2. Renal health assessment for diabetes patients (KED)
3. Colorectal cancer screening (collar)
4. Plug screening in children (LSC)
5. CHAMLAYDIA SUCCESS IN Women (CHL)
6. Metabolic monitoring of children and adolescents on antipsychotics (APM)
7. Cardiovascular surveillance for people with cardiovascular and schizophrenia diseases (SMC)
8. Diabetes screening for people with schizophrenia or bipolar disorder that use antipsychotic drugs (SSD)
9. Diabetes monitoring for people with diabetes and schizophrenia (SMD)

Star measurements

1. Hémoglobin A1C Control for diabetes patients
2. Renal health assessment for diabetic patients
3. Colorectal cancer screening (collar)

Health plans can access members -based data via the information portal for the members of the quest. The features include personalized reporting tools, hedis report models and information reports on improvement changes in individual clinical laboratories and lots (CLIA). The objective is to offer payers what they need and in the format they can use so that they can better serve their members.

“Quality teams do not need to spend weeks or months in pursuit of cards,” explains Loveless. “Instead, they can easily access reports by lots of files for the certificate.”

To learn more about how members based on members help payers, visit the quest diagnostics Member Knowledge Page.