The Role of Laboratories in ACOs

Physician Office Resources:LabOratory

The Role of Laboratories in ACOs

By Irwin Z. Rothenberg, MBA, MS, M.T. (ASCP), Technical Writer/Quality Advisor, COLA Resources, Inc.




Most experts now agree that a value-based model (quality of health outcomes per dollar expended) measured at the patient level is the only way to achieve real savings over time and bring about true system transformation.  The Accountable Care Organization is one of several models developed to achieve this.  Required is a robust IT structure across the continuum of “cradle to grave” care including HIEs, EHRs, Hospital Information Systems, Labs, e-Prescribing, Medical Device, and Diagnostic Imaging systems.  It also requires multi-disciplinary, multi- organizational, team -based care models to actively manage emerging care plans, care delivery, and compliance with evidence-based care practices across multiple providers and care settings[i].


In order to accomplish this, organizations are collecting and analyzing performance and outcomes measures.  Pathologists and laboratory professionals have the expertise to identify significant trends and patterns and medical outcomes from this data.  In turn, these analyses can be used to adjust the decision support and clinical pathways used to care for different disease states, and effectively reduce and control the cost of care[ii].


Indeed, laboratory clinical expertise, in combination with the lab’s network of physician and patient touch points, make laboratories a central component of an integrated provider organization.  By hosting the vast majority of centralized information, laboratories reaffirm the importance of highly functioning physician/laboratory relationships[iii].




Healthcare executives are beginning to understand how these relationships can be used to strengthen and enhance healthcare systems’ physician alignment strategy. Through the deployment of a robust connectivity system, laboratories have the ability to streamline physician office work flow, receive test orders and return results to a variety of EMR systems in real time, and play an essential role in building physician relationships. Downstream benefits can include enhanced lab order accuracy, more complete patient and billing information, improved revenue collections, and better patient outcomes -- all critical differentiators in an era of quality improvement and cost reduction mandates.


Decision support to ensure the appropriate utilization of laboratory tests also can create total savings in laboratory expenses -- 10 to 20 times greater than savings associated solely with unit costs. Thus, pathologists and laboratory professionals should be considered uniquely equipped to assist in the development of clinical pathways and clinical decision support software to guide physicians in test selection.




Clinical laboratories must recognize the opportunities ACOs create, and respond with strategies

which position the lab to reach its full potential within the ACO model. The following strategies

are crucial for laboratories to meet the clinical information needs of physicians practicing

within ACO organizations, and demonstrate their value by facilitating decision support and

coordinated care:


Extend and expand laboratory services by reaching out to all staff in physician offices, nursing facilities, clinics, and service centers.  Create a network of integrated and coordinated laboratory services across the continuum of care. Develop the infrastructure and logistics required to serve chronically ill patients who need to access care periodically in different venues from a variety of providers, in an ambulatory environment.


Build electronic connectivity solutions to providers that effectively integrate data in

and out of physician practice EMRs.  Laboratories can be instrumental in assisting physicians with the selection and implementation of EHRs, and with the meaningful use and interoperability of these systems.  They also can demonstrate value to their physician clients by streamlining order and result processes within physician offices.


Improve the operational efficiency of the laboratory. One of the most important steps a laboratory can take to position its services for inclusion in an ACO or coordinated-care model is to improve every process, so as to eliminate waste, minimize variation, and reduce costs.   


Develop utilization-management tools. Clinical utilization management has the potential to reduce or eliminate unnecessary expenditures. Test-utilization review within a hospital organization can be performed by a multispecialty medical committee, such as a laboratory formulary committee, with the scope and authority to recommend the appropriate use or availability of lab tests, as well as review processes for referred test orders and protocols for lab workup for specific disease states.  Laboratory experts should be involved in the development of computerized physician order entry (CPOE) with clinical decision support (CDS), test algorithms, and clinical pathways. Pathologists have the medical training necessary to analyze aggregate clinical data for outcomes and quality.


Understand the laboratory’s role in the Big Picture. The Director of the laboratories operating within hospitals or health systems should have a clear understanding of the health system’s clinical and financial objectives, including plans for an accountable care organization.  Successful laboratories will align the laboratory’s strategic objectives with those of the larger organization such as community marketing, and physician-alignment, or information technologies strategies.




Successful laboratories under the new challenges of healthcare reform will be the laboratories that are the  most integrated within their health systems, leveraging outreach relationships, actively participating in the formative stages of ACO development, and preparing for upcoming reimbursement changes.

The paradigm shift in healthcare from episodic care to chronic-care management represents a once-in-a-generation opportunity for proactive laboratories to redefine their value in a new, much larger role as integrators of critical clinical information and decision support.



Irwin Z. Rothenbergis a Technical Writer/Quality Advisor for COLA’s Educational subsidiary, COLA Resources, Inc. (CRI), a leader in online continuing education for physicians, laboratory personnel, and allied health professionals. CRI offers continuing education through online courses, informational products in both electronic and hard copy form, webinars on cutting-edge technology and regulatory issues, and CRI on-site Symposia for Clinical Laboratories, providing live educational sessions and interactive workshops with leading industry organizations. For more information, visit their website at or call 1-800-981-9883.



[i] Gilbert,   Alan.  Movement from “Fee  for Service” to “Fee for Value”. Healthcare Information and Management

 Systems Society (HIMSS)  News.  July 9, 2012.



[ii] Gilbert,   Alan.  Movement from “Fee  for Service” to “Fee for Value”. Healthcare Information and Management

 Systems Society (HIMSS)  News.  July 9, 2012.



[iii] Miles, Joe and Ronald L. Weiss. The Role of Laboratory Medicine in Accountable Care Organizations. White Paper ARUP Laboratories. Aug 2013. Retrieved from:




[iv] Miles, Joe and Ronald L. Weiss. The Role of Laboratory Medicine in Accountable Care Organizations. White Paper ARUP Laboratories. Aug 2013. Retrieved from:



[v] Miles, Joe and Ronald L. Weiss. The Role of Laboratory Medicine in Accountable Care Organizations. White Paper ARUP Laboratories. Aug 2013. Retrieved from: