By Deborah Borfitz
August 31, 2021 | The M.O. of healthcare is to accommodate providers rather than individuals seeking care and that runs counter to the industry’s “triple aim” of improving the health of populations, enhancing the experience of care, and lowering per capita costs, according to Jay G. Wohlgemuth, M.D., chief medical officer for Quest Diagnostics Nichols Institute. The pandemic has spotlighted some of these well-known failings but also provided some lessons on how to operate in a more consumer-centric way.
Wohlgemuth was a keynote speaker at last week’s Next Generation Dx Summit, addressing the acceleration of population-based precision health based on innovations COVID-19 helped introduce. The pre-pandemic situation—fragmented care delivering worse health outcomes than comparable countries around the globe despite being the top spender—was certainly in need of a fix, he says.
To drive population health toward the universal, triple-aim goals requires that health systems engage individuals in highly effective ways, so they take steps in preventive care or to manage a chronic disease, Wohlgemuth says. And it must be convenient, meaning something other than instructing patients to go get a needed test and then having them come back to be told what to do next.
When diagnostic tests for COVID became available, potentially infected people were directed to drive-through screening sites and hundreds per day would show up at parking lots across the country, he noted. Quest’s response was to develop a self-collection PCR kit to protect physicians from the virus by shipping the test to people’s home—in some cases, via drone delivery to their lawn—and sending results to their smartphone a day or two after receiving their nasal swab specimen.
It was not only a highly consumer-friendly way to access the test, says Wohlgemuth. Quest also had physicians guiding consumers through the process using telemedicine.
Personal Health Impacts
As has been widely reported, preventive healthcare has “dropped off the cliff” during the pandemic. By Quest’s estimation, diabetes testing is down 66%, physician visits have fallen (at various times) by more than 70%, and cancer screenings have plummeted by 90%. Not coincidentally, late-stage cancer diagnoses are now being seen among the 60,000 members in Quest’s employee health plan, he adds.
The downtrend in testing for hepatitis C is particularly concerning, as its detection leads to a targeted therapy that is curative, Wohlgemuth continues. The U.S. had been on track to suppress the viral infection within the next 10-20 years, but “we have lost ground big time.” Disparities in outcomes and access based on socioeconomic status, living in an urban environment, and race/ethnicity also persist.
In a study published earlier this year in Population Health Management (DOI: 10.1089/pop.2020.0163), and co-authored by Quest Diagnostics, researchers found that communities with the highest proportions of Black non-Hispanic and Hispanic populations have the highest SARS-CoV-2 positivity rates even after controlling for other risk factors.
COVID-19 is having both direct and indirect impacts on personal health, says Wohlgemuth, noting that 10% of those with the disease experience “long-haul symptoms” and need to be engaged. To make matters worse, those with the post-acute syndrome may have to “convince providers it is a problem likely due to COVID.”
Self-Collection Kits
Population health goals are achievable, Wohlgemuth stresses. He specifically cites the more than $50 million achieved for the Quest employee health plan since 2015 by better engaging individuals, which has gone toward lowering premium costs and investing in population health services such as mental health and fully virtual pharmacogenetic testing.
Quest Diagnostics was the 2020 recipient of the C. Everett Koop National Health Award for implementation of its population health program, he adds. For every 1,000 employees engaged in a year, 20 new cases of diabetes and 67 new cases of colorectal cancer are found.
Moving toward personalized care also means finding the people who have kidney failure and don’t yet know it, says Wohlgemuth. If they are in early renal failure, they might have the diagnosis confirmed via telemedicine and be referred to a nephrologist.
That’s a difficult journey to navigate, in or outside a pandemic, he says. “We need to engage people around their problems.” On a per-patient basis, prevention could save $60,000 a year for hemodialysis or at least $100,000 to $150,000 in first-year treatment alone for a kidney transplant.
A lot can be done at home using self-collection kits, Wohlgemuth says. At Quest, kits are either sent to employees’ home or, alternatively, they can go to a patient service center for testing. Ongoing access to telemedicine is available for a period through the virtual healthcare platform 98Point6.
The next version of 98Point6 will pull individuals’ drug history and entire electronic medical record, plus give them virtual primary care visits with nurse practitioners from Catapult Health, he continues. Providers will refer to checklists of needed preventive care and “broker next steps needed.”
Pharmacogenetic testing happens via home collection of a saliva or swab sample and telephonic visit with a pharmacist to go over the results as well as an individual’s drug regimen and, if necessary, “clean it up,” Wohlgemuth says.
To course correct on mental health, which currently operates like a “parallel universe” to primary care, Quest has made over 1,000 referrals to a telepsychiatry program at Johns Hopkins during the pandemic when rates of depression have been skyrocketing, he says. Globalization, urbanization, and food practices have all played a role, he adds.
Quest is now actively surveilling respiratory viral threats around the globe and proactively developing tests before the bugs arrive in the U.S., says Wohlgemuth. The company will be building between eight and 17 such assays “even if we never use them” rather than engage in a race to create them in the middle of a pandemic, as it did with COVID.
A few years ago, Quest Diagnostics developed a Global Diagnostics Network to address worldwide health challenges and improve local patient care, he says. The member companies include China-based KingMed Diagnostics as well as Korea-based Green Cross Labs, which provided the SARS-CoV-2 samples that allowed Quest to validate its COVID-19 test in a single week.