ARUP Consultative Services

Utilization Management Solutions

In a survey conducted by the American Board of Internal Medicine, the organization responsible for the Choosing Wisely campaign, 72 percent of physicians prescribe an unnecessary test or procedure at least once a week; furthermore, 73 percent of physicians report the frequency of unnecessary tests and procedures in the healthcare system as being a very or somewhat serious problem.

Utilization management is your answer, and ARUP’s consultants are your experts. Fortify your laboratory to improve quality and stay ahead of healthcare reform by addressing utilization problems now.

Benchmarking

Passion for delivering high-quality care drives healthcare professionals, and we tend to get competitive. Comparing your performance to that of your peer group is a powerful tool to drive change and acknowledge success.

ARUP Consultative Services’ ever-growing utilization benchmarking database houses highly refined data to produce a comprehensive reference set for utilization comparison. 

Service features:

  • Peer-to-peer performance evaluation
  • Identification of opportunities for improvement
  • Evaluation of characteristics of top performing peers for improvement modeling

Deliverables:

  • Identification of top improvement opportunities
  • Formal report of findings and opportunities

For more information on our benchmarking database, contact your ARUP account executive or email consultativeservices@aruplab.com.

Sendout Utilization Dashboard

The sendout dashboard is a premium tool available to all ARUP clients at no cost. This dashboard brings your introductory analysis of  sendout utilization to life in a dynamic environment. You will be able to review your sendout testing data 24/7. This tool is available via ARUP Connect and requires no additional log-on credentials.

For more information on the sendout utilization dashboard, contact your ARUP account executive or email consultativeservices@aruplab.com.

Utilization Analysis (Inpatient and/or Outpatient)

Most laboratory administrators and pathologists want to improve the utilization of laboratory services within their institutions, but don’t have the time to do so. ARUP’s expertise and fluency in diagnostic testing means we can be your committed resource for utilization management (UM) initiatives.

Our data analysts bring together numerous data files to create a multi-dimensional data set for utilization evaluations. Our unique, customized approach evaluates utilization patterns in a way no one else can to deliver highly valuable, evidenced-based recommendations.

Service features:

  • Importation of various data sets and assembly of comprehensive 12-month data set
  • Customized utilization analyses, including but not limited to:
    • Duplicate testing
    • Unnecessary repeat testing (testing intervals)
    • Reflex testing
  • Identification of opportunities to improve inappropriate and over-utilization
  • Ongoing data analysis and decision support for the duration of the engagement

Deliverables:

  • Comprehensive report of findings and recommendations
  • Formal presentation of findings to stakeholders

For more information about inpatient or outpatient utilization analysis, contact your ARUP account executive or email consultativeservices@aruplab.com

Utilization Management Program Development with Utilization Analysis

The key to a successful UM program is having the right governance structure.  Having all key players at the table is essential to the quality and efficiency of the working group. The key players at one institution may not be the same for another. As your consultants, we bring our clients’ lessons learned to position you and your program for success, the first time around.

Service features:

  • Organization of the planning and steering committees
  • Formulary development
  • Support through intervention implementations
  • 12-month utilization analysis and evidence-based improvement recommendations

Deliverables:

  • Comprehensive report of findings and recommendations
  • Formal presentation of findings to stakeholders

For more information about developing your UM program, contact your ARUP account executive or email consultativeservices@aruplab.com.

Test-Interval Guidance

Going beyond duplicate checking and formularies, test-interval guidance supports the diagnostic process and improves the efficiency of care by providing evidence-based guidance on the appropriate intervals for specific testing to occur. 

Marrying the concept with decision support, we work with your clinical decision support and electronic medical record teams to assist in designing and implementing interventions at the time of order.

Key features:

  • Literature evidence for your selected five target tests (see comprehensive list)
  • Evaluation of pre-intervention data and projected cost savings
  • Support in moving this initiative through medical leadership for approval prior to implementation
  • Support of EMR team in developing and implementing IT interventions
  • Post-implementation analysis and cost-savings calculations

Deliverables:

  • Detailed report including findings from our utilization analysis and recommendations for improvement
  • Formal presentation of findings and recommendations to key stake holders

For more information on test-interval guidance, contact your ARUP account executive or email consultativeservices@aruplab.com.


Learn more about ARUP's comprehensive utilization management, UM+.

Business Development Solutions

In a rapidly changing industry, healthcare organizations face more pressure than ever before to do more with less, improve outcomes, and find ways to remain sustainable in an increasingly capitated environment.

ARUP Consultative Services understands these challenges and engages in ongoing market research to keep abreast of local, regional, and national healthcare transitions to ensure you are well positioned to navigate the path forward. Our extensive experience with laboratory technical and business operations makes us your one-stop shop for business development solutions.

Market Opportunity Assessment

Understanding external forces that exist in the marketplace is one of the most important steps a laboratory can take to strengthen existing and capture new business. The market opportunity assessment allows you to identify opportunities and take action to reduce leakage with affiliated (in-reach) physicians and capture new business with non-affiliated (outreach) physicians within and beyond current service areas.

Service features:

  • Estimated revenue opportunity within a defined geographic region
  • Competitive analysis of national and regional laboratories operating in that region
  • Referral service requirements
  • Physician satisfaction levels

Deliverables:

  • Comprehensive report highlighting:
    • Growth opportunity
    • Competitive challenges
    • Complete analysis of survey data
  • Formal presentation of findings and recommendations.

For more information regarding the market opportunity assessment, contact your ARUP account executive or email consultativeservices@aruplab.com.

Outreach Operations Assessment

Building and running a successful outreach business requires the right infrastructure and the right team. Regardless of whether you need a complete operational assessment for a new business unit or simply need to fine-tune specific operational challenges, ARUP brings an experienced consulting team to the table to ensure a comprehensive analysis of pre-analytic and post-analytic outreach operations.  

Service features:

We evaluate the following:

  • Patient service centers and satellite labs
  • Courier operations
  • Specimen handling and receipt
  • Registration, barcoding, and processing
  • Client services
  • Referral testing
  • IT connectivity and functionality
  • Pricing
  • Billing and collections
  • Specimen exception and problem resolution
  • Test ordering and result reporting functions

Deliverables:

  • Comprehensive report highlighting:
    • Operational infrastructure necessary for competitive outreach operations
    • Customer support services
    • Capital investment requirements
  • Formal presentation of findings and recommendations

For more information regarding the outreach operations assessment, contact your ARUP account executive or email consultativeservices@aruplab.com.

Outreach Business Plan

Laboratory outreach programs don’t plan to fail, but some fail to plan. Our consulting team offers services designed to help you develop, operate, and expand your outreach program with a comprehensive business plan specifically designed for your organization.

Service features:

  • Overview of laboratory testing market potential with physicians who utilize clinical and anatomic pathology laboratory services to determine new revenue opportunity with outreach operations
  • Operational evaluation of pre-analytic and post-analytic laboratory services to identify inefficiencies and gaps in service levels required to operate a competitive outreach program
  • Customized sales forecasting
  • Five-year business plan with return on investment

Deliverables:

  • Detailed business plan provided in hard copy and electronic format
  • Formal presentation of findings and recommendations

For more information about the outreach business plan offering, contact your ARUP account executive or email consultativeservices@aruplab.com.

Pricing Strategies

With declining reimbursement from government and private payers, developing the right pricing strategy is increasingly important. Our consulting team will help your lab evaluate strategies that strike the right balance between being competitively priced and making the necessary margin to cover cost and support the organizational mission.

Service features:

  • General pricing strategies
  • Use of multiple fee schedules
  • Discount policies
  • Synergies with pricing and service

Deliverables:

  • Detailed report highlighting:
    • Different pricing strategies for inpatient and emergent patients versus outpatients and ambulatory patients
    • Variable pricing based on test mix and volume
    • Pricing for specific market conditions

For more information on pricing strategies, contact your ARUP account executive or email consultativeservices@aruplab.com.

Reimbursement Analysis

Cost accounting for many laboratories is a significant challenge, yet in an era of legislative change that continues to drive reimbursement down, labs must understand their cost structure. Our Consultative Services team includes skilled financial analysts with vast experience evaluating laboratory financials who can help position you to make well-informed, strategic decisions.

Service features:

  • Overview of managed care organizations in a defined region
  • Provider and payer trends impacting reimbursement:
    • Transition from volume to value based reimbursement
    • Accountable care models
    • High-deductible health plans
    • Narrow networks
  • Detailed break-even analysis of your data at the CPT code level

Deliverables:

  • Data analysis, including:
    • Identification of hypothetical break-even points
    • Degree of profit or loss
    • Cost as percent of charges
    • Cost as percent of revenue
    • Potential impact of incremental discounts.

For more information regarding reimbursement analysis, contact your ARUP account executive or email consultativeservices@aruplab.com.

Strategic Business Planning

Develop and align your laboratory business plan with organizational initiatives. Demonstrating cost containment and value beyond test results that support the continuum of care is critical for success in today’s challenging healthcare industry.

Consultative Services can guide you in selecting and tailoring the optimal laboratory model and identify opportunities to integrate and consolidate. Establish the laboratory service line as central and essential to long-term sustainability of your organization.

Service features:

  • Laboratory operational evaluation
  • Financial model forecasting the impact of integration and/or consolidation on revenue and volume;
  • Comprehensive business plan with current and projected profit margins

Deliverables:

  • Business plan provided in hard copy and electronic format
  • Formal presentation of the business plan to executive and laboratory administrative stakeholders

For more information on our strategic business planning, contact your ARUP account executive or email consultativeservices@aruplab.com.

Laboratory Operations Solutions

At ARUP, we have mastered laboratory operations. We increase our sample volume every year and, through innovative approaches to pre-analytic, analytic, and post-analytic processes, continually increase our quality too. With shrinking budgets and declining reimbursement from government and private payers, we know you are looking for ways to minimize waste and operate more efficiently. We can leverage our in-house expertise to help you respond to the demand of increased accountability for controlling costs and improving efficiencies.

Insourcing Opportunity Assessment

Demonstrating your commitment to cost-containment can establish your lab as a value center, not a cost center. Evaluating your test menu for insourcing opportunities is a win-win; insourcing increases your savings or revenue and moves testing closer to the patient.

We believe laboratory testing should be delivered as close to the patient as possible. Our consultants will evaluate your sendout volumes and costs to identify insourcing opportunities.

Service features:

  • Volume and cost distributions
  • Break-even volume
  • Opportunities tailored to your lab’s existing infrastructure
  • Financial analysis based on contract types (risk-based, fee-for-service, etc.)
  • Comparison of analytic performance of insourcing recommendations

Deliverables:

  • Comprehensive report of findings and recommendations, including;
    • Five-year insourcing financial forecasting
    • Break-even volume analysis

For more information about the insourcing opportunity evaluation, contact your ARUP account executive or email consultativeservices@aruplab.com.

Technical Operations Assessment

Redundancy and waste are a major threat to your laboratory’s survival. ARUP’s Consultative Services and technical experts can help you improve operational efficiency and reduce waste. Our team includes Lean practitioners who can provide you with the best solutions to help you survive and thrive. ARUP receives X samples per day destined for testing in our X number of specialized laboratory sections; efficiency is key to our success.

Service features:

  • Pre-analytic operational evaluation of:
    • Patient service centers
    • Courier services
    • Client services
    • Specimen receiving, registration, and processing
    • Staffing and workflow
    • Pre-analytical automation
    • Referral testing
    • Exception handling
  • Analytical operational evaluation of:
    • Space and design layout
    • Waste reduction with application of Lean principles
    • Specimen flow
    • Technical automation
    • Testing platforms
    • Specimen storage and retrieval
  • Post-analytic evaluation of:
    • Result reporting
    • Billing and collections

Deliverables:

  • Comprehensive report of findings and recommendations, including:
    • Workflow analysis
    • Graded recommendations (by ease of implementation and impact)

For more information about the technical operations assessment, contact your ARUP account executive or email consultativeservices@aruplab.com.