(Left to right) Ben Chacon, senior healthcare consultant; Martha Bale, VP, director of Technical Operations, Executive Administration; and Andrew Fletcher, medical director, Consultative Services, prepare for a business review meeting.
At a monthly average cost of $1,910 per patient, infliximab ranked fourth in the Centers for Medicare and Medicaid Services 2016 Medicare Drug Spending Dashboard.
The high cost of the drug, which is used to treat Crohn’s disease and other autoimmune diseases, makes it a good candidate for therapeutic drug monitoring (TDM) to ensure a patient is responding well to the drug.
ARUP offers TDM tests for infliximab and other drugs. These tests analyze antibodies to determine whether a medication is active in the patient’s bloodstream. TDM tests also are available for adalimumab, which reduces inflammation in autoimmune diseases; imatinib, which treats chronic myeloid leukemia; and other drugs.
If patients respond well to imatinib, their health improves faster, and they save the trouble of having to try second-generation drugs not yet available in generic dosages.
“That's exciting, because it helps labs [in client medical centers] demonstrate their value outside of the laboratory. This is a real way to quantify savings and improve treatment at the same time.”
Senior healthcare consultant, Consultative Services
ARUP’s program of analyzing test ordering patterns, or ATOP™, helps zero in on the potential benefits of TDM, as well as other opportunities to improve patient care for ARUP clients. In the past year, ARUP’s Consultative Services Department has included ATOP in standard business reviews for existing clients, at the same time demonstrating how clients can use their ARUP Dashboards to explore their data to find efficiencies themselves each month.
“That’s exciting, because it helps labs [in client medical centers] demonstrate their value outside of the laboratory. This is a real way to quantify savings and improve treatment at the same time,” notes Dave Shiembob, senior healthcare consultant, Consultative Services, ARUP.
Here are some main areas ARUP includes in ATOP:
ARUP Dashboard with opportunities for improvement. Clients see their test data displayed in the dashboard in a way that demonstrates opportunities to improve test utilization by facility and by provider. They also see their own test utilization benchmarked against similar systems or hospitals. “We go over the actual dashboard with them on a screen; we know the clients will find things we didn’t see, because they know their physicians and patients,” says Shiembob.
Ability to include several departments in the presentation. For instance, for some ATOP presentations, executives, information technology (IT) specialists, and others join lab directors and other leaders. “It’s handy to have others attend. In particular, if IT is there, they can quickly make any interface changes that may be connected with test misorders,” notes Shiembob.
Recommendation to wait to order factor V Leiden tests. As an expensive test that should follow an initial screening for various conditions, factor V Leiden is one of several cases in which screening tests should take place first. ARUP presents on this.
Ability to identify obsolete tests or tests that can be performed in-house. Aldolase testing, for instance, has been replaced by tests for the enzyme creatine kinase, or CK to check for damage to CK-rich tissue resulting from heart attacks, muscle breakdowns, and kidney injury, and ALT and AST tests, both for measuring liver function. “Every hospital lab handles those tests, so there’s no need to send them to us. One client was spending $10,000 a year with us on Aldolase. There’s $10,000 potential savings that we pointed out to them,” says Shiembob.
An assessment such as ARUP’s ATOP at a business review opens up new opportunities. “If several departments attend these meetings, that’s a chance for collaborating within your own organization and immediately having all the problem solvers in the room,” says Shiembob. “There can be fast action points, and an opportunity for you to take action then—to put those efficiencies in and improve care.”
So, how does this compare with competitors’ offerings? “We’re confident that ARUP’s dashboards and ATOP reports are the best in the industry,” says Shiembob. “Our commitment to partnership and efficient healthcare means this area is a primary focus for us.”
Catherine Arnold, Science Communications Writer