Public Health Laboratories and Health System Change

Prepared by Roy Ahn, Daniel S. Gaylin, Alison Keiller, Daniel N. Mendelson, Adil Moiduddin, and Robert J. Rubin, M.D. of The Lewin Group under the direction of Cheryl Austein, Project Officer for the Office of Health Policy, within the Office of the Assistant Secretary forPlanning and Evaluation (ASPE), Department of Health and Human Services. October 6, 1997


TABLE OF CONTENTS

EXECUTIVE SUMMARY

Results

Conclusions

INTRODUCTION

STUDY METHODS

Literature Review

Interviews of Clinical Laboratory Experts

Informal Poll of PHL Directors

Case Studies of States: Michigan, Tennessee, and Washington

POLICY CONTEXT AND BACKGROUND: ENVIRONMENTAL SCAN

The Public Health Infrastructure

PHL Structure, Organization, and Activities

Federal Government Role in PHL Activities

Centers for Disease Control and Prevention and PHLs

Other Federal Agencies and PHLs

Private Clinical Laboratory Environment

Structure of the Market

Trends Affecting PHLs

Computerization of Laboratory Functions

Universal Coding Systems for Clinical Laboratories

Internal Laboratory Information Systems

The State of Automation in Tennessee

Inter-Laboratory Communication

Creation of Integrated Knowledge Bases

Environmental Scan Conclusions

STUDY FINDINGS: ANALYTICAL RESULTS

Impact of Managed Care on PHLs

Reduced PHL Testing Volume

Concerns About Reporting

Difficulty in Obtaining Payment

Improved Collaboration With Private Constituencies

Impact of Other Health Market Change on PHLs

Reduced PHL Testing Volume

Increase in Volume of Some Expensive Tests

Erosion of Disease Reporting

Potential Positive Effects From Consolidation

PHL Responses to Health Market Change

PHL Contracts With MCOs and Private Laboratories

Other PHL Responses to Managed Care and Health Market Change

CONCLUSIONS

Impact of Managed Care

Evolution in Laboratory Infrastructure

Private Clinical Laboratories

Laboratory Information Systems

Models for Relationships

Provide Services As A Subcontractor To MCOs

Establish a Testing Network in Collaboration with Other Vendors

Actively Manage Activities of MCOs through Contracts

Shape the Delivery System Through Dialogue / Collaboration

Core PHL Function

Traditional Definition of Core Services

Issues Inherent in Health Market Change

Positioning PHLs for the Future: The Federal Role

Structure of Laboratory System

Information Technology

Outreach and Communication

APPENDICES

Appendix A: Bibliography

Appendix B: ASPE Public Health Laboratory Interview List

Appendix C: Poll of Public Health Laboratory Directors

Appendix D: Case Studies

Site Visit Protocols

Michigan State Case Study Summary

Tennessee State Case Study Summary

Washington State Case Study Summary