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
Results
Conclusions
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
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
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 B: ASPE Public Health Laboratory Interview List
Appendix C: Poll of Public Health Laboratory Directors
Appendix D: Case Studies
Michigan State Case Study Summary
Tennessee State Case Study Summary
Washington State Case Study Summary