Public Health Laboratories and Health System Change . The CLAC: A General Model for Communication


In the State of Washington, a public-private venue called the Clinical Lab Advisory Council (CLAC) is shaping the laboratory delivery system. The CLAC was created by the PHL director in cooperation with the Office of Laboratory Quality Assurance and a range of private laboratory interests in the state. The CLAC was initially conceived as a response to the fragmented laboratory system and the need for dialogue between stakeholders in the laboratory community. It currently serves to address these needs, as well as a range of other issues raised by membership.

Council membership is composed of 16 representatives of the following groups: (1) major laboratory professions (i.e., laboratory scientists, laboratory managers, medical assistants, pathologists); (2) managed care organizations; (3) hospitals; (4) physician office laboratories; (5) independent reference laboratories; (6) other health or medical associations; and (7) the state department of health. Full meetings of the CLAC occur periodically; in addition, the Council has appointed advisory work groups to develop recommendations on issues such as:


  • Structure and integration of the laboratory delivery system
  • Practice guidelines / use of clinical labs in medical decision-making
  • Reimbursement issues, including treatment of specific tests
  • Licensure of laboratory personnel, training, and credentialing
  • The role of the PHL relative to core public health function
  • Emerging science policy (e.g., genetic and point-of-care testing)

Both public and private sector interests indicate that they have benefited significantly from the CLAC. The PHL also uses key members of the CLAC informally as a sounding board to test likely reaction to new policies and procedures.

Public-private collaborations or contracts in laboratory services B to the extent that they exist at all  -- are in their formative stages. Because of both the newness and limited number of examples of public-private collaboration in the laboratory field, the topic has not been thoroughly studied and is not well understood. Despite many PHLs reporting collaborations of some type, our interviews and case studies suggest that collaboration in this field has been progressing slowly as a whole.

Laboratory directors hypothesize that there are two key barriers to collaboration: (1) managed care's lack of awareness of PHL functions and capabilities; and (2) PHL directors' concern over private sector motives and priorities in procuring laboratory services. Several managed care interviewees in our study were, in fact, unaware of the traditional role of PHLs within the larger public health infrastructure. Moreover, cost-driven procurement of laboratory services was generally cited by both private and public stakeholders as catalyzing change in the industry, both in terms of increasing competitiveness and in decreasing activities for PHLs.

An alternative explanation for the lack of collaboration that was articulated in a few of our interviews with individuals from the private sector was that commercial laboratories or MCOs simply had little to gain from collaboration. As businesses, commercial laboratories are closely focused on turning a profit in an increasingly difficult and competitive environment.