Vermont-based clinical laboratory company integrates social determinants of health (SDH) with lab data to help doctors at University of Vermont Health Network better manage their opioid patients

Aspenti Health, a full-service diagnostic laboratory specializing in toxicology screening, has won the nation’s first ever Clinical Lab 2.0 “Shark Tank”! The competition was held May 2, 2019, in conjunction with the 24th Annual Executive War College on Lab and Pathology Management in New Orleans.

The Clinical Lab 2.0 “Shark Tank” showcased forward-thinking clinical laboratories and anatomic pathology groups that are committed to the Clinical Lab 2.0 movement, a Project Santa Fe Foundation initiative aimed at guiding laboratories from test volume to lab value models.

“We are thrilled to be recognized for our work serving the unique needs of substance use healthcare. And, most importantly, across our organization for our unyielding commitment to employing innovations to solve this [opioid] crisis,” Aspenti Health CEO Chris Powell stated in the news release.

The projects were judged on Clinical Lab 2.0 attributes, such as:

  • Risk stratification by population;
  • Closure of care gaps;
  • Lab results as early detection; and
  • Lab intervention for improved clinical outcomes.

“This project, as well as all of the other cases that were presented, were quite strong and all were aligned with the mission of the Clinical Lab 2.0 Movement,” said Khosrow R. Shotorbani, President, Executive Director, Project Santa Fe Foundation, in a news release. “This movement transforms the analytic results from a laboratory into actionable intelligence at the patient visit in partnership with front-liners and clinicians—allowing for identification of patient risks—and arming providers with insights to guide therapeutic interventions.

“Further, it reduces the administrative burden on providers by collecting SDH [social determinants of health] predictors in advance and tying them to outcomes of interest,” continued Shotorbani. “By bringing SDH predictors to the office visit, it enables providers to engage in SDH without relying on their own data collection—a current care gap in many practices. The lab becomes a catalyst helping to manage the population we serve.”

Co-Use of Opioids Tied to Social Factors

Aspenti Health’s “Shark Tank” entry—“Integration of the Clinical Laboratory and Social Determinants of Health in the Management of Substance Use”—focused on the social factors tied to the co-use of opioids and benzodiazepines, a combination that puts patients at higher risk of drug-related overdose or death. The project revealed the top two predictors of co-use were the:

  • Prescribing provider practice, and the
  • Patient’s age.
“This was a unique project because it integrated social determinants, which are a key part of our overall health and wellness, with laboratory data, which is well-defined, quantitative, and very accurate,” said Jill Warrington, MD, PhD (above), Chief Medical Officer at Aspenti Health and Assistant Professor in the Department of Pathology and Laboratory Medicine University of Vermont Medical Center, in an exclusive interview with Dark Daily. “So, combining something that is really meaningful clinically with something that is very predictive and accurate has a nice blend of strengths.” (Photo copyright: Aspenti Health.)

Myra L. Wilkerson, MD, who served on a three-judge panel tasked with selecting the winning project, said the Vermont toxicology laboratory’s entry stood out in two key areas.

“We felt their project had an application to a broader population, but also moved beyond traditional [laboratory] functions or even medicine,” explains Wilkerson, who is Chair of the Diagnostic Medicine Institute for the Geisinger Health System. “Patient advocacy groups, payers, and providers all have come to realize you can identify a disease, you can provide a treatment, but so many other things impact it, especially in this community. When it is an addiction, there are so many other factors that play into whether or not they are going to be successful in their treatment plan. And a lot of them are social things.”

Educating Care Givers and Public on Dangers of Co-Use Drug Addictions

Working in collaboration with Staple Health and the University of Vermont Health Network, Aspenti selected “co-use” for this initial lab outcome study because of the significant patient safety implications and relative simplicity of its definition—the co-presence of positive laboratory results for both opioids and benzodiazepines.

According to the National Institute on Drug Abuse, more than 30% of overdoses involving opioids also involve benzodiazepines. Aspenti’s “Shark Tank” presentation highlighted the fact that co-use of the drugs accounts for nearly 2.5% of opioid-related emergency department visits, costing the healthcare system an estimated $47.5 million per year.

Based on the study results, Aspenti Health plans to develop educational programs that warn about the dangers of co-using opioids and benzodiazepines.

“We identified geographically hotspots where co-use was more prevalent, so we can target our educational initiatives centered on those geographical locations—not just to providers, but also to families and patients—to raise awareness about co-use so the risks are mitigated collectively,” Warrington said.

Advancing the Value-based Healthcare Agenda

The Executive War College Clinical Lab 2.0 “Shark Tank” advances a conversation about the lab industry’s future that began at the inaugural 2016 Project Santa Fe meeting. Lab industry stakeholders brainstormed about the transition from volume-based to value-based healthcare, and the role laboratory-driven innovations could play in reducing total cost of care.

As healthcare shifts to a value-based reimbursement model, Wilkerson believes laboratory leaders must re-engineer their role in the continuum of care by creating meaningful clinical diagnostic insights for population health initiatives.

“What’s your executive leadership concerned about? What are your payers concerned about? What are your accrediting or regulatory bodies concerned about? What are their top priorities and how can you do something that improves patient care but helps them address their problems as well?” she asks. “That’s where you create value.”

As the Clinical Lab 2.0 Innovation Award winner, Aspenti Health will receive:

  • An invitation to speak at national lab conferences this fall;
  • A consultation with a Project Santa Fe member lab to discuss successful Clinical Lab 2.0 innovations and identify new ways to deliver more value in patient care; and
  • Publication of a case study of their Clinical Lab 2.0 project by Dark Daily or its sister publication The Dark Report.

With labs in Vermont and Massachusetts, Aspenti continues to identify opportunities for directly contributing to improvements in the care of substance abuse and pain management patients. Warrington says that with its SDH project, Aspenti plans to focus on other key laboratory outcome measures—such as treatment adherence and relapse. Next steps include integrating this work into the practices of partner doctors within the University of Vermont Health Network.

Wilkerson’s advice to other clinical laboratories is to follow Aspenti Health’s lead.  

“When you look at the national trends, the percentage of traditional fee-for-service or volume-based healthcare is going to go down to 25% of the total healthcare spend by 2021,” she points out. “The other 75% will be based on value-added services around quality metrics, efficiency, cost reduction, utilization, etc. Labs that aren’t starting to think this way now are going to be behind and at risk in the future.”

—Andrea Downing Peck

Related Information:

Aspenti Health Wins Clinical Lab 2.0 Innovation Award

First-Ever ‘Shark Tank’ on Clinical Lab 2.0 and Adding Value Happens May 2 in New Orleans: Clinical Laboratories with Innovative Services Invited to Present

Improving American Healthcare Through “Clinical Lab 20”: A Project Santa Fe Report

National Institute on Drug Abuse: Benzodiazepines and Opioids

Project Santa Fe Labs Deliver Value with Tests

Improving American Healthcare Through “Clinical Lab 2.0”: A Project Santa Fe Report