The clinical lab industry is on the cusp of a major transformation of the normally accepted business model as a result of the emergence of telemedicine as a common means for delivering ambulatory care. I have been blogging about the advantages of telemedicine for years (see, for example: Insurance Companies Can Use Telemedicine to Enlarge Their Provider Networks). In a recent note addressing megatrends in healthcare, I suggested that telemedicine was one of them and will soon be part of the "new normal" in healthcare delivery (see: Ten Megatrends in Healthcare with Special Emphasis on Ambulatory Care). My prediction was reinforced by a recent futuring article about Kaiser Permanente (see: Taking Bids on the Hospital of the Future). Here is a quote from it pertaining to the growth of telehealth:
Kaiser physicians now handle more patients via telehealth (59 million a year) than they do in person (50 million). Jennifer Liebermann, who runs the [hospital of the future] test facility, says patient feedback guided development of the TV remote system rolling out to a handful of hospitals and helped fine-tune it over the course of two years to make sure it was easy to use. Kaiser rejected at least one system interface, she says, after elderly patients deemed it too confusing.
In three to five years, I think that the majority of ambulatory care patients will commonly engage with their healthcare providers via telemedicine and thus will not be readily available for venipuncture (or finger prick) for specimen acquisition and lab tests. Instead, I think that such patients will be more inclined to visit a patient service center (PSC) or, perhaps even more commonly, a blood collection center in a neighborhood retail drug store. For this reason alone, health systems need to establish remote blood drawing centers in retail drug stores.
Hospitals have been accustomed to relatively high profit margins on their lab testing. This was feasible because outpatients have been a "captive" audience at the time of outpatient visits. It was convenient for them to just walk to the blood drawing center in the ambulatory care building. However, these high margins for even lab testing have been a challenge for patients not covered by health insurance. This is increasingly the case for consumers with high-deductible plans who may seek low-priced direct-access-testing (DAT) which will also be available in retail drug stores. Although Theranos made many mistakes, one of the positive things achieved by the company was broad publicity about the low cost of DAT.
One more relevant point. Look for more on-site, point-of-care (POC) lab testing in the drug stores in association with blood drawing services. Think of the Quest/LabCorp business model as sophisticated logistics plus large-scale lab testing with the former involving specimen pickup at physician offices plus transportation to large central labs. Perhaps with more efficient, multiplexed POC analyzers in retail drug stores, lab testing in these sites may become more competitive cost-wise with large reference labs. Certainly, test results in an hour or less would result in much higher patient satisfaction with lab testing. The IVD industry needs to deliver POC analyzers with a much lower cost-per-test to satisfy the impending, growing demand for them in retail drug stores.