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June 13, 2022

Medical Claims Data Underscores Need to Improve Lab-Testing Access and Action

By David Stein

Blood tests are a critical piece of routine medical care, guiding clinical decisions and aiding patient understanding. They give actionable data to the provider. They make preventive care easier. They reduce potential health risks. They help people understand changes to their bodies. They keep track of the unique needs of individuals.

Despite the benefits, consumer surveys suggest that people often skip common wellness blood tests, which is a missed opportunity to improve preventive care and health outcomes. 

As a science-first company, we wanted to see if health insurance data supported the anecdotal evidence about blood testing to gain a better understanding of the utilization of routine blood tests and the impact on health. With our partners, Becton, Dickinson and Company (BD) and Trinity Life Sciences, we set out to analyze current practice using medical claims data from Optum’s Clinformatics Data Mart.

What the data showed us

We analyzed anonymized medical claims of nearly 10 million U.S. adults in 2018 and 2019 from commercial and Medicare Advantage plans. The population in the study was diverse. It was not skewed by healthy young adults who traditionally don’t have primary-care providers or regularly have wellness visits. The median age in the sample size was 56.4 years old, with a balanced mix of gender. Many had conditions such as high cholesterol, diabetes, or thyroid complications.

The data validates many of our observations: More than one-fifth of patients (21%) do not receive routine blood work and routine primary care visits each year. Additionally, among the patients who did not have routine blood work, 63% had at least one comorbid condition that would benefit from routine blood testing, such as high cholesterol and diabetes.

When I see statistics like this, I’m puzzled. Why have coverage if you won’t use it for routine care at no cost to you? Are payers taking this opportunity to engage and educate their members? This is a missed opportunity to improve care and health outcomes. Missed routine blood testing and annual exams could delay the diagnosis or treatment of diseases and conditions, which has significant costs and burdens to patients and the healthcare system.

If members with coverage are delaying or skipping routine care altogether, I would imagine the numbers for those with no coverage or those that are under-insured would be even higher. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care.

The good news is that about one-third of the patients — the largest cohort in the study — are getting regular blood work AND seeing providers for routine medical visits. The purpose behind regular health screenings is to look for signs of diseases and illnesses as early as possible. They also are an important part of maintaining good health, especially as they get older.

On the other end of the spectrum is the cohort that needs the most support — the one in five adults who aren’t receiving routine blood work and primary care visits. It’s not like this group is living their best, and healthiest, life. If anything, they should be staying on top of their health. Within this cohort, 22% of the patients had high cholesterol, 8% had a Vitamin D deficiency, 7% had diabetes and 7% had thyroid complications. These are all conditions that require monitoring through regular blood tests and can lead to some serious illnesses down the road.

In all, 35% of the population studied did not have routine blood work and 52% did not have a routine visit. Not surprisingly, the highest percentage of patients with no blood work were aged 18 to 34.

Notably, there is an inflection point of increasing comorbidity burden in the critical age range of 35 to 64 years, where early access to preventative blood testing could help long-term patient outcomes.

The study did not go into specific reasons for non-compliance. Yet we know there are many reasons why people don’t get needed blood tests, including: They aren’t convenient; they don’t fit into their busy lifestyles; people have a fear of needles; and they lack understanding of the importance. The claims data reveal a big gap in our medical care: the need for convenient, accessible blood testing that leads to increased adherence.

The need for innovation that drives new behaviors

The thing is blood testing hasn’t changed in more than 70 years. Medically accurate testing still requires large sample volumes taken with a needle from an arm by a phlebotomist. Blood testing hasn’t kept up with consumer preferences for digital ease, retail access and transparent health data.

That’s why Babson Diagnostics is reimagining the entire blood testing process from start to finish. Partnering with BD, a leading global medical technology company, we are testing an innovative, capillary blood-collection device*. We plan to pair BD’s device with our automated sample handling and analytical technologies that are designed to enable testing that requires only one-tenth the sample volume of traditional venipuncture methods without sacrificing quality, accuracy, or the number and types of tests that are possible. 

Today, many health plan members are turning to retail pharmacies for local, trusted healthcare services. That is why we are bringing our blood testing ecosystem to retail partners, with a future focus on enabling at-home collection, mobile testing services and even self-collection. This is a paradigm-shifting solution that extends the medical home and addresses multiple unmet needs in the healthcare system.

The findings of our research were presented at ISPOR, the leading professional society for health economics and outcomes research. Read more about the blood-testing utilization research.

*The BD capillary collection device is an investigational device under 21 C.F.R. 812 and requires additional studies to make any definitive conclusions about safety or efficacy.