← Becker’s Healthcare Podcast
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- [00:00]
A
Hi everyone, this is Lucas Voss with Beckers Healthcare. Thanks so much for tuning in to the Beckers Healthcare podcast series. It's great to have you on. Today we're talking about elevating lab operations, an important topic. And joining me for today's discussion, very excited to have them both on. Dr. Sanjay Nagandra, medical Director, center for Esoteric Testing and Atlantic regional laboratories at LabCorp and Cameron Thomason, National Vice President, Acute Care Services and Vision Hospitals and Health Systems, also at LabCorp. Cameron and Sanjay, thank you for being here today. It's great to have you.
- [00:34]
B
Thank you.
- [00:35]
C
Thanks for having us.
- [00:36]
A
It's great to have you both. I do want to kick off with introductions for those that might not know you yet. Dr. Nagendra, we'll start off with you.
- [00:46]
B
Sure. Thank you. I'm Sanjay Nagendra. I'm a hematopathologist and I'm currently serving as medical director at LabCorp center for Esoteric Testing and Atlantic Regional Laboratories. I was helpful in one of the co founders of our lab Stewardship Committee at LabCorp several years ago. Previously, before coming to LabCorp, I worked in the hospital setting in large health systems in the Midwest and in the Northeast where I helped found laboratory stewardship programs there and trying to use the momentum here also at LabCorp.
- [01:25]
A
Great to have you. Cameron, over to you.
- [01:28]
C
Hi. Yes, thanks. So, Cameron Thomason, it's hard to believe when I say this out loud, but more than two decades of experience in healthcare. I began my career inside of health systems. I spent about 15 years in hospitals and health systems which really helped build a foundation around how financials and the economics and strategy really intertwined with clinical operations. I started in managed care contracting and financial analytics and then at a community hospital I served as the chief of staff for our CEO and quickly moved into a COO type role where I had all non nursing clinical areas, 14 of our physician practices, community health and wellness. And that was really formative in my experience. So I tell all young folks, if you can spend time at a community hospital, do it because you wear a lot of hats. And I learned a lot about operations in the day to day running of a health system and how the financials really strategically align with clinical priorities. From there we merged with a large system and I got some experience and complexity at scale by leading lab and pathology for that large academic medical center and five additional community hospitals. But today I'm lucky enough to lead acute care services nationally with LabCorp. We focus on building and evolving strategic partnerships for health systems. Really looking at hospital lab Management and our value add programs through data driven analytics. And you know, I try to stay deeply involved in health systems and the finance community. I'm lucky enough to have served as a past president of North Carolina Healthcare Financial Management association and that really helps me to take the lens of value and stewardship, long term sustainability and health care delivery. But truly what I really love about what I get to do is step back and look at the industry friction points and design practical solutions in partnership with our health systems to deliver better outcomes for our patients and providers. And that really, you know, it really, really aligns with our mission at LabCorp of improving health and improving lives. And that's what drives me every day. And happy to share a little bit with you guys today.
- [03:49]
A
Well, it's great to have you both on both certainly a wealth of knowledge in the industry and certainly for this conversation, which is very exciting, very exciting for me to have you, have you both on for this. Dr. Nagandra, I want to start off with you. You touched a little bit on on your role in your introduction and talked about lab stewardship. And I want to start off with just the bare bones definition of that. Right. There is a lot of variety in meanings and context when it comes to lap stewardship. How do you define it today and how has that concept evolved from your perspective?
- [04:21]
B
Great, thanks for the question. First, I'd like to start with a broad definition. Lab stewardship is a coordinated, responsible management of laboratory resources, processes and data. The goals of it are really to optimize patient care and ensure quality and to control costs. As a secondary effect, the key elements in a laboratory stewardship program are appropriate laboratory test utilization, compliance with regulatory standards and then with the appropriate utilization, operational efficiency, having data driven decision making and having ethical practices and sustainability. Now as that is a really broad definition, we can go out and see how is it in a commercial laboratory such as LabCorp. What do we do here? Well, it is really about focusing on optimizing the test menu for clinically relevant assays. As you know, assays change over time and so they need to be updated, some need to be discontinued. So avoiding unnecessary or redundant tests too. So having basically if you have a similar test in two panels, then try to combine it into one so you don't say the information twice. You educate clients and healthcare providers on the available test offerings. What are these? There's so many tests available these days that it's very hard for the clinicians to keep up. We're responsible for really educating the clients and health care providers on what Are the available tests and what are their indications. Finally, I think that lab stewardship as a secondary effect is that although you have evidence based medicine and we tried that, a secondary effect of that then is, is. Is really, you know, having balancing profit profitability with that. Everybody thinks that, you know, lab stewardship is bad because it does, it affects profitability. But that's not necessarily true because you're really fine tuning on tests. And there's some tests that are overutilized and there's some tests that are underutilized. And so it's really a balance between the two. In the hospital setting, its scope and definition is also a little different. It's really integrating laboratory into patient care pathways and collaborating with clinicians for necessary aligned test ordering. We want to standardize, not everything in medicine can be standardized, but we can certainly standardize things for diagnoses and provide education about prevention of overutilization of tests. But that's very important. But there's also the underutilization of test tests that they should have ordered, but they didn't. That's also part of lab stewardship in the hospital setting. Now many hospital providers are aware of the antimicrobial stewardship committees that are there. That is one been in the first areas of lab stewardship that have been used and we've been using data for that. You know, it starts with that, but it expands much further into all the laboratory tests. It's management of limited budgets and staff, ensuring rapid turn time of critical results. So if you're not, if you're doing the tests that are not important, clinically important, then it might be costing you turnaround time for the tests that need to be performed. So it makes it, it's a really balance of trying to understand that. So understanding that then how has the concept evolved? I'm going to talk specifically in the hospital setting that prior to the pandemic there was a shift from really at that time we were doing basic utilization review and now we've more shifted to comprehensive multidisciplinary programs. Many hospitals have integrated diagnostic stewardship with real time analytics and clinical collaboration. So that's really important. And instead of talking solely on cost and cost focused committees, government structures are now looking at evidence based ordering and patient outcomes. And that's really what's really important. And I think COVID 19 really accelerated this and really a current focus right now with this AI revolution, everything is looking at informatics for utilization monitoring, artificial intelligence and decision rules in clinical workflows and sustainability initiatives. So an overarching goal Here, as we approach 2026 for lab stewardship is to think of it as a proactive, system wide approach to improving care quality, reducing waste and supporting many endeavors such as population health.
- [09:02]
A
Certainly something that affects a lot of different pieces. Right. As you've just mentioned, it touches a lot of different parts of operations itself. And Cameron, I'd love to piggyb off of something that Dr. Ngandra just said. Right. Which is the optimization piece of this. We talk a lot about cost pressures in healthcare. Unfortunately, there was recent reporting that non labor expenses rose about 5.7%, so almost 6% year over year. And I'd love to ask you from your perspective too, with your operations background as well, why are hospitals now looking at lab stewardship as a lever for cost control?
- [09:41]
C
Yeah, it's a great question. I mean, no doubt health systems face pressures to do more with fewer resources, tighter margin, lower reimbursement, rising clinical complexity, cost of capital increasing. So financial sustainability while improving care really becomes that lever that every health system is trying to achieve. And I think the unique thing about lab stewardship is it aims to do both of those things. I think it's important to understand that lab stewardship, lab stewardship committees create value far beyond the incremental cost savings from reducing overuse or inappropriate testing. As Dr. Nagendra mentioned, there's a direct impact on quality, safety and clinical outcomes. So if health system leaders can focus on a lever that helps them control cost but also improves quality and safety, it's hard to argue with that strategy. Right. So optimization in the laboratory alone isn't going to do it. So a Stewardship program, as Dr. Nagendra mentioned, also includes having an informed and aligned provider community so that they're making the appropriate diagnostic stewardship decisions at the point of care. And I think a common misconception is, is that lab stewardship lives inside the lab. It doesn't really live inside the lab. The reality is it's a cross functional enterprise approach. The lab serves as the steward of the data, the standards and the insight. But cross functional teams are how those programs become embedded in the operation. Alignment with clinical guidelines like choosing wisely and other areas allow physicians to, you know, really get behind a stewardship program. And effective clinical decision support can guide best choices without adding friction to provider workflows. You know, a high performing program not only looks for opportunities and communicates them, but tracks the outcomes beyond cost. And then, you know, as the organization sees those wins and sees the impact on improved outcomes and safety, you know, there becomes a buy in Data's gotta be accessible and trusted and actionable. But when a fully integrated stewardship program becomes a lever for safer, higher quality care, and it also lowers cost, then, you know, the health system can really make an impact in all areas. And I think it's easier for leadership to get physicians and other areas of the organization behind the effort.
- [12:29]
A
Yeah, and I know we'll talk about leadership here in a little bit too, but Dr. Nagander, I wanted to come back to something that you touched on when you talked a little bit of how this has evolved. Right. You talked about data, you talked about AI. Those are certainly things that will impact the Future here in 2026 and also beyond. And, and we know that roughly about 70% of clinical decisions are driven by lab data. And I'd love to know from your perspective, what are some of those tools you think health systems most need right now to reach the highest levels of lab stewardship that they're aiming for and really also support better community health. What are some of those, some of those things that you think about here for the future?
- [13:09]
B
Well, there are four key areas that come to mind. The first is advanced analytics and decision support. There's real time utilization of dashboards to understand test patterns. Test matters not only overall, but by provider too, because every provider may have had a background, a different background, how to use tests to understand that. And then these dashboards can also include other things like turnaround times and cost metrics. The other item is a clinical decision support system and these are becoming more and more widely used. For example, LabCorp has a clinical decision support known as diagnostic assistant. And these types of things are integrated into the electronic health record to provide additional insight into diagnostic results from outside the health system. So for example, it'll suggest appropriate tests, flag redundant orders, all the point of patient care, the point of patient care to providers in their normal workflow. So, so it doesn't interfere with workflow, but it's an aid to make sure when busy providers are using it, to make sure that they order the right test. We also in the advanced analytics is predictive analytics and using lab data to identify high risk patients. For example, now we have predictive models and we can look by types of lab abnormalities to say, have an increased risk of sepsis or chronic disease protection. Do we need to do other safeguards for these patients? These are not only good for lab stewardship, but also for patient safety. Secondly, we have how we can integrate data. It's usually using unified data platforms, combining lab results with imaging, pharmacy and social determinants. Of health. For example, there are some laboratory tests that can tell you rapidly whether you have a certain type of illness, but it a infectious disease but at the same time it's of no use unless you integrate it with pharmacy. And so if the pharmacist can provide quick antibiotics then it's helpful. So that's why using unified data platforms is very important. The other thing is population health lab stewardship can be used. LabCorp has a tool called Insight analytics for population health. What it does is aggregate lab data across communities for disease tracking. You can look at it and you can see where, for example Hemoglobin A1C for diabetes care, where is it underutilized, what zip code is it, where can we look and see to try to get more care to those zip codes. And so it's an underutilization also tool that you can do for population health. The third is patient engagement and transparency. It's really not only educating the clinician but also educating the patient. So the patient facing portals and patients now have access, quick access to all their laboratory data but it's important for them to understand it. And so I think it's important for the portals to have clear lab result interpretation and education. Many patients will ask their providers can you get me this test? Give me that test. And then there's pressure for the clinicians to order those tests. So educating to the patient too that this is not necessary or what is necessary or not in a very basic way can be helpful. Community outreach dashboards also in aggregated health trends is also important for patient engagement, especially with the public health agencies for targeted interventions. And that goes along with the population health. Finally we talk about AI powered diagnostic pathways. Everybody's talking about artificial intelligence now, but algorithm driven test selection is really important because we can look at clusters of tests and say why didn't you order this test or that test based upon that? That can be much more cost effective than ordering 100 different tests at one time. It'll tell you based upon evidence based medicine what types of tests to order. These things are becoming more and more popular and will continue to increase and drive lab stewardship in the hospital settings.
- [17:51]
A
Yeah, once again we talk about that multi level impact. That was certainly a breakdown as to where all of this has impact and who is involved. And who is involved is a great transition as well for for me too. Cameron, I'd love to come back to the leadership piece that we touched on earlier a little bit. Right. You mentioned the buy in piece and how important it is to have conversations about the impact that this can have. How could leaders initiate a strong lap stewardship program that it's also aligned with their strategic goals. Right. For the health system overall. What are some of those factors that are key there?
- [18:23]
C
Yeah, in my experience, to create a strong stewardship program that stays long term aligned with the strategy of the health system, there's five key components. Executive support, governance, participation, data and communication. A successful stewardship program is going to begin with visible executive sponsorship and clear enterprise alignment. It has to be promoted from the top. The stewardship must be positioned as a health system priority, not a lab only initiative. Without that, it's going to be fragmented rather than embedded in the care delivery process. Next, high performing programs are built into a formal governance structure. So we build a governance structure around a lab stewardship committee. They're not run as ad hoc projects, but they have a clear charter that defines the purpose, the scope, the decision rights, what the success metrics are, a cadence of meetings, all those things that give you that North Star to guide the work over time. The third is participation. So as we've said a couple of times, this is multidisciplinary, cross departmental. You've got to have buy in and participation from physician leaders, physician champions, nursing, pharmacy, IT quality and regulatory and operations all coming to the table as equal value partners to the stewardship program. It's a maturity journey. It's progressing, you know, from awareness to education to standardization and continuous optimization. But at the heart is the data and analytics. The value comes from having accessible, trusted, near real time data. The way we do that is through our vision analytics platform. We really want to have easy access to utilization patterns, variations, evidence based opportunities, those sorts of things, because we want that data to be easily accessed so that the time is spent on finding the opportunities, prioritizing engagement, what that change management behavior needs to be rather than data extraction. And then on the back end, the same thing. We should be able to track improvements for not only cost savings, but behavior changes, quality and safety, timeliness of care and the outcomes associated with the opportunity. And then consistently communicating. This is where the communication comes in. You have to communicate those wins across the organization to accelerate engagement, you know, quick wins, build momentum. And lab stewardship's no different. When it's aligned with the strategy, governed well, data enabled and clinically led, it can become a part of that operating rhythm and the culture of the health system. And in that model, the lab serves as the trusted partner for the clinicians and delivers that safer, higher quality care that comes at a more sustainable, lower cost. So if those five components exist, that lab stewardship program can be long term, aligned with strategy and becomes a part of how you deliver care, not an ad hoc extra thing that the organization is doing.
- [21:47]
A
Well, Cameron and Dr. Nagandra, I appreciate you both taking some time. A wealth of knowledge from both of you here. What a great episode. I do want to turn the floor over to you with any final thoughts that you might have for our audience here. Just anything that we haven't touched on that might be important for you to mention. Dr. Nadiganro, we'll start off with you.
- [22:05]
B
Sure. Thank you. I just wanted to highlight just real quickly on our lab Stewardship program at LabCorp Diagnostics. We have in the last several years created a multidisciplinary team which included executive leadership, physicians, scientists, administrators to discuss LabCorp's test menu and opportunities for directory improvement. And that could be either in discontinuing an obsolete test or a test that has low clinical utility. For example, in the last several years we've discontinued tests such as red cell folate and a peripheral smear review by pathologist and many other tests as well based upon national guidelines. We're also working on panel and algorithmic type testing. We have many, many tests that have panels and work on cascades to ensure clinicians order the right test. For example, many clinicians unfortunately don't order the right test for iron deficiency anemia or B12. We've developed cascades so they don't have to worry about that. They can go through and the cascade goes through and it will order a test if needed. And as a lab stewardship concern, if there was a test that's not needed, it wouldn't be done. Finally, we continue to educate clinicians on the changes through webinars, web pages, white papers and talking to hundreds of clinicians yearly on the changes that we have on a one on one basis. So we're doing a lot here at LabCorp Diagnostics with lab stewardship.
- [23:54]
A
Cameron, over to you, Anything else that you might want to add here?
- [23:57]
C
Sure. Just quickly, I'm in the business of building partnerships, so maybe a couple of thoughts on what to look for in a partner if you're looking to partner for stewardship. And I really think the most important takeaway is credibility anchored in experience and execution. You want a trusted advisor who brings a purpose built approach that's designed specifically for your health system. Embedded analytics, as I mentioned before, that can translate into action and performance improvement and really demonstrated sustainable performance across a long term relationship, not just isolated wins. And that's really the philosophy we bring to our health systems. We've really been working along health systems for more than two decades and now have the privilege of managing over 200 hospital laboratories nationwide. And what I really think makes that powerful is not scale for its own sake, but the continuous learning and refining operational playbooks and sharing those insights across our network. We think of that as like this ecosystem of shared learning where collaboration accelerates best practices and helps all of us be better together. And I think that's really what a partnership should look like and how to run an effective stewardship program. And when that's anchored in a shared mission and culture, the strategic partnership becomes more than a program. It's a long term partnership focused on delivering high quality care and the best possible outcomes for patients and communities. And that's really what I think we're all looking to do together.
- [25:26]
A
Well, it's certainly great to have you both on again. Thank you so much for taking some time for us here today. It's fantastic to have you on Dr. Nagendra and Cameron, and we also want to thank our podcast sponsor, LabCorp. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.