TriCore Reference Laboratories is striving to become more than merely a lab. Instead, TriCore thinks of itself, as it says on its website, as a “clinical information company offering expertise in population health management and targeted intervention.” Based in Albuquerque, New Mexico, TriCore performs a full range of laboratory testing, under the direction of more than fifty pathologists and scientific directors, for healthcare providers throughout New Mexico. But, as Renee Ennis, TriCore’s CFO, explains, it is repositioning itself to do so much more than that.
“The clinical lab has traditionally played a background or support role in the overall healthcare landscape. It is usually located in the basement of the hospital and is an afterthought, if you will, for most of the care continuum,” Ennis says. “We are focusing on bringing the lab to the forefront. We want the lab to have a seat at the table to positively impact that overall care continuum.”
The force that is driving that transformation, she says, is lab data. “We have an immense amount of longitudinal patient lab data. We service the three largest healthcare systems in New Mexico. If your insurance coverage changes, or if you go from one system or hospital to another, or your physician changes, we still have all your lab data.”
Any physician therefore can retrieve a patient’s entire lab record for any work done at TriCore. “This longitudinal patient view provides a stronger, more meaningful clinical insight to physicians, driving better outcomes for patients, making life easier for providers, and hopefully reducing the cost of healthcare because physicians won’t be repeating previously performed lab work,” Ennis says. “In addition, clinicians can be alerted to gaps in care when patient labs are compared to standard guidelines of care.”
Ennis has a bachelor’s degree in finance. While working at a lab in Phoenix in the 1990s, she earned an MBA in healthcare management from the University of Phoenix. Then, she moved to a lab in Las Vegas to work as controller before she was recruited by TriCore to be their chief financial officer in 2004. In 2014, she moved to a large health system in New Mexico to be vice president of revenue cycle, then was promoted to CFO of the system, before rejoining TriCore in April 2018 to help lead the transformative changes it was looking to make.
The company’s transformational strategy, about five years in the making, was driven by changes in the healthcare payer landscape. “Lab work is transactional. The doctor orders the test, the patient has the test done, we provide the results. That works in a transactional or fee-for-service system,” she says. “As healthcare shifts to a value-based system, the focus is on population health and value-based reimbursement. We think the lab can help by providing actionable insight based on the vast amount of data produced by the lab work we perform.”
Lab results account for about 70 percent of the data physicians use to make a diagnosis. “If we harness our data effectively,” she says, “it has the potential to help providers make better decisions for individual patients and help health systems and payers make strategic decisions to serve a population’s healthcare needs.”
“As healthcare shifts to a value-based system, the focus is on population health and value-based reimbursement. We think the lab can help by providing actionable insight based on the vast amount of data produced by the lab work we perform.”
The rest of the lab industry is aware of this trend, she acknowledges. “There is definitely a movement within the industry in this direction, but others might not be moving as quickly as we are. As a leader in this transition, I think a lot of eyes are on what we are doing and how we are doing it.”
To understand how TriCore is accomplishing this, visualize a pyramid, Ennis says. “The base is what we call Lab 1.0, our foundational business, producing high-quality testing and results. That is our core business, what we do great.” One level up the pyramid and building on that foundation, the company is diversifying and generating other revenue streams by establishing and running labs in other facilities—effectively outsourcing TriCore’s management capabilities to hospitals, she says. For further diversification, they also created the TriCore Research Institute, leveraging TriCore’s expertise in new-test development and partnering with in-vitro diagnostics companies to conduct device trials.
The third layer of the pyramid, Lab 2.0, is the transformation layer. “This is where the lab has a seat at the table with other disciplines,” she says. TriCore recently acquired the Rhodes Group, a laboratory IT company that has developed the technology infrastructure to harness the data TriCore generates and transform it into valuable information for TriCore’s healthcare partners.
One new value is “diagnostic optimization,” or turning that data into actionable insights for individual care and population health. For example, the company is working with a major payer in New Mexico to notify them about women in their plan who are pregnant.
“Our chief medical officer was reading a study that showed a significant number of women find out they are pregnant from lab testing done at an ER,” she says. “Women go in for some condition and the lab finds out they are pregnant before anyone else. If no one follows up, the only time the insurance company finds out is when she has the baby. At that point, it’s too late to intervene and ensure the mother gets proper and timely prenatal care.” TriCore now communicates with the insurer early; then the insurer can then connect the mother with care coordinators who will support her in her prenatal care.
Ennis says her role as CFO has changed as much as healthcare itself over the past ten to fifteen years. “Originally it was about producing and analyzing financial statements, sitting behind a desk and crunching numbers,” she says. “Today, you can’t succeed just by producing financial reports. I am out there peeking under the sheets, looking around the corners, using critical thinking skills, and becoming more of a strategic partner to the CEO and executive leadership team.”
It’s a change she relishes. “It’s more fun. I absolutely love it,” she says. “TriCore celebrated its twentieth anniversary in 2018. We are all excited about that, the growth we have experienced over the past twenty years, and we are really excited about seeing what the next twenty years looks like.”