Amanda Wilde (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm your host today, Amanda Wilde. In this podcast episode, we are joined by Dr. Yuri Fesko, Senior Vice President and Chief Medical Officer of Quest Diagnostics.

Quest Diagnostics is one of ACHE's premier corporate partners. Our premier corporate partners support ACHE'S vision and mission to advance healthcare leadership excellence. Today we're focusing on how lab partnerships can help healthcare executives build a more resilient and cost-effective health system.

Welcome Dr. Fesko.

Yuri Fesko, MD: Thank you very much.

Host: It's so good to have you here. Before we get into the lab partnerships, let's just follow your trajectory a bit. Can we start with your background and maybe lead us to your role at Quest Diagnostics?

Yuri Fesko, MD: Sure. So, I did my medical school, my residency, and my fellowship at Case Western Reserve University. I trained in internal medicine and then went on to do a hematology oncology fellowship at University Hospitals of Cleveland. Went on to Duke University Medical Center, where I joined their Wake County practice.

Um, I was there greater than 15 years, in multiple roles. And at the end was the Medical Director Chair for Wake County, for medical oncology. Transitioned over to Quest Diagnostics in 2017. Came in as their Medical Director for Oncology, have had a variety of roles within Quest Diagnostics.

And approximately a year and a half ago became the Chief Medical Officer overseeing medical affairs, some of the payer relations, some analytics groups, as well as many of the research and lab integration strategies for the company.

Host: Lab integration step strategies is what we are here to talk about, and I'm sure that varied background really informs your decisions. When evaluating potential lab partners, what should healthcare executives look for to ensure alignment with long-term strategic goals?

Yuri Fesko, MD: There's a fair number of things that a healthcare executive needs to sort of look at. You know, like is a lab going to be able to provide the analytics that a, a health system is going to need? When I say that, health systems typically, they may have one or two main hospitals, they may have several outlying hospitals, and usually those are acquired through acquisitions over time.

Many times they'll have different lab information systems and, and it can be very difficult to get good analytics on what's going on in the health system. With a partnership with Quest, we've very much focused on providing those kind of analytics to help to organize care, to make sure that there are no gaps, that things are being done in a format that makes sense for Quest as well as the health system, for their strategic goals.

The other thing is scalability. Again, can you come in and support this health system to provide lab services across their network? It's one thing to do one site, but you if they have multiple sites, there's different levels of complexity and that's something that really needs to be evaluated. Finally, it's technology and innovation. So, lab, like everything else continues to innovate, change, platform shift. There's new technologies that come on and you really want a laboratory partner who's going to be able to make sure that they're able to provide those services to the health system, for today, but also for tomorrow, like what's coming down the pike.And you want a partner who's going to be able to do that for you.

Host: That's a really helpful overview of sort of the areas to focus on. There's another piece of this is helping build a cost effective health system. How do strategic lab partnerships help health systems navigate financial pressures?

Yuri Fesko, MD: So, as we all know financial pressures never end. So in the lab space, partnering with a large lab like Quest Diagnostics, can provide a fair amount in terms of, you know, we obviously have preferred relationships with a lot of the vendors across the country because of the size and scale of Quest.

And so we can negotiate, instrument costs at lower level, reagent costs at a lower level and that helps to increase profitability and productivity by doing that. We can also help with best practices in terms of automation. You know, some of the newer technologies that are coming down to deal with some of the labor related issues that labs face, within that, we can also elevate the quality and the expertise. It's difficult to be an expert in everything. Quest, because it lives in the lab space can be very good at understanding how best to, you know, I don't know, for example, do coagulation or, um, you know, hematology?

Because we do it all day long. What are the best instruments? What are some of the pitfalls of a particular method? These are all things to sort of, think about as well as, some of these ways that we deal with in terms of innovation in the lab, automation, et cetera, it can help with some of the labor shortages that we face in the lab industry, whether or not that's technologists, med techs, et cetera. These are real challenges that health systems face. Quest faces them and we've innovated to basically help to deal with those issues.

Host: What is a real world example of a successful deal that delivered a measurable impact like cost savings or addressing technology or personnel changes?

Yuri Fesko, MD: I'll give you one that I thought was very interesting. So we worked with a health system in Virginia that we wanted to speed up the time to getting, it's called somatic oncology testing done. Basically, when a person is diagnosed with a cancer, there are biomarkers that need to be done, near and dear to my heart, to help to make sure that the patient has the right stuff done for the day one oncology visit.

Because if you come in and I don't know all the biomarkers of your particular cancer, it's difficult for me to say what treatment we would put you on because a lot of them are dependent on those biomarkers. So we, worked with this health system to one, develop a strategy where we were able to turn around those biomarkers for particular types of cancers at a particular stage, working with the pathologist, the oncologist, and to some extent the surgeons.

As well as our laboratory to get them turned around, within seven days of the time that they were diagnosed. That's very important because then the patient comes into that first visit after, you know, having a biopsy and the information's provided to the medical oncologist so that day one visit is much smoother and it also helps the health system in that you don't have different testing performed all the time where, depending on the stage, it could be completely different. It could be different platforms. A lot of this stuff was optimized. The other thing is we worked with the payers in that market, to see if we could bring down some of the prior authorization because, they understood our protocol that we were putting together. And they understood that the genes that were being tested were not, ones that were not necessarily going to be used. They understood that it was being offered in the appropriate stage and format. It brought down a lot of these barriers that impede care, but most importantly, make the clinician's lives in the clinics easier. Lab is not just about being in the basement. It's about being integrated into that health system and making it so that a good lab, you don't really think about it. It's done. And this was something we really took to heart and tried to work with the client to make that the case.

Host: These partnerships can take pressure off the system and sort of streamline things, make things run more smoothly, and add value on several levels. Do you ever run into negative reactions or misconceptions about the role of these partnerships in the healthcare leadership space?

Yuri Fesko, MD: We do. I mean, I think, there are some misconceptions that like lab is really just a transactional service. And it is way more than that. Lab really connects the clinic, or the health system. So, you know, the patient spends most of their time in the outpatient settings, we're trying to work with the health system to make sure that those patients are able to get the care that they need. But you know, really outside the four walls of the hospital, if they get admitted, a lot of times Quest is working with the health system to make sure that the right testing's done in the hospital, understanding that the right testing's being done on the right patients and that we're getting the outcomes that we want. But it is very much a strategic partnership. We as a lab, have to listen to what the goals and objectives of the health system are. Where do you want to be in two to three years? What are your pain points within the clinics?

What are the pain points within the hospital, within the network? It's not just about always the logistics of operating the lab, but it's also understanding what does this health system want to be? Where does it want to go? Listening to that, we can help to optimize the strategy to provide a laboratory system that, again, if we do it well, it's just sort of like, Hey, I don't hear a lot about the lab because it's always done.

It's done well. There's not a lot of issues with it. We've put the pieces together, and the clinics, the hospital, it runs efficiently and we help to remain a valued partner to that health system of like each health system's goals and objectives can be different and we're listening and trying to help solve that together.

Host: So you are reframing the role of these partnerships for healthcare leaders. How are you doing that?

Yuri Fesko, MD: It's very much meeting with the leadership of the health system. One of the misconceptions many times that we will run into is keeping laboratory services completely in the health system, not partnering with anybody saves money. That's not really true. Because there are a lot of optimizations that can come with a partnership strategy, with a big lab like Quest Diagnostics, there can be significant savings that are bound by a partnership. That doesn't mean that we totally take over and you have no input into what's going on.

That is not the case. We do try to implement best practice in the lab, optimize the workflows. Where particular laboratory testing may be done in a health system so that we don't have duplicative testing in, three different hospitals, that could all be done in one. And that can generate cost savings as well.

As we talked about the reagent cost, the instrumentation cost potentially going down. But again, each one of those is very, very individualized. It's listening to that health system, understanding again, what are their goals and objectives, working together to achieve them. Also using our best practice to try to optimize that lab in a way that it functions very well. It saves money, and it delivers the laboratory services to all the places that that health system is.

Host: How do you see that role of laboratory services in the near future? How will that evolve, do you think, over the next three to five years?

Yuri Fesko, MD: I think it is definitely becoming more and more complicated. I would say that. The reason I say that is because there's more and more push to basically have patients outside the hospital. Admissions are getting more and more rare. We're doing things that when I was a fellow, would be definitely inpatient.They're being done on an outpatient basis. There's more complexity to the laboratory testing that's performed. And there's a lot more strategy, there's a lot more meeting the patient where they are.

So again, you have to provide those laboratory services. You could have an immunosuppressed population where you may rely on Quest Diagnostics to basically provide mobile phlebotomy for those at-risk populations that you really don't want to come in.

Having them drawn potentially, at home through a mobile service. But then integrating that into the laboratory network that that health system has. Also, clinics no longer are just at the main campus. They can be at multiple sites. Making sure that all those sites have consistent laboratory services and that you're providing the analytics back to the health system to show if there are, potentially gaps in any laboratory services that are needed or potentially over utilization of a particular laboratory service within particular service line. Those are all important things. And it really, that's why I'm saying the lab is increasingly integrated into the health system, listening to what do they want to be in the next three to four years. We have to be part of that and, help to drive those objectives, you know, through the lab. But marrying to the health system basically.

Host: You will help drive and optimize to get to those goals and help the hospital also be nimble in these upcoming years, whereas you say things will get more complex.

Yuri Fesko, MD: Yeah, everything from we have health systems that are asking us about things like, evaluating, you know, like if a patient came into a clinic and is trying to figure out, this is a immunosuppressed patient, are there biomarkers that could be done to determine if the patient is showing any signs of sepsis before it even happens? We then take that back to our lab network to see are there things that are out there in the market? Are there things that we can bring to that health system to do that? We're trying to keep the patients out of the hospital. There are increasingly potentially point of care devices.

Quest can potentially do those things and integrate it into the laboratory strategy. There can also be ways of drawing blood that we're working with manufacturers that are doing a needleless draw where you basically place a device on the arm. Again, it could be done for high risk populations where they can basically send it back to the lab to be analyzed, but they don't have to necessarily come into a clinic or a draw site to have it done. These are the kinds of innovations and working together that I think those are the complexities that are going on in the system. And if you're trying to do it all on your own, I can say, from being a practicing clinician, it's difficult to keep up with just the medicine alone. Nevermind how can the lab keep up with all of this? And that's where Quest can definitely facilitate, some innovation and potentially cost savings as well as integration for the health system.

Host: Yeah, there's more and more to manage as there's more and more specialization and as you say, as technology is envolving, so. That has to be a focus of these collaborations. Thank you so much for sharing your thoughts about the evolution and future of lab partnerships and your insights, and just thank you for sharing your expertise on navigating these partnerships.

Yuri Fesko, MD: Well, thank you for having me.

Host: That was Dr. Yuri Fesko, Senior Vice President and Chief Medical Officer of Quest Diagnostics. Quest Diagnostics is one of ACHE'S Premier corporate partners. Our premier corporate partners support ACHE'S vision and mission to advance healthcare leadership excellence.

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