How TriCore is achieving medical innovation with AI

On a bright, sunny afternoon in Albuquerque New Mexico, Courtney is on her way in to TriCore Reference Laboratories (TriCore) to get some routine bloodwork done. At 3 months pregnant, this is an important part of her wellness journey to ensure she receives proper prenatal care. She gets the screenings for diabetes, blood pressure, rubella, etc. but today’s tests aren’t ordinary. In fact, they are extraordinary because they are being logged in a database at TriCore’s labs to help rule out any future problems and track various tests at different stages of the pregnancy.

Today, Courtney’s bloodwork came back great. Everything is looking normal and she is on her way to a healthy and happy pregnancy. She is but one expecting mother across the state of New Mexico seeing the benefits of TriCore’s new system. She is also part of a pilot program looking to reduce the amount of preterm deliveries and NICU occupants by leveraging innovative technology.

The path to more robust prenatal care starts here

Over 30% of New Mexico’s births are to women who receive either intermediate or inadequate prenatal care.[1] Inadequate prenatal care can lead to complications like preterm birth, which can develop into additional medical problems for both the mother and the infant. TriCore is doing its part to ensure situations like this are significantly reduced. By integrating lab results into an artificial intelligence algorithm, they are able to take laboratory data and translate it into actionable information.

“What we are doing is completely innovative and different,” says Rick VanNess, Director of Product Management at TriCore.

For expecting mothers like Courtney, this means she can see very early on if she is at risk for any complications later on down the road. This helps patients plan and helps physicians treat proactively, leading to healthier babies and happy families.

“Laboratory tests allow us to monitor a patients’ health throughout their care and enable us to inform patients that they might be at risk for preterm delivery because of an abnormal result before and/or during their care,” says Rick VanNess. “We can then inform a care provider in an effort to avoid an adverse outcome.”

Cost savings and innovation

While patient health was the most important driver for TriCore, the development of a new system also had budgetary benefits. With Medicare reimbursements on the national clinical laboratory fee scheduled to be cut by 10% per year for the next three years and up to 15% per year the following three years, TriCore needed to find new ways of bringing in revenue. Dr. David Grenache, Chief Scientific Officer at TriCore, says, “We had to think of a way to diversify our traditional line of business and demonstrate the value of the laboratory to the system as a whole.”

They have more than demonstrated the value of their laboratory as a place for innovation with their new approach incorporating AI in clinical lab testing. Clinical test results compose of 2-3% of medical expenses each year but contribute a far greater amount back to the medical decision-making process. TriCore has used routine test results, blood panels, and urine screening test results as a way to proactively alert medical professionals to potential complications patients face. She is also part of a pilot program looking to reduce the amount of preterm deliveries and NICU occupants by leveraging the value of lab test results.

Building an AI algorithm

TriCore developed their algorithm using guidelines from ACOG (American College of Obstetricians and Gynecologists) and the USPSTF (US Preventative Services Task Force). It relies on real-time and longitudinal laboratory results, selected heath information, and published care guidelines to risk-stratify expecting mothers according to gaps in care and/or increased risk of complications.

On the technical side of things, TriCore partnered with the Rhodes Group, an lT company owned by TriCore. Together, they built the Health Intervention algorithm using Microsoft SQL and Power BI on Windows machines.

“Microsoft Power BI is the presentation layer on top of all of that logic, and it’s an extremely powerful presentation tool. It gives us a wow factor when we go talk to our customers,” says Grenache.

After the initial launch of the new software, their pilot program showed a 40% reduction of preterm delivery and a greater than 50% reduction in Neonatal Intensive Care Unit occupants.

Looking to the future with AI technology

The potential for AI in medical testing goes far beyond just prenatal care. TriCore is developing more algorithms to analyze health risks associated with hepatitis C, diabetes, sepsis, and chronic kidney disease. At their current rate, they are looking to develop about two algorithms per year to help achieve medical innovation.

“If you don’t find a way to diversify and prove your value, you’re going to be closing your doors, or you’re going to be acquired by one of the bigger labs,” explains Genache.

TriCore is standing out as an innovator and bringing benefits to other labs, patients, and care providers.

Their success has demonstrated added value for their lab, keeping them competitive among larger institutions, and expecting mothers like Courtney out of the path of preventable medical conditions.

[1] https://www.medicaid.gov/medicaid/quality-of-care/downloads/secretarys-report-perinatal-excerpt.pdf