The Covid-19 pandemic has sparked the question—is home testing the future of labs? Will we transition to a world in which brick and mortar lab sites are no longer necessary?

Patients want the convenience they've experienced through telehealth and online grocery shopping amid the Covid-19 pandemic to extend to other aspects of their lives, even lab testing. This article refers to home testing as patients collecting samples and sending them to lab sites for testing rather than going into a lab site or having providers administer tests from the patient's home.

Slide deck: 3 questions health plan leaders are asking about labs

Our research shows that while excitement around home testing is warranted, ubiquitous home testing is further out on the horizon than one might think. Read on to learn how and why providers, health plans, and patients are still hesitant about making home testing the norm.

Provider executives and lab directors are concerned about the quality of home tests

We interviewed health system leaders and lab directors across the country and found that providers are generally wary about home testing. C-suite leaders at health systems see home testing for labs as a potential liability, fearing low quality and high costs. Similarly, lab directors are often concerned about proper protocols for follow-up care and patient education.

Primary care providers may be more willing to use home testing to screen patients before clinic visits, but they often still feel it is necessary to confirm the tests in-office for those with positive or concerning results.

Therefore, it can be challenging to identify which tests are best for home testing and how to follow-up based on the test results. Home testing may add a layer of "lite" lab tests that serve as early warning signs but must be confirmed or duplicated through an in-office test.

In general, providers are worried that patient-collected samples will vary in quality, increase the overall utilization of lab services by requiring site-based testing to confirm results, and ultimately drive-up costs.

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Health plans are also skeptical of home testing's value proposition, but acknowledge that home tests offer patient convenience

In conversations with health plan leaders, we found that while health plans may be covering at-home Covid-19 tests during the Covid-19 pandemic, there is limited support for the broader home testing value proposition.

In a 2021 Advisory Board survey of 35 leaders from health plans, respondents were seven times more likely to prefer provider point-of-care testing over patient home testing when it comes to ensuring high quality care.

Health plans are concerned that patient-collected samples may not be collected correctly and may drive unnecessary utilization and costs. Like providers, health plans predict that a positive at-home test would have to be followed up in a physician office or lab testing site.

They have also made note of potential issues that can impact test quality including how long samples sit before analysis and the complications that may arise with transportation logistics.

While plans recognize that home testing has the potential for increased patient convenience, the overarching concerns over quality, costs, and unnecessary testing make them unlikely to fully embrace home testing soon.

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There are some exceptions to health plans' hesitancy to embrace home lab testing—tests like Cologuard for example, or patient populations that require regular testing to avoid downstream costs. In addition, health plans are also more favorable towards home tests that are collected by a provider or technician, since this addresses quality concerns and can drive down costs for patients who are frailer and require preventative care and monitoring.

Even patients still prefer convention over convenience

The stakeholder that may have the greatest say in how quickly home testing becomes common is patients themselves. Patients are already purchasing direct-to-consumer tests such as genetic tests from 23andMe or food sensitivity tests from EverlyWell. They value the convenience of taking a test at home and receiving the results digitally afterwards.

An estimated 26 million consumers have sent DNA samples to the four leading commercial ancestry and health databases to decode any mysteries in their genetic pool. Patients also prefer to conduct other tests at home, such as Cologuard or rapid oral HIV testing. In a study based in San Diego, California, 62% of survey participants selected home as their preferred location for a rapid HIV test.

While some types of home testing draw consumer attention, patient demand varies by the test collection method and the outcome that is being tested. A 2020 Advisory Board survey found that a doctor's office was still the top ranked preferred location for a Covid-19 test, followed by a drive through testing site. Less than a quarter of respondents selected a self-administered home test as their first choice for Covid-19 testing.

This trend continued across other types of labs. In the same survey, 74% of patients ranked the doctor's office or commercial lab site as their preferred location for routine lab testing such as a blood draw.

This preference for convention, which may go back to quality concerns, greatly trumped the convenience of having these labs performed both at a drive-thru or a patient's home. Also, home testing can only be convenient for patients if the industry can overcome the challenges of last-mile logistics, and quickly get these tests in patients' hands and back to the lab to analyze results.

Covid-19 may have sparked general interest in at-home tests among consumers, but patients still tend to prefer a doctor's office or patient testing site for routine blood work and more complex labs.

The future of home testing

As new waves of Covid-19 rise and fall, home testing is likely to continue to be a topic of interest. However, widespread home testing is likely further out on the horizon than one might expect amidst our current home delivery culture. Concerns about quality and cost push providers, payers, and patients towards conventional testing sites for at least the next few years.

We're watching several trends that may indicate accelerating home testing adoption:

• Advancements in home testing technology that limit the potential for error when patients collect their own samples. Lab vendors are exploring different technologies such as biometric patch sensors in lieu of at-home blood draws.
• E-commerce giants expanding their at-home diagnostics footprint. Amazon is already offering Covid-19 testing kits online, and they have an established advantage in last-mile logistics.
• Provider involvement in home testing. Technology and patient preference shifts could motivate health systems to create a home testing business that lends provider credibility to at home options.
• Increased accessibility and affordability of "lite" lab tests that can easily be administered at home, paid for out-of-pocket, and serve as an addition (rather than a substitution) to regular testing.