CEO SUMMARY: Laboratory benefit management companies that offer a range of services to health insurers are gaining influence over clinical lab testing in important ways. On behalf of health insurers, LBMs will select labs for a payer’s network, then manage that network. They also manage claims and lab-test utilization, often reviewing medical necessity. A primary
Clinical Laboratory TrendsSkip to articles
Clinical laboratories, where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease, are facing numerous challenging trends as healthcare reform continues to evolve.
Some of these clinical laboratory trends include:
- The Protecting Access to Medicare Act (PAMA) of 2014.
Under PAMA, many clinical lab organizations will see a substantial decline over the coming years in the prices paid to them for the highest-volume lab tests reimbursed under Medicare Part B. The law specifies that the federal Centers for Medicare & Medicaid Services (CMS) can begin enacting those price cuts in 2017.
- Laboratory benefit management program
The laboratory benefit management program is a controversial program created by UnitedHealthcare in 2014. All outpatient laboratory services for members who are part of the Laboratory Benefit Management Program are subject to new requirements including advance notification and new medical policies.
Physicians serving UHC’s commercial patients in Florida must notify UHC when ordering any of 80 clinical laboratory tests. Pre-authorization is also required for certain tests.
During its introduction phase, the program has generated widespread resistance from Florida physicians, who protest that it will cause unnecessary delays for patient treatment, and undue burdens for doctors ordering tests. In addition to problems with lab test pre-notification algorithms within the BeaconLBS system, other problems cited by physicians include the exclusion of all but 13 Florida labs from the BeaconLBS “laboratory of choice network.”
- Accountable care organizations
ACOs are the product of a provision in the Affordable Care Act of 2010. They are integrated care networks of providers with the ability to provide care to, and manage patients, across the continuum of care that should include different institutional settings, such as ambulatory care, inpatient hospital care, and even post-acute care. Clinical labs have had difficulty gaining entry into newly- forming ACOs.
At the same time, a positive clinical laboratory trend is the increasing popularity of personalized medicine (PM), a medical model that proposes the customization of healthcare – with medical decisions, practices, and/or products being tailored to the individual patient. In this model, diagnostic testing is critically important, as it is often employed for selecting appropriate and optimal therapies based on the context of a patient’s genetic content or other molecular or cellular analysis.
CEO SUMMARY: Four trends are disrupting the nation’s healthcare system in ways that no one would have predicted just a few decades ago. Ted Schwab, a healthcare strategist, described these trends during his keynote presentation at the 24th Annual Executive War College in May. His insights and predictions will help clinical laboratory directors and pathologists develop
IT’S OFFICIAL! A YEAR-LONG COLLABORATION involving a health insurer, a clinical laboratory, and an analytics company showed that insurers and physicians can use clinically-actionable intelligence developed from medical lab test data to improve patient outcomes.
This important accomplishment in patient care comes with another significant milestone: The health insurer is paying the lab outside of the
CEO SUMMARY: Organizations developing blockchain technology say it is a tamper-proof method of sharing data across networks and among providers, health insurers, and health systems. The Synaptic Health Alliance includes four of the largest health insurers, a health network, and Quest Diagnostics. Its first project, now in its second year, will use blockchain to create
CEO SUMMARY: For two years, clinical lab professionals at WakeMed Health and Hospitals have tested the use of aerial drones to transport patient specimens from a physicians’ office satellite lab/draw station to the WakeMed Medical Center’s central lab. Late last month, they completed the first successful revenue-generating commercial transport of lab supplies by drone in
CEO SUMMARY: At Northwell Health, the clinical laboratory team has been busy building and opening two new, large laboratory facilities. First to open was the lab in Little Neck, Queens, a shared lab with NYC Health and Hospitals. This lab will handle 36 million tests annually. The second lab to open is Northwell’s new core
NEW CLINICAL LABORATORY CONTRACTING INITIATIVES are planned at UnitedHealthcare (UHC), including the launch of a preferred laboratory network this summer.
The nation’s largest health insurer with 49 million beneficiaries, UHC announced in May that it would add Quest Diagnostics as an in-network lab provider effective Jan. 1, and retain Laboratory Corporation of America as a network
CEO SUMMARY: This will be one of the most challenging years facing the clinical lab industry since the early 1990s, when closed panel HMOs were the disruptive force that generated deep cuts in lab test prices. However, unlike HMOs of that era, the CMS scheme to collect private payer lab test prices and use that
CEO SUMMARY: In its work for a federally qualified health center, Sonic Healthcare USA helped physicians use a data-driven approach to population health management that incorporated integrated financial and clinical analytics. Also, Sonic developed technologies that give ordering physicians clinical decision support and targeted patient engagement tools. It then developed a way to contact patients
TWO NATIONAL COMPANIES just signed the lab industry’s largest agreement to put clinical laboratory patient service centers (PSCs) into retail stores. Earlier this month, Walgreens Boots Alliance and Laboratory Corporation of America announced plans to open 600 PSCs in Walgreens stores in coming years.
Since June 2017, Walgreens and LabCorp have opened 17 patient service centers