CEO SUMMARY: It’s been a common strategy among managed care payers to seek the lowest prices for clinical laboratory testing when negotiating contracts with labs. However, lower prices may become less important over time as the health system moves away from fee-for-service payment toward value-based reimbursement. Now evidence is accumulating that at least some large
Tag: electronic health record systems
CEO SUMMARY: Since Anthem and AIM Specialty Health began a prior-authorization program for genetic testing July 1, a Northeast lab has not had any genetic tests approved through the new system. Physicians told the lab that the steps required for prior authorization were disruptive. Those doctors who regularly order genetic tests had not been trained
CEO SUMMARY: UnitedHealthcare will not implement the claims impact part of its laboratory benefit management program in Texas on March 1, 2017, as it had previously announced. Opposition to the program and the requirement that physicians use the BeaconLBS system when ordering about 79 lab tests is building among physicians in Texas. Officials from the
CEO SUMMARY: As of January 1, 2017, clinical laboratories and pathology groups in Texas will find it more difficult to serve the 500,000 patients enrolled in UnitedHealthcare’s fully-insured commercial plans in the Lone Star State. That’s because—just as it did in Florida—UnitedHealthcare, with its partners BeaconLBS and Laboratory Corporation of America, is implementing its laboratory
CEO SUMMARY: One common complaint about the efforts of UnitedHealthcare to introduce its unpopular laboratory benefit management program in Florida is that the insurer-and its agent, BeaconLBS, a division of Laboratory Corporation of America-don’t respond to physicians when they request guidance. One family practice physician in Jacksonville said that UHC has not even acknowledged several letters he sent via certified mail, return receipt requested.
CEO SUMMARY: From the launch in 2013 of a big accountable care organization in Wisconsin, the North Shore Pathologists at Columbia-St. Mary’s Hospital have been involved. Among the lessons learned are the importance of structuring the pathology contract with the hospital to anticipate value-based reimbursement and having full access to the ACO’s data. The pathologists are using this data to develop test utilization programs that help physicians order the right lab test for the right patient.
APRIL 15 IS THE DATE when UnitedHealthcare will begin denying laboratory claims in Florida that do not meet the requirements of its unpopular laboratory benefit management program.
CEO SUMMARY: Yet another specialty society is opposing the laboratory benefit management program UnitedHealthcare introduced in Florida last fall. Rheumatologists have joined four other specialty physicians in saying UHC’s BeaconLBS system could be detrimental to patient care. In a letter to UHC, the Coalition of State Rheumatology Organizations said it, “will pursue the reversal of this policy with our state and national societies through every regulatory, legislative, and public means possible.”
Another national health insurance corporation is preparing to institute pre-authorization for genetic tests. Cigna Corporation announced on July 23 that it had selected InformedDNA, to administer its new genetic testing and counseling program. Pathologists and laboratory administrators should note that one goal of Cigna’s new program is “to prevent the ordering of inappropriate genetic tests,”
CEO SUMMARY: Health information exchanges (HIEs) are operating nationwide, but few handle lab test orders and results with ease the way HealthBridge does. This long-established HIE in Cincinnati, Ohio, allows physicians to send lab test orders from their electronic health record systems (EHRs) and to receive matched lab test results back in their EHRs. One