By Joseph Burns, from the Volume XXVI No. 2 – February 4, 2019 issue
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
By Joseph Burns, from the Volume XXV No. 10 – July 9, 2018 issue
CEO SUMMARY: As health networks and hospitals consider outsourcing their lab outreach programs, the lab team at Dartmouth-Hitchcock Medical Center (D-H) offers lessons about the value of retaining outreach. D-H is now in the eighth year of a sustained expansion of its laboratory outreach business. It has combined its lab outreach strategy with a proven
By Joseph Burns, from the Volume XXV, No. 1 – January 2, 2018 issue
IN THE FIRST BROAD EXPANSION OF ITS pilot decision-support program for clinical lab testing in Florida, UnitedHealthcare (UHC) will add genetic and molecular tests, drug tests, and pathology procedures, among other assays starting in two months.
On March 1, UHC will expand its laboratory benefit management program in Florida beyond the initial 80 routine anatomical and
By Robert Michel, from the Volume XXIV, No. 16 – November 20, 2017 issue
CEO SUMMARY: With each passing year, the primary role of hospital and health system labs evolves in a different direction than that of independent lab companies. This trend is a response to the creation of integrated delivery networks paid on value and how they are scored on their ability to keep patients out of hospitals
By Joseph Burns, from the Volume XXIV, No. 13 – September 18, 2017 issue
CEO SUMMARY: NYU Langone Health recognized the clinical and financial advantages of providing competitive lab outreach testing services to its employed physicians. The laboratory joint venture with Sonic Healthcare USA will allow NYU Langone to increase use of its hospital labs and will facilitate standardizing its testing methods, results, and reference ranges. The first phase
By Joseph Burns, from the Volume XXIV, No. 11 – August 7, 2017 issue
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
By Joseph Burns, from the Volume XXIV, No. 10 – July 17, 2017 issue
CEO SUMMARY: Quest Diagnostics is no longer an equity partner in the CompuNet Clinical Laboratory joint venture, which has operated successfully since its founding in 1986. Typical of other lab JVs and inpatient lab management agreements that the hospital or health system partners do not renew, none of the owners of CompuNet will comment on
By Joseph Burns, from the Volume XXIV, No. 4 – March 13, 2017 issue
CEO SUMMARY: To prepare for the transition from fee-for-service to value-based payment, Western Connecticut Health Network, a three-hospital health system, announced a laboratory joint venture with Sonic Healthcare. Benefits will include lower test costs, more competitive prices, and the ability to offer same-day turn-around in Western Connecticut. Another benefit is that physicians in towns WCHN
By Joseph Burns, from the Volume XXIV, No. 2 – January 30, 2017 issue
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
By Joseph Burns, from the Volume XXIV, No. 1 – January 9, 2017 issue
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
