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test utilization

Labs Begin Applying Lean to Cut Costs, Add Value

CEO SUMMARY: In more than 40 presentations by 55 speakers, two big themes dominated the 11th annual Lab Quality Confab in New Orleans last week. One theme is the urgent need to cut clinical laboratory costs. The second theme is the need for both clinical labs and anatomic pathology groups…

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Two Largest Payers Start Lab Test Pre-Authorization

CEO SUMMARY: Once Anthem and UnitedHealthcare establish their respective genetic test prior-authorization programs, a new era for genetic testing will commence. The 80 million beneficiaries served by these two payers make up half of the individuals who have private health insurance. It is…

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Issues Encountered with Anthem’s Pre-approval

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 …

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In Texas, BeaconLBS Start Will Be Delayed

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…

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Why Lab Prices Declined 32% During 3-Year Study

CEO SUMMARY: Researchers studied the effect reference pricing had on an employer’s efforts to steer consumers to low-cost clinical labs. The study showed that patients were particularly sensitive to lab test prices—in part because those prices varied widely. Over the course of the …

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Cigna Expands Program For Genetic Counseling When Genetic Tests Are Needed

CEO SUMMARY: For three years, Cigna has required genetic counseling for members seeking genetic testing for hereditary breast, ovarian, and colorectal cancer, and for a particular heart condition. Such counseling increased member satisfaction, causing Cigna to expand the program. It now r…

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July 5, 2016 Intelligence: Late Breaking Lab News

More developments have happened at Theranos, Inc., the beleaguered clinical lab company based in Palo Alto, California. On June 24, Brook Buchanan, Vice President of Communications at Theranos, resigned, giving personal reasons for the decision. Buchanan was hired in November 2015, …

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200-Analyte Medication Test Panel Adds Value for Physicians

CEO SUMMARY: Delivering more value with lab tests requires going beyond simply working with physicians to improve test utilization by focusing on unnecessary or inappropriate tests. PeaceHealth Laboratories in Oregon successfully executed a two-step strategy to add value with its testing …

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Lab CEO Sees Three Trends Cutting Volume, Revenue

CEO SUMMARY: Following the sale of his hospital lab outreach business to a national lab company, former CEO James Fantus told THE DARK REPORT about the significant trends he saw unfolding in the Northeast. They include: a shrinking number of physician customers for labs; a rising number o…

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New Company Tracks Details and Prices For 60,000 Molecular and Genetic Tests

CEO SUMMARY: Advances in the speed, accuracy, and cost of next-generation gene sequencing making it possible for clinical labs to create thousands of new tests. How many new tests? NextGxDx, an information technology company, says the nation’s clinical laboratories are introducing new m…

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