This is an excerpt from a 1,900-word article in the April 29, 2019 issue of THE DARK REPORT. The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: A new UnitedHealthCare (UHC) preferred lab network will launch July 1 with seven lab companies. In an April 22 announcement, UHC said physicians and consumers may continue to use its existing network of more than 300 labs currently in-network. THE DARK REPORT is first to bring this news to its members, and includes extensive commentary on the preferred lab network from UHC’s Vice-President, National Lab Program.
SEEKING LOWER COSTS, SHORTER WAIT TIMES, AND IMPROVED PATIENT OUTCOMES from clinical laboratories and anatomic pathology groups, UnitedHealthcare (UHC) named seven laboratories to a new preferred lab network. In an announcement on April 22, the nation’s largest health insurer also said physicians and consumers may continue to use its network of more than 300 legacy clinical laboratory providers.
Saying it wants “more affordable procedure costs, shorter wait times, and higher quality” from its providers, UHC will ask the preferred labs to follow the triple aim of improving the patient experience of care and the health of populations and reducing the per capita cost of care.
“The preferred lab network is an advanced way for us to work with selected lab partners to deliver on UnitedHealthcare’s triple aim in the lab space,” said Linda Simmons, UHC’s Vice-President, National Lab Program.
“By following the triple aim, we aim to improve healthcare value by making healthcare more affordable, and by improving patient outcomes and satisfaction for our patients and their physicians,” commented Simmons.
In a departure from the way most health insurers contract with clinical labs and anatomic pathology groups, UHC will track patient outcomes among those members who use the preferred laboratories to understand how labs can improve patient outcomes. Doing so will take several years, Simmons said.
In its news release announcing the UnitedHealthCare preferred lab network (PLN), the company said, “The creation of the PLN is an advanced way to work with selected lab providers to deliver care that places a greater emphasis on patient outcomes and the total cost of a person’s care.”
Rigorous Quality Criteria
The seven preferred laboratories were selected based on a “rigorous quality review process,” UHC said. The seven labs that will begin serving UHC members on July 1 are:
- AmeriPath/DermPath (a subsidiary of Quest Diagnostics)
- BioReference Laboratories
- GeneDx (a subsidiary of BioReferenceLaboratories)
- Laboratory Corporation of America
- Mayo Clinic Laboratories
- Quest Diagnostics
For consumers, UHC said there is no change in lab access because members can continue to use any of the more than 300 laboratories currently in its network of legacy labs. Depending on which lab a member chooses, costs may increase as follows:
- Preferred labs (seven) are the lowest cost labs.
- In-network (or legacy) labs (more than 300 nationwide) cost a bit more.
- Out-of-network labs (thousands nationwide) cost the most.
UHC explained that the cost of testing will differ for each type of laboratory a consumer would use, noting that preferred labs will have shorter wait times, online scheduling at patient service centers, higher quality of care, and lower costs.
“Services accessed through the PLN are at a lower average cost than other lab providers,” UHC said. “For example, pathology services for a biopsy in the PLN would cost about $90. Consumers could still choose a lab not in the PLN, but the cost would increase to about $150. An out-of-network lab would cost even more.”
By including all of the more than 300 of its in-network labs along with the preferred labs, UHC aims to serve all members, Simmons said. “Regarding access to testing, we’re looking for each laboratory to be able to provide services to all of our members in all lines of business with an emphasis on convenience,” she added.
Those physicians who refer patients to a preferred lab should expect to see improved service, the health insurer said. Physicians will “notice prompt turnaround times for lab results, ease-of-use when ordering lab [tests] electronically, as well as easy access to physician-to-lab medical director consultations to support patient care,” UHC added.
“[Physicians] will not need to do anything different to access services from these providers. The seven labs participating in the PLN will be designated as such in UnitedHealthcare’s provider directories,” said UHC.
UHC wants physicians to choose labs based on quality and costs. Physicians often order clinical laboratory tests based on habit or historical practice and may not realize that more affordable and higher quality options are available, UHC said.
Choosing Among Labs
In the interview, Simmons offered some detail about how UHC selected the labs for the PLN. “The preferred lab network is based on differentiated criteria for access, cost, and quality,” she said. “Also, it serves as a way for us to differentiate among the many labs in our network, including the more than 300 labs that are currently in network nationwide. We invited those laboratories to apply to be in the preferred lab network, and of those 300, we received more than 90 applications.”
Many of the in-network legacy labs are independent laboratories and several are based in hospitals and health systems, although Simmons would not say how many are in each category.
Each clinical laboratory seeking to participate in the PLN needed to complete a proprietary application that UHC prepared.
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