Managed Care Update

UnitedHealthcare Forming Network of Preferred Labs

Nationwide start date set for July 1 but few details are available for interested labs

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 provider. Both national labs would be available to serve UHC members nationwide.

In December, UnitedHealthcare said it would implement a preferred lab network on July 1 and continue to grow its network. In its network bulletin for December, UHC stated, “In 2019, UnitedHealthcare will be growing its national network of participating laboratory providers to better support members and the care providers who order laboratory services.”

New Preferred Lab Network

UHC wants to achieve better support for members and their care providers by implementing its new network of preferred labs, UHC said in an email to The Dark Report. “The preferred lab network will feature currently-contracted laboratory care providers that have met higher standards for access, cost, data, quality, and service,” UHC said in its bulletin. “These standards will help us work with the labs to improve the care provider and member experience.”

The health insurer is inviting independent clinical labs that already participate as in-network lab providers for UHC members to apply to join the preferred network, UHC said. “In the summer of 2019, we’ll announce more information about the program, along with the labs that will be included in the preferred lab network,” UHC said.

Existing Contracted Labs

“In answer to questions from The Dark Report, Linda Simmons, UHC’s Vice-President, National Lab Program, said via email, “The preferred lab network won’t change a member’s access to labs or lab services. Right now, UnitedHealthcare currently has more than 300 independent, free-standing labs contracted through local, regional, and national agreements.”

Last year, UnitedHealthcare expanded its network of free-standing laboratories, adding more than 25 contracts, she said. Among the factors UHC considers when adding labs to its network, the health insurer analyzes each lab’s access, cost, data, quality, and service, she said. “There are multiple factors that influence network contracting and is dependent upon the type of services that the lab performs,” Simmons added.

In recent months, some clinical labs have received letters from UHC in which the health insurer explained that it was terminating these labs from its network. Simmons did not say how many labs, if any, were cut from the UHC network. She added that any changes in the number of labs in the network are a result of routine, annual network maintenance and not part of any new effort initiated after Quest was added to the UHC network. The number of clinical labs in its network changes continually to meet the needs of the market.

“To adapt to the ever-changing health-care environment, and to innovate ways to improve it, UnitedHealthcare continually evolves the way we structure our services and our network,” she wrote.

Labs Can Reapply

Should a lab be cut from the network, however, that lab can reapply. “If a free-standing lab is terminated from the network, or their application for a lab contract is denied, the lab has the opportunity to reapply for network status after a year,” she said.

Asked if UHC worried that cutting independent labs would leave the health insurer with only the two large national labs, she said UHC would retain a large network of labs. “UnitedHealthcare will continue to maintain a robust and extensive lab network while also developing the preferred lab network,” Simmons wrote. “The preferred lab network allows us to work with network labs to improve the lab, care provider, and member experience through higher standards for access, cost, data, quality, and service.”

UHC did not respond to questions about what standards it would use to define access, cost, data, quality, and service for laboratories that wanted to be in the new preferred laboratory network.

Increased Market Share

Before this year, Quest was an in-network lab for a limited number of UHC plans in some markets, but as of the first of year, Quest will be in-network nationwide for all UnitedHealthcare plans.

UHC Has No Plans to Expand BeaconLBS

CLINICAL LAB EXECUTIVES WANT TO KNOW MORE about how UnitedHealthcare plans to contract with lab providers. For this reason, lab directors and pathologists watched closely when UHC introduced the BeaconLBS program in Florida and the steps it took to launch this lab benefit management initiative in Texas.

Given that BeaconLBS is a subsidiary of Laboratory Corporation of America,The Dark Report asked UHC about its plans to use the BeaconLBS system in Texas and nationwide. “The BeaconLBS lab benefit pilot program is currently in effect in Florida,” a UHC spokesperson said. “Plans to extend the program to Texas or elsewhere are on hold.”

In 2015, UHC implemented this program for UHC’s commercial members in Florida. Since then, physicians have been instructed to use the BeaconLBS electronic ordering system for one or more of 31 diagnostic tests, and to use what UHC calls its “laboratories of choice” network.

In 2015, many clinical lab directors and ordering physicians in Florida objected to the program’s requirements. Physicians complained that the system was cumbersome, time-consuming, and did not work well with some of the electronic record systems they used. (See “Some Florida Docs Are Not Using BeaconLBS System,” TDR, June 1, 2015.)

After a less-than-stellar roll out in Florida, UHC said it would introduce BeaconLBS in Texas in 2017. After that idea met fierce resistance from ordering physicians and clinical laboratory directors in the Lone Star State, UHC suspended implementation of the BeaconLBS system in Texas. (See “BeaconLBS Is Coming to Texas,” TDR, Oct. 17, 2016.)

Contact the UHC general provider line at 877-482-3210 from 8am to 8pm, local time, Monday through Friday.

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