CEO SUMMARY: With a quiet announcement this month that it was bringing its laboratory benefit management program to Texas on March 1, 2017, UnitedHealthcare is taking on a big challenge. Enrollment in UHC’s commercial plans in Texas is 4.3 million. That is twice the two million commercial plan members UHC has in Florida, where it introduced the LBMP in 2015. Moreover, UHC has just 18 weeks to educate physicians about the program and recruit Texas labs into the BeaconLBS lab network.
PHYSICIANS IN TEXAS ARE LEARNING that, effective March 1, 2017, they will be required to comply with UnitedHealthcare’s laboratory benefit management program pilot when ordering certain clinical laboratory tests that require pre-notification or pre-authorization.
When implemented in Florida last year, this same program encountered significant opposition from physicians and clinical laboratories in the Sunshine State. Even today, more than one year later, many physicians remain unhappy with the requirement that they obtain pre-notification or pre-authorization before ordering lab tests as required with the BeaconLBS system.
In Texas, as in Florida, the pilot program will be managed by Beacon Laboratory Benefit Solutions, Inc., a subsidiary of Laboratory Corporation of America. Again, similar to Florida, the program covers UnitedHealthcare members in Texas who are enrolled in the company’s commercial plan.
The announcement was made using a low-key approach. UnitedHealthcare’s Network Bulletin for October carried the news. (See sidebar below.)
In the announcement, UHC says that physicians will be required to use the system as of March 1, 2017. That is when UHC will begin to enforce what it describes as “claim and service impacts.” UHC also stated that physicians could begin using the BeaconLBS physician decision support tool on Jan. 1, 2017.
This is a more ambitious pilot program than what UHC undertook in Florida. Recent figures show that UnitedHealthcare has approximately 4.3 million beneficiaries in commercial plans in Texas. That is more than double the 2 million beneficiaries in UHC commercial plans in Florida.
Another interesting element to UHC’s announcement that it would deploy this lab test pre-notification/pre-authorization program is that, as of this date, the list of UHC’s “Laboratories of Choice” network on its website does not include any local Texas laboratories. It lists 20 laboratory companies that are currently in the LOC network for Florida.
a Surprise For Texas Labs?
If it is true that UHC and BeaconLBS representatives have not yet contacted clinical labs and pathology groups in Texas about becoming a laboratory of choice network lab, then the announcement of the March 1, 2017, start for the laboratory benefit management program may be a surprise for laboratories throughout the Lone Star State.
It will certainly be a surprise for those physicians who most frequently use the list of about 80 clinical lab tests for which pre-notification or pre-authorization must be obtained and put on the lab test requisition for labs in the UHC network to be paid.
THE DARK REPORT contacted several state medical specialty societies and the Texas Medical Association. Officials at each organization responded that they were unaware that UnitedHealthcare had announced that the laboratory benefit management program would become effective in Texas next year.
No response To Inquiries
As of this date, UnitedHealthcare and BeaconLBS had not responded to inquiries from THE DARK REPORT. The only public information seems to be the announcement in the UHC Network Bulletin for October and certain pages on the UHC website which have been updated to include information about implementation of the program in Texas starting next year.
There will be much interest in which laboratories in Texas decide to enter into agreements with BeaconLBS to be a member of the laboratory of choice network. Not only do these agreements have pricing and restrictive terms that many Florida labs rejected, but signing such an agreement means that the lab is then subject to terms created by a company owned by LabCorp, a major competitor.
It is be expected that the entire clinical laboratory industry will watch the launch of the laboratory benefit management pilot program in Texas. Throughout the United States, lab administrators are aware that implementation of this lab test program in Florida triggered much opposition by physicians, clinical laboratories, and pathology groups.
Florida Docs Frustrated
In the Sunshine State, some physicians and labs were frustrated about various aspects of the program, difficulties in using the BeaconLBS system to obtain pre-notification and pre-authorization, and the algorithms used to determine whether a lab test order was medically necessary or not.
Because UnitedHealthcare has twice the number of lives in its commercial plans in Texas, compared with Florida— 4.3 million and 2 million respectively—it faces an even bigger challenge to implement the laboratory benefit management pilot program. Thus, it is odd that its first official announcement that the LBMP was coming to Texas was published just 18 weeks before the scheduled implementation date of March 1, 2017.
Another factor may add interest to this story as it unfolds. Texans are legendary for valuing their independence and are willing to fight hard to maintain it. Might it turn out that UnitedHealthcare finds itself facing better-organized resistance by Texas physicians than it did from Florida physicians?