Labs Have Strategies to Address Narrow Networks

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IN TODAY’S EVOLVING HEALTHCARE SYSTEM, labs and pathology groups of all sizes in all communities are dealing with the issues of payers narrowing networks and the formation of ACOs, with all the unknowns about reimbursement that come with this new organizational model of healthcare.

That is why you will be interested to learn more about a community hospital in New Hampshire that created a unique way to get its outreach lab program back into the provider network of the state’s major health insurer and an anatomic pathology group in Alabama that assertively created a role for itself in an ACO that was first organized in 2012.

Each example of a lab developing a strategy to protect access to patients in its community is a reminder that the healthcare marketplace will reward lab organizations that are willing to be innovative and experiment with new ways to deliver lab testing services that meet the changing needs of health insurers and ACOs.

On pages 10-15 you will read about how 88-bed Frisbie Memorial Hospital in Rochester, New Hampshire responded when it found itself excluded from the site of service network of Anthem Blue Cross Blue Shield of New Hampshire. With the support of the hospital’s CEO, a new, standalone lab company was created specifically to offer lab testing services at a more competitive price than what was charged by the hospital’s lab. This lab earned provider status in Anthem’s Site of Service network, even as the hospital itself remains out of network.

Pathologists and pathology practice administrators would do well to study the strategy and business thinking of CytoPath, P.C., a five-pathologist group in Alabaster, Alabama, just a few miles from Birmingham. On pages 7-9, we describe how, back in 2012, when CytoPath learned that the local health system was forming an ACO, it acted decisively to ensure that its pathologists would be included as providers within the ACO. Not only did this require a willingness to accept a different model of reimbursement, but the pathology group needed to make ongoing investments in information technology in order to deliver the expanded sets of data required by the ACO.

Each of these market initiatives teaches lessons in how all labs can positively respond to the changes happening in healthcare. And, once again, it is THE DARK REPORT which is bringing you the news and analysis of these innovations.

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