Managed Care’s Next Evolutionary Step

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MANAGED CARE IS IN THE MIDST OF SHIFTING from a volume-buying discount club to a value-added partner in healthcare. During the past two years, THE DARK REPORT has identified developments in the marketplace supporting this trend and provided these insights to our clients and regular readers.

Further proof of this shift in the business model of managed healthcare are the value-added initiatives underway at UnitedHealth Group, based in Minneapolis, Minnesota. At last month’s Executive War College in Cincinnati, Dr. Richard Migliori “wowed” the crowd with his discussion of how United Health Group was using detailed clinical data sets to stimulate significant improvements in the quality of care provided to its 15 million beneficiaries. You can read his comments on pages 9-14 of this issue.

Dr. Migliori is Chief Clinical Strategist at Ingenix, a business division of UnitedHealth chartered with the task to develop new healthcare tools based on clinical information. Obviously laboratory test data plays an increasingly important role in this effort. In fact, Dr. Migliori closed his presentation with this comment: “Eventually the requirement that the clinical laboratory data be shipped to us in a usable format will be universal.”

For years, both lab administrators and pathologists have regularly stressed that laboratory data, when properly gathered and studied, holds fantastic potential to radically improve the quality of care even as it contributes to a lowering of healthcare costs. Now, after 15 years of delivering that message, there are influential players in the healthcare community taking notice of this fact.

This sets up an interesting situation. As health insurers, health systems, and government health programs become increasingly willing to fund the development of new ways to gather, store, analyze, and use lab data, will lab administrators and pathologists be willing to invest in the resources necessary to deliver that data in a usable form?

It’s time for the lab community to step to the plate and develop value-added services built upon lab test data. As demonstrated by UnitedHealth Group, the appetite of payers and health systems for useful information is growing rapidly. Reimbursement for these services will grow proportional to their value in improving healthcare outcomes.

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