Market Disruption Coming to Labs in Texas

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IT WON’T BE WELCOME NEWS TO CLINICAL LABS AND PATHOLOGY GROUPS IN TEXAS that UnitedHealthcare will introduce its laboratory benefit management program in the Lone Star State. It will change the access many labs have to UHC patients and probably reduce the money these labs are paid if and when they do perform testing for UHC patients.

These were some of the outcomes many laboratories in Florida reported after UHC instituted the laboratory benefit management program (LBMP) there in March 2015. Because most labs in Florida considered the terms offered by BeaconLBS—which manages the program for UHC—as unfavorable, only 20 labs currently participate in UHC’s laboratory of choice network in Florida and 25% to 30% of those are Laboratory Corporation of America or lab divisions of LabCorp (which owns BeaconLBS).

Another point of interest is that UHC announced the LBMP program in Texas just 18 weeks in advance of the March 1, 2017, start date. For that reason, the health insurer will have to scramble to educate physicians about the program and how to use the BeaconLBS system. Also, if UHC has not yet finalized agreements with Texas labs to participate in its laboratories of choice network, it will be pressed to accomplish that task.

I would be remiss in my assessment of this story if I didn’t call attention to the fact that, last year, a significant number of physicians and state medical specialty societies in Florida went on the record with strong objections and opposition to the UHC laboratory benefit management program and the BeaconLBS system used in its implementation.

Since Texans have a justified reputation for protecting their rights, will UHC and BeaconLBS face tougher opposition from Texas physicians and their medical societies as they learn the details of the LBMP? Surely some Texas doctors will consider UnitedHealthcare to be just as unwelcome a dictator as their forebears did of Mexican President and General Antonio López de Santa Anna. The big question then, would be, might Texas doctors rebel against this scheme and cause UHC to stop implementation of the LBMP with the same success that General Sam Houston and the Texans did in the battle of San Jacinto on April 21, 1836? On that date, they routed the Mexican army and captured Santa Anna. Houston’s victory ensured the independence of Texas.


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