Feb 17, 2017 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Ongoing shift to narrow provider networks excludes many medical laboratories, thus causing them to lose access to patients served by these networks
If there is any single trend that has worked against the clinical and financial interests of community clinical laboratories and hospital/health system lab outreach programs, it is the trend of narrow networks. When medical laboratories and other providers find themselves excluded from a payer’s provider network, they lose access to the patients served by that network.
Thus, it won’t be good news that a major consulting company has confirmed that the trend of narrow payer networks is intensifying. The study was conducted by healthcare consulting firm McKinsey and Company.
McKinsey concluded that insurers participating in the government’s Healthcare Exchanges continue to move toward narrow networks of healthcare providers. This trend often leaves smaller clinical laboratories, hospital lab outreach programs, and anatomic pathology groups on the sidelines as insurers attempt to reduce costs. (more…)
Dec 28, 2016 | Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
A look at the numbers resulting from healthcare reform and the Affordable Care Act across the eight years of the Obama Administration
Over the eight years of the Obama administration, there has been significant and unprecedented legislation intended to address the well-known problems with health insurance and high healthcare costs in this country. There has also been plenty of bluster, criticism, and commentary about the consequences of the Affordable Care Act (ACA), which became law in 2010.
With a new administration and Congress about to take office, many media outlets and experts are looking back over the past eight years to assess what actually happened to the US healthcare system during this time. From independent medical laboratories and pathology groups, to large-scale health systems, reform and the impact of the Obama Administration has changed—and continues to change—the way America approaches healthcare.
Over President Obama’s two terms, there were significant changes to payment structures, insurance markets, and communications between healthcare service providers. In turn, these initiatives have spurred innovation and drastically altered the way many healthcare and diagnostics providers operate. (more…)
Dec 21, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Local medical labs and pathology groups are often excluded from narrow networks. Thus, another round of “network provider reduction” is a serious issue
Total enrollment in health insurance products may be increasing, but in its recently-issued study, McKinsey and Company determined that the Health Insurance Marketplace (Health Exchange) is shrinking even as the number of enrollees continues to rise.
The development is unfavorable to the nation’s clinical laboratories and pathology groups because fewer health plans on the exchange means less access to patients. It also means that the remaining health insurers are taking steps to further narrow their existing networks in order to curb expenses by limiting options.
The new report published by McKinsey and Company reveals that insurers are moving towards plans that offer fewer options for consumers, mostly due to losses suffered on the health exchanges. The report, titled, “2017 Exchange Market: Plan Type Trends,” states that in 2017 a majority of the healthcare plans (about 75%) available to consumers under the Affordable Care Act (ACA) will be Health Maintenance Organizations (HMOs) and other similar limited-option plans, such as Exclusive Provider Organizations (EPOs).
EPOs are a hybrid of HMOs and PPOs and share some common options from both. Of the states investigated, McKinsey found that about 15% of customers eligible for ACA exchanges will have no PPOs available to them. (more…)
Dec 16, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
Accountable Care Act has reduced the number of uninsured, but has failed to deliver lower costs for most Americans or employers
More big increases are coming to Obamacare premiums during 2017. This is an important development and, depending on how the new Congress decides to address problems with the Affordable Care Act (ACA), the consequences can be either positive or negative for clinical laboratories and anatomic pathology groups.
Large increases in healthcare premiums can have a trickle-down effect on clinical laboratories and pathology groups since health insurers tend to reduce reimbursements to providers when they are in a financial squeeze. And while the November election puts the future of the ACA in doubt, a recently released Kaiser Family Foundation (KFF) study adds further evidence that Obamacare (colloquial for the ACA) has fallen short of its goal of reining in healthcare costs while simultaneously expanding healthcare coverage to millions of Americans.
The KFF study shows premiums in the ACA’s Health Insurance Marketplace will continue to increase in many regions in 2017. Researchers blame the higher price in part to the phasing out of the ACA’s reinsurance program and the unexpected losses many participating insurers have experienced. (more…)
Dec 2, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing
Self-insurance trend could push more businesses to independent and local clinical laboratories if self-insurers prefer to offer employees local access to testing services
Three years after the roll out of the Affordable Care Act’s (ACA’s) major provisions, more small and midsize companies may be opting to self-insure their employee health plans rather than face the coverage mandates and administrative costs imposed by Obamacare, a recent study found. It is uncertain how this trend will improve the access clinical laboratories and pathology groups have with these patients.
The Employee Benefit Research Institute (EBRI) study looked at trends in private sector self-insured health plans between 1996-2015, with a focus on 2013-2015, to assess whether the ACA might have affected those trends.
Researchers analyzed survey data from nearly 40,000 employers that participated in the US Census Bureau’s Medical Expenditure Panel Survey Insurance/Employer Component. They found that from 2013 to 2015: (more…)
