UnitedHealthcare announces it may exit the federal marketplace because of slow growth and higher-than-expected claims; clinical laboratories may see less reimbursement
Health insurance premiums in 2016 for plans offered through federal Obamacare exchanges (more formally known as the Health Insurance Marketplace) will see an average rate hike on midrange plans of 7.5%. This amount may vary widely depending on which state a consumer lives. In 2016, 38 states will have healthcare consumers apply for and enroll in coverage through the HealthCare.gov platform.
Big increases in healthcare premiums from one year to the next have a direct link to the amount of money health insurers will pay clinical laboratories for lab test claims. That’s because, when health insurers are in a financial squeeze, they tend to reduce reimbursement to providers, including clinical laboratories.
This news about premium increases for 2016 comes from a report issued by the Centers for Medicare and Medicaid Services (CMS). The rate analysis is part of the federal agency’s 2016 Marketplace Affordability Snapshot. CMS said that nearly eight in 10 returning marketplace consumers will be able to find a plan with premiums for less than $100 per month after tax credits and seven out of 10 will pay less than $75, once taxpayer subsidies are factored in.
“For most consumers, premium increases for 2016 are in the single digits and they will be able to find plans for less than $100 a month,” stated Kevin Counihan, CEO of the Health Insurance Marketplace, in the CMS statement. (more…)
SoloHealth Stations are in 3,200 retail stores nationwide and growing
There’s a hot new consumer health product working its way into pharmacies across the nation. Say goodbye to the ubiquitous self-serve blood pressure stations found next to the pharmacy counter. Say hello to the next generation of consumer self-serve health kiosks.
This trend may open a door for innovative clinical laboratories to add their service offerings to the kiosks in their communities. One example of the fast adoption of these new kiosks is the SoloHealth Station. SoloHealth has already placed its kiosks in 3,200 retail locations nationwide.
Each day, more than 130,000 individuals use them and, on average, each consumer spends 4.5 minutes per session, according to a report issued by Marketwatch.com. (more…)
With payouts riding on patient outcomes and value, ACO providers will welcome innovative services that clinical labs and pathologist could provide that improve patient outcomes
Both private health insurance companies and employers are betting on value-based insurance as the key to improving healthy behavior in patients. This will require more patient engagement in managing their chronic conditions. It will also include motivating patients to consider less expensive treatment options, particularly when the more expensive treatment path has limited benefits.
In this way, accountable care brings the patient into picture. It is a trend that opens the door for innovative clinical laboratories and anatomic pathology group practices to develop medical laboratory testing services that payers and employers recognize as contributing to improved patient outcomes—and for which they will adequately reimburse the laboratories providing these services.
Private Health Insurers Have More Flexibility in Design of Health Plans (more…)
Clinical laboratories and pathology groups may want to review the prices they charge insured patients versus uninsured patients
There is a certain irony in the fact that hospitals and other medical providers typically charge patients without health insurance as much as three times what they charge Medicare or an insured patient. This situation is getting increased media scrutiny, which is one reason why clinical laboratories and pathology groups may want to review their own policies for charging patients without health insurance.
One good study on prices charged to self-pay patients was conducted by Gerard Anderson, Ph.D., a health economist at the Johns Hopkins Bloomberg School of Public Health. His study was funded by the Henry J. Kaiser Family Foundation and published in the May-June 2007 journal Health Affairs.
Anderson analyzed 2004 hospital billing data. He concluded that the gap between rates charged self-pay and insured patients has grown substantially since the mid-1980s. “In the 1950s, the uninsured and poor were charged the lowest prices for medical services. Today they pay the highest prices…,” wrote Anderson, noting that self-pay charges often reflect the hospital’s “chargemaster” prices–the top prices used to negotiate discounts with insurers. (more…)
Adoption of EHR systems by small practices, small hospitals, and rural health providers lags behind the pace of urban-based hospitals and physician groups
As larger numbers of physicians implement electronic health record (EHR) systems, clinical laboratories are faced with the task of building interfaces that connect their laboratory information systems (LIS) to those EHRs.
Recent numbers indicate that hundreds of thousands of physicians are now enrolled in the federal EHR incentive program. This puts medical laboratories and anatomic pathology groups squarely in the midst of the drive to encourage physicians to both implement an EHR in their clinical practice and use that EHR in ways that meet “Meaningful Use” requirements.
Some 225,765 providers are participating in the Medicare and Medicaid EHR incentive programs created by the American Recovery and Reinvestment Act of 2009. The Centers for Medicare and Medicaid Services (CMS) report that almost $4.5 billion in financial incentives have been paid to hospitals and physicians for implementation of electronic health record (EHR).