Nov 1, 2013 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations
In September UnitedHealthcare and its collaborators announced plans to create what is planned to be one of the largest accountable care organizations in Wisconsin
As predicted, national health insurance companies are moving deliberately to be part of large accountable care organizations (ACOs). For example, in Wisconsin, three health systems and one of the nation’s largest health insurers are developing a multi-system accountable care organization designed to compete with the largest ACO in the state.
ACOs Expected to Use Medical Laboratory Testing in Different Ways
For pathologists and clinical laboratory executives, this development is a reminder that ACOs will play a significant role in healthcare’s transformation. Also, these super-sized ACOs will have their own influence on the transformation of medical laboratory testing in this country, since ACOs can be expected to use medical laboratory testing in different ways and are unlikely to use fee-for-service as the primary method of payment for laboratory testing.
In September when UnitedHealthcare (UHC) (NYSE: UNH) announced it was collaborating with two health systems to form an ACO in Wisconsin to cover 100,000 patients. A third health system (Ministry Health) joined the new ACO network a week later. UHC efforts are part of a nationwide strategy to double what it spends to provide care in ACOs. (more…)
Oct 16, 2013 | Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Sales and Marketing, Management & Operations
Recent hospital mergers are creating super-sized health systems that immediately gain leverage over insurers when negotiating managed care contracts
Experts say the nation is experiencing its biggest surge in hospital mergers in more than a decade. Moreover, this latest wave of deals is creating supersized hospital systems that are expected to dominate healthcare and possibly lead to higher healthcare costs.
The ongoing consolidation of hospital ownership means further consolidation of the hospital laboratories that find themselves merged into larger health systems. That will have both good and bad consequences for pathologists and medical laboratory managers working within these organizations. (more…)
Sep 11, 2013 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations
News stories are reporting that Walgreens is participating in ACOs now forming in New Jersey, Florida, and Texas
Retail clinics are positioning themselves to play a major role in the delivery of basic primary care services. Consumer and payer acceptance of the “convenience care” model has brought the concept to a tipping point in its potential to shift the way that some basic primary care—and medical laboratory testing—services are delivered.
Dark Daily has long predicted that retail clinics would want to expand their services beyond the original formula of a nurse practitioner who handles a basic menu of easy-to-diagnose conditions. Consumers have readily accepted this healthcare delivery model. In fact, a new title has been coined that has its own Wikipedia.com page: Convenient care clinic. (more…)
Sep 3, 2013 | Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Commission issues 12 recommendations to enhance physician and patient satisfaction, while creating a financially sustainable healthcare system
How quickly will fee-for-service disappear as a primary source of reimbursement for clinical laboratories, pathologists, hospitals, and physicians? If the recommendation of one credible group of physicians has its way, fee-for-service reimbursement could disappear in as little as five years.
This recommendation was made by National Commission on Physician Payment Reform as part of a report it issued in May. In its press release, the commission issued a call “for eliminating stand-alone fee-for-service payment by the end of the decade.” The group urges a transition over five years to a blended payment system that will yield better results for both public and private payers, as well as patients.” (more…)
Jul 8, 2013 | Coding, Billing, and Collections, Digital Pathology, Instruments & Equipment, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Sales and Marketing, News From Dark Daily
Clinically integrated networks is one market trend in response to shift away from fee-for-service payment and toward value-based provider reimbursement
One fast-developing trend is that of academic centers forming integrated networks with various providers within a community and a surrounding region. This is related to a movement to establish accountable care organizations (ACOs). But it is also a response to actions by payers to narrow their networks and exclude high-cost providers, such as academic centers.
This business model has a mutual goal. Each integrated network is anchored by an academic medical center and is designed to foster closer interaction between the academic subspecialists and the wider clinical community. For pathologists and clinical lab managers, such integrated provider networks may often encourage participating physicians to send their reference and esoteric medical laboratory test referrals to the academic center and not to the physicians’ primary laboratory provider. (more…)
