Healthcare Consumers Opting for Lowest Cost Plans on Obamacare Exchanges, Putting Additional Pressures on Marketplace Insurers

Price transparency trend is altering decision-making in many aspects of healthcare and providing lesson for medical laboratory executives Medical laboratory executives are well aware that price transparency is an increasingly powerful trend in healthcare. Now, as consumers increasingly opt for lower-cost options when making healthcare decisions, the 2010 Affordable Care Act (ACA) provides a notable example of this new reality, with consumers making cost, not choice, their top concern when...

Up to 50% of Aetna, UnitedHealth Group, and Anthem Reimbursements Go to Value-Based Contracts; Clinical Laboratories Must Implement Value-Based Strategies to Remain Competitive

Aetna expects 75% to 80% of its medical spending will be value-based by 2020 Many pathologists and medical laboratory executives may be surprised to learn how quickly private health insurers are moving away from fee-for-service payment arrangements. According to Forbes, the nation’s largest health insurance companies now associate nearly 50% of reimbursements they make to value-based insurance initiatives. This is a sign that value-based managed care contracting continues to gain momentum. And...

Federal Judges Block Anthem-Cigna and Aetna-Humana Deals to Protect Market Competition and Healthcare Consumers

Mergers that would have reshaped the nation’s largest insurance companies would directly affect the provider networks independent medical laboratories rely on For pathology groups and medical laboratories, the news about two thwarted deals involving mega insurance companies might be seen as a positive development. The proposed deals—Anthem’s $48-billion bid to buy Cigna, and a proposed $37-billion Aetna–Humana merger—would have reshaped the US health insurance industry had they not been...

Aetna CEO Declares Affordable Care Act in ‘Death Spiral’ in a Speech of Interest to Pathologists and Medical Laboratory Professionals

Aetna’s CEO Mark Bertolini highlights how the current system increases costs for both insurers and consumers At the moment, probably no issue is more politicized than that of the Affordable Care Act (ACA), often called Obamacare. Because it controls the design of health insurance coverage, it also influences the way health plans pay hospitals, physicians, clinical laboratories, and anatomic pathology groups. However, understanding the truth about what is working and what is not with the...

McKinsey Reports That Consumers Will Find Fewer Options under the ACA in 2017 while Fewer Health Plans Means Less Access for Clinical Laboratories

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...