News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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More Media Reports About How Health Insurers Are Reluctant to Reimburse for Genetic Tests, Thus Angering Many Patients and Causing Medical Laboratories to Go Unpaid

Pathologists should take note that an increasing number of patients who want genetic tests are complaining when they learn their insurance plan will not pay for such tests

Concerned about the increased cost of genetic tests, health insurers are becoming reluctant to pay for many types of molecular diagnostics and gene tests. As they do, however, they face a buzzsaw of angry patients—many of whom see a genetic test as their last resort for a diagnosis and selection of a therapy that might just work for them.

Reuters recently reported that health insurance companies are reluctant to pay providers for gene-sequencing tests until more research becomes available. This is a sign for pathologists and clinical laboratory managers that enough patients have been affected by this to justify news coverage by a major news source.
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WellPoint’s New Pay-for-Performance Program to Pay Hospitals More for Meeting Quality Measures

Private payers taking first steps on a path toward value-based purchasing that could eventually include clinical pathology laboratory testing services

Pay-for-performance just took a leap forward with news that one of the nation’s largest health insurers will link hospital reimbursement to specific quality measures. This development could be a precursor to similar payer initiatives that involve how private payers reimburse clinical laboratories and anatomic pathology groups.

Indianapolis-based WellPoint, Inc. (NYSE: WLP) will revamp the way it reimburses about 1,500 hospitals across the country. In a news story published by Bloomberg Businessweek, Rick Wartzman, Executive Director of the Drucker Institute at Claremont Graduate University, explained that, going forward, WellPoint wants to base annual payment increases to hospitals using a formula that incorporates the health insurer’s quality criteria, rather than to the quantity of services delivered.
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Expansion of Medical Home Concept Requires Response by Clinical Laboratories

Meet the concept of the medical home. It is a managed-care delivery model that charges physicians with coordinating overall care for patients with chronic illnesses. Since its’ inception just a few years ago, it has spread nationwide. Medical home demonstration projects now operate in 22 states. Two states, Rhode Island and North Dakota, have implemented statewide programs.

By design, the medical home is a patient-centered, integrated care model. An important goal is to create a strong, long-term relationship between the physician and the patient. It does this by replacing episodic care based on illness with proactive, coordinated care provided by a physician-led team.

In 2008, the National Committee for Quality Assurance (NCQA) introduced standards to determine if a medical practice operates as a Patient-Centered Medical Home (PCMH). These standards meet the definition of a medical home as defined by a consortium that includes the American Academy of Pediatrics, American College of Physicians, American Academy of Family Physicians and American Osteopathic Association.

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