Clinical Pathology Laboratories Should Understand How Wellpoint Used ‘Capped-Pricing’ Strategy to Save CalPERS $5.5M on Surgery Costs

New strategy by employers and payers encourages patients to choose lower-cost providers, or pay the difference over the price cap

Payers are teaming with employers to steer patients to lower cost providers. Their common goal is to reduce the cost of care without compromising the quality of care delivered to their beneficiaries. This trend may involve clinical laboratories and anatomic pathology groups, particularly where a lab is seen as a high-cost provider in its service area.

There is credible evidence that patients are willing to consider lower-cost providers. For example, a pilot project aimed a cutting the cost for knee and hip surgeries saved $5.5 million for the California Public Employees Retirement System (CalPERS), the nation’s largest pension fund and third largest purchaser of healthcare benefits. (more…)

CALPERS Saves $15 Million in Health Premiums Because Proactive Care Reduced Hospital Inpatient Admissions

Clinical laboratories and pathology groups may need to re-strategize should hospital inpatient admission rates begin declining as a result of proactive clinical care programs

More hospitals are ramping up their services in proactive outpatient care. The goal is to reduce hospital admissions and curb costs. The challenge is that fewer admissions and shorter stays mean a drop in hospital revenues. For the hospitals’ clinical laboratories, it also means less inpatient lab test volumes.

Hospitals are doing this in response to changes in reimbursement models specifically designed to incentivize providers to keep people out of hospitals. Of all sites that deliver patient care, hospitals account for the greatest share of the nation’s healthcare dollar. This makes them a prime target for cost cutting, noted a recent story in Modern Healthcare (MH).