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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American Medical Association’s Study of Nation’s 25 Largest Health Insurers Indicates that Biggest Companies Hold Dominant Market Share in Most Regional Markets

Survey results show pathologists and clinical lab managers why largest health insurers have market clout and can exclude local labs from their provider networks

Over the past two decades, ongoing mergers and acquisitions of health insurance organizations have led to ever-greater concentration of market share, even as the number of large health insurance companies has shrunk. One consequence of this trend is that many clinical laboratories and anatomic pathology groups have lost access to managed care patients.

The degree of market concentration will surprise most pathologists and medical laboratory professionals. The concentration of market ownership is clearly demonstrated by the fact that the 25 largest health insurers in the United States now control two-thirds of this $744-billion market. But the largest plans are not necessarily the best, according to 2013 consumer satisfaction surveys conducted by J.D. Power & Associates. (more…)

Castlight Health Offers Employers a Cloud-based Price Transparency Tool to Help Employees Shop for Low-Cost, High Quality Health Services

Similar to Oscar Healthcare in New York, this California-based enterprise technology company offers services to make it easy for individuals to see providers’ prices, including medical laboratory test prices

Another company has entered the marketplace with their unorthodox business model to support health insurance programs. One cornerstone feature is a tool that enables both employers and beneficiaries to see the prices of different providers.

This young player in the health benefits marketplace is Castlight Health (NYSE: CSLT). Based in San Francisco, it was founded in 2008. One aspect of Castlight that pathologists and clinical laboratory managers may find particularly interesting is its price transparency tool. (more…)

Push by ACOs to Give Patients a Stake in Their Healthcare Provides Opportunities for Engagement by Clinical Laboratories and Pathologists

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…)

Why Health Insurers Want to Pre-Authorize Genetic and Expensive Clinical Pathology Lab Tests

McKesson Corp. and MuirLab working to implement lab-friendly strategies to meet payer needs

Unfolding events make it likely that genetic testing will become a good news/bad news story for local clinical laboratories and pathology groups. The good news is that genetic tests and molecular assays will bring more diagnostic precision to patients and their physicians—and that points to an auspicious future for pathology and laboratory medicine.

The bad news is that payer requirements in the United States for pre-authorization of genetic tests may lock-out most local laboratories as providers for these specialized and important clinical laboratory tests. That’s the irony of this developing trend!


New Managed Care Contract Opportunity for Clinical Labs and Pathology Groups

As health insurers build patient-friendly web sites, they now want all the lab test data

For laboratories wanting to contract with managed care plans, it will soon be “all about the data.” In upcoming contract renewal talks, expect health insurers to have a keen interest in working specifically with those clinical laboratories and pathology groups which can interface and electronically provide lab test data.

Dark Daily is first to identify this important development. It creates an opportunity for local laboratories to contribute added value to payers in their region. There is a specific reason for this increased interest. Health insurers are building information-rich Web sites for their insured beneficiaries. It is now important for them to have laboratory test data that they can use to populate the digital health record of their beneficiaries.