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...

Clinical Laboratories and Pathology Groups May See Fewer Fee-For-Service Payments as More Hospitals and Health Systems Become Self-Insured

As national health insurers push more risk to hospital systems and medical groups, many hospital administrators become more interested in establishing their own health insurance companies New modes of provider reimbursement—such as bundled payments and budgeted payments—are motivating hospitals and health systems to reconsider their existing relationships with health insurers. Hospital administrators want to control the dollars they save by improving patient care, instead of allowing insurance...

Trend of Hospitals Re-entering the Health Insurance Market May Benefit Hospital Laboratories

As ACO movement gathers momentum, hospitals and health systems see opportunities in providing health insurance Hospitals and health systems are getting back into the health insurance business. Not only is this seen as an opportunity created by the development of accountable-care organizations (ACOs), but it may help the clinical laboratories of these same hospitals that serve office-based physicians in their communities. This trend is another result of the Obamacare legislation. Some hospital...

UnitedHealth to Acquire Brazil’s Largest Private Health Insurer for a Price of $4.9 Billion

UnitedHealth’s acquisition of Brazil’s Amil is another example of healthcare’s globalization and may open door for clinical laboratory acquisitions in Brazil UnitedHealth Group (NYSE: UNH) is buying an HMO in Brazil. The two players are the largest insurers in their respective countries. For pathologists and clinical laboratory professionals, this merger demonstrates that the trend toward globalization of healthcare—including laboratory medicine—continues one step at a time. Brazil’s Growing...

HEDIS Data Provides Evidence that Physicians Are More Effective in Using Clinical Pathology Laboratory Tests Improve Patient Care

NCQA published annual report showing increased rates of screening for most of its HEDIS quality measures and medical laboratory testing often plays a role in these screening activities For almost a decade now, clinical laboratories and pathology groups have been asked by many private payers to provide laboratory test data for a number of clinical services. In turn, these private health insurers annually submit this data to the Healthcare Effectiveness Data and Information Set (HEDIS) program...
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