Apr 21, 2011 | Laboratory News, Laboratory Pathology
Pathologists may be asked to do more consults by oncologists practicing in a medical home
Recently a pioneering oncology practice in Philadelphia was recognized by the National Committee for Quality Assurance (NCQA) as a medical home practice. Though the NCQA medical home program focuses on primary care, a few specialty practices have gained medical home recognition.
This is a milestone on the road to expanded use of the medical home care model. It is also an early warning to pathologists and clinical laboratory managers that other medical specialties may take steps to implement a medical home practice. It is believed that physicians practicing in this care model are likely to be more careful users of medical laboratory tests.
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Feb 12, 2007 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Kaiser Permanente has taken the radical step of introducing a new suite of consumer-driven products called Custom Care. This is the first time, since its founding more than 60 years ago, that Kaiser Permenante is offering a health insurance plan that is not based on its staff-model HMO. For lab directors and pathologists, this is an important sign of the steadily-increasing importance of consumer-directed health plans (CDHPs) in the American healthcare marketplace.
Kaiser Permanente first launched the Custom Care products in its California region in May 2006. According to the press release from Kaiser, “This new suite of Consumer Directed Health Care products offers a range of benefit design and financial accounts options, along with online health information, decision support tools, incentive and discount programs, and access to Kaiser Permanente’s integrated delivery system. Kaiser Permanente Custom Care provides customers with additional options to actively manage their health care expenses and provides consumers with the tools to become more active participants in managing their health care services and costs.”
Based on response to the response of its test marketing of Custom Care insurance products, an emboldened Kaiser upped their stake in CDHPs by launching Custom Care HealthInvestor HSA. These plans became effective on January 1, 2007. HealthInvestor combines a Wells-Fargo-administered health savings account with a high-deductible health plan in which members pay a larger share of bills in exchange for lower premiums. Kaiser does not expect people to flock to this new plan model, but says that it is laying the ground work for the future of health care. “It’s a new business strategy for us, “said Kaiser spokeswoman Beverly Hayon in the August 14, 2006 issue of Modern Healthcare, “to be much more responsive to the marketplace in terms of what our employers need and what individual consumers are looking for.”
Laboratories should take note that, when an organization the size of Kaiser Permanente feels obligated to offer consumer-driven health care options after 60 years of offering only HMO products, other large insurers cannot be far behind. Consumers enrolled in consumer-driven healthcare plans are more likely to be highly involved in their health care and to only want the bare minimum of health care services. They are also likely to shop around to find a fair and reasonable price for such services.
Laboratories and pathology groups need to track the progress of the CDHP trend. Consumers covered under high-deductible policies and HSA plans are being educated to shop carefully for healthcare providers and to use both price and quality to guide their decisions. To be competitive and to serve the changing expectations of patients, laboratories and pathology groups will need to create services that are patient-friendly and deliver this care in a cost-effective fashion.
Oct 25, 2006 | Laboratory News, Laboratory Pathology
Remember Medicare+Choice during the 1990s? That was the private sector Medicare HMOs encouraged by Congress during those years. Now the program is back, in a new form. In August, The Wall Street Journal reported that hundreds of thousands of seniors are signing up for private fee-for-service Medicare Advantage plans. These plans deliver traditional benefits without the usual restrictions on access to doctors and hospitals. Some of the nation’s biggest health insurers, such as WellPoint and Humana, are launching more such plans and marketing them in more areas.
Medicare Advantage plans are set up so that the federal government pays a flat rate to insurance companies to manage care, rather than paying beneficiaries’ claims directly. To encourage seniors to sign up for these plans, the cost to the patient for private plans are cheaper, on average, than those for traditional Medicare fee-for-service program. The government recently raised the reimbursement rates for Medicare Advantage plans to $10,000 per enrollee per year. This has motivated insurers to reduce premiums and add additional benefits, such as vision insurance and prescription drug discount plans, to attract more seniors to enroll in the private Medicare Advantage insurance plans.
Enrollment in Medicare Advantage plans jumped to 802,068 as of August 1, up from just 20,000 three years ago. Seniors like the plans because they offer more freedom of choice in doctors in contrast to Medicare Advantage HMOs and PPOs. Those plans may provide no coverage or lesser coverage if patients go outside of the plan’s provider network of doctors and hospitals.
WellPoint will be offering Medicare Advantage fee-for-service plans in all 50 states by 2007. Humana, which already offers the plans in 35 states, and WellCare Health Plans, also plan to expand the geographic area of their fee-for service offerings during the next 12 months.
The rise in private fee-for-service plan participants is likely to be felt strongly by laboratories doing business in rural areas. The new arrangements of Medicare Advantage plans encourage rural patients, physicians, and hospitals to participate. This was not true of Medicare+Choice in the 1990s because of the closed provider panels and restrictions on utilization of services by patients. For local laboratories in urban areas, increased enrollment in Medicare Advantage plans may cause them to lose access to those patients. That’s because the private payers offering Medicare Advantage plans often only incorporate the national laboratories as network providers.
We will also note that enrollment in Medicare Advantage is likely to increase only as long as Congress is motivated to fund Medicare Advantage plans generously. A change in leadership in Congress or the Administration may lead to reduced support for private sector solutions in the Medicare program.
See Seniors Flock to Private Medicare Plans for the complete article.
