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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McKinsey Study Confirms Trend Toward Narrow Healthcare Networks on Health Insurance Exchanges; Smaller Clinical Laboratories and Pathology Groups Often Excluded

Ongoing shift to narrow provider networks excludes many medical laboratories, thus causing them to lose access to patients served by these networks

If there is any single trend that has worked against the clinical and financial interests of community clinical laboratories and hospital/health system lab outreach programs, it is the trend of narrow networks. When medical laboratories and other providers find themselves excluded from a payer’s provider network, they lose access to the patients served by that network.

Thus, it won’t be good news that a major consulting company has confirmed that the trend of narrow payer networks is intensifying. The study was conducted by healthcare consulting firm McKinsey and Company.

McKinsey concluded that insurers participating in the government’s Healthcare Exchanges continue to move toward narrow networks of healthcare providers. This trend often leaves smaller clinical laboratories, hospital lab outreach programs, and anatomic pathology groups on the sidelines as insurers attempt to reduce costs. (more…)

Some Accountable Care Organizations Are Showing Improved Patient Outcomes and Lower Costs: Still Unclear How Payment Will Be Made for Clinical Laboratory Tests

Clinical laboratories and anatomic pathology groups should develop business strategies designed to support better patient outcomes and reduced costs for ACO patients

Accountable Care Organizations (ACO) are not only growing in number but some ACOs are also reporting outcomes that indicate their value-based reimbursement model may produce better results for patients than traditional fee-for-service (FFS) medicine.

For the pathology profession, this news further emphasizes the need for medical laboratories and group pathology practices to have a seat at the table during the organization of ACOs so they can make a clinical contribution and negotiate adequate reimbursement from the fixed fees paid to ACOs. At the moment, one big question for labs is how they are to be paid under  a value-based reimbursement model. (more…)

Ranking of Nation’s 15 Biggest Accountable Care Organizations (ACOs) Shows Fast Growth of this Model of Integrated Clinical Care

Across the nation, as many as 500 ACOs are organizing or already delivering clinical services to as many as 43 million Americans

There is no better way to track the progress of accountable care organizations (ACOs) than to monitor a list of the largest ACOs in the United States. Many pathologists and clinical laboratory managers already serve patients who are enrolled in ACOs.

Oliver Wyman, a consulting firm headquartered in New York City, is tracking the development of ACOs in different regions of the nation. It recently published the statistics on the number of ACOs and estimated ACO enrollment.
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Clinical Pathology Labs Take Note! Six ACO Early Adopters Seek Accreditation from NCQA

Clinical laboratory managers and pathologists can expect ACOs to impact competition for laboratory services

Six accountable care organizations (ACO) stepped up and applied for accreditation through the National Committee for Quality Assurance (NCQA). In many ways, this marks the beginning of the ACO era in American healthcare.

These six intrepid first-mover organizations will be familiar to most pathologists and clinical laboratory managers. In a recent press release, the NCQA announced their names. They are:

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