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 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 because fewer health plans on the exchange means less access to patients. It also means that the remaining health insurers are taking steps to further narrow their existing networks in order to curb expenses by limiting options.

The new report published by McKinsey and Company reveals that insurers are moving towards plans that offer fewer options for consumers, mostly due to losses suffered on the health exchanges. The report, titled, “2017 Exchange Market: Plan Type Trends,” states that in 2017 a majority of the healthcare plans (about 75%) available to consumers under the Affordable Care Act (ACA) will be Health Maintenance Organizations (HMOs) and other similar limited-option plans, such as Exclusive Provider Organizations (EPOs).

EPOs are a hybrid of HMOs and PPOs and share some common options from both. Of the states investigated, McKinsey found that about 15% of customers eligible for ACA exchanges will have no PPOs available to them. (more…)

Narrow Networks Mean Shrinking Opportunity for Pathology and Clinical Medical Laboratories

Pathology groups and medical laboratories may benefit if federal and state legislators legislate broadening of provider networks

Insurers are increasingly using narrow networks as a business strategy to control costs. As a consequence, more consumers are complaining even as some excluded providers are suing health insurers. For pathologists and clinical laboratory managers, this accelerating trend of excluding providers means increasingly restricted access to patients.

Health Insurers Walk a Fine Line between Cost and Access

Many health plans currently sold on the new state insurance exchanges offer substantially smaller networks of providers than was typical in recent years, according to a story published in Modern Healthcare. The payers say narrower networks are necessary for two reasons.

First, narrow networks can keep premiums affordable. Second, health insurers say narrow networks help them address the requirements of the Patient Protection and Affordable Care Act (ACA). (more…)

Gen Y Entrepreneurs Launch Oscar, a Consumer-Friendly Health Insurance Company in Bid to Disrupt Traditional Health Insurers

In New York City, innovative clinical laboratories have the opportunity to become a network provider for the region’s newest health insurance company

Three Generation Y entrepreneurs are ready to take on traditional health insurers with their own innovative health insurance company. They claim their novel start-up can better meet the new consumer expectations and behaviors within the insurance industry. If correct, their venture could disrupt the post-Obamacare insurance world.

Game-changing Health Insurance Company?

The Gen Y trio is made up of Josh Kushner, Kevin Namezi, and Mario Schlosser. They recently launched Oscar Health Insurance, based in New York. Kushner is the founder of the tech investment firm Thrive Capital. Kevin Nazemi, Oscar’s president, is a former director of healthcare for Microsoft Corp. (NASDAQ: MSFT). Mario Schlosser is a former McKinsey & Company computer scientist. (more…)

Hospitals Report Growing Levels of Bad Debt as Many Patients with High-Deductible Plans Are Unable to Pay Their Medical Bills

Pathology groups and clinical laboratories should be taking steps to collect from patients at the point of care, as a key strategy to minimize patient bad debt

Here’s some bad news for hospital Chief Financial Officers (CFOs) and an early warning for clinical laboratory administrators. A rising number of patients with high deductible health plans (HDHPs) are unable to pay their medical bills.

Enrollment in HDHPs has soared in recent years because more employers and health insurers have adopted these plans. HDHPs also are called consumer-directed health plans (CDHPs) and typically have annual family deductibles of between $5,000 and $10,000. (more…)

Aetna CEO Warns of Approaching Health Insurance ‘Premium Rate Shock’ in 2014 for Consumers and Others Under Affordable Care Act

Steep increases in insurance costs may leave patients with less money to cover deductibles and copayments for clinical laboratory tests

Next year, consumers and small businesses can expect what one health insurance CEO says will be, “Premium rate shock for 2014.” As this happens, clinical laboratories and pathology groups are likely to find it even more difficult to collect co-pays, deductibles, and out-of-pocket fees from patients who had medical laboratory tests performed.

The premium rate shock remark was made by no less than Mark Bertolini, the CEO of Aetna, Inc. (NYSE: AET). In his speech at an investor conference, he predicted premiums would rise by 20% to 50% next year before the government subsidies are applied. In some markets, rates could double, he added.

Aetna is not alone in seeking steep hikes in health insurance premiums. Blue Shield of California is seeking a rate increase of 12% to 20% for more than 300,000 individuals, The Los Angeles Times reported. These new rates would go into effect in March, the company said. (more…)