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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Attention Pathologists! MD Anderson and UnitedHealthcare Ink Bundled Payment Agreement for Cancer Care

If bundled payment becomes more common in treatment of cancer, then anatomic pathologists need a strategy to demonstrate their clinical value to physicians and payers

MD Anderson Cancer Center and UnitedHealthcare (NYSE: UNH) announced a bundled payment agreement for the treatment of certain types of cancer. This development has implications for anatomic pathologist who provide cancer testing services to hospitals throughout the United States.

The new three-year pilot at MD Anderson’s Head and Neck Center in Houston, Texas, is the first use of a bundled payment model in a large, comprehensive cancer center. Officials say it is expected to lower costs while improving the quality of patient care and outcomes. As many as 150 patients with head and neck cancer who are enrolled in employer-sponsored UnitedHealthcare (UHC) plans will participate in the pilot.

“For the last five years, MD Anderson and its Institute for Cancer Care Innovation have been looking at how to best approach a single price for treating cancers. It is a complex question because cancer is a complex disease and each patient unique,” stated Thomas W. Feeley, M.D., Head of Anesthesiology and Critical Care, and Head of the Institute, in an MD Anderson news release. “Bundled pricing is something that patients and care providers want, and this is our first opportunity to better understand how we can manage costs without sacrificing quality care and patient outcomes.” (more…)

In Florida, UnitedHealthcare’s New Clinical Laboratory Benefit Management Program Triggers Objections from Physicians and Excludes Most Medical Laboratories

College of American Pathologists and associations for family physicians and ob-gyns in Florida have asked UnitedHealthcare to discontinue implementation of BeaconLBS system

Medical laboratory testing is at the center of a contest of wills in Florida. On one side is a health insurer that wants to require physicians to obtain pre-notification or preauthorization for a list of clinical laboratory tests. On the other side are the physicians who question the clinical basis for these requirements and the time and resources required to comply with the health insurer’s program.

This rancorous dispute is in reaction to the laboratory benefit management program created by UnitedHealthcare (NYSE: UNH) (UHC) administered by BeaconLBS, a business division of Laboratory Corporation of America (NYSE: LH) (LapCorp). (more…)

Promising Diabetes Prevention Programs Are Fueling Shift toward Wellness-focused Care and May Encourage More Utilization of Clinical Laboratory Tests

Predictions are that more disease-prevention programs will be developed, creating the opportunity for laboratories to be more proactive in helping clinicians keep patients well

Pathologists and clinical laboratory managers take note! The Centers for Disease Control and Prevention (CDC) is accumulating a growing body of evidence that its community-based diabetes prevention program is effective at improving the health of participating patients.

These auspicious findings may encourage a steep increase in the number and type of disease-prevention programs. In turn, greater deployment of such programs could further accelerate healthcare’s shift away from a reactive treatment of disease model to a proactive disease prevention model of care.

Such developments would be favorable for medical laboratories and pathology groups. As physicians pay more attention to diagnosing disease at earlier stages, they will want to tap the expertise of pathologists, Ph.D.s, and laboratory scientists. (more…)

Cigna to Preauthorize Genetic Tests

Clinical laboratories and pathology groups serving Cigna beneficiaries can expect to see new requirements for genetic tests used to diagnose breast cancer, colon cancer and long QT syndrome

Effective this week, Cigna (NYSE: CI) in Bloomfield, Connecticut, is implementing a new program that requires genetic counseling and pre-authorization for certain genetic tests. This is an important development and clinical laboratory executives can expect to see other health insurers take similar steps.

Cigna wants to control costs and improve the appropriateness of ordering expensive genetic tests. It will start with tests for three conditions and may require counseling for other types of genetic tests if this program is successful. Industry observers expect other health insurers will follow Cigna’s example and also require genetic counseling for a compelling reason: all insurers recognize that more than 50% of all genetic tests may be ordered inappropriately, experts say.


Illumina Is Using Acquisitions to Challenge Roche in Fast-growing Market for Gene-based Clinical Pathology Laboratory Testing

Hot competition for genetic testing market share is a signal to medical laboratories to ramp up their molecular and genetic testing capabilities

Financial analysts see something of an “old west” style shootout on the horizon for genetic testing in the clinical laboratory testing market. Market leaders in next-generation gene sequencing are prepared to use acquisitions to build dominant shares in a gene testing market that experts say could hit $25 billion by 2022.

Reporters at Bloomberg Businessweek believe that San Diego-based Illumina, Inc. (NASDAQ: ILMN) is girding up to take on industry giant Roche Holding AG (ROG.VX). Both Illumina and Life Technologies Corp. (NASDAQ:LIFE) are buying up smaller players in the gene testing market.

These two market leaders in DNA sequencing equipment have played important roles in revolutionizing genetic testing. Now, they intend to stake out a share of the fast-growing genetic diagnostics market themselves, a recent Businessweek story reported. (more…)