Up to 50% of Aetna, UnitedHealth Group, and Anthem Reimbursements Go to Value-Based Contracts; Clinical Laboratories Must Implement Value-Based Strategies to Remain Competitive

Aetna expects 75% to 80% of its medical spending will be value-based by 2020 Many pathologists and medical laboratory executives may be surprised to learn how quickly private health insurers are moving away from fee-for-service payment arrangements. According to Forbes, the nation’s largest health insurance companies now associate nearly 50% of reimbursements they make to value-based insurance initiatives. This is a sign that value-based managed care contracting continues to gain momentum. And...

When It Comes to Mining Healthcare Big Data, Including Medical Laboratory Test Results, Optum Labs Is the Company to Watch

Example is a big data-based study involving Optum and Mayo Clinic that indicates diabetes management can be too aggressive for some patients Mayo Clinic has tapped Optum Labs’ huge data set to fuel research suggesting diabetes management can be too aggressive among those diabetics who don’t have problems controlling their glucose level. Optum Labs’ data is also being mined to investigate dozens of research initiatives, including a major fight against Alzheimer’s disease. These projects provide...

Health Insurers Spending Big Dollars to Be Players in ‘Big Data’; Trend has Implications for Clinical Pathology Laboratories

With healthcare reform likely to limit their growth, health insurers are expanding into data management to create new revenue streams Faced with swift changes in healthcare, many of which are not favorable to the traditional business model of private health insurers, the nation’s largest payers are positioning themselves to be major players in the management of “big data.” That may have interesting implications for clinical laboratories and anatomic pathology groups, which typically generate...

Big Health Insurers Acquire Health IT Horsepower to Support Their Accountable Care Organizations

Actions by major insurers indicate that ACOs operated by hospitals will have competition Until recently, most media coverage about nascent accountable care organizations (ACOs) centered on the plans of major hospitals and health systems to organize ACOs within their communities. Now comes news that major health insurers are making sizeable investments as they prepare to launch their own ACOs. These developments could be auspicious for local clinical laboratories and anatomic pathology groups....