Kaiser Family Foundation Estimates Approximately 16% of US Population Uninsurable under Pre-ACA Underwriting Standards

As the latest attempts to replace the Affordable Care Act (ACA) generate increased debate over protections for pre-existing conditions, Kaiser Family Foundation highlights that using pre-ACA underwriting guidelines would result in an estimated 52-million Americans unable to obtain coverage With the American Health Care Act (AHCA) clearing the House on the way to the Senate, the public and media are scrutinizing key points. One highly-contested topic is insurance availability for people with...

Healthcare Big Data Drives a New Round of Collaborations between Hospitals, Health Systems, and Care Management Companies

Recently-announced partnerships want to use big data to improve patient outcomes and lower costs; clinical laboratory test data will have a major role in these efforts In the race to use healthcare big data to improve patient outcomes, several companies are using acquisitions and joint ventures to beef up and gain access to bigger pools of data. Pathologists and clinical laboratory managers have an interest in this trend, because medical laboratory test data will be a large proportion of the...

Walmart Health Plan Praised as Affordable, Superior Option to Obamacare Exchange Coverage While Offering Expanded Provider Networks

Yet financial pressures on insurers continue to increase premiums and potentially squeeze reimbursement rates for clinical laboratories and pathology groups Walmart shoppers expect to find low prices on the retailer’s shelves, but the discounter’s full-time employees may be surprised to learn their company healthcare plan is also a low-cost leader. This is a significant finding and is significant for pathologists and clinical lab managers because the Walmart health benefit plan includes an...

Pathologists and Clinical Lab Executives Take Note: Medicare Has New Goals and Deadlines for Transitioning from Fee-For-Service Healthcare Models to Value-Based Reimbursement

Alternative payment models and value-based payment schemes create financial unknowns for clinical laboratories and anatomic pathology groups What happens to pathologists and clinical laboratories when fee-for-service reimbursement ceases to be the primary payment method for anatomic pathology services and medical laboratory tests? After all, fee-for-service reimbursement for lab tests is what underpins today’s financial model for lab test services. Under this transaction-based business...

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...