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…)

Aetna is Sued by California Medical Societies and Doctors over Its Out-of-Network Policies

It is not known whether any clinical laboratories or pathologists are plaintiffs in this unusual lawsuit of providers versus health insurer

When it comes to out-of-network policies, clinical laboratories clinical laboratory are not the only unhappy class of providers. In California, a coalition of healthcare organizations, physicians, and providers is suing the nation’s third-largest health insurer for its policies and practices relating to out-of-network providers.

It was in July when the Los Angeles County Medical Association (LACMA), California Medical Association (CMA), and various healthcare organizations and providers filed a lawsuit against Aetna Health of California, Inc. (Aetna CA). Aetna CA is a division of Aetna Health Management (NYSE:AET), based in Hartford, Conn. (more…)

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