Employers Can Save Money by Adopting Self-funded Healthcare Models, and Clinical Laboratories Have Opportunities to Support These Plans

By negotiating directly with healthcare providers, employers cut health insurers out of the loop, at least for certain specified healthcare conditions and surgeries It’s a new trend in how employers provide healthcare benefits for their employees. In order to save money, a growing number of employers are going to low-cost hospitals, physicians, and other providers to contract directly for their services. This may be the opening that allows some clinical laboratories to approach larger...

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...

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...

HEDIS Data Provides Evidence that Physicians Are More Effective in Using Clinical Pathology Laboratory Tests Improve Patient Care

NCQA published annual report showing increased rates of screening for most of its HEDIS quality measures and medical laboratory testing often plays a role in these screening activities For almost a decade now, clinical laboratories and pathology groups have been asked by many private payers to provide laboratory test data for a number of clinical services. In turn, these private health insurers annually submit this data to the Healthcare Effectiveness Data and Information Set (HEDIS) program...

Behavioral Economics Likely to Push Up Utilization of Clinical Pathology Laboratory Tests

Wellness Programs Require Appropriate and Timely Use of Medical Laboratory Tests Pathologists and clinical laboratory managers know that smoking, obesity and unnecessary utilization are major factors in the skyrocketing cost of healthcare. These are primary reasons behind the desired transition from reactive and acute care to a health system organized to deliver proactive care. Consumer cooperation will be essential for this transition to succeed. Each year, the number of employer-funded or...
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