Jun 29, 2012 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations
Price transparency expected to encourage competition among healthcare providers, including medical laboratories
Before consumers visit a clinical laboratory, they can now check the “fair” price of medical laboratory tests. New websites have sprung up that make it easy for consumers to find what experts consider to be fair market prices for each type of lab test, as well as for other medical procedures and healthcare services.
Pathologists should think of the well-known “Kelly Blue Book” that has been the price authority for prices of new and used automobiles for decades. These new medical price websites are easy to use and make it quick for a consumer to find “fair” prices for common clinical laboratory test and medical procedure.
These new web-based companies are organized to serve the needs of consumers who are enrolled in high-deductible health plans (HDHP). For an individual, an annual deductible can be as high as $2,500—and as much as $5,000 for a family. Thus, clinical laboratory managers should not be surprised that consumers are actively price-shopping before they visit their laboratory to have a specimen collected.
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May 23, 2012 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Pathology
Goal of unique collaboration is to give physicians a more accurate way to diagnose and treat many types of cancer
Two noteworthy healthcare organizations will collaborate with IBM (NYSE: IBM) to explore how IBM’s Watson can be used to help physicians deliver improved outcomes to patients. The collaboration involves one major health insurer and a prominent academic medical center in Los Angeles.
WellPoint, Inc. (NYSE: WLP) will interact with oncology experts at the Cedars-Sinai Cancer Institute in Los Angeles to “educate” and program Watson as a physician’s assistant. What makes this particularly interesting for anatomic pathologists is the potential of this project to marry advances in molecular diagnostics with artificial intelligence in ways that allow physicians to diagnose different cancers earlier and with greater accuracy.
In its story about this development, the Los Angeles Times reported that, per IBM, physicians at Cedars-Sinai Medical Center’s Samuel Oschin Comprehensive Cancer Institute will be the first to use the Watson technology.
The institute’s doctors will serve as advisers and lend expertise to help shape the initiative to develop effective ways to use Watson. “Cedars Sinai will provide the guidelines and insights to put into Watson,” stated Manoj Saxena, General Manager of IBM Watson Solutions, in a story published by Forbes Magazine.
Watson is IBM’s computing system that incorporates deep question answering technology that allows it to search quickly through vast amounts of data, then process it and analyze it in a way similar to that of the human brain. The Watson system is capable of processing the equivalent of about 200 million pages of data in about three seconds, Forbes reported.
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Nov 4, 2011 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Private payers taking first steps on a path toward value-based purchasing that could eventually include clinical pathology laboratory testing services
Pay-for-performance just took a leap forward with news that one of the nation’s largest health insurers will link hospital reimbursement to specific quality measures. This development could be a precursor to similar payer initiatives that involve how private payers reimburse clinical laboratories and anatomic pathology groups.
Indianapolis-based WellPoint, Inc. (NYSE: WLP) will revamp the way it reimburses about 1,500 hospitals across the country. In a news story published by Bloomberg Businessweek, Rick Wartzman, Executive Director of the Drucker Institute at Claremont Graduate University, explained that, going forward, WellPoint wants to base annual payment increases to hospitals using a formula that incorporates the health insurer’s quality criteria, rather than to the quantity of services delivered.
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Aug 10, 2009 | Laboratory Management and Operations, Laboratory Pathology
While no one was looking, nine big insurers grabbed 76.7% of privately-insured patients!
Consolidation of major health insurance companies in recent years is a trend which reinforced the market clout of the nation’s two largest lab companies at the expense of local laboratories and pathology groups. However, few pathologists and clinical lab managers know precisely how much market power is currently concentrated into the hands of only a few health insurance companies.
Dark Daily now unveils a remarkable analysis. At this moment, just nine companies control 76.7% of all privately-insured individuals in the United States! Moreover, the three biggest of these health insurance firms—UnitedHealth Group, WellPoint, and Aetna—collectively cover 85.6 million of the185 million Americans enrolled in private health plans. That’s 48.3% of the total U.S. market.
As shown in the table below, when the other six companies are added—Humana, HealthCare Service Corp., Cigna Group, Kaiser, Highmark and Health Net—the nine biggest health insurers cumulatively insure 141.9 million of the 185.1 million Americans with private health insurance—or 76.7% of the total.
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Jul 6, 2009 | Laboratory News, Laboratory Pathology
Rescinding health policies of 20,000 people in past five years saved health insurers $300 million
For years, Americans have heard news stories about the sick patient whose health insurance policy was rescinded in the midst of a health crisis. Now comes public acknowledgement—at a Congressional hearing no less—that this business practice exists!
Executives from three of the nation’s largest health insurers admitted to this practice when testifying at a Congressional investigation recently. Observers believe the surprisingly candid acknowledgement about health insurance recissions pretty much guarantees insurers will be excluded from the health care reform debate. It may even ensure inclusion of a government health insurance plan in the final legislation which passes. (more…)
