Apr 22, 2009 | Laboratory News, Laboratory Pathology
As out-of-pocket costs for health care rise, consumers are motivated to manage their own care and insurers are providing them tools to make the job easier. The latest innovation, which is available exclusively to WellPoint and North Carolina Blues plan members, is a consumer rating system from Zagat that helps people shop for doctors.
This interesting new development was recently the subject of a detailed intelligence briefing in April 6, 2009 issue of The Dark Report. The Zagat Health Survey is designed to be both doctor friendly and easy for patients to use. It does not address physician quality. Rather, it offers a snapshot of individual physicians-based on criteria that impact the consumer experience. Clinical laboratory managers and pathologists will eventually need to respond to this trend. That’s because, as it becomes more common for consumers to rate providers, health plans will begin asking their beneficiaries to rate the service they received from medical laboratory test providers.
Patients are asked to rate a physician on four criteria, using a scale of 0 to 3, with 3 being excellent. Zagat then averages consumer scores for a physician and multiplies by 10 to create the familiar Zagat 0-30 number ratings. Reviewers are also asked if they would recommend the doctor to other plan members.
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Aug 11, 2008 | Laboratory News, Laboratory Pathology
Fewer than 10% of U.S. physicians prescribe drugs electronically, according to The Wall Street Journal. Furthermore, only 35 million of the 3.6 billion prescriptions dispensed by U.S. retail pharmacies are sent electronically. One factor discouraging wider acceptance of electronic prescribing is the resistance of older physicians to any change their long-established habits. By contrast, young physicians leaving medical school are fast to adopt e-prescribing when it is available in general practice settings.
There are many advantages to electronic prescriptions. Probably the most significant benefit is prevention of medication errors. The Institute of Medicine of the National Academies reports that more than 1.5 million times per year an error in medication leads to patient injury in the U.S. Another major-and oft-overlooked-feature of electronic prescribing is that many electronic systems are capable of identifying generic substitutes for brand name drugs. That saves patients money. Blue Cross and Blue Shield of Massachusetts reports that members who receive electronic prescriptions save, on average, about $250 per year on maintenance medications. Some electronic prescription software is even capable of choosing drugs that comply with a patient’s particular type of insurance.
As a way to motivate doctors to make the switch to electronic prescriptions, some private insurers offer financial incentives and subsidies to help with the cost of this technology. State and national programs are available to ease the technology and implementation costs of the transition, thus lowering the cost for doctors to adopt e-prescribing. In Ohio, WellPoint, Inc. pays 1% above the regular fee schedule to physicians who prescribe electronically. In the Northeast, WellPoint will pay as much as 6% above the regular fee schedule to physicians who use electronic prescriptions to achieve certain performance metrics.
About 70% of pharmacies-including all major chains-are already connected and capable of accepting electronic prescriptions. Experts say that it will soon be common for physicians to use smart phones to transmit prescriptions live from a patient’s room. Laboratories should take note of this slow, but forward progress toward e-prescribing. That’s because, as more physicians begin actively using an e-prescription service, they will want direct electronic access to lab test data.
Related Articles:
- Digital Prescriptions Gain Favor
- Digital prescriptions gain favor, except with docs
Oct 25, 2006 | Laboratory News, Laboratory Pathology
Remember Medicare+Choice during the 1990s? That was the private sector Medicare HMOs encouraged by Congress during those years. Now the program is back, in a new form. In August, The Wall Street Journal reported that hundreds of thousands of seniors are signing up for private fee-for-service Medicare Advantage plans. These plans deliver traditional benefits without the usual restrictions on access to doctors and hospitals. Some of the nation’s biggest health insurers, such as WellPoint and Humana, are launching more such plans and marketing them in more areas.
Medicare Advantage plans are set up so that the federal government pays a flat rate to insurance companies to manage care, rather than paying beneficiaries’ claims directly. To encourage seniors to sign up for these plans, the cost to the patient for private plans are cheaper, on average, than those for traditional Medicare fee-for-service program. The government recently raised the reimbursement rates for Medicare Advantage plans to $10,000 per enrollee per year. This has motivated insurers to reduce premiums and add additional benefits, such as vision insurance and prescription drug discount plans, to attract more seniors to enroll in the private Medicare Advantage insurance plans.
Enrollment in Medicare Advantage plans jumped to 802,068 as of August 1, up from just 20,000 three years ago. Seniors like the plans because they offer more freedom of choice in doctors in contrast to Medicare Advantage HMOs and PPOs. Those plans may provide no coverage or lesser coverage if patients go outside of the plan’s provider network of doctors and hospitals.
WellPoint will be offering Medicare Advantage fee-for-service plans in all 50 states by 2007. Humana, which already offers the plans in 35 states, and WellCare Health Plans, also plan to expand the geographic area of their fee-for service offerings during the next 12 months.
The rise in private fee-for-service plan participants is likely to be felt strongly by laboratories doing business in rural areas. The new arrangements of Medicare Advantage plans encourage rural patients, physicians, and hospitals to participate. This was not true of Medicare+Choice in the 1990s because of the closed provider panels and restrictions on utilization of services by patients. For local laboratories in urban areas, increased enrollment in Medicare Advantage plans may cause them to lose access to those patients. That’s because the private payers offering Medicare Advantage plans often only incorporate the national laboratories as network providers.
We will also note that enrollment in Medicare Advantage is likely to increase only as long as Congress is motivated to fund Medicare Advantage plans generously. A change in leadership in Congress or the Administration may lead to reduced support for private sector solutions in the Medicare program.
See Seniors Flock to Private Medicare Plans for the complete article.
