Dec 27, 2013 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Healthcare Experts Now Exploring New Care Coordination Strategies and Overcoming Gaps in Measuring Performance
For many healthcare professionals, the jury is still out as to whether accountable care organizations (ACOs) will prove effective at delivering the two important goals of improved patient outcomes at a lower overall cost of care over an extended period of time.
That is why close attention is being given to the experience of Medicare’s Pioneer ACOs, since they were among the first ACOs to begin delivering clinical services. In particular, physicians and hospital administrators want to learn useful lessons from the successes and setbacks of the different Pioneer ACOs.
By improving the coordination of care, accountable care organizations are expected to provide patients with better care while reducing healthcare costs. That’s why the Center for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program is structured to pay ACOs financial incentives or impose penalties, depending on whether performance quality measures and healthcare spending targets are met. (more…)
Dec 9, 2013 | Coding, Billing, and Collections, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
Healthcare’s coming shift from fee-for-service to value-based reimbursement creates both a crisis and an opportunity for clinical laboratories and pathology groups.
With the era of fee-for-service medicine under siege, every clinical laboratory and anatomic pathology organization needs a strategy for getting paid, as new reimbursement models that support patient-centric care will make up a larger portion of lab revenues. Unfortunately, few real-world examples exist today to guide clinical laboratory executives as they develop these strategies.
Patient-centric medical care is an important goal for every healthcare provider. Patient-centered medical homes are enjoying strong growth and acceptance. Accountable care organizations (ACOs) are designed to serve the individual needs of each patient. Meanwhile, hospitals and physicians are getting better at measuring patient satisfaction because health plans are basing payment on these scores. (more…)
Nov 4, 2013 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Management & Operations
With payouts riding on patient outcomes and value, ACO providers will welcome innovative services that clinical labs and pathologist could provide that improve patient outcomes
Both private health insurance companies and employers are betting on value-based insurance as the key to improving healthy behavior in patients. This will require more patient engagement in managing their chronic conditions. It will also include motivating patients to consider less expensive treatment options, particularly when the more expensive treatment path has limited benefits.
In this way, accountable care brings the patient into picture. It is a trend that opens the door for innovative clinical laboratories and anatomic pathology group practices to develop medical laboratory testing services that payers and employers recognize as contributing to improved patient outcomes—and for which they will adequately reimburse the laboratories providing these services.
Private Health Insurers Have More Flexibility in Design of Health Plans (more…)
Nov 1, 2013 | Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations
In September UnitedHealthcare and its collaborators announced plans to create what is planned to be one of the largest accountable care organizations in Wisconsin
As predicted, national health insurance companies are moving deliberately to be part of large accountable care organizations (ACOs). For example, in Wisconsin, three health systems and one of the nation’s largest health insurers are developing a multi-system accountable care organization designed to compete with the largest ACO in the state.
ACOs Expected to Use Medical Laboratory Testing in Different Ways
For pathologists and clinical laboratory executives, this development is a reminder that ACOs will play a significant role in healthcare’s transformation. Also, these super-sized ACOs will have their own influence on the transformation of medical laboratory testing in this country, since ACOs can be expected to use medical laboratory testing in different ways and are unlikely to use fee-for-service as the primary method of payment for laboratory testing.
In September when UnitedHealthcare (UHC) (NYSE: UNH) announced it was collaborating with two health systems to form an ACO in Wisconsin to cover 100,000 patients. A third health system (Ministry Health) joined the new ACO network a week later. UHC efforts are part of a nationwide strategy to double what it spends to provide care in ACOs. (more…)
Oct 16, 2013 | Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Sales and Marketing, Management & Operations
Recent hospital mergers are creating super-sized health systems that immediately gain leverage over insurers when negotiating managed care contracts
Experts say the nation is experiencing its biggest surge in hospital mergers in more than a decade. Moreover, this latest wave of deals is creating supersized hospital systems that are expected to dominate healthcare and possibly lead to higher healthcare costs.
The ongoing consolidation of hospital ownership means further consolidation of the hospital laboratories that find themselves merged into larger health systems. That will have both good and bad consequences for pathologists and medical laboratory managers working within these organizations. (more…)
