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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Doctors Tell News Reporters about their Frustration with UnitedHealths Choice of LabCorp

When UnitedHealthcare decided to make Laboratory Corporation of America its exclusive national contract laboratory, effective January 1, 2007, it certainly set itself up for objections from doctors and patients who would be upset at the exclusion of Quest Diagnostics as a UnitedHealth laboratory provider.

Now UnitedHealth has triggered another round of complaints from physicians by suggesting that it could fine a doctor $50 if his or her patient has tests done by a laboratory other than LabCorp or one of the other in-network labs. Doctors with patients who go out-of-network could also be subject to lower reimbursement and even exclusion from UnitedHealthcare’s network.

The Associated Press wrote a story about these unhappy doctors and their criticism of UnitedHealth’s new policies limiting choice of laboratories and threatening penalties for non-compliance. In response to press inquiries, Tyler Mason, a UnitedHealthcare spokesman, said the policy is not intended to punish doctors for the choices of their patients, but to remind doctors to refer patients to labs in the network. He said UnitedHealthcare would not fine doctors if a patient defies their referrals and selects a non-network lab. Mason suggested that the fine scenario was “very unlikely.”

The news of this potential fine hit the airwaves the same day, February 14, 2007, as a press release from Quest Diagnostics that revealed the results of a study conducted by independent market research organization National Analysts Worldwide. The study interviewed a representative sample of physicians that had experience with both Quest Diagnostics and LabCorp over the past 6 months. It revealed that physicians with “a preference overwhelmingly chose Quest Diagnostics over Laboratory Corporation of America Holdings (LabCorp)… Physicians also were asked to rate Quest Diagnostics and LabCorp on 11 key elements of laboratory service. Quest Diagnostics outscored LabCorp on every measure.”

However, Quest Diagnostics has already told Wall Street analysts that it expects to lose 100% of its UnitedHealth lab testing business by the end of this year. Based on that fact, it appears that having network status as a contract laboratory trumps superior service – at least where UnitedHealth patients are concerned.

Dark Daily observes that UnitedHealthcare’s bold move to restrict a doctor’s choice of laboratories appears to be succeeding. The upcoming February 19 issue of The Dark Report will have an in-depth analysis of the market changes triggered by the January 1 effective date of the new UnitedHealth contract with LabCorp. What bears watching in the coming months is whether the protests of irate doctors and patients will be strong enough to cause UnitedHealth to backpeddle on its efforts to force contract compliance on laboratory referrals. Further, if UnitedHealth succeeds in lowering its laboratory testing costs by a significant amount because of this contract strategy, that success could embolden other payers to implement similar restrictive laboratory contracting arrangements.

United Health Disrupts the National Contract Status Quo Between the Two Blood Brothers

It was major news yesterday when the public learned that UnitedHealth Group Incorporated had awarded an exclusive, 10-year national contract for laboratory testing services to Laboratory Corporation of America. UnitedHealth is the nation’s second largest health insurance company, with approximately 26 million beneficiaries. LabCorp says it should see an additional $3 billion in revenue during the 10-year term of its pact with UnitedHealth.

This new contract takes effect on January 1, 2007. After that date, Quest Diagnostics Incorporated ceases to be a contract provider of laboratory services to UnitedHealth beneficiaries, with a few exceptions. Quest Diagnostics acknowledges that its UnitedHealth book of business represents 7% of total revenues, or about $385 million per year. That business is now at risk, for a number of reasons.

What is big news for LabCorp and Quest Diagnostics is likely to be a “ho hum” for most other laboratories. That’s because they are already excluded from lab testing contracts with UnitedHealth. What may be of more immediate impact to hospital lab outreach programs and independent laboratory companies is the fact that LabCorp will be developing contract networks for UnitedHealth in selected regions around the United States. Depending on the prices and terms of such contract networks, local labs may find it advantageous to participate to gain access to UnitedHealth beneficiaries.

As to the two blood brothers, Dark Daily predicts the capture of UnitedHealth’s business by LabCorp will intensify competition between the two billion-dollar behemoths. Quest Diagnostics will not lie down and cede the UnitedHealth business to LabCorp. Nor will LabCorp be anything but aggressive about exploiting this opportunity. From this perspective, news that LabCorp has been granted an exclusive, 10-year lab testing services contract with UnitedHealth Group is just the first round. Stay tuned, because the battle is about to get nasty. Check out coming issues of The Dark Report for additional intelligence about this tectonic shift in national lab contracts.

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