Friday, March 6, 2015

Two Online Articles on Payer Utilization Controls for Diagnostics

The trade journals DARK DAILY and MANAGED CARE published two separate articles on rising utilization controls on diagnostic tests.

The links are here:

Managed Care:  (here, 3000 words)...  Health Plans Deploy New Systems To Control Use of Lab Tests 

Dark Daily: (here, 1500 words)...  As Medical Laboratory Test Utilization Grows, Health Insurers Develop Programs to Manage Rising Costs

Sound bite [Dark Daily]:

After seeing a rise in the volume of clinical lab tests physicians order, managed care plans are develop a variety of strategies to manage utilization and costs
Health insurers are taking more aggressive actions to control the cost of clinical laboratory testing. For many years, clinical laboratories and pathology groups have been concerned about the strategies used by Medicare to control the utilization and costs of medical laboratory tests. Private health insurers usually follow the actions of Medicare, the nation’s largest health insurer. But today, managed careplans are developing their own lab-test-utilization strategies in addition to following those of Medicare.
Recently, Managed Care magazine explained many of the steps health insurers take to keep the costs of clinical laboratory tests under control. The cover story in the October issue of the magazine, “Health Plans Deploy New Systems To Control Use of Lab Tests,” outlined how health insurers Cigna, Group Health Cooperative, Priority Health, and UnitedHealthcare (UHC) are managing lab test utilization.