HEALTH PLAN Solution #3

Cost Control through Leakage Management

Laboratory ‘Leakage’ can be defined as the use of non-participating or non-contracted laboratory services by either the patient or the patient’s doctor.

 

On average, laboratory services performed by a non-participating laboratory costs three times the services of a participating (contracted) laboratory.

 

Now there are several reasons why a physician office or a patient might use the services of a non-participating laboratory:

  • The physician office prefers to send all of their laboratory work to a single lab as a means of maintaining consistent results and to establish a reliable work flow for the office staff. Typically, this lab holds contracts for the majority of insurance plans accepted by that office.

  • The physician office may have experienced issues with the quality or service of the contracted lab.

  • The out-of-network lab may have some affiliation with the PO such as is the case with lab testing that is sent to a hospital outreach laboratory service.

  • The out-of-network lab may offer services that may be considered as a compliance restriction for other labs (e.g., the lab performs services other than is directly associated to laboratory testing such as electrocardiograms or the filing of patient charts).

Leakage Management requires coordination between the participating laboratory network and the health plan. The health plan must identify the non-compliant physician offices on a regular basis so that the laboratory networks may attempt to move the laboratory testing away from the non-participating laboratory.

 

Quite often, the contracted lab will meet with resistance as described in the above bullets. These physician offices that are opposed to a change to a contracted laboratory must be documented so that they can be monitored and managed to compliance. Halfpenny Technologies facilitates the management of this issue through its Leakage Management Program.

 

Using CRM (customer relations management) technology, Halfpenny processes health plan leakage information and produces leads that are forwarded to the participating laboratory network. These leads are matched to contracted laboratories by both geography and by specialty. In this manner, the physician office is only approached by laboratories that are capable of servicing the unique needs of their practice. The participating laboratories report on the status of the conversion via the CRM. Reports for both successful and non-successful office conversions are generated for review by the health plan so that alternate strategies may be deployed only where necessary.

 

The result is a reduction in the leakage cost!
 

To learn more about the bottom line benefits that a managed laboratory network can offer to your health plan, contact us today.