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Proactive management in the managed care era.

J S Parrott1

  • 1Medical College of Virginia Hospitals and Physicians, Virginia Commonwealth University, USA.

Clinical Laboratory Management Review : Official Publication of the Clinical Laboratory Management Association
|August 5, 1998
PubMed
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Preparing clinical laboratories for managed care requires understanding evolving health maintenance organization (HMO) strategies. Developing analytical skills in physician data and costs is key for future success in managed care contracting.

Area of Science:

  • Healthcare Management
  • Clinical Laboratory Science
  • Health Economics

Background:

  • Managed care and health maintenance organizations (HMOs) significantly impact clinical laboratory operations.
  • Evolving corporate strategies and contracting models present ongoing challenges for laboratories.
  • Employers often lack data-driven approaches for selecting HMOs, hindering quality-based competition.

Purpose of the Study:

  • To outline strategies for clinical laboratories to prepare for the future impact of managed care.
  • To emphasize the importance of data analysis and strategic knowledge for laboratory success.

Main Methods:

  • Analysis of corporate strategies within health maintenance organizations (HMOs).
  • Evaluation of managed care contracting trends.

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  • Assessment of employer selection criteria for HMOs.
  • Identification of key data points for laboratory analysis (physician ordering, HMO information, costs, capitation rates).
  • Main Results:

    • Clinical laboratories face challenges due to evolving HMO strategies and contracting.
    • Lack of data utilization by employers in HMO selection limits laboratory competition on quality.
    • Developing analytical skills is crucial for navigating the managed care landscape.

    Conclusions:

    • Clinical laboratories must proactively adapt to the complexities of managed care.
    • Enhanced analytical capabilities regarding physician data, HMOs, costs, and capitation are essential for future viability.
    • Strategic preparation is vital for laboratory managers to ensure success in a managed care environment.