New or rebranded companies are emerging in the laboratory benefits manager (LBM) and prior authorization provider (PAP) space. What was once a small, fairly tame corner of American health care has become a hot spot because of uncontrolled costs and increasing numbers of tests, especially genetic ones. The LBMs and PAPs companies are bombarding managed care executives with intense marketing. Much of the marketing is incomplete and misleading. Companies are trying to apply the pharmacy benefits manager model to laboratory testing. However, managing pharmacy and laboratory costs are not the same, and some of these programs will add significant overhead and member and provider burdens. Here are some of the questions managed care executives should ask before contracting with an LBM or a PAP:
Charles Cini, Kentmere Healthcare Consulting Corporation
These questions show that the use of an LBM or a PAP should be just one of the potential results of your laboratory benefit management program, not the program itself. You shouldn’t have to pay for services you already provide yourselves or add a middleman that’s not necessary.