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Molecular Pathology and Managed Care: Challenges and Opportunities.

Ross Jeffrey S. M.D.
Diagnostic Molecular Pathology: August 1998
Original Articles: PDF Only

The inherent costs of sophisticated molecular-based diagnostic tests are of significant importance to managed care organizations. Providers of molecular diagnostic services have emphasized that these tests can provide a reduced length of stay for hospitalized patients resulting from earlier definitive diagnosis, a reduction in the use of less expensive nondefinitive tests, a reduction in expensive ancillary diagnostic services such as radiologic imaging and endoscopies, an enhanced ability to predict disease outcome and responses to various expensive therapies, and new programs in detecting disease risk and maintaining patient wellness. In order for these newer molecular-based tests to be included in the list of covered services by the health maintenance organizations (HMOs), the clinical value and potential cost-benefit ratios must be articulated to the medical directors, administrative officials, and subscribers of the HMOs by the molecular diagnostic test providers.

(C) Lippincott-Raven Publishers.