Surviving PAMA: Keep an Eye on Industry Disruptors

A talking point of a G2 Lab Institute 2018 presentation deserves closer attention, especially given its implications for the lab industry.

"Advantages and Disadvantages Confronting Labs in a Post-PAMAgeddon World," was the title of the Lab Institute session led by Lâle White, executive chairman and CEO of XIFIN, a health information technology company that leverages diagnostic information to improve the quality and economics of healthcare.

Changing Landscape

As part of her presentation, White looked at industry disruptors, with a focus on how consumerism and data analytics shape the future of healthcare delivery.

She cited these partnerships as examples of macro trends, noting the following activity:

• Amazon – Chase – Berkshire Hathaway Alliance
  • Already obtained licenses for durable medical equipment (DME) distribution in 48 states
  • Could partner with pharmacy benefit managers (PBMs)
  • Amazon and Echo capabilities (schedule office visit; virtual house calls)
  • AI based in-home healthcare and diagnostics

• CVS – Aetna Merger and Cigna/Express Scripts
  • Both mergers designed to control rising medical costs and provide data analytics
  • CVS has 9,700 pharmacies and 1,100 walk-in clinics (Minute Clinic vs. ER option or physician visit)
  • Three largest PBMs become vertically integrated with insurers (United Health Care/Catamaran)

• Walmart – Humana
  • Combining retail pharmacies with a PBM
  • Data analytics building a 360 view of consumer
  • Medicare Advantage growth – better care at lower cost
  • Delivering care close to consumer

• Pharma Invests in Labs (Novartis, Roche, Opko)
  • Companion deals drive therapeutic drug sales
  • Big Data (next-generation sequencing) identifies cancer related DNA
  • Big Data helps physicians optimize test orders and treatment choices
  • Big Data helps manage population health and control medical costs

Implications of Disruption

White discusses these partnerships in relation to the Protecting Access to Medicare Act (PAMA), but arguably this disruption will have far-reaching impacts on healthcare and diagnostic testing.

Going forward, the healthcare industry, including labs, will be driven by:

• consumer preference for convenience;
• solutions that allow for increased capture and sharing of data;
• solutions that streamline care;
• attention to cost control; and
• technology and alliances that enable all of the above.

This is not an "in the future" scenario – it's happening now.

Is your lab prepared?