With Theranos deal, Capital BlueCross aims to disrupt markets--even its own

Earlier this month, Pennsylvania-based Capital BlueCross announced a new partnership with lab-testing company Theranos, the health startup that performs routine lab tests with only a fingerprick's worth of blood.

The venture could be a step in the right direction for insurer initiatives to promote price transparency throughout the industry, FierceHealthPayer previously reported.

"We are always on the lookout for new ways to disrupt our markets, even our own," Aji Abraham, Capital BlueCross's senior vice president of Business and Network Development, told FIerceHealthPayer in an interview.

The insurer recognized the variation in lab-testing costs for its members and decided that investing in the startup would be a wise move.

"There are some 200-odd tests Theranos does with only a drop of blood, as opposed to a full-blood draw," Abraham said. "Now, members get the same results within 24-48 hours or less instead of waiting a week or two to hear back. This has a huge impact for our members."

As the industry as a whole moves in a more consumer-centric direction, enhancing price transparency--and, in turn, fulfilling the triple aim--remains high on the list for both insurers and providers.

"This venture hits the triple aim for us," Abraham said. "For starters, it's less painful for members to get bloodwork done so now they're more inclined to get the testing. For providers, they can get their patients' results back fast. Lastly, the price is right: The pricing is 50 percent lower than the Medicare reimbursement rate."

Promoting price transparency is no easy feat. As Abraham noted, every market is different, as is every payer-provider relationship. Recent analysis points out that in order for the industry to move paying for value rather volume, payers need to assist providers, most notably in terms of developing reports that can help providers manage patient information.

"It's hard to get to that trusting payer-provider relationship," Abraham said. "A lot of times, even if a payer has a good relationship with a hospital, the hospital may not want the insurer knowing its rates. Our new collaboration with Thernaos is looking to change the way insurers and providers team up with one another."

Abraham mentioned it's important for insurers, and providers, to look at the bigger picture. "We're focusing on global risk, accountable care organizations and most importantly, how we can all work together to promote care for our members," he added.

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