The most frequently reported impact of managed care was a reduction in the number of specimens submitted to the laboratory for testing. Seventeen of the 49 PHL directors (35%) reported that managed care had led to a decrease in the number of specimens sent to the laboratory. Reports of testing decrease as an impact of managed care were directly related to the level of managed care penetration in the state. PHLs in states with high managed care penetration had a greater probability of associating managed care with reduction in testing volume. Some PHL directors specified the types of tests for which volume was decreasing, and others indicated specific initiatives (e.g., Medicaid managed care) as contributing to a general decrease in testing at the PHL.The results from the poll are corroborated by our findings from the case studies and interviews. The Tennessee PHL director reported that TennCare, the state's managed Medicaid program, has indirectly resulted in a reduction in test volume for the state's PHL. The PHL traditionally conducted much of the patient testing for the Medicaid population. However, with the implementation of TennCare, Medicaid patients were covered by MCOs that chose to subcontract for laboratory services with large independent reference laboratories like LCA, thereby bypassing the PHLs.
Other state PHLs have also suggested that managed care is indirectly affecting their testing volume, either for all tests or for specific tests that are of public health importance and do not necessarily affect the treatment of individual patients (e.g., blood lead testing). Kansas's state PHL estimates that it has seen a 5-8% decrease in testing volume, due in part to the presence of managed care. States such as Connecticut, Maine, and Wisconsin have also noted decreases in the number of specimens seen by the laboratory. Four other PHLs have reported a decrease in the number of blood lead tests performed by their laboratories.