This section describes how state PHLs are responding to health market changes, including the growth of managed care. The types of responses range from specific subcontracts for select services negotiated between some state PHLs and private laboratories and/or MCOs, to various types of public-private collaborations (e.g., formation of public-private Clinical Lab Advisory Council in Washington State). In other instances, the PHL responses have involved proactive strategic planning of the laboratory's operations to better meet the needs of the MCOs and of the larger group of laboratory service purchasers. In addition, some state PHLs have discontinued certain types of laboratory services that directly compete with the larger, independent reference laboratories.
The collaborations between PHLs, MCOs, providers, and commercial laboratories vary tremendously in scope and duration. In our informal poll, 15 PHL directors (31%) reported either a contractual or other type of collaborative relationship with MCOs, providers, or private laboratories (see Figure 17) in their state, but information on the level of interaction suggested very limited and specific arrangements.
Of these contracted or other types of collaborative arrangements, most were between PHLs and private laboratories, with only five relationships reported between PHLs and MCOs. Interestingly, the probability that a state reported being involved in collaborations with managed care organizations or commercial laboratories was unrelated to the level of managed care penetration in the state. Of the 34 PHLs reporting no current involvement in contractual or collaborative relationships, seven reported an interest in future contracting with MCOs. However, it should be noted that failure to indicate a future interest in contracting with MCOs does not necessarily indicate that such an interest does not exist on the part of the laboratory.
Figure 17: Public/Private Collaboration
Our poll of PHL directors found six PHLs reporting involvement in collaborative arrangements with MCOs or commercial laboratories B three specified that the collaboration was with the MCOs, and three specified that the collaboration was with commercial laboratories. The nature of these collaborative arrangements included joint participation in disease surveillance programs, drug resistance surveys, and dialogue on clinical laboratory issues that affect both public and private laboratories.
Several of the collaborative efforts can be characterized as preliminary in nature. For example, in Vermont, the state PHL, 15 hospital-based laboratories, and a private commercial laboratory are beginning to meet formally to discuss laboratory issues of common interest. The North Carolina PHL is entering into a dialogue with private laboratories about the effect of hospital consolidation on all parties. New Mexico's PHL is also in the process of working with MCOs, the state health agency, and hospitals to conduct statewide surveys of anti-microbial resistance.