Along with six other provider advocacy groups, the College of American Pathologists (CAP) issued a letter on Jan. 26 requesting that UnitedHealthcare (UHC) discontinue its Designated Diagnostic Provider (DDP) program. The DDP program, which was introduced in July 2021, seeks to direct patients to preferred laboratories for outpatient clinical services, offering reimbursement only in cases where diagnostics are performed by laboratories with DDP status.
“We understand that cost and affordability are important factors in offering a value proposition in plan benefit design to your health insurance clients who purchase coverage for their employees,” the letter states. “However, when these beneficiaries become subject to narrow network constraints and their physicians, in turn, are forced to redirect referrals from their preferred pathology laboratories — where there has been a well-established and trusted care coordinating relationship — to new laboratories, we maintain that these barriers and burdens hinder care for patients and lead to counterproductive results regardless of a health plan’s intent to add transparency and promote cost management.”
The DDP program, according to the letter, may undermine confidence in the patient–physician relationship; lead to confusion for patients seeking diagnostic information; disrupt the chain of clinicopathological correlation; and disproportionately affect the ability of smaller laboratories to function.
Other professional societies and advocacy groups that have joined CAP in this endeavor include the American Medical Association, American Academy of Dermatology, American College of Obstetricians and Gynecologists, American College of Rheumatology, American College of Dermatopathology, and the Medical Group Management Association.
“[W]e ask UHC to invite all medical and hospital professional organizations to the table for a robust and constructive dialogue on how all parties can contribute to reaching a consensus that equitably advances value to covered beneficiaries and health plan purchasers,” the letter concludes. “Understanding the wide array of diagnostic laboratory services as well as appreciating the complexities associated with pathology services is the first step needed in designing value for patients, their ordering physicians, and their corresponding pathologists.”
For more information, visit: https://www.cap.org/advocacy/latest-news-and-practice-data/february-1-2022#story1
To view the full letter, visit: https://documents.cap.org/documents/uhc-ddp-jan-262022.pdf
