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February 6, 2016 – 10:49 pm
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I began posting blog notes about direct access testing (DAT) some ten years ago (see, for example: Reinventing Direct Access Testing (DAT)) DAT, also called consumer directed testing, enables consumers to order lab tests for themselves via web sites in those states where it is legal. Even in states where it is prohibited, there were work-arounds using physician networks employed by the web site and providing MD test approval in the background. Quest even had a DAT subsidiary called QuesTest but exited this market in 2006 (see: QuesTest Bails Out of the DAT Market).

Although it has not emphasized its participation, LabCorp seems to have served as the back-end lab for most if not all DAT web sites. These web sites developed computer interfaces to LabCorp with PDF reports then sent to the web sites for customer retrieval. This LabCorp participation became obvious to consumers ordering tests because they were instructed to report to LabCorp patient service centers for their blood draws. It was recently revealed that LabCorp is now entering the DAT market with its own branded product (see: The Doctor Is Out: LabCorp to Let Consumers Order Own Tests). Below is an excerpt from the article:

Consumers will soon be able to bypass their doctors by going online to order cholesterol readings, thyroid tests and other bloodwork from the biggest diagnostics company in the U.S. Laboratory Corp. of America Holdings will let customers go online to pay for tests, visit a service center to get blood drawn, then view the results on the Web. The company has already been doing back-office lab work for a number of Internet firms that let people order up tests without a doctor. Rapid and at-home diagnostics are a growing corner of the health-care market, with businesses like WellnessFX Inc. and Direct Laboratory Services LLC tapping into demand from patients who want to get sensitive results in private or seek to monitor their health outside of the traditional doctor’s office.

Companies like LabCorp are tapping into demand from consumers who want to measure their bodies to monitor the effects of exercise and healthy living and to learn about their potential risks of disease.LabCorp is also facing competition as options emerge for consumers to get tests without visiting a service center at all. Startup Theranos Inc., founded in 2003, has developed a diagnostic kit available in some Walgreens locations that it says can provide a range of results, from lipid panels to the presence of HIV, with mere drops of blood. LabCorp’s direct-to-consumer business will initially be run online. The company is exploring a partnership with a drugstore chain as well - an idea that rival Quest Diagnostics Inc. tried and scrapped.

WellnessFX, based in San Francisco, charges $988 for its most comprehensive package, which includes biomarkers for omega-3 fatty acids and fibrinogen, a protein produced by the liver. Customers can go to a Quest Diagnostics center to do their bloodwork, and they can add a 40-minute consultation with a physician to discuss the results. DirectLabs, based in Mandeville, Louisiana, offers more routine tests like a $29 metabolic panel - glucose, kidney, fluids, electrolytes, calcium and liver - and a $49 measure of Prostate Specific Antigen, which the company says can be used to detect cancer. Lab operators like LabCorp and Quest Diagnostics are looking for new sources of revenue as they contend with lower reimbursement from insurers and Medicare. The recent movement by hospital companies to buy up physician-owned medical practices has also siphoned off some of the lab work that the major providers had traditionally done.

I have covered Theranos in detail in the past which not only threatens the LabCorp and Quest business models but also those of the major in-vitro diagnostic companies (see: Finally, Some Important New Details about the Theranos Business Model). I also posted a note suggesting that the business models of Quest/LabCorp were suffering from the double whammy of lower reimbursements and the loss of private physician office business (see: Quest Diagnostics and Lab Corp Business Models Becoming Obsolete). I should emphasize, however, that Quest is still showing great quarterly profits. To offset a future anticipated loss of revenue, LabCorp now seems to be wisely expanding its business model to include DAT business.

We are now seeing some segmentation of the DAT market with WellnessFX offering a very expensive set of tests, including some esoteric tests, and an optional MD consultation. Quest provides the lab testing at the back-end. By way of contrast, DirectLabs offering inexpensive testing which has historically been the niche of most of the web-based DAT sites. This allowed them to appeal to cost-sensitive consumers, some of which were uninsured or had high-deductible health plans.

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