Tag: utilization management

Anthem Launches Program to Manage Genetic Tests

CEO SUMMARY: Pre-authorization of genetic tests is coming to physicians serving patients insured by Anthem, Inc. Its specialty benefits management company, AIM Specialty Health, will manage the program. AIM will work with InformedDNA, a company that specializes in genetic testing clinical decision support and genetic counseling for health insurers. Anthem has about 40 million members

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Cigna Expands Program For Genetic Counseling When Genetic Tests Are Needed

CEO SUMMARY: For three years, Cigna has required genetic counseling for members seeking genetic testing for hereditary breast, ovarian, and colorectal cancer, and for a particular heart condition. Such counseling increased member satisfaction, causing Cigna to expand the program. It now requires genetic counseling with an independent board-certified genetics specialist for members considering whole exome

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New Company Tracks Details and Prices For 60,000 Molecular and Genetic Tests

CEO SUMMARY: Advances in the speed, accuracy, and cost of next-generation gene sequencing making it possible for clinical labs to create thousands of new tests. How many new tests? NextGxDx, an information technology company, says the nation’s clinical laboratories are introducing new molecular and genetic tests at the rate of 10 per day! The company,

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Lab Test Utilization Delivers Big Gains at Cleveland Clinic

CEO SUMMARY: Since the launch of a laboratory test utilization program in 2011 at the Cleveland Clinic, more than 35,000 duplicate or inappropriate test orders have been stopped. The test utilization team introduced five initiatives that are not designed to cut spending but to introduce evidence-based and consensus-driven methods to lab-test ordering. Another benefit is that needless blood draws are being eliminated, thus improving patient care and satisfaction.

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Some Florida Docs Are Not Using BeaconLBS System

CEO SUMMARY: Some physicians in Florida are not complying with UnitedHealthcare’s laboratory benefit management program since the claims impact took effect on April 15. Although officials from UnitedHealthcare and BeaconLBS, a business division of LabCorp, state publicly that the program is going well, physicians and several state medical associations continue to voice serious objections to several key elements of UnitedHealthcare’s lab test utilization management program.

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Increasing Costs for Genetic Tests Are Busting Lab Budgets

CEO SUMMARY: Across the nation, hospital administrators are recogniz- ing that effective lab test utilization is a critical factor in a lab’s success. At Seattle Children’s Hospital, clinical pathologists, clinical chemists, and labora- tory genetic counselors are using an innovative utilization management pro- gram to ensure the appropriate use of genetic and molecular tests. They also formed Pediatric Laboratory Utilization Guidance Services. In two years, PLUGS has gained 32 members, including seven hospital labs serving adults. Interest in utilization management is driven by a desire to decrease test order- ing errors and to control the cost of send-out tests.

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Pathologists Contribute To Care in Wisconsin ACO

CEO SUMMARY: From the launch in 2013 of a big accountable care organization in Wisconsin, the North Shore Pathologists at Columbia-St. Mary’s Hospital have been involved. Among the lessons learned are the importance of structuring the pathology contract with the hospital to anticipate value-based reimbursement and having full access to the ACO’s data. The pathologists are using this data to develop test utilization programs that help physicians order the right lab test for the right patient.

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