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Reimagine laboratory benefit management

Lab testing is the most utilized medical benefit, with 13 billion clinical lab tests performed each year. Of these tests, 30% are unnecessary. An absence of clinical efficacy data is making inappropriate utilization worse. This often leads to unnecessary interventions and costs.

To address this, Optum is collaborating with Avalon Healthcare Solutions, a leader in laboratory benefit management. Optum also has an exclusive partnership with Palmetto GBA, the administrator of the MolDX® Program, which identifies and establishes Medicare coverage and reimbursement for molecular diagnostic tests on behalf of the Center for Medicare and Medicaid Services (CMS). 

This joint offering helps you better align lab testing with clinical guidelines. The result: better care and proven cost savings, ranging from $1–$3 PMPM.

Laboratory insights

  

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Deep lab test knowledge

Over 140 evidence-based routine and genetic lab policies

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Automated policy adherence

Real-time clinical policy adherence enforcement

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Unique genetic test identification

An exclusive extension of Palmetto GBA MolDX® Program

Increased outpatient lab savings

Proven $1–$3 PMPM cost savings for health plans

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Realize cost savings with improved outcomes.