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.
Deep lab test knowledge
Over 140 evidence-based routine and genetic lab policies
Automated policy adherence
Real-time clinical policy adherence enforcement
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
Align lab testing with clinical guidelines
We bring you:
- Deep lab test knowledge and expertise
- Unique genetic test identification
- Automated lab policy adherence technology and prior authorization services
This helps to ensure that routine and genetic lab testing follows guidelines in an automated, scalable way.
Routine lab testing is anything but routine
The industry’s only automated routine test management solution ensures lab testing follows clinical guidelines. This solution evaluates lab claims in real time. Proprietary technology uses thousands of rules to check that lab tests are appropriate and consistent with your policies.
A new way to manage genetic testing
We bring you comprehensive genetic test policies and prior authorization services alongside unique genetic test identification. This helps physicians to order the correct genetic tests, paving the way to innovations in utilization management.