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Laboratory Benefit Management

Manage all routine and genetic lab testing spend using evidence-based guidelines and greater automation.

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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.

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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

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Increased outpatient lab savings

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

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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.

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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.

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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.

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Realize cost savings with improved outcomes.

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