Optum is launching a new health plan solution that aims to reduce unnecessary testing and ensure that patients are receiving the screenings that are best for them.
The laboratory benefit management tool will assist insurers in aligning lab tests with clinical guidance and will automate large parts of lab benefit administration, Optum said in an announcement provided first to Fierce Healthcare.
The company estimates that insurers could save between $12 to $36 per member per year, or about $3 billion.
Tests that lack clinical indications can lead to unneeded sample collection form patients as well as a higher risk of false positive results, which can compound unnecessary healthcare costs. There is a dearth of industry standards and efficacy data around lab tests, making it common for results to be misinterpreted or tests to be misused.
The tool is now available to all health plans, Optum said.
Robert Mayer, senior vice president and general manager at Optum, told Fierce Healthcare that the team first began looking at this issue due to concerns around genetic testing, which led to digging further into the cost and quality of routine testing as well.
He said that most health plans were managing the costs around genetic tests through prior authorization, which can prevent unnecessary utilization but doesn't fully get at the potential issues around the quality and efficacy of testing. Optum, instead, is aiming to harness data to match patients with the tests that are best for their unique needs.
Routine testing, meanwhile, represents a huge untapped area to address cost and quality, Mayer said.
"It's been around forever, it's a massive cost curve," he said. "It's vastly undervalued and the opportunities there are substantial."
In addition to the headaches that unnecessary testing can cause for insurers, it's also a pain point for members. Patients use their coverage for testing frequently, and an abundance of tests is something they're going to feel acutely, Mayer said.
As part of the solution, Optum will tap clinical experts within the company to develop evidence-based policies around lab testing and to evaluate new tests as the market rapidly evolves.
“Testing is expanding so rapidly that most clinicians do not have the bandwidth to stay up-to-date on which ones are the highest quality. As clinicians, we all want reliable test results as we make decisions for our patients,” Jill Hagenkord, M.D., chief medical officer at Optum Genomics, said in a statement. “This laboratory benefit management solution leverages deep clinical expertise to help guide clinicians to the tests with the highest clinical validity and utility.”