Modern point of care lab benefit management is a must for payers, hospitals and other health systems. While it is estimated that lab testing represents less than 3% of total U.S. healthcare spending, it is the single highest volume activity in medical care, with an estimated 4-5 billion test performed in 2017 at a total cost of $113 billion2. Payers and providers alike are dealing with expanding test menus, growing lab costs, the use of lab data in pay for performance strategies and tracking quality metrics1. The results of those tests impact an estimated 70% of all decisions regarding a patientā€™s diagnosis and treatment, so it is important to make sure lab testing is used correctly, to support better patient outcomes while also controlling costs. Ā BeaconLBS provides solutions for all key stakeholders through point of care technology deployed in the physician workflow to ensure that lab test utilization is appropriate and that the right patient receives the right test at the right time.

Inappropriate lab testing, which includes both over- testing and under-testing, has been a concern due to rapid growth of lab test utilization8. While many have speculated that repeat and redundant testing play a large role in inappropriate lab utilization, a recent study demonstrated that nearly 44% of initial tests are inappropriate1Ā and could result in costlier and incorrect downstream care1. One recent example from the literature3Ā reported on the findings of a team of experts who examined 200 random cases of patients being evaluated for a bleeding disorder at a large center that provided both primary and tertiary care. They found that test overutilization, too many tests or the wrong tests, and underutilization, meaning that testing and diagnostic opportunities were missed, resulted in a diagnostic error rate in 155 of the 200 cases (77.5%) causing delays in delivering proper care and resulting in significant downstream costs that could have been avoided if test ordering was appropriate3.

Beacon LBS Lab Benefit Management Leads to Improved Evidence Based Care and Lower Costs

Changing how physicians consider lab testing at the point of care has been identified as a key component of lab benefit management1,6. The BeaconLBS clinical decision support platform is integrated into over 30 different EMRs and lab ordering systems, so it fits right in to the physician workflow. A stand-alone web based portal is available, too, for those who prefer a more direct approach. Use of the platform in the Florida market from 2014 to 2018 for 79 tests resulted in significant improvements in use of evidence based guidelines to drive test utilization. The 79 tests that would most likely benefit from point of care decision support were identified from a review of claims data and then correlated with tests that had evidence based professional or governmental recommendations or guidelines, and the recommended point of care education, messaging, steerage and question sets were reviewed and approved by clinical and laboratory experts on BeaconLBSā€™ national clinical advisory board. The platform has now been used by over 85,000 physicians for 550,000 patients. Its use has improved lab utilization and resulted in a 46% improvement with physician compliance with evidence-based test ordering, and a 19% reduction in patient out-of-pocket cost5.

The platform is highly customizable to address initial testing, repeat testing, steerage to in-network quality labs (i.e. Labs of Choiceā„¢), and the unique requirements of specialty testing such as genetic testing, tumor profiling and toxicology. The principles of the BeaconLBS lab benefit management platform are based on research5,6Ā focus on education, guidance and management, and can be tailored to meet specific needs.Ā  Features include:

  • Education on evidence based guidelines
  • Decision support messaging on guidelines
  • Policy development and management
  • Utilization management reports
  • Out of pocket member cost transparency
  • Privileging of ordering providers
  • Advanced notification options
  • Prior authorization
  • Laboratory test formulary
  • Customized, combined interventions

In addition, the BeaconLBS platform offers claim editing and special lab management tools. BeaconLBS has registered over 90% of the labs in the United States, and mapped their tests to lab benefit management policies. As a result, BeaconLBS has one of the largest current comprehensive database of lab test of any company or organization. BeaconLBS provides a free consultation service to review your lab utilization data and provide you with a comprehensive report on how to improve test utilization and provide better care for your members while driving savings to your bottom line.

Set up a consultation today by filling out ourĀ contactĀ form. Donā€™t forget to sign up to get notified when new articles are published. In the coming weeks we will be diving deeper into topics critical for lab benefit management, such as understanding genetic testing costs, the concerning growth of toxicology tests, how to identify and work with quality labs, and many more.

References:

  • Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R (2013) The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis. PLoS ONE 8(11): e78962.
  • https://www.prnewswire.com/news-releases/the-clinical-laboratory-services-market-is-projected-to-reach-usd-14614-billion-by-2022-from-usd-11344-billion-in-2017-at-a-cagr-of-52-300580348.html as accessed on April 2, 2018
  • Sarkar MK1, Botz CM2, Laposata M2. Diagnosis (Berl). An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time. 2017 Mar 1;4(1):21-26. doi: 10.1515/dx-2016-0042
  • Geoffrey S. Baird, Petrie M. Rainey, Mark Wener, Wayne Chandler Reducing Routine Ionized Calcium Measurement Clinical Chemistry Mar 2009, 55 (3) 533-540; DOI: 10.1373/clinchem.2008.116707
  • Internal dataĀ https://www.beaconlbs.com/about-us/Ā as accessed on April 2, 2018.
  • Baird G. The laboratory test utilization management toolbox. Biochemia Medica. 2014;24(2):223-234. doi:10.11613/BM.2014.025.
  • Burns J. Health Plans Deploy New Systems To Control Use of Lab Tests. MANAGED CARE October 2014 Available at: https://www.managedcaremag.com/archives/2014/10/health-plans-deploy-new-systems-control-use-lab-tests