Lab testing in the United States plays a crucial role in patient care, driving about 70% of clinical decisions, yet it remains a largely under-managed medical expense. With over 14 billion tests performed annually at a cost of $85 billion, routine and genetic lab testing significantly influence healthcare spending. The rapid increase in available tests, especially in genetics, raises costs and complexity. Despite its common use, lab testing often bypasses prior authorization, making it vulnerable to overuse, fraud, and inefficiencies like panel stuffing and unnecessary repeated tests. Additionally, the location of testing can lead to considerable differences in patient costs.

To address this growing challenge, health plans are increasingly recognizing the importance of specialized Lab Benefits Managers. LBMs not only reduce fraud and waste but also provide critical oversight by implementing science-based policies and real-time claim reviews to ensure only clinically necessary and valid tests are approved. Their capacity to analyze lab data for population health trends enables plans to intervene earlier and allocate treatments more effectively. As healthcare costs continue to escalate, leveraging LBMs offers a strategic and sustainable way for payers to control expenses while enhancing patient outcomes.

Read the full article at Managed Healthcare Executive.