Federal Transparency Initiatives
The Federal Trade Commission (FTC) is pushing forward with transparency rules. Its aim is to reduce consumer risk in healthcare. Key areas include:
- Hospital price transparency
- Payer transparency
- The No Surprises Act
All three are aimed at requiring hospitals and payers to improve transparency for costs and services—empowering people to make choices about their care.
Interoperability is another important topic for the FTC. It’s defined as timely and secure access to data and data integration across health systems. Examples include:
- Digital prior authorizations (e-prior auth) to make prior auth faster and less burdensome
- Payer-to-payer data exchanges to streamline health processes
- “Gold card bills” already active in select states, empowering providers to procure determinations directly in their electronic health record systems
The LAB Coalition
The Laboratory Access & Benefits (LAB) Coalition was launched in July 2021 with a mission to bring together key stakeholders within the lab ecosystem to advocate for legislative and regulatory solutions to ensure high-value lab testing. It is a multi-stakeholder industry group.
Avalon, as a founding member, and other lab industry leaders are focused on:
- Ensuring consistent, reliable cost and benefit coverage
- Supporting quality oversight
- Promoting equitable access to lab tests
Advocacy areas include:
- Prior authorization
- Over-the-counter lab tests
- 21st Century Cures 2.0
- The VALID Act
The 2022 Lab Trend Report: Early Insights
Avalon’s Lab Trend Report is made up of data and insights from 40 million lives contracted through Avalon’s partnerships. The annual report is forthcoming and will include sections on:
- The lingering impact of COVID-19
- Market forces impacting the healthcare system
- Avalon’s view on healthcare trends
Lab Value Management
Three key insights from the webinar:
- COVID-19: The pandemic had a large impact in making up for depressed utilization of testing and in driving higher laboratory spend overall.
- Genetic Testing: A 17% compounded annual growth rate for genetic testing is accelerating spend in this exploding area; prenatal and preconception testing lead the growth.
- Place of Service: Hospital laboratory testing continues to have an outsized impact when it comes to billed costs. For certain organ disease panels, in a hospital laboratory a patient may pay up to 250% more than at another place of service.
