Shifts in the Lab Ecosystem: Transparency and Unnecessary Testing


Avalon Healthcare Solutions hosted a webinar on federal policy news and laboratory trends. Julie Barnes, the Principal of Maverick Health Policy, spoke alongside Brett Meeks, Executive Director of the Lab Access & Benefits (LAB) Coalition.

Multiple Federal Rules and Regulations Coming
Julie Barnes gave a snapshot of the numerous regulatory changes coming next year. There are multiple requests for information currently out, which means federal agencies are requesting input from the private/industry sector to comment on proposed policy changes. 

NCQA Innovation Summit
The NCQA Innovation Summit occurred last week and highlighted progress on health plan quality measures, which are critical to continuous improvement. Maverick Health Policy summarized many of the sessions at the summit.

U.S. Government Accountability Office Report & Senate Finance Committee Concerns
The GAO recently published a report on the payer market illuminating the top payers. This report revealed how consolidated the market has become. The report names the main insurance players in each market vertical.

Senate Finance Committee Chair Ron Wyden will likely engage in a dialogue on what should be allowed when Medicare Advantage plans are marketed to seniors. There may be new regulatory activities because Congress is interested in tracking the use of marketing tactics.

Electronic Prior Authorization Continues to Move Forward
There is agreement amongst those in Washington that the prior authorization process needs to be streamlined. It would be beneficial for both providers and patients to have an automatic way to connect the electronic health record to the plan’s system. Electronic prior authorization would mean efficient, real-time decision-making on coverage questions. A proposed rule is expected soon.

LAB Coalition
Brett Meeks introduced the LAB Coalition as a consortium of thought leaders who are advocating for legislative and regulatory solutions. The LAB Coalition is focused on:

  1. Cost and reimbursement: Ensuring consistent and reliable costs for lab services
  2. Oversight and regulatory authority: Improving oversight and validation for high-quality lab testing
  3. Medical necessity and prior authorization: Modernizing coverage determinations for lab services
  4. Access, equity, and value-based arrangements: Providing equitable access to lab services

Post-Election Analysis
The Republicans did not take the Senate, which means it is at least a 50-50 split (Georgia as of the webinar had not reported an outcome). This outcome has political meaning for confirming judges, and for whether Vice President Kamala Harris will have to be involved to break ties (in the event of an evenly divided Senate). We will not know all the implications until mid-December.

A few other key takeaways include:

  • There was no “red” wave and many candidates endorsed by former President Donald Trump did not win.
  • Florida Gov. Ron DeSantis won big.
  • The country is more evenly divided.
  • Candidate quality does matter (i.e. voters chose candidates with political expertise rather than household names).
  • In Brett’s analysis, healthcare isn’t a large focus for the GOP right now.

In the coming weeks, determinations will be made on key committees in the U.S. House of Representatives. The remainder of 2022 will be busy with government funding running out Dec. 16, which means there may be a new budget package.

Healthcare Challenges
Bill Kerr, CEO of Avalon, closed the webinar. Healthcare is a large industry that makes up 19% of the U.S. gross domestic product (GDP) and continues to grow. Challenges face the industry moving forward without significant change in solving the excess in healthcare; solutions could include leveraging technology and telemedicine to do right by all stakeholders.

Lab Trend Report
The Lab Trend Report is available now on Avalon’s website to download. The report addresses market forces affecting lab spend and health plans, Avalon’s view of lab trends, and Lab Values Management through data.

Register for the September Webinar

Tuesday, September 17
2 – 3 p.m. EDT

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