Lab Insights Solutions

Genetic Test Management

New advancements in genetic testing call for new ways to manage it.

75,000 genetic tests are currently on the market with 10 new genetic tests per day. The sheer volume of genetic tests and new tests make it difficult for health plans to stay up to date.1

1 in 3 genetic tests are ordered in error. Many of these patients do need a genetic test—just not the one that was ordered. Many providers have limited knowledge or experience with ordering and interpreting these, so test order errors are common. This translates to additional costs, but, more importantly, it delays lab results, diagnoses, and treatments for patients.2

Even though genetic testing makes up a small percent of today’s lab spend, it’s the fastest growing component of lab testing. Health plans are responding by increasing their prior auth team and services or outsourcing genetic testing to a lab benefits manager to handle the increasing complexity.   

Lucky for you, Avalon has the first end-to-end Genetic Test Management solution to simplify the process and add clarity. Our prior authorization capability is a pre-service review that manages utilization in line with evidence-based guidelines to ensure appropriate care. The ordering physicians or laboratory providers receive approval before performing testing on members. This alters the care pathways for members with orders for high-cost genetic tests before laboratories conduct those tests. Avalon focuses on peer-to-peer consulting to help the physician order the right test and right treatment. This helps improve the appropriateness of their ordering over time. Genetic counselors are also available if needed for ordering physician or patients.  

Sources:
1. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1427
2. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis 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://doi.org/10.1371/journal.pone.0078962

Avalon’s Lab Insights Solutions work together to arm you with critical lab-driven insights to accelerate your value-driven care success. ​
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Avalon’s Genetic Test Management solution is efficient with over 80% of Prior Authorizations submitted electronically, cost effective with 4:1 ROI, and leads to the right care for the member.

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