Health systems such as the Cleveland Clinic years ago began implementing test utilization management systems, and more recently a number of outside vendors have moved into the business.
Reducing the cost of routine lab testing, which account for 90% of overall test expenses, shows promise in helping reduce costs for insurers.
"I think we have known that laboratory testing has been a driver of costs for some time, and exactly the best way to manage that large space with a lot of transactions, at typically a lower average cost than some of our other claims that come in, can be quite problematic," said Rahul Singal, chief medical officer for Avalon Healthcare Solutions. "We can't take time and review each and every request for a thorough medical necessity evaluation, yet we know that [lab testing] is not always being applied in a way that leads to better health-care outcomes."
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