Some healthcare organizations, including our own, are working to establish a rational and transparent coding scheme. Identifying which test is performed, by whom, and at which lab would help to connect patients, providers, insurers and labs with all the information they need to ensure the right decision making in a more efficient manner. Indeed diagnostics represent an opportunity for labs and plans to collaborate to reduce the cost of care.
Prospectively managing the network of labs selected within the clinician's workflow is another important step. According to research at McKesson, more than 20% of the costs of molecular diagnostics can be attributed to out-of-network or "non-par" labs at a cost that is double to quadruple that of in-network labs. With the high proliferation of these non-par labs, health plans are having difficulty managing and contracting with them to support all appropriate testing in-network.
The administrative burden created by the enormous range of tests can be relieved by providing transparent information to all parties – most importantly at the point of care, where test orders are initiated and fulfilled. The best tools help the physician decide on the most appropriate test; they also inform the plan whether to authorize the test and the treatment. Ideally, a lab that performs the test would be identified and informed that the test has been authorized. A process that might otherwise consume hours of manual back-and-forth work could be automated – saving not only valuable administrative time, but also bringing better, faster patient care.