Optum launches laboratory benefit management solution to reduce unnecessary testing
Potential savings for health plans range from $12-$36 per member per year - or more than $3 billion annually, Optum says.
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Optum announced it's launching a laboratory benefit management solution designed to help health plans reduce unnecessary lab testing and ensure their members receive appropriate, high-quality tests.
The potential savings for health plans range from $12-$36 per member per year – or more than $3 billion annually, Optum said. The offering is designed to help health plans align lab testing with clinical, evidence-based guidelines and automate large parts of lab benefit administration.
Rob Mayer, senior vice president and general manager of Optum, said by statement that lab testing is one of healthcare's most common touchpoints and the benefit that health plan members use the most.
"This new solution will help health plans determine which tests are clinically proven, streamline decisions and automate processes to significantly reduce unnecessary testing for their members and increase cost savings," said Mayer.
WHAT'S THE IMPACT?
Unnecessary lab testing is widely recognized as wasteful and potentially harmful to patients. Roughly 13 billion clinical lab tests are performed every year, making it the most utilized medical benefit, according to research from the National Library of Medicine.
Health plans spend tens of billions of dollars on lab tests annually – yet one meta-study showed that 30% of lab tests are unnecessary.
Tests not clinically indicated can lead to unnecessary sample collection from patients and increased chances of incorrect results. The absence of industry standards and clinical efficacy data exacerbates misuse and misinterpretation of tests, often leading to inappropriate and unnecessary interventions, according to research published in ScienceDirect.
Optum said its decision to launch the new solution was based on these challenges and is also a response to an influx of new lab tests entering the market.
The new solution includes a multi-organizational team of clinical experts whose task it is to develop evidence-based lab policies and evaluate new tests.
It's now available to all health plans.
THE LARGER TREND
UnitedHealth Group, which owns Optum, showed a slight year-to-year improvement in the first quarter of this year, with a $5 billion net profit, compared with $4.9 billion in Q1 2021, according to the organization's first-quarter earnings report.
Optum led this year-over-year earnings growth, which UHG attributed to the accelerating expansion of its value-based care delivery initiatives. Optum first-quarter revenues grew 18.9%, to $43.3 billion, and operating earnings grew 19.8%, to $3.2 billion.
The company also recently received approval from the Massachusetts Attorney General's Office to go ahead with its planned purchase of Atrius Health. The AG's office has determined that, pending judicial review by the Massachusetts Supreme Court, Atrius Health has met its requirements under Massachusetts charities law to sell its business to Optum Health and transfer its charitable assets to the Atrius Health Equity Foundation.
Atrius and Optum agreed to increase the purchase price for Atrius' charitable assets from $73 million to $236 million, which means additional money for the Atrius Health Equity Foundation, according to the AG's office.
Optum's United Kingdom division, Optum UK, recently announced it was acquiring healthcare technology company EMIS for about $1.51 billion. While the deal is not yet finalized, EMIS directors are expected to unanimously recommend that shareholders vote in favor of the deal.
The filing indicates that Optum has operated within the U.K.'s NHS framework for about 20 years. In that country, it's focused primarily on population health management, which affects about 45 million people in the U.K.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
