The comprehensive solution aligns testing with clinical evidence, helping health plans better manage lab test utilization and spending

Optum today announced the launch of a comprehensive 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. The offering will help health plans align lab testing with clinical, evidence-based guidelines and automate large parts of lab benefit administration.

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.¹ Health plans spend tens of billions of dollars on lab tests annually ― yet studies show that 30% of lab tests are unnecessary.²

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.³

Given these challenges and as more lab tests enter the market, health plans need a solution to address the current lack of test management and oversight.

“Lab testing is one of the most common touch points in health care and the benefit health plan members use most often,” said Rob Mayer, senior vice president, and general manager, Optum. “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.”

Challenges are growing with frequent advances in genomics testing, which can assess a person’s genetic code to evaluate the personal risk of contracting one or more specific diseases. Optum’s new solution includes a multi-organizational team of clinical experts to develop evidence-based lab policies and evaluate new tests in this rapidly growing and evolving space.

“Testing is expanding so rapidly that most clinicians do not have the bandwidth to stay up-to-date on which ones are the highest quality. As clinicians, we all want reliable test results as we make decisions for our patients,” Jill Hagenkord, MD, chief medical officer, Optum Genomics, said. “This laboratory benefit management solution leverages deep clinical expertise to help guide clinicians to the tests with the highest clinical validity and utility.”

This laboratory benefit management solution is now available to all health plans. Additional information is available here Optum/Laboratory Benefit Management.

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¹ Price, Christopher & St John, Andrew. (2014). Clinica Chimica Acta. Anatomy of a value proposition for laboratory medicine. 436, 104–111.

² Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One. 2013 Nov 15;8(11):e78962. doi: 10.1371/journal.pone.0078962. PMID: 24260139; PMCID: PMC3829815.

³ B.E.L. Vrijsen, C.A. Naaktgeboren, L.M. Vos, W.W. van Solinge, H.A.H. Kaasjager, M.J. ten Bergc. Inappropriate laboratory testing in internal medicine inpatients: Prevalence, causes and interventions. National Library of Medicine, February 7, 2020.

About Optum

Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 210,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE: UNH). For more information, visit www.optum.com.

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