Precision Genetic Test Management
Designed to help health plans streamline prior authorization processes and reduce administrative burden related to genetic testing.
Genetic test management is anything but routine.
Genetic testing is becoming more complicated and more common. In 2020, the U.S. genetic testing market reached $4.3B and is expected to grow to $10B by 2027. 175,000 clinical genetic tests are available today, and 10 new genetic tests are introduced daily.
Relying on current utilization management tools, such as prior authorization processes, to control healthcare costs may become unsustainable and cause care delays, burden healthcare providers, and increase healthcare costs.
Together with burdensome tools, the lack of discrete genetic test codes to show genetic test validity, quality, and utility adoption aggravates the situation. Coupled with the need to be on top of evidence-based test guidelines to ensure the genetic test is necessary and appropriate, a change in lab benefit strategy is required.
Be certain. The market’s only comprehensive genetic test benefit program.
Download Avalon’s Top Nine Elements for an Optimal Genetic Test Benefit Program
Precision Genetic Test Management is the next evolution of Avalon’s genetic test management solution, combining the lab testing expertise of Avalon with accurate claims data to produce a first-of-its-kind solution to manage genetic testing.
The solution addresses genetic test necessity by uniting evidence-based lab policies with automated policy adherence, accredited pre- and post-service clinically-led reviews, and appropriate, high-quality testing using discrete genetic codes for specificity.
PGTM is uniquely different from other genetic test management programs in two primary ways: First, Z-Codes®, created by the MolDX® Program and administered by Palmetto GBA®, are proprietary unique identifiers for discrete genetic tests that are the emerging standard for genetic test identification. The use of Z-Codes for MA plans negates the need for prior authorization and decreases prior authorization needs for commercial plans. Second, with the prior authorization process grounded in science and combined with Z-Codes, appeals and overturned decision rates are lower.
The result is decreased administrative burden with discrete genetic code mapping, test quality, and validity from a specialized genetic network, and expedited appropriate treatment through compliance with clinically-led policies. Avalon estimates savings of $0.50 to $0.65 per member per month when using our Precision Genetic Test Management solution.
Avalon Healthcare Solutions