Darwin could very well have been talking about the laboratory industry when he came up with his evolutionary theory “survival of the fittest.”
The industry is going through a major transition. While the lab has historically accounted for 5% of the overall healthcare spend, it is now greater than 12%. The reason? Molecular diagnostics, which is the second-fastest growing part of healthcare following specialty pharmaceuticals.
With this rapid growth comes serious growing pains.
Those independent labs and private payors who don’t innovate to manage the tidal wave of requirements — such as prior authorizations — will struggle to manage their costs and, ultimately, their survival.
We are seeing higher reimbursements from Medicare for molecular diagnostic testing, and the private payor community is starting to embrace these tests.
Laboratory Benefit Managers (LBMs) are entering the space and magnifying the need for innovation to help them manage the exploding volume of authorizations. As a result, price compression activity is also increasing.
Private payors are requiring prior authorization in greater numbers to deal with what they believe is an over-utilization of molecular diagnostic and precision medcine testing. For the first time, they are requiring PAs be handled by the physician’s office — a decided shift in the way PAs have been done in the laboratory services industry.
To make this exploding PA process work best for all, a new solution is called for. That’s where CoverMyTest comes in. We have developed a one-and-done technology solution that all constituents in the prior authorization ecosystem can embrace. We work seamlessly with a lab’s workflow to trim the manpower needed to process PAs. It’s a simple matter of providing CMT with the PA info and we’ll take it from there to reach all of the necessary parties with speed and precision.
- We cut operating cost by reducing a lab’s internal manpower needs.
- We deliver results quickly.
- Our level of service is top-notch.