Why Health Insurers Want to Pre-Authorize Genetic Assays and Expensive Clinical Pathology

Healthcare Reform: Engaging with Payers to
Enable Clinical and Financial Decision Support at the Point of Care

Learn how and why your laboratory must be prepared to ensure
“the right test, at the right cost and the right time.”

YOUR PRESENTERS:

Matthew Zubiller, Vice President and General Manager, Advanced Diagnostics Management, McKesson Corporation

Michael Tarwater, Executive Director, MuirLab

Justin M. Clark (Moderator), Director of Operations, THE DARK REPORT

LIVE AUDIO RECORDINGS from Audio Conference: July 13, 2010

Twin threats to the status quo in laboratory testing are coming your way …and soon! The first threat is enactment of the ObamaCare health bill, which includes mandates to improve utilization of diagnostic procedures, including clinical pathology laboratory tests.

The second threat involves payer requirements for pre-authorization of genetic tests and expensive molecular assays. Already, several of the nation’s largest health insurance companies have instituted pre-authorization protocols for certain genetic tests. Laboratories unaware of these new requirements will not find it easy to be reimbursed after performing these expensive genetic and molecular tests.

Pre-authorization of Genetic Tests
Lab industry experts predict that pre-authorization of laboratory tests and real-time decision support systems for physician lab test ordering will prove disruptive, particularly for local clinical labs, hospital laboratory outreach programs, and community hospital-based pathology groups. That’s because most payers have a long-established pattern of including national laboratory companies in their provider networks, while making it difficult for local laboratories to gain contract access to their beneficiaries.

But there is a way for laboratories to turn the tables on payers as pre-authorization and other requirements for genetic tests and molecular assays become more common in the marketplace. Simple steps to be discussed during this special audio conference can position your laboratory organization as an added value provider for the important health plans in your community.

You’ll get straight talk and useful information about these twin trends when you listen to the latest Dark Report and DARKDAILY.COM audio conference “How Your Local Laboratory Can Win a Place at the Table When Payers Require Pre-authorization of Genetic Tests and Other Expensive Clinical Laboratory Assays” from Tuesday, July 13, 2010. Two expert speakers and innovators in this new field will take you inside these highly-disruptive developments.

Why Payers Want Genetic Test Pre-authorization
First, you’ll hear from Matt Zubiller, Vice President and General Manager of McKesson Corporation’s newest business service: Advanced Diagnostics Management. Zubiller will discuss why payers are interested in pre-authorization of laboratory tests and why these same health insurers will be paying closer attention to appropriate utilization of genetic tests and molecular assays. Labs will need to access the evolving payer policies on laboratory testing, which are available for review, but which are often hard to find and not easy to interpret.

Zubiller has a checklist of necessary steps that allow your laboratory to predict whether your lab’s claims will be reimbursed for tests ordered by referring physicians. Most importantly, this checklist will help your lab avoid the surprise of a denial after these claims were submitted to the payer.

You’ll also learn why the twin trends described above will hit laboratories with an increase in payer-imposed controls—designed to better manage lab test utilization and reduce costs. Payer policies determine your lab’s level of reimbursement. By extension, labs have a clinical and financial interest in ensuring that the right tests are ordered and performed.

To help laboratories carve out an added value relationship with payers, Zubiller will discuss ways that your laboratory can align with payers to ensure that the right tests are ordered. Learn how your lab can make it easier for physicians to access the latest evidence-based clinical guidelines and payer policies. These are the critical components of your laboratory’s plan to get paid for tests it performs.

You will learn why clinical and financial decision support tools will be needed by both the laboratory and those physicians at the point of care. These decision support tools bring about increased transparency, simplicity, and value—exactly what payers want from their preferred laboratory providers. At the same time, these point-of-care decision-support tools can help your lab reduce costs, manage utilization, and meet the ever-stricter payer requirements for appropriate ordering of expensive laboratory tests.

How MuirLabs Serves Health Plans in California
The second speaker is Michael Tarwater, who is Executive Director at MuirLab, located in Walnut Creek, California. MuirLab is one of the nation’s more successful hospital laboratory outreach programs. Managed Care plans in California have already been aggressive at implementing pre-authorization requirements for genetic tests and other clinical laboratory assays. Tarwater will explain how and why this is happening first in the nation’s most populous state—which, coincidentally—is home to a mushrooming number of Internet-based genetic testing companies. His clinical laboratory has found itself in the eye of the genetic testing hurricane, in a manner of speaking.

Based on MuirLab’s experiences in working with these health insurers while responding to physician requests for genetic tests and molecular assays, Tarwater has lots of practical insights and useful recommendations to share. He’ll help you understand how payers view the economics of lab test utilization and why they are putting specific genetic tests in the pre-authorization bulls-eye. You’ll learn what MuirLab has done to establish its value proposition with payers.

You will also learn about new tools—including the latest decision-support software—that apply real-time eligibility, clinical, and benefit policy checks before tests are ordered. Explore how these easy-to-use, intuitive web-based tools enable physicians to see the evidence-based clinical guidelines for the tests they are preparing to order.

More importantly, these tools allow physicians to see what the patient’s share of costs for the recommended diagnosis is likely to be—before they order the test! These same tools have a direct benefit for laboratories, because they automate the delivery of clean, complete, and covered lab test orders to your lab.

Order Audiotoday to hear this timely Dark Report audio conference and tap into this invaluable source of insight and experience. Get all that you need to prepare your lab for the coming new restrictions on lab-test ordering and reimbursement, especially important because these pre-authorization requirements target your lab’s most expensive reference and molecular tests!

For one low price—just $245—you and your entire team can take part in this fast-paced, insightful audio conference.

Here’s just some of what you’ll learn during this in-depth 90-minute conference:

• Why pre-authorization of expensive genetic tests and molecular assays is a high priority for health insurers across the nation!
• How health plans will use evidence-based medicine guidelines to determine medical policy and coverage requirements for clinical laboratory tests!
• Strategies that clinical labs and pathology groups can use to align with payers to help ensure that referring physicians order the right laboratory test at the right time for the right cost!
• Ways that evidence-based tools for clinical decision support can help clinical labs reduce the number of write-offs they post for non-covered benefits.
• Secrets of encouraging physicians to use of point-of-care decision-making tools—and how it benefits your clinical laboratory when they do.

…and much more!

ORDER AUDIO Now! Or for more information, call us toll-free at 800-560-6363.

Distinguished Faculty

Matt Zubiller is vice president and general manager of McKesson’s Advanced Diagnostics Management business. His team leads initiatives that advance McKesson’s role in the realm of personalized medicine, genetics and molecular diagnostics. Matt brings a deep understanding of payers rules about utilization management and molecular diagnostics.

Before joining McKesson, Matt worked for a global strategy-consulting firm in London and co-founded a spin-off from a leading Enterprise Resource Planning software and services vendor. He then founded and sold a boutique consulting practice that worked with early-stage technology companies, entrepreneurs and venture capitalists in the US, UK, and India.

Matt holds an MBA from London Business School and a management of technology degree from the Berkeley College of Engineering and the Haas Business School. He was recently named to Healthspottr’s “Future Health 100” as a healthcare innovations leader.

Michael Tarwater is Executive Director at MuirLab. He joined John Muir Health in 2007 as Director Laboratory Information Systems, and was recently promoted to current position. He is responsible for laboratory information systems, quality assurance, safety, education and process improvement. Mr. Tarwater has 28 years in IT, with 12 in laboratory information management, eight in travel/transportation and eight in manufacturing/distribution.

ACCENT® Continuing Education Credit
The American Association of Clinical Chemistry (AACC) designates this program for a maximum of 1.5 ACCENT® credit hours towards the AACC Clinical Chemist’s Recognition Award. AACC is an approved provider of continuing education for clinical laboratory scientists in the states of California, Florida, Louisiana, Montana, Nevada, North Dakota, Rhode Island, and West Virginia.