McKesson Announces Advanced Diagnostics Management Solution to Simplify Molecular and Genetic Test Selection and Reimbursement

The burgeoning $4 billion U.S. molecular and genetic testing market is expected to double by 2012, representing a third of all diagnostic testing costs, according to industry sources. These new tests enable earlier diagnosis of disease as well as safer, more effective, tailored treatments for patients. However, the advent of personalized medicine is clinically challenging and financially complex for payors, labs, providers, and patients. With little information on the comparative effectiveness and cost of specific tests, and the labs that perform them, physicians may select tests that are unproven, unnecessary, and not covered by insurance, resulting in suboptimal care and costly payments for patients. In turn, selecting the wrong test increases administrative and medical costs for insurers, while labs suffer reimbursement hassle, delays, and denials.

Designed to address these issues, McKesson’s Advanced Diagnostics Management solution provides payors and labs with a patent pending collection of advanced web-based services that enable informed test selection, electronic routing, and automatic authorization against centralized rules for coverage and orders. By connecting to clinical laboratories and payors, providers can inform their patients instantly on how much a test will cost, whether their health insurance will cover it, and which labs are best qualified to perform the test.

McKesson’s powerful breadth of technology and clinical content, combined with its RelayHealth connectivity solutions across the payor, provider and diagnostic facility markets, uniquely position the company to deliver its Advanced Diagnostic Management solution. Evidence-based test decisions are supported by InterQual® Molecular Diagnostics Criteria, the industry’s first point-of-service, evidence-based clinical criteria for molecular and genetic testing. The new InterQual criteria cover more than 270 high volume molecular and genetic tests in the areas of infectious disease, oncology, and inherited diseases. The new offerings also incorporate InterQual Imaging Criteria.

Early customers include labs and regional health systems such as John Muir Health, and major payors such as MVP Health Plan. Blue Cross and Blue Shield of Massachusetts (BCBSMA), New England’s largest health plan, is also deploying the new solution to provider partners who frequently order genetic tests or inquire about the coverage offered by the patient’s health plan. “We anticipate having the ability to automate information about new genetic and molecular diagnostics tests will help clinicians be better informed about the value of and indications for such tests, and to guide better diagnostic choices leading to optimal utilization decisions,” said Barry Zallen, MD, medical director, Medical Innovation and Leadership, BCBSMA. “We also expect their new technology will offer a pathway for automating authorizations. Our goal is to achieve better care for our members with a lower administrative burden and lower cost.”

Scott Liff, vice president, chief operating officer, MuirLab, added, “By having clean order requests, we don’t inconvenience doctors or their patients for the information we need to conduct tests and bill for them. Having timely access to accurate information helps us eliminate potential delays while also helping us to ensure health plans will reimburse us for tests.”

“When health plans and care providers understand the impact of their choices on the quality and cost of care, the patient benefits,” said Matthew Zubiller, business leader for McKesson’s new solution. Zubiller added, “McKesson is at the forefront of this important and emerging market. Having the right criteria to select the right test and a clear understanding of insurance coverage before that test is performed are fundamental to improving the economics and quality of healthcare.”

The Advanced Diagnostics Management solution offered through McKesson centralizes clinical and financial rules to automate authorizations and help ensure reimbursable lab orders. Once fully deployed, initial studies estimate that the solution will help users achieve a three- to five-times return on investment by reducing reimbursement delays and denials for labs, while lowering administrative costs and inappropriate utilization for health plans.

For more information, please visit www.mckesson.com/diagnostics

About RelayHealth

RelayHealth, McKesson´s connectivity business, operates as a neutral partner in an open network environment, offering connectivity services and integration among all organizations, systems, and solutions. Its intelligent network is designed to streamline clinical, financial and administrative communication between patients, providers, payors, pharmacies, pharmaceutical manufacturers, and financial institutions. RelayHealth works to accelerate the delivery of high–quality care and improve financial performance through solutions such as online consultation of physicians by patients, electronic prescribing, point-of-service pharmacy claims resolution by payors, pre–visit patient financial clearance by providers, and post–visit provider bill settlement by payors and patients. RelayHealth securely processes more than 12 billion financial and clinical transactions annually. For more information, call 800–778–6711, or visit our Web site at www.relayhealth.com.

About McKesson

McKesson Corporation, currently ranked 18th on the FORTUNE 500, is a healthcare services and information technology company dedicated to helping its customers deliver high-quality healthcare by reducing costs, streamlining processes, and improving the quality and safety of patient care. McKesson is the longest-operating company in healthcare today, marking its 175^th anniversary last year. Over the course of its history, McKesson has grown by providing pharmaceutical and medical-surgical supply management across the spectrum of care; healthcare information technology for hospitals, physicians, homecare and payors; hospital and retail pharmacy automation; and services for manufacturers and payors designed to improve outcomes for patients. For more information, visit http://www.mckesson.com.