• Advanced Diagnostics Management Health Plan Program


Addressing the complexity of molecular diagnostics and genetic testing utilization

Health plans need better tools and information to proactively address the complexity, cost and quality issues of molecular and genetic testing, particularly given the rapid growth in this field. To help plans manage molecular diagnostics spend and improve patient care, our Advanced Diagnostics Management Health Plan Program uses a powerful combination of decision-support tools, InterQual Criteria and expert analytics, delivering a substantial return on investment. Our Health Plan Program incorporates a hosted Web-based solution, dramatically reducing implementation, operating and maintenance costs while delivering a short time-to-value for the customer.

Comprehensive customized approach

An integrated approach to managing molecular diagnostics spend, our Health Plan Program employs a host of McKesson decision-support technology tools and services, including:

These elements integrate in a sophisticated way to enable highly informed point-of-care decision making and provide the measures to manage molecular diagnostics spend—while improving patient care.

To optimize each molecular diagnostics decision, our Health Plan Program gives physicians and clinical labs immediate access to a health plan's coverage, network and clinical rules, as well as customized utilization management policies—in one single stop—at the point of care.

Translating information into savings and better care

With only a handful of CPT codes for the plethora of molecular diagnostics tests available, plans need innovative ways to capture and measure their spend and utilization on these tests—to know what they’re paying for and why, so they can develop benchmarks for both cost and quality. Through a comprehensive four-step cycle, our Health Plan Program provides the insight and tools plans need to continually strengthen their effectiveness in addressing molecular diagnostics spend and quality of care:

  1. Measure test volumes and cost through retrospective analysis and benchmarking, as well as by collecting information on every new order via real-time notification beforehand for a quick, detailed picture of utilization whenever it's needed.
  2. Define and codify medical, benefit, network and payment policy based on complete and timely data to ensure that policies for coverage are clearly communicated and consistently interpreted.
  3. Manage testing spend and network performance by influencing behavior at the point of care with automated, rules-based notification, authorization and ordering tools.
  4. Extend the program to incentivize policy compliance by developing alternative reimbursement and engagement models with providers and labs.

With our Health Plan Program, plans can take a proactive approach to care. You get proven tools that analyze molecular diagnostics spend and utilization, while supporting network physicians in making the right decisions for their patients.

Benefits

  • Lowers inappropriate medical spend, delivering a substantial return on investment
  • Provides automated, targeted clinical and financial decision support in real time at the point of care
  • Gives providers immediate access to coverage, medical appropriateness and network rules
  • Ensures consistently applied policies and evidence-based decisions
  • Drives in-network activity
  • Enables timely analysis on ongoing utilization management and out-of-network services
  • Extends to support other major utilization management areas, such as procedures and imaging

Would you like to know more about using our Advanced Diagnostics Management Health Plan Program to support optimal molecular test utilization? Call us at 800.782.1334 or request more information.