Overview
According to recent reports, Optum is planning to launch a new insurance program to reduce unnecessary lab tests. This will presumably save insurers around $3 billion a year.
Optum is a division of UnitedHealth Group, which is the largest private insurer in the United States. Officials from Optum emphasized the need for oversight when it comes to laboratory tests, especially with the widespread availability of new genetic tests.
The purpose of this program is to lower the rates of unnecessary lab tests that lead to inaccurate results and/or unnecessary follow-up procedures. This is done by ensuring doctors are ordering clinically-relevant tests.
This article will briefly discuss the new plan made by Optum as well as the ramifications it can bring to the American healthcare system.
The New York Times report and Optum response (Unnecessary Lab Tests)
The plan of Optum emerged briefly after the New York Times released an investigation that questioned the results of many prenatal tests.
After analyzing the results of five screening tests, the authors found that the results were inaccurate in up to 93% of cases. This led many pregnant women to panic about potential complications that were not present. Consequently, these women underwent more unnecessary testing.
The Food and Drug Administration (FDA) released a statement this past April, warning people about the inaccuracy of prenatal tests that screen for genetic disorders.
According to Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health, these tests “have not been reviewed by the FDA and may be making claims about their performance and use that are not based on sound science.”
The inaccuracy of these tests and their excessive use created an opportunity for Optum, which it plans to take advantage of.
Jill Hagenkord, chief medical officer of Optum Genomics, said that the field of laboratory testing is growing so fast that most clinicians cannot stay up to date. This can compromise the quality of the ordered tests, leading to a cascade of unnecessary testing and procedures.
Optum estimates that around 30% of the yearly ordered tests (13 billion clinical lab tests) are unnecessary. With the attempts of Optum to crack down on testing, laboratory operators could be challenged. In this context, Quest Diagnostics stated that they are committed to the appropriate usage of all lab tests.
Officials from Quest said their goal is to provide solutions for healthcare providers to optimize their use of lab tests. They also want to engage the patients in preventive care, which can significantly reduce the costs of out-of-network utilization.
Takeaway message
The overuse of testing found in prenatal care triggered a chain of reactions that ended up with a solid plan from Optum to cut down on unnecessary testing. Whether this decision will be beneficial for patient care or not remains to be seen. With that said, we predict that it could have several ramifications in diagnosing and treating patients.
We hope that this article managed to highlight the plan of Optum to reduce unnecessary testing.
