Wednesday, October 23, 2019

Philips and Deverka Publish Major Review of Lab Benefit Managers in Health Affairs

On this blog a few weeks ago, I highlighted new articles in CAP TODAY and at 360DX on lab benefit management in its different forms (here). These range from (A) software that adapts guideline-based care or appropriate use criteria into EHR's at the physician's point of care to "traditional" lab benefit management systems which are often consultancies to (B) payers which implement denials or prior authorization.   Concurrently, there were Hill hearings on the burden of prior authorization (links in the blog cited).

October 23, 2019

At Health Affairs, UCSF's Phillips and Deverka publish a major review of the LBM industry for genetic testing.   It's open access here.  

In its August 2019 quarterly call, Myriad noted it had lost as much as $50M in recent quarters to more aggressive use of LBMs (here, here).  It's an impactful business and policy area.


Concurrently, the CRO-based consultancy Evidera publishes a nice suite of open-access articles on real world evidence, pragmatic randomized trials, and use of RWE for health technology assessment and payers.  See index here.


For an Oct. 24 article on payers and ICD10 claims denials, here.


One thing that LBMs do is manage prior authorization.   There are two articles on prior authorization published online in February 2020 in JAMA (see Resneck; see Gaines).  While these two op ed's focus on drug prior authorization, there is a logical crossover with diagnostics prior authorization.