Session # 6422

Defining Value-based Practices for Clinical Laboratories: Quality, Flexibility, and Collaboration

Genetic tests are powerful, complex and expensive diagnostic tools. Correctly selecting, ordering and interpreting a genetic test is challenging even for individuals with clinical expertise in specific conditions. Ensuring the “best” genetic test also involves securing insurance coverage or payment for the test. Similar to antibiotic stewardship, laboratory test stewardship refers to a set of coordinated strategies to improve the use of laboratory tests with the goal of enhancing patient health outcomes, reducing order errors and inappropriate tests, and decreasing unnecessary costs. Whether it is overt or not, there are multiple steps involved in genetic test stewardship, and everyone involved has a responsibility to ensure that patients and families receive the highest value test. In this session, we will address common challenges in genetic test ordering, as well as discuss strategies aimed at maximizing the value of genetic testing with a collaborative approach between clinicians, utilization management teams, insurance payers and clinical laboratories.

The session is organized around the flow of genetic test orders, and the five speakers correspond to different stages in this process with each of their unique roles in maximizing the value of genetic tests. Ideally, a test order starts with thoughtful test selection: A clinician will present her perspective and data about an example of genetic test selection and test algorithm development. The next speaker will discuss insurance preauthorization, including institutional approaches to integrate the preauthorization process with test review. The third speaker will present the payer perspective and highlight strategies for clinicians, laboratorians, and payers to collaborate and implement efficient preauthorization processes and rational coverage policies. The fourth speaker will discuss his institution’s approach to a utilization management service that promotes appropriate genetic testing and optimizes test orders. The final speaker will discuss the role of clinical reference laboratories in implementing resource-conscious genetic testing. Facing the unique opportunities and challenges brought up by the era of genomics, this session highlights a collaborative approach to increase the value of genetic testing.

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