The cost and complexity of genetic testing is growing rapidly. Spend for many health plans is rising 25-75% per year, but how much of that delivers clinical value?
Concert Genetics leverages genetics expertise, proprietary market data and a test order management system rated highly by providers to deliver actionable insights, cost savings and effective management of genetic testing.
A Rapidly Growing Field
Genetic testing is one of the fastest growing segments in healthcare. There are more than 75,000 genetic testing products on the market, and 10 new tests are added each day. However, fewer than 200 billing codes exist to represent all these genetic tests. So, it is often impossible to tell what test a claim represents. Given these factors, it’s no surprise health plans experience:
Test prices and reimbursements that vary widely and sometimes rise well above relevant benchmarks
Test orders out of policy or against available guidelines
Highly variant coding, especially for expensive multi-gene panels
Fortunately, Concert Genetics has a solution to bring order to the chaos.
Data Analytics & Enrichment for Actionable Insights
Actionable insights begin with deciphering what tests are actually being performed and billed. Concert is uniquely positioned to decode claims because we maintain a proprietary database of the U.S. clinical genetic testing market.
Using sophisticated analytic methods, we match each claim with a specific test (or testing category). Then, we enrich that data with pricing data, policy and laboratory network information, enabling us to provide insight in several key areas:
Medical Policy – How well do reimbursements align with policies, and where are gaps in policies causing issues?
Payment Integrity – Where are coding variation, errors, and even gamesmanship by a small number of providers, leading to waste and inefficiency?
Laboratory Contracting – How do reimbursements align with contracted rates, and where will do contracting opportunities exist?
Concert Genetics has performed this analysis on claims representing over 150 million members for health plans large and small, identifying hundreds of millions of dollars in savings.
Provider-Facing Test Order Management
The Concert Platform is a provider-facing test order management system used by thousands of clinicians and leading hospitals nationwide to navigate the cost and complexity of genetic test selection, ordering, and results retrieval. Well-liked by clinicians (as evidenced by high Net Promoter Scores), this platform delivers:
Insurance coverage information on a test-specific basis drawing directly from the policies of the patient’s health plan
Coverage criteria in a simple checklist format to support in-policy orders
Identification of which tests need prior authorization
Health plans seeking more effective genetic testing management can leverage the Concert Platform to systematically communicate medical policies, network laboratories and prior authorization requirements to clinicians on a test-specific basis at the point of order.
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