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UnitedHealthcare’s Lab Benefit Management (LBM) program is improving quality and advancing patient safety. It gives physicians real time evidence-based guidelines and helpful information about lab quality and efficiency standards at the time tests are ordered. A new online ordering system makes it easier for doctors to choose in-network labs and encourages more consistent use of evidence-based guidelines, reducing disparities in patient care and often lowering a patient’s out-of-pocket costs. The program applies to 79 commonly ordered lab tests.

Wild Dress Shoes Sachs Sachs Rhino Rhino Dress Wild Shoes The LBM program is currently being piloted with physicians in Florida and Texas.  It is only applicable to UnitedHealthcare members enrolled in fully insured commercial health plans at this time. 

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Yes, the LBM program is based on broad input from the provider community to ensure it’s as easy as possible for physicians and labs to use while advancing quality and patient safety. For example:

  • We’ve held hundreds of meetings with physicians, pathologists, and their professional societies over the last two years in Florida to effectively build the program with their input.
  • A new Scientific Advisory Board was created in early 2016 based on feedback from the provider community, comprised of primary care physicians and physician specialties who frequently order lab services. This Board meets regularly to help evaluate pilot results and advise on lab quality criteria.
  • We rely on 20 years of clinical evidence from external, independent medical sources so physicians have evidence-based recommendations at their fingertips when they order a lab test. 

We have seen some great results from the pilot program in Florida, which launched in October 2014.

  • 67% – physicians’ compliance with evidence-based guidelines when ordering lab tests has increased to 67 percent, up from 46 percent just one year earlier, improving the quality of care.
  • 19% – average savings in out-of-pocket costs for UnitedHealthcare members enrolled in the pilot, the result of using in-network  labs and higher quality, lower cost facilities. 
  • 95% of UnitedHealthcare members are now using in-network labs, helping those individuals maximize their benefits coverage and reducing their out-of-pocket costs.
  • 75%-80% of physicians are using the online ordering system, illustrating increased familiarity and comfort with providing lab notifications.

There continues to be significant variation in both the quality and cost of lab services, oftentimes even within the same community. And physicians and patients have no way to compare the quality of lab services today, making it difficult to support informed health care decisions. Consider the following independent studies:

  • A 2014 survey of U.S. physicians found that 73 percent say the frequency of unnecessary tests and procedures is a serious problem, and 85 percent say having specific, evidence-based recommendations they can use with patients would be an effective solution (Robert Wood Johnson Foundation).
  • A March 2015 JAMA study found that pathologists disagree 25 percent of the time in their interpretation of breast biopsies to diagnose breast cancer, underscoring the value of a second opinion for more complex lab results. 

No, the LBM program does not change your benefits coverage or access to UnitedHealthcare’s full network of participating labs. The (LBM) program was created to improve quality and advance patient safety by giving physicians real time evidence-based guidelines when ordering lab services and making it easier for them to send UnitedHealthcare members to in-network labs.

Physician Decision Support (PDS®) is the name of the new online system for ordering lab tests. Physicians log into PDS® or access it through their EHR system (13 EHRs are integrated today) to order a lab test for UnitedHealthcare patients if it is among the 79 tests included in the program. Check out our Canvas Klesky Klesky Canvas Klesky Sneakers Sneakers wpI671xq that illustrates how to order a lab test using PDSRhino Wild Sachs Dress Dress Sachs Rhino Shoes Wild Shoes ®, which generally can be done in five easy steps.

The average physician orders 1.8 tests per month requiring advanced notification. The time it takes to complete the advanced notification is minimal, and there are no additional administrative costs to access or use the Physician Decision Support (PDS) tool. Our pilot in Florida showed the following patterns:

  • On average, it took 72-seconds (range of 50 – 123 seconds) to complete a lab test order without advanced notification.
  • Rhino Dress Sachs Wild Sachs Rhino Dress Shoes Shoes Wild On average, it took 30 seconds to order lab services using the PDS tool and answering questions about evidence-based guidelines (range of 10 – 44 seconds).
  • Rhino Wild Rhino Sachs Sachs Shoes Wild Dress Dress Shoes On average, it took about 14 seconds to order lab services using the PDS tool when no questions are prompted (range of -4 – 24 seconds).

The reason for faster incremental time under the BeaconLBS portal is due to searching on a smaller population of tests (the list of advanced notification tests  is 79 tests, compared to the full test directory of more than 2,000 tests. 

No, this is a pre-notification program, not pre-authorization, which means UnitedHealthcare is simply requesting a notification when one of 79 different lab tests included in the LBM program are ordered. This notification enables us to share important evidence-based guidelines for different lab tests at the time they’re being ordered, improving quality and lowering costs. Based on a review of the tests Florida physicians commonly ordered across most specialties, on average only 2-3 lab test orders per month are among the 79 that require pre-notification.

Only 79 tests are included in the LBM program. Physicians must use the PDS® tool if they’re submitting a lab service for one of these 79 tests. Based on a review of the lab services our Florida network physicians commonly order across most specialties, on average only 2-3 lab orders per month were among the 79 tests requiring pre-notification. Some specialties, however, may have higher utilization of these 79 tests.

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“Lab-of-Choice™” is how we identify preferred labs within UnitedHealthcare’s broader lab network that meet certain quality and accreditation criteria and offer lower overall costs. Just as health care’s Triple Aim encourages better care, a better patient experience and lower costs, a Lab-of-Choice™ has shown a commitment to these same standards. However, physicians can send UnitedHealthcare members to Sachs Wild Rhino Wild Shoes Shoes Sachs Dress Rhino Dress anylab participating in our network.

LabCorp is UnitedHealthcare’s national lab partner and helped design the LBM program, but physicians can send UnitedHealthcare members to any lab participating in our network. They are not required to use a LabCorp facility. Currently, there are 27 Labs of Choice, 70 percent of which are non-LabCorp facilities, ensuring broad access and diverse options for patients.

The PDS® system includes a pre-populated drop down menu of in-network labs for the patient’s insurance plan, making it much easier for physicians to send their patients to participating labs. Labs meeting higher quality designations and lower overall cost are listed first (referred to as Labs-of-Choice™), but all contracted labs participating in UnitedHealthcare’s network are listed and can be used by patients. UnitedHealthcare members in the Florida pilot have seen 19% lower out-of-pocket costs on average because of more frequent use of in-network labs. Out-of-network labs often charge significantly more and members are not maximizing the insurance coverage available to them.

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