New end-to-end Genetic Testing Solution addresses overpayments and waste while driving value for providers, payers, and members
FRISCO, Texas--(BUSINESS WIRE)--Apr. 25, 2022-- Magellan Healthcare, the behavioral health and specialty division of Magellan Health, Inc., today announced a new collaboration with Concert Genetics, a software and managed services company that provides the data and digital infrastructure to manage genetic testing. Working together, the two companies will offer an innovative, end-to-end solution that leverages Magellan’s utilization management processes and claims integrations to deliver efficient management, improved quality, and accurate payment in genetic testing.
The genetic testing landscape has changed dramatically and continues to evolve. With more than 175,000 orderable tests on the market1 and an estimated annual growth rate of 13%,2 the rapid expansion of genetic testing, combined with its complexity, is challenging stakeholders across the healthcare system. Variation in coding and billing generates ambiguity and can lead to unnecessary review costs. Thousands of code variations exist, and on average, 6.9 codes are billed per test.3 Complex coding in a rapidly evolving field can lead to challenges with managing administrative processes, such as claims editing.
Due to the volume of tests available, the effort required to manage genetic testing can seem endless. Despite accounting for 1%-2% of medical spend, health plans can dedicate as much as 15% of clinical reviews and 20% of medical policies to this area. Additionally, current medical policies for genetic tests can be difficult to navigate, leading to inconsistent application and errors, and often fall behind the continuously evolving landscape of new tests, evidence, and guidelines.
The new solution will combine an authoritative catalog of genetic tests and unique test ID system with regularly updated medical policies, test-specific coding standards, lab quality information, and real-time claim editing capabilities, all delivered through Magellan’s proven delegated delivery model.
“Magellan Healthcare’s new genetic testing solution will enable health plans to manage variation and risk while reducing administrative burden and medical costs,” said Sajel Lala Kana, M.D., FACMG, board-certified geneticist and physician clinical reviewer for Magellan Healthcare. “Removing the ambiguities surrounding genetic tests, codes, and medical policies opens the door to a new, innovative approach that supports payers in this complex space.”
Webinar on genetic testing
Tuesday, May 24, 2022, 2:00-3:00 p.m. ET: Join us during Public Health Genetics Week for the Magellan Healthcare webinar, “Rare Disease Genetic Testing—Access and Diagnosis, and Direct-to-Consumer vs. Clinical Testing.” Magellan Healthcare’s Dr. Sajel Kana, board-certified clinical geneticist, and Concert Genetics’ Dr. Gillian Hooker, board-certified genetic counselor and molecular biologist, will address the genetic testing landscape, access to genetic testing for rare diseases and more common uses, as well as the differences between direct-to-consumer and clinical genetic tests. Click here to register.
To learn about Magellan Healthcare’s end-to-end genetic testing solution, visit www.MagellanHealthcare.com/GT.
About Magellan Healthcare: Magellan Healthcare, Inc., the healthcare business unit of Magellan Health, Inc., offers solutions for complex conditions in the areas of behavioral health and medical specialty treatment. Magellan Healthcare serves commercial health plans, employers, state and local governments, and the Federal government, including the Department of Defense. For more information, visit MagellanHealthcare.com.
About Magellan Health: Magellan Health, Inc., is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan's customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.
1 Concert Genetics, 2022
2 Fortune Business Insights, 2021
3 Concert Genetics, 2019
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Source: Magellan Health, Inc.