BeaconLBS works with our health plan, employer and accountable care organization (ACO) partners to use evidence-based policies and guide lab test benefit management. Our process occurs in four steps.
We examine claims and other data around test ordering using clinical and actuarial expertise to identify tests that may be over-utilized and outside of compliance with evidence-based guidelines.
A team of clinical experts review the peer-reviewed literature and professional society guidelines for evidence-based data to support test utilization policies. Evidence is collated and developed into policies applying the most appropriate approach for the test under review to determine analytical validity, clinical validity, and clinical utility. Some examples of evidence reviews include:
- Grading of Recommendations Assessment, Development and Evaluation (GRADE)
- Analytic Validity, Clinical Validity, Clinical Utility and Associated Ethical, Legal and Social Implications (ACCE)
- Point-of-Care Key Evidence Tool (POCKET)
When the policy draft is complete, it is sent to the BeaconLBS clinical advisory team, a group of internal and external advisers with expertise in all major medical disciplines and laboratory medicine. A final draft is ready for our clients after consensus is reached using the Delphi technique, which is a structured method of communication designed to gain input from experts and aid them in reaching agreement. Our clients modify or adopt the policies after they are examined through their own clinical review processes. All policies are updated at least annually, and sooner if warranted.
With our clients, we develop a “test formulary” from evidence-based policies that contains the fewest number of tests that will have the greatest clinical and financial impact. We also call this our Decision Support Test (DST) list. BeaconLBS has over 95% of the lab tests in the market registered and uploaded into our Physician Decision Support (PDS) platform, and these tests are aligned with the DST list in a proprietary lab mapping process.
Once the DST list is approved, the client-specific DST experiences are coded into the BeaconLBS platform. Each DST can be managed through a claim edit, steerage to another test option to lower the member out-of-pocket cost or for quality purposes, through healthcare provider education at the point of care, or through prior authorization. The BeaconLBS platform is deployed at the point of care through participating EHRs, lab ordering systems, the client website, or the BeaconLBS portal.
This evidence-based approach to developing policies and DST lists has resulted in great outcomes. BeaconLBS has observed a nearly 70% increase in compliance with evidence-based policies, 50% improvement in using in-network, high-quality labs, and a more than 50% reduction in member out-of-pocket costs.
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- Internal data