Avalon Healthcare Solutions Teams with Sentara Health Plans to Offer Genetic Testing Management

Avalon Healthcare Solutions announced it is building on its relationship with Sentara Health Plans and will begin offering Sentara’s members genetic testing management (GTM).¹

The companies began working together in 2021. Since then, Avalon said it has reduced out-of-pocket lab spending costs for Sentara’s one million members throughout Virginia and Florida.

"We're proud of the results we've delivered for Sentara Health Plans and its members, and we look forward to expanding the relationship," Avalon CEO Bill Kerr, MD, stated in the press release. "Lab benefits management is an often-overlooked part of healthcare, and we salute Sentara for its initiative and foresight in making it an integral part of its offerings."

Dr. Kristyn Greifer, senior vice president and chief medical officer of Sentara Health Plans, added in the release, "Lab testing informs 70% of healthcare decisions, so it's essential to have an expert partner to guide us in evaluating and managing testing in an ever more complicated healthcare landscape. Our collaboration with Avalon has allowed us to take a more comprehensive and informed approach to testing, which has proven beneficial for the plan, our members, and providers."

Genetic testing can help identify possible comorbidities, avoid unnecessary tests, and guide treatment decisions and management. These kinds of tests are becoming necessary tools in informing and enhancing personalized medical decisions and also in making lab services more accessible. The Food and Drug Administration, the Centers for Medicare and Medicaid Services, and the Federal Trade Commission perform evaluations of genetic and genomic tests, using three criteria: analytical validity, clinical validity, and clinical utility.²

Avalon’s 2024 Lab Trend Report, an analysis of 15 million of its clients’ health plan members, identified a rise of 5% in the use of genetic testing. Health plan spending on genetic testing also rose 8% from 2022, for an average of $13.The report showed no significant change in the use of routine testing but noted that spending on genetic testing was 3.6x higher than routine testing, about 30% of payer spending.³

Challenges to the management of these tests include insufficient coding to identify tests, quality control, pricing, and determining the clinical utility of the tests.³

The decisions that will help patients get the correct treatment when they need it will be piloted by an independent clinical advisory board that will develop evidence-based testing policies with an overall goal of reducing improper testing usage. Avalon’s GTM solutions include the use of utilization management, compliance enforcement, test quality assessment, and new lab technology evaluation.¹

The implementation of the GTM offerings will be available for certain plans in December of this year, with other plans to follow by the first quarter of 2026.

Sources

Avalon Healthcare Solutions to Team with Sentara Health Plans to Offer Genetic Testing Management. Avalon Healthcare Solutions. January 15, 2025. Accessed January 20, 2025. https://www.prnewswire.com/news-releases/avalon-healthcare-solutions-to-team-with-sentara-health-plans-to-offer-genetic-testing-management-302351150.html

Regulation of Genetic Tests. National Human Genome Research Institute. February 19, 2024. Accessed January 20, 2025. https://www.genome.gov/about-genomics/policy-issues/Regulation-of-Genetic-Tests#:~:text=Several%20federal%20agencies%20regulate%20genetic,lead%20to%20improved%20health%20outcomes

Genetic Testing on the Rise While Routine Lab Testing Stabilizes with Better Management, Report Finds. Avalon Healthcare Solutions. June 11, 2024. Accessed January 21, 2025. https://www.prnewswire.com/news-releases/genetic-testing-on-the-rise-while-routine-lab-testing-stabilizes-with-better-management-report-finds-302168942.html