Utilization management in the clinical laboratory: an introduction and overview of the literature

There is a broad literature addressing the need for improving utilization management in medical care. Numerous review articles and case studies have described approaches to utilization management challenges in the laboratory. This article will present an overview of the literature on laboratory utilization management and will compile a "toolbox" of strategies that can be used to address specific utilization management initiatives. A clear theme among successful utilization management programs is the need to recruit institutional champions both for the overall utilization management program and for ad hoc assistance with specific utilization challenges. It is important that these individuals represent a cross section of laboratory and clinical specialties and that the group be organized as a committee that has been established by the administrative and physician leadership of the organization. The changing nature of healthcare reimbursement will likely provide increased motivation to control laboratory testing and costs. Clinical pathologists are in a unique position to observe testing behavior patterns, suggest alternatives, implement order entry changes, manage testing algorithms and provide interpretive services for laboratory testing. For these reasons, clinical pathologists have a major opportunity to become institutional leaders in utilization management.