Avalon Lab Trend Report Insights for 2025
The growing importance of biomarkers and genetic diagnostics highlights both innovation challenges and opportunities for health plans.
A remarkable growth in the field of genetic and biomarker testing is revolutionizing the lab landscape. The 2025 Lab Trend Report from Avalon Healthcare Solutions brings crucial insights into this sector. The report utilizes extensive data from over 18 million health plan members, part of Avalon’s portfolio of more than 44 million managed lives, to provide a deeper understanding of the intertwining issues of cost, diagnostic demands, and groundbreaking clinical innovations.
Understanding Current Trends in Laboratory Testing
As Bill Kerr, MD, CEO, notes, lab testing stands as a vital component in healthcare, affecting a majority of clinical decisions, yet remains inadequately managed in many instances. For healthcare providers and insurers to effectively leverage the benefits of diagnostic testing, a modernization of their practices regarding how tests are chosen, administered, and reimbursed is essential. The findings of this report shed light on the data-driven insights necessary for health plans to adapt in an ever-evolving sector.
Discrepancies in Testing Costs
Despite the growing use of testing, significant price discrepancies exist based on testing locations. A comparison featured in the Lab Trend Report revealed a striking difference in the costs for a basic and comprehensive metabolic panel (CPT 80053). Specifically, a test performed at an independent lab costs $8.51, while the same test costs $12.04 at a physician’s office and a whopping $48.45 at a hospital outpatient lab. This disparity highlights a consistent trend, where hospital outpatient labs charge significantly more across the most frequently ordered tests.
Routine Test Costs and Trends
Routine testing represents about 90% of testing by volume, costing contracting health plans an average of $192 per member per year (PMPY) last year, reflecting a 2% increase compared to previous assessments. While the need for general routine testing saw a 4% increase to $183 PMPY, the demand for COVID testing plummeted by 27% to just $9 PMPY, primarily due to decreasing volumes related to the pandemic. This increase in overall utilization suggests that testing frequency rose more than changes in pricing.
From 2020 to 2024, clients benefitting from Avalon’s program management saw a minimal rise of just 1% in routine testing spending. In contrast, the broader industry exhibited at 2-5% annual growth. The data points to a substantial 16% rise in general non-COVID spending during this period, attributed largely to an aging population and the rise in chronic conditions.
Challenges Facing Routine Testing Management
In managing routine testing, health plans encounter hurdles such as both overutilization and underutilization of tests. There’s an urgent requirement for disease-specific care models to mitigate discrepancies in service delivery and the associated costs—including waste and abuse within the system.
Insights into Genetic Testing Trends
The annual health plan expenditure on genetic testing in 2024 reached $14.80 PMPY, indicative of a 10% increase from the previous year. Concurrently, the uptake of genetic testing also increased by 10%. This growth signifies a broader trend towards incorporating genetic assessments into patient care, despite genetic tests only constituting 10% of tests by volume and commanding 30% of payer expenditure.
Over the five-year span from 2020 to 2024, total spending on genetic testing surged by 66%, with utilization increasing by 56%. Avalon clients experienced a spending increase significantly below the 75% industry forecast, highlighting the effective strategies Avalon has implemented for managing costs and utilization related to genetic diagnostics.
With over 175,000 genetic tests available in the U.S. and around 500 CPT codes for coverage, challenges persist in genetic test management. Concerns around inadequate coding, quality control issues, pricing troubles, and determining the clinical utility of these tests remain significant hurdles in this rapidly evolving field.
Emerging Trends in Biomarker Testing
Avalon's report identifies notable trends in the utilization of biomarker testing for various healthcare needs—from diagnostics to monitoring disease progression. Among the promising advances in biomarker testing are:
- Multi-cancer early detection (MCED) tests, designed to identify signals in the bloodstream emitted by cancer cells
- Polygenic risk score (PRS) tests, which assess the risk individuals have for common diseases based on their genetic make-up
- Tests for Alzheimer’s disease measuring blood amyloid levels in symptomatic patients
As Kristie Ressler, DO, Chief Medical Officer at Avalon states, the goal is to collaborate with health plans to minimize diagnostic waste and ensure that testing facilitates efficient and effective healthcare solutions. As diagnostic methodologies evolve, payers must adopt approaches that are equally advanced—anchored in robust data and evidence-based practices.
About Avalon Healthcare Solutions
Avalon specializes in diagnostic intelligence, assisting health plans and providers in harnessing the complete potential of diagnostic science. By simplifying complex diagnostic challenges, accelerating the integration of proven innovations, and optimizing diagnostic investments, Avalon empowers organizations to improve health outcomes and control costs through smart care. Their proprietary Diagnostic Insights Platform leverages evidence-based policies and curated lab networks to drive effective healthcare solutions at scale.
Currently, Avalon serves over 30 health plans and supports 44 million members across the nation, delivering comprehensive testing solutions aimed at improving patient care and providing measurable value.
Frequently Asked Questions
What is the primary focus of Avalon Healthcare Solutions?
Avalon Healthcare Solutions specializes in diagnostic intelligence aimed at improving health outcomes and optimizing healthcare investments.
How has genetic testing expenditure changed recently?
Expenditure on genetic testing rose to $14.80 PMPY in 2024, marking a 10% increase compared to 2023.
What challenges does routine testing management face?
Routine testing faces challenges such as overutilization, underutilization, and discrepancies in care delivery across different settings.
What is the significance of Avalon’s lab report?
The Lab Trend Report provides insightful analysis regarding the costs, utilization, and emerging trends in lab diagnostics, particularly genetic and biomarker testing.
How does Avalon Healthcare Solutions support health plans?
Avalon helps health plans by delivering data-driven insights to manage costs effectively and improve diagnostic testing strategies.
