HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that while radiology costs have stabilized since first coming under scrutiny in 2005, insurers are seeing these costs quickly rise again. In several recent reports in Health Plan Analysis, HealthLeaders-InterStudy analysts find that to control costs, insurers continue to rely on traditional approaches such as pre-certification, but are also using multi-pronged strategies to educate providers about proper test usage.
"Industry observers estimate that radiology costs have risen more rapidly than other healthcare expenses. Contributing to this growth is the emergence of new technology, such as breast-specific gamma imaging and more widespread use of imaging technology in general," said Jane DuBose, Director of Health Plan Analysis for HealthLeaders-InterStudy. "Previously, spending was centered around hospitals, but now there are more independent testing facilities and physician offices have increased access to equipment, so health plans are actively engaging in cost containment strategies to help manage the increased cost of more widespread use."
UnitedHealthcare has initiated an imaging accreditation program for providers in 38 states. When a physician orders a test outside of guidelines from the American College of Radiology, a "peer to peer" dialogue occurs between UnitedHealthcare staff and the ordering physician. According to an official with UnitedHealthcare, this intervention has resulted in changed tests 3 percent of the time and cancellation of tests 9 percent of the time.
In Nevada, Anthem Blue Cross and Blue Shield is beginning to use data to give providers more information about best practices on imaging techniques, in hopes of lowering its imaging costs which account for 10 to 12 percent of its entire medical costs in the state.
Premera Blue Cross has launched a new initiative in Washington state that requires providers wanting to schedule an advanced imaging procedure to answer a series of questions. The intent is not approval or denial of the test, but merely to determine if the proper test is being requested in hopes of eliminating unnecessary or duplicated tests and, thus, decreasing costs.
"Plans throughout the country are struggling with how best to control imaging costs. Florida, for instance, as the home to 3.15 million seniors, is a hotbed for imaging, and leads the nation in radiology spending per Medicare patient. As use of imaging technology grows, health plans will likely explore more programs to ensure providers are up-to-speed on the latest guidelines," said DuBose.
About Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing healthcare businesses to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly, Health Plan Analysis provides a detailed look at plan design and financials, as well as information about mergers, legislation and other influencers driving healthcare in a particular region.
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