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Insurers Employ Multiple Solutions to Avoid Radiology Expense Spike
Date:11/19/2008

NASHVILLE, Tenn., Nov. 19 /PRNewswire/ -- 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.

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SOURCE HealthLeaders-InterStudy
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