Prior to partnering with National Imaging Associates, advanced imaging utilization levels for the western region of this national multi-million member health plan were not significantly higher than national averages.
Nonetheless, management and the NIA team understood that radiology was a growing medical management challenge and needed to be proactively addressed.
Because there was not an overwhelming amount of inappropriate utilization already built into the system, NIA focused on slowing utilization growth and preventing poor ordering practices from taking root.
NIA's prior consultation program successfully mitigated growth trends from ~24% (Exhibit A) prior to implementation to the low single digits (Exhibit B). The health plan realized savings of ~$1.38 in year one and ~$3.05 in year two (Exhibit C). Further, current utilization levels are 20-30% less than other regions within this national plan that pursued alternate medical management strategies.
Exhibit A -
Pre-Implementation Advanced Imaging Utilization Growth Rates by Modality Percent
Exhibit B -
Advanced Imaging Utilization Trend Comparison Percent
Exhibit C -
Year 1 Estimated Program Savings Dollars Per Member Per Month
Year 2 Estimated Program Savings Dollars Per Member Per Month
Exhibit D -
Comparison of Management Strategies Effect on Utilization of MRI/A
(Annual Procedures Per 1000 Members)
