When NIA first analyzed the utilization experience for this major regional health plan, the advanced imaging growth rate for the plan's Medicare members was almost double the rate for commercial lives (Exhibit A). As a result, the health plan decided to implement a program for both categories of members.
Program results for the commercial lives were highly positive; NIA successfully reversed an historic 16% historic growth rate to -13% in the first year of the program. Medicare results were even better: prior to program implementation, CT+MRI utilization grew 25%, but after a year under NIA's management, Medicare utilization levels were 19% lower (Exhibit B).
On a PMPM cost savings basis, Medicare results were four times greater than those for commercial lives. In year one, estimated savings were $1.64 PMPM for commercial members, and $6.46 for Medicare members (Exhibit C).
The positive performance continues as current utilization levels remain lower than those prior to implementation, even after two years.
Exhibit A -
Pre-Implementation Advanced Imaging Utilization Growth Rates by Modality and Line of Business
Exhibit B -
CT and MRI Utilization Trend Comparison
Exhibit C -
Commercial Estimated Program Savings
(Dollars Per Member Per Month)
Medicare 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)
