Case Study 1 – Proactive Management of a Growing Imaging Challenge
Before partnering with National Imaging Associates (NIA), advanced medical imaging utilization levels for the Western region of this national multi-million-member health plan were not significantly higher than national averages.
Nonetheless, the health plan's management and NIA's team understood that diagnostic medical imaging was a growing medical management challenge that needed to be proactively addressed.
Because there was not an overwhelming amount of inappropriate utilization already built into the system, NIA focused instead on ensuring the continued appropriate use of imaging services - effectively slowing utilization growth and preventing poor ordering practices from taking root.
As a result, our medical necessity review program successfully mitigated growth trends from ~24% (as shown below in Exhibit A) prior to implementation to the single digits (as shown below in Exhibit B). Our health plan customer realized savings of ~1.38 in the first year and ~3.05 in the second year (referenced below in Exhibit C).
In addition to cost savings, utilization levels remained 20-30% lower than those in the plan's other regions, where alternate medical management strategies were pursued - without the benefit of a partnership with NIA.
Exhibit A: Pre-Implementation Advanced Imaging Utilization Growth Rates by Modality Percent
Exhibit B: Advanced Imaging Utilization Trend Comparison Percent
Exhibit C:
Year One Estimated Program Savings Dollars Per Member Per
Month
Year Two Estimated Program Savings Dollars Per Member Per Month
Exhibit D: Comparison of Management Strategies Effect on
Utilization of MRI/MRA
(Annual Procedures Per 1,000 Members)
For more information about partnering with NIA to drive better patient outcomes and bottom-line results, contact us.