on December 16, 2011 |
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Topics: Payer Relations, Reimbursement, Finance, Imaging, Service Lines
Emily Hague, Imaging Performance Partnership
Though traditionally patients have received imaging services from the programs they are referred to by their personal physicians, price sensitivity has begun to proliferate, with patients being steered to lower cost providers by payers and RBMs. Stories of imaging price steerage continue to surface, with no signs of lessening.
Accelerating trend toward increased transparency
In September, Ohio’s Anthem Blue Cross and Blue Shield launched a program called Radiology Imaging Shopper. This proactive initiative goes a step further than online databases like Anthem Care Comparison – the insurer will actually reach out to patients receiving pre-authorization for imaging procedures to share cost and quality data in an effort to help patients make more informed decisions about their care.
Wellpoint is piloting AIM Smart Shopper, a similar initiative in Indianapolis. When physicians request approval for an imaging procedure, Wellpoint’s subsidiary American Imaging Management (AIM, a radiology vendor) will contact the physician to recommend cheaper options with similar ratings on quality measures. If the physician’s office does not change their recommendation, AIM will contact the patient directly. In the first four months of the pilot, Wellpoint found that patients were redirected to less expensive providers 11% of the time.
And Anthem and Wellpoint are not the only ones – Coventry and UnitedHealth Group are also among insurers pushing to enhance patient access to cost and quality data, and direct patients toward less expensive sites of care.
What this means for imaging providers
As patient awareness of prices increases, so too will their price sensitivity. The continued proliferation of price sensitivity and steerage means imaging providers will need to find new ways to compete – either retaining volumes and mitigating steerage under existing pricing models, or moving beyond current pricing paradigms. The Imaging Performance Partnership’s 2011 study Overcoming Emerging Barriers to Growth helps to address these challenges to volumes and pricing.
