Anthem Blue Cross and Blue Shield Announces Results from Program to Contain Rising Health Care Costs and Protect Members' Health.DENVER, Colo. & RENO, Nev. -- As health insurance costs continue to rise faster than inflation rates, health insurers are engaged in a heated battle to find new ways to slow the rate of premium increases while improving members' overall health experience. One promising strategy is to more effectively manage radiology services. In May 2002, Anthem Blue Cross and Blue Shield Blue Shield A US not-for-profit health care insurer that is a reimbursement intermediary for physicians. Cf Blue Cross. in Colorado and Nevada contracted with National Imaging Associates (NIA NIA National Institute on Aging (NIH) NIA National Indoor Arena (UK) NIA National Intelligence Agency (South Africa and Thailand) NIA National Institute of Accountants ), a radiology management vendor, to assist in managing high-end imaging (MRIs, PET scans, CT scans and nuclear cardiology nuclear cardiology Imaging The use of nuclear imaging techniques in the noninvasive study of cardiovascular disease–eg, myocardial perfusion imaging, planar imaging, SPECT–single-photon-emission computed tomography, infarction imaging. ) services and protect members from unnecessary, and potentially harmful, medical testing. The results of this program have been overwhelmingly positive. "In the United States today, radiology services represent 10 percent of the health care dollar. Radiology is a $70 billion industry -- in fact, high-end or advanced imaging services are outpacing pharmacy drug costs. And, the medical literature reflects the startling star·tle v. star·tled, star·tling, star·tles v.tr. 1. To cause to make a quick involuntary movement or start. 2. To alarm, frighten, or surprise suddenly. See Synonyms at frighten. fact that 50 percent of all imaging doesn't provide information that improves patient diagnosis and treatment," said Dr. Robert London, VP, Health Care Management, Anthem Blue Cross and Blue Shield. "By using appropriate radiology testing, health outcomes for our members are improved. For example, using an ultrasound instead of a more invasive test may give a more accurate diagnosis to the physician. NIA radiologists work with our network physicians to optimize the use of imaging providers." Regardless of the fact that half of the imaging services performed aren't medically necessary medically necessary Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt's condition if omitted, in accordance with accepted , don't provide valuable health information, and may expose the patient to unneeded radiation, utilization of services continues to increase. (The Wall Street Journal, August 31, 2004). For example, annually, CT scan utilization is increasing about 15 percent, MRI 1. (application) MRI - Magnetic Resonance Imaging. 2. MRI - Measurement Requirements and Interface. nearly 20 percent, nuclear cardiology roughly 17 percent, and PET scan over 96 percent. (NIA, 2004) In order to temper these trends, Anthem contracted with NIA to pre-certify advanced imaging tests and collect data on referring and rendering physician practice. The results have been highly encouraging. In the first year of the program, Anthem reported CT, MRI and Nuclear Cardiology utilization growth rates of minus 1 percent, 1 percent and 9 percent, respectively; similar growth rates for advanced imaging procedures and non-advanced tests (e.g., plain films, ultrasounds) and decreased unnecessary medical tests for members. "There's no question that sophisticated imaging techniques can be quite valuable when used judiciously and in the best interest of the patient. At Anthem, we want to make sure that our members aren't unnecessarily exposed to radiation, are not subjected to unnecessary testing and receive medically appropriate care," continued Dr. London. "In addition, we're doing everything we can to help slow the rate of premium increases. Our decision to work with NIA has been very positive for Anthem and our members and has resulted in significant savings, which are expected to continue in years two and three." About Anthem Blue Cross and Blue Shield in Colorado Anthem Blue Cross and Blue Shield's mission is to improve the health of the people it serves. Anthem Blue Cross and Blue Shield in Colorado is a subsidiary of WellPoint, Inc. (NYSE NYSE See: New York Stock Exchange : WLP WLP WebLogic Portal (Bea Systems) WLP Wafer Level Packaging WLP Women's Learning Partnership (Bethesda, MD) WLP Workplace Learning & Performance WLP World Library Partnership, Inc. ). WellPoint, Inc. is an independent licensee of the Blue Cross and Blue Shield Association
Located between Wapakoneta and Lakeview at the intersection of U.S. , Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through HealthLink and UniCare. Additional information about WellPoint is available at www.wellpoint.com. |
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