Radiology Benefits Management
With ongoing advancements in the field, radiology is increasingly considered an integral component of the non-invasive diagnostic tools available to physicians. In fact, radiology is among the fastest-growing areas of health care spending, with estimates of projected annual growth exceeding 20 percent.
While most health plans with unmanaged radiology benefits are experiencing this type of growth in advanced imaging utilization costs, NIA health plan customers experience minimal or no increases annually.*
Rapidly advancing imaging technology, an aging population, and direct-to-patient advertising are among the factors that continue to fuel this growth making a continuous stream of new diagnostic imaging procedures and equipment available to physicians and their patients. Our programs are designed to make sure patients receive consistent quality and appropriate advanced imaging services, whether in a hospital or a free-standing facility.
*Source: NIA National Claims Database
Advanced Radiology
Advanced imaging technology includes:
- Magnetic Resonance Imaging (MRI/MRAs)
- Computerized Tomography (CT)
- Nuclear Cardiology
- Positron Emission Tomography (PETs)
These advanced procedures account for only 20 percent of total imaging volume but nearly 75 percent of the annual increase in radiology spending and will continue to inflate radiology costs for many years to come. Unfortunately, in our experience, about one-third of advanced tests are either clinically inappropriate or do not contribute to the physician’s diagnosis or treatment.
Radiology Benefits Management Solutions
With more than 20 million lives under contract, National Imaging Associates, Inc. (NIA), Magellan’s radiology subsidiary, is the largest radiology benefits management firm in the country. Currently partnering with managed care organizations in 36 states, NIA is improving the quality and cost-efficiency of diagnostic imaging testing for health plan members and physicians. Through our programs, we help make sure that:
- members do not have to undergo unnecessary repeat diagnostic scans,
- diagnostic imaging services are used only when they are clinically appropriate, and
- only qualified specialty clinicians render and evaluate imaging tests.
How We Work With Our Customers
Each of our customer health plans is unique, so we begin by conducting an in-depth analysis of past utilization, cost and delivery of diagnostic imaging services. The analysis includes a review of the following:
- Historical provider practice patterns
- Provider reimbursement differentials
- Appropriateness and level of utilization delivered to members
- Access to qualified imaging providers
- Audit of claims and assessment of correct coding
- Strategies to improve cost and quality based on local health care delivery and regulations
This analysis, combined with information from our imaging claims database and marketplace experience allows us to assist our clients in developing strategies to improve the appropriateness and quality of diagnostic radiology services delivered to their members.