CHICAGO, Sept. 21, 2011 /PRNewswire/ -- AIM, a leading specialty benefit management company today announced the results of a customer case study that shows prospective clinical review for echocardiography improves the clinical appropriateness of cardiac imaging services and helps prevent unnecessary utilization.
Implemented in 2009 by a health plan covering a three-state region, AIM's clinical review program for echocardiography resulted in a decrease in utilization of 18 percent, the study shows, with the added benefits of helping to reduce unnecessary health care spending and enhancing patient safety and value for consumers.
This is especially important as rampant and often unnecessary or inappropriate imaging procedures are frequently cited as contributing to our nation's unsustainable health care costs. According to a 2008 report by America's Health Insurance Plans, imaging procedures grew nearly 40 percent from 2000 to 2005 and estimates suggest that one third of these procedures are inappropriate, costing between $3 billion to $10 billion annually. Moreover, the report finds, between 20 and 50 percent of high-tech diagnostic imaging for various conditions fails to provide information that improves patient diagnosis and/or treatment and may be considered redundant or unnecessary.
Using a rigorous methodology, AIM evaluated a client population of approximately three million members over a two-year period in 2009 and 2010 to determine the impact its echocardiography clinical review program had on provider ordering behaviors and utilization patterns. The study finds that the clinical review program resulted in a decrease in utilization of certain cardiac imaging services of 18 percent, compared to the same period the year before the program was implemented. The program demonstrated success especially in managing utilization on the front end of the ordering process through efficient evaluation of orders along with focused provider education, where necessary, as opposed to a high rate of denials.
"As a company committed to driving the appropriate use of clinical services, AIM is pleased that our clinical review program for cardiac imaging services continues to demonstrate profound results in decreasing unnecessary utilization, improving patient safety and delivering significant savings for the entire health care system," says Brandon Cady, chief executive officer of AIM. "Now more than ever, our industry must drive appropriate use to ensure both high-quality care for patients and value for every health care dollar spent within our system. While AIM is investing in dynamic models to transform the way we ensure appropriateness and efficiency, the clinical review and intervention model continues to prove its superior effectiveness over time."
In addition to validating the impact of AIM's clinical review program on unnecessary or inappropriate utilization, the case study also shed some light on ordering patterns among providers. Although Appropriate Use Criteria (AUC)* for Stress Echocardiography (SE) and Myocardial Perfusion Imaging (MPI) are almost identical for clinical scenarios related to coronary artery disease (CAD), providers in this market tend to refer lower-risk patients for SE and higher-risk individuals for MPI. Therefore, the program was most impactful in managing SE requests based on the clinical characteristics of the patients as presented by ordering physicians.
"Delivering efficient and effective clinical review, based on current AUC and literature, is reducing variability and bringing practice standards closer in line with evidence-based medicine," said Thomas Power, M.D., FACC, AIM's medical director for cardiology. "The emphasis on promoting evidence-based medicine offers significant benefits to physicians and patients by supporting efforts to deliver the most clinically appropriate and efficient care."
In 2008, AIM launched its clinical review program for echocardiography services covering Stress Echocardiography (SE), Resting Transthoracic Echocardiography (TTE) and Transesophageal Echocardiography (TEE). Under the program, a provider ordering one of these services contacts AIM via phone or its self-service Web portal to provide demographic and clinical information appropriate to the requested service. This information allows AIM to evaluate the request using tools such as coronary artery disease (CAD) risk scoring consistent with the appropriate use criteria established by the American College of Cardiology (ACC). The initial results of an echocardiography clinical review program implemented by AIM demonstrate how these programs can improve clinical appropriateness, decrease unnecessary utilization and change ordering behaviors of providers, especially through peer-to-peer consultations with AIM physician reviewers and physicians.
Driven by clinical guidelines modeled after the ACC's appropriate use criteria, this program successfully reduced utilization per 1,000 members from 28.6 before the program was launched to 23.6 across a population of 2.8 million members.
Since it began, the AIM clinical review program for echocardiography services has been implemented by health plans in 16 states, covering over 13 million individuals.
For more information on the AIM study visit: www.americanimaging.net
*AUC Criteria are developed by the American College of Cardiology for several cardiac imaging methods to determine whether a particular approach to care is reasonable in a given clinical scenario.
AIM is a leading specialty benefit management company with over 20 years of experience in the radiology benefit management industry. AIM's mission is to make healthcare services more clinically appropriate, safer and more affordable. AIM promotes the most appropriate use of diagnostic imaging through the application of widely accepted clinical guidelines delivered through an innovative platform of technologies and services. AIM pioneered the use of web self-service technology in diagnostic imaging management and has continually integrated technology tools to create a more effective and efficient clinical review processes in support of the physician-patient relationship. AIM also manages a growing platform of healthcare services including cardiac services and specialty pharmaceuticals. Through a commitment to delivering excellence in clinical content, service, innovation and operational performance, AIM has developed a national client base of health plans, and currently provides its services to more than 35 million health plan members. AIM is an operating subsidiary of WellPoint, Inc. (NYSE: WLP; www.wellpoint.com). For more information on AIM, please visit http://www.americanimaging.net.
SOURCE American Imaging Management, Inc.