SEATTLE, Sept. 11, 2013 /PRNewswire/ -- A study published in September's Journal of Managed Care Medicine suggests that automated prior authorization can reduce overutilization of advanced imaging services.
ADVANTAGE Health Solutions, Inc. (AHS), an Indiana-based health plan, performed the research as part of a larger study that evaluated the impact of physician engagement on accountable care. AHS deployed an automated authorization solution developed by MCG (formerly Milliman Care Guidelines), a leading provider of clinical guidelines to healthcare payor and provider markets.
"There's good evidence that advanced imaging services such as CT, MRI, and PET scans are over utilized," said Dr. Anthony N. Akosa, VP of Medical Affairs and Informatics at AHS. "This is not just a cost issue. It's also a patient safety and care quality issue, particularly for scans emitting ionizing radiation. Our study strongly suggests that pairing automated authorization with evidence-based clinical guidelines – as the MCG solution does – can ensure delivery of safe, effective care while also reducing medical costs by 39% or more."
The larger AHS study also looked at reducing overutilization of emergency room services and expanding use of comparable generics, all within a framework of increased provider and patient engagement. Overall, the intervention showed a return on investment of 8 to 1.
"The AHS research indicates that, equipped with accurate information, physicians are better able to champion effective care," said Jon Shreve, chief executive officer of MCG. "We're pleased to work with partners such as AHS to explore new, evidence-base avenues that support accountable care."
About ADVANTAGE Health Solutions, Inc.
ADVANTAGE Health Solutions, Inc. SM, a local provider-sponsored health plan, offers health care benefits and solutions to Indiana employer groups of all sizes. ADVANTAGE has always taken a different approach in providing health plan benefits through their large and diverse network of providers. They focus on helping their members stay healthy and, when necessary, understand and deal with the challenges of chronic health conditions. It's not just about low cost, high quality health care access. It is about avoiding those unnecessary services and utilization that do not add value to the healthcare dollar. For more information, visit www.advantageplan.com (http://www.advantageplan.com)
MCG, formerly Milliman Care Guidelines, independently develops and produces evidence-based clinical guidelines and software used by more than 2,200 clients, including 1,200 hospitals and seven of the eight largest U.S. health plans. Updated annually by an experienced team of clinicians, the care guidelines support the care management of a majority of Americans. For more information, visit www.careguidelines.com. (http://www.careguidelines.com)
Tel +1 206 389 5405
SOURCE MCG, formerly Milliman Care Guidelines