Anthem says closer review of imaging costs paying off |

Anthem says closer review of imaging costs paying off

John Seelmeyer

While rising drug costs get a lot of attention, the costs of sophisticated imaging in health-care are outpacing pharmacy expenses for health insurers.

In fact, radiology services today represent about 10 percent of the health-care dollar.

Anthem Blue Cross and Blue Shield says it managed to get a handle on the costs by more careful review of radiology services ordered by physicians.

Overall, the increased review saved Anthem $1 a month per member in Nevada, says William Bannen, vice president of Nevada healthcare management for the company.

And equally important, Bannen says, the program didn’t generate ill will among physicians whose orders were reviewed.

“We didn’t get much push-back on this,” the Anthem executive says.

The reason? Anthem contracted with National Imaging Associates, which uses board-certified radiologists to pre-certify advanced imaging tests.

Physicians, he says, are open to the advice of other specialists especially in a fast-changing field such as high-end imaging.

A year after Anthem began using the precertification program in Nevada and Colorado, it reduced the number of CT scans paid by its members by about 1 percent.

The use of MRI scans grew by 1 percent, and the use of nuclear cardiology grew by 9 percent.

(The insurer didn’t break out results separately for Nevada and Colorado.) By comparison, the national growth rate for CT scans is about 15 percent a year, use of MRIs is growing by nearly 20 percent a year, and the growth in nuclear cardiology is running about 17 percent a year.

Anthem and other insurers question whether all the sophisticated tests are necessary.

“The medical literature reflects the startling fact that 50 percent of all imaging doesn’t provide information that improves patient diagnosis and treatment,” says Robert London, vice president of health care management for Anthem.

He said Anthem will continue to work with National Imaging Associates on management of high-scanning services.