A startup company working to root out misdiagnoses in radiology has inked its first partnership with a commercial payer.
New York-based Covera Health first made waves when it teamed up with Walmart last year to help the retail giant guide employees toward high-value imaging. Now, the analytics firm has signed on with Premera Blue Cross in the Pacific Northwest to do the same on the insurer side, the two announced Tuesday.
They’ll work to establish “radiology centers of excellence” around the highest quality practices, aiming to avoid unnecessary surgery or other care that stems from substandard imaging. Premera will offer the program to its fully insured population, along with self-insured companies that opt into the offering. They plan to start with a musculoskeletal focus and will gradually expand across all imaging.
“We’ve done a lot to measure the effectiveness and overall quality of physicians who deliver surgical care. But we believe we can prevent members from ever needing that surgery by moving upstream and making sure that the interpretations and diagnoses are accurate,” Rick Abbott, VP of product and market solutions for Premera, told Radiology Business Tuesday. “This not only improves overall quality for the member and reduces downstream harm, but it eliminates a substantial amount of financial waste as well.”
Abbott said it’s too early to estimate how much they might save through the program, as they have not yet established a baseline. However, Covera CEO Ron Vianu said clients in more established programs elsewhere have achieved 10%-30% in savings, which translates directly to improved outcomes including reduced surgeries and opioid prescriptions.
Based in Mountlake Terrace, Washington, Premera Blue Cross provides benefits and tailored services to roughly 2 million customers, ranging from individuals to Fortune 100 companies. Abbott declined to specify how many members the partnership would reach, but he did say it will stretch across all 50 states. “It’s going to be a pretty large amount of our business.”
Premera already has an infrastructure to review advanced imaging cases and make sure the procedure is appropriate, Abbott added. With Covera’s help, they can now pinpoint whether the radiologist selected to interpret a scan is the right fit, based on quality. In the short term, they’ll make a recommendation to the patient using this information, while in the longer term, some employers have expressed interest in changing benefit structures to financially incentivize members to use higher quality radiologists.
Vianu first founded Covera in 2017 and the firm announced back in January that it had raised $23.5 million in funding to fuel further growth. The chief executive said they have fielded interest from other payers, and he expects similar announcements soon, with several currently “in the pipeline.” Last year’s announcement with Walmart has certainly drawn attention, he added.
“Premera is the first plan to work with us in this direct manner; previously, it has all been through the employer community. So, we are super excited about the partnership for that reason,” Vianu told Radiology Business.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.