Anthem/AIM: Imaging programs can provide quality, affordable care to health-plan consumers

Those of us who work in the healthcare industry share the same goal: ensuring that consumers have access to high-quality, affordable healthcare. In many clinical settings, one of the first steps to ensuring consumers receive optimal care for their conditions is through the use of imaging, which has become a key diagnostic tool for many diseases and has an important role in monitoring treatment and predicting outcomes. 

While patients often have access to an array of high-quality imaging facilities, imaging costs can vary widely from site to site. An August 2017 report from Modern Healthcare cited a study by Amino, a health-information company, which found that a limb MRI can cost up to $1,500 more if performed in a hospital rather than at a freestanding imaging center. Addressing significant variation in imaging costs such as these, while presuming imaging quality, will require us to work together to develop solutions that reduce potential barriers to high-value care. 

That is why Anthem and its subsidiary, AIM Specialty Health, developed its innovative Imaging Clinical Site of Care program. This program helps identify clinical situations where MRI and CT scans can be done in freestanding clinics or imaging centers rather than in a hospital setting, all the while delivering a comparable level of quality at a reduced cost. 

While access to high-quality care is our utmost consideration, we also have a strong responsibility to consumers—many of whom have selected high-deductible plans—to keep their out-of-pocket costs and premiums at affordable levels. More specifically, consumers who have not met their deductible may incur out-of-pocket costs that are nearly $1,000 higher for imaging studies completed in the hospital setting versus a freestanding center.

Through AIM’s portal, referring clinicians have access to a variety of data that identify imaging sites for consumers. The AIM solution shows comparative imaging-facility scores that highlight self-reported measures of adherence to standards established by the ACR and the Intersocietal Accreditation Commission. 

Reported measures also include details regarding the specialty and training of the interpreting physician, technologist qualifications, accreditation and equipment status. AIM will only propose freestanding imaging facilities that are clinically appropriate and have a site score similar to or better than the nearby hospital facility. Sites are listed first by score, then by cost and, finally, by distance from the provider’s office.

While Anthem’s Imaging Clinical Site of Care program offers consumers access to affordable, quality healthcare in a clinically appropriate setting, we recognize it is not applicable in all situations. As an example, certain rural areas have insufficient access to freestanding imaging centers and will warrant ongoing reliance on outpatient hospital imaging. Likewise, Anthem will continue to approve in-hospital imaging for emergencies or for pre-operative testing. 

Anthem continues to seek feedback from providers and hospitals so we can further evaluate the program. Based on feedback to date, Anthem has added clinical scenarios that warrant in-hospital imaging. These include imaging for children under 10, patients who may need moderate or deep anesthesia, and patients with a known chronic disease who have already had prior imaging related to their condition at a hospital and require ongoing surveillance. 

For situations that don’t meet these criteria, physicians can request a peer-to-peer review with a board-certified radiologist.

Feedback from our radiologist colleagues has been considered in any changes made to the program to date. We welcome your comments at SolutionMedicalDirector@AIMSpecialtyHealth.com, and we invite your partnership in realizing our shared goals of better quality and greater affordability for our collective consumers and patients. 

Dr. Latif is vice president of healthcare management at Anthem, Inc. Dr. Soffa is senior vice president at AIM Specialty Health.