Case Study 3 – Successful Utilization Management Program in Medicare Population
When National Imaging Associates (NIA) first analyzed the utilization experience for this major regional health plan, the advanced imaging growth rate for the plan's Medicare members was almost double the rate for commercial members (as shown below in Exhibit A). As a result, our health plan customer decided to implement a program for both categories of members.
The results were highly positive for the commercial health plan members as NIA successfully reversed a 16% historic growth rate to -13% in the first year of the program.
Medicare results were even better. Prior to implementing the program, CT and MRI utilization experienced an annual growth rate of 25%. But after a year under NIA's management, Medicare utilization levels were 19% lower (as shown below in Exhibit B).
On a per-member-per-month cost savings basis, Medicare results were four times greater than those for commercial members. In the first year, estimated savings were $1.64 per member per month for commercial members, and $6.46 for Medicare members (as referenced below in Exhibit C).
The positive performance continued for this health plan as utilization levels remained lower than pre-program levels - even with two years.
Exhibit A: Pre-Implementation Advanced Imaging Utilization Growth Rates by Modality and Line of Business
Exhibit B: CT and MRI Utilization Trend Comparison
Exhibit C:
Commercial Estimated Program Savings
(Dollars Per Member Per Month)
Medicare Estimated Program Savings
(Dollars Per Member Per Month)
Exhibit D: Comparison of Management Strategies Effect on
Utilization of MRI/MRA
(Annual Procedures Per 1,000 Members)
For more information about partnering with NIA to drive better patient outcomes and bottom-line results, contact us.