American Imaging Management (AIM) has launched Opti Net, a concierge-type program that delivers pricing and capability information to health plan members, using data submitted by health plans and imaging facilities. Early pilot data indicate the program may save $1,000 for each study redirected to an alternate provider.
The Chicago-based specialty benefits management company, a subsidiary of WellPoint, aims to promote informed decision-making by patients and physicians. Opti Net is initially being used for advanced diagnostic imaging procedures, such as CT and MRI exams that are administered in an outpatient setting.
"Advanced diagnostic imaging exams are very expensive and often patients and their physicians are not aware that price can vary dramatically depending on where the exam is performed," said Brandon Cady, president and CEO of AIM. "We routinely see instances where different facilities located in the same area–with the same type of equipment and the same type of physicians reading the results–have prices that vary by more than a thousand dollars."
Opti Net operates in tandem with AIM's clinical appropriateness program. When a physician goes through the review process for an imaging exam, AIM provides price and capability information that can be used by the physician to select an imaging facility. After the review process is completed, Opti Net compares the price and capability scoring for the imaging facility selected during the review process with other facilities located in the same geographic area. If the program finds another facility that offers comparable or better capabilities at a lower price, an AIM representative proactively calls the consumer to provide this information. While wholly voluntary, if the consumer decides to switch to an alternative imaging facility for the exam, AIM assists in scheduling the service.
The Opti Net tool for CT and MRI is being piloted with WellPoint's affiliated health plan in Indiana within a nine-county Indianapolis market where AIM and the health plan identified a broad cost difference among advanced diagnostic imaging procedures. The cost variance for CT scans was more than $1,000 in many instances, while the variance for MRI procedures was almost $2,000, according to AIM.
In the first two months of the pilot, more than 460 exams were impacted by the program, according to AIM. In these cases, WellPoint's affiliated health plan members in the Indianapolis region voluntarily chose to switch imaging facilities to a lower-cost alternative. The average price savings for services that were redirected is estimated to be $1,000 per exam, AIM shared.