Radiology Case Study

Effective Radiology Benefit Management

Experiencing double digit year over year increases in advanced technology outpatient diagnostic imaging services a health plan with over 1 million members partnered with CareCore National to manage their radiology benefit.  CareCore National's approach consisted of employing both utilization and quality management measures.

Result highlights:

• Immediate and dramatic decreases in inappropriate utilization
• Imaging centers required to comply with quality standards

The combined utilization and quality management programs resulted in a greater than fifty percent (50%) reduction in utilization which brought the plan’s utilization back within managed national norms and continued to manage the ongoing trend.

The graphs below provide the full chronology of trend increases prior to the program inception as well as the utilization experience after CareCore National intervention.  The information is presented in procedures per 1000 covered lives on a modality-by-modality basis.