After a successful pilot in its Hudson, N.Y. region, MVP Healthcare is rolling out McKesson’s Advanced Diagnostics Management (ADM) to the rest of its provider network to automate the clinical review and authorization of imaging tests.
The two-month pilot has been projected to save an annual $2 million-plus in staff time, enabling staff redeployment for other projects, said Holly Smolinski, assistant director of utilization management at MVP.
With the elimination of its gold card policy, which exempts exemplary physicians from going through clinical criteria, MVP expects the number of authorization requests to jump from 30,000 to 100,000. Automating the process will allow MVP to handle the increased load.
Health plans are looking for better management of administrative and medical costs associated with advanced diagnostics, as well as process automation, said Matthew Zubiller, of McKesson’s advanced diagnostics management team.
Automation reduces the amount of communication coordination among the care teams, he said. For every authorization request processed manually, payers spend $25 to $75 and providers spend $25 to $50.
ADM’s focus is on the total cost of care management and optimal use to get the care and management right, Zubiller said. Thirty percent of imaging orders are inappropriate or ordered in error, he pointed out. ADM identifies appropriate tests and if a test should have been ordered but wasn’t. Even if the test costs more, it will prevent more costly treatment down the road, he said.
MVP will roll out ADM to its Albany, N.Y., region by mid-August and continue monthly rollouts until the end of the year.
While total automation is ideal, Smolinski expects a mirroring of the pilot’s results. Two-thirds of the Hudson region’s authorization requests are submitted through ADM.
Bibb Allen, MD, of the American College of Radiology and a member of the Imaging e-Ordering Coalition, said the ACR supports the removal of inappropriate uses and advocates for a system that provides appropriate criteria for ordering physicians at the time of ordering.
