Nation’s largest commercial insurer launching new program aimed at curbing imaging costs
The nation’s largest commercial insurer recently launched a new program aimed at curbing costs for major imaging services.
UnitedHealthcare is currently circulating surveys to hospitals and freestanding centers, asking them to share details on their quality performance. Using this data, the Minnetonka, Minnesota, company is placing physicians into separate tiers, with the highest labeled as “Designated Diagnostic Providers.”
Patients seeking major radiology services—such as magnetic resonance imaging, CT, MR angiography, PET, or other nuclear exams—will now need to visit top-tiered providers to incur the lowest out-of-pocket cost.
“The new benefit design will protect our members from higher imaging costs by providing access to imaging facilities that meet broadly recognized quality and efficiency standards,” UnitedHealthcare said in a January 2022 update. “Benefits will be available for major imaging services received from a non-Designated Diagnostic Provider, but it will be covered with higher member cost share.”
Providers in applicable markets started receiving the questionnaire the week of Jan. 17, the American College reported. Quality metrics considered include whether the facility is accredited, provides timely services, and submits electronic images. ACR also said UnitedHealthcare will measure efficiency by cost, with all radiology providers sharing the same monetary targets, regardless of setting.
“UnitedHealthcare stated in a discussion with the American College of Radiology after the program was announced that quality and efficiency are considered equally when determining a provider’s tier level,” the organization said Jan. 28. “The ACR will continue to engage with UnitedHealthcare as questions and/or concerns about the program arise. The ACR encourages providers that receive the survey to complete it as soon as possible.”
Fully insured, small group commercial plan members had the new benefit added to their insurance Jan. 1, while large group beneficiaries will join them July 1. Members and referring physicians will be able to start identifying and utilizing Designated Diagnostic Providers on the same summer date in five months, the insurer said in an FAQ document.
UnitedHealthcare said local availability of the new benefit is subject to state regulatory approval. The frequently asked questions document lists several exclusions, including the state of Hawaii, Medicare and Medicaid plans, and imaging services performed on an admitted inpatient, in an emergency room, or at a specialty or primary care provider office. Modalities such as X-ray, ultrasound and mammography are also outside the program’s scope. The insurer launched a similar service for preferred diagnostic laboratory providers in 2021.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.