In a field as complex as healthcare, it can be hard for even doctors to keep up with the latest evidence-based guidelines. But that is where AIM Specialty Health comes in, as its services help ensure clinical best practices are adopted in the outpatient setting.
The Chicago-based firm focuses on improving the clinical appropriateness, safety and affordability of radiology, cardiology, oncology, sleep medicine and specialty pharmaceutical benefits. AIM started operations in 1989 as American Imaging Management.
President and CEO Brandon Cady says that while the company’s initial focus was on promoting the appropriate use of diagnostic imaging, it branched out over the years into cardiology, specialty drugs, radiation therapy and most recently, sleep medicine. “Our focus is on tackling high cost services experiencing rapid growth in terms of utilization,” Cady explains. “These services can be extremely difficult for our health plan clients to manage internally.”
According to Julie Thiel, AIM’s vice president of clinical operations, a key driver of high utilization is inappropriate ordering on behalf of the provider. According to several peer-reviewed studies, imaging inappropriateness estimates range anywhere from 10 to 20 percent, and for certain imaging exam types, that figure can be as high as 30 to 40 percent. At an average cost per test of $700 to $2,000, the costs of inappropriate imaging are staggering.
“As a partner to over 42 health plans across the country, we work with providers to ensure that the utilization of these services is based on the latest clinical guidelines as outlined by physician organizations like the American College of Radiology and the American College of Cardiology,” Thiel states.
This March, the company adopted the AIM Specialty Health name to reflect this evolution from a radiology benefits company to a specialty benefit management company. In fact, by 2013, AIM will have more than 11 million members covered by each of its service lines outside of radiology in addition to the 32 million covered by AIM’s core diagnostic imaging program.
Kevin McDermott, AIM’s vice president of provider and consumer programs, is leading the company’s most recent initiative – promoting public awareness of the significant price variance between servicing providers.
Through AIM’s Specialty Care Shopper, a proactive patient outreach program, once a service is approved, an AIM representative will contact the patient with information about high-quality, low-cost providers in their local community. The representative will even help the patient schedule their appointment.
“If you were to get an MRI or a CT, there could be a significant price variance between providers even within the same community,” McDermott says, noting that one provider may charge thousands of dollars, but another might charge only $600 for the same service.
McDermott notes that the program is about more than just getting patients to the lowest cost provider, but also about promoting providers that offer the highest quality care. In fact, cost is just one factor in AIM’s scoring criteria, which also includes staff credentials, equipment, accreditation and patient convenience.
“The Specialty Care Shopper Program was designed to help shine a light on a key problem with today’s healthcare system – patients lack the tools necessary to shop for care using comparative information on the quality and capabilities of providers,” McDermott continues.
The Specialty Care Shopper program covers 3.5 million members in 10 states and will grow to 8 million by the end of the year. Already, the program is showing positive results. In the Indianapolis metro area, the program has resulted in an estimated $2.4 million in annual savings since its launch in December 2010.
With all eyes on the healthcare industry, Cady says that AIM is focused on continuing to expand its portfolio with solutions that will position its health plan clients to capitalize on the shifting dynamics of the industry.
AIM is already working with health plans that are pioneering the adoption of value-based reimbursement and incentive models by providing real time performance data on network providers.
“This data provides valuable insight about provider and patient behaviors when it comes to the use specialty care,” Cady says. “And understanding these behaviors will be critical in developing new standards as the U.S. healthcare industry transforms from volume-based to value-based.”