Health plan looks to doctors to steer patients' imaging business

WellPoint introduces a system to give physicians cost and quality data on imaging centers. But doctors are not sure the information is useful -- or accurate.

By Emily Berry, AMNews staff. Jan. 21, 2008.

WellPoint's Anthem Blue Cross and Blue Shield divisions in Indiana, Ohio, Missouri, Kentucky and Wisconsin have launched a program the company says is intended to direct patients to better-quality, lower-cost imaging facilities. But some physicians say the program is likely to be more of a hassle than a help.

Like many of its peers, Anthem had already put in place prior authorization to try to limit imaging tests, which it had identified as one of its fastest-growing costs. The WellPoint division handling those prior authorizations, American Imaging Management, then developed OptiNet.

When a doctor calls or goes online to obtain prior authorization for an imaging procedure, that physician hears or sees a list of local imaging facilities that, along with listing the distance from the patient's home, shows letter grades for quality and average cost for the procedure being ordered.

OptiNet bases the letter grade on reported hours of operation, qualifications of staff and physicians, and type and age of equipment, said Paul Danao, vice president for business development at American Imaging Management, based in Deerfield, Ill. It started OptiNet in November 2007.

He said if the facility adds a technician, buys new equipment or hires a new physician, the quality information can be changed, and the facility's quality score will be updated on the following business day.

Imaging facilities don't have to participate in OptiNet, and physicians don't have to take it into account when suggesting facilities to their patients. In any case, physicians aren't welcoming its presence.