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Some insurers' costs for high-tech imaging services are increasing 15% to 20% per year. In response, health plans are rolling out radiology benefit management programs, disclosing more cost and quality data to consumers and carefully reviewing the clinical literature to develop coverage policies for emerging advanced imaging tests.

For example, CT scans may be used to diagnose coronary artery disease, as a far less invasive alternative to acatheter angiography, but does it improve patient outcomes or decrease the number of more invasive procedures? And although many insurers cover PET scans for multiple oncologic conditions, the inappropriate use of PET scans also is growing.

Two experts on medical technology assessment and health insurers’ clinical policy decisions provide practical insights on strategies for some of the newest advanced imaging technologies:

• Which new and emerging advanced imaging tests are likely to have the greatest impact on health plans?
• How are health insurers developing coverage policies for these tests?
• What upcoming FDA and CMS policy changes and expected clinical study results could change how insurers reimburse for the scans — and what can insurers do about it?
• What specific strategies can insurers use to address rising imaging costs?
• What results has one insurer experienced in terms of utilization and medical-cost reductions? How were its radiology benefit management programs structured?

Speakers

KEN PATRIC, M.D., is vice president and chief medical officer for commercial and established markets at BlueCross BlueShield of Tennessee. He is board-certified in family practice and has been with BlueCross BlueShield of Tennessee for more than 13 years in various positions, including associate medical director, medical director of quality management, medical director of HMO Blue, senior medical director of medical management & operations, and corporate medical director. Dr. Patric received his BA in Biology from the University of California, San Diego in 1972; completed medical school at the University of Rochester School of Medicine in 1976; and completed his Family Practice residency at the University of California, Davis School of Medicine in 1979. Prior to joining the Tennessee Blues plan, Dr. Patric was in private practice for 15 years in various settings in California, where he was also Chief of Staff and a board member of Woodland Memorial Hospital, board member of an 80+ physician IHO, board member of the California Medical Association & California Academy of Family Physicians, and Clinical Professor of Family Practice at the University of California, Davis School of Medicine.

DIANE HAYES, Ph.D., is vice president of research and development for the medical technology assessment firm Hayes, Inc. Dr. Hayes, an epidemiologist, completed a three-year postdoctoral fellowship on cancer epidemiology at the State University of New York at Buffalo and Roswell Park Cancer Institute in 1991. She was a co-investigator on two National Institutes of Health randomized controlled trials, including the Women’s Health Initiative and the Polyp Prevention Trial, prior to joining Hayes, Inc. Dr. Hayes has published many peer-reviewed articles and has been involved in health technology assessment and evidence-based decision making for more than 10 years.

Moderator: Jill Brown, managing editor of AIS’s Health Plan Week

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