FRANKLIN, Tenn. - January 27, 2010
MedSolutions urges Medicare Advantage plans to declare utilization management intentions in 2011 Part C application, using quality improvement to drive 20 percent cost savings
In the midst of reimbursement changes that will reduce payments to Medicare Advantage plans, the Centers for Medicare and Medicaid Services (CMS) is continuing its focus on utilization management (UM) programs that use quality improvement to control rising costs.
According to MedSolutions (www.medsolutions.com), a leading provider of medical cost management services for Medicare Advantage plans, the 2011 Part C Medicare Advantage application gives plans multiple opportunities to declare their intention of implementing UM programs. UM programs offered by MedSolutions are designed to apply evidence based medicine to improve quality, ensuring the appropriate usage of diagnostic imaging, pharmacy benefits and other healthcare services.
“This year’s Part C application includes at least six distinct questions related to utilization management ” said Bradley Towle, Vice President of Medicare at MedSolutions. “We believe this reinforces a recognition that UM programs can be just as effective in improving quality and reducing costs within Medicare populations as they have been in commercial populations.”
Currently, MedSolutions estimates that more than 90 percent of commercial health plans have implemented UM programs for diagnostic imaging. By comparison, only 30 percent of Medicare Advantage plans are currently applying UM programs for diagnostic imaging, yet Medicare beneficiaries utilize imaging services three times more than commercial members.
“In this environment of diminishing resources, today’s Medicare Advantage plans are being asked to improve quality while simultaneously reducing costs,” said Towle. “Utilization management initiatives like our radiology benefits management programs use evidence-based guidelines to help plans of all sizes drive immediate savings while improving quality of care. These initiatives are especially critical for Medicare Advantage plans, since overutilization can be the difference between profitability and losses.”
MedSolutions works with commercial and government payors to improve quality and control unnecessary costs and risks associated with diagnostic imaging testing and treatment across a variety of medical specialties. Using robust, evidence-based guidelines, longstanding clinical expertise and industry-leading technology, the company’s program ensures that imaging requests meet standards set forth by national physician-led organizations while delivering savings of more than 20 percent in Medicare Advantage.
The questions related to UM can be found on the following pages of the 2011 Part C Medicare Advantage application: http://www.cms.hhs.gov/MedicareAdvantageApps/
- page 34 (item 9)
- page 95 (item 6)
- page 96 (item 9)
- page 99 (item 46)
- page 114 (item 2)
- page 115 (item 3C)
About MEDSOLUTIONS
MedSolutions specializes in intelligent cost management of medical services—yielding significant, quality-driven savings for commercial, Medicare and Medicaid payors. The company maintains management contracts for more than 25 million individuals nationwide. Using robust data, predictive intelligence technology and clinical expertise, the company's innovative solutions extend beyond radiology management to other areas of medical specialty, including cardiology, oncology, ultrasound, emergency room and PremerusSM Diagnostic Accuracy. MedSolutions has been recognized three consecutive years for its provider call center operations by the prestigious J.D. Power and Associates Award. Visit www.MedSolutions.com.
