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The Alliance is moving ahead with plans to add CT and MRI scans to QualityPath effective Jan. 1, 2017.

Adding CT and MRI to QualityPath will help The Alliance make a difference in these areas:

  • Total cost: Alliance employers spend a significant amount on CT and MRI each year. For example, employers typically spend more on imaging each year than the combined cost of all QualityPath surgeries. One in 11 people who get care through The Alliance network has an outpatient CT or MRI each year.
  • Cost variation: CT and MRI costs vary widely from one facility to another. Within The Alliance network, the lowest price for an MRI of a joint in the lower leg is $440 while the highest is $3130, based on cost estimates obtained from Find a Doctor in April 2016. This variation can be difficult to predict, as no single facility is high-cost or low-cost in all types of CT or MRI imaging.
  • Quality measurement: Quality measures are available for facilities that offer CT and MRI scans, yet consumers currently lack an easy way to tap into these quality measures to choose a facility based on quality and cost.
  • Ability to steer consumers: Some employers already reward consumers for choosing lower-cost facilities for CT and MRI scans, which shows consumers are likely to be receptive to information about cost and quality.
  • Opportunity to allow more health care facilities to participate. Hospitals, clinics and free-standing imaging facilities that offer CTs and MRIs throughout The Alliance service area can now apply to be part of QualityPath.

QualityPath will cover most types of outpatient CTs and MRIs; however, some highly specialized CT and MRI scans will be excluded. The QualityPath warranty on CTs and MRIs will cover scans that must be redone because of poor image quality, which is an unusual occurrence.

The CT and MRI request for proposal (RFP) for hospitals and clinics was posted on April 13. CT and MRI requirements include:

  • Annually completing an application process that verifies their accreditation
  • Participating in the ACR National Radiology Data Registry;
  • The ability to share images electronically
  • Participating in national safety efforts, including the Image Wisely and Image Gently programs that aim to lower the amount of radiation used in medically necessary imaging for adults and children while eliminating unnecessary tests
  • Demonstrating appropriate use of certain types of scans.
  • Committing to processes shown to improve outcomes for patients, including decision support for ordering CTs and MRIs.

Plan design requirements for QualityPath CT and MRI scans are currently being developed. For more information, contact Member Services Manager Mike Roche at 800.223.4139 x6645 or mroche@the-alliance.org.

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