In this Sunday morning scientific session, learn how a healthcare improvement initiative made Minnesota the poster child for the U.S. Centers for Medicare and Medicaid Services' (CMS) $10 million grant project to pilot the use of clinical decision-support software.
Cally Vinz, vice president of clinical products and strategy of the Institute for Clinical Systems Improvement (ICSI), a Bloomington, MN, nonprofit organization, will discuss how a 12-month pilot project has evolved into a statewide initiative and a model for the nation.
Claims for diagnostic imaging procedures had been increasing about 8% a year in Minnesota during the 2000s, a result of the increasing use of CT, MRI, PET, and nuclear cardiology exams. By 2006, most health plans in the state required preauthorization of these exams, and a general consensus by payors, providers, and radiologists existed that a better method was needed.
During calendar year 2007, 2,300 healthcare providers of five large medical groups and the health plans paying their claims participated in a year-long pilot program administered by ICSI. Appropriateness criteria from the American College of Radiology (ACR) were used to determine the efficacy of ordering a CT, MRI, PET, or nuclear cardiology exam. Preauthorization by health plans was not required if the ACR's evidenced-based criteria was utilized.
The results: The diagnostic quality of scans ordered in Minnesota improved in 2007 by 10%. Unlike prior years, there was a 0% increase in claims during 2007 compared to 2006, and the program achieved an estimated $28 million in cost savings from not ordering inappropriate exams.
This pilot convinced participants to implement a software-based decision-support program (RadPort, Nuance Communications, Burlington, MA) using a centralized evidence-supported appropriateness database that can be accessed either through a healthcare facility's electronic health record (EHR) system or via an Internet-based Web portal.
The program now covers half of insured residents living in Minnesota. In 2011, it will be expanded to cover potentially the entire population, including Medicare/Medicaid participants and individuals who are uninsured.