UnitedHealthcare’s Imaging Designation

UnitedHealthcare continued its war against imaging costs, introducing its new Designated Diagnostic Provider program. This program is built to drive more exams through providers that meet UnitedHealthcare’s definition of quality and cost, and could have a big impact on its imaging partners.

Designated Criteria – Hospital outpatient and freestanding imaging centers that are contracted with UHC to provide advanced imaging (MRI, CT, PET, MRA, nuclear) must apply to receive Designated Diagnostic Provider status. Imaging providers who don’t meet UHC’s cost / quality criteria will be instructed to make specific improvements or settle for “non-Designated” status (they’ll still be in-network).

Patient Incentives – UnitedHealthcare patients referred for advanced imaging will be automatically sent to Designated Diagnostic Providers, and will face far higher co-pays if they somehow find a non-Designated imaging center (e.g., $680 vs. $290 for a CT).

Designated Dilemma – UnitedHealthcare’s contracted imaging providers will now either have to adopt what are surely UHC-friendly policies, or brace for a lot less UHC patients. These Non-Designated Providers would also have to be okay with charging UHC patients far higher co-pays than if they went to a Designated Provider.

UHC’s Outpatient Push – UnitedHealthcare has been aggressively shifting patients away from hospitals and towards outpatient imaging centers for quite a while, and this latest move ensures that most of these outpatient exams will happen at its preferred imaging centers. 

The Takeaway
One of the ways UnitedHealth Group achieved its massive growth was by steering patients to the highest-value procedures and treatments. The new Designated Diagnostic Provider program seems like a very effective way to apply that strategy to medical imaging coverage, even if many imaging providers might not like it.

RadNet’s Big AI Play

Imaging center giant RadNet shocked the AI world this week, acquiring Dutch startups Aidence and Quantib to support its AI-enabled cancer screening strategy.

Acquisition Details – RadNet acquired Aidence for $40M-$50M and Quantib for $45M, positioning them alongside DeepHealth within its new AI division. Aidence’s Veye Lung Nodules solution (CT lung nodule detection) is used across seven European countries and has been submitted for FDA 510(k) clearance, while Quantib’s prostate and brain MRI solutions have CE and FDA clearance and are used in 20 countries worldwide.

RadNet’s Cancer Screening Strategy – RadNet sees a huge future for cancer screening and believes Aidence (lung cancer) and Quantib (prostate cancer) will combine with DeepHealth (breast cancer) to make it a population health screening leader. 

RadNet’s AI Screening History – Even if these acquisitions weren’t expected, they aren’t out of character for RadNet, which created its mammography AI portfolio through a series of 2019-2020 acquisitions (DeepHealth, Nulogix) and equity investments (WhiteRabbit.ai). Plus, acquisitions have been a core part of RadNet’s imaging center strategy since before we were even talking about AI.

Unanswered Questions – It’s still unclear whether RadNet will take advantage of Aidence / Quantib’s European presence to expand internationally or if RadNet will start selling its AI portfolio to other hospitals and imaging center chains.

Another Consolidation Milestone – All those forecasts of imaging AI market consolidation seem to be quickly coming true in 2022, following MaxQ’s pivot out of imaging and RadNet’s Aidence / Quantib acquisitions. It’s also becoming clearer what type of returns AI startups and VCs are willing to accept, as Aidance and Quantib sold for about 3.5-times and 5.5-times their respective venture funding ($14M & $8M) and Nanox acquired Zebra-Med for 1.7 to 3.5-times its VC funding ($57.4M).

The Takeaway

It seems that RadNet will leverage its newly-expanded AI portfolio to become the US’ premier cancer screening company. That would be a huge accomplishment if cancer screening volumes grow as RadNet is forecasting. However, RadNet’s combination of imaging AI expertise, technology, funding, and training data could allow it to have an even bigger impact beyond the walls of its imaging centers.

Growing with Desert Radiology

Desert Radiology executive Matt Grimes starred in a recent Aunt Minnie webinar, detailing the Las Vegas radiology group’s operational and growth strategy, and sharing some very relevant takeaways for imaging providers and vendors. 

About Desert Radiology – Desert Radiology (DR) operates 11 imaging centers, services 14 acute care hospitals across Southern Nevada, and staffs over 80 radiologists and 500 clinical/support teammates. DR was founded nearly 55 years ago, but it has nearly doubled its imaging centers and radiologist workforce in the last five years.

Challenges – Desert Radiology faces more than its share of challenges, some of which are unique to the Las Vegas area (large managed care population, no local radiology med school programs), and some that are common across the country (radiologist hiring/recruitment, competition, declining reimbursements, rising volumes).

Growth Starts from Within – In order to grow without burning out its team, DR restructured its shift schedules to better fit staff members’ needs and diversified its radiologist career paths to match their personal goals (e.g. multiple partner tracks, an associate track, and a telerad track). 

Engagement Pivot – DR previously relied on radio and billboard ads to reach new patients but pivoted towards a community engagement strategy, with a focus on outreach, charity work, and deepening its relationship with local providers and partners.

Population Health Partnerships – Because of Las Vegas’ high concentration of managed care patients, Desert Radiology places considerable focus on reducing unnecessary imaging and achieving early/accurate diagnoses. This patient environment has also driven DR to deepen its local healthcare relationships, leading to new population health-appropriate agreement structures and referrer programs.

Selecting The Right OEMs – When evaluating new scanners, DR first examines image quality by having its radiologists evaluate images while blinded to the scanner brands (avoiding bias). It then evaluates the proposed scanners’ ease of use, workflow fit, and overall value, before making a final decision.

DR’s Case for United Imaging – Grimes also detailed how Desert Radiology has benefitted from working with United Imaging (the webinar’s sponsor), specifically highlighting the value of UIH’s “Software for Life” (scanners automatically updated with future software) and “All-In” (scanners include all possible features/packages) policies.

The Takeaway – We get plenty of insights from the commercial and academic side of radiology each week, but operational insights are still rare, making this webinar particularly useful for the many imaging groups with similar goals and challenges as Desert Radiology.

Get every issue of The Imaging Wire, delivered right to your inbox.

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Imaging Wire team