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.

Intermountain’s Imaging Centers

Intermountain Healthcare expanded into outpatient imaging with the launch of its new imaging center subsidiary, Tellica Imaging. Plenty of hospital systems have outpatient imaging centers, but how and why Intermountain created Tellica brings some important takeaways.

About Tellica – Tellica Imaging plans to open a fleet of outpatient MRI and CT centers, starting with three Utah locations by late 2021, five locations in 2022, and more locations in “subsequent years.” The Tellica centers will prioritize patient convenience and value, targeting easy-to-access locations and adopting a novel flat-rate pricing model that’s well below typical in-hospital rates.

The Value-Based Angle – Given Intermountain’s role as one of the country’s flagship value-based care systems and its unique payor-provider structure, launching a series of imaging centers that are lower cost and more convenient makes a lot of sense. It’s also a step away from the hospital-based/owned procedure trend that’s helped hospitals from a reimbursement perspective, but brought a long list of unintended consequences (higher patient/payor costs, provider consolidation, imaging overuse, etc.).

The Payor Angle – Even though many patients use Intermountain’s in-house insurer (SelectHealth), Intermountain also works with a long list of commercial and government payors, nearly all of which have been incentivizing (or forcing) health systems to move more imaging procedures to outpatient centers. SelectHealth likely has the same preferences.

The Offsite Trend – In addition to the above payor pressures, there are some major trends underway that favor offsite imaging, including the rapid adoption of at-home/remote patient care, new COVID-related offsite policies, and the federal government’s efforts to make healthcare procedures more “shoppable.”

The Takeaway – Hospital-owned outpatient imaging centers aren’t all that unique, but Intermountain’s structure definitely is (payor-provider, value-based, non-profit) and so is its decision to launch these centers with such a patient-friendly value proposition. Even if most hospitals aren’t yet ready to offer flat-rate scans, the factors that drove Intermountain to create Tellica are likely forcing plenty of other systems to rethink their own approach to offsite imaging.

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-- The Imaging Wire team