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.

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-- The Imaging Wire team