Health insurers’ need to approve hospital medical scans before agreeing to pay for them is the subject of some recent media coverage.
A recent Wall Street Journal story highlighted the efforts of UnitedHealth Group Inc., parent of Cypress-based PacifiCare Health Systems, which has hired radiology benefit managers who work with health maintenance organizations to streamline the approval process.
The article also cited Aetna Inc., WellPoint Inc. and Cigna Corp., all of which have members in Orange County.
Insurers argue that using radiology benefit managers can offer up-to-date and well-researched information on when to perform imaging scans. In addition, radiology benefit managers quoted in the article said that they approve 70% or more of doctors’ requests for scans, after getting basic information from the providers.
Not everyone believes adding the middle man will speed up the process. Some believe that the managers’ review of procedures delays the timing in getting scans and in some cases they reject necessary scans, posing risks for their patients, according to doctors quoted in the article.
But others said the process could save money.
The article noted that medical scans, such as computed tomography and magnetic resonance imaging, have helped drive up healthcare costs. The price for a positron emission tomography, or PET, scan could easily top $2,000. The average national cost for an MRI of the neck and spine is $977.31, according to the American College of Radiology.
The number of CT scans and MRIs rose 43% in five years to a combined 96.2 million procedures in 2007, according to IMV Medical Information Division Inc., a market research firm. Additionally, PET scans more than tripled from 2001 to 2005 to an estimated 1.1 million.
Get What You Give
A new study from the Center for Studying Health System Change suggests that one of the most cherished beliefs of healthcare reform,consumer engagement,still needs to be encouraged.
The center looked at the level of what it calls “patient activation,” or the level of “knowledge, skill and confidence” a person has in managing his or her health.
Participants were asked questions about their health and healthcare and were assigned an activation score based on their responses.
The study found that only about 41% of adults were at the highest level of patient activation. Those with higher levels tended to have much lower levels of unmet medical care needs and also received greater support from their doctors and other healthcare providers for self-management of chronic conditions, the study said.
The study also found that participants who were younger, more educated and had higher incomes tended to be more active in their healthcare, along with people who had private health insurance. It also found racial differences, with Latinos having much lower patient activation levels than other groups.
Because activation is changeable, “it is a potentially important lever for change in the healthcare system,” said Judith Hibbard, a co-author of the study, in a statement.
OC is one of 12 communities that the center, a Washington, D.C., nonprofit funded by the Robert Wood Johnson Foundation, included in the study.
Ev3 Boss Finds New Gig
James Corbett, who in the spring left Ev3 Inc., a medical device maker with a significant operation in Irvine, has a new gig. Corbett now is chief executive of Vertos Medical Inc., a San Jose-based device maker.
Vertos is working on a device to treat lumbar spinal stenosis, a painful, degenerative spine condition that’s diagnosed in more than 1.5 million people in the U.S.
Corbett served as Ev3’s chief executive for four years until April, when he stepped down and was replaced by Robert Palmisano, a former chief executive with IntraLase Corp., which is now part of Santa Ana’s Advanced Medical Optics Inc.
Corbett’s 28-year medical device career also includes serving as chairman of Micro Therapeutics Inc., which Ev3 bought in 2006, as well as a number of executive roles in 11 years at Baxter International Inc., a company from which many OC device bosses have emerged from.
Corbett will maintain his OC residence, a Vertos spokeswoman said.
Bits and Pieces:
Irvine drug maker Spectrum Pharmaceuti-cals Inc. said it received a $41.5 million payment from Allergan Inc. under its new collaboration deal to develop apaziquone, a bladder cancer drug Masimo Corp., an Irvine medical device maker, introduced SofTouch, a disposable pulse oximetry sensor designed to monitor the oxygen levels of babies who weigh 1 to 2 pounds at birth The University of California, Irvine School of Medicine has struck a deal with Brookside Institute, a Newport Beach company that focuses on substance abuse treatment. The medical school’s students will be participating in substance abuse treatment training through the institute Costa Mesa-based CLRS Technology said it received Food and Drug Administration approval for Claro, a device that uses intense pulsed light to treat mild to moderate acne.
