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Blue Cross Blue Shield of Massachusetts' Radiology Program Delivers Low Cost, High Quality

BOSTON — November 19, 2008 — Blue Cross Blue Shield of Massachusetts (BCBSMA) today announced its high tech radiology (HTR) management program reduced medical expenses by an estimated $28 million during 2007, its second full year of operations.

In 2005, BCBSMA partnered with American Imaging Management (AIM) to implement the HTR program. Over the past two years the company has used the innovative design to work with providers to ensure a patient receives necessary radiology tests and reduce the chance that members would be exposed to subsequent unnecessary diagnostic care.

"By improving the quality of care our members receive and lowering the cost, the HTR program is a great example of how our company's Quality = Affordability approach is working to eliminate the waste in health care services," said Dr. John Fallon, Chief Physician Executive at BCBSMA. "The costs associated with the misuse and overuse of high-technology imaging had been increasing at an unsustainable rate previous to the implementation of this program."

Providers in the HTR program saw their radiology utilization trends fall from double digits to roughly 4% in 2007. After calculating the estimated cost of utilization without the program and comparing it to the cost of radiology utilization the company experienced in 2007, the estimated savings totaled $18 million for the vendor component and $10 million for the self-managed component.

"Because of the hybrid, focused design of our program, it delivered these strong savings while minimizing the hassle factor for our members and providers," said Andrew McClure, Senior Director for Results and Compliance at BCBSMA. "We're also proud of the educational focus of the program, where we control utilization through sharing evidence, as opposed to denying care."

A recent Massachusetts Medical Society (MMS) study found that, of all plans MMS reviewed, BCBSMA's program was the most closely aligned with the society's radiology management program principles. An internal provider satisfaction survey also showed that the BCBSMA program was favored over more aggressive approaches implemented by competitors.

Based on first-year results, BCBSMA supported expansion of the program to the Medicare Advantage product, which went live earlier this year. The 2007 savings are for the HMO/POS products only. Expansion of the program to PPO products is currently underway.

"The program has a minimal impact on members, costs less, delivers strong savings, and is preferred by providers - it's a win all around," McClure said.


Blue Cross Blue Shield of Massachusetts ( ) was founded more than 70 years ago by a group of community-minded business leaders. Today, headquartered in Boston, BCBSMA provides coverage to more than 3 million members, 2.5 million in Massachusetts. BCBSMA believes in rewarding doctors and hospitals for delivering safe and effective care, and in empowering patients to take more responsibility, become educated health care consumers and become stronger partners with their doctors. Blue Cross Blue Shield of Massachusetts is an independent licensee of the Blue Cross Blue Shield Association.


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