Care to Care Acquires License to Perform Radiology Utilization Management in Texas
Newly Licensed Specialty Healthcare Company Can Help Texas Health Plans Reduce Advanced Imaging Costs and Improve Safety
New York, NY (October 5, 2011) – Care to Care, a Radiology Benefit Management (RBM) company, has been granted a license by the Texas Department of Insurance to manage outpatient diagnostic imaging services. This license authorizes the company to provide utilization management of radiology procedures for Medicaid, Medicare, and Commercial products offered by health plans, self-insured and self-funded employer groups and unions.
Medical loss ratio (MLR) is a common measure of a health plan’s financial and medical efficiency. For health plans, including those that service Medicaid and Medicare beneficiaries, keeping the MLR to 80-85 percent is optimal. A ratio in this range reflects the insurer’s compliance with regulatory MLR requirements, while at the same time demonstrating effective care management of its membership. One significant component of the MLR equation is the cost of diagnostic imaging, which over the past five years has consumed approximately ten cents of every dollar spent in healthcare delivery.
As an RBM organization with significant expertise, Care to Care has provided utilization and quality management for a number of health plans nationwide and sees a great opportunity, now newly licensed in Texas, to work with health plans operating in the state. For example, one Texas Medicaid managed care plan had experienced an average of 14 percent trend increase in advanced imaging utilization from 154.5 procedures-per-1000 members in 2007 to 218.7 in 2009. This trend also reflected a rise in the plan’s per-member-per-month (PMPM) spending, which grew from $22.77 to $35.81 PMPM or an average of 29 percent during this same period. For this plan, the application of a utilization management program would result in savings of approximately $5 million over a three year period.
