Study: A Short-Term and Long-Term Reduction in CT and MRI Exams Occurred After the Implementation of a Non-Denial Prior Authorization Program

December 4, 2017

A study titled “CT and MRI Utilization Trends in the Context of a Non-Denial Prior Authorization Program” has been published in Health Services Research & Managerial Epidemiology.

The study’s lead author, Adam C. Powell, Ph.D., and his team sought to assess shifts in CT and MRI utilization over a 9-year period after a private health insurer’s implementation of a nondenial, consultative prior authorization program.

Normalized rates of exams per 1,000 person-years were plotted over 2005−2014 for people with Humana commercial and Medicare Advantage health plans in the San Antonio market, with 2005 utilization set as a baseline. The program was implemented at the beginning of 2006. Dr. Powell and his team compared CT and MRI utilization changes with contemporaneous changes in low-tech plain film and ultrasound utilization.

Growth in high-tech imaging utilization decelerated or reversed during the period. In 2006, CT utilization dropped to between 76 percent to 90 percent of what it had been in 2005, depending on the plan. In 2014, utilization was 52 percent to 88 percent of its initial level. MRI utilization declined to 86 percent to 94 percent of its initial level in 2006, and then to 50 percent to 75 percent in 2014. Ultrasound utilization was greater in 2014 than in 2005 for some plans. Plain film utilization declined between 2005 and 2014 for all plans.

There was an immediate and sustained decline in CT and MRI utilization after the introduction of the program. While many factors may have impacted the long-term trends, the mixed trends in low-tech imaging suggest that a decline in low-tech imaging was not responsible for the decline in CT and MRI utilization.

According to Dr. Powell, “This study shows that Humana was able to reduce CT and MRI utilization in the San Antonio market without denying a single exam. Both immediate and long-term decreases in utilization occurred after the implementation of HealthHelp’s educative, non-denial model.”

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