December 6, 2011 — Care to Care, a URAC-accredited radiology benefit management (RBM) company, was recently designated as a Preferred Vendor by the Association of Community Affiliated Plans (ACAP).
The ACAP Preferred Vendor program provides streamlined access to pre-qualified vendors in areas of interest specific to ACAP plans and their membership. Each vendor must be sponsored and approved by a member plan in ACAP’s network; they must also understand the unique needs of the patient populations in Medicaid, Medicare and SCHIP programs served by network members. Care to Care’s induction as a Preferred Vendor was sponsored by ACAP member Elderplan.
Diagnostic imaging is one of the fastest growing components of healthcare costs; it has developed so rapidly that physicians have not yet integrated the strengths of new exams into their practices or accounted for their limitations. Tests are frequently ordered without a firm knowledge of what they can contribute to diagnostic certainty.
Care to Care’s RBM programs reduce wasteful medical imaging by assuring that tests ordered are appropriate for the clinical condition and will provide useful information to the patient.
“ACAP is pleased to welcome Care to Care to our Preferred Vendor program,” said Margaret A. Murray, ACAP chief executive officer. “This program and the Vendor Education Series – an opportunity for our members to learn from Preferred Vendors about topics of interest – have proven to be of great value to ACAP member plans.”
“We sponsored Care to Care after we saw the value in cost savings and patient safety that their solutions brought to the table,” said Hany Abdelaal, DO, Elderplan’s chief medical officer. “Previously, radiology was a very high cost, unmanaged benefit. Working with Care to Care helped Elderplan target the monitoring and management of what had become a hidden cost center. As a result, Care to Care’s impact on Elderplan’s spending on high-tech radiology utilization was significant.”
“First, we want to offer our thanks to Elderplan for its generous support in introducing and sponsoring us for the ACAP Preferred Vendor program,” said Barbara Kelman, chief operating officer of Care to Care. “We are very appreciative of the opportunity to work with ACAP plans and to address what have become tremendously important issues.”
“Although most payer types can benefit from Care to Care’s programs,” Kelman continued, “our greatest value is realized by Medicare Advantage plans, which serve populations with heavy utilization of high-tech imaging and high risk of inappropriate or unnecessary tests. These plans must solve a challenging regulatory calculus mandating that quality services be delivered cost-effectively. The increased payments they receive through risk adjustment must balance the MLR equation while optimizing five star ratings. The Medicare Advantage plans we serve have found our programs to be of great value in this regard.”
For more information: www.caretocare.com