A message from Dr. Binesh Patel, senior medical director
New radiology initiative aims to improve care quality and patient outcomes

Studies have shown a great deal of variability in the interpretation of imaging — and misdiagnoses can increase costs substantially and negatively affect patient outcomes.

Last year, we completed an evaluation of diagnostic imaging and related costs and subsequently developed a roadmap of solutions to address these items:

• Quality of images
• Variation in interpretation of images
• Potential overutilization of imaging

We expect our efforts to increase diagnostic accuracy, improve outcomes and reduce cost of care, and provide guidance to referring health care providers who want to find high-quality, high-value imaging for their patients.

To assist us in our efforts, we’ve formed a relationship with Covera Health. You may have read about this in a previous Record article.

Covera will designate certain radiology facilities as Centers of Excellence and work with other facilities to help them improve their quality. Once identified, providers will be informed of these high-quality, high-value centers when they submit prior authorization requests.

On prior authorization requests approved by Carelon Medical Benefits Management (formerly known as AIM Specialty Health^®), Covera designations will display as follows:

• For Blue Care Network commercial, BCN Advantage℠ and Medicare Plus Blue℠ members, facilities will be identified as having high-quality designations and will be listed as recommended providers.
• For Blue Cross Blue Shield of Michigan commercial, facilities will be identified as having high-quality designations.

Blue Cross fully insured commercial members are included in the program, but no targeted efforts will be made to move these members to identified COEs.

Providers that are designated as high quality and cost effective will receive an additional “high-value” designation on prior authorization requests approved by Carelon.

If you have any questions about this program, contact Covera Health by calling 1‑855‑211‑2272 or sending an email to bcbsmsupport@coverahealth.com.

Covera Health is an independent company that supports Blue Cross Blue Shield of Michigan and Blue Care Network by providing programs to help improve the diagnostic quality, quality of care and member outcomes related to radiology.

Carelon is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage authorizations for select services.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.