The AIM Advantage

• Widely accepted clinical guidelines: Clinical appropriateness of diagnostic imaging through the use of clinical guidelines and algorithms based on the most current clinically accepted practices.
• Intelligent and efficient clinical review process: Optimal provider usability through the use of intelligent clinical algorithms, extensive provider education and an efficient clinical review process
• Real-time authorizations through industry-leading web portal: Better provider efficiency and communication through AIM's ProviderPortal® application. This full service web portal offers a broad array of provider related services including real-time, 24/7/365 access to order entry, claims, and eligibility information. Provider offices can use the ProviderPortal® to submit orders, receive registration numbers on a real-time basis, recheck patient eligibility, locate imaging centers, and exchange information securely.
• Sophisticated data analysis: Comprehensive reporting to provide health plans with key information on diagnostic imaging ordering patterns and utilization
  

Improving the Appropriate Use of High-Tech Imaging

The evolution of diagnostic imaging has been one of the most significant developments in modern medicine. Advances in diagnostic imaging are fundamentally changing the way that medicine is practiced and offer significant potential to improve clinical outcomes. While advances in imaging use have rightfully received significant attention, the rapid escalation of imaging costs has also been a key issue. Driven by spiraling utilization and high unit costs, imaging has become one of the fastest growing components of health care spending in the United States.

While technology advances and broadening clinical application account for part of the growth in imaging, it is clear that some of the growth in imaging is due to clinically inappropriate use. Inappropriate imaging creates a number of issues including:

• Patient safety concerns, primarily due to the high levels of radiation emitted during certain high-tech imaging studies
• Sub-optimal treatment plans based on false positives or incorrect findings from use of the wrong imaging strategy
• Unnecessary spending by patients, employers and health plans

Multiple reasons have been cited for inappropriate imaging including:

• The need for better provider education regarding the evolving uses of imaging
• System inefficiency resulting in waste and duplication,
• Growing issue of self-referral that occurs when providers purchase, operate and control referrals to their own equipment.

In order to improve the appropriate use of high-tech imaging, AIM works with health plans to improve high-tech imaging utilization through the application of widely accepted clinical guidelines during the imaging ordering process. In addition to clinical content, AIM's technology facilitates the clinical review process through its ProviderPortal® application.

The AIM Approach to Order Entry

AIM's Order Entry programs improve appropriate utilization of outpatient high-tech imaging by focusing on the ordering provider. The process includes three separate review components: Intake, Registered Nurse, and Provider.

Orders submitted by providers can be approved at any point within the process upon confirmation that the request is consistent with AIM's Diagnostic Imaging Clinical Guidelines. Each point in the review process is designed to identify and approve appropriate requests as quickly and easily as possible.

The AIM review process offers providers the ability to submit requests either via the phone or the Internet using AIM's ProviderPortal®. Under either entry point, providers can receive a real-time approval when submitting appropriate clinical information. The additional levels of clinical review are performed in a collegial manner that stresses efficient service and a provider centric approach to discussions.

The Value of AIM's Approach to Order Entry

AIM's approach to Order Entry creates significant value for health plans, their providers and their members.

Health Plans:

• Improves high-tech imaging utilization. Through AIM's programs, health plans typically experience utilization reductions of 15% to 35%.
• Provides relevant, usable and timely information to health plans to support a broad range of initiatives including: provider education, provider network, medical policy, and reimbursement strategies.
• Delivers a positive provider experience through training, efficient service and technology reduces health plan provider relations issues associated with program implementation.
• Supports health plan web portal strategies. AIM's ability to create a seamless linkage between its ProviderPortal® application and health plan websites creates another driver for provider use of health plan portals.

Providers:

• Ensures that provider ordering patterns are consistent with clinically accepted uses for high-tech imaging.
• Delivers an industry-leading provider experience with a focus on effective and efficient service. AIM's ProviderPortal® offers Ordering Providers a full-service, easy-to-use web tool for prior authorization that can deliver real-time authorizations over the web.
• Facilitates the transmission of ordering information between Ordering Providers and Servicing Facilities through AIM's ProviderPortal®, creating improved communication and reduced administration.
• Achieves high provider satisfaction ratings. In 2006, AIM earned a 96% satisfaction rating from providers using AIM's services.

Members:

• Ensures the peace of mind from knowing that their high-tech imaging studies are consistent with clinically accepted uses of high-tech imaging, eliminating potential concern over unnecessary exposure to radiation.
• Offers a significant financial benefit for members by ensuring appropriate use during period of high costs for high-tech imaging and a growing shift towards increased patient cost sharing.