MANAGED CARE January 2012. ©MediMedia USA
Our recent cover story http://sn.im/22bdng9 [1] shows how some health plan executives favor clinical decision support systems over utilization management [2] to better control costs and improve doctor performance. CDS, they argue, seems to work better in a changing world in which the financial risk of delivering care shifts from insurers to the kinds of entities in which physicians play a larger role. Too often patients will demand, for example, scans that a doctor knows will not help. CDS helps the doctor to make the correct choice and then to explain to the patient why the scans shouldn’t be done.
Pat Courneya, MD, a senior medical director at HealthPartners, a health plan and care delivery system in Minnesota, sang CDS’s praises to contributing editor Joseph Burns. Courneya says that “we have seen that decision support as a tool has led to an essential flattening of the cost trend in high-tech imaging since 2007, greater satisfaction among providers and patients on the front lines of care, and a more direct path to answers to the questions clinicians and patients are asking about their conditions.”
Steven Gerst, MD, of MedCurrent, a company that supplies CDS systems, says that plans could save “1 to 3 percent on their administrative costs by leveraging the CDS technologies now available.”
OK, you’d expect a vendor to tout CDS, but Uncle Sam is interested as well. The Centers for Medicare & Medicaid Services (CMS) began a two-year demonstration project this summer to test whether the use of CDS can improve the quality of care and reduce unnecessary radiation exposure and utilization.
CMS plans to use the data from this project to assess the effect that using CDS has on the appropriateness and utilization of advanced medical imaging services ordered for Medicare fee-for-service patients. These systems, if they work out, should be a boon to plan, physician, and patient.