New application developed by AIM increases health plan staff productivity

A new application developed by American Imaging Management® (AIM) to manage the clinical review of specialty pharmaceuticals has increased health plan staff productivity and the number of drugs reviewed while reducing costs.

AIM, a leading diagnostic imaging benefit management and technology company with health plan clients representing over 35 million consumers and an operating subsidiary of WellPoint, Inc. (NYSE: WLP), adapted the successful clinical and technology platform used by the company to manage diagnostic imaging to meet the growing challenge of specialty pharmaceuticals, which include drugs that are typically high-cost oral and injectable medications used in treating complex, chronic diseases.

The adaptable platform allows a health plan to either implement the application within its own call center to enhance existing processes or to contract management of the program with AIM.

"Specialty pharmaceuticals are the fastest growing component of drug spend. The twenty percent annual growth rate for these drugs is similar to what was seen in outpatient diagnostic imaging prior to radiology benefit management," said Brandon Cady, president of AIM. "Whether a program is managed by a health plan or by AIM, our application is an effective and efficient clinical solution that delivers immediate and significant results."

Using the company's well-established clinical and technology platform as a starting point, AIM developed a clinical review application for specialty pharmaceuticals. The application utilizes clinical algorithms similar in form to the ones used by AIM to review diagnostic imaging, adapted for the unique aspects of these drugs.

"We knew that maintaining the form and function of our clinical algorithms was critical to creating a system that could effectively and efficiently review orders for these drugs," said Thomas Weisman, M.D., chief medical officer of AIM. "However, we also recognized that there were unique clinical requirements -- such as knowing certain patient demographics, drug strength and dosage amounts -- that would require us to customize our existing system."

Working with an advisory group that included health plan medical and pharmacy experts, AIM's initial version of the application was completed and rolled out in partnership with WellPoint's affiliated health plans in December 2008.

"Due to rapidly growing costs, WellPoint's plans established a clinical review process of specialty pharmaceutical orders in 2006," said Anthony Nguyen, MD., senior vice president of care management at WellPoint. "However, our process was entirely paper-driven, resulting in administrative inefficiencies. It also limited the number of drugs we could review. We needed a better system and were excited to work with AIM given their success in diagnostic imaging management."

Since the initial program rollout, the number of WellPoint plans using the application has increased from 1 to 12 and the number of drugs available for review has grown from 45 to 75. The application has had a significant impact on WellPoint's specialty pharmaceutical review program.

"We are thrilled with the impact that AIM's program has had on our review program," said Nguyen. "The average cost to review a case has decreased by 40 percent and average turnaround time has decreased by 65 percent. We now have the ability to review up to 75 drugs with a consistency in clinical guidelines and processes that didn't exist before."

In addition to improving the clinical review process, AIM's program expands a health plan's ability to manage the overall delivery of specialty pharmaceuticals.

"Our program allows health plans to manage drugs that are delivered under both the medical benefit and the pharmacy benefit. Drugs delivered under the medical benefit are often excluded from pre-authorization programs between a pharmaceutical benefit manager (PBM) and a health plan," noted Brandon Cady. "Our program allows health plans to manage these drugs more comprehensively as opposed to having them fall through the cracks."

The program also allows health plans to gather valuable clinical information. "Having a centralized system to gather and analyze ordering information offers significant value on its own," said Thomas Weisman. "Health plans can identify what type of specialty drug protocols are being used in the community to support identification and dissemination of best practices."

AIM's program will continue to evolve with the 2010 addition of specialty pharmacy to AIM's ProviderPortal® application. AIM's ProviderPortal® has been widely adopted for diagnostic imaging, processing over 50 percent of the imaging orders received by the company. The enhancement will allow providers to obtain clinical review for specialty pharmaceuticals using the same easy-to-use web interface that is currently available for outpatient diagnostic imaging clinical review.