Care to Care granted license to manage outpatient diagnostic imaging services in Virginia

Care to Care, a radiology benefits management company, has been granted a license by the Virginia Department of Health to manage outpatient diagnostic imaging services in the State of Virginia as a Private Review Agent (PRA). This license authorizes the company to provide utilization management of radiology procedures for commercial, Medicare, and Medicaid products offered by health plans, self-insured and self-funded groups, locals, and unions.

The exponential growth in utilization of diagnostic imaging along with its high cost has affected payers and consumers.  In 2008, the Governmental Accountability Office (GAO) released a report documenting a 200 percent increase in imaging spending between 2000 and 2006; a large portion of this increase was attributed to physician self referral.  A study by the McKinsey Global Institute found that CT and MR procedures alone contribute $26.5 billion in unnecessary spending annually.  Further, a recent study by the Archives of Internal Medicine warns that the 70 million CT scans performed in 2007 will cause 29,000 cancers over the next 20 to 30 years leading to 15,000 deaths.   

Care to Care's work focuses on helping payers appropriately manage the utilization of high-tech outpatient diagnostic imaging -- MR, CT, PET, and Nuclear Medicine -- through programs that include medical necessity review, network management, quality assurance, and provider privileging. Claims editing and adjudication services are also available. Care to Care's medical necessity review uses evidence-based clinical criteria established to ensure diagnostic imaging procedures requested are medically indicated and appropriate.  "We are pleased to receive Virginia licensure.  By granting licensure, the State of Virginia recognizes Care to Care's ability to provide sound utilization management of diagnostic imaging.  Care to Care places great importance on the relationship between payers and their providers.   Our philosophy is to work along with the payer to ensure their members have access to high-quality facilities that provide medically-appropriate, safe diagnostic imaging, which in turn will result in reduced radiology spending," said Care to Care's COO / Senior Vice President Barbara Kelman.

"Clinically inappropriate use of advanced diagnostic imaging is a significant driver of Virginia's health care costs. Radiology benefits management, using evidence-based criteria, has proven to reduce clinically inappropriate imaging, prevent unnecessary radiation exposure and expense," said Care to Care's Chief Medical Officer Dr. Michael Komarow.