Humana adopts radiology benefit management programs to reduce unnecessary radiation exposure

Humana Inc. (NYSE: HUM) has reduced unnecessary radiation exposure for its members by the equivalent of more than five million chest x-rays since 2004, demonstrating how health benefits companies can lead the way in improving the quality and safety of health.

“Reducing radiation by limiting unnecessary and inappropriate studies can save lives”

Humana, one of the federal government's largest Medicare Advantage partners, accomplished this reduction through effective radiology benefit management programs developed by HealthHelp, a leading specialty benefit management provider.

"Humana continually strives to improve quality and safety for our members, and it was this commitment that led us to adopt radiology benefit management more than five years ago," said Louis I. Hochheiser, M.D., Humana's corporate medical director for clinical policy.

Making sure patients receive the right diagnostic imaging tests at the right times in high-quality facilities, significantly reduces unnecessary radiation exposure, HealthHelp chief medical officer Mark Hiatt, M.D., testified at a public meeting held by the U.S. Food and Drug Administration (FDA).

As part of the FDA's initiative to reduce unnecessary radiation exposure in diagnostic imaging, Dr. Hiatt explained how effective radiology benefit management programs can help protect patients from inappropriate and duplicative testing.

The necessity for a coordinated approach to reducing radiation exposure was emphasized by a new study from the National Cancer Institute that projects 29,000 excess cancers will be diagnosed from the 72 million CT scans that Americans got in 2007 alone. The study also indicates that nearly 15,000 of those cancers could be fatal. The Institute also projects that 29,000 future cancers will be directly attributable to CT scans performed in 2007. Using HealthHelp's programs, Humana manages advanced diagnostic imaging procedures through a consultative, multipronged approach that provides a national model for reducing radiation exposure. HealthHelp's programs:

• Eliminate unnecessary and improper testing,
• Provide physicians with the latest medical evidence,
• Set quality standards for imaging and radiology facilities,
• Ensure procedures are performed by qualified physicians using high-quality equipment,
• Help payers establish quality provider networks, and
• Educate patients about the benefits and risks of imaging procedures.

"While manufacturing improvements for diagnostic imaging devices are one important aspect of reducing radiation exposure, other factors that affect appropriate use, quality, and safety must also be addressed," Dr. Hochheiser said.

According to Dr. Hiatt, the key to reducing radiation exposure lies in establishing collaborative, common-sense processes. The processes are based on widely accepted medical guidelines, employ peer-to-peer physician consultation, and rely on continuous improvement that incorporates feedback from experts and the latest medical evidence.

"Reducing radiation by limiting unnecessary and inappropriate studies can save lives," Dr. Hiatt summarized. "To Humana's credit, its foresight has proven prescient, as recent studies and unfortunate stories have sounded the alarm about the deleterious effects of medical radiation."