Minnesota’s groundbreaking Institute for Clinical Systems Improvement (ICSI) has reached an agreement with Nuance, Burlington, Massachusetts, to license its decision-support and analytics software for a statewide electronic utilization management initiative to ensure delivery of clinically indicated high-tech diagnostic imaging. The statewide initiative builds on an earlier, successful pilot that brought high-tech imaging growth down to zero in 2007, saving the state $28 million. ImagingBiz spoke with Scott Cowsill, MBA-HCM, chair of the Imaging e-Ordering Coalition and senior product manager of diagnostic solutions, Nuance.
ImagingBiz: The ICSI statewide project follows an earlier pilot in the Minneapolis area. What was accomplished in the smaller project that ICSI hopes to duplicate on a larger scale?
Cowsill: The ICSI pilot program, although it was smaller, was still significant in size. From what they tell me, it represented 50% of the high-tech diagnostic imaging ordering clinicians. What they gleaned from the pilot was that if they could do this statewide (and they extrapolated much of the savings), they could save $60 million dollars by eliminating unnecessary or inappropriate high-tech imaging, once it was rolled out statewide to all ordering clinicians.
Beyond the savings, the pilot proved that there are other solutions besides an RBM that work. Not only do they work, but they are more user-friendly for all of the players: Providers like using clinical decision-support because it is more user-friendly: more educative, less of a barrier, and a zero-penalty approach. Payors like it because it is more streamlined and more cost-effective: It is less than what the RBMs charge them per-member, per-month. And the patients like it because now there is not a third-party intermediary between them trying to get a high-tech diagnostic imaging exam, there is no one in between the physician–patient relationship.
ImagingBiz: Was this an outpatient-only pilot?
Cowsill: I am pretty sure it was based on ambulatory care, outpatient settings, but there may have been some inpatient involvement. I don’t think the new project will be restricted to just outpatient imaging, but the majority of it initially will be targeted at outpatient use.
ImagingBiz: This win has been a long time coming for radiology decision-support software, and it appears that a key was ICSI’s ability to align the incentives of payors, providers, and patients. As the president of the e-ordering initiative, do you see any other organizations with the alignment and the will to take on such a project?
Cowsill: Actually, I do, now that Minnesota has done it. Everybody has been watching Minnesota for the past three-and-a-half, four years, and they say that, “OK, if they did it, we can do it.” You’d be surprised at the traction this is getting across the country and in other states, and I can speak to a few of these.
One, specifically, is the state of Washington. They actually passed legislation, that’s House Bill 2105 by Rep. Eileen Cody (D-34th district). In the legal verbiage, it addresses ICSI by name, and in a high-level summary basically says we want to do the same thing that Minnesota did. They put together a group there and they are in the process of bringing together all of the payors and the providers to find a common solution to use. That’s one state that has legislation, and I can tell you that there are a couple other states that we have spent time in recently that are not far behind.
In the pecking order, Minnesota has done it, I would say Washington will be next, and then there are probably two or three states right behind Washington that are on the verge of having all of the players come to the table and say yes, this is the solution. As the states sign on, I think you will see this happen very quickly.
ImagingBiz: In addition to licensing Nuance’s decision-support software, the larger initiative will deploy RadCube, the analysis tool. Was this used in the pilot, and if so, how? What type of analysis would the software enable and who will have access to the tool?
Cowsill: As far as I know RadCube was not used in the pilot: They did their raw data extraction on their own and it wasn’t as all-inclusive as what they are looking for in the broader initiative now that we are rolling out across the state. So, no, it wasn’t used, but obviously they had output data that they did report on and publish.
With the cube in the broader initiative,