Anthem Blue Cross and Blue Shield in Wisconsin Expands Transparency of Diagnostic Imaging

MILWAUKEE, Oct. 30 /PRNewswire/ — Anthem Blue Cross and Blue Shield in Wisconsin announced today it will provide physicians with information on the quality and capabilities of the plan’s contracted imaging providers. As part of the company’s commitment to transparency, Anthem is introducing a new online tool that enables physicians to review and compare cost and quality information from various imaging centers and hospitals, which will help them to better advise patients seeking these services.

Developed by American Imaging Management (AIM), a subsidiary of Anthem’s parent company, OptiNet(SM) is the first-ever web-based network transparency tool for physicians. Through OptiNet, physicians will, for the first time, be provided with comparative cost and quality information for providers of advanced imaging services including CT, MRI, Nuclear Medicine and PET scans.

“Diagnostic imaging is one of the fastest growing areas of cost and utilization in health care,” said John Foley, vice president of health services for Anthem Blue Cross and Blue Shield in Wisconsin. “As physicians and patients seek out new tools and information to guide their health care decisions, Anthem’s OptiNet is a new way for them to secure accurate and up-to-date information about the quality and capabilities of its contracted imaging providers.”

OptiNet collects quality data supplied by diagnostic imaging providers on the following: staff certifications, quality of the equipment, and patient accessibility. The data is compared against widely recognized standards in order to generate quality scores for each imaging modality offered by the provider, as well as for the entire site. Quality scores and cost data, which is the average allowed payment amount for the provider based on claims data, are made available to physicians when they order advanced imaging procedures for their patients. The information is presented through a user-friendly comparison tool to help enhance the physician/patient decision-making process. Both quality and cost components are scheduled to be available in Wisconsin by the end of November 2007.

“Delivering data through easy-to-use tools creates the opportunity for physicians to share important information with their patients before the service is scheduled, promoting important dialogue between physicians and their patients,” said Foley.

OptiNet also helps improve the overall quality of imaging delivery services within the region by enabling imaging physicians to identify and improve those areas where they not meeting fundamental standards.

“In addition to the quality index scores, imaging providers receive a review document that clearly details opportunities for improvement. And we are working with providers on an ongoing basis to ensure the OptiNet tool is as comprehensive and accurate as possible.” said Foley.

AIM is a leader in managing outpatient imaging services through innovative solutions. AIM pioneered the integration of technology and clinical content for radiology management through the introduction of web-based prior authorization in 2002. AIM also introduced the first set of web-enabled tools to promote quality and cost transparency into the selection of the best value in diagnostic imaging facilities.

In Wisconsin, Anthem Blue Cross and Blue Shield is the trade name used by Blue Cross Blue Shield of Wisconsin (“BCBSWi”) and Compcare Health Services Insurance Corporation (“Compcare”), independent licensees of the Blue Cross and Blue Shield Association.

Anthem Blue Cross Blue Shield is one of the largest health insurers in Wisconsin. BCBSWi and Compcare are subsidiaries of WellPoint, Inc. WellPoint, Inc. is an independent licensee of the Blue Cross Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare