Aligning Physicians and Enhancing the Value of Imaging Services

An integrated delivery system with over 20 hospitals and a large health plan identified imaging service optimization as a key strategy for improving quality and better managing costs. The system conducted more than 5,500 imaging exams per day, and roughly 50% of all patients were imaged. Leadership saw alignment with radiologists as essential to thriving in a value-based environment.

The system’s long-term goals were to enhance the value of imaging services and achieve greater alignment with radiologists. Applying a common set of practices and philosophies to each radiology group ensured a consistent framework across all aligned groups. This included a consistent set of alignment objectives, common compensation principles and parameters, standard service requirements, and representation on a centralized management and governance body. Collaborative working sessions were held every other week to negotiate, design, and implement the new strategy. The process also incorporated a multiyear, phased approach for further integrating radiology providers, including an explicit goal of forming a new “supergroup” that would preserve existing group structures but also allow for a single contract.

The health system successfully employed or implemented a comprehensive professional services agreement with each of the nine groups. The health system now bills and collects for all professional radiology services globally and can more easily enter into value- or risk-based payer contracts. As a result, the system was able to create a common compensation system across both employed and contracted radiologists, eliminating perceived financial barriers and integrating the groups into a more cohesive service. A system-wide committee known as the Imaging Guidance Council was created and serves as a critical structure for integrating the various groups. The council also manages appropriate utilization, rationalizes services across the system, approves system-wide clinical protocols, creates level-loading parameters, and establishes annual goals (both clinical and administrative). The system is now capable of implementing value-added services such as decision support tools; radiational safety measures; and one-call scheduling, registration, and pre-authorization. In short, the strategy allowed imaging services to become a value generator, not just a volume generator.

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