Contributor: In the Shift to Value, We Can’t Afford to Leave Radiology Behind

More than 60% of health care payments in 2020 included “some form of quality and value component.” That’s a big leap from 11% in 2012, and an indicator that value-based care is nearing an inflection point.

Progress thus far has been fueled by an expanding number of alternative payment models, continued adoption by payers, and increased investment in companies that enable and support these models. Medicare Advantage plans continue to drive the shift to value, with 57% of payments flowing through advanced payment models.

Yet, for as much traction as value-based care has made, 1 important group has been left behind.

Despite the fact that it touches every high-cost episode of care, radiology has existed entirely outside of health care’s value-based care movement. Approximately $145 billion was spent on medical imaging last year. Almost none of that spend was tied to value. Nearly 50,000 highly trained specialists whose expertise lies in making critical diagnoses and directing appropriate patient care continue to operate in a fee-for-service model.

Aaron Friedkin, MD

Radiology informs the care of millions of people every year. In fact, it’s often the first step in their care journey – one that can determine what type of doctors they will see and the treatments they will need. How has it been overlooked?

Radiology has long been health care’s blind spot. Radiology studies are routinely regarded as one-off artifacts representing passing moments in a patient’s journey, where patients and payers alike presume that the results will, by and large, be the same regardless of the location and radiologist associated with their study. As a result, the field has been relegated to a commodity rather than a service with variable quality and value. In reality, the field is highly variable; a patient's diagnosis is directly influenced by their selection of an imaging center, the equipment that is used to image the patient, and the radiologist who reads their study. In a 2017 study, for example, 1 patient experiencing back pain received a magnetic resonance imaging (MRI) from 10 different imaging centers. No 2 imaging centers interpreted the study alike.

By ignoring the critical role radiology plays in patient care, health care organizations are jeopardizing the cost and quality of care for any patient in a value-based arrangement. Health care organizations have a massive opportunity to strengthen their shift to value by bringing radiology into the fold.

Recognizing Radiology’s Value

For health care organizations to unlock the value of radiology, they must first recognize diagnostic imaging’s outsized impact on care and appreciate radiologists as specialized clinical consultants with variable expertise and performance.

A lack of appreciation for radiology’s broader potential is another roadblock to value. Most health care organizations fail to appreciate the breadth of clinical insights that can be garnered from radiology studies. Images and reports, when compiled and analyzed through the lens of longitudinal patient care, can identify, inform, and support the needs of individual patients and entire populations.

Once health care organizations fully recognize the value of radiology, the road is clear to begin designing its role within value-based arrangements.

Designing Quality Incentives

People who are waiting in a lobby for their MRI should be confident that the radiologist reading their study will make the right diagnosis. But without standards to define, measure, and report on diagnostic performance, there is no way to ensure meaningful and accurate interpretations are being made – no clear guidance for radiologists to improve their performance, no process for health plans and employers to know the value of what they’re paying for, and no assurance for patients that they’re getting the right diagnosis.

With continued downward pressure from CMS around reimbursement rates and increasing demands from payers for site neutral payments, the time is now to reimagine how the field of radiology is incentivized.

There is certainly opportunity for payers to reward behaviors that will ultimately improve performance and quality among radiologists. Evidence-based guidelines for care, best-in-class imaging protocols, and timely communication with referring physicians are all areas ripe for incentive.

But the greater opportunity to align incentives across stakeholders is rewarding the delivery of accurate, high-quality interpretations that support improved outcomes and appropriate downstream care. This will provide the foundation for value-based arrangements between payers and the radiology community.

Integration with existing accountable care models

Accountable care models have transformed the way that care is delivered and paid for by ensuring care teams are aligned around what’s best for their patients, incentivized to provide high-quality care, and accountable for the outcomes. Providers in these models are increasingly sophisticated, which will inevitably lead to the recognition that high-quality radiology is critical to effectively managing clinical outcomes and cost.

By embedding radiology care within existing accountable care models, health care organizations can drive closer coordination across the care continuum while creating a mechanism for radiologists to support broader population-level performance. The most obvious place to begin that integration is with primary care.

Primary care providers (PCPs) are increasingly moving to full-risk capitation arrangements, driven in large part by Medicare Advantage plans. These providers are striving to reduce waste, improve outcomes, and ensure their patients receive the most appropriate care. PCPs in a full-risk model will want to ensure their patients receive care from high-quality radiology groups that provide comprehensive diagnostic insights to support both acute and longitudinal patient care.

In an ideal arrangement, if the radiology group can quantify the impact of the care they deliver, both providers would share in the economic benefits of the model. Success in this arena would encourage payers to tie more of their payments to value.

Supporting Population Health

Timely, meaningful, and actionable insights are essential for any organization that is accountable for the health and outcomes of a population. Today, most health care organizations rely on claims data to construct a picture of the populations they manage and inform opportunities for intervention. Claims data, however, are notoriously delayed and incomplete.

Health care organizations will need to leverage new sources of insight to effectively manage health and engage patients at critical points in their care journey. In comparison to claims data – payment-based representations of clinical interactions – the findings and diagnoses contained in radiology images and reports are actual clinical representations of a patient. This information is readily available without the lag associated with submitting and processing claims.

These clinical insights, contained within every radiology study, have incredible potential to inform patient care and support population health management – be it by identifying a patient with a chronic condition such as atherosclerosis or osteoporosis who would benefit from enhanced clinical support, or understanding the disease burden of a population to inform the development and deployment of clinical programs. These insights could open up entirely new ways to support patient care in partnership with accountable providers and payers.

Radiology is, in many ways, the bedrock of patient care. Health care’s transition from volume to value will be incomplete and less impactful if organizations cannot find a way to tie radiology to the movement. That can’t be done, however, until the value of the practice is properly recognized and rewarded, and radiologists have an opportunity to demonstrate and deliver that value.