IME estimates that it is saving approximately $2.4 million annually with the new program: $1.3 million from the cancellation of non-medically appropriate requests, $600,000 from service denials and $500,000 from the avoidance of additional staff to manage a solely manual process.
With cost savings on the increase and member health at the forefront of decision-making, IME has reconstructed its diagnostic imaging authorization processes and stabilized growth in utilization. Now realizing the advantages to managing advanced imaging more prospectively, administrators like Vermeer “expect even better results” as the program continues to develop and as IME itself expands membership and continues to offer coverage to Iowa’s vulnerable Medicaid population.
Tonya Sickels, R.N., B.A., is director, Medicaid Programs, Telligen, Iowa Medicaid Enterprise (IME), which administers the Medicaid program for Iowa and its Medicaid beneficiaries.
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