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Payers Await Details on Employer Mandate Delay

Margaret Dick Tocknell, for HealthLeaders Media, July 10, 2013

WellPoint, AAP Effort Leads to Pediatric CT Study
More than 25% of the children evaluated in emergency departments for headache received a CT scan, possibly exposing them to unnecessary radiation and increased cancer risks, according to study published in the July issue of Pediatrics. The study stemmed from efforts by WellPoint and the American Academy of Pediatrics to find out how practice patterns for treatment of pediatric headache align with practice guidelines.

CTs are often performed at the behest of parents even though providers often gain little clinically useful information from these imaging studies.

The American Academy of Neurology recommends MRIs as opposed to CT imaging for people with headache, a normal history and neurologic examination. "We found that AAN imaging guidelines were most often followed by neurologists when treating children, but not by other physicians," Dr. Alan Rosenberg, WellPoint’s vice president of medical and clinical pharmacy policy," said in a press release.

BCBS of Michigan Posts PCMH Savings
Blue Cross Blue Shield of Michigan has saved an estimated $155 million over the first three years of its patient-centered medical home program, according the Blues plan and University of Michigan researchers in a study published in the Health Services Research Journal.

In addition to the savings the PCMH increased quality scores by 3.5% and increased preventive care scores by 5.1%. The PCMH has an estimated one million members.

"This tells us that patients benefit from higher quality and improved preventive care even as physician practices are progressing toward full implementation of the PCMH model," Michael Paustian, PhD, lead author and manager, department of clinical epidemiology and biostatistics for BCBS of Michigan.

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