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Julia Brown is a Content Specialist for Managed Healthcare Executive.
Medicare payments for sleep testing increased by $173 million from 2001 to 2009.
Sleep labs might be overutilized when it comes to testing for and diagnosing obstructive sleep apnea (OSA), and plans are paying the price.
AIM Specialty Health, a specialty benefit management company, recently launched its sleep management program, which aims to improve the clinical appropriateness and cost-effectiveness of diagnostic testing and ongoing therapy services for OSA. Parent company, WellPoint, Inc., is implementing the program with its affiliated health plans in 13 states.
The integrated program includes a clinical appropriateness review, a provider assessment allowing plans to evaluate providers based on quality and cost measures, as well as member engagement and therapy compliance monitoring.
“Comprehensive sleep programs ensure that patients get the most appropriate care, in the highest value setting,” says Brandon Cady, CEO, AIM Specialty Management. “These programs also improve patient engagement to sleep therapy and result in reduced costs for members, health plans and employers. ”
Without closely tracking compliance, health plans might be paying for unused equipment and supplies. When compared to home testing, there is a significant cost to the healthcare system. In fact, Medicare payments for sleep testing increased by $173 million from 2001 to 2009, according to the Office of the Inspector General. On the other hand, home testing accounts for only 1% to 3% of sleep study volume, although experts agree that it can be just as effective as lab testing at one-fifth the cost.
By collecting information directly from sleep testing and durable medical equipment vendors, providers, health plans and their members can make more informed decisions regarding care.