Program Drives Appropriate Use and Cost Effectiveness for Sleep Testing and Therapy Services
WellPoint to implement AIM Specialty℠ Health’s New Sleep Management Program
AIM Specialty Health℠, a leadingspecialty benefit management company serving 42 health plans with more than 32 million members, today announced the launch of its sleep management program designed to help improve the clinical appropriateness and cost-effectiveness of diagnostic testing and ongoing therapy services for Obstructive Sleep Apnea. AIM’s parent company, WellPoint, Inc., is implementing the sleep management program with its affiliated health plans in 13 states.
According to the Foundation, more than 18 million adult Americans suffer from sleep apnea. Many with the disease are undiagnosed. However, sleep labs may be over-utilized when it comes to testing for and diagnosing OSA when compared to home-testing and at a significant cost to the health care system. For example, Medicare payments for sleep testing from $62 million in 2001 to $235 million in 2009, according to the Office of the Inspector General.
“With the costs of sleep testing and therapy escalating, there’s a clear need for health plans to ensure appropriate testing, optimize the use of home testing and promote improved patient engagement with therapeutic programs,” explained Mike Backus, senior vice president of product strategy at AIM. “AIM’s program leverages our core competencies in managing a broad platform of specialty services to generate savings by intervening at key points in the OSA diagnosis and treatment process and aligning sleep studies and treatment with clinical guidelines.”
Through an integrated management program that includes clinical appropriateness review, provider assessment, member engagement and therapy compliance monitoring, AIM’s program is expected to generate significant savings for its healthcare payor clients across the country.
Unlike other sleep management programs, AIM’s program provides a comprehensive provider assessment component that enables health plans to evaluate service providers based on key quality and cost measures. By collecting this information directly from sleep testing and durable medical equipment vendors and presenting that information, ordering providers, health plans and their members will be better equipped to make informed decisions about their care.
“Today, home testing accounts for only 1 percent to 3 percent of sleep study volume, even though experts agree that home testing can often be just as effective as testing in a lab but often at one-fifth the cost,” said Doug Wenners, senior vice president of provider engagement and contracting for WellPoint. “Likewise, unless compliance is closely tracked, health plans may be paying for equipment and supplies that are not being used. AIM’s Sleep Management program will ensure health plan members seek the most appropriate services for improving their health and well-being, to which sleep contributes greatly.”
AIM’s sleep management program is the company’s latest addition to its specialty benefit management platform which now includes radiology, cardiology, oncology and specialty drugs.
As part of its Sleep Management Program, AIM selected NovaSom as a strategic partner for health plans that want to supplement their network with a market leading in-home sleep testing provider. NovaSom is a Glen Burnie, MD.-based provider of payor-aligned, technology-driven solutions for obstructive sleep apnea (OSA) management.
AIM Specialty Health or “AIM” is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. AIM's mission is to make health care services more clinically appropriate, safer and more affordable. As such, it promotes the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. AIM is an operating subsidiary of WellPoint, Inc. (NYSE: WLP) (). For more information on AIM, please visit .