Sleep Management Program Supports Quality and Cost Effectiveness for Sleep Testing
Anthem Blue Cross and Blue Shield in Missouri Members Save Money, Time through Home Sleep Testing
Anthem Blue Cross and Blue Shield in Missouri members could gain convenience and potentially save money and time by testing for obstructive sleep apnea at home while sleeping in their own bed.
In-home tests generally cost $200-$400, which is significantly less than facility tests in Missouri that range from $789 in an independent freestanding center to more than $1,555 in a hospital outpatient department.
“For members who have high-deductible plans or consumer-driven health plans, this program can be useful in helping them control the portion of their health care costs they pay directly,” said Steve Martenet, president of Anthem Blue Cross and Blue Shield in Missouri. “The sleep management program is one of several programs we are putting in place to help members and employers reduce or maintain costs while still offering the same quality of services. We are hopeful that these kinds of programs can also help us in controlling the rise of insurance premiums.”
More than 12 million Americans suffer from sleep apnea and many are undiagnosed, according to the . It’s a condition caused by the obstruction of the upper airway that causes repetitive pauses in breathing during sleep that can lead to daytime sleepiness or fatigue. Sleep apnea also increases health risks, such as cardiovascular disease, high blood pressure, stroke, diabetes, depression, weight gain and obesity.
The Harvard Medical School Division of Sleep Medicine estimated in 2010 that the total annual economic cost of sleep apnea was $65-$165 billion – greater than asthma, heart failure, stroke and hypertensive disease. The numbers included costs to diagnose and treat the condition, with a much larger percentage of the costs derived from hidden health care costs related to its impact on other diseases and its role in motor vehicle accidents.
While a home-based test is likely appropriate for 70-80 percent of patients with suspected sleep apnea, Anthem claims data show only about 1-2 percent of all sleep apnea testing takes place at home, according to a 2010 analysis byAIM Specialty Health, which is operating the sleep management program. Physicians enter information about their patient into an AIM web service tool to determine whether an at-home test is appropriate for their patient.
The June 2012 edition of SLEEP published a research study indicating that home-based diagnosis and therapy for obstructive sleep apnea in patients who meet criteria similar to those established in AIM’s program are clinically appropriate in properly selected patients, and achieves better long-term patient compliance.
For those whose condition is more appropriate for facility testing, Anthem will contact members and inform them of options for sleep testing sites that have met accreditation and certification guidelines and provide competitive prices.
Members can easily set up home sleep tests and sleep in their own beds. Data is collected by the device and analyzed by technicians and physicians. Once a member receives a machine used to treat sleep apnea, equipment vendors can monitor to see how regularly the patient is wearing the device and follow up with calls to help resolve issues.
“If members are struggling, we want to get them help as soon as possible so they can get back on track, improve their chances of benefiting from therapy, and ultimately produce overall better outcomes,” said Wayne Meyer, M.D., medical director at Anthem Blue Cross and Blue Shield in Missouri.
The program is available now to fully insured and many self-insured members. Anthem has plans to expand the offering to self-insured groups in 2013.
In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at . Also, follow us on Twitter at , on Facebook at , or visit our YouTube channel at .
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 .