Predictors of MRI Leakage Among Patients Attributed to an Academic Medical Center Commercial Risk-Shared Insurance...

Area of Science:

• Health Services Research
• Medical Economics
• Radiology Management

Background:

• Risk-shared insurance contracts are increasingly common for healthcare organizations.
• Leakage of advanced diagnostic imaging can negatively impact financial and quality metrics within these contracts.
• Identifying drivers of imaging leakage is crucial for optimizing care delivery and cost management.

Purpose of the Study:

• To determine factors predicting Magnetic Resonance Imaging (MRI) leakage in patients under an academic medical center's (AMC) risk-shared commercial insurance contract.
• To analyze the association between ordering provider alignment and MRI leakage.

Main Methods:

• Analysis of administrative claims data from 2015-2016 for patients in a risk-shared commercial insurance contract at an AMC.
• Defined primary outcome as MRI leakage: outpatient MRI at a non-affiliated site.
• Categorized ordering provider alignment as strong, weak, or none; used multivariate regression to assess leakage predictors.

Main Results:

• 12.7% of 13,272 MRI studies leaked from the AMC.
• MRI studies ordered by providers with weak (OR, 3.16) or no (OR, 3.68) AMC alignment were significantly more likely to leak compared to those with strong alignment.

Conclusions:

• Lack of provider alignment with the AMC's commercial risk-shared contract is the strongest predictor of MRI leakage.
• Population health management strategies should address provider networks and referral patterns to mitigate imaging leakage.