This provider of diagnostic imaging services has grown by leaps and bounds by promoting efficient, high quality imaging services.

One Call Medical already captures more than one quarter of all money spent on high-end radiology for workers’ compensation claims, and the company now has its sights set on the healthcare segment.

The diagnostic imaging service company has entered into a partnership with Magellan Health Services, Inc. During the first year of this partnership, One Call Medical CEO Kent Spafford predicts the company’s contracted providers will schedule 100,000 scans in the healthcare segment, in addition to the 330,000 scans One Call currently schedules annually on the workers’ compensation side.

Spafford believes the partnership with Magellan will be the first of many accords with employee health plan providers that will use One Call’s extensive network of contracted imaging centers.

Kent Spafford, CEO

“We initiate our referral process when a doctor receives an authorization to order a scan,” Spafford explained. “The claims office contacts us, and we immediately coordinate the scheduling of the patient.” One Call’s network providers are within a 15-minute drive of any urban zip code, so patient access is not an issue. In fact, the company works with more than half of all MRI facilities in the US and schedules 1% of the 3 billion total diagnostic imaging tests performed each year.

Tool trio
Once a physician prescribes a diagnostic imaging test, One Call’s client (a third-party payer, employer, or insurance company), contacts One Call to handle test scheduling, which typically occurs within 48 hours. After the test is scheduled, One Call handles all communication related to the test, using propriety software and EDI to manage claims quickly and accurately.

One Call’s trio of communication tools comprises e-Referral, e-Response, and e-Attachment. The e-Referral tool allows customers to input data quickly and easily, eliminating time spent on paperwork or submitting referrals telephonically, while increasing the accuracy of information.

With e-Response, claims examiners and nurse case managers have all the information about a patient they need in one place, eliminating the need to track down an appointment or patient information. e-Attachment allows electronic transmission of medical reports between One Call and its clients, which means reports are received and read in real time and stored electronically.

The EDI component sends billing data electronically to One Call’s clients, reducing billing cycle times, costs related to delays, and lost invoices. Making sure that providers are paid promptly strengthens business relationships and improves customer service between One Call and its provider network. The company has also developed a password-protected, Web-based customer care center where customers can submit referrals and access claims information, helping keep data secure and organized.

Strong referral
One Call’s national provider network consists of contracted MRI and electromyography (EMG) facilities that have undergone a rigorous credentialing approval process.

Imaging centers partner with One Call because of its market-leading referral business, combined with the fact that One Call immediately reimburses its providers for the required tests at contracted rates. “We don’t want every provider in our network,” Spafford said. “We want to make sure that we have adequate coverage and quality providers. These providers value our relationship because we offer them significant business and pay for it.”

Another growing aspect of One Call’s business is its EMG product. An EMG is a diagnostic exam that tests for injuries such as carpal tunnel syndrome, which is the second leading cause of workplace injuries. Fifty One Call employees work in the provider development and credentialing department in conjunction with a radiology medical advisory board composed of board certified radiologists, neurologists, and physiatrists to confirm that each provider passes standards set forth by the National Committee for Quality Assurance.

In the workers’ compensation realm, 27% of all money spent on high-end radiology is managed by One Call, with just 6% going through competitors. That leaves a sizable chunk of business going to providers that are non-contracted, which Spafford said means that payers are paying too much for these procedures.

Spafford believes his company can continue to grow by focusing on this lucrative segment, building more business with existing customers while bringing new ones on board. Customers include Liberty Mutual, Travelers, Zurich, AIG, numerous large employers, and state funds. “At the end of the day, we think we can double our workers’ compensation business model through the diagnostic management program in two or three years,” Spafford said.

During the current calendar year, the CEO expects revenues of between $205 million and $210 million, a double-digit increase over the previous year. “About half of our business comes from the self-insured employers through third-party administrators,” Spafford said.

As the medical landscape changes with the addition of health savings accounts, health reimbursement accounts, and flexible spending accounts, Spafford believes consumers will become more price conscious, which plays well for a company determined to keep costs low and quality high. “Today, people don’t pay for their own healthcare, so they make decisions based on convenience rather than cost,” Spafford said. “We already know where they can find those services, so it makes sense for us to start developing that product.”

Between increasing its marketshare of the workers’ compensation market and extending its foray into healthcare scheduling, Spafford believes One Call Medical is poised for a bright future. MRIs and CT scans are definitive tests these days and are being ordered more often as a frontline diagnostics tool to put patients on the road to recovery sooner. “Scans are great for workers’ compensation claims because the difference between a sprain or a tear of the knee can easily be determined, and the appropriate measures (therapy for a sprain, surgery for a tear) can be taken immediately,” Spafford said.

On the healthcare side, the goal is the same: diagnosing patients as soon as possible so a treatment plan can be devised. “The high-end radiology business is growing between 10% and 20% each year, so there’s also an opportunity to rein in unnecessary costs,” Spafford said.

Grayson Walker, This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , is a freelance writer based in Atlanta.