Care to Care: Focused Innovation
Consulting
Written by Amanda Gaines   
Friday, 29 February 2008
Radiology Benefit Management - Care to Care: Focused Innovation - RedCoat Publishing
The growth and success of this radiology benefit management company, said Martin Farbenblum, stems from looking at the industry in a new light.
A company’s health is often based on its ability to evolve. Although New York-based Care to Care was founded recently, the radiology benefit management (RBM) company’s strength would make even the most critical analyst proud, and it all came from looking at the industry from a different perspective.

Martin Farbenblum - Radiology Benefit Management - Care to Care: Focused Innovation - RedCoat Publishing
Martin Farbenblum, Chairman of the Board
“The founders felt the need to pay closer attention to payor and provider issues and recommendations about carve-out vendors managing radiological services,” said Martin Farbenblum, newly appointed chairman of the board. “Radiology and diagnostic imaging services are not ordered frivolously. They’re ordered for a specific need. The concept of managing this is not necessarily about the denial of services, as most understand managed care to be. It’s about selecting the appropriate diagnostic imaging procedure.”

Rather than using only an algorithm to determine approvals, referring providers deal directly with radiologists on cases that do not meet clinical criteria. The goal is to approve the vast majority of imaging requests that are appropriate, referring those that don’t meet generally accepted clinical guidelines to a board certified radiologist for further review. In this manner, client service levels are improved as the overall process is expedited, and this method of case review ensures determinations are made within a 24-hour period.

Requests are then compared to clinical guidelines developed by experts in radiological services. A complete match leaves no question and automatic approval. If the test is out of character or generally not recommended for the diagnosis being sought, the request will be held until a radiologist has reviewed and discussed it with the requesting physician. The radiologist then makes a recommendation to modify the request and provide the authorization. When the correct exam is ordered and utilization is managed, quality imaging care is realized, and the harmful effects of unnecessary radiation are avoided.

Jump-start advantage
Care to Care’s competitors primarily target the larger payor or insurer populations. The company realized, however, that a pocket of smaller-sized payors with the same needs, high utilization rates, and high costs in radiological services had not been served by the competition. These small and medium-sized payors have the same issues with radiology cost and utilization as the large group plans but, prior to Care to Care’s entry into the market, were virtually ignored.

Care to Care was launched at roughly the same time as two larger, privately owned imaging management companies were acquired. As an outcome of these acquisitions, experienced senior leaders from the RBM industry became interested in joining the Care to Care team. Vic Panza and Jamie Burns, founding managers of one of these organizations, brought decades of experience in business development, network and provider management, and legal and regulatory expertise. Along with other seasoned industry managers, Care to Care has assembled a management team with in-depth experience in every aspect of imaging management.
 
Additionally, because the company was founded roughly 10 years after a number of its competitors, Care to Care learned from their shortcomings and leveraged the experience of the industry experts within the management team. Rather than giving clients a small selection of cookie-cutter choices, Care to Care products are customized to client needs. “Eventually, we’ll see trends in what people are selecting, and we’ll have a different type of program completely,” Farbenblum said. “The challenge right now is for payors in all market segments to understand that a flexible program can work. Until now, they’ve only been exposed to standard one size fits all programs.”

As word spread about Care to Care, the company soon found itself flooded with calls from self-insured clients with interest in its network products rather than its utilization management services. The company has since built a framework to support a variety of products, striving to deliver the best solution for each client’s specific needs. Often, it begins with a managed network product and, as need dictates, evolves into a full, delegated utilization management model. A key element of the Care to Care philosophy is helping the client understand and quantify its diagnostic imaging cost and utilization, assisting them in defining an appropriate program.

“We have a new target market where the interest is different, enabling more volume to be sent to our network providers,” said Farbenblum. “The more volume they get, the more financial success they have. It’s a matter of being attuned to the needs of the industry and the target market.”

The interest of the self-insured also pushed Care to Care to a national level, engaging in relationships with unions, for example, that hadn’t considered using RBM services. The company then hired a business development manager with a focus on the TPA market, which opened the door to the American Association of PPOs—a national organization. At a recent exhibit with the American Association of PPOs, Care to Care was the only RBM in attendance, achieving yet another milestone and demonstrating another benefit to the company’s slightly different view of the industry.

“Radiology costs have quietly risen to be about 10% of the healthcare dollar and are growing at a rate of about 20% a year,” he said. “Utilization, especially when looking at the high-tech radiology, is growing at 75% a year. These costs are consuming premium dollars, and many plans aren’t monitoring or even aware it’s happening.”

In January, when Care to Care elected Farbenblum as chairman of the board, it marked yet another evolution for the company. His professional history in radiology gives him the ability to maintain a strong handle on new technologies, which, he said, come out roughly every 18 months. And as a founder of MagnaCare, a health plan solutions provider, Farbenblum brought a slightly different vision for the company’s relationship with its PPO market.

“In addition to managing this market, we should be consultants to our payor clients, helping them understand what should and shouldn’t be covered and how it should be reimbursed,” he said. “Once again, our pitch is not to deny. Our pitch is to ask why and ensure we hear the appropriate answer.”

With a pipeline of plans interested and a membership including roughly 22 plans and 4.8 million members, it’s clear that the backbone of the company will continue to be its ability to investigate possibilities many overlook. “We’ve been successful with our current client base and pipeline by distinguishing ourselves from the competition. It takes the education of the provider community, and that’s what we’re offering,” Farbenblum concluded. 
 
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