AIM Specialty Health, a specialty benefit management company serving 42 health plans with more than 32 million members, launched 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.
"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 savings for its health care payor clients across the country.
AIM’s program provides a 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, according to AIM.
"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."
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 home sleep testing provider.