A healthcare IT business has set out to improve the way referrals to radiology providers for injured workers are handled. By creating a cloud-based platform that connects payers, radiology practices, self-insured employers and third party administrators it seeks to generate better outcomes for patients.
The problem, as Spreemo CEO and serial healthcare entrepreneur Ron Vianu sees it, is the current system is inefficient and disjointed. It is a cumbersome, paper-based approach that relies on costly, manual workflows. Middlemen are given financial incentives to direct employees to the lowest priced providers.
Vianu explained that his Hoboken, New Jersey-based company wants provider performance to be just as important as price. “We don’t have any objective metrics to determine whether one radiologist has better outcomes over another. You might be able to find out if there is a long wait for the doctor or if they are rude, but nothing more meaningful than that. If there is really to be a marketplace in healthcare, people have to understand what they are buying.”
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Vianu says its system cuts through the administrative middlemen and improves communication between providers and payers. It matches patients with radiology centers based on quality, geographic proximity, customer service scoring and cost. Some of the information is derived from medical claims data. Its scoring system grades providers based on interpretative accuracy, equipment type and scheduling and report turnaround performance.
Spreemo sees an appetite for creating simpler structures in workers compensation.
Providers choose payers they want to work with for referrals. with which they want to work. They also set fee schedules and billing terms.
“What’s unique about where we are in the industry is carriers are willing to pay more if there are better outcomes,” Vianu said. The company has established partnerships with payers and employers in Pennsylvania, New Jersey, and New York. It is now making a push in California and Florida.
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A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
So why radiology? One aspect of workers compensation is the pervasiveness of diagnostic imaging. “Radiology was the least recognized as a quality based practice so we felt we could make the largest impact on clients,” Vianu said.
In the longterm it’s also looking into adding orthopedic surgery practices. Beyond that it wants to introduce a consumer model for its business.
