ImagineMD Awarded Level One Validation for Cost Savings by Validation Institute
ImagineMD has been awarded LEVEL 1 validation for cost savings by Validation Institute.
As they say on their website, “Validation Institute is dedicated to providing unbiased, data-driven insights on health care solutions and services by validating performance claims made by solutions providers and educating purchasers to drive transparency in the marketplace and maximize cost-savings.”
ImagineMD analyzed medical claims and pharmacy data from 1/1/2021 through 7/31/2021 of a 400-person employer group that had direct-contracted with ImagineMD to obtain primary care services for its employees. The employer had transitioned from a fully insured Blue Cross Blue Shield plan to a self-funded health plan beginning January 1st, 2021. Employees could choose one of two plans: an ImagineMD plan, which provided members and their families with ImagineMD primary care physicians, and an Open Access plan, which provided members and their families access to fee-for-service primary care physicians. The only two differences between the two plans were that the Open Access plan had a $1,500/$3,000 per member/family deductible and a maximum out-of-pocket cost of $5,000/$10,000 per member/family compared to a zero-dollar deductible and a $1,500/$3,000 per member/family maximum out-of-pocket cost for the ImagineMD plan (which was intentionally structured to incentivize high-utilizers of healthcare to choose the ImagineMD plan). Other than these two differences, the plan designs were identical. Both were no-network, reference-based pricing plans with matched copays, coinsurance, and coverage.
After adjusting for the differences in risk between the two plans, ImagineMD’s analysis showed that the ImagineMD plan cost 35 percent less than the Open Access plan (note: Validation Institute’s analysis capped each plan’s cost at the 95th percentile and showed a 21 percent cost savings for the ImagineMD plan). When compared to the cost the company would have incurred had they remained fully insured with Blue Cross Blue Shield, the ImagineMD plan cost 60 percent less.
As a result of being awarded Level 1 validation, ImagineMD will now be able to include in all its contracts with employers the following language:
“If Customer feels that ImagineMD did not achieve what its validation language says it achieves, Customer may submit a claim up to $25,000 to the Validation Institute (VI). VI will review the claim and either pay it, offer a smaller payout, or request a binding, final finding by an arbitrator assigned by the American Arbitration Association.”
While costs savings are important, clinical outcomes are even more so. Unfortunately, because the sample size in this analysis was small (~200 plan members), we were unable to show that the ImagineMD plan resulted in better clinical outcomes beyond frequent anecdotal reports. We expect to have sufficient measures of clinical outcomes to earn Quality validation in the second year of the plan. What we do know is this: we will not contribute to a system that leaves individuals to fall through the cracks in the healthcare system.
What we can say now—what the data proves—is that ImagineMD’s model of care provides patients with a level of access to care that yields a far better patient experience and that vastly reduces costs to both the employee—in the form of reduced deductibles, copays, and coinsurance—and to the employer in the form of the total health plan cost.