Organizations that bear the cost of paying for healthcare, whether traditional commercial and governmental health plans, self-insured employers, or others that bear risk (“payors”), have often looked at the practice of radiology as a commoditized service to be managed based primarily on cost and utilization. In other words, too often, the view is that you “take a picture” of the patient and get comparable results no matter where or how the image was acquired.
In order to help shift this view, Covera Health, founded in 2017, has worked collaboratively with the radiology provider community to help quantify and highlight the value of quality within radiology and its impact on clinical outcomes and costs. As a result of these efforts, payors are increasingly recognizing not only that quality differences exist, but that those differences can impact how a patient is diagnosed and treated, and whether the patient experiences the best outcome they could.
Covera Health has recently joined forces with Nuance Communications to help the overall radiology community scale the positive patient impact of these new quality programs with the launch of the Quality Care Collaborative (QCC). The QCC is a nationwide program designed to support all radiologists and the patients they care for, while simultaneously supporting payors in their efforts to support the best outcomes for their members and reduce unnecessary medical expense.
The QCC combines two powerful platforms – Nuance’s nationwide Precision Imaging Network (PIN) and Covera’s Diagnostic Intelligence Platform. The QCC enables a continuous quality improvement partnership between providers, payors, and employers as they work together in a trusted and secure setting on long-term, sustainable quality improvement programs, peer-learning initiatives, and value-based care efforts.
How it works
The QCC is designed to be a supportive, non-punitive partnership managed under the auspices of the Covera Patient Safety Organization (PSO). Pursuant to the Patient Safety and Quality Improvement Act of 2005, an Agency for Healthcare Research and Quality (AHRQ) certified PSO provides physicians with uniform protections against sharing of patient safety and quality improvement data with participating payers.
The QCC establishes a clinical workflow-integrated infrastructure that enables radiology providers, via an opt-in model, to access quality analytics and support improved diagnostic precision through trusted, widely deployed technology. Powered by Microsoft Azure, PIN delivers workflow-integrated, AI-generated insights across the care continuum. It is built upon the Nuance PowerScribe radiology reporting solution, used by 80% of U.S. radiologists, the Nuance PowerShare image sharing solution, connected to more than 10,000 healthcare facilities, and Nuance’s secure AI cloud infrastructure that enables an entire ecosystem of third-party diagnostic imaging AI services to be integrated into clinical workflows.
Because of the way the QCC builds strong, scalable partnerships between payers and providers, all centered around improving care quality for patients, this will be a meaningful step in the right direction towards combating commoditization and supporting radiologists in their efforts to engage in continuous peer learning and practice improvement.
Applying AI, together, to build a heathier future
The QCC delivers AI-powered insights at no cost to radiologists caring for members affiliated with participating payors. The program now has full nationwide scale with provider integrations through Nuance’s PowerScribe and PowerShare solutions, all within the full control of the provider organizations as they choose to participate or not.
Walmart is the first large employer to join the QCC. “We’re excited about the collaboration between Covera and Nuance and the positive impact it can have on improving the quality of care for all, as well as improving health equity by increasing access to quality care in local communities,” said Lisa Woods, Walmart vice president for physical and emotional well-being. Other major health plans are scheduled to launch in 2023.
By fostering secure, data-driven collaboration and mutual trust across the payor/provider ecosystem, the QCC applies the full potential of AI and bridges the silos that have hindered wider cooperation. Looking ahead, the QCC can build a healthier future by uniting diverse healthcare stakeholders in a shared effort to meaningfully improving healthcare quality, costs, and outcomes into an everyday reality.