Misdiagnoses are a silent but devastating problem in the health care industry. An estimated 12 million Americans experience diagnostic errors annually, and such errors double the risk of patient death compared with other medical errors.
Multiple studies over the past several years have concluded that misdiagnoses are the leading cause of malpractice claims, and, according to the National Academy of Medicine, have a significant impact on both patient outcomes and health care costs.
Though many patients and payers have long considered radiology--the study of medical imaging to diagnose various conditions within the human body--to be a near-commodity medical service, in fact, quality and accuracy can vary widely. Radiology was the responsible service in 49 percent of all paid medical malpractice claims involving diagnostic misinterpretation in 2014, according to CRICO, a division of the Risk Management Foundation of Harvard Medical Institutions.
Enter Covera Health. Co-founded by CEO Ron Vianu and orthopedic surgeon and medical director Raz Winiarsky, the data analytics company aims to tackle misdiagnoses in radiology head-on.
"In our view, this is not a shortcoming or lack of skill on the part of radiologists generally, but a result of the historic difficulty of measuring quality and accuracy objectively and sharing feedback in a way that raises the standard of care for everyone," says Vianu. "Errors come from many places, from lack of image quality due to older machines, inappropriate protocols that prioritize speed at the expense of coverage, as well as a need for further specialization among those reading the most complex scans, such as spine or brain MRIs."
While some aspect of human error in medicine is inevitable, in the view of Vianu and Winiarsky, in radiology it is also increasingly avoidable through the targeted application of Covera Health's clinical analytics platform, developed in partnership with practicing radiologists--part of the broader narrative of big data within medicine.
"We've developed objective quality metrics to identify and cultivate a high-performance network of radiology providers capable of reducing misdiagnoses and improving patient outcomes," says Vianu, "at the same time helping commercial payers and self-funded insurers reduce unnecessary medical costs by helping patients avoid inappropriate treatments."
Partnering With Radiologists and Data Scientists
Covera Health's business model is predicated on partnering directly with radiology providers across the country. For those imaging centers that meet its quality criteria, Covera Health implements a unique data-sharing arrangement.
"To address a common misconception, what we're not doing is sitting in an ivory tower determining the gold-standard diagnosis for each and every report," Covera Health's chief data science officer, Daniel Elgort, explains. "With access to more than seven years of medical records and radiology scans from tens of thousands of patients, we've been able to analyze millions of data points to understand the drivers and predictors of quality, what types of errors providers may be prone to making, and which providers and centers are most likely to deliver an accurate diagnosis."
Covera Health shares this data with those selected radiology centers, providing a reliable system of feedback--which has been inconsistent or entirely unavailable in the past.
For employers and other health care entities, Covera Health aims to connect patients to the highest-quality local providers--helping to ensure the correct diagnosis from the start of care and generating savings by reducing misguided health care spending.
Covera Health and Walmart
The multiyear, strategic collaboration with Walmart has already produced some compelling results. In an independent, prospective study of 80,000 patients, those routed through Covera Health's network showed substantive improvements in both outcomes and downstream costs.
The ongoing program is composed of three primary elements--a nationwide network of radiologists that meet Covera Health's criteria; ongoing quality assurance and monitoring with providers; and rigorous measurement of the program's impact on outcomes and post-imaging costs.
"The goal of all our benefit plans is to provide our associates and their family members with access to high-quality health care to ensure they receive the right care at the right time," detailed Lisa Woods, senior director of benefits design and strategy at Walmart U.S., in the press release. "A quality MRI or CT scan can improve the accuracy of the diagnosis early in the care journey, helping create the correct treatment plan with the best opportunity for recovery."
Walmart's umbrella of health plans for employees, associates, and dependents is enormous, covering more than 1.1 million Americans. As such, Covera Health is banking on their model significantly improving outcomes and costs across a vast subset of patients.
"We want to help large self-insured employers point their employees to high-quality radiology centers so they get the right care from the start," confirms Vianu. "To do that, we need to be on the side of providers, giving them the tools and feedback they need to perform at their very best."