Adam* is a 50-year-old man diagnosed with Barrett’s esophagus without dysplasia.
One year after his diagnosis, Adam is experiencing no new symptoms. His physician recommends a surveillance upper GI endoscopy in a hospital setting.
Monitoring Adam’s condition
Achieving better outcomes
By avoiding the unnecessary EGD, Adam avoids potential health risks associated with the procedure such as aspiration during sedation and pneumonia. He also saves time and trips to the hospital, as well as unnecessary costs for both his health plan and himself.
Avoiding unnecessary care & costs
The Evernorth Medical Benefit Services review of the American College of Gastroenterology’s evidence-based guidelines indicates that a surveillance EGD is only recommended every 3 to 5 years. As Adam is not experiencing new symptoms, we determine an EGD is not appropriate at this time.
Had Adam’s EGD been medically necessary, we would have recommended a lower-cost setting for the procedure than the hospital.
Evernorth Medical Benefit Services leverages evidence-based guidelines and innovative technologies to inform and expedite the most effective care decisions for each patient’s needs, including redirection to clinically appropriate, affordable settings.
Learn more
What if an EGD was needed?
Clinical review
We ensure procedures are in accordance with the most up-to-date literature and national guidelines to promote the most clinically appropriate and cost-effective care for each patient.
Our Gastroenterology solution ensures appropriate evidence-based use of endoscopic procedures and also provides Site of Care redirection, when necessary.
Gastroenterology
*Not patient’s real name. Images are for illustration purposes only.
Is it necessary?
The result: Better health outcomes, and lower costs for patients and payers alike.
Meet Adam
