Glover IV M, Weilburg J, Sistrom C, et al. - For patients attributed to a single risk-shared commercial insurance contract at a large academic medical center (AMC), administrative claims data from 2015 through 2016 were investigated to determine factors that are predictive of leakage of MRI examinations among patients attributed to an academic healthcare organization’s risk-shared commercial insurance contract. There were 13,272 MRI encounters amongst 8,215 patients who met the inclusion criteria. Of leaked MRI studies, the overall proportion was 12.7%. In comparison with MRI studies ordered by providers with strong AMC alignment, MRI studies ordered by providers with weak AMC alignment or no AMC alignment were more inclined to leak. Thus, the most robust predictor of MRI leakage was an ordering provider with no alignment with an AMC’s commercial risk-shared insurance contract. Population health management initiatives proposed to decrease leakage should acknowledge the influence of provider networks and clinical referral patterns that drive imaging utilization.