Market Overview

Cardiac Management Program Avoids Follow-Up Tests, According to Analysis Presented at American Heart Association Scientific Sessions

LOS ANGELES--(BUSINESS WIRE)--

Unnecessary imaging tests are prevented with the help of a cardiac imaging management program, and lead to a 12 percent overall reduction in the likelihood of follow-up tests, including myocardial perfusion imaging and cardiac CT scans, according to an analysis presented today at the American Heart Association's annual scientific meeting.

“While the reduction in follow-up tests is important on its own, we can extrapolate that unnecessary catheterizations, angioplasty procedures and heart bypass procedures were prevented as well,” said Andrea DeVries, director of research operations for HealthCore Inc., an outcomes research company. “Unnecessary tests, even those that seem innocuous, such as echocardiograms, can have a significant impact on patients and the health care system as a whole, as false positives can lead to more unnecessary and potentially harmful tests and procedures.”

Cardiovascular imaging procedures represent 29 percent of all medical imaging and related examinations make up at least one third of the several billion medical imaging examinations performed worldwide. Yet, studies published in 2010 and 2011 indicate that approximately 15 percent of cardiac imaging exams are inappropriate based on criteria established by the American College of Cardiology.

HealthCore analyzed information provided by AIM Specialty Health SM based on data about 2.6 million people that were eventually reduced to a study group of 96,906 people who were members in WellPoint-affiliated health plans in Indiana, Ohio, Kentucky, Missouri and Georgia before and after the cardiac program was implemented in these states. Both HealthCore and AIM are subsidiaries of WellPoint.

HealthCore compared patients managed through the AIM cardiac management program to others who received no management from AIM. HealthCore followed the patients' health data for up to 24 months after their initial diagnostic test. The HealthCore analysis found that for every 100 index tests across the entire study population the following domino effect of medical services occur within 12 months: 20 additional follow-up diagnostic tests, 10 catheterizations, three angioplasty procedures, and one heart bypass surgery.

“Patients whose tests were approved through the prior authorization process were more likely to have an appropriate index test and fewer downstream imaging tests were performed compared to the unmanaged population,” said Thomas Power, MD, FACC, AIM medical director, and a practicing cardiologist. “Not only does unnecessary testing have no positive impact on patient outcomes, but it may have negative effects, such as procedural risks, unnecessary anxiety and, depending on the test, radiation exposure. And, of course, these unnecessary tests impact affordability over the long-term for everyone.”

The poster, “Utilization Management Reduces Repeated Outpatient Cardiovascular Imaging,” was authored by HealthCore's Abiy Agiro, Ph.D., Gosia S. Sylwestrzak, M.A, Andrea DeVries, Ph.D., and AIM's Thomas Power, M.D.

AIM's cardiac imaging program applies medical necessity clinical guidelines, which were developed using the American College of Cardiology Foundation's appropriate use criteria as a primary source, to help ensure that a requested cardiac procedure is appropriate for the patient.

The analysis also found:

  • Two in every nine patients with a baseline diagnostic test had a follow-up test within 24 months.
  • One in every six patients with a baseline diagnostics test had a follow-up test within a year.
  • A follow-up test was most likely to happen during the first month after the initial test.

Holding other variables constant, the likelihood for downstream image testing increased with age, was lower for females than males and increased as member comorbidity burdens increased. As expected, in both managed and unmanaged populations, members with history of cardiovascular events had a higher likelihood of receiving downstream testing. And finally, members whose index test was a nuclear imaging test had a lower likelihood of downstream testing.

About HealthCore Inc.

HealthCore, based in Wilmington, Del., is the clinical outcomes research subsidiary of WellPoint, Inc. HealthCore has a team of highly experienced researchers including physicians, biostatisticians, pharmacists, epidemiologists, health economists and other scientists who study the “real world” safety and effectiveness of drugs, medical devices and care management interventions. HealthCore offers insight on how to best use this data and communicates these findings to health care decision-makers to support evidence-based medicine, product development decisions, safety monitoring, coverage decisions, process improvement and overall cost-effective health care. For more information, go to www.healthcore.com.

About AIM Specialty Health

AIM Specialty Health or “AIM” is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. With more than 32 million members covered across 50 states. AIM's mission is to make health care services more clinically appropriate, safer and more affordable. As such, it promotes the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. AIM is an operating subsidiary of WellPoint, Inc. (NYSE: WLP; www.wellpoint.com). For more information on AIM, please visit www.aimspecialtyhealth.com.

AIM Specialty Health
Lori McLaughlin, 317.407.7403
lori.mclaughlin2@wellpoint.com

 

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