Study: Impact of a Private Health Insurer’s Coronary Computer Tomography Angiography Coverage Decision

December 1, 2017

A study titled the “Impact of a Private Health Insurer’s Coronary Computer Tomography Angiography Coverage Decision” has been presented at the RSNA 2017 Annual Meeting.

After discussions with HealthHelp, Humana released a policy in April 2014 explicitly providing coverage for coronary computed tomography angiography (CCTA) for the noninvasive assessment of angina. CCTA had been reimbursed, although a policy was not in place; there have never been policies regarding the use of cardiac nuclear medicine (CNUC) exams or stress echocardiograms (STE) for angina evaluation. The study’s lead author, Adam C. Powell, Ph.D., and his team sought to evaluate how the use of non-invasive tests for chest pain and catheterizations, in addition to the relationship between catheterizations and percutaneous coronary interventions (PCIs), shifted after the new policy’s implementation.

Claims for chest pain-related tests, catheterizations, or PCIs from between April 2013 and April 2015 were extracted for patients with Medicare Advantage plans who had any of the three tests. Chi-square tests were used to examine whether there was an association between the date of utilization (before or after April 2014) and the distribution of testing, the likelihood that patients receiving a test received a catheterization, and the likelihood that patients receiving a catheterization received a PCI.

Relative CCTA utilization expanded from 1.36 percent of noninvasive testing claims in the pre-period to 1.43 percent in the post-period, CNUC expanded from 88.69 percent to 89.30 percent, and STE contracted from 9.95 percent to 9.27 percent. The distribution of utilization was significantly different in the two periods (P<.0001). Patients receiving any of the tests has a 14.0 percent chance of receiving a catheterization in the year before the policy and a 14.1 percent chance in the year after (P<.65). Patients undergoing a catheterization had a 32.6 percent chance of receiving a PCI in the year before the policy and a 34.0 percent chance in the year after (P<.025).

Change in the distribution of tests after the coverage policy’s implementation was modest, but statistically significant. The significant increase in the likelihood that patients who underwent catheterization also underwent PCI suggests that the change in relative utilization of noninvasive tests may have prevented unnecessary invasive testing.

According to Dr. Powell, “HealthHelp and Humana are committed to understanding the impact that their decisions have on patient care. Prior dialogue between the organizations resulted in the 2014 CCTA policy. Since then, HealthHelp and Humana have presented a CCTA-related study at the American Heart Association’s 2015 Scientific Sessions and developed this new study to specifically examine how care shifted after the policy change.”

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