Cardiac Imaging Program Overview

Cardiovascular diseases are the leading cause of death in the world, underscoring the importance of further development of both novel diagnostic and therapeutic strategies in this field. Medical imaging, comprised of echocardiography, nuclear cardiology, cardiac computed tomography (CT), cardiac magnetic resonance imaging (MRI), and positron emission tomography (PET), plays an important role in the clinical management of patients with cardiac diseases. When properly integrated into clinical practice, cardiovascular imaging promotes prompt, efficient, and cost-effective patient care. However, benefits of cardiovascular imaging may be offset by inappropriate testing. Efforts to ensure appropriate imaging while containing health care costs include developing evidence-based guidelines. Care to Care aims to enable its clients to make sure that their members with cardiac disease receive the right test at the right time to achieve the best outcomes through the use of evidence-based medicine.

Care to Care’s cost-effective, evidence-based criteria are developed in a transparent manner with peer review. The proprietary criteria were specifically designed to assist referring physicians who see patients with complex medical histories and may need to use high-tech imaging modalities in their diagnostic assessment. Cares to Care’s guidelines are based on the American College of Cardiology (ACC), American Heart Association (AHA), and the American College of Radiology (ACR) recommendations for diagnostic and surveillance imaging of acquired and congenital anomalies of the heart. Care to Care assures that patients receive the appropriate care without delay while delivering a reduction in inappropriate cardiac imaging spending.

Care to Care provides value-added results for our clients by integrating advanced cardiac imaging with clinical insight. Care to Care has been performing utilization management for imaging procedures since 2007, and has grown to manage well over 1.5 million lives for insurers throughout the United States. We are proud of our proprietary clinical criteria, physician friendly approach, client satisfaction and retention, and industry standard effectiveness. Our focus on safety specific to unnecessary exposure to radiation and radioactive isotopes drives our program. The ultimate goal for Care to Care is to aid physicians to be guardians of responsible health care, by providing appropriate cardiovascular testing.

Care to Care proposes a consultative approach to heart health including:

Myocardial Perfusion Imaging, Tomographic (SPECT)

Myocardial perfusion imaging with single photon emission computed tomography (SPECT) is a widely established method for non-invasive evaluation of coronary artery stenosis. The most important applications of SPECT are in the diagnosis of CAD, prediction of disease progression, selection of patients for revascularization and assessment of acute coronary syndromes. While highly regarded by many cardiologists, this study may not be indicated. Other less expensive studies that do not expose members to radiation and radioactive isotopes may be more appropriate.

Cardiac Positron Emission Tomography (PET)

PET remains the reference technique that has been extensively validated for the accurate detection of hemodynamically significant coronary stenosis as compared with invasive coronary angiography. This high profile procedure readily available to physicians is another indication of rapid technological advances with enhanced clinical application that have promoted the utility of cardiac imaging. However, this has also raised concerns about over-utilization and inappropriate use in imaging.

Cardiac Computed Tomography (CT) and Cardiac Computed Tomography Angiography (CTA)

Cardiovascular imaging represents one-third of all imaging workload. Key drivers of this trend are profound increases in utilization of CT and MRI. CT has been utilized for a) coronary angiography (coronary CTA) and b) coronary calcium scoring. The radiation doses to the patient are not small as compared to other radiological procedures. The radiation risk is an important issue to consider as benefit-risk ratio may not be weighted towards benefit to the patient. Our utilization management program is designed to ensure that cardiac CT provided to our members is delivered with consistent nationally recognized guidelines, while allowing payers to reduce inappropriate expenditures.

Cardiac Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiograms (MRA)

MRI is well-established for evaluation of a wide variety of congenital and acquired cardiovascular diseases. With radiation exposure and patient safety concerns at a crescendo, cardiac MRI benefits from not requiring ionizing radiation or iodinated contrast. The Care to Care approach to quality management enables our clients to manage cardiac MRI expenses within the parameters of existing contracted provider network.