Work

Health Plan-Based Atherosclerosis Imaging for Members with Diabetics

Year: 2026

Type: article

Abstract: BACKGROUND: Quantitative coronary CT angiography plaque analysis (QCCTA) is a novel tool for atherosclerosis detection. OBJECTIVES: The authors examined utilization of a health plan offering of QCCTA to diabetic members and the impact of utilization on health plan costs. METHODS: Diabetic health plan members ≥40 years without prior myocardial infarction were offered QCCTA as a pilot benefit. Benefit utilizers were compared to eligible nonutilizers for incident cardiovascular episodes of care post-notification of eligibility. RESULTS: Over 14 months, 2,064 of 38,079 health plan members were identified as eligible. Utilizers (19.1%) were predominantly White (76.4%) and female (72.6%) residing in communities with high census median household income ($54,321 [$54,321-$71,159]). Utilizers' glycemic control was better (glycated hemoglobin 6.5% [6.0%-7.3%] vs 7.0% [6.4%-7.7%], P = 0.05), and 10-year atherosclerotic cardiovascular disease risk was lower (8.5% [4.2%-15.8%] vs 10.8% [5.7%-20.3%], P = 0.07). Detailed claims data from a matched cohort of 169 utilizers and 169 nonutilizers after a median of 19 months' follow-up showed more incident cardiovascular episodes of care in utilizers (1 [1-3] vs 1 [1-1], P < 0.0001) and higher incremental per-member per-month health plan expenditure for cardiovascular episodes of care ($19.04/month [4.65-85.11] vs $0/month [0-0], P < 0.0001). Per-member per-month was similar after adjusting for baseline glycated hemoglobin and atherosclerotic cardiovascular disease risk score (P = 0.78). CONCLUSIONS: Utilization of QCCTA offered to an employed population with diabetes varies by demographics while increasing near-term health plan expenditure for cardiovascular care. Longer-term studies are warranted to evaluate QCCTA's impact in value-based care models on diabetic members' health outcomes and total health plan spend.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2025.102554