Expanding Primary Care-Based Echocardiography Access in a Value-Based Care Network: Impact on Heart Failure Detection, Utilization, and Spending.
Wolf Philip P, Howell Scott S, Avery Samantha S, Mackenzie Andrew A et al.
This retrospective observational study assessed whether expanding primary care-based echocardiography access within a rural Pennsylvania value-based care network was associated with differences in heart failure (HF) diagnosis patterns, health care utilization, and spending compared with internal controls and a state-level benchmark. Eligibility, medical, and pharmacy claims were analyzed from 2 sources: third-party payers covering the primary care network and Merative's MarketScan Medicare data as a state-level reference. Members with HF-related risk factors were identified using diagnosis codes and followed for 12 months after index risk factor documentation, and the inverse probability of treatment weighting was used, incorporating age, sex, risk score, HF risk-factor category, and eligibility duration to address baseline demographic and clinical differences. Among members with HF risk factors, 21.0% of internal study members received an incident HF diagnosis compared with 13.7% of MarketScan members (P < 0.01). Internal cohort diagnoses were less likely to occur in inpatient (IP) settings than MarketScan diagnoses (0.53% vs. 10.2%; P < 0.01) and occurred after longer intervals from risk factor documentation (202 vs. 142 days; P < 0.01). Among diagnosed members, the internal cohort had lower HF-related IP admissions (21 vs. 28 per 1,000 member-years; P < 0.01), fewer HF-related emergency department visits (34 vs. 49 per 1000 member-years; P < 0.01), and lower average monthly spending ($1,937 vs. $2,826; P < 0.01). These findings suggest that expanding primary care-based echocardiography access in a rural value-based care setting was associated with greater HF detection, more outpatient-based diagnosis, and lower downstream acute care use and spending, broadly applicable to health systems and payers investing in diagnostics.