Cardiology Authorization Reviews

Prevalent but Preventable

Nearly half of all American adults have some form of cardiovascular disease (CVD).² It’s the leading cause of death for both men and women,¹ and the nation’s costliest chronic disease.³

The escalating diabetes epidemic is just one of the contributors to CVD that can be controlled. Others include obesity, inactivity, unhealthy diet, and high blood pressure. A study by the Centers for Disease Control (CDC) found that more than 80 percent of heart attacks and strokes in middle-aged Americans are preventable.⁴ Yet medical costs for CVD totaled $318 billion in 2016, and are due to climb to a staggering $749 billion by 2035.3

Early preventive measures are critical for reducing overall costs. One of the main factors driving up medical expenses is the particularly wide variation in CVD care.⁵ Specialty-specific experience is needed to understand unique clinical context and treatment choices to perform accurate reviews and make appropriate determinations. These challenges, combined with sky-high CVD incidence and cost numbers, mean more pressure for payers looking to maximize their already strained review resources. Many health plans are now looking for help from a utilization management organization, like AllMed, to perform evidence-based utilization reviews to manage cost and provide care when appropriate.