HealthTrackRx Case Study
Client Challenge:
HealthTrackRx (HTRx) is an infectious disease laboratory that provides PCR-based infectious disease tests to over 10,000 clinicians nationwide, advancing healthcare through decentralized physician-directed testing, large-scale surveillance pathogen testing, antimicrobial stewardship, and value-based care programs. HTRx specializes in RT-PCR (Real-Time Reverse Transcription Polymerase Chain Reaction), one of the foremost methods of detecting bacteria or viruses on the molecular level.
Background:
Polymerase Chain Reaction (PCR) laboratory tests stand out for their heightened sensitivity and precision when compared to conventional diagnostic techniques. During the COVID-19 pandemic, PCR tests emerged as physician’s preferred choice in scenarios where the likelihood of viral presence was low, but certainty regarding the absence of the virus remained of prime importance. This need for assurance was particularly prevalent in various industries and travel.
HTRx extends the utility of its technology beyond COVID-19 diagnostics, recognizing a substantial market for its applications. Ensuring diagnosis accuracy is crucial for physicians, and PCR tests boasts impressive accuracy in both sensitivity and specificity for samples. This precision is instrumental in aiding physicians to combat antibiotic resistance effectively by correctly identifying pathogens. HTRx not only conducts meticulous testing analyses in its laboratories but also ensures the delivery of timely results by the following day.
In collaboration collaboration with Cirdan Health Systems and Consulting, an HMA Company (Cirdan), HTRx initiated a retrospective analysis of PCR testing compared to cases where patients received no laboratory testing or underwent traditional culture testing. HTRx’s aim for the study was to:
- Develop data-supported arguments for the utilization of PCR testing over traditional diagnostic lab techniques, prioritizing HTRx’s core syndromic test offerings and clinical focus areas.
- Secure evidence and validation of PCR test values on payer financial results; and
- Construct a clinical dossier that can be used in future discussions with payers, lab specialty benefit managers, or other potential partners to facilitate increased utilization and optimize PCR test reimbursement.
Approach:
- One of the goals of Cirdan’s study was to validate HealthTrackRx’s PCR testing as a cost-effective tool to reduce patient’s healthcare utilization and overall cost of care associated with an infectious disease event. To facilitate this study a retrospective longitudinal analysis was conducted by Cirdan leveraging Wakely, an HMA Company’s access to the 2021 MarketScan database, encompassing around 20 million individuals, to analyze the impact of PCR testing across a variety of infectious disease types.
- Cirdan underscored the adoption of PCR testing over traditional diagnostics and emphasized the PCR test’s pivotal role in improving payer financial outcomes and clinical efficacy. The analysis demonstrated improved member outcomes, as evidenced by fewer healthcare encounters in the weeks following a PCR test. This reduction in healthcare utilization speaks volumes to the patient benefits of PCR testing because it underscores the PCR test’s ability to pinpoint pathogens and guide physicians to accurately prescribe antibiotics that will render the infectious disease harmless. This process is known as antibiotic stewardship and it greatly empowers physicians to prescribe the most effective treatment, while reducing the risk of antibiotic resistance.
Results:
Table 1 illustrates gross savings estimates that a payer could potentially expect if they were to transition to a PCR test approach. Cirdan did not reduce the gross savings estimates to reflect potential investment costs that may be required to implement the PCR solution.
Table 1 – Estimated Gross Impact of PCR Testing on a Payer’s Total Cost of Care (2021 Dollars)
| Diagnosis Cohort | Studied Prevalence % | Cohort TCOC PMPM | Cohort PMPM as a % of TCOC PMPM | Est. Cohort Savings PMPM | Est. Cohort Savings | Est. Savings as a % of TCOC PMPM |
|---|---|---|---|---|---|---|
| Infection 1 | 3.6% | $ 4.22 | 0.71% | $ 0.01 | 0.3% | 0.00% |
| Infection 2 | 6.9% | $ 13.55 | 2.30% | $ 0.83 | 6.1% | 0.14% |
| Infection 3 | 1.19% | $ 3.93 | 0.67% | $ 0.93 | 23.7% | 0.16% |
| Infection 4 | 3.4% | $ 12.46 | 1.% | —- | —- | —- |
| Infection 5 | 0.2% | $ 0.36 | 0.06% | — | — | — |
| All Cohorts | 15.2% | $ 34.52 | 5.85% | $ 1.77 | 5.1% | 0.30% |
TCOC = Total Cost of Care (i.e., $590 PMPM in 2021 MarketScan); PMPM = Per Member Per Month; PCR = Polymerase Chain Reaction
*Caution: Individuals may be present in more than one diagnostic cohort; therefore, prevalence, TCOC PMPM, cohort savings and TCOC savings may not be additive, and subtotals may be potentially overstated.
Notably, PCR testing demonstrated material cost-savings potential in specific infection types. The finding illustrated the convenience and efficiency of PCR testing—where a single test can diagnose a comprehensive panel of pathogens, through a streamlined diagnostic process.