Heart Failure Disease Management ProgramWith an estimated healthcare bill of nearly $28 billion this year alone, and approximately 5 million Americans afflicted, heart failure is a serious and costly chronic disease. In a recent Medicare survey, Centers for Medicare and Medicaid Services (CMS) found that 14% of its members had heart failure, and accounted for 43% of all Medicare costs.
Our Approach
There is no cure for heart failure but with proper treatment and changes in lifestyle, most patients can live full and active lives. The key is to ensure that patients receive proactive intervention and treatment. A recent national study found that of the patients in the study sample who had heart failure, only 64% received recommended care. Our Heart Failure Disease and Case Management Program closes that gap, ensuring that patients receive best-practice care based on national guidelines.
- Accurate patient identification: Our powerful and proprietary predictive modeling tools accurately identify patients with, or at risk of, heart failure and its co-morbidities.
- Rapid enrollment: We quickly enroll these patients into the program for primary and secondary prevention. Importantly, our comprehensive review proccess includes the use of patient-specific abstracted chart data, producing electronic medical records for improved health care delivery.
- Risk stratification: Sophisticated analytics stratify members into low, moderate, and high-risk groups for targeted intervention, empowering physicians with recommendations linked to the plan formulary.
- Ongoing surveillance: A continuous record of each patient's evaluations and automatic reminders for future evaluations are just some of the examples of our continuum of care to improve overall health.
- Comprehensive reporting: Health plans receive customized reports of outcomes and quality improvements to see demonstrated, positive health and financial outcomes, on an ongoing basis.
The QMed Advantage—Engaging Physicians. Empowering Patients.
Our Heart Failure Disease Management Program is all-encompassing and collaborative. We are committed to delivering services built on our patient-centered and physician-directed approach to clinical care. Using our superior healthcare information systems, we provide physicians with patient-specific, evidence-based recommendations based on data gathered from the most comprehensive array of sources—including information from patient charts. We ensure physicians have best information with which to make appropriate treatment decisions, to improve patient health and reduce chronic episodes.
Patients receive support, both medical as well as personal, to help them better manage their disease and enhance their lifestyle. Each patient receives educational materials, as well as personal services and tools, based on their specific needs. A skilled Care Manager is assigned to each patient to provide the guidance and support that heart failure patients need to make critical lifestyle changes. Care Managers are the experienced, resourceful professionals who help patients set goals and achieve them.
Eligibility Requirements
Requirements for eligibility and program participation include a history of Congestive Heart Failure:
- Right or left
- Diastolic or systolic
Program Benefits
- We conduct regular chart reviews on appropriate patients to gather all pertinent information and to assess severity and other co-morbidities.
- All data from this evaluation is entered into our database, which utilizes stratification analysis to automatically stratify patients and generate evidence-based recommendations within 24 hours.
- When trends indicate a change in a patient's health status, the treating physician is notified and the patient can be assessed before expensive emergency room or hospital care is required.
- We recommend based on national guidelines, heart failure, lipid, hypertensive and other medications.
- We provide physicians with patient progress updates.
- We design our programs to ensure minimal impact on the physicians' daily workflow.
We support patients, empowering them with self-management tools, educational materials, and individualized support specific to each patient's needs. We also provide Health Risk Assessment to determine beneficial services for each patient case. Our Care Manager provides patient support between visits to:
- Educate patients on warning signs and symptoms
- Inform patients on medications, tests, and exams important to their health
- Provide educational materials including booklets, brochures, newsletters, and wallet cards
- Instruct patients for usage of a home medical device to monitor symptoms on a daily basis
- Alert patients for reminders to tests, lab work, and vaccinations
- Work with patient families and community resources
Our Heart Failure Disease Management Program outcomes are proven and measurable:
- 57% reduction in Emergency Room visits
- 68% reduction in in-patient hospitalizations
- 75% increase in the use of an ACE Inhibitor
- 63% increase in the use of a Beta Blocker
- 91% compliance of physicians to recommendations to optimize CHF medications
- 82% improvement in the patient's feelings of well-being
- Savings which exceed 20% in population based programs
In a heart failure program for seniors, physicians were compliant to recommendations to optimize medications by 91% overall. (See chart below.)
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